Abstract
Objective
To determine the momentary effect of social-cognitive factors, in addition to motor
capability, on post-stroke paretic arm/hand use in the natural environment.
Design
A 5-day observational study in which participants were sent 6 Ecological Momentary
Assessment (EMA) prompts/day.
Setting
Participants’ daily environment.
Participants
Community-dwelling, chronic stroke survivors with right-dominant, mild-moderate upper
extremity paresis (N=30).
Interventions
Not applicable.
Main Outcome Measures
Time duration of bimanual and unimanual paretic arm/hand use indexed by accelerometry;
social-cognitive factors (social context, self-efficacy, mood) captured by EMA; motor
capability of the paretic limb measured by Fugl-Meyer Upper Extremity Motor Assessment
(FM).
Results
After accounting for participants’ motor capability, we found that momentary social
context (alone or not) and self-efficacy significantly predicted post-stroke paretic
arm/hand use behavior in the natural environment. When participants were not alone,
paretic arm/hand movement increased both with and without the less-paretic limb (bimanual
and unimanual movements, P=.018 and P<.001, respectively). Importantly, participants were more likely to use their paretic
arm/hand (unimanually) if they had greater self-efficacy for limb use (P=.042). EMA repeated-measures provide a real-time approach that captures the natural
dynamic ebb and flow of social-cognitive factors and their effect on daily arm/hand
use. We also observed that people with greater motor impairments (FM<50.6) increase
unimanual paretic arm/hand movements when they are not alone, regardless of motor
capability.
Conclusions
In addition to motor capability, stroke survivors’ momentary social context and self-efficacy
play a role in paretic arm/hand use behavior. Our findings suggest the development
of personalized rehabilitative interventions which target these factors to promote
daily paretic arm/hand use. This study highlights the benefits of EMA to provide real-time
information to unravel the complexities of the biopsychosocial (ie, motor capability
and social-cognitive factors) interface in post-stroke upper extremity recovery.
Keywords
List of abbreviations:
CAHM (Confidence in Arm and Hand Movements Scale), EMA (Ecological Momentary Assessment), FM (Fugl-Meyer Upper Extremity Motor Assessment), HLM (hierarchical linear regression model), PANAS (positive and negative affect schedule), TimeB (bimanual arms/hands movement measured by the accelerometry), TimeR (unimanual paretic right arm/hand movement measured by the accelerometry)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 23, 2022
Accepted:
September 5,
2022
Received in revised form:
June 27,
2022
Received:
March 4,
2022
Footnotes
Disclosures: Carolee Winstein serves as a member of the DSMB for Enspire DBS Therapy, Inc, a consultant for MicroTransponder Inc, and receives royalty payments from Human Kinetics, Inc (for sixth edition of Motor Control and Learning), and DemosMedical Publishers (for second edition of Stroke Recovery and Rehabilitation). All other authors declare no conflict of interest.
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
