Instrumental indices for upper limb function assessment in stroke patients: a validation study

Maybe we are finally getting to some objective measurements of physical  impairments. It's about fucking time, all these other measurement tools do nothing to tell you anything specific. A great stroke association president would have initiated objective diagnosis and measurement decades ago. But we've had decades of failure to contend with and I still see NO hope in the forseeable future.

Instrumental indices for upper limb function assessment in stroke patients: a validation study

• Maria Longhi,
• Andrea MerloEmail author,
• Paolo Prati,
• Meris Giacobbi and
• Davide Mazzoli

Journal of NeuroEngineering and Rehabilitation201613:52

DOI: 10.1186/s12984-016-0163-4

©  The Author(s). 2016

Received: 11 December 2015

Accepted: 3 June 2016

Published: 8 June 2016

Abstract

Background

Robotic exoskeletons are increasingly being used in objective and quantitative assessment of upper limb (UL) movements. A set of instrumental indices computed during robot-assisted reaching tasks with the Armeo®Spring has been proven to assess UL functionality. The aim of this study was to test the construct validity of this indices-based UL assessment when used with patients who have had a stroke.

Methods

Forty-four 45- to 79-year-old stroke patients with a Wolf Motor Function Test ability score (WMFT-FAS) ranging from 10 to 75 and a Motricity Index (MI) ranging from 14 to 33 at shoulder and elbow were enrolled, thus covering a wide range of impairments. Residual UL function was assessed by both the WMFT-FAS and the WMFT-TIME, as well as by a set of 9 numerical indices assessing movement accuracy, velocity and smoothness computed from a 3D endpoint trajectory obtained during the “Vertical Capture” task of the Armeo®Spring device. To explore which variables better represented motor control deficits, the Mann-Whitney U Test was used to compare patients’ indices to those obtained from 25 healthy individuals. To explore the inner relationships between indices and construct validity in assessing accuracy, velocity and smoothness, a factor analysis was carried out. To verify the indices concurrent validity, they were compared to both WMFT-FAS and WMFT-TIME by the Spearman’s correlation coefficient.

Results

Seven indices of stroke subjects were significantly different from those of healthy controls, with effect sizes in the range 0.35–0.74. Factor analysis confirmed that specific subsets of indices belonged to the domains of accuracy, velocity and smoothness (discriminant validity). One accuracy index, both velocity indices and two smoothness indices were significantly correlated with WMFT-FAS and WMFT-TIME (|rho|  = 0.31–0.50) (concurrent validity). One index for each of the assessed movement domains was proven to have construct validity (discriminant and concurrent) and was selected. Moreover, the indices were able to detect differences in accuracy, velocity and/or smoothness in patients with the same WMFT level.

Conclusions

The proposed index-based UL assessment can be used to integrate and support clinical evaluation of UL function in stroke patients.