| Motion Analysis |
| Biarticular dynamometer - To evaluate the potential use and function of a static dynamometer measuring torque throughout the upper extremity for use in the neurological population. This was a case study which involved one subject with hemiparesis. Torques was measured at the shoulder, elbow, and forearm at different force levels on both sides. (Boissy,1998) | Observational study of single subject Singe case study of a subject with hemiplegia measuring torque at shoulder, elbow, and forearm supination and pronation on both the affected and non-affected side. Subject was in wheelchair. Force transducers were utilized as a strain gauge. Coordinate systems, angles and lever arms, the rotational matrix, torque computation, and correction were calculated and included. Comparisons were made between the non affected and affected extremities. | Comparison of torque values on 1 subject – relatively weak evidence. The discussion did address sources of error, error estimates, and total relative error. Additional research was recommended possibly in conjunction with biofeedback. |
| Optoelectric motion analysis systems - Upper limb kinematics were analyzed during functional reach to grasp in typical and motor delayed children. The purpose of this study was to utilize kinematic analysis to provide an objective assessment of compensatory movement patterns. (Coluccini, 2007) | Observational: Descriptive Subjects included five healthy children, five healthy adults, and ten children with motor impairments. Measurements and kinematic analysis was conducted on functional reach to grasp movements of both upper extremities. The kinematic variables included: 1) head – angle of the head relative to trunk 2) trunk – angle of trunk to the lab coordinate system 3) shoulder – angle of the arm relative to the trunk 4) elbow – angle of the forearm relative to the arm 5) Wrist – angle of the hand relative to the forearm 6) end effect- displacement, velocity, and acceleration. | Statistical analysis included data from both the affected and non-affected side utilizing the Wilcoxon rank test, ANOVA, and Mann-Whitney t-test. Results showed that acceleration profiles of the hand are highly repeatable and the stability of acceleration patterns increases with increased speed. The authors concluded that children with motor impairments produce movements more slowly, unusual patterns, and repeatability was lowered. Reliability, sensitivity, and specificity were not addressed in this study. Comparisons of movement control and recruitment were examined in this study. |
Reach and Grasp Cycle using Optoelectric motion analysis system: Light-reflective markers were placed on the children at specific bony landmarks on the torso and upper limbs. Participants were seated comfortably at a height-adjustable table with hip and knees at 90 degrees flexion and both feet flat on the floor. Both arms were rested on the table so that the shoulder was in a neutral position, elbows flexed 90 degrees, forearms pronated, and wrist in neutral with palms flat on the table. A cylindrical cup was placed at 75% of the participant's maximum reach. From the start position, each participant was instructed to reach forward and grasp the cup, bring it to his/her mouth to simulate drinking, replace the cup to original location, release cup, and return his/her arm to the start position. The typically developing (TD) children were instructed to use his/her dominant hand while the patients with CP performed the task with his/her more impaired hand in order to assess the extent to which they deviated from the normal level of function. Data was recorded during single Reach and Grasp Cycle after one to two practice trials. Data was recorded using an eight-camera optoelectric motion analysis system recording at 60 Hz and filtered using a Butterworth filter with a cutoff frequency of 12 Hz. (Butler, 2010) | Observational: Descriptive Twenty-five Typically Developing (TD) children and adolescents (n=25); 11 male and 14 female, with a mean age 11.0 ± 4.1 years. Children with moderate, left-sided spastic hemiplegic CP (n=2). Both female, ages 14 and 15 years. | The utility of the Reach and Grasp Cycle was demonstrated by the consistent kinematic patterns that emerged among the TD children, as well as the clinically significant differences in joint motion that arose between the children with CP and the TD children. The Reach and Grasp Cycle allows for objective quantification of control of upper limb motion in children. Full representation of anatomically correct shoulder motion was not possible due to estimation of upper limb joint centers from external marker offset contributed to systematic error. |
| Assessment of lower extremity movement with a six camera system. Resultant leg displacement and velocity were used to determine movement characteristics including duration, distance, peak velocity, jerk, and number of acceleration peaks. (Rademacher, 2008) | Observational: Descriptive Subjects included 12 infants with myleomeningiocele and 12 with typical development. The children's spontaneous leg movements were assessed in supine. Experimental study | Data reduction was necessary secondary to technical difficulties allowing for including of 85% of trials of children with myelomeningocele and 93% of the children who were typically developing. The first three variables were calculated (duration, distance, and peak) to reflect overall efforts to initiate movement. The second three variables (velocity, jerk, and number of acceleration peaks) were calculated to address smoothness/motor control. Data analysis revealed that children with myelomeningocele across ages 1 to 6 months presented with decreased leg movements. Duration of movement was also shorter for the group with myelominingocele. Differences were seen between the two groups in symmetry and asymmetry of leg control. |
| A triaxial accelerometer was used to measure spontaneous movement in 3 dimensional spaces of the upper extremity in children who were preterm. Acceleration scores were recorded from the right wrist when the child was active over a period of 200 seconds. (Ohgi, 2008) | Observational: Descriptive Prematurity was defined a birth occurring prior to 37 weeks gestation. Premature infants with brain injury and 7 low risk premature infants were included in the study. | The acceleration time series data was analyzed with both nonlinear and linear analysis. Nonlinear time series analysis indicated that premature infants present with nonlinear, chaotic, dynamic movements. Infants with brain injury present with more unstable and unpredictable movements and increased disorganization in their movements. |
