Dexterity Test You Can Use for Stroke Patients

 Watching this; unless your are a high functioning stroke patient you will fail. I would fail at the reaching part due to spasticity, fail at hand opening due to spasticity, completely fail the whole test!

SO DEMAND YOUR THERAPIST CURE YOUR SPASTICITY FIRST!

Dexterity Test You Can Use for Stroke Patients

The association between dexterity and upper limb impairment during stroke recovery

 'Assessments' and 'associations' ARE ABSOLUTELY WORTHLESS in getting survivors recovered! You'll want full recovery when you are the 1 in 4 per WHO that has a stroke!

You just might want to start that research now.

The association between dexterity and upper limb impairment during stroke recovery

Belen Valladares^1,2*Robinson Georg Kundert²Johannes Pohl³Jeremia P. O. Held¹Andreas R. Luft^1,2Janne Marieke Veerbeek^4†Meret Branscheidt^1,2†

• ¹Department of Neurology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
• ²Cereneo Center for Research and Neurorehabilitation, Vitznau, Switzerland
• ³Data Analytics and Rehabilitation Technology (DART), Lake Lucerne Institute, Vitznau, Switzerland
• ⁴Clinic for Neurology and Neurorehabilitation, Luzerner Kantonsspital, University Teaching and Research Hospital, and University of Lucerne, Lucerne, Switzerland

Introduction: Stroke-induced upper limb disabilities can be characterized by both motor impairments and activity limitations, commonly assessed using Fugl-Meyer Motor Assessment for Upper Extremity (FMMA-UE) and Action Research Arm Test (ARAT), respectively. The relationship between the two assessments during recovery is largely unstudied. Expectedly they diverge over time when recovery of impairment (restitution) plateaus, but compensation-driven improvements still occur. The objective of this study is to evaluate the alignment between FMMA-UE and ARAT in defining upper limb functional recovery categories by ARAT scores. We aimed to establish cut-off scores for both measures from the acute/early subacute, subacute and chronic stages of stroke recovery.

Methods: Secondary analysis of four prospective cohort studies (acute/early subacute: n = 133, subacute: n = 113, chronic: n = 92) stages post-stroke. Receiver operating characteristic curves calculated the area under the curve (AUC) to establish optimal FMMA-UE cut-offs based on predefined ARAT thresholds distinguishing five activity levels from no activity to full activity. Weighted kappa was used to determine agreement between the two assessments. We used minimally clinically important difference (MCID) and minimal detectable change (MDC₉₅) for comparison.

Results: FMMA-UE and ARAT scores showed no relevant divergence across all recovery stages. Results indicated similar cut-off scores in all recovery stages with variability below MCID and MDC₉₅ levels. Cut-off scores demonstrated robust AUC values from 0.77 to 0.86 at every recovery stage. Only in highly functional patients at the chronic stage, we found a reduced specificity of 0.55. At all other times sensitivity ranged between 0.68 and 0.99 and specificity between 0.71 and 0.99. Weighted kappa at the acute/early subacute, subacute and chronic stages was 0.76, 0.83, and 0.81, respectively.

Discussion: Our research shows a strong alignment between FMMA-UE and ARAT cut-off scores throughout stroke recovery, except among the subgroup of highly recovered patients at the chronic stage. Discrepancies in specificity potentially stem from fine motor deficits affecting dexterity outcomes that are not captured by FMMA-UE. Additionally, the high congruence of both measures suggests they are not suited to distinguish between restitution and compensation. Calling for more comprehensive assessment methods to better understand upper limb functionality in rehabilitation.(NO, NO,NO! Solve stroke recovery instead!)

Rudimentary Dexterity Corresponds With Reduced Ability to Move in Synergy After Stroke: Evidence of Competition Between Corticoreticulospinal and Corticospinal Tracts?

How in the hell is anything here going to help survivors recover?

Rudimentary Dexterity Corresponds With Reduced Ability to Move in Synergy After Stroke: Evidence of Competition Between Corticoreticulospinal and Corticospinal Tracts?

Merav R. Senesh, MSc, Karina Barragan, David J. Reinkensmeyer, PhD

First Published August 24, 2020 Research Article Find in PubMed 

https://doi.org/10.1177/1545968320943582

Article information

 

Abstract

Objective

When a stroke damages the corticospinal tract (CST), it has been hypothesized that the motor system switches to using the corticoreticulospinal tract (CRST) resulting in abnormal arm synergies. Is use of these tracts mutually exclusive, or can the motor system spontaneously switch between them depending on the type of movement it wants to make? If the motor system can share control at will, then people with a rudimentary ability to make dexterous movements should be able to perform synergistic arm movements as well.

Methods

We analyzed clinical assessments of 319 persons’ abilities to perform “out-of-synergy” and “in-synergy” arm movements after chronic stroke using the Upper Extremity Fugl-Meyer (UEFM) scale.

Results

We identified a moderate range of arm impairment (UEFM = ~30-40) where subjects had a rudimentary ability to make out-of-synergy (~23%-50% on the out-of-synergy score) and dexterous hand movements (~3-10 blocks on Box and Blocks Test). Below this range persons could perform in-synergy but not out-of-synergy or dexterous movements. In the moderate range, however, scoring better on out-of-synergy movements correlated with scoring worse on in-synergy movements (P = .001, r ≈ −0.6).

