Matching Task Difficulty to Patient Ability During Task Practice Improves Upper Extremity Motor Skill After Stroke: A Proof-of-Concept Study.
To test the feasibility of the Fugl-Meyer Assessment of the Upper Extremity "keyform," derived from Rasch analysis, as a method for systematically planning and progressing rehabilitation.



Feasibility study, single group design.



University rehabilitation research laboratory.



Participants (N=10; mean age, 59.70±9.96y; 24.1±30.54mo poststroke) with ischemic or hemorrhagic stroke >3 months prior, voluntarily shoulder flexion ≥30°, and simultaneous elbow extension ≥20°.



The keyform method defined initial rehabilitation targets (goals) and progressed the rehabilitation program after every third session. Targets were repetitively practiced within the context of client-selected functional tasks not in isolation.



Feasibility was defined by subject's pain or fatigue, upper extremity motor function (Wolf Motor Function Test), and movement patterns (kinematics). Assessments were administered pre- and posttreatment and compared using paired t tests. Task-difficulty and patient-ability measures were calculated using Rasch analysis and compared using paired t tests (P<.05).



Ten participants completed 9 sessions, 200 movement repetitions per session in <2 hours without pain or fatigue. Participants gained upper extremity motor function (Wolf Motor Function Test: pretreatment, 22.23±24.26s; posttreatment, 15.46±22.12s; P=.01), improved shoulder-elbow coordination (index of curvature: pretreatment, 1.30±0.15; posttreatment, 1.21±0.11; P=.01), and exhibited reduced trunk compensatory movement (trunk displacement: pretreatment, 133.97±74.15mm; posttreatment, 108.08±64.73mm; P=.02). Task-difficulty and patient-ability measures were not statistically different throughout the program (person-ability measures of 1.01±0.05, 1.64±0.45, and 2.22±0.65 logits and item-difficulty measures of 0.93±0.37, 1.70±0.20, and 2.06±0.24 logits at the 3 testing time points, respectively; P>.05).



The Fugl-Meyer Assessment of the Upper Extremity keyform is a feasible method to ensure that the difficulty of tasks practiced were well matched to initial and evolving levels of upper extremity motor ability.
Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC; Department of Health Science and Research, Medical University of South Carolina, Charleston, SC; Division of Occupational Therapy, Department of Health Professions, Medical University of South Carolina, Charleston, SC. Electronic address: WoodbuML@musc.edu.
Michelle L
ML
Woodbury
Department of Health Science and Research, Medical University of South Carolina, Charleston, SC.
Kelly
K
Anderson
Department of Health Science and Research, Medical University of South Carolina, Charleston, SC.
Christian
C
Finetto
Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC; Department of Health Science and Research, Medical University of South Carolina, Charleston, SC.
Andrew
A
Fortune
Department of Health Science and Research, Medical University of South Carolina, Charleston, SC.
Blair
B
Dellenbach
Department of Health Science and Research, Medical University of South Carolina, Charleston, SC.
Emily
E
Grattan
Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC; Department of Health Science and Research, Medical University of South Carolina, Charleston, SC; Division of Occupational Therapy, Department of Health Professions, Medical University of South Carolina, Charleston, SC.
Scott
S
Hutchison
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D004185:Disability Evaluation; D005221:Fatigue / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009048:Motor Skills; D010146:Pain / Q000503:physiopathology; D016059:Range of Motion, Articular; D000071939:Stroke Rehabilitation / Q000379:methods*; D034941:Upper Extremity / Q000503:physiopathology*
Occupational therapy; Rehabilitation; Stroke