Maybe we are finally getting to some objective measurements of physical impairments. It's about fucking time, all these other measurement tools do nothing to tell you anything specific. A great stroke association president would have initiated objective diagnosis and measurement decades ago. But we've had decades of failure to contend with and I still see NO hope in the forseeable future.
Instrumental indices for upper limb function assessment in stroke patients: a validation study
- Maria Longhi,
- Andrea MerloEmail author,
- Paolo Prati,
- Meris Giacobbi and
- Davide Mazzoli
Journal of NeuroEngineering and Rehabilitation201613:52
DOI: 10.1186/s12984-016-0163-4
© The Author(s). 2016
Received: 11 December 2015
Accepted: 3 June 2016
Published: 8 June 2016
Abstract
Background
Robotic exoskeletons are
increasingly being used in objective and quantitative assessment of
upper limb (UL) movements. A set of instrumental indices computed during
robot-assisted reaching tasks with the Armeo®Spring has been proven to
assess UL functionality. The aim of this study was to test the construct
validity of this indices-based UL assessment when used with patients
who have had a stroke.
Methods
Forty-four 45- to 79-year-old
stroke patients with a Wolf Motor Function Test ability score (WMFT-FAS)
ranging from 10 to 75 and a Motricity Index (MI) ranging from 14 to 33
at shoulder and elbow were enrolled, thus covering a wide range of
impairments. Residual UL function was assessed by both the WMFT-FAS and
the WMFT-TIME, as well as by a set of 9 numerical indices assessing
movement accuracy, velocity and smoothness computed from a 3D endpoint
trajectory obtained during the “Vertical Capture” task of the
Armeo®Spring device. To explore which variables better represented motor
control deficits, the Mann-Whitney U
Test was used to compare patients’ indices to those obtained from 25
healthy individuals. To explore the inner relationships between indices
and construct validity in assessing accuracy, velocity and smoothness, a
factor analysis was carried out. To verify the indices concurrent
validity, they were compared to both WMFT-FAS and WMFT-TIME by the
Spearman’s correlation coefficient.
Results
Seven indices of stroke
subjects were significantly different from those of healthy controls,
with effect sizes in the range 0.35–0.74. Factor analysis confirmed that
specific subsets of indices belonged to the domains of accuracy,
velocity and smoothness (discriminant validity). One accuracy index,
both velocity indices and two smoothness indices were significantly
correlated with WMFT-FAS and WMFT-TIME (|rho|
= 0.31–0.50) (concurrent validity). One index for each of the assessed
movement domains was proven to have construct validity (discriminant and
concurrent) and was selected. Moreover, the indices were able to detect
differences in accuracy, velocity and/or smoothness in patients with
the same WMFT level.
Conclusions
The proposed index-based UL
assessment can be used to integrate and support clinical evaluation of
UL function in stroke patients.
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