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The task of transporting objects is a fundamental part of daily living activities. Previous kinematic studies focusing on tasks such as pointing, reach-to-grasp, and drinking have not fully captured the motor behaviors involved in object transportation, including placing a cup on a table or storing items in specific places. Hence, this study aimed to analyze the motor behavior associated with transporting a mug using upper limb kinematic variables. Fifteen healthy adults were instructed to transport an open-handle mug across a table. The kinematic metrics evaluated included object end-error for accuracy, frontal and lateral end-range for precision, movement time, peak velocity, time to peak velocity for control strategy, object path ratio for efficiency, and interjoint coordination. The stability of motor behavior was assessed through a test-retest analysis. The mug transporting task achieved accuracy with a radius <10 mm around the target, a peak velocity of â¼0.4 m/s, a control strategy where acceleration time constituted about 30% of the movement time, and a slightly curved trajectory. The test-retest analysis confirmed stable motor behavior across all kinematic metrics (ICCs > 0.75). Thus, the mug transporting task exhibited unique and stable kinematic characteristics, distinguishing it from non-transport activities and effectively mirroring transporting activities of daily living.
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Extremidade Superior , Humanos , Fenômenos Biomecânicos/fisiologia , Masculino , Feminino , Extremidade Superior/fisiologia , Adulto , Adulto Jovem , Desempenho Psicomotor/fisiologia , Movimento/fisiologiaRESUMO
PURPOSE: To develop a new instrument to identify barriers to self-administered home-based task-oriented practice post-stroke and test its content validity. MATERIALS AND METHODS: The sample consisted of individuals with stroke and neurological rehabilitation professionals. The study consisted of two steps: (1) Instrument development, involving three processes; a data search in the literature, interviews with the target population and an open questionnaire (online) sent to professionals; and (2) Testing the content validity of the instrument by asking individuals with stroke and professionals about the comprehensiveness and relevance of the items and additionally asking individuals with stroke about the comprehensibility of the items. For each item in the instrument, the threshold validity scores were ≥0.80 in the Content Validity Index and ≥0.75 for the Kappa agreement. RESULTS: The preliminary version was developed with 46 items. The content validation was performed in three rounds. The last version of the instrument Barriers to self-administered home-based task-oriented practice post-stroke (BASH-TOP-Stroke) contained 34 items in five response categories, in which the higher the value presented, the greater the number of barriers. The content validity for the items was excellent. CONCLUSIONS: The study provides a new instrument to help identify barriers to self-administered home-based task-oriented practice post-stroke.
Barriers to self-administered task-oriented home-based exercises can be specific to this form of practice.Understanding barriers to self-administered task-oriented home-based exercises is essential to increase the amount of practice for optimizing motor recovery.The Barriers to self-administered home-based task-oriented practice post-stroke (BASH-TOP-Stroke) questionnaire was developed to evaluate barriers to self-administered task-oriented home-based exercises in individuals post-stroke.BASH-TOP-Stroke has excellent content validity based on patients and professionals and could help to identify strategies that may reduce barriers to self-administered home-based task-oriented practice after stroke.
