Background
During upper extremity (UE) stroke rehabilitation it is critical to match patient-ability to task-difficulty to promote neural reorganization and UE skill re-learning. However, there are few methods to do so. A Fugl-Meyer Upper Extremity Assessment (FMA-UE) “keyform,” derived from Rasch Analysis informed and progressed an UE rehabilitation program.
Objective
Test the feasibility of the keyform method for systematically planning and progressing rehabilitation. We hypothesized that optimally-challenging task-practice will maximize UE motor skill reacquisition.
Methods
Inclusion criteria: ischemic stroke >3 mo., voluntarily shoulder flexion ≥30° and simultaneous elbow extension ≥20°. The keyform method defined initial targets (goals) and progressed therapy after every 3rd session. Therapy targets were practiced within the context of client-selected functional tasks not in isolation. Feasibility was defined by subject pain/fatigue, UE motor function (Wolf Motor Function Test, WMFT) and movement patterns (kinematics). Assessments were administered pre- and post-treatment and compared with paired t-tests. Task-difficulty and patient-ability measures were calculated with Rasch analysis and compared with paired t-tests (p<0.05).
Results
Ten subjects (59.70±9.96 yrs., 24.1±30.54 mo. post-stroke) participated in 9 sessions, 200 movement repetitions/session in <2 hrs without pain or fatigue. Subjects gained UE motor function (WMFT: Pre 22.23±24.26 seconds, Post 15.46±22.12 seconds, p=0.01), improved shoulder-elbow coordination (index of curvature: Pre 1.30±0.15, Post 1.21±0.11, p=0.01) and exhibited reduced trunk compensatory movement (trunk displacement: Pre 133.97±74.15 mm, Post 108.08±64.73 mm, p=0.02). Task-difficulty and patient-ability measures were not statistically different throughout the program (Person-ability measures of 1.01±0.05, 1.64±0.45 and 2.22±0.65 logits and item difficulty measures of 0.93±0.37, 1.70±0.20, and 2.06±0.24 logits at the 3 testing time points respectively, p>0.05).
Conclusion
The FMA-UE keyform is a feasible method to assure that the difficulty of tasks practiced were well matched to initial and evolving levels of UE motor ability.