Predictors of Arm Nonuse in Chronic Stroke: A Preliminary Investigation

You don't know what the fuck you are doing, do you? Where is the objective damage diagnosis to explain why non-use occurs?  What is even worse is that your mentors and senior researchers don't understand either. If you don't know which of these nine reasons is causing the nonuse you can never assign the correct rehab protocol to fix it. 

See this example of nine reasons for a movement disability:

 

You can't tell me these all have the same solution, I'm not that stupid.
1. Penumbra damage to the motor cortex.
2. Dead brain in the motor cortex.
3. Penumbra damage in the pre-motor cortex.
4. Dead brain in the pre-motor cortex.
5. Penumbra damage in the executive control area.
6. Dead brain in the executive control area.
7. Penumbra damage in the white matter underlying any of these three.
8. Dead brain in the white matter underlying any of these three.
9. Spasticity preventing movement from occurring.

The latest here:

Predictors of Arm Nonuse in Chronic Stroke: A Preliminary Investigation

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Laurel J. Buxbaum, PsyD*, Rini Varghese, MS*, Harrison Stoll, MA*, ...

First Published June 1, 2020 Research Article Find in PubMed

https://doi.org/10.1177/1545968320913554

Article information

Abstract

Background.
 Nonuse (NU) after stroke is characterized by failure to use the contralesional arm despite adequate capacity. It has been suggested that NU is a consequence of the greater effort and/or attention required to use the affected limb, but such accounts have not been directly tested, and we have poor understanding of the predictors of NU.  
Objective.
We aimed to provide preliminary evidence regarding demographic, neuropsychological (ie, apraxia, attention/arousal, neglect), and psychological (ie, self-efficacy) factors that may influence NU in chronic stroke.  
Methods.
Twenty chronic stroke survivors with mild to moderate sensory-motor impairment characterized by the Upper-Extremity Fugl-Meyer (UEFM) were assessed for NU with a modified version of the Actual Amount of Use Test (AAUT), which measures the disparity between amount of use in spontaneous versus forced conditions. Participants were also assessed with measures of limb apraxia, spatial neglect, attention/arousal, and self-efficacy. Using stepwise multiple regression, we determined which variables predicted AAUT NU scores.  
Results. Scores on the UEFM as well as attention/arousal predicted the degree of NU (P < .05). Attention/arousal predicted NU above and beyond UEFM (P < .05).  
Conclusions. The results are consistent with the importance of attention and engagement necessary to fully incorporate the paretic limb into daily activities. Larger-scale studies that include additional behavioral (eg, sensation, proprioception, spasticity, pain, mental health, motivation) and neuroanatomical measures (eg, lesion volume and white matter connectivity) will be important for future investigations.

Keywords stroke, upper-extremity paresis, arousal, arm nonuse, attention, self-efficacy, apraxia, neglect

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