| 3-D kinematic analysis of three upper-limb functional tasks: hand-to-head task, hand-to-mouth task, and reach task at a self selected speed assessing dominant/non-dominant UE in controls and effected/unaffected UE in CP group. Twenty-one markers were placed on each child's trunk and upper limbs. Assessment was performed one time. (Mackey, 2006) | Observational: Descriptive 10 children with hemiplegic cerebral palsy (mean age, 13.3y; range, 10– 17y) and 10 control children (mean age, 9.8y; range, 6–12y). | Children with hemiplegia were significantly slower than control children in time taken to complete tasks (P<0.05). Children with hemiplegia achieved slower movement velocities (P<0.05). Children with hemiplegia had significantly less supination (P<0.03) and shoulder flexion (P<0.03) and increased compensatory trunk flexion (P<0.01) compared with control data (hand-to-mouth task). The reach task highlighted restriction of elbow extension in children with hemiplegia |
| Computerized motor –skill analyzer (CMSA) evaluated visuo-motor skilled movements of the arm. The examiners looked at the reproducibility of the measurement with the CMSA and the correlation between motor skills of the affected arm evaluated with the CMSA and clinical tests for upper extremity function. The efficacy of the CMSA in evaluating motor skills or the arm during stroke rehabilitation was addressed. Tests were administered by PTs and OTs. The therapists were blind to the results of the measurements made by the CMSA. (Yamanaka, 2005) | Observational: Reliability, Validity o Controlled, single-blind study consisting of sample used for two analyses First group consisting of 13 healthy participants and 14 patients with the stroke to examine reproducibility of measurements with CMSA Second group of 20 patients with diagnosis of CVA to examine correlation between motor skills of the affected UE evaluated with the CMSA and functional parameters from results of clinical tests for the UE. | The inter- class correlation coefficients for lap time, geometric trajectory error, trajectory error integrated over time and the marker trajectory error integrated over time were (P<0.01) in healthy participant and (P<0.01) in patients with stroke. There was a training effect-participants got better as then participated more in the test. CMSA demonstrated highly reproducible intra-class correlation coefficients. The trajectory error integrated over time and the geometric errors of the affected arm in stroke patients were negatively correlated wit the Brunnstrom stage and the simple test for evaluating hand function. The marker trajectory error integrated over time in stroke patients was negatively correlated with the simple test for evaluating hand function. CMSA for the arm is useful for quantitatively evaluating delicate visuo-motor sills of the arm. The correlation between motor skills of the effected arm in the CMSA and STEF reveals the importance of voluntary control in the shoulder and elbow for carrying objects- because with the CMSA the arm is supported without finger function and with the STEF performance is influenced by shoulder, elbow, and finger function. Evaluation of visually guided tracking movements with the CMSA has acceptable reproducibility and sensitivity to impaired fine motor control of the arm. |
| Upper extremity movements were recorded using an ultrasonic device (CMS 50; Zebris) to calculate continuously the 3-dimensional spatial positions of small markers attached to moving parts. Spatial coordinates of the markers were sampled at a frequency of 66 Hz each and with a spatial resolution of 0.2mm. The movements assessed were a set of diadochokinetic movements with the subject's right hand via alternate palmer flexion and dorsal extension of the wrist (hand tapping) at a self-paced and then at an assigned speed using a metronome set at a pace of 1.68Hz (100 beats/min). (Bazner, 2005) | Observational: Descriptive 18 patients diagnosed with SVE (subcortical vascular encephalopathy—which is thought to present as a "lower body Parkinsonism" but is due to multiple subcortical lacunar infarctions, diffuse white matter lesions or both) 18 patients diagnosed with Parkinson's disease and 18 health controls All subjects were right hand dominant. | Tapping frequency was not significantly different between all groups assessed; rationale for why PD patients were not less was probably due to the PD patients assessed during medication "on" phase. The tapping amplitude and angular velocity was significantly less in patients diagnosed with PD compared to the control and SVE group (p<0.001). Hand tapping was executed with low amplitudes and with a trend of disturbed rhythm due to freezing episodes and "start hesitation." SVE group demonstrated dysrhythmic tapping but normal amplitudes. The metronome was successful in all patients conforming to the rhythm but the above stated changes in the amplitude and variability was still noted in the SVE group; the authors of this study inferred from their results that SVE patients should not be characterized as "lower body Parkinsonism" due to the differences in how they perform with the use of the metronome and with diadochokinectic movements. |
