Chia-Lin Koh

A Systematic Review of Cognitive Interventions to Improve Functional Ability in People Who Have Cognitive Impairment Following Stroke

Abstract Purpose: Cognitive impairment is a frequent consequence of stroke and can impact the ability of people who have had a stroke to perform everyday activities. There are a number of intervention strategies that various health professionals may use when working with people who have cognitive impairment post stroke. The purpose of this systematic review was to determine whether interventions for people with cognitive impairment after a stroke improve their functional performance of basic and/or instrumental activities of daily living (ADL). Method: Searches were performed in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, PsycBITE, OTseeker, and Dissertation Abstracts. Studies were eligible for inclusion if they were a randomised controlled trial or quasi-randomised controlled trial that evaluated an intervention that focused on providing cognitive retraining to adults with clinically defined stroke and confirmed cognitive impairment and measured functional ability, either basic or instrumental ADL, as either a primary or secondary outcome measure. Results: Four studies, involving a total of 376 participants, were included in this review. There was no statistically significant difference between groups on basic ADL performance in any of the four studies or on instrumental ADL in the one study that measured this. Conclusion: There were not an adequate number of high quality trials to be able to make recommendations that support or refute the use of specific cognitive retraining interventions to improve functional outcomes following a stroke. More research is required before conclusions can be made about the effect of cognitive interventions on functional outcomes post stroke.

Predicting recovery of voluntary upper extremity movement in subacute stroke patients with severe upper extremity paresis.

Background and Objective Prediction of voluntary upper extremity (UE) movement recovery is largely unknown in patients with little voluntary UE movement at admission. The present study aimed to investigate (1) the extent and variation of voluntary UE movement recovery, and (2) the best predictive model of the recovery of voluntary UE movement by clinical variables in patients with severe UE paresis. Design Prospective cohort study. Methods 140 (out of 590) stroke patients with severe UE paresis completed all assessments. Voluntary UE movement was assessed using the UE subscale of the Stroke Rehabilitation Assessment of Movement (STREAM-UE). Two outcome measures, STREAM-UE scores at discharge (DCSTREAM-UE) and changes between admission and discharge (ΔSTREAM-UE), were investigated to represent the final states and improvement of the recovery of voluntary UE movement. Stepwise regression analyses were used to investigate 19 clinical variables and to find the best predictive models of the two outcome measures. Results The participants showed wide variation in both DCSTREAM-UE and ΔSTREAM-UE. 3.6% of the participants almost fully recovered at discharge (DCSTREAM-UE > 15). A large improvement (ΔSTREAM-UE >= 10) occurred in 16.4% of the participants, while 32.9% of the participants did not have any improvement. The four predictors for the DCSTREAM-UE (R2 = 35.0%) were ‘baseline STREAM-UE score’, ‘hemorrhagic stroke’, ‘baseline National Institutes of Health Stroke Scale (NIHSS) score’, and ‘cortical lesion excluding primary motor cortex’. The three predictors for the ΔSTREAM-UE (R2 = 22.0%) were ‘hemorrhagic stroke’, ‘baseline NIHSS score’, and ‘cortical lesion excluding primary motor cortex’. Conclusions Recovery of voluntary UE movement varied widely in patients with severe UE paresis after stroke. The predictive power of clinical variables was poor. Both results indicate the complex nature of voluntary UE movement recovery in patients with severe UE paresis after stroke.

Test–re-test reliability of two sustained attention tests in persons with chronic stroke

Primary objective: To investigate the test–re-test reliability of the Conners’ Continuous Performance Test II (CCPT) and Digit Vigilance Test (DVT) in persons with chronic stroke. Methods and procedures: Thirty-nine persons with stroke participated in this study. The participants were twice administered both the CCPT and DVT over a 1-week interval. Results: The CCPT performance was reported by two error measures (i.e. Omissions and Commissions) and three time measures (i.e. Hit Reaction Time, Hit Reaction Time Standard Error and Variability of Standard Error). These five measures of the CCPT had good-to-excellent test–re-test reproducibility (ICCs = 0.70–0.90) and limited substantial random measurement errors (SEM% = 7.6–75.2%). Only the Commissions demonstrated substantial practice effects (Cohens effect size d = 0.38). The DVT had two indicators: the Total Error measure had moderate reproducibility (ICC = 0.55), substantial practice effects (d = 0.30) and random measurement errors (SEM% = 60.8%); the Total Time measure showed excellent reproducibility (ICC = 0.91), less practice effects (d = 0.10) and limited random measurement errors (SEM% = 10.1%). Conclusion: Only the time measures (i.e. Hit Reaction Time for the CCPT and Total Time for the DVT) had satisfactory test–re-test reliability in persons with chronic stroke, which implies that the time measures are good indicators of sustained attention on both tests.

