ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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JMBS 2021, 6(5): 247–254
https://doi.org/10.26693/jmbs06.05.247
Clinical Medicine

Tools for Assessing the Function of the Upper Extremity in Patients with Stroke: the Prognostic Role of Finger Extension

Khramtsov D. M. 1,2, Vorokhta Yu. M. 1,2,3, Sazonov V. Yu. 2, Grishchenko G. V. 1, Kotov S. A. 2
Abstract

The purpose of the study was to determine the prognostic role of finger extension and to assess the function of the upper extremity in patients with stroke. Materials and methods. The study was performed on the basis of the Medical Center "Expert Health" and clinical units of Petro Mohyla Black Sea National University, Mykolaiv, Ukraine during 2020-2021. 89 patients who underwent acute cerebrovascular accident by ischemic type with paresis of the upper extremity were examined. All patients were examined in accordance with current clinical protocols in 3 and 6 months after undergoing stroke. Additionally, patients underwent a standard hand function test – Action Research Arm Test, as well as an extended test – Action Research Arm Test +in its own modification (IsoTren LTD). Statistical processing was performed by methods of analysis of variance and correlation using Statisica 13.0 software (TIBCO, USA). Results and discussion. When assessing the functional status of patients, the average values of Barthel Index were 65.4±1.4 points, which corresponded to 2.7±0.3 points by modified Rankin Scale. The main difficulties were observed in such skills as writing (d170), use of means of communication (landline and mobile phone, computer, gadgets – d360), fine motor movements (d440), cooking (d630), eating (d550), washing (d510), personal hygiene (d520) and toilet use (d530), etc. When evaluated according to the standard Action Research Arm Test 3 months after the stroke, the average score was 39.9±1.5, according to the subtest of the Extensors’ Function Assessment Test – 8.3±0.4 points, which corresponds to the overall score for Action Research Arm Test +of 48.1±1.4 points. After 6 months, the score of the Action Research Arm Test 3 months after the stroke, the average score was 43.4±1.2 points ( = +8.8%), according to the subtest of the Extensors’ Function Assessment Test – 9.9±0.4 points ( = +19.3%), which corresponds to the overall score on Action Research Arm Test +of 53.2±1.3 points ( = +10.6%). Correlation analysis showed that the results of the subtest of the Extensors’ Function Assessment Test and Action Research Arm Test significantly correlate with each other (r = 0.72 p <0.01). The developed original test to assess the function of extensors has a specificity of 95.6% with a sensitivity of 98.5% (J = 0.95). This estimate corresponds to LR += 24.75, which allows us to assess the prognostic value of finger extension as very high. When assessing the internal consistency of the standard test Action Research Arm Test and Action Research Arm Test +, it was found that Cronbach = 0.87, which indicates a high degree of consistency of the tests. Conclusion. It is advisable to use the extensor function assessment test together with the standard Action Research Arm Test (modified Action Research Arm Test +)

Keywords: functional recovery, diagnosis, upper extremity, acute cerebrovascular accident

