Movement pattern and upper extremity muscle activation during fast and slow continuous steering movement.

Continuous steering movement (CSM) is an essential component of the upper extremity (UE) task during vehicle driving, and could be a suitable candidate for multi-joint rehabilitation programs for patients with UE disabilities. This study aims to evaluate the UE muscle activation during CSM and how the rotating speed and direction affect CSM's kinematic and kinetic performance. Surface electromyography (EMG), hand contact information, and steering torque were measured under fast (180°/s) and slow (60°/s) constant-velocity CSM to reveal the activation of shoulder and elbow muscles, temporal characteristics, and force exertion during the stance and swing phases of a CSM cycle. Data from 24 normal young adults showed that shorter contact duration but higher force exertion occurred in the hand moving in an outward steering direction during only fast CSM in either the clockwise (CW) or counterclockwise (CCW) direction. During a steering cycle (either fast or slow speed), the triceps brachii, sternal part of the pectoralis major (PS), and posterior deltoid play major roles in generating steering torque in the CW direction of the CSM. In contrast, the PS, clavicular part of the pectoralis major (PC), and anterior deltoid (AD) largely contribute to torque generation during the CCW CSM. During the swing phase of CSM, AD, PC, and PS are the major muscles that move the hand for the next grasping of the steering wheel in all four conditions. Using the mean activation profiles of the major contributing muscles, the functional roles of these elbow and shoulder muscles were analyzed and are discussed herein. These findings help us to further understand the activation patterns of UE muscles and the kinematic and kinetic changes during two rotating directions and two speeds of CSM, and suggest important implications for future practice in clinical training.

Validation of the Brief Pain Inventory in Patients With Low Back Pain.

STUDY DESIGN: Cross-sectional psychometric testing in a sample of patients with low back pain (LBP). OBJECTIVE: The aim of this study was to examine the construct, convergent, and discriminative validity of the Brief Pain Inventory (BPI) in patients with LBP. SUMMARY OF BACKGROUND DATA: The BPI was originally developed to assess cancer pain. Currently, it is commonly used to measure pain intensity and pain interference in patients with malignant or nonmalignant pain. However, the two-factor construct of the BPI has not been confirmed in an LBP population. METHODS: A total of 271 patients with LBP completed the BPI and Oswestry Disability Index (ODI) questionnaires. The construct validity (i.e., the two-factor structure: intensity scale and interference scale) of the BPI was determined by confirmatory factor analysis. The convergent validity was investigated by examining the relationships between the BPI scales and the ODI scores. The discriminative validity of the BPI was examined by testing if the BPI scale scores differed among groups of patients with different levels of disability. RESULTS: Confirmatory factor analysis partially confirmed the two-factor structure of the BPI for use in patients with LBP. The convergent validity of the BPI was supported by its moderate correlation between the interference scale and the ODI score (ρ = 0.66, P < 0.001), and by its low correlation between the intensity scale and the ODI score (ρ = 0.39, P < 0.001). Finally, both the intensity scale and the interference scale discriminated among patients with varying levels of disability (both P < 0.001). CONCLUSION: The two-factor structure of the BPI as a measure of pain intensity and interference in patients with LBP was partially confirmed. Furthermore, our results lend some supports to the convergent validity and discriminative validity of the BPI. LEVEL OF EVIDENCE: N/A.

Reliability and responsiveness of the activities of daily living computerized adaptive testing system in patients with stroke.

OBJECTIVE: To examine the intrarater reliability, interrater reliability, and responsiveness of the Activities of Daily Living Computerized Adaptive Testing system (ADL CAT) in patients with stroke. DESIGN: One repeated-measures design (at an interval of 7d) was used to examine the intrarater reliability and interrater reliability of the ADL CAT. For the responsiveness study, participants were assessed with the ADL CAT at admission to the rehabilitation ward and at discharge from the hospital. SETTING: Eight rehabilitation units. PARTICIPANTS: Three different (nonoverlapping) groups of patients (N=157) were recruited. Fifty-five and 42 outpatients with chronic stroke participated in the intrarater and interrater reliability studies, respectively; 60 inpatients who had recently had a stroke participated in the responsiveness study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE ADL CAT RESULTS: The intraclass correlation coefficient values were .94 and .80 for the ADL CAT in the intrarater reliability and interrater reliability studies, respectively. The classical test theory-based minimal detectable change values were 6.5 and 9.5 for the ADL CAT in the intrarater reliability and interrater reliability studies, respectively. The Kazis' effect size and standardized response mean of the ADL CAT were moderate (.62-.73). CONCLUSIONS: The ADL CAT has good intrarater reliability and interrater reliability in outpatients with chronic stroke, and sufficient responsiveness in inpatients with stroke undergoing inpatient rehabilitation. Further investigations on the responsiveness of the ADL CAT in outpatients are needed to obtain more evidence on the utility of the ADL CAT.

Effects of noxious versus innocuous thermal stimulation on lower extremity motor recovery 3 months after stroke.

