Reliability of the Modified Ashworth Scale After Stroke for 13 Muscle Groups.

OBJECTIVE: To evaluate the reliability of the protocol for administration of the Modified Ashworth Scale (MAS) for all commonly affected muscle groups after stroke. DESIGN: A repeated-measures design was used in administration of MAS for 13 muscle groups on 2 assessment days. Intrarater reliability and interrater reliability (between 3 raters) was assessed. SETTING: Inpatient rehabilitation. PARTICIPANTS: 30 patients, 1-19 months after stroke (age 55.1±13.5 years; N=30). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Intra- and interrater reliability of the muscle tone assessment protocol with MAS for 7 upper and 6 lower limb muscle groups compiled from previous studies; 1 modified and 4 originally described. The weighted kappa was calculated. RESULTS: The most and the least frequently assigned MAS grades were 0 and 4, respectively. Agreement was the highest for grade 0 (49% within raters, 32% between raters). Intrarater reliability was good to excellent for upper limb (κ=0.71-0.94) and moderate to excellent for lower limb (κ=0.55-0.97) muscles. Interrater reliability was poor to good for upper limb (κ=0.25-0.66) and moderate for lower limb (κ=0.41-0.54) muscles. CONCLUSIONS: The intrarater reliability of MAS was moderate for the hip flexors. The reliability results for the other 4 muscles studied anew after stroke were similar to the predetermined ones. The better intrarater reliability results confirmed previous findings. Because of the low interrater reliability, caution is needed in interpreting the results when reassessment is not possible by the same examiner. A well-described protocol for administering the MAS may lead to its standardization.

Effectiveness of Ultrasound-Guided Canal Adductor Blockade for Chronic Pain and Functioning in Knee Osteoarthritis: A Prospective Longitudinal Observational Study.

METHODS: Seventy-seven patients with chronic knee osteoarthritis pain received ultrasound-guided ACB with 14 ml 0.25% levobupivacaine and 100 mcg clonidine. At baseline and 1 month after the blockade, we assessed maximal and minimal pain intensity in the knee using a numeric rating scale (NRS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). The range of motion in extension and flexion (ROMext and ROMflex) and quadriceps muscle strength of both knees (QS), Timed Up and Go Test (TUG), and 30-Second Chair Stand Test (30CST) results were determined at baseline, 1 hour, 1 week, and 1 month after the blockade. RESULTS: ACB with levobupivacaine and clonidine appeared to decrease pain severity (NRSmax 8.13 to 4.2, p < 0.001 and NRSmin 3.32 to 1.40, p < 0.001). Similarly, knee ROMext decreased from 3.90 preintervention to 2.89 postintervention at 1 month, p < 0.001; ROMflex decreased from 5.70 to 3.29, p < 0.001; TUG time decreased from 3.22 to 2.93, <0.001; QS increased from 18.43 to 22.77, p < 0.001; CST increased from 8.23 to 10.74, p < 0.001. The KOOS for pain (36.40 to 58.34), symptoms (52.55 to 64.32), activities of daily living functions (ADLs, 36.36 to 60.77), and quality of life (QoL, 17.87 to 30.97) also increased, all p < 0.001. CONCLUSION: ACB appeared to decrease pain and increase ambulation. If our preliminary results are reproducible in a planned randomized controlled trial, ACB could be a useful adjunctive pain therapy in patients with disabling pain due to knee OA.

Validity, responsiveness, floor and ceiling effects of the Berg Balance Scale in patients with Guillain-Barré syndrome.

