Measuring arm function early after stroke: is the DASH good enough?

 The only reason to measure arm function IS TO KNOW EXACTLY WHAT PROTOCOLS TO DELIVER FOR RECOVERY! If you don't know that; you're obviously a blithering idiot! With nothing on protocols to recover, you just proved my point; you are an idiot!

Measuring arm function early after stroke: is the DASH good enough?

1. Karen Baker1, 
2. Louise Barrett2, 
3. E Diane Playford1, 
4. Trefor Aspden3, 
5. Afsane Riazi3, 
6. Jeremy Hobart2

1. Correspondence to Professor Jeremy Hobart, Clinical Neurology Research Group, Plymouth University Peninsula Schools of Medicine and Dentistry, Room N13 ITTC Building, Plymouth Science Park, Derriford, Plymouth PL6 8BX, UK; jeremy.hobart@plymouth.ac.uk

Abstract

Objective Despite a growing call to use patient-reported outcomes in clinical research, few are available for measuring upper limb function post-stroke. We examined the Disabilities of the Arm, Shoulder and Hand (DASH) to evaluate its measurement performance in acute stroke. In doing so, we compared results from traditional and modern psychometric methods.

Methods 172 people with acute stroke completed the DASH. Those with upper limb impairments completed the DASH again at 6 weeks (n=99). Data (n=271) were analysed using two psychometric paradigms: traditional psychometric (Classical Test Theory, CTT) analyses examined data completeness, scaling assumptions, targeting, reliability and responsiveness; Rasch Measurement Theory (RMT) analyses examined scale-to-sample targeting, scale performance and person measurement.

Results CTT analyses implied the DASH was psychometrically robust in this sample. Data completeness was high, criteria for scaling assumptions were satisfied (item-total correlations 0.55–0.95), targeting was good, internal consistency reliability was high (Cronbach's α=0.99) and responsiveness was clinically moderate (effect size=0.51). However, RMT analyses identified important limitations: scale-to-sample targeting was suboptimal, 4 items had disordered response category thresholds, 16 items exhibited misfit, 3 pairs of items had high residual correlations (>0.60) and 84 person fit residuals exceeded the recommended range.

Conclusions RMT methods identified limitations missed by CTT and indicate areas for improvement of the DASH as an upper limb measure for acute stroke. Findings, similar to those identified in multiple sclerosis, highlight the need for scales to have strong conceptual underpinnings, with their development and modification guided by sophisticated psychometric methods.

https://doi.org/10.1136/jnnp-2015-310557

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Poststroke fatigue in subacute and chronic stroke rehabilitation phase: prevalence, associated factors and impact on self-efficacy and functional ability

 Prevalence has been known for over a decade. WHY THE FUCK AREN'T YOU CURING FATIGUE? This did nothing useful, you're all fired!

At least half of all stroke survivors experience fatigue Or is it 70%?

Or is it 40%?

Poststroke fatigue in subacute and chronic stroke rehabilitation phase: prevalence, associated factors and impact on self-efficacy and functional ability

•,,,

Abstract

 Background Stroke is a leading cause of death and long-term disability worldwide, with low-income and middle-income countries accounting for about 87% of stroke-related deaths and disability-adjusted life-years. Among poststroke complications, poststroke fatigue is a common but often under-recognised condition characterised by emotional, cognitive and physical exhaustion unrelated to exertion and not relieved by rest. Poststroke fatigue can hinder functional recovery, yet it remains underassessed in the study area. So this study investigates the prevalence, associated factors and impact of poststroke fatigue on self-efficacy and activities of daily living.

Methods A hospital-based cross-sectional study was conducted through a systematic random sampling technique on 370 study participants. The Fatigue Severity Scale, Nottingham Extended Activities of Daily Living and Stroke Self-efficacy Questionnaire were used to collect questionnaires related to fatigue and its impact. The data were analysed on SPSS using binary logistic regression to assess associated factors and ordinal logistic regression to assess impacts of fatigue on self-efficacy and activities of daily living.

Result Fatigue was reported by 65.4% of participants (95% CI 60.30% to 70.20%) during the subacute and chronic rehabilitation phases. Older age, both overweight and underweight body mass index, National Institutes of Health Stroke Scale ≥12, lacked physiotherapy follow-up and experiencing depression were associated with poststroke fatigue with 95% CI and p<0.05. Moreover, individuals with poststroke fatigue were approximately 5.4 times less likely to report higher functional levels and 3.6 times less likely to demonstrate greater self-efficacy compared with those without fatigue.