| Kinematic and kinetic analysis of upper extremity movement in individuals with upper limb impairments post stroke was measured with the use of a potentiometer and torque transducer. (Tsoa, 2007) | Observational: Descriptive Subjects included patients with upper extremity impairments including ten status post stroke and eight status post non-complete SCI. Ten healthy subjects were also included in this study. Tone was assessed in patients with upper extremity impairments using the Ashworth scale. Subjects were placed in an apparatus and asked to move their forearm from full flexion to extension at maximum speed. This was repeated five times. Elbow position and torque were measure with the potentiometer and torque transducer. Angular velocity and acceleration were calculated. Kinematic and kinetic analysis was included as well as movement smoothness, number of movement unit, normalized jerk score. | Statistical analysis was conducted utilizing non-parametric Wilcoxon rank test and Spearman correlation coefficient. No significant correlations were found between the Ashworth scores and objective measures of voluntary movement. The findings also indicated that the modified Ashworth scale was relatively unreliable when compared to objective measures of spasticity. Results demonstrated increased impairments in both the group status post stroke and status post SCI presented with similar impairments. It was concluded that the unimpaired arm on a patient with neurological impairment can be used as a control for comparison for the impaired arm. |
| Kinematic analysis of fast voluntary neck movements in patients with cervical dystonia prior to and after administration of botulinum toxin type A. (Gregori, 2008) | Observational: Descriptive Subjects included 15 right handed people with cervical dystonia as well as 13 control subjects. All patients with cervical dystonia had been treated with botulinum toxin type A for several years. Head movements were recorded with the motion analyzer system. Subjects were seated in a chair and asked to perform the following movements: right and left rotational, flexion and extension neck movements, and to move as fast as possible. Each type of movement incorporated three blocks of five consecutive movements performed in a random order. Subjects were studies prior to and after administration of botulinum toxin type A. | MANOVA statistical analysis showed a significant effect of between-group factor movement. Movement times were longer in subjects with cervical dystonia that the controls. Patients with cervical dystonia performed neck flexion and extension with longer times than the control group. After treatment analysis demonstrated improved movements. The significance of this study was the establishment that analysis of kinematics of neck movements in patients with cervical dystonia can be a measurement tool for determining severity of impairment and effects of interventions. |
The ZEBRIS computer-controlled ultrasound –based motion analyzer system (ZEBRIS, Medizintechnik Gmblt, Isny, Germany) was used to measure the displacements of the shoulder joint during active elevation. The ArmModel software connected to the system constantly calculates records and displays the spatial position of all anatomical markers. The test lasts approximately 40-50 minutes. Using a polyester belt, the sensors are placed as either individual sensors or in groups such as "triplets" which are placed on a rigid plate –3 markers/plate. The triplets are placed on the upper arm, lower arm and sternum and then individual sensors are placed on specific parts of the clavicle and then a triplet placed on the scapula. These sensors are connected to the movement system via cables. An ultrasound based pointer is used to assign anatomical points and records the spatial position in the system of coordinates to determine the calibration. The subject is asked to elevate the arm from a neutral position to approximately 100-120 degrees in the plane of the scapula with elbow extended and the forearm pronated via using standardized mounted pipe handles upon which the fingers would be placed. The movement frequency was determined by the use of a metronome. The position of the sensors was monitored throughout the movement to determine the parameters for modeling shoulder joint motion. (Illyes, 2007) | Observational: Descriptive 74 shoulder joints of 50 healthy subjects were analyzed. 32 males (average age=28.1 +/- 5.1 yrs); 18 females (average age=24.6 +/- 6.1 yrs). | Scapulothoracic and glenohumeral rhythms are bilinear. The steepness of the scapulothoracic rhythm significantly increases past 60 degrees of elevation (0.00113); the slope of the regression line demonstrates that the glenohumeral rhythm is significantly decreased past 60 degrees of elevation (p<0.121). The role of the scapula is extremely enhanced following 60 degrees of elevation. |
Five potential predictors to the outcomes of WMFT after CIMT were used in individuals with hemiparesis after a stroke. Specifically, finger extension/grasp release was defined by Fugl-Meyer assessment. Pre/post-tests were administered before/after 2 weeks of CIMT and data was compared to outcome measurements of WMFT. (Fritz, 2005) | Observational: Descriptive A convenience sample of 55 individuals, >6 months after stroke whose upper extremity was mildly to severely involved. Inclusion criteria of high function group required active movement of the wrist through at least 20° of the flexion-extension range from a relaxed flexed position, and movement of at least 3 fingers 20° at the metacarpal-phalangeal and interphalangeal joints. Inclusion in the low-functioning group required evidence of trace wrist extension and extension of 2 fingers from a fully flexed position but did not meet the criteria established in the high-functioning group. | |
| EMG Recording | | |
| EMG patterns of 8 principle muscles of the paretic upper extremity measured, while non-effected UE performed movements verbally directed by examiners. Irradiated muscle activity recorded for 3 seconds, isometric muscle contraction was performed 3 times consecutively, with 2-minute rest between trials. Clinical measurements include: Fugl-Meyer assessment Scale, Barthel Index of ADL's, And Brunnstrom Stages of Motor Recovery Scale. Assessment performed 1 time. (Hwang, 2005) | Experimental Twenty patients with CVA (Brunnstrom Stages of Recovery II-VI) divided into 2 groups: greater levels of irradiation (SG, n=10), or lesser levels of irradiation (SL, n=10). Inclusion criteria for CVA subjects: unilateral motor deficit in UE and LE, not on anti-spastic meds, full PROM of effected UE, right UE dominant. Control group 20 healthy subjects, right UE dominant. | Level of GS activity in the paretic arm, especially when contra lateral elbow flexors (P<0.05) contracted, directly related to functional outcomes: FMA score (H = 77.5, P=0.035) and BR stage (H=77.5, P+.035) between the 2 stroke groups. Subjects in the SG group had better neurological scores. The BI scores for both stroke groups were not different (H = 101.5, P=0.789). Increased GS intensity was associated with muscle contractions of the flexor muscles of the opposite proximal joint (P<0.005), but was poorly correlated for wrist and hand (P>0.05) in CVA group. Global patterns of mirror movement are pertinent to motor functioning of the proximal arm following a stroke. Patients with hemiparesis post CVA contralateral muscle contractions produced GS throughout the affected UE. |
