Abstract
Objective
To quantitatively determine levels of upper extremity movement impairment by using
a cluster analysis of the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) with
and without reflex items.
Design
Secondary analysis.
Setting
University and research centers.
Participants
Individuals (N=247) with chronic stroke (>6mo poststroke).
Interventions
Not applicable.
Main Outcome Measures
Cutoff scores defined by FMA-UE total scores of clusters identified by 2 hierarchical
cluster analyses performed on the full sample of FMA-UE individual item scores (with
and without reflexes). Patterns of motor function defined by aggregate item scores
of clusters.
Results
FMA-UE scores ranged from 2 to 63 (mean, 26.9±15.7) with reflex items and from 0 to
57 (mean, 22.1±15.3) without reflex items. Three clusters were identified. The distributions
of the FMA-UE scores revealed considerable overlap between the clusters; therefore,
4 distinct stroke impairment levels were derived.
Conclusions
For chronic stroke, the cluster analysis of the FMA-UE supports either a 3- or a 4-impairment
level classification scheme.
Keywords
List of abbreviations:
FMA-UE (Fugl-Meyer Assessment of the Upper Extremity), IRT (item response theory), UE (upper extremity)To read this article in full you will need to make a payment
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References
- More outcomes than trials: a call for consistent data collection across stroke rehabilitation trials.Int J Stroke. 2013; 8: 18-24
- The post-stroke hemiplegic patient. 1: A method for evaluation of physical performance.Scand J Rehabil Med. 1975; 7: 13-31
- Assessing motor deficits in neurological rehabilitation: patterns of instrument usage.Neurorehabil Neural Repair. 2001; 15: 23-30
- A systematic literature review of outcome measures for upper extremity function using the international classification of functioning, disability, and health as reference.PMR. 2011; 3: 846-860
- Physiotherapy coupled with dextroamphetamine for rehabilitation after hemiparetic stroke: a randomized, double-blind, placebo-controlled trial.Stroke. 2006; 37: 179-185
- Characterization of global synkineses during hand grip in hemiparetic patients.Arch Phys Med Rehabil. 1997; 78: 1117-1124
- Task-specific training with trunk restraint on arm recovery in stroke: randomized control trial.Stroke. 2006; 37: 186-192
- The responsiveness of the Action Research Arm test and the Fugl-Meyer Assessment scale in chronic stroke patients.J Rehabil Med. 2001; 33: 110-113
- Two common tests of dexterity can stratify upper limb motor function after stroke.Neurorehabil Neural Repair. 2014; 28: 788-796
- Comparison of three tools to measure improvements in upper-limb function with poststroke therapy.Neurorehabil Neural Repair. 2015; 29: 341-348
- The restoration of motor function following hemiplegia in man.Brain. 1951; 74: 443-480
- Motor testing procedures in hemiplegia: based on sequential recovery stages.Phys Ther. 1966; 46: 357-375
- The Fugl-Meyer Assessment of motor recovery after stroke: a critical review of its measurement properties.Neurorehabil Neural Repair. 2002; 16: 232-240
- Dimensionality and construct validity of the Fugl-Meyer Assessment of the upper extremity.Arch Phys Med Rehabil. 2007; 88: 715-723
- Rasch analysis staging methodology to classify upper extremity movement impairment after stroke.Arch Phys Med Rehabil. 2013; 94: 1527-1533
- The reliability of the Wolf Motor Function Test for assessing upper extremity function after stroke.Arch Phys Med Rehabil. 2001; 82: 750-755
- Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke.Stroke. 2000; 31: 2390-2395
- Repetitive bilateral arm training and motor cortex activation in chronic stroke: a randomized controlled trial.JAMA. 2004; 292: 1853-1861
- Effect of gravity on robot-assisted motor training after chronic stroke: a randomized trial.Arch Phys Med Rehabil. 2011; 92: 1754-1761
- Bilateral and unilateral arm training improve motor function through differing neuroplastic mechanisms: a single-blinded randomized controlled trial.Neurorehabil Neural Repair. 2011; 25: 118-129
- Sequencing bilateral and unilateral task-oriented training versus task oriented training alone to improve arm function in individuals with chronic stroke.BMC Neurol. 2014; 14: 236
- Temporal and spatial control following bilateral versus unilateral training.Hum Mov Sci. 2008; 27: 749-758
- Finding groups in data: an introduction to cluster analysis.John Wiley & Sons, New York2009
- An exploratory analysis of functional staging using an item response theory approach.Arch Phys Med Rehabil. 2008; 89: 1046-1053
- Defining post-stroke recovery: implications for design and interpretation of drug trials.Neuropharmacology. 2000; 39: 835-841
- Applying item response theory and computer adaptive testing: the challenges for health outcomes assessment.Qual Life Res. 2007; 16: 187-194
- What do motor “recovery” and “compensation” mean in patients following stroke?.Neurorehabil Neural Repair. 2009; 23: 313-319
- Hemiplegic limb synergies in stroke patients.Am J Phys Med Rehabil. 2006; 85: 112-119
- Absence of a proximal to distal gradient of motor deficits in the upper extremity early after stroke.Clin Neurophysiol. 2008; 119: 2074-2085
- Mayo and NINDS scales for assessment of tendon reflexes: between observer agreement and implications for communication.J Neurol Neurosurg Psychiatry. 1998; 64: 253-255
Article Info
Publication History
Published online: August 09, 2016
Footnotes
Supported by the National Institutes of Health (grant nos. NIH P60 AG12583 and NIH R21 HD052125), National Institute on Disability and Rehabilitation Research IDS 2 (grant nos. H133G010111, NIH R21 HD047756, and NIH P30 AG028747), Department of Veterans Affairs Merit Award (award no. B6935R), and Baltimore VA Geriatrics Research, Education and Clinical Centers.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine