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Clinical and kinematic assessments of upper limb function in persons with post-stroke symptoms
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Stroke is a common and multifaceted disease that often involves motor deficits in the upper limb. This thesis investigated reliability and validity of existing clinical assessments of upper limb function in persons with post-stroke symptoms and in non-disabled controls. Study I was conducted in a clinical setting where the Motor Evaluation Scale of Upper Extremity in Stroke patients (MESUPES) was assessed in persons post-stroke by two physiotherapists selected from a group of four.  Study II-IV took place in a motion analysis laboratory with an optoelectronic system. Kinematic measures and clinical measures were used to investigate the validity of the Arm Posture Score (APS), the Finger-to-Nose test (FNT), and the Standardised Nine Hole Peg test (S-NHPT) in persons post-stroke and non-disabled controls.

 

The results showed that the MESUPES had a high inter-rater reliability while the concurrent validity was not fully confirmed. MESUPES has a maximum score of 58 and the minimal detectable change ranged from 5 to 8 for a confidence level of 80% and 95%. The Arm Posture Scores, which include either four or six arm movement variables, were able to distinguish between the affected and non-affected arms, as well as between the affected arm and the non-dominant arm of the controls. The total movement time of the FNT, which is a coordination test, was able to distinguish persons post-stroke from controls, at least at a group level. Movement smoothness, accuracy and compensation, obtained from kinematic analysis, were the most discriminative variables for the FNT. Smoothness was most strongly correlated with the timed FNT and had the greatest association with the variance of the timed FNT. For the S-NHPT, which is a dexterity test involving grasping and reaching, the movement times, smoothness and compensation discriminated between the stroke group and the control group. Persons post-stroke spent considerably more time in the grasp-related parts of the task compared to controls. Smoothness and upper limb impairments had the strongest correlation with the S-NHPT.

 

In conclusion, the clinical measures used within stroke rehabilitation seem valid and reliable, although some limitations are highlighted by the kinematic assessment. MESUPES was shown to be a reliable assessment of upper limb movement quality after stroke. The kinematic analysis revealed that the timed FNT does not have sufficient discriminative validity at an individual level. The timed FNT reflected speed-related aspects of pointing movements such as smoothness and length of the deceleration phase, but should not be used as an overall measure of upper limb coordination after stroke. The timed S-NHPT demonstrated sufficient discriminative validity and reflected smoothness and upper limb impairments. For both the FNT and S-NHPT, kinematic analysis showed that the clinical outcomes of those tests (time of performance) did not adequately detect qualitative aspects of the upper limb movements after stroke such as possible compensatory movements. Therefore, clinical assessments that capture qualitative aspects of upper limb movements would improve the assessment of upper limb coordination and dexterity after stroke. In addition, 3D movement analysis provided unique information about upper limb function after stroke, not least in persons with mild post-stroke impairments. The APS, for instance, which quantifies how much the arm swing during gait deviates from normal, discriminated between persons with stroke and non-disabled persons. Such subtle deviations are not possible to quantify with the human eye.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2015. , 74 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1722
Keyword [en]
Cross-sectional studies, Arm, Hand, Gait, Outcome assessment, Clinical laboratory techniques
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:umu:diva-103244ISBN: 978-91-7601-280-2 (print)OAI: oai:DiVA.org:umu-103244DiVA: diva2:812649
Public defence
2015-06-12, Aulan, Vårdvetarhuset, Umeå universitet, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-05-22 Created: 2015-05-19 Last updated: 2015-05-22Bibliographically approved
List of papers
1. Measurement properties of the motor evaluation scale for upper extremity in stroke patients (MESUPES)
Open this publication in new window or tab >>Measurement properties of the motor evaluation scale for upper extremity in stroke patients (MESUPES)
2012 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 4, 288-294 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: To investigate inter-rater reliability of the Motor Evaluation Scale for Upper Extremity in Stroke patients (MESUPES), to provide estimates of the minimal detectable change (MDC) of the MESUPES and to investigate concurrent validity in relation to the arm scores of the Modified Motor Assessment Scale (M MAS). Methods: Forty-two stroke patients (mean age 56 +/- 12 years) were independently assessed within a 48-hours window by two raters in different pairs (total available raters = 4). Results: Weighted. analysis indicated good to very good agreement at item level (range 0.63-0.96). The relative and absolute reliability of the total score of MESUPES (maximum 58) was high according to the intraclass correlation coefficients (ICC = 0.98) and the standard error of measurement (SEM = 2.68). The MDC for three levels of confidence was calculated: A score change of 8, 7 and 5 is necessary for a MDC to have confidence of 95%, 90% and 80%, respectively, of a genuine change. Correlation between the MESUPES and M MAS was high (r(s) = 0.87). Conclusions: The MESUPES shows high inter-rater reliability, and our study provides useful estimates of MDC for different levels of certainty. Additional research to confirm concurrent validity and to examine other psychometric properties of the MESUPES such as sensitivity is needed.