Surface electromyography(sEMG)was assessed using bipolar surface electrodes, bilaterally placed on the subject's skin overlying the body of masseter muscle and the anterior temporalis muscle. Electromyography (EMG) activity at rest was recorded, the patient was asked to clench the teeth maximally three times for 2 s, with 2-s relaxation between each clench. The clenching exercise was repeated also with a cotton roll positioned over the posterior teeth of both sides, as suggested by the manufacturer's guidelines. Kinesiographic recordings were made with the use of a magnet temporarily applied on the subject's buccal mucosa under the lower arch central incisors to monitor the location of the mandible against a sensor array suspended in front of the face by a lightweight frame suspended on the bridge of the nose and connected behind the head by straps. All tasks were performed three times at ten-minute intervals, and the average value of the three attempts was recorded. (Manfredini, 2011) | Observational study comparing EMG assessment in individuals with and without temporomandibular disorder(TMD). Consecutive patients (mean age 34.9 years) seeking TMD treatment (n=36). Diagnostic criteria for temporomandibular disorder diagnosis of myofascial pain either without limited opening or with limited opening An age-and sex-matched group of 36 TMD-free subjects. | Clinicians should not use sEMG and KG devices as diagnostic tools for individual patients who might have myofascial pain in the jaw muscles. Whether intended as a stand-alone measurement or as an adjunct to making clinical decisions, such instruments do not meet the standard of reliability and validity required for such usage Receiver operating characteristics curve analysis showed that, except EMG parameters during clenching tasks, all the other outcome sEMG and kinesiographic measures did not reach acceptable levels of sensitivity and specificity, with a 30.6–88.9% percentage of false-positive results. |
| Surface EMG data was collected throughout the testing procedure from the medial hamstrings (MEH) and the gastrocnemius (GAS) as well as their antagonists (rectus femoris and tibialis anterior respectively.) EMG data was collected during 3 Maximum Voluntary Isometric Contractions of agonist and antagonist muscles as well as during rest periods. Joint position, angular velocity and acceleration were defined by using two inertial measurement units (IMU) to track the movement of the distal segment in relation to the proximal. Passive stretch trials were carried out by manually moving the joints from a predefined starting position through the full ROM at low velocity (during 5 seconds), at medium velocity and at high velocity (as fast as possible.) Stretch trials were repeated four times with an interval of 7 s rest between repetition (Bar-On, 2013) | Observational: reliability, validity. Children with spastic CP (n=28) and children with Tardive Dyskinesia(n=10); age 5-18 years old. Participants were excluded if they had received botulinum type-A injections within 6 months prior to the assessment; intrathecal baclofen; lower limb orthopedic surgery; had bony deformities/contractures hindering neutral alignment; severe weakness and lack of control of the tested muscle. Surface EMG signals were filtered from 20 to 500 Hz and the root mean square envelope of the surface EMG was extracted. Joint position, angular velocity and acceleration were estimated by applying a Kalman smoother to the IMU data. Torque was calculated using segment lengths and moment arms, external forces, the exerted moments, and the forces caused by gravity and inertia. Performance based and spacticity based outcome parameters were included in the data analysis. | Reliability: Parameters for GAS and MEH showed moderately high reliability (lower within- than between-session SEM values for all except 1 parameter). No evidence of systematic bias was found. Average between-session EMG change for the GAS was 0.57%, a torque change of 0.09 N m, a 0.06 J work-change; and 0.81%, 0.31 N m, and 0.92 J for the MEH, respectively. Validity: Performance related parameters were generally similar between the CP and TD groups. Moderate correlations were found for the GAS between EMG-change, torque-change, work-change and the individual MAS-scores (r = 0.463, r = 0.474, r = 0.492 respectively) Moderate to good correlations were found for the MEH (r = 0.638, r =0.444, r = 0.594 respectively). MTS of the GAS correlated poorly with EMG-change (r = 0.098) and work-change (r = 0.116)and fairly with torque-change (r =0.219) For MEH, MTS had a very good correlation to EMG-change (r = 0.809), a moderate correlation to work-change (r = 0.586) and a fair correlation to torque change (r = 0.275). High EMG changes may be attributed to the fact that EMG-parameters in this study were analyzed in a range highlighting velocity-dependency, rather than evaluating EMG over the entire ROM. |
Surface EMG data was collected throughout the testing procedure from the medial hamstrings (MEH) and the gastrocnemius (GAS) as well as their antagonists (rectus femoris and tibialis anterior respectively). EMG data was collected during 3 MVICs of agonist and antagonist muscles as well as during rest periods. (Lynn, 2013.) | Observational: reliability and validity Children age 4 - 18 with a diagnosis of spastic CP (n=46) Participants were excluded in cases of ataxia or dystonia; severe muscle weakness; ROM less than 25% of the normal values for all lower limb joints; cognitive problems that hinder communication and cooperation during the assessment; treatment with botulinum type-A six months prior to assessment or previous lower limb orthopedic surgery, intrathecal baclofen or selective dorsal rhizotomy. Surface EMG signals were filtered from 20 to 500 Hz and the root mean square envelope of the surface EMG was extracted. Joint position, angular velocity and acceleration were estimated by applying a Kalman smoother to the IMU data. Torque was calculated using segment lengths and moment arms, external forces, the exerted moments, and the forces caused by gravity and inertia. Severity related parameters included change in torque, maximum deceleration, minimum power, work and Root Mean Squared EMG. Reliability between sessions was assessed with interclass correlation coefficients. Correlation coefficients were also used to study construct and clinical validity. | Reliability: The majority of the parameters showed moderately high to high between-session reliability. Validity: Poor correlation was found between max deceleration and change in torque, and between work and RMS-EMG and between maximum change in torque and RMS-EMG. |