Full text: PDF (Ukr) 312K

References
  1. Bavikatte G, Subramanian G, Ashford S, Allison R, Hicklin D. Early Identification, Intervention and Management of Post-stroke Spasticity: Expert Consensus Recommendations. J Cent Nerv Syst Dis. 2021 Sep 20;13:11795735211036576. https://www.ncbi.nlm.nih.gov/pubmed/34566442; https://www.ncbi.nlm.nih.gov/pmc/articles/8461119. https://doi.org/10.1177/11795735211036576
  2. Wolf S, Gerloff C, Backhaus W. Predictive Value of Upper Extremity Outcome Measures After Stroke-A Systematic Review and Metaregression Analysis. Front Neurol. 2021 Jun 10;12:675255. https://www.ncbi.nlm.nih.gov/pubmed/34177780; https://www.ncbi.nlm.nih.gov/pmc/articles/8222610. https://doi.org/10.3389/fneur.2021.675255
  3. Levin MF, Magdalon EC, Michaelsen SM, Quevedo AA. Quality of Grasping and the Role of Haptics in a 3-D Immersive Virtual Reality Environment in Individuals With Stroke. IEEE Trans Neural Syst Rehabil Eng. 2015 Nov;23(6):1047-55. https://www.ncbi.nlm.nih.gov/pubmed/25594971. https://doi.org/10.1109/TNSRE.2014.2387412
  4. Blumenfeld H. Neuroanatomy Through Clinical Cases, Second Edition, Text with Interactive eBook. NY: Sinauer Associates; 2011. 975 p.
  5. Andersen KK, Olsen TS. One-month to 10-year survival in the Copenhagen stroke study: interactions between stroke severity and other prognostic indicators. J Stroke Cerebrovasc Dis. 2011 Mar-Apr;20(2):117-23. https://www.ncbi.nlm.nih.gov/pubmed/20580257. https://doi.org/10.1016/j.jstrokecerebrovasdis.2009.10.009
  6. Magnusson G, Ballegaard S, Karpatschof B, Nyboe J. Long-term effects of integrated rehabilitation in patients with stroke: a nonrandomized comparative feasibility study. J Altern Complement Med. 2010 Apr;16(4):369-74. https://www.ncbi.nlm.nih.gov/pubmed/20423207. https://doi.org/10.1089/acm.2009.0097
  7. McLaren R, Signal N, Lord S, Taylor S, Henderson J, Taylor D. The volume and timing of upper limb movement in acute stroke rehabilitation: still room for improvement. Disabil Rehabil. 2020 Nov;42(22):3237-3242. https://www.ncbi.nlm.nih.gov/pubmed/30951402. https://doi.org/10.1080/09638288.2019.1590471
  8. Borges LR, Fernandes AB, Melo LP, Guerra RO, Campos TF. Action observation for upper limb rehabilitation after stroke. Cochrane Database Syst Rev. 2018 Oct 31;10(10):CD011887. https://www.ncbi.nlm.nih.gov/pubmed/30380586; https://www.ncbi.nlm.nih.gov/pmc/articles/6517007. https://doi.org/10.1002/14651858.CD011887.pub2
  9. Cooray C, Mazya MV, Bottai M, Scheitz JF, Abdul-Rahim AH, Moreira TP, et al. Are you suffering from a large arterial occlusion? Please raise your arm! Stroke Vasc Neurol. 2018 Sep 3;3(4):215-221. https://www.ncbi.nlm.nih.gov/pubmed/30637127; https://www.ncbi.nlm.nih.gov/pmc/articles/6312073. https://doi.org/10.1136/svn-2018-000165
  10. Grattan ES, Velozo CA, Skidmore ER, Page SJ, Woodbury ML. Interpreting Action Research Arm Test Assessment Scores to Plan Treatment. OTJR (Thorofare N J). 2019 Jan;39(1):64-73. https://www.ncbi.nlm.nih.gov/pubmed/29444623; https://www.ncbi.nlm.nih.gov/pmc/articles/6070435. https://doi.org/10.1177/1539449218757740
  11. Lang CE, Waddell KJ, Barth J, Holleran CL, Strube MJ, Bland MD. Upper Limb Performance in Daily Life Approaches Plateau Around Three to Six Weeks Post-stroke. Neurorehabil Neural Repair. 2021 Oct;35(10):903-914. https://www.ncbi.nlm.nih.gov/pubmed/34510934; https://www.ncbi.nlm.nih.gov/pmc/articles/8442937. https://doi.org/10.1177/15459683211041302
  12. Simpson LA, Hayward KS, McPeake M, Field TS, Eng JJ. Challenges of Estimating Accurate Prevalence of Arm Weakness Early After Stroke. Neurorehabil Neural Repair. 2021 Oct;35(10):871-879. https://www.ncbi.nlm.nih.gov/pubmed/34319189; https://www.ncbi.nlm.nih.gov/pmc/articles/8442135. https://doi.org/10.1177/15459683211028240
  13. Nakayama H, Jørgensen HS, Raaschou HO, Olsen TS. Compensation in recovery of upper extremity function after stroke: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 1994 Aug;75(8):852-7. https://www.ncbi.nlm.nih.gov/pubmed/8053790. https://doi.org/10.1016/0003-9993(94)90108-2
  14. Kwakkel G, Wagenaar RC, Twisk JW, Lankhorst GJ, Koetsier JC. Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial. Lancet. 1999 Jul 17;354(9174):191-6. https://www.ncbi.nlm.nih.gov/pubmed/10421300. https://doi.org/10.1016/S0140-6736(98)09477-X
  15. Smania N, Paolucci S, Tinazzi M, Borghero A, Manganotti P, Fiaschi A, et al. Active finger extension: a simple movement predicting recovery of arm function in patients with acute stroke. Stroke. 2007 Mar;38(3):1088-90. https://www.ncbi.nlm.nih.gov/pubmed/17255546. https://doi.org/10.1161/01.STR.0000258077.88064.a3.
  16. Houwink A, Nijland RH, Geurts AC, Kwakkel G. Functional recovery of the paretic upper limb after stroke: who regains hand capacity? Arch Phys Med Rehabil. 2013 May;94(5):839-44. https://www.ncbi.nlm.nih.gov/pubmed/23201317. https://doi.org/10.1016/j.apmr.2012.11.031.
  17. Jonsdottir J, Thorsen R, Aprile I, Galeri S, Spannocchi G, Beghi E, et al. Arm rehabilitation in post stroke subjects: A randomized controlled trial on the efficacy of myoelectrically driven FES applied in a task-oriented approach. PLoS One. 2017 Dec 4;12(12):e0188642. https://www.ncbi.nlm.nih.gov/pubmed/29200424; https://www.ncbi.nlm.nih.gov/pmc/articles/5714329. https://doi.org/10.1371/journal.pone.0188642
  18. Plantin J, Verneau M, Godbolt AK, Pennati GV, Laurencikas E, Johansson B, et al. Recovery and Prediction of Bimanual Hand Use After Stroke. Neurology. 2021 Aug 17;97(7):e706-e719. https://www.ncbi.nlm.nih.gov/pubmed/34400568; https://www.ncbi.nlm.nih.gov/pmc/articles/8377875. https://doi.org/10.1212/WNL.0000000000012366
  19. International Classification of Functionality. Available from: https://www.icf-research-branch.org/download
  20. Borovikov VP. STATISTICA: Iskusstvo analiza dannykh na kompyutere [Statistica: The art of data analysis on the computer]. SPb: Piter; 2003. 700 s. [Russian]