Circle drawing as evaluative movement task in stroke rehabilitation: an explorative study

<p>Abstract</p> <p>Background</p> <p>The majority of stroke survivors have to cope with deficits in arm function, which is often measured with subjective clinical scales. The objective of this study is to examine whether circle drawing metrics are suitable objective outcome measures for measuring upper extremity function of stroke survivors.</p> <p>Methods</p> <p>Stroke survivors (n = 16) and healthy subjects (n = 20) drew circles, as big and as round as possible, above a table top. Joint angles and positions were measured. Circle area and roundness were calculated, and synergistic movement patterns were identified based on simultaneous changes of the elevation angle and elbow angle.</p> <p>Results</p> <p>Stroke survivors had statistically significant lower values for circle area, roundness and joint excursions, compared to healthy subjects. Stroke survivors moved significantly more within synergistic movement patterns, compared to healthy subjects. Strong correlations between the proximal upper extremity part of the Fugl-Meyer scale and circle area, roundness, joint excursions and the use of synergistic movement patterns were found.</p> <p>Conclusions</p> <p>The present study showed statistically significant differences in circle area, roundness and the use of synergistic movement patterns between healthy subjects and stroke survivors. These circle metrics are strongly correlated to stroke severity, as indicated by the proximal upper extremity part of the FM score.</p> <p>In clinical practice, circle area and roundness can give useful objective information regarding arm function of stroke survivors. In a research setting, outcome measures addressing the occurrence of synergistic movement patterns can help to increase understanding of mechanisms involved in restoration of post stroke upper extremity function.</p

The Rivermead Mobility Index Allows Valid Comparisons Between Subgroups of Patients Undergoing Rehabilitation After Stroke Who Differ With Respect to Age, Sex, or Side of Lesion

Item does not contain fulltextOBJECTIVE: To investigate differential item functioning or item bias of the Rivermead Mobility Index (RMI) and its impact on the drawing of valid comparisons with the RMI between subgroups of patients after stroke who differ with respect to age, sex, or side of lesion. DESIGN: Cross-sectional study. SETTING: A rehabilitation center in the Netherlands and 2 stroke rehabilitation units and the wider community in the United Kingdom. PARTICIPANTS: The RMI was completed for patients undergoing rehabilitation after stroke (N=620; mean age +/- SD, 69.2+/-12.5y; 297 [48%] men; 269 [43%] right hemisphere lesion, and 304 [49%] left hemisphere lesion). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mokken scale analysis was used to investigate differential item functioning of the RMI between subgroups of patients who differed with respect to age (young vs older), sex (men vs women), and side of stroke lesion (right vs left hemisphere). RESULTS: No differential item functioning was found for any of the comparison subgroups. CONCLUSIONS: The RMI allows valid comparisons to be made between subgroups of patients undergoing rehabilitation after stroke who differ with respect to age, sex, or side of lesion.1 juni 201

Providing Training Enhances the Biomechanical Improvements of an Alternative Computer Mouse Design

To determine if an alternative mouse promotes more neutral postures and decreases forearm muscle activity and if training enhances these biomechanical benefits is the purpose of the study. Computer mouse use is a risk factor for developing musculoskeletal disorders; alternative mouse designs can help lower these risks. Ergonomic training combined with alternative input devices could be even more effective than alternative designs alone. Participants performed a set of computer mouse tasks with a standard mouse and an alternative mouse while an electromagnetic motion analysis system measured their wrist and forearm postures and surface electromyography measured the muscle activity of three wrist extensor muscles. Fifteen participants received no training on how to hold the alternative mouse, whereas the remaining 15 participants received verbal instructions before and during use of the alternative mouse. The alternative mouse was found to promote a more neutral forearm posture compared with the standard mouse (up to 11.5° lower forearm pronation); however, pronation was further reduced when instructions on how to hold the mouse were provided. Wrist extensor muscle activity was reduced for the alternative mouse (up to 1.8% of maximum voluntary contraction lower) compared with the standard mouse, but only after participants received instructions. The alternative mouse design decreased biomechanical exposures; instructions enhanced this potential ergonomic benefit of the design

Item hierarchy-based analysis of the Rivermead Mobility Index resulted in improved interpretation and enabled faster scoring in patients undergoing rehabilitation after stroke.

Item does not contain fulltextOBJECTIVE: To enable improved interpretation of the total score and faster scoring of the Rivermead Mobility Index (RMI) by studying item ordering or hierarchy and formulating start-and-stop rules in patients after stroke. DESIGN: Cohort study. SETTING: Rehabilitation center in the Netherlands; stroke rehabilitation units and the community in the United Kingdom. PARTICIPANTS: Item hierarchy of the RMI was studied in an initial group of patients (n=620; mean age +/- SD, 69.2+/-12.5y; 297 [48%] men; 304 [49%] left hemisphere lesion, and 269 [43%] right hemisphere lesion), and the adequacy of the item hierarchy-based start-and-stop rules was checked in a second group of patients (n=237; mean age +/- SD, 60.0+/-11.3y; 139 [59%] men; 103 [44%] left hemisphere lesion, and 93 [39%] right hemisphere lesion) undergoing rehabilitation after stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mokken scale analysis was used to investigate the fit of the double monotonicity model, indicating hierarchical item ordering. The percentages of patients with a difference between the RMI total score and the scores based on the start-and-stop rules were calculated to check the adequacy of these rules. RESULTS: The RMI had good fit of the double monotonicity model (coefficient H(T)=.87). The interpretation of the total score improved. Item hierarchy-based start-and-stop rules were formulated. The percentages of patients with a difference between the RMI total score and the score based on the recommended start-and-stop rules were 3% and 5%, respectively. Ten of the original 15 items had to be scored after applying the start-and-stop rules. CONCLUSIONS: Item hierarchy was established, enabling improved interpretation and faster scoring of the RMI.1 juni 201