Test of Everyday Attention in patients with chronic stroke: Test–retest reliability and practice effects

Abstract Objective: To examine the measurement properties of Test of Everyday Attention (TEA) in patients with chronic stroke including: test–retest reliability between parallel forms (i.e. forms AB, BC and CA), practice effect and critical values for detecting true change corrected for practice effect and measurement error. Methods: Ninety patients with chronic stroke (months since onset >6) were randomly assigned to receive forms AB, BC or CA of the TEA in a counterbalanced order. A test–retest design was used with a 1-week interval. Results: All TEA sub-tests had good-to-excellent test–retest reliability among the three parallel forms except the Telephone Search While Counting (ICC = 0.51–0.59). Small practice effects were observed for almost all sub-tests. The reliable change index corrected for practice effect (RCIp) was provided for each sub-test. Conclusions: Most TEA sub-tests show promise as reliable measures of attention for repeated use with the parallel forms in patients with chronic stroke. Practice effects must be considered to interpret an individual change in clinical settings. Therefore, the value of RCIp provides a conservative estimate of a patient’s progress, representing the smallest change in the TEA score that could be interpreted as true change, corrected for practice effects and measurement error.

Practice effects and test-re-test reliability of the Five Digit Test in patients with stroke over four serial assessments

Abstract Objectives: To investigate practice effect and test–re-test reliability of the Five Digit Test (FDT) over four serial assessments in patients with stroke. Design: Single-group repeated measures design. Methods: Twenty-five patients with stroke were administered the FDT in four consecutive assessments every 2 weeks. The FDT contains four parts with five indices: ‘basic measures of attention and processing speed’, ‘selective attention’, ‘alternating attention’, ‘ability of inhibition’ and ‘ability of switching’. Results: The five indices of the FDT showed trivial-to-small practice effects (Cohen’s d = 0.03–0.47) and moderate-to-excellent test–re-test reliability (intra-class correlation coefficient = 0.59–0.97). Practice effects of the five indices all appeared cumulative, but one index, ‘basic measures of attention and processing speed’, reached a plateau after the second assessment. The minimum and maximum values of the 90% confidence interval (CI) of reliable change index modified for practice (RCIp) for this index were [−17.6, 11.2]. Conclusions: One of five indices of the FDT reached a plateau, whose minimum and maximum values of the 90% CI RCIp are useful to determine whether the change in an individual’s score is real. However, clinicians and researchers should be cautious when interpreting the test results of these four indices over repeated assessments.

Development of Two Barthel Index-Based Supplementary Scales for Patients with Stroke

Background The Barthel Index (BI) assesses actual performance of activities of daily living (ADL). However, comprehensive assessment of ADL functions should include two other constructs: self-perceived difficulty and ability. Objective The aims of this study were to develop two BI-based Supplementary Scales (BI-SS), namely, the Self-perceived Difficulty Scale and the Ability Scale, and to examine the construct validity of the BI-SS in patients with stroke. Method The BI-SS was first developed by consultation with experts and then tested on patients to confirm the clarity and feasibility of administration. A total of 306 participants participated in the construct validity study. Construct validity was investigated using Mokken scale analysis and analyzing associations between scales. The agreement between each pair of the scales’ scores was further examined. Results The Self-perceived Difficulty Scale consisted of 10 items, and the Ability Scale included 8 items (excluding both bladder and bowel control items). Items in each individual scale were unidimensional (H≥0.5). The scores of the Self-perceived Difficulty and Ability Scales were highly correlated with those of the BI (rho = 0.78 and 0.90, respectively). The scores of the two BI-SS scales and BI were significantly different from each other (p<.001). These results indicate that both BI-SS scales assessed unique constructs. Conclusions The BI-SS had overall good construct validity in patients with stroke. The BI-SS can be used as supplementary scales for the BI to comprehensively assess patients’ ADL functions in order to identify patients’ difficulties in performing ADL tasks, plan intervention strategies, and assess outcomes.

Prediction of lower extremity motor recovery in persons with severe lower extremity paresis after stroke

ABSTRACT Objective: To investigate the extent of motor recovery and predict the prognosis of lower extremity (LE) recovery in patients with severe LE paresis after stroke Methods: 137 patients with severe LE paresis after stroke were recruited from a local medical centre. Voluntary LE movement was assessed with the LE subscale of the Stroke Rehabilitation Assessment of Movement (STREAM-LE). Univariate and stepwise regression analyses were used to investigate 25 clinical variables (including demographic, neuroimaging, and behavioural variables) for finding the predictors of LE recovery. Results: The STREAM-LE at discharge (DCSTREAM-LE) of the participants covered a very wide range (0–19). Specifically, 5.1% of the participants were nearly completely recovered, 11.7% were moderately recovered, 36.5% were slightly recovered, and 46.7% remained severely paralysed. ‘Score of STREAM-LE at admission (ADSTREAM-LE)’ and ‘volume of lesion and oedema’) were significant predictors of LE movement at discharge, explaining 25.1% of the variance of the DCSTREAM-LE (p < 0.001). Conclusions: LE motor recovery varied widely in our participants, indicating that patients’ recovery might not follow simple rules. The low predictive power (about a quarter) indicates that LE motor recovery in patients with severe LE paresis after stroke was hardly predictive.

No Difference Between Noxious and Innocuous Thermal Stimulation on Motor Recovery of Upper Extremity in Patients With Acute Stroke: A Randomized Controlled Trial With 6-Month Follow-up

Thermal stimulation (TS) has been developed and incorporated into stroke rehabilitation. However, whether noxious and innocuous TS induce the same effects on motor function recovery after stroke is still unknown. A comparative study of different temperature combination regimens is needed.