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OBJECTIVE: The objective of this study was to investigate the validity, reliability, and measurement error of the Fugl-Meyer Assessment (FMA) when it was remotely administered by videoconferencing (Tele-FMA) and to describe barriers to remote administration of the FMA. METHODS: Forty-five participants who had strokes and had a smartphone or laptop computer with a camera and internet access were included. An in-person assessment was compared with a remote assessment in 11 participants, and 34 participants completed only the remote assessment. Rater 1 (R1) remotely administered, recorded, and scored the items of the FMA, after which the recording was forwarded to be scored by Rater 2. At least 7 days later, R1 rated the videorecording of the remote assessment a second time for the evaluation of intrarater reliability. In-person assessment was completed by R1 at the participant's home. Criterion validity was analyzed using the Bland-Altman limits of agreement, and convergent validity was analyzed using Spearman correlation coefficient. The intrarater and interrater reliability was analyzed using the intraclass correlation coefficient, and individual items were analyzed using the weighted kappa. The standard error of measurement and minimal detectable change were calculated to evaluate the measurement error. RESULTS: Bland-Altman plots showed adequate agreement of in-person FMA and tele-FMA. A moderate positive correlation was found between Tele-FMA lower extremity (LE) scores and step test results, and a strong positive correlation was found between Tele-FMA-upper extremity (UE) and Stroke Impact Scale hand function domain. Significant and excellent (0.96 ≤ ICC ≤ 0.99) interrater and intrarater reliabilities of the Tele-FMA, Tele-FMA-UE, and tele-FMA-LE were found. Regarding the individual items, most showed excellent reliability (weighted kappa > 0.70). The standard error of measurement for both reliabilities was small (≤3.1 points). The minimal detectable change with 95% CI for both the Tele-FMA and Tele-FMA-UE was 2.5 points, whereas it was 1.3 points for the Tele-FMA-LE. CONCLUSION: Tele-FMA has excellent intrarater and interrater reliability and should be considered as a valid measurement. IMPACT: The FMA is widely used in clinical practice. However, the measurement properties of the remote version applied by videoconferencing were unknown. This study's results demonstrate the validity and reliability of the Tele-FMA for assessing poststroke motor impairment remotely via videoconferencing. The Tele-FMA may be used to implement telerehabilitation in clinical practice.
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Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Reprodutibilidade dos Testes , Psicometria , Extremidade Superior , Reabilitação do Acidente Vascular Cerebral/métodos , Comunicação por VideoconferênciaRESUMO
PURPOSE: This study aimed to assess the following in individuals after stroke: (1) relationship between upper limb (UL) use by direct observation at home with use perceived and measured by accelerometers; (2) complementarity of these three measurements; and (3) relationship between UL bilateral capacity and bilateral use. MATERIALS AND METHODS: Thirty-one individuals with chronic hemiparesis participated in this cross-sectional study. UL use was assessed using a behavioral map (BM), the Motor Activity Log-Amount of Use (MAL-AOU), and accelerometers, while UL capacity was assessed using the Test d'Evaluation des Membres Supérieurs des Personnes Âgées (TEMPA). RESULTS: The BM was strongly correlated with perceived use (MAL-AOU, ρ = 0.76) and accelerometer (ρ = 0.70). Bilateral UL use (BM) was moderately (ρ = 0.65) correlated with bilateral MAL-AOU and bilateral use by accelerometers (ρ = 0.62). The BM aided our understanding of how the paretic UL was used. The correlation between bilateral capacity (TEMPA bilateral) and bilateral use (BM) was significant (ρ = 0.49), while that with bilateral MAL-AOU and accelerometer were ρ = 0.68 and ρ = 0.50, respectively. CONCLUSION: A BM is a valid way to quantify UL use and can complement information assessed regarding perceived use and by accelerometers.Implications for rehabilitationBehavioral maps may be valuable to complement information assessed by perceived UL use and accelerometers.Quantifying bilateral capacity will reflect in a better understanding of actual paretic UL use after stroke.Accelerometers can underestimate the amount of paretic UL use in asymmetrical bilateral tasks.
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Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Acelerometria , Estudos Transversais , Humanos , Acidente Vascular Cerebral/complicações , Extremidade SuperiorRESUMO
BACKGROUND AND PURPOSE: Regarding people with stroke, simple outcome measures in clinical settings capable of representing the actual use of the upper extremity (UE) would be useful to rehabilitation professionals for the purposes of goal setting. This study seeks to describe the relative levels of paretic UE use, investigate the association between manual dexterity and task-related UE use, and to establish the manual dexterity cutoff points that correspond to relative levels of paretic UE use. METHODS: Forty-six adults with chronic hemiparesis participated in this cross-sectional study. Behavioral mapping was employed to ascertain the actual amount of UE use by the identifying the unimanual and bimanual activities performed in the participants' homes within a 4-hour period. Participants were classified into 4 levels of paretic UE integration into activities considering the data from the behavioral mapping (activity, hand function, and type of grasp). The Box and Block Test (BBT) and the Nine Hole Peg Test (NHPT) were used to evaluate dexterity. The Spearman test was used to evaluate the correlations. In analyzing the receiver operating characteristic curve, we applied the Youden index to determine the cutoff points. RESULTS: Participants with full/almost full (n = 11), partial (n = 12), and limited (n = 12) integration of the paretic UE into activities and with little/no use (n = 11) were identified. Unimanual and total paretic UE activities were found to have a high correlation with the BBT scores. The boundaries between the integration levels were between full/almost full and partial integration, BBT greater than 30 blocks or NHPT of 41 seconds and less; between partial and limited, BBT greater than 16 blocks; and between limited and little/no use, BBT greater than 3 blocks. Both tests show good accuracy (≥0.81). DISCUSSION AND CONCLUSIONS: The BBT presents a positive high correlation with paretic UE use at home and was shown to be better able to identify "limited" and "partial" integration of the paretic UE. Both tests can identify when the paretic UE is fully/almost fully integrated into activities at home.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A354).
