Determining Levels of Upper Extremity Movement Impairment by Applying a Cluster Analysis to the Fugl-Meyer Assessment of the Upper Extremity in Chronic Stroke

Abstract

Objective To quantitatively define levels of upper extremity movement impairment using cluster analysis of Fugl-Meyer upper extremity (FM-UE) with and without reflex items. Design Secondary analysis of FM-UE individual item scores compiled from baseline testing of 5 studies with consistent testing procedures. Setting University and VA research centers. Participants: Individuals (N=−247) with chronic stroke (>6 months post-stroke). Interventions Not applicable. Main Outcome Measures Cut-off scores defined by total FM-UE scores of clusters identified by two hierarchical cluster analyses run on full sample of FM-UE individual item scores (with/without reflexes). Patterns of motor function defined by aggregate item scores of clusters. Results FM-UE scores ranged from 2–63 (mean=26.9±15.7) with reflex items and 0–57 (mean=22.1 ±15.3) without reflex items. Three clusters were identified. The distributions of the FM-UE scores revealed considerable overlap between the clusters, therefore four distinct stroke impairment levels were also derived. Conclusions For chronic stroke, the cluster analyses of the upper extremity FM support either a three or a four impairment level classification scheme.

Dosage Matters: A Randomized Controlled Trial of Rehabilitation Dose in the Chronic Phase after Stroke

“…Severity stratification was based on baseline UEFM score; those with UEFM 41-58 were "mild" and those with 19-40 "moderate". 12 Chronicity stratification was based on stroke onset; those 5 months to 1.5 years post-stroke were "early" and those >1.5 years were "late".…”

An Objective Technology-based Assessment of Arm and Hand Sensorimotor Disability in Neurological Disorders

“…Additionally, only data from the paretic limb were analyzed for stroke patients, which were subdivided into three groups according to their FMA-UE score (ceiling: FMA-UE=66; mild impairment: 54≤FMA-UE<66; moderate impairment: 35≤FMA-UE<54). 54 For illustrative purposes, movement and grasping force trajectories and resulting sensorimotor profiles were visualized for one representative healthy, stroke, MS, and ARSACS subject in Figure 2 (variability in Figure SM3).…”

Offering a helping hand

“…For the five females and five males included in this study, time since stroke varied from 2.5 to 10 years. Six (60%) of the included stroke patients were mildly affected, and four (40%) were moderately affected [92]. In six participants, the affected side was their dominant side before they suffered the stroke.…”

“…Therefore, no movement execution data is available from this participant (FMA = 33). The group involved five (45%) mildly affected (FMA score > 41), and six (55%) moderately affected (28 ≤ FMA score ≥ 41) stroke patients, based on a categorization of the FMA score [92]. Five participants had right hemiparesis and six had left hemiparesis.…”

“…Ten chronic stroke survivors were included in this study (Table 9.2). Based on a categorization of the FMA score without reflexes [92], six (60%) of the included stroke survivors were mildly affected (FMA score > 41), and four (40%) were moderately affected (28 ≥ FMA score ≥ 41). In six of the participants, the affected side was the dominant side pre-stroke.…”