Chronic stroke survivors underestimate their upper limb motor ability in a simple 2D motor task

 So the whole fucking point of this research is to blame the survivor for their lack of recovery? Sorry, THE BLAME FOR LACK OF RECOVERY LIES DIRECTLY ON THE STROKE MEDICAL 'PROFESSIONALS'! Professionals would own that responsibility,  but you don't have 'professionals' working to get you 100% recovered, do you?

Chronic stroke survivors underestimate their upper limb motor ability in a simple 2D motor task

• Sebastian Sporn,
• M. Coll,
• S. Bestmann &
• N. S. Ward 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 175 (2024) Cite this article

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Abstract

Background

Stroke survivors can exhibit a mismatch between the actual motor ability of their affected upper limb and how much they use it in daily life. The resulting non-use of the affected upper limb has a negative impact on participation in neurorehabilitation and functional independence. The factors leading to non-use of the affected upper limb are poorly understood. One possibility is that non-use comes about through inappropriately low confidence in their own upper limb motor abilities.

Objective

We asked whether chronic stroke survivors underestimate the motor ability of their affected upper limb.

Methods

20 chronic stroke survivors (Mean FM: 28.2 ± 10.5) completed a 2D reaching task using an exoskeleton robot. Target sizes were individually altered to ensure success rates were similar for both upper limbs. Prior to each reaching movement, participants rated their confidence about successfully hitting the target (estimated upper limb motor ability).

Results

Confidence ratings were significantly lower for the affected upper limb (estimated ability), even though it was equally successful in the reaching task in comparison to the less affected upper limb (actual ability). Furthermore, confidence ratings did not correlate with level of impairment.

Conclusions

Our results demonstrate that chronic stroke survivors can underestimate the actual motor abilities of their affected upper limb, independent of impairment level. Low confidence in affected upper limb motor abilities should be considered as a therapeutic target to increase the incorporation of the affected upper limb into activities of daily living.

Introduction

Stroke is the leading cause of long-term neurological disability worldwide [1, 2]. A major contributor to individual disability is impairment of the upper limb, which is seen in upto 75% of stroke survivors [3,4,5]. Optimal recovery of the upper limb requires that it is regularly incorporated into activities of daily living and failure to do so will slow down recovery. Identifying factors that contribute to lower than expected levels of upper limb use will help identify much needed therapeutic targets.

Confidence about succeeding at a motor task is important for maintaining our daily interactions with the environment. Consequently, there is interest in whether some survivors incorporate the affected upper limb into daily life less than would be expected given their level of impairment, something often referred to as ‘non-use’ [6,7,8,9]. Upper limb ‘non-use’ in everyday life can restrict participation in meaningful daily activities and social interactions [10] and increase the risk of long-term deterioration in upper limb motor ability [11]. Characterising ‘non-use’ of the upper limb after stroke will lead to improvements in both recognition and treatment of this important clinical problem.

A potential mismatch between estimated (‘what I think I can do’) and actual (‘what I can actually do’) upper limb ability has been found in some [12,13,14,15,16,17], but not other [18,19,20,21] studies. These studies all characterised non-use as a difference between impairment measures (e.g. FMA-UL scale) and retrospective self-reported assessments of day to day upper limb use (e.g. Stoke Impact Scale) in stroke survivors with only mild impairment (FMA-UL > 50). A more thorough characterisation of post-stroke upper limb non-use might be possible by (i) assessing estimated and actual upper limb ability within the same objective assessment framework, and (ii) investigating stroke survivors with at least moderate or even severe impairment who also seem likely to suffer reduced confidence in affected upper limb motor ability.

Here, we revisit the issue of confidence about upper limb ability in chronic stroke survivors through the design of a novel 2D planar reaching task that can assess both actual and estimated upper limb ability in stroke survivors with a wide range of upper limb motor impairment. This experimental design enabled us to address the following questions in chronic stroke survivors: (i) Is confidence in achieving task success the same in the more and less affected upper limb? (ii) How is confidence about upper limb task success related to actual task performance? (iii) Is confidence about upper limb task success and actual task performance related to clinical measures including upper limb impairment?

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