A First Step Toward the Operationalization of the Learned Non-Use Phenomenon: A Delphi Study

Abstract

Background The negative discrepancy between residual functional capacity and reduced use of the contralesional hand, frequently observed after a brain lesion, has been termed Learned Non-Use (LNU) and is thought to depend on the interaction of neuronal mechanisms during recovery and learning-dependent mechanisms. Objective Albeit the LNU phenomenon is generally accepted to exist, currently, no transdisciplinary definition exists. Furthermore, although therapeutic approaches are implemented in clinical practice targeting LNU, no standardized diagnostic routine is described in the available literature. Our objective was to reach consensus regarding a definition as well as synthesize knowledge about the current diagnostic procedures. Methods We used a structured group communication following the Delphi method among clinical and scientific experts in the field, knowledge from both, the work with patient populations and with animal models. Results Consensus was reached regarding a transdisciplinary definition of the LNU phenomenon. Furthermore, the mode and strategy of the diagnostic process, as well as the sources of information and outcome parameters relevant for the clinical decision making, were described with a wide range showing the current lack of a consistent universal diagnostic approach. Conclusions The need for the development of a structured diagnostic procedure and its implementation into clinical practice is emphasized. Moreover, it exists a striking gap between the prevailing hypotheses regarding the mechanisms underlying the LNU phenomenon and the actual evidence. Therefore, basic research is needed to bridge between bedside and bench and eventually improve clinical decision making and further development of interventional strategies beyond the field of stroke rehabilitation.

Reliability and Validity of the Motor Activity Log (MAL-30) Scale for Post-Stroke Patients in a Spanish Sample

“…The FMA-EU was used as the gold standard for the criterion validity, since it has proven to be a scale that is widely used in clinical practice due to its good psychometric properties and has been validated [ 9 , 38 ] for the Spanish population. The FMA-UE is an instrument used to measure the functionality of the paretic upper limb in post-stroke patients.…”

“…Hemiparesis is one of the main neurological deficits or impairments resulting from a stroke that involves a lack of muscle strength and dissociated movement of the affected hemibody [ 9 , 10 ]. It is also one of the main causes of alterations in the patient’s daily life and affects the quality of life (QoL) [ 11 , 12 ].…”

“…The lack of recovery of motor ability and functionality and the presence of learned non-use, from a clinical point of view, can significantly reduce the occupational performance of the patients [ 10 , 11 ]. The patient’s report of their capacity for the spontaneous use of the affected upper limb in ADLs should be associated with both its efficient use and the subjective perception of its effectiveness [ 9 , 20 ], but to ensure an awareness of this, it is necessary to obtain valid and reliable outcome measures that assess individual qualities with the objectives of implementing personalized programs and evaluating the effectiveness of the interventions applied [ 21 , 22 ].…”

Virtuous and Vicious Cycles of Arm Use and Function Post-stroke

“…Acquired non-use has long been recognized to be a major issue facing patients post-stroke, but only recently has there been an attempt to operationalize this complex phenomenon where multiple physiological (e.g., sensorimotor impairment, lesion load), behavioral (e.g., expected success and effort), and psychological factors (e.g., self-efficacy, perceived effort) intersect ( 20 , 28 , 29 ). Although little is known about how these multiple factors interact to create acquired non-use, interventions that aim at reducing non-use have been developed.…”

Ein erster Schritt zur Operationalisierung des erlernten Nonuse-Phänomens: eine Delphi-Studie

“…Die transdisziplinär konsentierte Definition des Phänomens ist ein wichtiges Ergebnis der Studie: „Learned non-use is the discrepancy between a retained motor capacity, which can be retrieved when requested, and the spontaneous use of this motor capacity in daily life, a discrepancy that develops due to experience in inept or non- productive perceived attempts to use that capacity. It is accompanied by compensatory motor behavior identifiable in other body parts“ 5 .…”