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      Proprioception deficits in chronic stroke—Upper extremity function and daily living

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      PLoS ONE
      Public Library of Science

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          Abstract

          Background

          Proprioception deficits are common post-stroke and predict poor functional outcome. It is unknown if the presence of proprioception deficits is negatively associated with the motor and functional ability of the affected upper extremity and daily living at the chronic stage post-stroke.

          Aims

          1) To describe proprioception deficits of individuals with chronic stroke, 2) to correlate the severity of proprioception deficits with the motor and functional ability of the upper extremity, and 3) to compare independence in basic and instrumental activities in daily living (BADL, IADL), upper extremity motor and functional abilities between individuals with and without proprioception deficits.

          Methods

          102 adults aged 29–85 years with chronic stroke participated in this cross sectional study. The upper extremity was assessed for proprioception (Thumb localization Test), motor [Fugl-Meyer Motor Assessment (FMA)] and functional ability [Action Research Arm Test (ARAT), Box and Block Test (BBT)], grip strength and daily use [Motor Activity Log (MAL)]. Independence in BADL and IADL was also assessed.

          Results

          71 participants had intact proprioception, 31 participants had mild-moderate proprioception deficits. Negative significant (p<.001) correlations were found between the severity of proprioception deficits to the motor ability (FMA) (r = -.41), functional ability (ARAT) (r = -.48), dexterity (BBT) (r = -.43), grip strength (r = -.41) and daily-use (MAL amount and quality) (r = -.55 and r = -.54, respectively) of the affected upper extremity. Significant between-group differences were found for BADL, IADL and upper extremity measures.

          Conclusion

          Proprioception deficits of individuals with chronic stroke are negatively associated with upper extremity motor and functional abilities and independence in daily living. Therefore, proprioception should be assessed at the chronic stage post-stroke.

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          Most cited references36

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          A performance test for assessment of upper limb function in physical rehabilitation treatment and research.

          R C Lyle (1981)
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            Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident.

            This study establishes intratester reliability for all components of physical performance and intertester reliability for the total scores of upper and lower extremity motor performance in a cumulative numerical scoring system devised by Fugl-Meyer et al. Intertester reliability was found to be high for the total scores of upper and lower extremity motor performance. All intratester and intertester reliability coefficients were high and statistically significant. Establishing the reliability of the Fugl-Meyer method of assessing recovery of function following cerebrovascular accident has increased the usefulness of this method for clinical assessment and as a tool for the comparative analysis of the effectiveness of various therapeutic interventions.
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              Reliability and validity of the upper-extremity Motor Activity Log-14 for measuring real-world arm use.

              In research on Constraint-Induced Movement (CI) therapy, a structured interview, the Motor Activity Log (MAL), is used to assess how stroke survivors use their more-impaired arm outside the laboratory. This article examines the psychometrics of the 14-item version of this instrument in 2 chronic stroke samples with mild-to-moderate upper-extremity hemiparesis. Participants (n=41) in the first study completed MALs before and after CI therapy or a placebo control procedure. In addition, caregivers independently completed a MAL on the participants. Participants (n=27) in the second study completed MALs and wore accelerometers that monitored their arm movements for 3 days outside the laboratory before and after an automated form of CI therapy. Validity of the participant MAL Quality of Movement (QOM) scale was supported. Correlations between pretreatment-to-posttreatment change scores on the participant QOM scale and caregiver MAL QOM scale, caregiver MAL amount of use (AOU) scale, and accelerometer recordings were 0.70, 0.73, and 0.91 (P 0.81), test-retest reliability (r>0.91), stability, and responsiveness (ratio>3) of the participant QOM scale were also supported. The participant AOU and caregiver QOM and AOU scales were internally consistent, stable, and sensitive, but were not reliable. The participant MAL QOM scale can be used exclusively to reliably and validly measure real-world, upper-extremity rehabilitation outcome and functional status in chronic stroke patients with mild-to-moderate hemiparesis.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                30 March 2018
                2018
                : 13
                : 3
                : e0195043
                Affiliations
                [001]Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
                University of Chicago, UNITED STATES
                Author notes

                Competing Interests: The author has declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0001-6410-2389
                Article
                PONE-D-17-35864
                10.1371/journal.pone.0195043
                5877860
                29601594
                ff7a4182-d02d-43ea-bc9d-3daeac735d2a
                © 2018 Debbie Rand

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 5 October 2017
                : 15 March 2018
                Page count
                Figures: 0, Tables: 2, Pages: 10
                Funding
                The author received no specific funding for this work.
                Categories
                Research Article
                Biology and Life Sciences
                Neuroscience
                Sensory Perception
                Proprioception
                Biology and Life Sciences
                Psychology
                Sensory Perception
                Proprioception
                Social Sciences
                Psychology
                Sensory Perception
                Proprioception
                Medicine and Health Sciences
                Neurology
                Cerebrovascular Diseases
                Stroke
                Medicine and Health Sciences
                Vascular Medicine
                Stroke
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Limbs (Anatomy)
                Arms
                Hands
                Thumbs
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Limbs (Anatomy)
                Arms
                Hands
                Thumbs
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Limbs (Anatomy)
                Arms
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Limbs (Anatomy)
                Arms
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Limbs (Anatomy)
                Arms
                Hands
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Limbs (Anatomy)
                Arms
                Hands
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognitive Neuroscience
                Cognitive Neurology
                Cognitive Impairment
                Biology and Life Sciences
                Neuroscience
                Cognitive Neuroscience
                Cognitive Neurology
                Cognitive Impairment
                Medicine and Health Sciences
                Neurology
                Cognitive Neurology
                Cognitive Impairment
                Biology and Life Sciences
                Biomechanics
                Hand Strength
                Research and Analysis Methods
                Research Assessment
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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