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Belief, Confidence, and Motivation to Use the Paretic Upper Limb in Daily Life Over the First 24 Weeks After Stroke.

ABSTRACT: BACKGROUND AND PURPOSE:The recovery patterns of upper limb (UL) impairment after stroke are established. Psychosocial factors such as belief that paretic UL recovery is possible, confidence, and motivation to use the paretic UL in everyday tasks are unexplored early after stroke. The purpose of this exploratory study was to characterize belief, confidence, and motivation to use the paretic UL in daily life, and self-perceived barriers to UL recovery over the first 24 weeks after stroke. METHODS:This was a longitudinal cohort study (N = 30) with 8 assessment sessions over the first 24 weeks after stroke. Belief, confidence, and motivation to use the paretic UL and self-perceived barriers were quantified via survey and analyzed using descriptive statistics. Change in the number of self-perceived barriers between weeks 2 and 24 was tested using a paired-samples t test. The relationship between UL capacity, depressive symptomatology, cognition, and each psychosocial factor was examined using Spearman rank-order correlation analyses. RESULTS:Twenty-two participants completed all study assessments. Belief, confidence, and motivation were high across the 24 weeks, with little variation. There was no difference between the average number of barriers from weeks 2 to 24. There was no relationship between the clinical measures and psychosocial factors at week 2, 12, or 24. DISCUSSION AND CONCLUSIONS:High levels of belief, confidence, and motivation appear consistent over the first 6 months after stroke. The lack of correlations between psychosocial factors and clinical measures suggests belief, confidence, and motivation may not be vulnerable to functional status early after stroke.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A283).

SUBMITTER: Waddell KJ

PROVIDER: S-EPMC6744298 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Belief, Confidence, and Motivation to Use the Paretic Upper Limb in Daily Life Over the First 24 Weeks After Stroke.

Waddell Kimberly J KJ Tabak Rachel G RG Strube Michael J MJ Haire-Joshu Debra D Lang Catherine E CE

Journal of neurologic physical therapy : JNPT 20191001 4

<h4>Background and purpose</h4>The recovery patterns of upper limb (UL) impairment after stroke are established. Psychosocial factors such as belief that paretic UL recovery is possible, confidence, and motivation to use the paretic UL in everyday tasks are unexplored early after stroke. The purpose of this exploratory study was to characterize belief, confidence, and motivation to use the paretic UL in daily life, and self-perceived barriers to UL recovery over the first 24 weeks after stroke.< ...[more]

PMID: 31436612

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Project description:BACKGROUND: MUNDUS is an assistive framework for recovering direct interaction capability of severely motor impaired people based on arm reaching and hand functions. It aims at achieving personalization, modularity and maximization of the user's direct involvement in assistive systems. To this, MUNDUS exploits any residual control of the end-user and can be adapted to the level of severity or to the progression of the disease allowing the user to voluntarily interact with the environment. MUNDUS target pathologies are high-level spinal cord injury (SCI) and neurodegenerative and genetic neuromuscular diseases, such as amyotrophic lateral sclerosis, Friedreich ataxia, and multiple sclerosis (MS). The system can be alternatively driven by residual voluntary muscular activation, head/eye motion, and brain signals. MUNDUS modularly combines an antigravity lightweight and non-cumbersome exoskeleton, closed-loop controlled Neuromuscular Electrical Stimulation for arm and hand motion, and potentially a motorized hand orthosis, for grasping interactive objects. METHODS: The definition of the requirements and of the interaction tasks were designed by a focus group with experts and a questionnaire with 36 potential end-users. RESULTS: The functionality of all modules has been successfully demonstrated. User's intention was detected with a 100% success. Averaging all subjects and tasks, the minimum evaluation score obtained was 1.13?±?0.99 for the release of the handle during the drinking task, whilst all the other sub-actions achieved a mean value above 1.6. All users, but one, subjectively perceived the usefulness of the assistance and could easily control the system. Donning time ranged from 6 to 65 minutes, scaled on the configuration complexity. CONCLUSIONS: The MUNDUS platform provides functional assistance to daily life activities; the modules integration depends on the user's need, the functionality of the system have been demonstrated for all the possible configurations, and preliminary assessment of usability and acceptance is promising.