The objective of this study was to comparemotor impairment measures obtained with EMG activity of the LE (walking two 30-second trials on an instrumented treadmill) and the Fugl-Meyer lower extremity motor evaluation (FM-LE). A nonnegative matrix factorization (NNMF) was used to account for variance in EMG patterns. This study looked at six variables associated with gait including: walking speed, Berg balance test (BBT), Dynamic Gait Index (DGI), Paretic propulsion (Pp), Paretic step ratio (PSR), and paretic preswing (PPS). (Bowden, 2010) | Observational: validity, reliability Subjects with chronic, post-stroke hemiparesis (n=34), 13 right sided and 21 left sided hemiparesis, (15 female and 19 male). Inclusion: hx of single, unilateral stroke, ambulatory without contact assistance, able to follow multiple-step commands, and no other medical conditions interfering with their ability to walk. Healthy controls (n=17), 3 male and 14 female. Walked at 0.6m/s to match the average walking speed of hemiparetic participants. | FM-LE may be an effective measure for voluntary, discrete actions of the LE. It appears to be insufficient in capturing necessary information about walking. With NNMF factors explaining its variability, EMG patterns correlated with all 6 walking performance variables (P<0.25). Of the six biomechanical measures of walking examined, only walking speed, BBT, and PSR significantly correlated with FM-LE. The FM-LE failed to distinguish the severity of the hemiparesis in most participants (specifically between moderate and severe hemiparesis). |
| Treadmill tests | | |
| Subjects walked on a Treadmill with computer controlled speed for a total of 7 minutes with incremental speed increase every one minute. Inter-limb coordination during gait was recorded every 30 seconds. A single investigator performed the clinical assessment of all patients. (Winogrodzka, 2005) | Experimental laboratory study Twenty-nine early and drug-naive Parkinson's Disease patients all diagnosed according to the criteria of the UK. Parkinson's Disease Society Brain Bank and showed a positive apomorphine challenge test. | Significant correlations were found between the rigidity and bradykinesia and the coordination measure of gait (P≤0.007). Bradykinesia and rigidity as well as the extent of degeneration of the dopaminergic system were associated with a limited adaptive ability (flexibility) in movement coordination during gait. |
| Quantitative tests | | |
| Quantitative neuromotor tests were administered by a physical therapist and trained assistant in the child's school or day care in a closed room and included: alternating movements and pointing movement's postural tremor, postural sway and simple reaction time. Validation measures included global motor tasks and a neurological examination. The test was administered one time, and lasted 45 minutes. Tests were performed in the same order for all children, and the same equipment was used with all children during testing. (Despres, 2005) | Experimental laboratory study with Reliability and Validity Sample consisted of 110 children aged between of 4 and 6 years, in good health and free of any developmental problems. | Intensity of postural tremor, was higher on the second trial (t = 2.67, p = 0.01) than the first trial of tests. This shows fatigue plays a part on results of the test, and there should be time limits to the test. For alternating and pointing movement tests, the variables linked to speed showed better stability between the two trials (correlations vary between 0.61 and 0.82, p = 0.01) than the variables related to precision of movement (correlations vary between 0.23 and 0.54, p = 0.01). Girls performing tests in both the static condition (eyes open: F = 4.01, p = 0.04 and eyes closed: F = 6.44, p = 0.01) and the balance condition (tandem position: F = 4.65, p = 0.03) did better than boys in these tests. Boys obtained a weaker performance in global motor score (F = 15.45, p = 0.000), these tasks are related to equilibrium (walking on their heels: F = 7.25, p = 0.008; walking backwards on a line: F = 9.52, p =0.003). Girls obtained higher results than boys on attention and cooperation scores, (F = 16.60, p = 0.000 and F = 11.27, p = 0.001, respectively). Developmental variables: age was mainly linked to voluntary tasks (reaction time, r =0.43, p = 0.000; alternating movements, r =0.23 to 0.48, p < 0.01; pointing movements, r = 0.29 to 0.45, p < 0.001; global motor score (r = 0.36, p = 0.000). Age was not significantly correlated with measures of involuntary movement (postural tremor and postural sway). Pointing movements were associated with the ability to walk forward and backward on a straight line, and with the ability to hop on one foot. Rapid alternating movements were also correlated with these same three tasks and, with the qualitative pronation–supination test. Postural tremor was not associated with any global motor task. ☐ These tests could help in the early detection of children at risk for motor dysfunctions following neurotoxic exposure. These tests can also be used for the follow up of various conditions relating to motor functions (cerebral palsy, muscular dystrophy, preterm infants) and in the evaluation of the effects of medication. |
| Comparing functional outcomes measures in stroke rehab using the ICF. | | |
