Abstract
Objective
To test the feasibility of the Fugl-Meyer Assessment of the Upper Extremity “keyform,”
derived from Rasch analysis, as a method for systematically planning and progressing
rehabilitation.
Design
Feasibility study, single group design.
Setting
University rehabilitation research laboratory.
Participants
Participants (N=10; mean age, 59.70±9.96y; 24.1±30.54mo poststroke) with ischemic
or hemorrhagic stroke >3 months prior, voluntarily shoulder flexion ≥30°, and simultaneous
elbow extension ≥20°.
Interventions
The keyform method defined initial rehabilitation targets (goals) and progressed the
rehabilitation program after every third session. Targets were repetitively practiced
within the context of client-selected functional tasks not in isolation.
Main Outcome Measures
Feasibility was defined by subject's pain or fatigue, upper extremity motor function
(Wolf Motor Function Test), and movement patterns (kinematics). Assessments were administered
pre- and posttreatment and compared using paired t tests. Task-difficulty and patient-ability measures were calculated using Rasch analysis
and compared using paired t tests (P<.05).
Results
Ten participants completed 9 sessions, 200 movement repetitions per session in <2
hours without pain or fatigue. Participants gained upper extremity motor function
(Wolf Motor Function Test: pretreatment, 22.23±24.26s; posttreatment, 15.46±22.12s;
P=.01), improved shoulder-elbow coordination (index of curvature: pretreatment, 1.30±0.15;
posttreatment, 1.21±0.11; P=.01), and exhibited reduced trunk compensatory movement (trunk displacement: pretreatment,
133.97±74.15mm; posttreatment, 108.08±64.73mm; P=.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>.05).
Conclusions
The Fugl-Meyer Assessment of the Upper Extremity keyform is a feasible method to ensure
that the difficulty of tasks practiced were well matched to initial and evolving levels
of upper extremity motor ability.
Keywords
List of abbreviations:
FMA-UE (Fugl-Meyer Assessment of the Upper Extremity), IOC (index of curvature), TD (trunk displacement), UE (upper extremity), WMFT (Wolf Motor Function Test)To read this article in full you will need to make a payment
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References
- Motor learning: its relevance to stroke recovery and neurorehabilitation.Curr Opin Neurol. 2006; 19: 84-90
- Motor network changes associated with successful motor skill relearning after acute ischemic stroke: a longitudinal functional magnetic resonance imaging study.Neurorehabil Neural Repair. 2009; 23: 295-304
- Challenge point: a framework for conceptualizing the effects of various practice conditions in motor learning.J Mot Behav. 2004; 36: 212-224
- Motor training induces experience-specific patterns of plasticity across motor cortex and spinal cord.J Appl Physiol (1985). 2006; 101: 1776-1782
- Failure of motor learning for large initial errors.Neural Comput. 2004; 16: 1873-1886
- Saturated muscle activation contributes to compensatory reaching strategies after stroke.J Neurophysiol. 2005; 94: 2999-3008
- “Learned baduse” limits recovery of skilled reaching for food after forelimb motor cortex stroke in rats: a new analysis of the effect of gestures on success.Behav Brain Res. 2008; 188: 281-290
- Use-dependent alterations of movement representations in primary motor cortex of adult squirrel monkeys.J Neurosci. 1996; 16: 785-807
- Effects of repetitive motor training on movement representations in adult squirrel monkeys: role of use versus learning.Neurobiol Learn Mem. 2000; 74: 27-55
- Functional reorganization of the rat motor cortex following motor skill learning.J Neurophysiol. 1998; 80: 3321-3325
- Explicit information interferes with implicit motor learning of both continuous and discrete movement tasks after stroke.J Neurol Phys Ther. 2006; 30 (discussion 58-49): 46-57
- Rating scale analysis.Mesa Pr, Chicago1982
- Fundamentals of item response theory.Sage, Newbury Park1991
- Applying the Rasch model: Fundamental measurement in the human sciences.Erlbaum, Mahwah2001
- Best test design.Mesa Pr, Chicago1979
- The post-stroke hemiplegic patient: a method for evaluation of physical performance.Scand J Rehabil Med. 1975; 7: 13-31
- Dimensionality and construct validity of the Fugl-Meyer Assessment of the Upper Extremity.Arch Phys Med Rehabil. 2007; 88: 715-723
- Translating measurement findings into rehabilitation practice: an example using the Fugl-Meyer Assessment of the Upper Extremity with clients following stroke.J Rehabil Res Dev. 2011; 48: 1211-1222
- Longitudinal stability of the Fugl-Meyer Assessment of the Upper Extremity.Arch Phys Med Rehabil. 2008; 89: 1563-1569
- The construction of keyforms for obtaining instantaneous measures from the occupational performance history interview rating scales.Occup Ther J Res. 2005; 25: 1-10
- Instantaneous measurement and diagnosis.in: Smith R.M. Physical medicine and rehabilitation state of the art reviews, vol. 11: outcome measurement. Hanley & Belfus, Philadelphia1997: 315-324
- Feasibility of high-repetition, task-specific training for individuals with upper-extremity paresis.Am J Occup Ther. 2014; 68: 444-453
- What are the “ingredients” of modified constraint-induced therapy? An evidence-based review, recipe, and recommendations.Restor Neurol Neurosci. 2013; 31: 299-309
- Translating animal doses of task-specific training to people with chronic stroke in 1-hour therapy sessions: a proof-of-concept study.Neurorehabil Neural Repair. 2010; 24: 620-635
- Winsteps Rasch measurement computer program [computer program]. Version 3.70. Winsteps.com, Beaverton2006
- An application of upper-extremity constraint-induced movement therapy in a patient with subacute stroke.Phys Ther. 1999; 79: 847-853
- Compensatory strategies for reaching in stroke.Brain. 2000; 123: 940-953
- A new kinematic model of the upper extremity based on functional joint parameter determination for shoulder and elbow.Gait Posture. 2009; 30: 469-476
- Effect of trunk restraint on the recovery of reaching movements in hemiparetic patients.Stroke. 2001; 32: 1875-1883
- The impact of physical therapy on functional outcomes after stroke: what's the evidence?.Clin Rehabil. 2004; 18: 833-862
Article info
Publication history
Published online: April 23, 2016
Footnotes
Supported in part by the Ralph H. Johnson Veterans Affairs Medical Center and the Office of Research and Development, Rehabilitation Research and Development, Department of Veterans Affairs; Career Development-2 Award (award no. B-6332W); and Veterans Affairs Merit Review Awards (award no. N0799-R). Also supported by the Medical University of South Carolina Center of Biomedical Research Excellence for Stroke Recovery, an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health (grant no. P20GM12345).
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
