Thursday, May 2, 2013

Quantifying Arm Nonuse in Individuals Poststroke

In other words diagnose exactly why you can't move the arm. Damn this should have been identified 20 years ago. If you don't have a starting point how the hell do you know if any of your therapies work? As you can tell I think non-use is incorrectly applied lots of times. Ask your doctor for their expert opinion on why you can't move your arm, and challenge that if nonuse is mentioned.
I can see numerous different reasons and I am not medically trained.
1. The motor cortex area that controlled the arm was damaged and in the penumbra.
2. The motor cortex area that controlled the arm muscle is dead.
3. The pre-motor cortex was in the penumbra.
4. The pre-motor cortex is dead.
5. The executive control was in the penumbra.
6. The executive control area is dead.

Non-use is really only applicable in cases 1,3,5
http://nnr.sagepub.com/content/27/5/439.abstract?etoc

Abstract

Background. Arm nonuse, defined as the difference between what the individual can do when constrained to use the paretic arm and what the individual does when given a free choice to use either arm, has not yet been quantified in individuals poststroke. Objectives. (1) To quantify nonuse poststroke and (2) to develop and test a novel, simple, objective, reliable, and valid instrument, the Bilateral Arm Reaching Test (BART), to quantify arm use and nonuse poststroke. Methods. First, we quantify nonuse with the Quality of Movement (QOM) subscale of the Actual Amount of Use Test (AAUT) by subtracting the AAUT QOM score in the spontaneous use condition from the AAUT QOM score in a subsequent constrained use condition. Second, we quantify arm use and nonuse with BART by comparing reaching performance to visual targets projected over a 2D horizontal hemi–work space in a spontaneous-use condition (in which participants are free to use either arm at each trial) with reaching performance in a constrained-use condition. Results. All participants (N = 24) with chronic stroke and with mild to moderate impairment exhibited nonuse with the AAUT QOM. Nonuse with BART had excellent test-retest reliability and good external validity. Conclusions. BART is the first instrument that can be used repeatedly and practically in the clinic to quantify the effects of neurorehabilitation on arm use and nonuse and in the laboratory for advancing theoretical knowledge about the recovery of arm use and the development of nonuse and “learned nonuse” after stroke.

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