Arm function after stroke: measurement and recovery over the first three months

 In the 38 years since this, what EXACTLY has your competent? doctor initiated to get you recovered? DONE NOTHING? So, you DON'T have a functioning stroke doctor, do you?

I would completely fail the Frenchay Arm Test, Nine Hole Peg Test and the finger tapping test. NOTHING HERE would get any survivor recovered! Completely fucking useless!

Arm function after stroke: measurement and recovery over the first three months

ANDREW HELLER, DERICK T WADE, VICTORINE A WOOD, ALAN SUNDERLAND, RICHARD LANGTON HEWER, ELIZABETH WARD 

1987, Journal of Neurology, Neurosurgery & Psychiatry

From the Frenchay Stroke Unit, Department of Neurology, Frenchay Hospital, Bristol, UK SUMMARY Four short, simple measures of arm function, suitable for use with patients recovering from acute stroke, are described. These tests are: the Frenchay Arm Test, the Nine Hole Peg Test, finger tapping rate and grip strength. Good interobserver and test-retest reliability was demonstrated for all tests, and the Frenchay Arm Test was shown to be valid. Normal values for all tests were established on 63 controls. It was found that the limited sensitivity of the Frenchay Arm Test could be improved using the Nine Hole Peg Test and grip strength. Recovery of arm function has been studied in a sample of 56 patients seen regularly over the first 3 months after their stroke, using these standard measures. The results demonstrated a wide variation in recovery curves between patients. The use of the Nine Hole Peg Test enabled further recovery to be detected after patients achieved a top score on the Frenchay Arm Test. Failure to recover measurable grip strength before 24 days was associated with absence of useful arm function at three months. Measurement of finger tapping rate was not useful. Progress in science is dependent upon, and frequently follows, the development of new measurement techniques('Measurements' DO NOTHING TO GET SURVIVORS RECOVERED!). In the context of controlled trials of physiotherapeutic techniques, the major requirements are that any measure should be: valid, reliable when used by different observers, simple enough to be used on patients who are often old and suffering other problems, and sensitive enough to detect clinically significant differences. This paper discusses measures of arm function which might fulfil these criteria. Several tests of arm function have been published. One of the first, developed by Carroll,' was long and has since been shortened and renamed the Action Research Armtest.2 Tests of motor function3 4 often include specific tests of arm function. It is probable that most tests give similar results.5 Our unit has had an interest in recovery of arm function after stroke, and its measurement, for some 6 7 years. Starting with 25 clinical tests we have reduced the number to five which now constitute the Address for reprint requests: Dr R Langton Hewer, Department of Neurology, Frenchay Hospital, Bristol BS16 ILE, UK. Received 4 March 1986 and in revised form 8 August 1986. Accepted 23 September 1986. Frenchay Arm Test. In the first part of this paper we wish to establish the validity and reliability of the Frenchay Arm Test and compare it with some other tests of function which may add sensitivity. We then present data on recovery of arm function in the first 3 months after stroke, utilising the tests described, particularly investigating the variation among individuals. The rate of recovery of use in an arm paralysed after an acute stroke is usually fastest in the early weeks, with little change occurring after one year.68 Good recovery is unlikely if no movement is seen by one month.8 Recovery in other functions seems to follow a similar pattern: for example, general function,9 10 proprioception,1" and complex cognitive functions.12 Most of these studies have presented information in terms of the average ability of all patients. One criticism of this approach is that individual variability is lost, possibly leading to unjustified pessimism concerning patients who apparently have a poor prognosis. A further difficulty arises in trying to distinguish between adaptive recovery (that is, learning new ways of achieving old ends) and intrinsic recovery.'3 The recovery of arm function might reflect intrinsic recovery.6 714 group.bmj.com on October 9, 2016 -Measurement and recovery of arm function The tests Four separate tests will be discussed: 

(a) The Frenchay Arm Test, which takes less than 3 minutes to complete, consists of five pass/fail tasks, the patient scoring I for each one completed successfully. The patient sits at a table with his hands in his lap, and each task starts from this position. He is then asked to use his affected arm/hand to: 

1. Stabilise a ruler, while drawing a line with a pencil held in the other hand. To pass, the ruler must be held firmly. 

2. Grasp a cylinder (12mm diameter, 5cm long), set on its side approximately 15cm from the table edge, lift it about 30cm and replace without dropping. 

