Relationships between upper-limb functional limitation and self-reported disability 3 months after stroke

 Nothing here gets you recovered; so useless! Protocols get you recovered; CREATE THEM!

Relationships between upper-limb functional limitation and self-reported disability 3 months after stroke

Alexander W. Dromerick, MD; 

1–3* 

Catherine E. Lang, PhD, PT; 

3 

Rebecca Birkenmeier, MS, OTR; 

1 

Michele G. Hahn, MS, OTR; 

2 

Shirley A. Sahrmann, PhD, PT; 

1,3 

Dorothy F. Edwards, PhD 

1–2 

1 

Department of Neurology, and Programs in 

2 

Occupational Therapy and 

3 

Physical Therapy, Washington University, 

St. Louis, MO 

Abstract—This study explored relationships between upper- 

limb (UL) functional limitations and self-reported disability in 

stroke patients with relatively pure motor hemiparesis who were 

enrolled in an acute rehabilitation treatment trial. All participants 

were enrolled in the VECTORS (Very Early Constraint Treat- 

ment for Recovery from Stroke) study. VECTORS is a single- 

center pilot clinical trial of early application of constraint- 

induced movement therapy (CIMT). All 39 subjects who com- 

pleted 90 days of VECTORS were included in this analysis. 

Trained study personnel who were blinded to the treatment type 

performed all evaluations. Data in this article examine relation- 

ships between assessments performed 90 days after stroke. 

Functional limitation measures included the Action Research 

Arm (ARA) test and Wolf Motor Function Test (WMFT), and 

self-reported disability measures included the Functional Inde- 

pendence Measure (FIM) and Motor Activity Log (MAL) (by 

telephone). Mean plus or minus standard deviation time from 

stroke onset to randomization was 9.4 plus or minus 4.3 

days, and median time to follow-up was 99 days (range 68–178). 

Subjects with perfect or near-perfect scores on the ARA test or 

WMFT reported residual disability on the FIM and MAL. Qual- 

ity of movement on the WMFT (functional ability score) was not 

strongly associated with self-reported frequency, and speed of 

movement on the WMFT (timed score) was not associated with 

self-reported frequency (MAL amount of use). In this early UL 

intervention trial, we found that perceived disability measures 

captured information that was not assessed by functional limita- 

tion and impairment scales. Our results indicate that excellent 

motor recovery as measured by functional limitation and impair- 

ment scales did not equal restoration of everyday productive UL 

use and speed of task completion did not translate to actual use. 

Our results confirm the need for a measurement strategy(WRONG! You need to create EXACT RECOVERY PROTOCOLS! Don't you people have any functioning neurons? 'Measurements' do nothing towards recovery!) that is 

sensitive to change, assesses a broad performance range, and 

detects meaningful clinical improvements in early rehabilitation 

intervention trials. 

Key words: activities of daily living, arm, cerebrovascular 

accident, constraint therapy, functional limitation, hemiplegia, 

motor skills, outcome assessment (healthcare), randomized 

controlled trials, rehabilitation, upper limb.