'Assessing' this DOES NOTHING TO GET YOU RECOVERED! I still can't walk and carry anything in my left hand. There really is no point since I have strengthened my good side vastly more. I would fire anyone who does 'assessment' research with NOTHING PROPOSED TO FIX THE DEFICITS FOUND!
Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? No excuses are allowed! You're medically trained; it should be simple to precisely state EXACTLY WHAT GOOD 'assessments' do for recovery with NO EXCUSES! Your definition of competence in stroke is obviously much lower than stroke survivors' definition of your competence! Swearing at me is allowed, I'll return the favor. Don't even attempt to use the excuse that brain research is hard.
Upper Extremity-Cognitive Dual-Task Capacity Post-Stroke
Abstract
Background
Dual-task
capacity, which might be impaired poststroke, is needed for daily
functions. Therefore, dual-task capacity should be assessed during
rehabilitation. The Dual Overload Interference Test (DO-IT) is a new
upper extremity (UE) protocol for assessment, combining The Box and
Block Test with the Counting Backwards Test.
Objectives
To
validate DO-IT by comparing between (1) young and older healthy, (2)
stroke and healthy participants. Additionally, to correlate DO-IT with
(3) walking-cognitive dual-task assessment (healthy), and (4)
standardized cognitive and EF assessments (stroke).
Methods
A
cross-sectional study included younger and older community-dwelling
healthy individuals (N = 32), and younger and older individuals with
stroke (N = 83). DO-IT was administered to all participants. The #blocks
transferred (motor) and #correct numbers counted (cognitive) were
recorded for single and dual conditions. The walking-cognitive dual-task
test was administered to the healthy participants. Motor and cognitive
costs were calculated as the difference between single and dual tasks.
The Montreal Cognitive Assessment test (MoCA) and the Color Trail Test
(CTT) assessed cognition post stroke.
Results
Older
healthy adults had significantly lower dual-task motor capacity
compared to younger adults (median [interquartile range] blocks: older
26 [21-38], younger 46 [38-52], P < .01). Participants with
stroke showed higher motor costs than healthy participants. Dual-task
costs correlated between DO-IT to walking-cognitive (motor; r = .37-.41, cognitive; r = .41-.47, P < .05). DO-IT motor cost negatively correlated with MoCA (r = −.27, P < .05), and DO-IT motor performance correlated with MoCA/CTT-A\B (r = .29-.60, P < .05).
Conclusions
UE-Cognitive
dual-task capacity is affected post-stroke. DO-IT shows potential for
use in stroke rehabilitation and its validity should be further
researched.
Introduction
Executive
function (EF) deficits, common post-stroke, negatively impact
independence in daily living. EFs are higher cognitive abilities
involving working memory, cognitive flexibility, and dual-task capacity.1 EF deficits, reported in 43% to 75% of individuals post-stroke2 have consistently found to predict negative functional outcomes.3 EFs are essential for performing complex daily tasks such as cooking or trip planning.4 Therefore, it is important to assess EF post-stroke to accurately plan a therapeutic intervention.
EF are assessed using different tools to obtain different types of information. Pen and paper neuropsychological assessments5 assess specific EF components, but transfer to real life performance is limited.6 Performance-based assessments, where participants are requested to perform tasks, such as cooking,7
evaluate the impact of EF on daily functioning and can provide
information regarding EF deficits. These tasks involve hand functions
(mixing/pouring) and cognitive tasks (such as recipe following,
planning, organization, and safety and judgment),8
however, hand function is not assessed. To understand how the cognitive
load impacts hand function, clinicians should use an upper extremity
(UE)-cognitive dual-task assessment.
Dual-task includes performing two tasks simultaneously,1 usually a motor and a cognitive task: each task has a different purpose and can be performed and measured separately.9 Executing the dual-task adds cognitive load, causes motor-cognitive interference,9,10 and leads to reduced performance in either the motor or cognitive-task (or both tasks)11
due to the “cost” of simultaneously execution. Dual-task capacity can
be quantified by the performance during the dual-task condition (termed
“dual-task performance”) or by calculating the change between single-
and dual-task performance (termed motor/cognitive cost).12
UE-cognitive
dual-task assessments have been used mainly with older adults and
individuals with different neurological conditions12-14 to assess mild cognitive impairments and EFs. The studies that did include individuals with stroke15-19
still don’t allow for a clear understanding of dual-task capacity post
stroke due to the following reasons. The motor tasks used to assess
dual-task capacity are not suitable for individuals with stroke with
significant motor impairments because they entail small pieces (such as
the Purdue Pegboard Test20) or require in-hand manipulation (such as the Functional Dexterity Test21). Therefore, motor tasks used with individuals post stroke are not functional and entail proximal arm movements19 using kinematic measures.22 In addition, there is no gold standard for assessing UE dual-task capacity and different research groups23,24 have used different combinations of motor and cognitive tasks.12 Some of the motor-tasks that have been used as single tasks already require cognitive abilities,12 such as copying shapes25 or tapping in a sequence.26 Lastly, dual-task capacity has mainly been researched in laboratories,14 or by utilizing technologies,19,27
that do not exist in most clinical settings. In order to clearly
demonstrate that EFs are required for performing complex everyday tasks,
it is also important to assess associations between assessments of
UE-cognitive dual-task and assessments of EFs. A systematic review
conducted recently by our group demonstrated these challenges in the
assessment of dual-task capacity.12
This helped us identify the need for a practical and affordable
UE-cognitive dual-task assessment, specifically for individuals with
stroke.
We therefore developed the Dual
Overload Interference Test, or for short: DO-IT. The DO-IT protocol
includes the Box and Block Test (BTT)28 in conjunction with Backward Counting by Threes Test29
(a very commonly used cognitive-task). The BBT is a relatively simple
motor-task, that does not impose a high cognitive load, making it
suitable as a single motor task for individuals with stroke. Despite
this fact, BBT does not closely resemble real-life daily tasks, which
limits its ecological validity.
This study
aims to utilize the DO-IT to assess dual-task capacity involving the UE
post stroke. Specifically, we aimed to validate DO-IT by comparing
between (1) young and older healthy participants, and (2) stroke and
healthy participants. Additionally, we aimed to correlate DO-IT with (3)
walking-cognitive dual-task assessment in healthy participants, (4) and
standardized cognitive and EF assessments in the stroke group. These
aims support the recommendations of a recent Think Tank meeting of the
International Stroke Recovery and Rehabilitation Alliance (May 2024),
which stated that “cognitive-motor interactions are infrequently studied
but that they deserve attention”. If the validity of DO-IT is supported
in this study, DO-IT can be used in rehabilitation as tool for
assessing EF post stroke.
More at link.
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