Matching task-difficulty to patient-ability during task practice improves upper extremity motor skill after stroke: a proof of concept study

Publication date: Available online 23 April 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Michelle L. Woodbury, Kelly Anderson, Christian Finetto, Andrew Fortune, Blair Dellenbach, Emily Grattan, Scott Hutchison
ObjectiveTo test the feasibility of the Fugl-Meyer Upper Extremity Assessment (FMA-UE) "keyform," derived from Rasch Analysis, as a method for systematically planning and progressing rehabilitation.DesignFeasibility study, single group design.SettingUniversity rehabilitation research laboratory.ParticipantsSubjects with ischemic or hemorrhagic stroke >3 mo. prior, voluntarily shoulder flexion ≥30° and simultaneous elbow extension ≥20°.Intervention: The keyform method defined initial rehabilitation targets (goals) and progressed the rehabilitation program after every 3rd session. Targets were repetitively practiced within the context of client-selected functional tasks not in isolation.Main outcome measuresFeasibility was defined by subject pain/fatigue, upper extremity (UE) motor function (Wolf Motor Function Test, WMFT) and movement patterns (kinematics). Assessments were administered pre- and post-treatment and compared with paired t-tests. Task-difficulty and patient-ability measures were calculated with Rasch analysis and compared with paired t-tests (p<0.05).ResultsTen subjects (59.70±9.96 yrs., 24.1±30.54 mo. post-stroke) participated in 9 sessions, 200 movement repetitions/session in <2 hrs without pain or fatigue. Subjects gained UE motor function (WMFT: Pre 22.23±24.26 seconds, Post 15.46±22.12 seconds, p=0.01), improved shoulder-elbow coordination (index of curvature: Pre 1.30±0.15, Post 1.21±0.11, p=0.01) and exhibited reduced trunk compensatory movement (trunk displacement: Pre 133.97±74.15 mm, Post 108.08±64.73 mm, p=0.02). Task-difficulty and patient-ability measures were not statistically different throughout the program (Person-ability measures of 1.01±0.05, 1.64±0.45 and 2.22±0.65 logits and item difficulty measures of 0.93±0.37, 1.70±0.20, and 2.06±0.24 logits at the 3 testing time points respectively, p>0.05).ConclusionThe FMA-UE keyform is a feasible method to assure that the difficulty of tasks practiced were well matched to initial and evolving levels of UE motor ability.



from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/1XPq2T4
via IFTTT