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Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Adulto , Estudos Transversais , Humanos , Vida Independente , Paresia/etiologia , Acidente Vascular Cerebral/complicações , Extremidade SuperiorRESUMO
BACKGROUND: Devices are commonly used in aquatic gait rehabilitation; therefore, investigating the effect of these devices is important. We evaluated the combined use of buoyancy cuffs and ankle weights during aquatic gait on paretic leg kinematics in people with hemiparesis. METHODS: Fifteen adults (58.6⯱â¯4.8â¯years) in the chronic phase post-stroke walked on a 4.5â¯m walkway with underwater immersion at the height of the xiphoid process in five conditions: (1) without equipment; (2) with ankle weights or (3) buoyancy cuffs on both legs; (4) with a buoyancy leg cuff on the non-paretic leg and an ankle weight on the paretic leg; (5) with an ankle weight on the non-paretic leg and a buoyancy leg cuff on the paretic leg. Five trials were performed for each condition for a total of 25 trials and the kinematic data were recorded. Analysis of covariance was used with walking velocity as a covariate to analyze spatiotemporal and angular variables of the paretic leg. FINDINGS: The condition with buoyancy cuff on the paretic leg increased (~20°) the maximum angle of knee flexion in the mid-swing phase compared to that seen with weights on both legs or weight on the paretic leg. Buoyancy cuffs on the paretic leg increased the step length by 5.6â¯cm. The ankle weights on the paretic leg condition increased the total (6%) and single support (4%) duration compared to that seen with a buoyancy cuff on the paretic leg. INTERPRETATION: Aquatic gait with buoyancy cuffs on both legs or on the paretic leg can modify gait kinematics compared to that with weight on both legs or on the paretic leg. Long term effects of training with those conditions needs further research.
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Transtornos Neurológicos da Marcha/reabilitação , Marcha , Extremidade Inferior/fisiopatologia , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral , Idoso , Tornozelo , Articulação do Tornozelo , Fenômenos Biomecânicos , Estudos Transversais , Exercício Físico , Feminino , Humanos , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/fisiopatologia , Piscinas , CaminhadaRESUMO
BACKGROUND: Based on the premise that spasticity might affect gait post-stroke, cryotherapy is among the techniques used to temporarily reduce spasticity in neurological patients. This effective technique would enhance muscle performance, and ultimately, functional training, such as walking. However, understanding whether a decrease in spasticity level, if any, would lead to improving muscle performance and gait parameters is not based on evidence and needs to be clarified. OBJECTIVES: to investigate the immediate effects of cryotherapy, applied to spastic plantarflexor muscles of subjects post-stroke, on tonus level, torque generation capacity of plantarflexors and dorsiflexors, and angular/spatiotemporal gait parameters. METHODS: Sixteen chronic hemiparetic subjects participated in this randomized controlled crossover study. Cryotherapy (ice pack) or Control (room temperature sand pack) were applied to the calf muscles of the paretic limb. The measurements taken (before and immediately after intervention) were: 1) Tonus according to the Modified Ashworth Scale; 2) Torque assessments were performed using an isokinetic dynamometer; and 3) Spatiotemporal and angular kinematics of the hip, knee, and ankle (flexion/extension), obtained using a tridimensional movement analysis system (Qualisys). RESULTS: Cryotherapy decreased plantarflexor tonus but did not change muscle torque generation capacity and did not affect spatiotemporal or angular parameters during gait compared to control application. These findings contribute to the evidence-based approach to clinical rehabilitation post-stroke. CONCLUSIONS: The findings of this study suggest that cryotherapy applied to the calf muscles of subjects with chronic hemiparesis reduces muscle hypertonia but does not improve dorsiflexors and plantarflexors performance and gait parameters.