| The objective of this study was to compare the ICF model and outcome measures frequently used in stroke rehabilitation with a focus on the activities and participation components of the ICF. Fifteen functional outcome measures were linked to the most appropriate ICF category. It was possible to link all instruments except Rankin Scale. (Schepers, 2007) | Observational: Validity ICF codes for the first and second level categories were used in this comparison. The 15 instruments included 364 items, which contained 471 constructs. 63% of the constructs belonged to the activities and participation components of the ICF categories and 27% belonged to body functions. The remaining 10% of the constructs could not be linked to the ICF. | Results of this study show that the ICF is a useful framework and classification system to categorize health components as it relates to constructs of the functional outcome measures. The Rankin Scale was the only scale that could not be linked to the ICF because of the nature of its general concepts. It is the opinion of the authors that the Rankin Scale is a global functional health index only and that it has limited value in rehabilitation. A surprising finding was the number of links to the body functions category even though the outcome measures were selected based on their focus on activities and participation. This finding, however, was not deemed significant, because none of the instruments had more than half of their constructs linked to body functions and some items addressing body functions connected to activities and participation. The four instruments that solely measure activities and participation are the Berg Balance Test, Frenchay Activities Index, Rivermead Mobility Index and Timed Up and Go Test. The content comparison presented in this paper should enable clinicians and researchers to choose the best measure for the area of their interest. |
| Equal interval measure of neurological impairment based on the International Standards for Neurological and Functional Classification of Spinal Cord Injury Patients developed by ASIA. | | |
| The purpose of this study was to develop and validate an equal-interval measure of neurological impairment based on the classification established by the American Spinal Injury Association. The International Standards for Neurological and Functional Classification of Spinal Cord Injury was used to rate sensory and motor function from observations and information documented in the charts. Sensory was rated via pin pricks to light touch on a three point rating scale. Motor was rated with MMT at ten key muscles with a six point rating scale which included paresis to normal function. Raters evaluated left and right sides. (Bode, 1999) | Observational: Reliability, Validity This was a retrospective study of impairment characteristics abstracted by the Model of Spinal Cord Injury System from 1986 to 1998. 18 system members reported information based on national standards. Data for 3,325 patients was included in the study was collected from system admission, rehabilitation admission, and rehabilitation discharge. The International Standards for Neurological and Functional Classification of Spinal Cord Injury was used to rate sensory and motor function from observations and information documented in the charts. Sensory was rated via pin pricks to light touch on a three point rating scale. Motor was rated with MMT at ten key muscles with a six point rating scale, which included paresis to normal function. | A program called WINSTEPS 19 was used for Rasch Scale Analysis. The measure is hierarchical. A logit scale was transformed to a scale from 0 to 100. Improvement would be documented by moving to the left on the scale. It was noted that impairment scores decreased along with the neurological level of injury. The measurement of impairment incorporated both level and completeness of injury. The measure is interval level as opposed to an ordinal level ASIA scale or neurological level of injury. Results indicated that the impairment measure is a reliable, valid, and equal interval estimate of impairment severity. The authors indicated that the measure allowed for the use of more parametric statistics to monitor changes in severity of impairment. One of the clinical applications is to create a self scoring key for assessing severity of impairment. |
| Columbia scale |
| All participants are videotaped while performing tasks outlined on the Columbia Scale specifically for bradykinesia, gait disturbance, postural abnormality, and tremor. Observational ratings are made independently by 2 neurologists; one of these neurologists was a specialist in the clinical management of Parkinson's disease. Observers also rated participants using the Hoehn and Yahr stage of disability. The study's main focus was to examine the inter-observer agreement of selected scores from the above scales. (Montgomery, 1985) | Observational: Reliability, Validity Controlled, non-independent Sample consisted of 70 persons (48 men, 22 women) with Parkinson's, who did not have any other medical condition that affected movements studied. Characteristics of sample mean age (years) =64.8, 10.82; education (years) =12.7, 3.83; duration of illness (years) =6.7, 5.42. 90% of sample receiving levodopa. | All comparisons for central Columbia Scale scares and Hoehn and Yahr stages were non significant (all p>0.15) using Wilcoxon matched-pairs signed-ranks tests. There is a linear association between the severities of ratings of the 2 observers across cases. The observers reached agreement with respect to the 5 ratings of the Columbia scale when assessing these patients. The Comparison for dystonia was non significant Ratings for dyskinesia and dystonic posturing were unreliable, because of a difference in bias when assessing these aspects. The comparison for dyskinesia approached significance (p<0.10). An acceptable level of inter-observer reliability was achieved for 5 scores from the Columbia Scale and judgments of Hoehn and Yahr disability stages. Observers failed to agree in rating dyskinesias and dystonic postures. |
| Webster rating scale |