We investigated the measurement properties of the Berg Balance Scale in patients with Guillain-Barré syndrome. A retrospective analysis was performed of 81 patients with Guillain-Barré syndrome of age 17-84 years who had completed inpatient rehabilitation over a 5-year period. They were assessed with the Berg Balance Scale, the 10 Meter Walk Test, and the 6 Minute Walk Test at admission and discharge. The concurrent validity of the Berg Balance Scale was confirmed by very good correlations with the 10 Meter Walk Test at admission and discharge (ρ = 0.83 and 0.78, respectively) and by excellent and very good correlations with the 6 Minute Walk Test at admission (ρ = 0.91) and discharge (ρ = 0.77). The predictive validity of the Berg Balance Scale for the 10 Meter Walk Test and the 6 Minute Walk Test at discharge was moderate (ρ = 0.62 and 0.61, respectively) and very good (ρ = -0.87) for length of stay. The minimal clinically important difference of the Berg Balance Scale was estimated to be 10 points. The scale was highly responsive to changes in balance (Cohen's d 0.9). No floor effect was identified. A ceiling effect was identified only at discharge. The Berg Balance Scale is feasible in patients with Guillain-Barré syndrome at admission and discharge from rehabilitation. However, a ceiling effect may occur at discharge in patients with high levels of balance.

Measurement properties of the L Test with fast walking speed in patients after lower limb amputation in initial prosthetic training phase.

The L Test is a clinical mobility test used in patients after lower limb amputation. To assess dynamic balance, it should be performed with fast walking speed. Its measurement properties in the initial prosthetic training phase are not known yet. The objective of the study was to establish intra- and interrater reliability, concurrent and discriminant validity, minimal detectable change, effect size between the rehabilitation time points and ceiling effect of the L Test with fast walking speed in patients after lower limb amputation in initial prosthetic training phase. The study included 36 inpatients aged 19-86 years who were provided with a prosthesis for the first time. They were assessed repeatedly with the L Test, Ten-meter Walk Test and 6-min Walk Test. The intra- (ICC3, k = 0.94) and interrater reliability (ICC2, k = 0.96) of the L Test were excellent. Correlations with the walking tests were very good (r = 0.75-0.86). Regression analysis with respect to the level of lower limb amputation showed a linear relationship with other variables (R2 = 0.55). Influences of age, cause of lower limb amputation and walking aid were statistically significant. The L Test was responsive to change after two weeks of prosthetic training (Cohen's d = 1.21). No ceiling effect was identified. The L Test with fast walking speed is a feasible, reliable, valid, and responsive measure of basic mobility skills in patients after lower limb amputation in the initial prosthetic training phase.

Comparison of neuromuscular and cardiovascular exercise intensity and enjoyment between standard of care, off-the-shelf and custom active video games for promotion of physical activity of persons post-stroke.

BACKGROUND: Active video games have been embraced for the rehabilitation of mobility and promotion of physical activity for persons post-stroke. This study seeks to compare carefully matched standard of care stepping activities, off-the-shelf (non-custom) active video games and custom active video games that are either self-paced or game-paced for promoting neuromuscular intensity and accuracy, cardiovascular intensity, enjoyment and perceived effort. METHODS: Fifteen persons (ages 38-72) with mild to moderate severity in the chronic phase post-stroke (average 8 years) participated in a single group counter balanced repeated measures study. Participants were included if they were greater than 6 months post-stroke, who could walk 100 feet without assistance and stand unsupported for three continuous minutes. They were excluded if they had cardiac, musculoskeletal or neurologic conditions that could interfere with repeated stepping and follow instructions. In a single session located in a laboratory setting, participants executed for 8.5 min each: repeated stepping, the Kinect-light race game, two custom stepping games for the Kinect, one was repeated and self-paced and the other was random and game paced. Custom video games were adjusted to the participants stepping volume. Ten-minute rest periods followed the exercise during which time participants rested and completed the PACES an enjoyment questionnaire. Participants were instrumented with a metabolic cart and heart rate sensor for collection of cardiovascular intensity (METs and % of max HR) data. Stepping frequency, accuracy and pattern were acquired via video. Data were analyzed using a RMANOVA and post-hoc comparison with a Holm's/Sidak correction. RESULTS: Neuromuscular intensity (repetitions) was significantly greater for the off-the-shelf and self-paced custom game, however accuracy was greater for the custom games. Cardiovascular intensity for all activities took place in the moderate intensity exercise band. Enjoyment (measured with a questionnaire and rankings) was greater for the custom active video games and rate of perceived exertion was lower for the custom active video games. CONCLUSIONS: Custom active video games provided comparable intensity but better accuracy, greater enjoyment and less perceived exertion than standard of care stepping activities and a carefully matched off-the-shelf (non-custom) video game. There were no differences between the game-paced and self-paced custom active video games. TRIAL REGISTRATION: NCT04538326.