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Crioterapia , Marcha/fisiologia , Espasticidade Muscular/terapia , Força Muscular/fisiologia , Músculo Esquelético/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Articulação do Tornozelo/fisiopatologia , Fenômenos Biomecânicos , Estudos Cross-Over , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Espasticidade Muscular/fisiopatologia , Paresia/complicações , Paresia/fisiopatologia , Paresia/reabilitação , Amplitude de Movimento Articular , Método Simples-Cego , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/métodosRESUMO
BACKGROUND: Knowledge of paretic upper limb (UL) use in the actual environment is crucial for defining treatment strategies that are likely to enhance performance. OBJECTIVE: To quantify the hand function and type of grasp performed in the actual environment following stroke and determine if any differences in hand use are dependent on the degree of motor impairment. METHOD: This cross-sectional study enrolled 41 participants with chronic hemiparesis classified as having either mild (11), moderate (20), or severe (10) UL impairment. A behavioral map was used while observing hand use over the 4-h experimental period, during which we checked: activity- unimanual, bimanual or non-task-related; hand function- stabilization, manipulation, reach-to-grasp, gesture, support or push; and type of grasp- digital or whole-hand. RESULTS: Participants with severe impairment did not use the paretic UL spontaneously; analyzing the moderate and mild subgroup together, the predominant UL hand functions were stabilization and manipulation, the paretic UL performs the stabilization function using the whole-hand more frequently (71.2%) than digital (28.8%) grasp. In the subgroup analysis, the paretic and non-paretic UL in the moderate and the paretic UL in the mild subgroup perform the whole-hand stabilization more frequently than digital. Digital grasp is more accomplished by the non-paretic UL in reach-to-grasp hand function, particularly in the mild subgroup. CONCLUSION: The paretic UL is predominantly employed for stabilization function using a whole-hand grasp. The type of grasp in the actual environment is affected by motor impairment, and greater motor impairment leads to the performance of less complex tasks.
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Força da Mão/fisiologia , Mãos/fisiopatologia , Paresia/fisiopatologia , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Acidente Vascular Cerebral/complicaçõesRESUMO
Abstract Introduction: There is still no consensus on the recommendation of instruments for evaluation of the upper limb (UL) after Stroke. Objective: Identify the tasks most performed at home by people after stroke, and among these, which are contemplated in the instruments of assessments of UL activity identified in the literature. Method: Direct observation during four hours at the home of 40 participants (57,2±13,0 years old) with hemiparesis, the basic activities of daily life (BADL) and instrumental (IADL) were recorded, identifying those performed by a larger number of participants. Results: From the 247 observed tasks, 70,5% were related to IADL. In the literature we identified six instruments of capacity evaluation: Arm Motor Ability Test (AMAT); Action Research Arm Test (ARAT); Chedoke Arm and Hand Activity Inventory (CAHAI); JEBSEN-TAYLOR; Test d'Evaluation des Membres Supérieurs de Personnes Agées (TEMPA) and Wolf Motor Function Test (WMFT) and four Performance: Motor Activity Log (MAL); Manual Ability Measure (MAM-16 and MAM-36) and ABILHAND. Of the 64 tasks performed by a larger number of participants, the capacity instrument that contemplated the largest number of these was CAHAI (15%) and performance was MAL (33%). The instruments with the greater proportion of tasks observed at home in relation to the total number of the instrument were the TEMPA (all eight) and the MAL (21/30) tasks. Conclusion: Performance instruments contemplate greater proportion of tasks observed directly at home, however the capacity instruments assess distinct tasks. The combination of capacity and performance tools for UL assessment in this population is recommended.
