Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, October 30, 2018

Measuring Habitual Arm Use Post-stroke With a Bilateral Time-Constrained Reaching Task

So you measured something. What the hell use is that to getting survivors 100% recovered? That is the only goal in stroke research. At least it would be if I was in charge. 

Measuring Habitual Arm Use Post-stroke With a Bilateral Time-Constrained Reaching Task

  • 1Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
  • 2Physical Therapy, Jeonju University, Jeonju, South Korea
  • 3Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
  • 4Department of Electronics and Information Engineering, Korea University, Sejong, South Korea
Background: Spontaneous use of the more-affected arm is a meaningful indicator of stroke recovery. The Bilateral Arm Reaching Test (BART) was previously developed to quantify arm use by measuring arm choice to targets projected over a horizontal hemi-workspace. In order to improve clinical validity, we constrained the available movement time, thereby promoting more spontaneous decision making when selecting between the more-affected and less affected arm during the BART.
Methods: Twenty-two individuals with mild to moderate hemiparesis were tested with the time-based BART in three time-constraint conditions: no-time constraint, medium, and fast conditions. Arm use was measured across three sessions with a 2-week interval in a spontaneous choice block, in which participants were instructed to use either the more-affected or the less-affected arm to reach targets. We tested the effect of time-constraint condition on the more-affected arm use, external validity of the BART with the Actual Amount of Use Test (AAUT), and test-retest reliability across the three test sessions.
Results: The fast condition in the time-based BART showed reduced use of the more-affected arm compared to the no-time constraint condition P < 0.0001) and the medium condition P = 0.0006; Tukey post hoc analysis after mixed-effect linear regression). In addition, the fast condition showed strong correlation with the AAUT r = 0.829, P < 0.001), and excellent test-retest reliability (ICC = 0.960, P < 0.0001).
Conclusion: The revised BART with a time-restricted fast condition provides an objective, accurate, and repeatable measure of spontaneous arm use in individuals with chronic stroke hemiparesis.

Introduction

Spontaneous use of the more-affected upper extremity post-stroke is often lower than would be expected from impairment levels (1, 2), with low use associated with a reduced quality of life (3). Besides the common therapy goal of improving motor performance of the more-affected arm/hand, an additional approach would be to influence the decision-making system (4), with the aim to improve use of the more-affected arm/hand.
The three instruments commonly used for measuring spontaneous arm/hand use in the natural environment are the Motor Activity Log [MAL; (5)], the Actual Amount of Use Test [AAUT; (6)], and accelerometers (7, 8). These instruments are not ideal, however: the MAL relies on self-reported ratings from memory; the AAUT cannot be administered repeatedly once participants recognize that they are being tested, thereby revealing its covert nature; and accelerometers only provide overall activity, and thus not a direct measure of functional arm use.
We previously developed a simple and objective assessment tool, the Bilateral Arm Reaching Test (BART) to address these limitations (1). With BART, arm use is measured in a spontaneous choice block, in which participants are instructed to choose either the more-affected or the less-affected arm to reach displayed targets on a table. (I would never use my affected arm to reach for anything, spasticity prevents opening the hand, so success would never occur. So first of all you need to develop a cure for spasticity. Follow the goddamned stroke strategy. ) Although arm use as assessed with BART showed good test-retest reliability, it was only moderately correlated with the AAUT (1). In seeking to improve BART, we sought a better way to capture real-world spontaneous arm use. We turned to previous research in decision-making (911). Contemporary decision models posit that choices between potentially rewarding actions are driven by a combination of a goal-oriented system and a habitual system. The goal-directed system is called “model-based” because individuals learn through experience, and then mentally simulate, models of the decision environment to prospectively evaluate the outcomes of possible actions. In contrast, the habitual system is “model-free,” because choice is performed via direct comparison of expected rewards for each potential action (12). Mental simulations in the goal-directed system is a time-consuming process. As a result, performing choices under time-pressure enhances expression of the time-insensitive habitual system (13). For this reason, we modified BART by adding a short time-constraint condition to the experimental paradigm.
The aim of this study was to accurately quantify arm/hand use post-stroke with the time-based BART system. We hypothesized that a reduction of available decision time would reduce affected arm use. In addition, we reasoned that affected arm use in the time-constrained condition would more strongly correlate with arm use as assessed by the covert AAUT than arm use without time constraint.
Much more at link.


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