Christina Dcm Faria

Performance-based tests in subjects with stroke: outcome scores, reliability and measurement errors

Objectives: To assess the intra- and inter-rater reliabilities and measurement errors of seven widely applied performance-based tests for stroke subjects (comfortable/maximal gait speeds and both stair ascending/descending cadences, as well as the Timed ‘Up and Go’ test) and to verify whether the use of different types of outcome scores (one trial, the means of two and three trials, and the best and the worst values of the three trials) affected the score values, as well as their reliability and measurement errors. Design: Intra- and inter-rater reliability study. Setting: Research laboratory. Subjects: Sixteen stroke subjects with a mean age of 52 ± 17.9 years. Main measures: Seven performance-based tests, over two sessions, seven days apart, evaluated by two independent examiners. A third examiner recorded all data. One-way ANOVAs, intra-class correlation coefficients (ICCs) and percentages of the standard errors of measurement (SEM%) were used for analyses. Results: For all tests, similar results were found for all types of outcome scores (0.01 ≤ F ≤ 0.56; 0.34 ≤ p ≤ 0.99). For instance, at the comfortable gait speed, the means (SD) values for the first trial, the means of two and three trials and the best and worst of three trials were, respectively, 1.04 (0.25), 1.04(0.24), 1.05 (0.24), 1.10 (0.26), 1.02 (0.24) seconds. Significant and adequate values of intra- (0.75 ≤ ICC ≤ 0.96; p ≤ 0.002) and inter-rater (0.75 ≤ ICC ≤ 0.97; p ≤ 0.001) reliabilities were found for all tests and outcome scores. Measurement errors were considered low (5.01 ≤ SEM% ≤14.78) and were also similar between all outcome scores. Conclusions: For the seven tests, only one trial was necessary to provide consistent and reliable results regarding the functional performances of stroke subjects.

The Ability to Manage Stairs for Chronic Stroke Survivors Improves with Increases in Physical Activity Levels

Background: The ability to manage stairs has been recognized as the best predictor of physical activity levels in the community, when compared to walking speed and walking capacity. In addition, one third of stroke survivors require some assistance to manage stairs at six and 12 months post-stroke. Therefore, the aim of this study was to compare the ability to manage stairs for a large sample of chronic stroke survivors, based upon by their physical activity levels. Methods: The participants were recruited from the general community and had their general levels of physical activity assessed by the Human Activity Profile (HAP). Their physical activity levels were classified based upon their HAP’s adjusted activity scores as impaired ( 74). The ability to manage stairs was determined by the stair ascent and descent cadences (stairs/s). One-way analyses of variance (ANOVAs), followed by LSD post-hoc tests, were employed to compare the differences between the groups regarding their stair cadences. Results: Ninety-five chronic stroke survivors were evaluated with a mean age of 55.74 ± 12.3 years, a mean time since the onset of stroke of 64.4 ± 5.6 months, and a mean gait speed of 0.92 ± 0.35 m/s. Twenty five participants were classified as impaired, 53 as moderately active, and 17 as active. Thirteen participants used handrails to perform the stair tests, three from the impaired group and 10 from the moderately active group. ANOVAs revealed significant differences between the impaired, moderately active, and active groups for both stair ascent and descent cadencies [F=18.49 (2,92); p<0.01 and F=16.06 (2,92); p<0.01, respectively], indicating that increases in cadences were observed with increases in physical activity levels. Conclusions: Chronic stroke survivors with different physical activity levels demonstrated different abilities to manage stairs. Increases in stair ascent and descent cadences were 3 observed with increases in physical activity levels.

Handgrip strength deficits best explain limitations in performing bimanual activities after stroke

[Purpose] To evaluate the relationships between residual strength deficits (RSD) of the upper limb muscles and the performance in bimanual activities and to determine which muscular group would best explain the performance in bimanual activities of chronic stroke individuals. [Subjects and Methods] Strength measures of handgrip, wrist extensor, elbow flexor/extensor, and shoulder flexor muscles of 107 subjects were obtained and expressed as RSD. The performance in bimanual activities was assessed by the ABILHAND questionnaire. [Results] The correlations between the RSD of handgrip and wrist extensor muscles with the ABILHAND scores were negative and moderate, whereas those with the elbow flexor/extensor and shoulder flexor muscles were negative and low. Regression analysis showed that the RSD of handgrip and wrist extensor muscles explained 38% of the variance in the ABILHAND scores. Handgrip RSD alone explained 33% of the variance. [Conclusion] The RSD of the upper limb muscles were negatively associated with the performance in bimanual activities and the RSD of handgrip muscles were the most relevant variable. It is possible that stroke subjects would benefit from interventions aiming at improving handgrip strength, when the goal is to increase the performance in bimanual activities.