Conclusion

Rudimentary dexterity corresponded with reduced ability to move the arm in-synergy. This finding supports the idea that CST and CRST compete and has implications for rehabilitation therapy.

Keywords stroke, arm movement, dexterity, motor control, synergies, corticospinal tract

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A novel method for the quantification of key components of manual dexterity after stroke

I never could do any affected side finger dexterity tasks and still can't do any. You'll have to send your doctor after these protocols and tests since we have no standard place to store them for all clinicians to use. Another failure of our stroke associations.
 http://www.jneuroengrehab.com/content/12/1/64

Maxime Térémetz^1*, Florence Colle²³, Sonia Hamdoun², Marc A. Maier¹⁴ and Påvel G. Lindberg¹³

• * Corresponding author: Maxime Térémetz mteremetz@gmail.com

Author Affiliations

¹ FR3636 CNRS, Université Paris Descartes, Sorbonne Paris Cité, Paris, 75006, France
² Service de Médecine Physique et de Réadaptation, Université Paris Descartes, Hôpital Sainte-Anne, Paris, 75014, France
³ Centre de Psychiatrie et Neurosciences, Inserm U894, Paris, 75014, France
⁴ Université Paris Diderot, Sorbonne Paris Cité, Paris, 75013, France

For all author emails, please log on.

Journal of NeuroEngineering and Rehabilitation 2015, 12:64  doi:10.1186/s12984-015-0054-0
The electronic version of this article is the complete one and can be found online at: http://www.jneuroengrehab.com/content/12/1/64

Received:	7 April 2015
Accepted:	13 July 2015
Published:	2 August 2015

© 2015 Térémetz et al.

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Abstract

Background

A high degree of manual dexterity is a central feature of the human upper limb. A rich interplay of sensory and motor components in the hand and fingers allows for independent control of fingers in terms of timing, kinematics and force. Stroke often leads to impaired hand function and decreased manual dexterity, limiting activities of daily living and impacting quality of life. Clinically, there is a lack of quantitative multi-dimensional measures of manual dexterity. We therefore developed the Finger Force Manipulandum (FFM), which allows quantification of key components of manual dexterity. The purpose of this study was (i) to test the feasibility of using the FFM to measure key components of manual dexterity in hemiparetic stroke patients, (ii) to compare differences in dexterity components between stroke patients and controls, and (iii) to describe individual profiles of dexterity components in stroke patients.

Methods

10 stroke patients with mild-to-moderate hemiparesis and 10 healthy subjects were recruited. Clinical measures of hand function included the Action Research Arm Test and the Moberg Pick-Up Test. Four FFM tasks were used: (1) Finger Force Tracking to measure force control, (2) Sequential Finger Tapping to measure the ability to perform motor sequences, (3) Single Finger Tapping to measure timing effects, and (4) Multi-Finger Tapping to measure the ability to selectively move fingers in specified combinations (independence of finger movements).

Results

Most stroke patients could perform the tracking task, as well as the single and multi-finger tapping tasks. However, only four patients performed the sequence task. Patients showed less accurate force control, reduced tapping rate, and reduced independence of finger movements compared to controls. Unwanted (erroneous) finger taps and overflow to non-tapping fingers were increased in patients. Dexterity components were not systematically related among each other, resulting in individually different profiles of deficient dexterity. Some of the FFM measures correlated with clinical scores.

Conclusions

Quantifying some of the key components of manual dexterity with the FFM is feasible in moderately affected hemiparetic patients. The FFM can detect group differences and individual profiles of deficient dexterity. The FFM is a promising tool for the measurement of key components of manual dexterity after stroke and could allow improved targeting of motor rehabilitation.

Impaired Ipsilateral Upper Extremity Dexterity and Its Relationship with Disability in Post-Stroke Right Hemiparesis

I have no clue as to the point of this research. You may as well ask if water is wet.
http://jrsr.sums.ac.ir/index.php/jrsr/article/view/20

Maryam Parsaee, Shohreh Noorizadeh Dehkordi, Mehdi Dadgoo, Malahat Akbarfahimi

Abstract

Background: The objectives of this study were to compare manual dexterity (gross and fine) and coordination performance of the ipsilateral upper extremity of the right hemisphere stroke patients with the same side of a healthy group, and to determine the relationship of ipsilateral upper extremity dexterity and disability.
Methods: In a non-randomized analytical study, 30 individuals with a unilateral first-ever stroke from outpatient rehabilitation clinics and 30 age and sex-matched adults without history of neurological disorders were enrolled. Purdue Pegboard, Box and Block, and Finger to Nose tests were used to measure dexterity (fine and gross) and coordination performance of the stroke group compared with the same hand of the healthy group. The Barthel index was also used to assess disability or dependency of stroke patients in basic activities of daily living.
Results: Results showed that stroke individuals with involvement of ipsilateral hand had less coordination and dexterity when compared to the same hand of normal subjects (P=0.001). In addition, the relationship of gross and fine manual dexterity performance of the ipsilateral upper extremity with disability, including dependence in basic activities of daily living, were significant respectively (r=0.376, r= 0.391).
Conclusion: People with right stroke had significant ipsilateral upper extremity impairments (manual dexterity and coordination tasks), and this hand dexterity deterioration had an impact on their dependence in basic activities of daily living.