Conclusions Poststroke fatigue is highly prevalent among stroke survivors and negatively impacts both self-efficacy and functional ability. These findings highlight the need for early identification and targeted management of fatigue to improve rehabilitation outcomes and quality of life in stroke survivors.

What is already known on this topic

• Poststroke fatigue is a common and disabling consequence of stroke, often persisting into the subacute and chronic phases of recovery.

What this study adds

• Importantly, the study quantifies the impact of fatigue in the study setting and our country, demonstrating that individuals without fatigue are substantially more likely to achieve better functional outcomes and self-efficacy. These findings provide a more comprehensive understanding by assessing prevalence, factors and impact of stroke survivors in low-resource hospital settings.

How this study might affect research, practice or policy

• This study is the first of its kind in our country to comprehensively assess the poststroke fatigue and its functional and psychological impacts. Therefore, the study underscores the importance of strengthening poststroke care infrastructure, including accessible rehabilitation services and mental health support, particularly in resource-limited settings.

Case report: A period-based upper limb rehabilitation program using a degrees-of-freedom constraint strategy in severe post-stroke hemiparesis

 You can ask your competent? doctor to explain how this works in layperson terms and EXACTLY WHEN YOU GET TO USEIT!

Case report: A period-based upper limb rehabilitation program using a degrees-of-freedom constraint strategy in severe post-stroke hemiparesis

• 

  Norikazu Hishikawa 1

• K

  Koshiro Sawada 1

• Y

  Yuki Iwasaki 1

• S

  Satoru Kakoyama 2

• Y

  Yu Iitsuka 3

• Y

  Yoshiaki Komatsu 4

• H

  Hiroshi Maeda 2

• 

  Yasuo Mikami 1

• 1. Kyoto Furitsu Ika Daigaku Daigakuin Igaku Kenkyuka Rehabilitation Igaku Kyoshitsu, Kyoto, Japan

• 2. Gakusai Hospital, Kyoto, Japan

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Abstract

Background: Severe upper limb hemiparesis after stroke is often characterized by impaired motor function, increased flexor tone, and abnormal motor coordination, resulting in limited functional reaching. Because reaching requires coordinated control of joints, conventional task-oriented training may not sufficiently address motor control deficits arising from excessive or poorly regulated joint degrees of freedom (DoF). This case report describes a period-based upper limb rehabilitation program incorporating a constraint strategy targeting DoF to facilitate motor recovery in a patient with severe post-stroke hemiparesis. Case description: A 50-year-old man with left upper limb hemiparesis secondary to right putaminal hemorrhage (163 days post-onset) presented with severe impairment (Fugl–Meyer Assessment for Upper Extremity motor score, 12 points) and spasticity (Modified Ashworth Scale 2–3 in shoulder internal rotators, elbow flexors, and wrist flexors). Insufficient selective motor control and increased spasticity resulted in a dominant upper limb flexion synergy pattern, limiting his ability to perform forward reaching. Therapeutic intervention: A structured, period-based program was implemented over 21 consecutive days (60 minutes/day) with a proximal-to-distal progression and progressive release of movement constraints from the shoulder to the elbow and then to the wrist and fingers. Gravity-load management and DoF constraints were provided using an arm support device and a wrist–hand– finger orthosis in the early periods. As proximal voluntary control emerged, the wrist–hand–finger orthosis was replaced by a dynamic finger extension orthosis. In addition, neuromuscular electrical stimulation was applied to facilitate selective muscle activation across training periods. 

Follow-up and Outcomes: 

Spasticity of the paretic upper limb decreased progressively over the training period, with early reductions in proximal muscle tone followed by later reductions in distal spasticity.(Why are you treating spasticity at all? Don't you believe in the 'expert' opinion of Dr. William. F. Landau? 

 His statement from here:

Spasticity After Stroke: Why Bother? Aug. 2004 )

 Improvements in passive joint range of motion and consistent reductions in joint pain were observed throughout the intervention. Subsequently, motor function improved, as reflected by an increase in the Fugl–Meyer motor score to 16 points, with reduced synergistic movement patterns and more controlled reaching during tasks. Conclusion: An upper limb rehabilitation framework incorporating a DoF constraint strategy may support the recovery of coordinated motor control through a structured, period-based approach in individuals with severe post-stroke hemiparesis.