Arm function after stroke. An evaluation of grip strength as a measure of recovery and a prognostic indicator.

Sunderland, Alan; Tinson, D; Bradley, Lesley; Hewer, R L

doi:10.1136/jnnp.52.11.1267

Cited by 397 publications

(272 citation statements)

References 9 publications

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“…Remarkably, no further improvement in accuracy of prediction was found after 4 weeks, suggesting that long-term outcome of dexterity can already be optimally predicted within this time frame. In agreement with previous reports, [1][2][3]6 this latter finding suggests that the time window for predicting the return of dexterity is limited to only 1 month after onset. It is important to note that the optimal cutoff point for FM UE and MI leg scores is not fixed in time but is dependent on the poststroke time of assessment.…”

Section: Discussionsupporting

confidence: 81%

“…1,4 To date, most studies showed that type and localization of stroke and initial severity of paresis of the upper limb are some of the best predictors for outcome at 6 months. [2][3][4][5][6][7] The findings from all longitudinal studies with repeated measurements in time indicate that recovery of neurological impairment and disability shows a nonlinear pattern as a function of time, [1][2][3][4][5][6] but only few patients show additional improvement after 3 months after stroke. In addition, most studies found that the optimal prediction of outcome can be made within 4 to 5 weeks after stroke onset.…”

mentioning

confidence: 99%

“…[1][2][3]6 The absence of a measurable grip function at Ϸ1 month after stroke was found to be indicative of a poor functional recovery of the hemiplegic arm, [1][2][3] whereas early return of voluntary motion of the paretic arm within the first weeks after stroke is considered to be a good prognostic sign. 2,3,7 Most likely, the length of time during which one finds a lack of improvement reflects the intrinsic cerebral damage and should be seen as an important predictor of poor outcome. 7 Knowledge on outcome of the upper limb is of paramount interest to clinicians to optimize their treatment goals and to inform patients properly.…”

mentioning

confidence: 99%

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Probability of Regaining Dexterity in the Flaccid Upper Limb

Kwakkel

Kollen

Grond

et al. 2003

Stroke

1,159

449

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Background and Purpose-To improve the accuracy of early postonset prediction of motor recovery in the flaccid hemiplegic arm, the effects of change in motor function over time on the accuracy of prediction were evaluated, and a prediction model for the probability of regaining dexterity at 6 months was developed. Methods-In 102 stroke patients, dexterity and paresis were measured with the Action Research Arm Test, Motricity Index, and Fugl-Meyer motor evaluation. For model development, 23 candidate determinants were selected. Logistic regression analysis was used for prognostic factors and model development. Results-At 6 months, some dexterity in the paretic arm was found in 38%, and complete functional recovery was seen in 11.6% of the patients. Total anterior circulation infarcts, right hemisphere strokes, homonymous hemianopia, visual gaze deficit, visual inattention, and paresis were statistically significant related to a poor arm function. Motricity Index leg scores of at least 25 points in the first week and Fugl-Meyer arm scores of 11 points in the second week increasing to 19 points in the fourth week raised the probability of developing some dexterity

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Section: Discussionsupporting

confidence: 81%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Probability of Regaining Dexterity in the Flaccid Upper Limb

Kwakkel

Kollen

Grond

et al. 2003

Stroke

1,159

449

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“…1 One third to two thirds of stroke survivors may no longer be able to use their more affected upper extremity (UE). 2,3 One approach that is gaining interest, aimed at enhancing UE motor performance among patients with stroke, is constraint-induced movement therapy (CIT). 4 This preliminary study aimed to determine the effects of a 2-week CIT intervention on the force-producing capabilities of the hemiparetic hand during the performance of a functional dexterous task.…”