| Patients were pre- video recorded performing seven tests on the Webster rating scale: bradykinesia of hands, posture, UE swing, gait, tremor, facial expressions, and speech. For each patient, the video was presented to each assessing physician with the 7 items, and then the physician scored the test according to the Webster scales. Each neurologist had a copy of the full description of the scale during scoring. (Kennard, 1984) | Observational: Reliability, Validity Performance of seven patients with mild to moderate Parkinson's disease was pre-recorded on videotape. Two sessions were recorded-one in the morning and the same procedure was performed 8 hours later in the afternoon. Inter and intra-observer consistency was assessed by 19 practicing consultant neurologists with some experience using the Webster rating scale. | The inter-observer variance of the neurologist's scores at the same session standard deviation was ±1-2. There was considerable intra-observer variability. The inter-observer variance of the average of scores by one neurologist at the 2 sessions was standard deviation of ±1-3. A considerable variance in the Webster rating assessments is performed by each neurologist clinically- some physicians assess their patients differently than described on the test procedure. The study needed a larger sample group of Parkinson's patients with varying degrees of progression of the disease-this did not allow for conclusive analysis of the variance on individual items performed on the scale. |
| Wolf Motor Function Test |
| WMFT includes 15 functional tasks. Patients were timed and rated using a 6-point functional mobility scale. WMFT was administered to subjects twice, with a 2-week interval between administrations. Test sessions were videotaped for scoring at a later time by blinded trained and experienced therapists. Assessed inter-rater and test-retest reliability. Examined the reliability of WMFT for assessing upper extremity motor function in adults with hemiplegia. (Morris, 2001) | Observational: Reliability Controlled sample of 24 subjects with chronic hemiplegia (onset >1 year), showing moderate motor impairment. | Inter-rater reliability was 0.97 or greater for performance time; 0.88 or greater for functional ability Internal consistency for test 1 was 0.92 for performance time and 0.92 for functional ability Internal consistency for test 2 was 0.86 for performance time and 0.92 for functional ability. Test-retest reliability was 0.90 for performance time and 0.95 for functional ability. WMFT is an instrument with high inter-rater reliability, internal consistency, test-retest reliability, and adequate stability. |
| This study was conducted to establish the reliability and validity of the WMFT. Scores from the WMFT were compared to the UE portion of the Fugl-Meyer Motor Assessment (FMA) to investigate the criterion validity of the WMFT. The FMA was selected as a basis of comparison because it has been shown to be reliable and valid. However, the authors claim the WMFT to be easier to administer clinically than the FMA. (Wolf, 2001) | Observational: Reliability, Validity o 47 subjects were originally recruited via convenience sampling in this repeated measures study. Only 38 subjects were included, and they were split into two groups: 19 subject's s/p CVA (mean age 61.4 ±9.5 years) and 19 subjects with no impairments (mean age 60 ± 9.3 years). These were selected because they could be matched by age and sex. Inclusion criteria: medical stability, sitting and standing balance control, and intact cognition. Exclusion criteria: taking medications that affect motor performance, did not engage in strenuous activity before data collection sessions. Subjects performed each measure twice (12 -16 days apart), with scoring performed independently by 2 random raters. | Interrater reliability for the WMFT ranged from 0.97 to 0.99. Interrater reliability for each of the 15 WMFT tasks was 0.95 to 0.99 (p<0.0001). WMFT scores were different (p=0.0006) between groups for all UE comparisons. WMFT appeared to differentiate the more affected extremity and the less affected extremity from either extremity of subjects without impairment. The difference in WMFT scores between groups supports test construct validity. The relationship between the tests' scores for the more affected extremity of subjects after stroke supports criterion validity. Minimally, the test can show if interventions improve motor performance attributes, such as speed to complete tasks. |
| Action Research Arm Test (ARAT) | | |
| Study of 50 stroke patients assessing the reliability of the ARAT comparing the scores with other established measurements. Two part study: part one was an inter-rater study. The ARAT was administered by 3 OT's on the same patient within 3days. Each OT was blind to results of the other assessments. Part 2 was validity study. The ARAT was assessed by comparing the results of ARAT to the motor assessment scale. The association between the results of the ARAT and UE motor impairment was also examined. (Hsieh, 1998) | Observational: Reliability, Validity 108 stroke patients admitted to a hospital in Taipei were studied. Patients had to be able to follow verbal commands. | ☐☐ 0.98 intra-class correlation coefficient indicates high inter-rater reliability. High inter-rater reliability may have been achieved in this study because a small number of well-trained experienced therapists were used (>5 years). A systematic bias was found on the grasp, grip and pinch sub-scales and for the whole score. One rater scored systematically higher than the other 2 raters P≤0.01. ARAT measurements results were closely associated with UEMAS disability measurement (r=0.96). The results support the validity of the ARAT as a measure of UE functions in patient's s/p CVA. Scores of the ARAT were highly associated with those of the AMI and the UEMMAC impairment measurements which were r=0.87 and 0.94, respectively. These results indicate that the ARAT may reflect UE motor impairments due to cerebrovascular disease. |