Project description:BackgroundThe use of wearable sensor technology (e.g., accelerometers) for tracking human physical activity have allowed for measurement of actual activity performance of the upper limb (UL) in daily life. Data extracted from accelerometers can be used to quantify multiple variables measuring different aspects of UL performance in one or both limbs. A limitation is that several variables are needed to understand the complexity of UL performance in daily life.PurposeTo identify categories of UL performance in daily life in adults with and without neurological UL deficits.MethodsThis study analyzed data extracted from bimanual, wrist-worn triaxial accelerometers from adults from three previous cohorts (N=211), two samples of persons with stroke and one sample from neurologically intact adult controls. Data used in these analyses were UL performance variables calculated from accelerometer data, associated clinical measures, and participant characteristics. A total of twelve cluster solutions (3-, 4- or 5-clusters based with 12, 9, 7, or 5 input variables) were calculated to systematically evaluate the most parsimonious solution. Quality metrics and principal component analysis of each solution were calculated to arrive at a locally-optimal solution with respect to number of input variables and number of clusters.ResultsAcross different numbers of input variables, two principal components consistently explained the most variance. Across the models with differing numbers of UL input performance variables, a 5-cluster solution explained the most overall total variance (79%) and had the best model-fit.ConclusionThe present study identified 5 categories of UL performance formed from 5 UL performance variables in cohorts with and without neurological UL deficits. Further validation of both the number of UL performance variables and categories will be required on a larger, more heterogeneous sample. Following validation, these categories may be used as outcomes in UL stroke research and implemented into rehabilitation clinical practice.

Project description:BackgroundUpper limb paresis is one of the most frequent and persistent impairments following stroke. Only 12-34% of stroke patients achieve full recovery of upper limb functioning, which seems to be required to habitually use the affected arm in daily tasks. Although the recovery of upper limb functioning is most pronounced during the first 4 weeks post stroke, there are few studies investigating the effect of rehabilitation during this critical time window. The purpose of this trial is to determine the effect of electrical somatosensory stimulation (ESS) initiated in the acute stroke phase on the recovery of upper limb functioning in a nonselected sample of stroke patients.Methods/designA sample of 102 patients with upper limb paresis of varying degrees of severity is assigned to either the intervention or the control group using stratified random sampling. The intervention group receives ESS plus usual rehabilitation and the control group receives sham ESS plus usual rehabilitation. The intervention is applied as 1 h of ESS/sham ESS daily, followed by motor training of the affected upper limb. The ESS/sham ESS treatment is initiated within 7 days from stroke onset and it is delivered during hospitalization, but no longer than 4 weeks post stroke. The primary outcome is hand dexterity assessed by the Box and Block Test; secondary outcomes are the Fugl-Meyer Assessment, hand grip strength, pinch strength, perceptual threshold of touch, degree of pain, and modified Rankin Scale score. Outcome measurements are conducted at baseline, post intervention and at 6-month follow-up.DiscussionBecause of the wide inclusion criteria, we believe that the results can be generalized to the larger population of patients with a first-ever stroke who present with an upper limb paresis of varying severity. On the other hand, the sample size (n = 102) may preclude subgroup analyses in such a heterogeneous sample. The sham ESS treatment totals a mere 2% of the active ESS treatment delivered to the intervention group per ESS session, and we consider that this dose is too small to induce a treatment effect.Trial registrationClinicalTrials.gov, NCT02250365 . Registered on 18 September 2014.

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Belief, Confidence, and Motivation to Use the Paretic Upper Limb in Daily Life Over the First 24 Weeks After Stroke.

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Belief, Confidence, and Motivation to Use the Paretic Upper Limb in Daily Life Over the First 24 Weeks After Stroke.

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