Clinical factors associated with the development of nonuse learned after stroke: a prospective study

Costa, Rafael Dalle Molle da; Luvizutto, Gustavo José; Martins, Laís Geronutti; Souza, Juli Thomaz de; Silva, Taís Regina da; Sartor, Lorena Cristina Alvarez; Winckler, Fernanda Cristina; Módolo, Gabriel Pinheiro; Molle, Evelin Roberta Da Silva Dalle; Anjos, Sarah Monteiro dos; Bazan, Silméia Garcia Zanati; Cuadrado, Luís Martin; Bazan, Rodrigo

doi:10.1080/10749357.2019.1631605

Cited by 19 publications

(20 citation statements)

References 37 publications

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“…Molle Da Costa et al indicated that patients with poststroke learned nonuse of the upper limb had lower AOU and quality of movement in the MAL, accompanying lower functional independence and quality of life compared with patients with upper-limb use [23]. Although the ability of patients with stroke recovered after rehabilitation, they tended to underestimate the spontaneous use capability of the affected hand [44].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with chronic hemiparesis (stroke onset > 6 months) after the first stroke event were recruited from a rehabilitation center in a hospital between 2017 and 2019. A sample size of at least 14 participants per group was estimated following a study by Molle Da Costa et al [23]. The study process was explained to the patients, and written informed consent was obtained.…”

Section: Methodsmentioning

confidence: 99%

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Characteristics Associated with the Differential Activity of Nondominant and Dominant Affected Hands in Patients with Poststroke Right Hemiparesis

Lee¹,

Chen

Tsai³

et al. 2020

Occupational Therapy International

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Objectives. Spontaneous arm use in patients with poststroke hemiparesis is crucial to the recovery of functional interaction. Patients with stroke and subsequent right hemiparesis have more difficulty adapting to a right-handed environment. The aim of this study was to use wearable devices to assess the asymmetry and difference in the amount of activity of the nondominant and dominant affected hands among patients with stroke and right hemiparesis. The real activity of both hands was measured to assess the correlation with various aspects of the International Classification of Functioning, Disability and Health (ICF). Subjects and Methods. Patients with stroke and right hemiparesis were recruited. They were divided into two groups according to the affected hand. Groups A and B comprised patients with affected nondominant and dominant hands, respectively. The Fugl-Meyer assessment-Upper Extremity (FM-UE) scores, Motor Activity Log (MAL), and hand function domain scores on the Stroke Impact Scale (SIS) were used for assessment. Patients were asked to wear smart wearable devices on both hands 24 hours a day for a month. The amount of activity in both hands was recorded and analyzed. Results. A total of 29 patients with stroke were divided into group A (n=14) and group B (n=15). FM-UE scores were significantly and strongly correlated with the amount of use (AOU) in the MAL. The recorded differential real activity of both hands in group B was significantly lower than that in group A. The asymmetry index of hand use was significantly less favorable in group B. However, no significant differences in AOU in the MAL, FM-UE, and hand function domain in the SIS were identified between the nondominant and dominant affected hands. Conclusions. The asymmetry and differential activity of both hands were worse in the patients with poststroke right hemiparesis, whose dominant hand was affected. However, no differences of three aspects of the ICF were found between dominant and nondominant affected hands.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Characteristics Associated with the Differential Activity of Nondominant and Dominant Affected Hands in Patients with Poststroke Right Hemiparesis

Lee¹,

Chen

Tsai³

et al. 2020

Occupational Therapy International

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“…Randomized clinical trials with larger sample sizes and longer follow-up duration are warranted to confirm these preliminary results. Second, clinical characteristics of the participants, such as neglect subtypes, stroke types, onset time, lesion size, and stroke severity, might make a difference to the results; thus, a larger-scale study with subgroup analysis may help identify the efficacy of RAT ( 45 ). Third, the exoskeleton protocol included several intervention ingredients, while evidence needs to determine the effective components of the training programs with underlying neurological mechanisms.…”

Section: Limitationsmentioning

confidence: 99%

Robot-Assisted Arm Training in Stroke Individuals With Unilateral Spatial Neglect: A Pilot Study

Chen

et al. 2021

Front. Neurol.