Place, publisher, year, edition, pages
London: Informa Healthcare, 2012
Keyword
arm, motor evaluation scale for upper extremity in stroke patients MESUPES, movement, stroke
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-52025 (URN)10.3109/09638288.2011.606343 (DOI)000298191400003 ()
Available from: 2012-02-09 Created: 2012-02-08 Last updated: 2017-12-07Bibliographically approved
2. Assessment of arm movements during gait in stroke: the Arm Posture Score
Open this publication in new window or tab >>Assessment of arm movements during gait in stroke: the Arm Posture Score
Show others...
2014 (English)In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 40, no 4, 549-555 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of the study was to apply the Arm Posture Score (APS) to a stroke population, since comprehensive measures to quantify arm swing in the affected and non-affected arms during gait are lacking. A further aim was to investigate how gait speed and upper limb function estimated by clinical measures are related to the APS in the stroke group. The APS is the summarized root mean square deviation (RMSD) from normal, based on kinematics. Four arm movements (sagittal and frontal planes) as well as six arm movements (incorporating transversal plane) were included in the calculation of APS, referred to as APS4 and APS6, respectively. The study population consisted of 25 persons with stroke and 25 age- and gender-matched controls. The APS measures were significantly different between the affected and non-affected arms, as well as between the affected arm and the non-dominant arm of the controls (p≤0.001). Spasticity significantly influenced both APS measures, while speed only had a significant effect on the APS4. The APS measures correlated significantly to clinical measures of upper limb function. Both APS measures seem to be useful indices to quantify and discriminate between impaired and normal arm swing during gait after stroke. The variability of rotational arm movements needs to be studied further before considering the additional value of the APS6 over the APS4. When interpreting the APS, complementary kinematics should be taken into account, as the single value of the APS gives no information about the direction of the deviation.

Keyword
Arm Posture Score, Kinematics, Arm swing, Gait, Stroke
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-92066 (URN)10.1016/j.gaitpost.2014.06.014 (DOI)25065628 (PubMedID)
Available from: 2014-08-22 Created: 2014-08-21 Last updated: 2017-12-05Bibliographically approved
3. Validity of the timed Finger-to-Nose test as a measure of upper limb coordination in persons post-stroke - a kinematic analysis
Open this publication in new window or tab >>Validity of the timed Finger-to-Nose test as a measure of upper limb coordination in persons post-stroke - a kinematic analysis
(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-103241 (URN)
Available from: 2015-05-19 Created: 2015-05-19 Last updated: 2015-05-20
4. Validation and standardisation of the Nine Hole Peg test for kinematic quantification in persons post-stroke
Open this publication in new window or tab >>Validation and standardisation of the Nine Hole Peg test for kinematic quantification in persons post-stroke
(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-103243 (URN)
Available from: 2015-05-19 Created: 2015-05-19 Last updated: 2015-05-20

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