OBJECTIVE: To examine the effects of thermal stimulation (TS) on the lower extremity (LE) movement and function in patients with stroke. DESIGN: A double-blinded randomized controlled trial. SETTING: A university hospital. PARTICIPANTS: Patients (N=34) at least 3 months after stroke were randomly assigned into the experimental and the control groups. INTERVENTIONS: In addition to regular rehabilitation, the experimental group received a 30-minute noxious TS protocol (heat pain 46-47°C/cold pain 2-3°C) 3days/wk for 8 weeks, and the control group received a 30-minute innocuous TS protocol (heat 40-41°C/cold 23-24°C) 3d/wk for 8 weeks. MAIN OUTCOME MEASURES: The Low Extremity subscale of the Stroke Rehabilitation Assessment of Movement (LE-STREAM), the Mobility subscale of STREAM (Mob-STREAM), the Functional Ambulation Category (FAC), the Barthel Index (BI), the Postural Assessment Scale for Stroke Patients (PASS), and the Modified Ashworth Scale (MAS) were administered by a blinded rater at baseline, posttreatment (8wk), and follow-up (12wk). RESULTS: Twenty-three participants completed the study protocol and all outcome measurements. No preexisting group differences between the experimental group (n=11) and the control group (n=12) were found on demographic and clinical variables. Compared with baseline, the experimental group showed significant improvements at posttreatment and follow-up on the LE-STREAM, Mob-STREAM, FAC, and BI (P<.05) while the control group showed no significant improvements for all outcome measures. As for the between-group comparison, significant differences were seen at follow-up (12wk) on the LE-STREAM, Mob-STREAM, BI, and MAS. CONCLUSIONS: Our findings indicate that an 8-week program of noxious TS combined with a traditional stroke rehabilitation program can improve the LE-related movement and function in patients with stroke for more than 3 months.

Development of a computerized adaptive testing system of the Fugl-Meyer motor scale in stroke patients.

OBJECTIVE: To develop a computerized adaptive testing system of the Fugl-Meyer motor scale (CAT-FM) to efficiently and reliably assess motor function in patients with stroke. DESIGN: First, a simulation study was used to develop and examine the psychometric properties of the CAT-FM. Second, a field study was employed to determine the administration efficiency of the CAT-FM. SETTING: One medical center and 1 teaching hospital. PARTICIPANTS: Patients' responses (n=301) were used for the simulation study; 49 patients participated in the field study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The 2 CAT-FM item banks (upper extremity and lower extremity) include 37 items from the original Fugl-Meyer scale. The reliability, validity, and responsiveness of the CAT-FM were determined by the simulation study. RESULTS: Two stopping rules (reliability ≥0.9 or an increase of reliability <.01 after testing an item) were used. The simulation study showed that the CAT-FM had high reliability (≥.93 for upper-extremity and lower-extremity subscales) and concurrent validity (Pearson r≥.91 for the upper-extremity and lower-extremity subscales and motor scale). The responsiveness was moderate (standardized response mean for the upper extremity=.67, lower extremity=.79, and motor=.77) for the 226 patients who completed both assessments at 14 and 90 days after stroke. The field study found that, on average, the time needed to administer the CAT-FM was 242 seconds with 4.7 items. CONCLUSIONS: The CAT-FM is an efficient, reliable, valid, and responsive clinical tool for assessing motor function in patients with stroke.

Effect of thermal stimulation on upper extremity motor recovery 3 months after stroke.

BACKGROUND AND PURPOSE: To examine the effect of thermal stimulation (TS) on upper extremity (UE) motor recovery in patients at least 3 months after stroke. METHODS: Participants were randomly assigned to either the experimental group or the control group. In addition to regular rehabilitation programs, the experimental group received an UE-TS protocol for 30 minutes per day (3 days/week for 8 weeks); the control group received the same TS protocol on lower extremity. The UE subscale of the Stroke Rehabilitation Assessment of Movement and the Action Research Arm Test were primary outcome measures. The Modified Ashworth Scale and the Barthel Index were secondary outcome measures. All measures were administered at baseline, after TS, and at 1-month follow-up. RESULTS: Twenty-three participants (12 in the experimental group) completed the study. After treatment, the experimental group showed significant improvement compared to the control group in the scores of the UE subscale of the Stroke Rehabilitation Assessment of Movement and Action Research Arm Test. At follow-up examination, a significant improvement in the experimental group was observed on the UE subscale of the Stroke Rehabilitation Assessment of Movement. CONCLUSIONS: The 8-week additional UE-TS protocol improved UE motor recovery for stroke patients 3 months after onset.

Psychometric comparisons of 3 functional ambulation measures for patients with stroke.

BACKGROUND AND PURPOSE: We compared the test-retest reliability, validity, and responsiveness of the Dynamic Gait Index, the 4-item Dynamic Gait Index, and the Functional Gait Assessment for assessment of walking in patients with stroke. METHODS: Forty-five outpatients participating in the validity and responsiveness study were tested using the 3 walking measures as well as the 10-m walk test, Barthel Index, and Postural Assessment Scale for Stroke Patients. We tested them during the first week, then again after 2 months and 5 months of therapy. Another 48 chronic patients completed the 3 measures twice, 1 week apart, in the test-retest reliability study. RESULTS: Thirty-five participants completed 3 time-point assessments. The Functional Gait Assessment showed the least floor and ceiling effects, indicating it has the best discriminative ability for patients with stroke with high walking function. We found the 3 measures were highly correlated with each other, indicating excellent concurrent validity, and all measures at the first week of therapy were moderately to highly correlated with the Barthel Index scores at 5 months, indicating good predictive validity. Responsiveness of the 3 measures was moderate during a 5-month period, and all showed good test-retest reliability. The minimal detectable changes between tests indicate acceptable random error. CONCLUSIONS: All 3 measures showed sufficient validity, responsiveness, and reliability for assessment of walking function in patients with stroke undergoing rehabilitation, but the Functional Gait Assessment is recommended for its psychometric properties.