Development of a Comprehensive Outcome Measure for Motor Coordination, Step 2: Reliability and Construct Validity in Chronic Stroke Patients

Abstract

Background A comprehensive scale assessing motor coordination of multiple body segments was developed using a 3-phase content validation process. The Comprehensive Coordination Scale (CCS) evaluates motor coordination defined as the ability to produce context-dependent movements of multiple effectors in both spatial and temporal domains. The scale assesses motor coordination in individuals with neurological injuries at 2 levels of movement description: the motor performance level describes end point movements (ie, hand, foot), and the movement quality level describes limb joints/trunk movements contributing to end point movement. Objective To determine measurement properties of the scale in people with chronic stroke. Methods Standardized approaches determined the internal consistency (factor loadings), intrarater and interrater reliability (interclass correlation coefficient), measurement error (SEM; minimal detectable change [MDC]), construct validity, and interpretability (ie, ceiling and floor effects) of the CCS. Results Data from 30 patients with chronic stroke were used for the analysis. The internal consistency of the scale was high (0.94), and the scale consisted of separate factors characterizing end point motor performance and movement quality. Intrarater (intraclass correlation coefficient [ICC] = 0.97-0.97) and interrater (ICC=0.76-0.98) reliability of the whole scale and subscales were good to excellent. The CCS had an SEM of 1.80 points (total score = 69 points) and an MDC95 of 4.98 points. The CCS total score was related to Fugl-Meyer Assessment total and motor scores and had no ceiling or floor effects. Conclusions The CCS scale has strong measurement properties and may be a useful measure of spatial and temporal coordination deficits in chronic stroke survivors.

Construct Validity of the Upper-Limb Interlimb Coordination Test in Stroke

“…Our results support the hypothesis that the ILC2, one of 6 tests of the CCS, 25 , 26 is a valid assessment of UL interlimb coordination that is able to distinguish recovery from compensation by describing movement at both the performance and the movement quality levels. Moreover, it is the only clinical coordination measure assessing movements of both ULs as a single unit rather than each individually.…”

“… 25 The CCS relies on observational kinematics for movement assessment and has 3 subscales with excellent intra-rater (ICC = .95-.98) and interrater (ICC = .95-.99) reliability. 26 One of the 6 CCS tests is the Interlimb Coordination Test (ILC2), assessing bilateral UL coordination, in which seated individuals perform alternating anti-phase forearm rotations (i.e., pronation-supination) on their knees for 10s. In the CCS, the ILC2 test of rhythmic bimanual anti-phase movement was chosen since, rather than being driven by a common neural generator as used for in-phase movement, anti-phase movement is driven by more independent pathways and involves stronger interhemispheric coupling between motor regions.…”

Perceptions of stroke survivors regarding factors affecting adoption of technology and exergames for rehabilitation

“…The number of repetitions during rehabilitation sessions is too low compared to the thousands of repetitions needed to induce long‐lasting motor improvements based on neuroplasticity studies in animal models 13,14 . Thus, to enhance the therapeutic effectiveness of in‐clinic rehabilitation, we must enhance the quality and quantity of movement practice in home and community settings 15–18 …”

“…13,14 Thus, to enhance the therapeutic effectiveness of in-clinic rehabilitation, we must enhance the quality and quantity of movement practice in home and community settings. [15][16][17][18] Individuals with stroke are gaining increasing familiarity with electronic technologies such as smartphones, tablets, and wearable sensors (eg, FitBits). [19][20][21][22] To prepare for the future where individuals with stroke will expect the incorporation of technologies into clinical and home-based rehabilitation, evaluating their perceptions regarding technologies is crucial in informing research and clinical practice.…”

Effects of Robot-Assisted Gait Training with Body Weight Support on Gait and Balance in Stroke Patients

“…For evaluation, only the time taken to walk the middle 10 m was measured using a stopwatch [24]. The test-retest reliability was good (ICC = 0.87-0.88) and the intra-rater reliability was excellent (ICC = 0.95-0.99) in chronic stroke patients [25].…”