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Self-reported use of the paretic arm in chronic stroke requires high upper limb functional ability
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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1238–eS1642
at baseline, immediately following the intervention, 3 and 6 months. Between group differences were examined at baseline and for change values at each post-intervention time-point using. Within-group differences were examined for active and sham groups separately. Results: The active group demonstrated greater improvement in ARAT score and time immediately post-intervention (between-group difference; p < 0.05), but not at 3 or 6 month follow ups (p < 0.2). Within-group improvements were seen for both groups for ARAT and GAS, but the active group only for FM and MAL (p < 0.05). No significant changes were seen in cortical mechanisms. Conclusion(s): Long lasting improvements in upper limb function were observed following TST. Additional benefit of SS was seen immediately post treatment, but did not persist and the underlying mechanisms remain unclear. Implications: These results indicate that SS could facilitate better improvements in post stroke. Keywords: Stroke; Upper limb; Rehabilitation Funding acknowledgements: Funding received from the Dunhill Medical Trust, UK [Grant Number R102/0209] and the South London Clinical Local Research Network. Ethics approval: The study was approved by the UK National Research Ethics committee. http://dx.doi.org/10.1016/j.physio.2015.03.1379 Research Report Poster Presentation Number: RR-PO-99-11-Sat Saturday 2 May 2015 12:15 Exhibit halls 401–403 SELF-REPORTED USE OF THE PARETIC ARM IN CHRONIC STROKE REQUIRES HIGH UPPER LIMB FUNCTIONAL ABILITY M.K. Fleming 1 , D.J. Newham 1 , S.F. Robert-Lewis 2 , I.O. Sorinola 2 1 King’s
College London, Faculty of Life Sciences & Medicine, Centre for Human and Aerospace Physiology, London, United Kingdom; 2 King’s College London, Faculty of Life Sciences & Medicine, Academic Department of Physiotherapy, Division of Health and Social Care Research, London, United Kingdom Background: Restoring functional arm use after stroke is an important factor for independence in daily activities. A challenge in rehabilitation is identifying the main determinants of functional ability including arm use. This is of paramount importance to guide planning of therapy goals, manage the expectations of patients and their carers and for organisation of rehabilitation services. Purpose: This study aimed to identify potential predictors of self-reported paretic arm use at baseline and after task specific training (TST) in chronic stroke survivors.
Methods: Thirty-three participants with stroke (13 women, mean age 61.5 years, 3–130 months post stroke) recruited to a randomised controlled trial of somatosensory stimulation and upper limb task specific training (TST), who completed upper limb rehabilitation were included. They were randomised to receive 2 hours of either active or sham somatosensory stimulation to all three peripheral nerves (median, ulnar and radial), followed by 30 minutes of TST, 3 times per week for 4 weeks. The following outcome measures were assessed at baseline and at 3 months after the intervention: Fugl-Meyer upper limb assessment (FM), Action Research Arm Test (ARAT), Modified Ashworth Scale (MAS), Motor Activity Log (MAL) and Barthel Index (BI), in addition to demographic data of age and time since stroke. The dependent variable was the average baseline amount of use and change at 3 months following TST. Demographic (age and time since stroke) and clinical characteristics (BI, MAS, baseline ARAT, baseline FM, change in ARAT and FM at 3 months following TST) were entered stepwise into multiple linear regression analyses to determine the factors predicting baseline amount of use rating (MAL) and change at 3 months following TST. Significance was set at α = 0.05. Results: Action Research Arm Test (ARAT) score predicted amount of use at baseline (R2 = 0.47, p < 0.001) and using this model, an ARAT score of 54 (max 57) is required to score 2.5 on the MAL (use described as between rarely to sometimes). Following TST the change in ARAT predicted change in amount of use (R2 = 0.31, p = 0.001). The predictive power of the model was increased if Fugl-Meyer wrist component score was added (R2 = 0.41, p = 0.001). Conclusion(s): Paretic arm use in activities of daily living requires high functional ability. The increase in self-reported arm use following TST is dependent on the change in functional ability. Implications: These results provide further guidance for rehabilitation decisions and suggest that self-perceived arm use is based on functional ability. Keywords: Stroke; Upper limb; Motor activity log Funding acknowledgements: Study funded by the Dunhill Medical Trust [Grant Number R102/0209] and the South London Clinical Local Research Network. Ethics approval: Ethical approval for the study was granted by the National Research Ethics in the UK. http://dx.doi.org/10.1016/j.physio.2015.03.1380