Resumo Introdução: Ainda não há consenso sobre a recomendação de instrumentos para avaliação do membro superior (MS) pós-Acidente Vascular Encefálico (AVE). Objetivo: Identificar as tarefas realizadas no domicílio por pessoas pós-AVE e, dentre estas, quais estão contempladas nos instrumentos de avaliação de atividade do MS identificados na literatura. Método: Por observação direta, durante quatro horas no domicílio de 40 participantes (57,2±13,0 anos) com hemiparesia, foram registradas as atividades básicas de vida diária (ABVD) e instrumentais (AIVD), identificando aquelas executadas por maior número de participantes. Resultados: Das 247 tarefas observadas, 70,5% foram relacionadas às AIVD. Na literatura, identificamos seis instrumentos de avaliação da capacidade: Arm Motor Ability Test (AMAT); Action Research Arm Test (ARAT); Chedoke Arm and Hand Activity Inventory (CAHAI); JEBSEN-TAYLOR; Test d'Evaluation des Membres Supérieurs de Personnes Agées (TEMPA) e Wolf Motor Function Test (WMFT), e quatro de desempenho: Motor Activity Log (MAL); Manual Ability Measure (MAM-16 e MAM-36) e ABILHAND. Dentre as 64 tarefas realizadas por um maior número de participantes, o instrumento de capacidade que contemplou maior número destas foi o CAHAI (15%) e de desempenho foi o MAL (33%). Os instrumentos com maior proporção de tarefas observadas em domicílio, em relação ao número total do instrumento, foram o TEMPA (todas as oito) e o MAL (21/30 tarefas). Conclusão: Os instrumentos de desempenho contemplam maior proporção das tarefas observadas em domicílio, entretanto os instrumentos de capacidade avaliam tarefas distintas destas. Recomenda-se a combinação de instrumentos de capacidade e desempenho para avaliação do MS nessa população.
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Introdução: O Chedoke Arm and Hand Activity Inventory (CAHAI) foi desenvolvido nas línguas inglesa e francesa, com versão original nos dois idiomas, para a avaliação do nível de atividade dos membros superiores em indivíduos com hemiparesia após Acidente Vascular Encefálico (AVE). Objetivo: Realizar o processo de adaptação transcultural do manual de aplicação e da folha de pontuação do CAHAI para a língua portuguesa-Brasil. Método: Constituído de sete etapas, o processo de tradução consistiu em: i) duas traduções independentes; ii) compilação das duas traduções, formando uma única tradução; iii) revisão do layout, da tipografia e da gramática; iv) duas retrotraduções independentes; v) reunião com Comitê de Especialistas; vi) envio para a autora da versão original, e vii) pré-teste da versão CAHAI-Brasil (avaliadores: n=5; sujeitos: n=4). Resultados: A versão CAHAI-Brasil teve resultados satisfatórios nas etapas de tradução e adaptação, e índices de concordância entre os avaliadores adequados (kappa entre 0,76 e 1,00). Houve necessidade de substituir alguns termos utilizados no manual e de adaptar alguns dos materiais utilizados no teste. Conclusão: Este estudo mostra que a versão CAHAI-Brasil foi traduzida e adaptada com êxito.
Introduction: The Chedoke Arm and Hand Activity Inventory (CAHAI) was developed in English and French (original version in both languages) for evaluation of the level of the upper limb activity in subjects with hemiparesis after stroke. Objective: To translate and cross-culturally adapt the manual of application and scoring of CAHAI to Portuguese-Brazil. Method: The process included six steps: the translation process with two independent translation; merging of the two translation; layout, typography and grammar review; two independent backtranslations; meeting with the Committee of Experts, and sending to the author of the original version, and pre-testing of the version CAHAI-Brazil (raters: n=5; subjects: n=4). Results: The CAHAI-Brasil version had satisfactory results in the translation and adaptation, and appropriate index of agreement among raters (kappa between 0,76 and 1,00). Some expressions in the manual and some of the materials used for the test had to be adapted to Brazilian culture. Conclusion: This study show the CAHAI-Brazil version was successfully translated and adapted