mentioning

confidence: 99%

The Effects of Constraint-Induced Therapy on Precision Grip: A Preliminary Study

Alberts

Butler

Wolf

2004

Neurorehabil Neural Repair

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Objective-This preliminary study examines the effects of a 2-week constraint-induced therapy (CIT) intervention on the force-producing capabilities of the hemiparetic hand during the performance of a functional dexterous manipulation task.Methods-A 6-degree-of-freedom force/torque transducer that was embedded into the handle of a key allowed for the quantification of grasping forces and torques produced during the performance of a functional key-turning task. Clinical and kinetic data were collected from 10 subacute patients (3-9 months poststroke) who were participating in an ongoing national clinical study (EXCITE trial) examining the effects of CIT on upper extremity motor performance. Investigators were blinded to treatment designation. Five patients receiving treatment immediately completed 2 weeks of intensive CIT, whereas a group randomized to treatment 1 year later did not receive any therapy during a similar 2-week span.Results-Results indicated that 4 of the 5 patients in the CIT group, compared to the delayed group, showed significant clinical improvements in hand function, increased maximum precision grip force, improved force and torque regulation, and reduced variability in rate of force production during task performance.Conclusions-Improved force control may be a mechanism contributing to the observed improvements in dexterous function in those patients undergoing CIT. Keywords Constraint-induced therapy; Precision Grip; Dexterous functionStroke continues to be the 3rd leading cause of disability in the United States, with approximately 750,000 new or recurrent cases each year. Despite improvements in gait, a large percentage of stroke patients are limited in the performance of many daily activities, such as dressing and eating. 1 One third to two thirds of stroke survivors may no longer be able to use their more affected upper extremity (UE). 2,3 One approach that is gaining interest, aimed at enhancing UE motor performance among patients with stroke, is constraint-induced movement therapy (CIT). 4 This preliminary study aimed to determine the effects of a 2-week CIT intervention on the force-producing capabilities of the hemiparetic hand during the performance of a functional dexterous task. A secondary aim was to determine the feasibility of using this functional dexterous manipulation task along with biomechanical measures to quantify hand function of stroke patients in a clinical setting. Although others 9-11 have studied the effects of stroke on reaching and grasping, to our knowledge, this is the 1st investigation in which grasping forces and torques produced during a functional task were quantified in an attempt to understand how CIT affects grasping force control. METHODS ParticipantsData were collected from 10 right-handed sub-acute patients (3-9 months since stroke) who were participating in an ongoing national clinical trial examining the effects of CIT on UE motor performance and quality of life. 8 Study design, including detailed inclusion and exclusion criteria, has been r...

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“…prior to any study intervention, as well as 9 weeks after completion of the study intervention. Upper limb functions were tested using validated, internationally recognized neurological scales, including Motricity Index [17] (MI), Fugl-Meyer assessment (FMA) [18] and grip force [19]. MRI was conducted using a 3T clinical MRI scanner (Magnetom Trio Tim syngo, Siemens Medical Solutions, Erlangen, Germany) equipped with echo planar imaging (EPI) protocols and a 12-channel head coil receiver.…”

Section: Subjectsmentioning

confidence: 99%

Increased Brain Activation in Motor Cortex After Acupuncture Treatment for Motor Recovery in Chronic Stroke Patients

Chau¹,

Cheung²,

Xian-yong³

et al. 2009

TOREHJ

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Acupuncture has historically been recommended as adjunctive treatment to patients with stroke, but its effectiveness has yet to be proven. This case series aims to report the results of using functional magnetic resonance imaging (fMRI), together with motor function evaluations, to assess the effect of acupuncture on stable patients after stroke. Eleven chronic stroke patients underwent fMRI and motor function evaluations of their impaired upper limb before and after an 8-week period of acupuncture on two acupoints (Hegu LI-4 and Quchi LI-11), without undergoing simultaneous rehabilitation. Improvements in motor functions of the impaired upper limb were found after acupuncture treatment. Changes in cortical activities were closely related to the finding of improved motor functions. A larger and stronger activation was found in the sensorimotor area of the lesioned hemisphere after receiving the acupuncture intervention. Conjunction analysis demonstrated common regions that were activated during either motor task or acupuncture stimulation. Acupuncture may improve functions of the impaired upper limb in chronic stroke patients via modulating peri-infarct regions that are responsible for plasticity of the motor cortex.

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Arm function after stroke. An evaluation of grip strength as a measure of recovery and a prognostic indicator.

Cited by 397 publications

References 9 publications

Probability of Regaining Dexterity in the Flaccid Upper Limb

Probability of Regaining Dexterity in the Flaccid Upper Limb

The Effects of Constraint-Induced Therapy on Precision Grip: A Preliminary Study

Increased Brain Activation in Motor Cortex After Acupuncture Treatment for Motor Recovery in Chronic Stroke Patients

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