Lower-limb motor coordination is significantly impaired in ambulatory people with chronic stroke: A cross-sectional study

OBJECTIVES To establish the deficits of motor coordination of the lower limbs after stroke, in comparison with healthy controls, and to investigate whether the magnitude of the deficits would be influenced by the levels of motor recovery. DESIGN Cross-sectional study. SUBJECTS Chronic stroke patients and healthy subjects. METHODS Lower-limb motor coordination of both stroke and healthy volunteers was measured using the Lower Extremity Motor Coordination Test (LEMOCOT). The motor coordination deficits of the participants with stroke were analysed all together and separated, according to their levels of motor recovery, measured using the Fugl-Meyer lower-limb motor section scores. RESULTS Ninety-seven individuals with chronic stroke, 55 men, mean age 58 years, were evaluated. Motor coordination was significantly impaired on both paretic (mean: -22 touches; 95% confidence interval (95% CI) -24 to -19; deficit: 61%) and non-paretic (mean -6 touches; 95% CI -8 to -4; deficit: 17%) lower limbs. Significant differences in the LEMOCOT scores were found between the levels of motor recovery (p < 0.01), except between the participants with marked and moderate impairments. CONCLUSION Motor coordination of the lower limbs is significantly impaired after stroke, but the deficits of the non-paretic lower limb (17%) appear not to be clinically relevant. These findings suggest that interventions prescribed to improve motor coordination after stroke should focus on the paretic lower limb and/or include bilateral activities.

Motor Recovery, Tonus of the Plantar Flexor Muscles, and Age are Predictors of the Lower Limb Motor Coordination in Stroke Survivors

Motor coordination (MC) or dexterity refers to the ability to perform a motor task in an accurate, rapid, and controlled manner. Adequate coordination of the lower limbs is important for the performance of activities of daily living and for an independent life and in stroke individuals, MC impairments contribute significantly to disability. The Lower Extremity Motor Coordination Test (LEMOCOT) was developed to assess the motor coordination of the lower limbs and is a simple test with good clinical utility, adequate psychometric properties, and has been considered one of the best to assess lower limb MC. Many factors may predict MC, such as age, gender, body mass index, and muscular strength, but these factors may depend upon the characteristics of the investigated sample. Menezes et al. investigated the potential predictors of the lower limb MC, assessed by the LEMOCOT scores, in stroke survivors, and found that motor recovery, tonus of the plantar flexor muscles, and age reached significance (p<0.05), explaining 54% of the variance in the LEMOCOT scores. These findings could help rehabilitation professionals to evaluate MC deficits and plan interventions aimed at improving MC of the lower limbs for stroke subjects, based upon the knowledge of the possible factors that could contribute to MC impairments.

Lower Limb Motor Coordination of Stroke Survivors, Based Upon TheirLevels of Motor Recovery and Ages

Objective: To describe the motor coordination (MC) of the paretic lower limb of stroke survivors based upon their levels of motor recovery and ages and to compare their LEMOCOT scores with those predicted for healthy subjects of similar ages and genders. Methods: MC was assessed by the Lower Extremity Motor Coordination Test (LEMOCOT). The participants were divided, according to their ages and levels of motor recovery, based upon the Fugl-Meyer (FM) lower limb section scores (mild impairments: FM ≥ 23 and severe impairments: FM <23). To compare the LEMOCOT scores of the paretic lower limb with those predicted for healthy subjects, the predicted equations for the non-dominant lower limb of healthy subjects of similar ages and genders were employed. Results/Discussion: Age did not influence the LEMOCOT scores, but the subjects with severe motor impairments always showed lower scores, when compared to those with mild impairments, regardless of their ages. The subjects with mild motor impairments reached 75%, while those with severe motor impairments reached only 20% of the predicted scores for healthy subjects. Conclusions: The findings suggested that the subjects with mild motor impairments had better MC, than those with severe impairments, regardless of their ages. Furthermore, the subjects with mild motor impairments reached 75%, whereas those with severe impairments reached only 20% of the predicted scores for healthy subjects