Correlation between kinetic and kinematic measures, clinical tests and subjective self-evaluation questionnaires of the affected upper limb in people after stroke

IntroductionAssessment of stroke recovery should include multiple sources of information in order to obtain a complete understanding of the individual’s rehabilitation progress. Self-evaluation questionnaires’ scores do not always correspond to the scores of commonly used clinical evaluation tools. The purpose of this study was to assess the relationship between self-evaluation questionnaires, clinical tests, and kinematic and kinetic analyses of the affected upper limb after stroke, and to determine the correlation between these measures and self-reported general function 2–4 years after the stroke.MethodsTwenty-six subjects recovering from stroke were included in the study. Spearman’s correlation coefficient was used to measure the correlation between Stroke Impact Scale (SIS), Motor activity Log (MAL), Fugl-Meyer Assessment (FMA) and Action Reach Arm Test (ARAT) scores, and kinematic and kinetic analyses. A logistic regression was used to assess the extent to which these measures may predict the participants’ functional self-reported status 2–4 years post stroke.ResultsSections regarding hand function, hand force and general ADL of the self-evaluation questionnaires correlated with kinematic variables. However, only questionnaires that focus on hand function correlated with clinical tests. Mean and maximal hand velocity had the strongest correlations with self-evaluation questionnaires and with the clinical tests, more than other kinematic variables. Self-evaluation questionnaires and clinical tests were found to be correlated with hand kinetic metrics force-to-time ratio and number of force peaks. SIS hand force domain, mean velocity and maximal velocity predicted self-reported general function 2–4 years after the stroke.ConclusionSelf-evaluation questionnaires should be considered for wider use in the clinical evaluation of a patient’s stroke recovery, since they add important information on the individual’s functional status, which is not reflected in the clinical tests

Tacting and manding in correspondence training: effects of child selection of verbalization.

We investigated correspondence between verbal and nonverbal behavior in preschool children in a play setting. Four children (4 years old) participated in a multiple baseline across subjects design. Children were asked what toy(s) they were going to play with during an immediately upcoming play period. When no contingencies were placed on either verbal or nonverbal behavior, children showed high rates of correspondence. When children were required to verbalize about a toy from a restricted range of infrequently used toys, but no contingencies were placed on correspondence, low rates of correspondence were observed. High rates of correspondence were noted when reinforcement was contingent on it. Results are discussed in terms of tacting and manding

On the functional role of the verbalization in correspondence training procedures

We investigated the functional role of the child's and experimenter's verbalizations in correspondence training procedures with toy play behaviors in a day-care center setting. Six children participated in a multiple baseline across responses and/or multielement design. Baseline conditions were followed by reinforcement of verbalization. This resulted in little or no change in responding, similar to findings of previous research. Experiment I isolated the child's verbalization as the variable under study. With an experimenter's prompt and postplay reinforcement held constant, the effects of including versus omitting the child's verbalization were examined. A contingency-space analysis revealed that the presence or absence of the child's verbalization exerted no influence on play with the target toy. In Experiment II, a condition in which no experimenter's prompt occurred was added. Results suggested that the complete absence of any antecedent verbalization, by child or experimenter, resulted in much lower rates of play with the target toys. Again, however, when the experimenter's prompt was included, no clear difference was noted between conditions in which the child verbalized and conditions in which the child did not. These results raise doubts about the commonly held view of correspondence training procedures as a method of promoting self-regulation

Using intermittent reinforcement to program maintenance of verbal/nonverbal correspondence.

We investigated the effects of an intermittent reinforcement procedure on maintenance of verbal/nonverbal correspondence with nutritious snack choices in a day-care setting. Nutritious snack choices were first established using correspondence training procedures in a multiple baseline across three children. Withdrawal of the procedures with one subject led to loss of appropriate responding, suggesting the need for a maintenance strategy. The intermittent reinforcement procedure was implemented in a multiple baseline across subjects. Nutritious snack choices were observed consistently during the intermittent reinforcement condition and the subsequent extinction condition

Money, commodification and complementary health care: Theorising personalised medicine within depersonalised systems of exchange

Across the United Kingdom and other Western nations, complementary health care has become big business, with pressure to commercialise and technologise its goods and services. Economic liberalisation and the democratisation of health care have encouraged the increased commodification of complementary health services. This article focuses particularly on more personalised forms of complementary health care, such as folk healing, but equally highlights the importance of a whole health-care systems analysis when thinking about commodification and marketisation. We develop an exploratory synthesis of recent empirical data in the United Kingdom, in which we theorise the significance of money for complementary healthcare and folk healing. Four mutual themes and questions emerge and are presented here, with a discussion of their contribution to wider theoretical debates about money, the community, and social and health-care systems. © 2013 Macmillan Publishers Ltd