Feasibility of de Morton Mobility Index for adult patients of all ages at low and basic functioning level: a study using the Slovenian translation.

We investigated metric properties of the Slovenian translation of de Morton Mobility Index in patients with musculoskeletal impairments during rehabilitation. The study included 30 inpatients, aged 22-84 years, with musculoskeletal impairments with or without impairment of peripheral nerves. They were assessed repeatedly with de Morton Mobility Index, Functional Ambulation Classification, Ten-metre Walk Test, Six-minute Walk Test, Berg Balance Scale and the motor subscale of the Functional Independence Measure. Convergent validity of de Morton Mobility Index was confirmed by good to very good correlations with the other measurements. Known-groups validity was demonstrated by significant differences in de Morton Mobility Index scores between patients who were not able to walk and those who were able to walk with or without waking aid, at admission and after 4 weeks. Predictive validity of de Morton Mobility Index for functional independence after 4 weeks of rehabilitation was moderate. Minimal clinically important difference of de Morton Mobility Index was estimated to be five points. De Morton Mobility Index was responsive after 2 and 4 weeks of rehabilitation (Cohen's d 1.15 and 0.95, respectively). No floor or ceiling effects were identified. Internal validity of de Morton Mobility Index was confirmed by Rasch analysis. Hence, de Morton Mobility Index is a valid, unidimensional, and responsive measure of mobility for patients with musculoskeletal impairments at rehabilitation regardless of age. Its use is recommended for adult patients at low and basic functioning level.

Validity and Reliability of the Kinect for Assessment of Standardized Transitional Movements and Balance: Systematic Review and Translation into Practice.

The validity and reliability of using the Kinect camera to measure standardized assessment of transitional movement, stepping, and balance was systematically reviewed and critically appraised for quality of the methods and results. The study made recommendations of specific tests for practice based on inclusion of both validity and reliability testing as well as quality of results. Authors' willingness to share their software was reported. Translation into practice is limited by lack of redundancy among studies and access to the software to implement the tests.

Using Inertial Measurement Units and Electromyography to Quantify Movement during Action Research Arm Test Execution.

In patients after stroke, ability of the upper limb is commonly assessed with standardised clinical tests that provide a complete upper limb assessment. This paper presents quantification of upper limb movement during the execution of Action research arm test (ARAT) using a wearable system of inertial measurement units (IMU) for kinematic quantification and electromyography (EMG) sensors for muscle activity analysis. The test was executed with each arm by a group of healthy subjects and a group of patients after stroke allocated into subgroups based on their clinical scores. Tasks were segmented into movement and manipulation phases. Each movement phase was quantified with a set of five parameters: movement time, movement smoothness, hand trajectory similarity, trunk stability, and muscle activity for grasping. Parameters vary between subject groups, between tasks, and between task phases. Statistically significant differences were observed between patient groups that obtained different clinical scores, between healthy subjects and patients, and between the unaffected and the affected arm unless the affected arm shows normal performance. Movement quantification enables differentiation between different subject groups within movement phases as well as for the complete task. Spearman's rank correlation coefficient shows strong correlations between patient's ARAT scores and movement time as well as movement smoothness. Weak to moderate correlations were observed for parameters that describe hand trajectory similarity and trunk stability. Muscle activity correlates well with grasping activity and the level of grasping force in all groups.

Effects of Wii balance board exercises on balance after posterior cruciate ligament reconstruction.