3. Pick up a glass, half full of water positioned about 15 to 30cm from the edge of the table, drink some water and replace without spilling. 

4. Remove and replace a sprung clothes peg from a 1Omm diameter dowel, 15 cm long set in a 10 cm base, 15 to 30 cm from table edge. Not to drop peg or knock dowel over. 

5. Comb hair (or imitate); must comb across top, down the back and down each side of head. (b) Grip Strength was measured using a dynanometer (a bulb connected to an aneroid dial) on both the affected and unaffected sides. The maximum grip recordable was 300 mm Hg, which may affect our "normal" findings. The score was also recorded as a percentage of the unaffected side. (c) The Nine Hole Peg Test. 14 Sitting at a table, the patient is asked to take 9 dowels (9 mm diameter, 32 mm long) from the table top and put them into 9 holes (10 mm diameter, 15 mm deep) spaced 50 mm apart on a board. The time to complete this is recorded, with a cut-off at 50 seconds (when the number placed is recorded). The number of pegs placed per second is then calculated. (d) The fourth test was to measure the Finger Tapping Rate of the index finger over 10 seconds, using a mechanical coun- ter. This was done twice with the unaffected hand, and then twice with the affected hand. The best score was taken for each side, and the percentage of the normal side recorded. In practice it was found best to start with assessment of grip strength, then to do the Frenchay Arm Test, Nine Hole Peg Test and finally finger tapping rate, because the patient is more likely to succeed with the earlier tests. 

A modified standardized nine hole peg test for valid and reliable kinematic assessment of dexterity post-stroke

I never had this test. Probably because after spasticity set in, it was impossible to pick up the pegs and even more impossible to release them. So what the fuck is your solution to those that are that badly impaired? I expect a solution, not knowing one is medical malpractice. 

A modified standardized nine hole peg test for valid and reliable kinematic assessment of dexterity post-stroke

• Gudrun M JohanssonEmail author and
• Charlotte K Häger

Journal of NeuroEngineering and Rehabilitation201916:8

https://doi.org/10.1186/s12984-019-0479-y

©  The Author(s). 2019

• Received: 31 May 2018
• Accepted: 2 January 2019
• Published: 14 January 2019

Abstract

Background

Impairments in dexterity after stroke are commonly assessed by the Nine Hole Peg Test (NHPT), where the only outcome variable is the time taken to complete the test. We aimed to kinematically quantify and to compare the motor performance of the NHPT in persons post-stroke and controls (discriminant validity), to compare kinematics to clinical assessments of upper extremity function (convergent validity), and to establish the within-session reliability.

Methods

The NHPT was modified and standardized (S-NHPT) by 1) replacing the original peg container with an additional identical nine hole pegboard, 2) adding a specific order of which peg to pick, and 3) specifying to insert the peg taken from the original pegboard into the corresponding hole of the target pegboard. Eight optical cameras registered upper body kinematics of 30 persons post-stroke and 41 controls during the S-NHPT. Four sequential phases of the task were identified and analyzed for kinematic group differences. Clinical assessments were performed.

Results

The stroke group performed the S-NHPT slower (total movement time; mean diff 9.8 s, SE diff 1.4), less smoothly (number of movement units; mean diff 0.4, SE diff 0.1) and less efficiently (path ratio; mean diff 0.05, SE diff 0.02), and used increased scapular/trunk movements (acromion displacement; mean diff 15.7 mm, SE diff 3.5) than controls (P < 0.000, r ≥ 0.32), indicating discriminant validity. The stroke group also spent a significantly longer time grasping and releasing pegs relative to the transfer phases of the task compared to controls. Within the stroke group, kinematics correlated with time to complete the S-NHPT and the Fugl-Meyer Assessment (r_s 0.38–0.70), suggesting convergent validity. Within-session reliability for the S-NHPT was generally high to very high for both groups (ICCs 0.71–0.94).