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1238–eS1642
at baseline, immediately following the intervention, 3 and 6 months. Between group differences were examined at baseline and for change values at each post-intervention time-point using. Within-group differences were examined for active and sham groups separately. Results: The active group demonstrated greater improvement in ARAT score and time immediately post-intervention (between-group difference; p < 0.05), but not at 3 or 6 month follow ups (p < 0.2). Within-group improvements were seen for both groups for ARAT and GAS, but the active group only for FM and MAL (p < 0.05). No significant changes were seen in cortical mechanisms. Conclusion(s): Long lasting improvements in upper limb function were observed following TST. Additional benefit of SS was seen immediately post treatment, but did not persist and the underlying mechanisms remain unclear. Implications: These results indicate that SS could facilitate better improvements in post stroke. Keywords: Stroke; Upper limb; Rehabilitation Funding acknowledgements: Funding received from the Dunhill Medical Trust, UK [Grant Number R102/0209] and the South London Clinical Local Research Network. Ethics approval: The study was approved by the UK National Research Ethics committee. http://dx.doi.org/10.1016/j.physio.2015.03.1379 Research Report Poster Presentation Number: RR-PO-99-11-Sat Saturday 2 May 2015 12:15 Exhibit halls 401–403 SELF-REPORTED USE OF THE PARETIC ARM IN CHRONIC STROKE REQUIRES HIGH UPPER LIMB FUNCTIONAL ABILITY M.K. Fleming 1 , D.J. Newham 1 , S.F. Robert-Lewis 2 , I.O. Sorinola 2 1 King’s
College London, Faculty of Life Sciences & Medicine, Centre for Human and Aerospace Physiology, London, United Kingdom; 2 King’s College London, Faculty of Life Sciences & Medicine, Academic Department of Physiotherapy, Division of Health and Social Care Research, London, United Kingdom Background: Restoring functional arm use after stroke is an important factor for independence in daily activities. A challenge in rehabilitation is identifying the main determinants of functional ability including arm use. This is of paramount importance to guide planning of therapy goals, manage the expectations of patients and their carers and for organisation of rehabilitation services. Purpose: This study aimed to identify potential predictors of self-reported paretic arm use at baseline and after task specific training (TST) in chronic stroke survivors.
Methods: Thirty-three participants with stroke (13 women, mean age 61.5 years, 3–130 months post stroke) recruited to a randomised controlled trial of somatosensory stimulation and upper limb task specific training (TST), who completed upper limb rehabilitation were included. They were randomised to receive 2 hours of either active or sham somatosensory stimulation to all three peripheral nerves (median, ulnar and radial), followed by 30 minutes of TST, 3 times per week for 4 weeks. The following outcome measures were assessed at baseline and at 3 months after the intervention: Fugl-Meyer upper limb assessment (FM), Action Research Arm Test (ARAT), Modified Ashworth Scale (MAS), Motor Activity Log (MAL) and Barthel Index (BI), in addition to demographic data of age and time since stroke. The dependent variable was the average baseline amount of use and change at 3 months following TST. Demographic (age and time since stroke) and clinical characteristics (BI, MAS, baseline ARAT, baseline FM, change in ARAT and FM at 3 months following TST) were entered stepwise into multiple linear regression analyses to determine the factors predicting baseline amount of use rating (MAL) and change at 3 months following TST. Significance was set at α = 0.05. Results: Action Research Arm Test (ARAT) score predicted amount of use at baseline (R2 = 0.47, p < 0.001) and using this model, an ARAT score of 54 (max 57) is required to score 2.5 on the MAL (use described as between rarely to sometimes). Following TST the change in ARAT predicted change in amount of use (R2 = 0.31, p = 0.001). The predictive power of the model was increased if Fugl-Meyer wrist component score was added (R2 = 0.41, p = 0.001). Conclusion(s): Paretic arm use in activities of daily living requires high functional ability. The increase in self-reported arm use following TST is dependent on the change in functional ability. Implications: These results provide further guidance for rehabilitation decisions and suggest that self-perceived arm use is based on functional ability. Keywords: Stroke; Upper limb; Motor activity log Funding acknowledgements: Study funded by the Dunhill Medical Trust [Grant Number R102/0209] and the South London Clinical Local Research Network. Ethics approval: Ethical approval for the study was granted by the National Research Ethics in the UK. http://dx.doi.org/10.1016/j.physio.2015.03.1380