Recovering Motor Function After Stroke and Motor

Recovering Motor Function After Stroke Stroke and Motor Learning Strategies for Recovering Motor Function after Stroke Strategies for Recovering Motor Function after Stroke On an annual basis, close to a million U.S. citizens are hospitalized for stroke and their length of stay averages 5.3 days (NHLBI, 2013). Close to 60% of these are first time stroke patients. In terms of morbidity, stroke is responsible or 1.7 million Americans currently suffering from chronic physical and/or cognitive impairment.

With nearly 80% of all stroke survivors suffering from limb impairment (reviewed by Thieme et al., 2012), there is a great need for remedial strategies that minimize the level of disability these patients suffer from. This report will review recent research in the area of upper limb rehabilitation strategies to better understand progress being made in this area of research. Assessing Upper Limb Motor Impairment As Higgins and colleagues (2011) discuss, there is a lack of standardization concerning functional evaluation of upper limbs following a stroke.

To try and remedy this situation they developed an instrument designed to provide an accurate, score-based assessment of upper limb disability in stroke patients. The obvious advantages would be to create criteria that will allow doctors and researchers to establish baseline data and track the progress of rehabilitation efforts, and then directly compare patient data nationally and internationally. Towards this goal, Higgins and colleagues (2011) collected assessment items from a number of different sources and combined them to create a prospective Stroke Arm Ladder.

Some of the items included were how flexible arm and shoulder joints were, whether certain hand and arm manipulations could be demonstrated, and whether the patient could bathe and feed themselves or pick up a coin. The starting list contained 99 items and these were tested statistically using previously-published patient data for 942 stroke victims. Divergent and convergent validity was determined by comparing their findings to other tests and indices. Using the ?2 and F. statistic, the 99 items were pared down to just 34 (Higgins, Finch, Kopec, and Mayo, 2011).

Two important criteria used to test the items were (1) time since stroke event and (2) whether the item could be quantified numerically. Based on their analysis, time since stroke event was not a significant influence on item scores. This implied that the Stroke Arm Ladder can be used to assess upper limb function independent of time since stroke. Gender was also found to have little influence on item scores.

Some of the tasks on the final Stroke Arm Ladder included opening a jar or pill bottle, addressing and stamping an envelope, shrugging, picking up coins, bouncing a ball, clapping hands overhead and behind back, and clipping toenails (Higgins, Finch, Kopec, and Mayo, 2011). The Stroke Arm Ladder was also assessed for reliability, which is a measure of the instrument's ability to accurately determine a patient's disability severity, and sensitivity, which is a measure of the instrument's ability to detect differences between patients.

Based on their results, Higgins and colleagues (2011) argue that the Stroke Arm Ladder represents a reasonable prospective instrument for assessing the level of upper limb disability a stroke patient may be suffering from. However, further testing on patients and by randomized caregivers will be needed before the Stroke Arm Ladder will be ready for clinical use. Retraining the Mind-Body Connection A number of different strategies have been utilized to improve limb motor control following a stroke (reviewed by Thieme et al., 2012).

These strategies include robotic training, biofeedback, electrical stimulation, and motor imagery. However, Thiele and colleagues (2012) argue that while these techniques have improved arm function, improvements in daily living task performance have been lacking. One technique that has shown promise for improving the ability of patients to perform daily tasks is mirror therapy, which involves positioning a mirror in between the legs of the patient. From the patient's perspective, watching the movements of the good arm in the mirror creates the feeling of improved mobility of the impaired arm.

The goal of mirror therapy is therefore to reduce the level of visuospatial neglect the patient may be experiencing towards the impaired arm. To test the efficacy of mirror therapy for patients who are already well into their rehabilitation program, patients were randomized to receive either individual mirror therapy (N = 18), group (N = 21; 2 to 6 patients) mirror therapy, or mock mirror therapy (N = 21) (Thieme et al., 2012). Time since stroke was an average of 45 days. Average age of the 49 patients included in the study was 67 years and about two thirds were males.

Improvements in arm function were measured using the Fugl-Meyer Test -- arm section, Action Research Arm test, Barthel Index for daily living, Stroke Impact Scale, modified Ashworth Scale, and the Star Cancellation Test. All instruments, except the modified Ashworth Scale and Star Cancellation Test, revealed all treatment groups experienced significant improvement after 20 therapy sessions over the course of 5-week intervention (p < 0.002) (Thieme et al., 2012). In contrast to this finding, the Ashworth Scale and Star Cancellation Test revealed between group differences.

The Ashworth scale, which is used to assess changes in passive finger and wrist movement resistance, revealed that individual mirror therapy patients experienced significant improvement in finger flexors (p < 0.001), but not for wrist flexors (p = 0.08) and that intergroup difference.