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Background: Robot-assisted arm training (RAT) is an innovative exercise-based therapy that provides highly intensive, adaptive, and task-specific training, yet its effects for stroke individuals with unilateral spatial neglect remain to be explored. The study was aimed to investigate the effects of RAT on unilateral spatial neglect, arm motor function, activities of daily living, and social participation after stroke.Methods: In a pilot randomized controlled trial, individuals with unilateral spatial neglect after right hemisphere stroke were equally allocated to intervention group and control group, 45-min training daily, 5 days/week, for 4 weeks. Outcome measures included the Behavioral Inattention Test-conventional section (BIT-C), Catherine Bergego Scale (CBS), Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Modified Barthel Index (MBI), and World Health Organization Disability Assessment Schedule Version 2.0 (WHODAS 2.0).Results: From November 2018 to February 2021, 20 stroke patients (mean age 47.40 ± 8.47) were enrolled in the study. Robot-assisted arm training was feasible and safe for individuals with unilateral spatial neglect. Both groups had significant improvements in all outcome measures. Participants assigned to RAT therapy had significantly greater improvements in BIT-C (difference, 7.70; 95% CI, 0.55–14.85, P = 0.04), FMA-UE (difference, 5.10; 95% CI, 1.52–8.68, P = 0.01), and WHODAS 2.0 (difference, −7.30; 95% CI, −12.50 to −2.10, P = 0.01). However, the change scores on CBS and MBI demonstrated no significance between the groups.Conclusion: Our findings provide preliminary support for introducing robot-assisted arm training to remediate unilateral spatial neglect after stroke. The training program focusing on neglect of contralateral space and affected upper extremity may be effective in neglect symptoms, motor function recovery, and social participation, while not generalizing into improvements in activities of daily living.Clinical Trial Registration: Chinese Clinical Trial Registry (http://www.chictr.org.cn/) on 17 October 2019, identifier: ChiCTR1900026656.

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“…As the mismatch group differs from the good match group in perceived UL activity, factors related to a low perceived UL activity might also differentiate the mismatch from the good match group. Several factors are related to a low self-perceived UL activity after stroke, including lower cognition [ 27 ], lower age, higher stroke severity, lower somatosensory function and lower independence in activities of daily living (ADL) at rehabilitation discharge [ 28 ] and a higher level of education and a lower mood score in the subacute phase post stroke [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Evolution and prediction of mismatch between observed and perceived upper limb function after stroke: a prospective, longitudinal, observational cohort study

Essers

Gils

Lafosse³

et al. 2021

BMC Neurol

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Background A previously shown ‘mismatch’ group of patients with good observed upper limb (UL) motor function but low perceived UL activity at six months post stroke tends to use the affected UL less in daily life than would be expected based on clinical tests, and this mismatch may also be present at 12 months. We aimed to confirm this group in another cohort, to investigate the evolution of this group from six to 12 months, and to determine factors on admission to inpatient rehabilitation and at 6 months that can discriminate between mismatch and good match groups at 12 months. Methods Persons after stroke were recruited on rehabilitation admission and re-assessed at six and 12 months. Observed UL function was measured with the upper extremity subscale of the Fugl-Meyer Assessment (FMA-UE) and perceived UL activity by the hand subscale of the Stroke Impact Scale 3.0 (SIS-Hand). We defined mismatch as good observed UL function (FMA-UE > 50/66) but low perceived activity (SIS-Hand≤75/100). Potential discriminators at admission and 6 months (demographic characteristics, stroke characteristics, UL somatosensory function, cognitive deficits, mental function and activity) were statistically compared for match and mismatch groups at 12 months. Results We included 60 participants (female: 42%) with mean (SD) age of 65 (12) years. We confirmed a mismatch group of 11 (18%) patients at 6 months, which increased to 14 (23%) patients at 12 months. In the mismatch group compared to the good match group at 12 months, patients had a higher stroke severity and more somatosensory impairments on admission and at 6 months. Conclusions We confirmed a group of patients with good observed UL function but low perceived activity both at six and at 12 months post stroke. Assessment of stroke severity and somatosensory impairments on admission into rehabilitation could determine mismatch at 12 months and might warrant intervention. However, large differences in clinical outcomes between patients in the mismatch group indicate the importance of tailoring training to the individual needs.

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Clinical factors associated with the development of nonuse learned after stroke: a prospective study

Cited by 19 publications

References 37 publications

Characteristics Associated with the Differential Activity of Nondominant and Dominant Affected Hands in Patients with Poststroke Right Hemiparesis

Characteristics Associated with the Differential Activity of Nondominant and Dominant Affected Hands in Patients with Poststroke Right Hemiparesis

Robot-Assisted Arm Training in Stroke Individuals With Unilateral Spatial Neglect: A Pilot Study

Evolution and prediction of mismatch between observed and perceived upper limb function after stroke: a prospective, longitudinal, observational cohort study

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