Conclusions

The S-NHPT shows adequate discriminant validity, convergent validity and within-session reliability. Standardization of the test facilitates kinematic analysis of movement performance, which in turn enables identification of differences in movement control between persons post-stroke and controls that may otherwise not be captured through the traditional time-based NHPT. Future research should ascertain further psychometric properties, e.g. sensitivity, of the S-NHPT.

Box and Block Test v Box and Block Test vss. Nine Hole . Nine Hole Peg Test to Assess Manual Peg Test to Assess Manual Dexterity Skills in Adults who Dexterity Skills in Adults who Experience Upper Experience Upper--Extremity Extremity Hemiparesis Post-Stroke

I never had these tests, no point since I didn't have any grasp control.
http://www.tbrhsc.net/wp-content/uploads/2017/10/E-Ogilvie-Sept-19-Presentation.pdf
 BY: ERICA OGILVIE OT REG. (ONT).
EOGILVIE@SLMHC.ON.CA
STROKE REHAB 541
UNIVERSITY OF ALBERTA
NORTHWESTERN ONTARIO REGIONAL STROKE NETWORK
What is Manual Dexterity?
Stroke is the leading cause of adult disability with an estimated 25,500 new stroke events occurring annually in Ontario (Ontario Stroke Network, 2016).
Upper-extremity hemiparesis is an impairment that can impact an individual’s motor abilities post-stroke and decrease their manual dexterity skills.
Manual dexterity includes the ability to grip, manipulate, and release objects (Teremetz, Colle, Hamdoun, Maier, & Lindberg, 2015).
Important skill to possess to support engagement in activities of   daily living including grooming tasks, meal preparation, writing, and playing a musical instrument.

Effect of a mixed reality-based intervention on arm, hand, and finger function on chronic stroke

Don't worry, this will never come to fruition in your lifetime, or your childrens' lifetime, or your grandchildrens' lifetime.

Effect of a mixed reality-based intervention on arm, hand, and finger function on chronic stroke

• Carolina Colomer,
• Roberto LlorensEmail author,
• Enrique Noé and
• Mariano Alcañiz

Journal of NeuroEngineering and Rehabilitation201613:45

DOI: 10.1186/s12984-016-0153-6

©  Colomer et al. 2016

Received: 9 July 2015

Accepted: 3 May 2016

Published: 11 May 2016

Abstract

Background

Virtual and mixed reality systems have been suggested to promote motor recovery after stroke. Basing on the existing evidence on motor learning, we have developed a portable and low-cost mixed reality tabletop system that transforms a conventional table in a virtual environment for upper limb rehabilitation. The system allows intensive and customized training of a wide range of arm, hand, and finger movements and enables interaction with tangible objects, while providing audiovisual feedback of the participants’ performance in gamified tasks. This study evaluates the clinical effectiveness and the acceptance of an experimental intervention with the system in chronic stroke survivors.

Methods

Thirty individuals with stroke were included in a reversal (A-B-A) study. Phase A consisted of 30 sessions of conventional physical therapy. Phase B consisted of 30 training sessions with the experimental system. Both interventions involved flexion and extension of the elbow, wrist, and fingers, and grasping of different objects. Sessions were 45-min long and were administered three to five days a week. The body structures (Modified Ashworth Scale), functions (Motricity Index, Fugl-Meyer Assessment Scale), activities (Manual Function Test, Wolf Motor Function Test, Box and Blocks Test, Nine Hole Peg Test), and participation (Motor Activity Log) were assessed before and after each phase. Acceptance of the system was also assessed after phase B (System Usability Scale, Intrinsic Motivation Inventory).

Results

Significant improvement was detected after the intervention with the system in the activity, both in arm function measured by the Wolf Motor Function Test (p < 0.01) and finger dexterity measured by the Box and Blocks Test (p < 0.01) and the Nine Hole Peg Test (p < 0.01); and participation (p  < 0.01), which was maintained to the end of the study. The experimental system was reported as highly usable, enjoyable, and motivating.

Conclusions

Our results support the clinical effectiveness of mixed reality interventions that satisfy the motor learning principles for upper limb rehabilitation in chronic stroke survivors. This characteristic, together with the low cost of the system, its portability, and its acceptance could promote the integration of these systems in the clinical practice as an alternative to more expensive systems, such as robotic instruments.