PURPOSE: To establish the effects of training on Wii balance board (WBB) after posterior cruciate ligament (PCL) reconstruction on balance. METHODS: Included patient injured her posterior cruciate ligament 22 months prior to the study. Training on WBB was performed 4 weeks, 6 times per week, 30-45 min per day. Center of pressure (CoP) sway during parallel and one-leg stance, and body weight distribution in parallel stance were measured. Additionally, measurements of joint range of motion and limb circumferences were taken before and after training. RESULTS: After training, the body weight was almost equally distributed on both legs. Decrease in CoP sway was most significant for one-leg stance with each leg on compliant surface with eyes open and closed. The knee joint range of motion increased and limb circumferences decreased. CONCLUSION: According to the results of this single case report, we might recommend the use of WBB for balance training after PCL reconstruction. LEVEL OF EVIDENCE: Case series with no comparison group, Level IV.

Age-related and sex-related differences in hand and pinch grip strength in adults.

The purpose of the study was to quantify age-related changes in hand grip strength and three types of pinch grip strength (key pinch, tip pinch, and palmar pinch) among male and female participants. The study included 199 healthy participants (100 females, 99 males) aged 20-79 years, who were divided into four age groups. The Baseline Hydraulic Hand Dynamometer and Baseline Hydraulic Pinch Gauge were used according to the standard procedures. For both the dominant and the nondominant hands, statistically significant differences between males and females, and between the age groups, were found using the analysis of variance. Mean hand and pinch grip strength were generally higher for the dominant hand and in males. The highest values of hand and pinch grip strength were found for males in the age group 35-49 years, and for females in age groups 20-34 and 35-49 years. Regardless of sex, the age group 65-79 years obtained the lowest values for all strength measures. The post-hoc tests showed significant differences between this and the other age groups in the majority of measures. Fewer differences were found between the younger groups. All strength measures correlated negatively with age (r = -0.29 to -0.41; P<0.01). In conclusion, these results show age-related changes in hand and pinch grip strength of the dominant and nondominant hands among male and female participants. Normative values according to the age groups are presented.

A comparison of treadmill walking and overground walking in independently ambulant stroke patients: a pilot study.

Purpose. The purpose of the study was to compare the spatio-temporal and joint kinematic gait parameters of stroke patients walking on a treadmill and overground, to examine the assumption that patients walking on a treadmill will approximate the requirements of walking overground. Methods. Ten independently ambulant chronic stroke patients were included in the study. Vicon was used to collect spatio-temporal and joint kinematic data during overground walking at comfortable speed and at matched speed on the treadmill. Results. Walking on the treadmill demonstrated statistically significantly lower cadence, and longer step times of the non-hemiplegic and hemiplegic limbs. Absolute stance times of both limbs, absolute double support time, relative stance time and relative double support time were significantly longer during treadmill walking. Compared to overground walking, the inter-limb symmetries of step time, stance time, and stance/swing time ratio were significantly greater on the treadmill. During treadmill walking, joint kinematic data showed statistically significant changes with greater flexion of the nonhemiplegic knee and hip at initial contact, and less hip extension of the hemiplegic limb. Maximal ankle plantarflexion and knee extension of the hemiplegic limb occurred later in the gait cycle on the treadmill. Conclusion. These differences suggest it may be useful to use treadmill in conjunction with overground walking to focus on improving specific walking deficits in patients with stroke.

Increased cognitive load during simple and complex motor tasks in acute stage after stroke.

UNLABELLED: The aim of this study was to assess the activation of primary motor cortex, prefrontal cortex and parietal cortex during simple and complex motor tasks performed with the hemiparetic and non-hemiparetic hand. METHODS: Seven patients after stroke in the left brain hemisphere were included in the study. Functional magnetic resonance imaging (fMRI) was performed in the first and third week, and in three patients also three months after the stroke. RESULTS: Performance of both the simple and the complex tasks with the hemiparetic or non-hemiparetic hand resulted in activations of the motor cortex, prefrontal cortex and parietal cortex in majority of the consecutive fMRI sessions. Three months after the stroke fMRI data revealed reduced activation of primary motor cortex and parietal cortex in the contralesional hemisphere during the performance of the simple task by the hemiparetic hand. During the complex task, the reduction of activation was less prominent. CONCLUSIONS: Results of the present study suggest that in mildly impaired stroke patients a bilateral activation of prefrontal and parietal cortex may participate in the recovery process from stroke. The potential for measurement of cortical rehabilitation is discussed.