Concurrent validity and test-retest reliability of the Virtual Peg Insertion Test to quantify upper limb function in patients with chronic stroke

I would completely fail at this test even today, 9.75 years later.
1. The peg would have to be at least 2-3 inches in diameter so I could grasp it with my whole hand.
2. I would have to be allowed to pry my fingers open with my good hand to insert the peg.
3. I would have to be standing.
4. I would have to be allowed to pry my fingers off the peg with my good hand once inserted.
5. I would need the pegboard lower than my shoulders.
Nothing here helps me to recover any of my upper limb.
My conclusion from this is that assessment research is almost completely worthless. Come up with interventions that actually bring back functionality. I really wish researchers would at least think a minuscule amount about how their research will help make survivors lives better. This one does nothing of the sort. This is exactly why we need a stroke strategy, because this was a complete fucking waste of time.
http://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-016-0116-y

• Bernadette C. Tobler-Ammann,
• Eling D. de BruinEmail authorView ORCID ID profile,
• Marie-Christine Fluet,
• Olivier Lambercy,
• Rob A. de Bie and
• Ruud H. Knols

Journal of NeuroEngineering and Rehabilitation201613:8

DOI: 10.1186/s12984-016-0116-y

©  Tobler-Ammann et al. 2016

Received: 7 August 2015

Accepted: 17 January 2016

Published: 22 January 2016

Abstract

Background

Measuring arm and hand function of the affected side is vital in stroke rehabilitation. Therefore, the Virtual Peg Insertion Test (VPIT), an assessment combining virtual reality and haptic feedback during a goal-oriented task derived from the Nine Hole Peg Test (NHPT), was developed. This study aimed to evaluate (1) the concurrent validity of key outcome measures of the VPIT, namely the execution time and the number of dropped pegs, with the NHPT and Box and Block Test (BBT), and (2) the test-retest-reliability of these parameters together with the VPIT’s additional kinetic and kinematic parameters in patients with chronic stroke.

The three tests were administered on 31 chronic patients with stroke in one session (concurrent validity), and the VPIT was retested in a second session 3–7 days later (test-retest reliability). Spearman rank correlation coefficients (ρ) were calculated for assessing concurrent validity, and intraclass correlation coefficients (ICCs) were used to determine relative reliability. Bland-Altman plots were drawn and the smallest detectable difference (SDD) was calculated to examine absolute reliability.

Results

For the 31 included patients, 11 were able to perform the VPIT solely via use of their affected arm, whereas 20 patients also had to utilize support from their unaffected arm. For n = 31, the VPIT showed low correlations with the NHPT (ρ = 0.31 for time (T_ex[s]); ρ = 0.21 for number of dropped pegs (N_dp)) and BBT (ρ = −0.23 for number of transported cubes (N_tc); ρ = −0.12 for number of dropped cubes (N_dc)). The test-retest reliability for the parameters T_ex[s], mean grasping force (F_ggo[N]), number of zero-crossings (N_zc[1/sgo/return) and mean collision force (F_cmean[N]) were good to high, with ICCs ranging from 0.83 to 0.94. Fair reliability could be found for F_greturn (ICC = 0.75) and trajectory error (E_trajgo[cm]) (0.70). Poor reliability was measured for E_trajreturn[cm] (0.67) and N_dp (0.58). The SDDs were: T_ex = 70.2 s, N_dp = 0.4 pegs; F_ggo/return = 3.5/1.2 Newton; N_zc[1/s]go/return = 0.2/1.8 zero-crossings; E_trajgo/return = 0.5/0.8 cm; F_cmean = 0.7 Newton.

Conclusions

The VPIT is a promising upper limb function assessment for patients with stroke requiring other components of upper limb motor performance than the NHPT and BBT. The high intra-subject variation indicated that it is a demanding test for this stroke sample, which necessitates a thorough introduction to this assessment. Once familiar, the VPIT provides more objective and comprehensive measurements of upper limb function than conventional, non-computerized hand assessments.