Study purpose was to determine the intra- and inter-rater reliability of the Action Research Arm test, capability to detect a minimal clinically important difference of 5.7 points (Bronfort,1997), and to identify the less reliable test items. Intra-rater reliability of the sum scores and of individual items was assessed by comparing (1) the ratings of the laboratory measurements of 20 patients with the ratings of the same measurements recorded on videotape by the original rater, and (2) the repeated ratings of videotaped measurements by the same rater. Inter-rater reliability was assessed by comparing the ratings of videotaped subjectsby 2 independent raters. The resulting limits of agreement were compared with the MCID. (van der Lee, 2001) | Observational, randomized reliability study Subjects with stroke (n=66) who met the following inclusion criteria: (1) a history of a single stroke, at least 1 year previously, resulting in hemiparesis on the dominant side; (2) a minimum of 20° of active extension in the wrist and 10° of finger extension; (3) ARA test score below 51; (4) age between 18 and 80 years; (5) ability to walk indoors without a cane, indicating no major balance problems; (6) no severe aphasia (score >P50 on the Stichting Afasie Nederland test); and (7) no severe cognitive impairments (Mini-Mental State score ≥22). Stratified sample of 20 patients with chronic stroke, taken from the 66 who met inclusion criteria used in study, based on the intake ARA scores. Median age of 62years, median time since stroke onset of 3.6 years, and mean intake ARA score of 29.2 The reliability of the sum scores of all 19 items was assessed in 3 ways: (1) Spearman's rank-order correlation coefficient (Spearman's rho); (2) intraclass correlation coefficient (ICC); and (3) mean difference and limits of agreement (Bland and Altman plot). | Allintra- and inter-rater Spearman's rho and ICC values were higher than.98. The mean difference between ratings was highest for the inter-rater pair (.75; 95% confidence interval,.02-1.48), suggesting a small systematic difference between raters. Intra-rater limits of agreement were –1.66 to 2.26; inter-rater limits of agreement were –2.35 to 3.85. Median weighted kappas exceeded.92. The high intra- and inter-rater reliability of the ARA test was confirmed, as was its ability to detect a clinically relevant difference of 5.7 points. |
| Chedoke Arm and Hand Activity Inventory (CAHAI) |
CAHAI was developed to determine upper limb function by assessing relevant functional tasks. It consists of 13 real-life functional tasks that analyze bilateral hand activities; non-sex – specific functional tasks to determine upper limb function. The CAHAI uses a 7-point quantitative scale. The purpose of this study was to determine the test-retest reliability, validity and sensitivity to change of the CAHAI. It also wanted to determine if the CAHAI was more sensitive to change in arm function than the ARAT (Action Research Arm Test) and the CMSA (Chedoke-McMasters Stroke Assessment).. Training therapists administered the CMSA and the CAHAI at baseline and 2-6 wks later depending on the clinical progress noted; the ARAT was also administered at baseline and at follow-up. Inter-rater reliability was also assessed within 36 hours of 1st assessment of the CAHAI. (Barreca, 2005) | Observational: Reliability, Validity 39 patients were assessed and placed into 2 groups based on the key prognostic indicators for change which were the initial arm and hand motor impairment and the time post-stroke. Group 1=acute/mild to moderate group who were 8 weeks or less post stroke. Group 2=chronic/severe group who were 3 months or more post stroke. | Inter-rater reliability was very high with an intra-class correlation coefficient of 0.98. Validity of the CAHAI was supported by the higher correlations of the CAHAI with the ARAT and the CMSA vs the CMSA pain scale (p<0.001). Sensitivity to change was also supported by the significant differences of the area under the ROC curve of the CAHAI sum compared to the CMSA or the ARAT. |
| The purpose of this study was to determine if the longitudinal validity of scores on two editions of the Chedoke Arm and Hand Activity Inventory (CAHAI) was greater than the longitudinal validity of scores on the Action Research Arm Test and also to determine if the cross-sectional and longitudinal validity for the 13-item version of the CAHAI (CAHAI-13) was greater than that of the 9-item version (CAHAI-9). The CAHAI uses a quantitative scale to assess functional recovery of the arm and hand following a stroke. The CAHAI-13 and ARAT were administered twice to each participant by his or her treating therapist as well as by a research therapist, with time between assessments ranging from 2 to 6 weeks. CAHAI-9 scores were extracted from the CAHAI-13 scores. (Barreca, 2006) | Observational: Reliability, Validity o Subjects included 105 stroke victims who had experienced their first stroke and met the eligibility criteria consisting of a combined arm and hand impairment staging of 5 or less or between 7 and 11 measured by the Chedoke-McMaster Stroke Assessment (CMSA). Subjects were divided into two groups, mild to moderate impairment and severe impairment. Exclusion criteria included a lower motor neuron injury, a pre-existing disability of the arm or hand prior to the stroke, insufficient stamina to participate, or achievement of a combined arm and hand CMSA score of greater than 11. | Both versions of the CAHAI showed a higher sensitivity to change than the ARAT. Identical levels of cross-sectional validity were achieved by both versions of the CAHAI. However, the results were unclear as to whether or not the 9-item version of the CAHAI (CAHAI-9) is able to provide precise estimates of the 13-item version (CAHAI-13) on an individual basis. |
| Arm Motor Ability Test (AMAT) | | |
| The purpose of the study was to determine whether the original assessment of the reliability and sensitivity to change of the AMAT could be replicated and extended in a second laboratory. Subjects performed 13 timed compound tasks (4 were eliminated to ease test administration in the clinical setting). Functional Ability and Quality of Movement were rated according to 6-step rating scales. (Kopp, 1997) | Experimental study Observational: Reliability, Validity Subjects had recently experienced CVAs and were randomly assigned to one of two groups who received two administrations of AMAT separated by 1 week or 2 weeks. 30 stroke survivors recruited via a convenience sample from an outpatient stroke rehabilitation clinic of an academic medical center. Inclusion criteria: >6 mos post-CVA, hemorrhagic or non-hemorrhagic stroke, age ≥ 18, and ability to follow three-stage commands. An effort was made to recruit subjects with a wide range of motor impairments from very severe to very mild based on the FMA. Exclusion criteria: history of opposite hemisphere stroke, TBI, SCI, MS, Parkinson's disease, upper limb LMNL, uncompensated hemineglect, and visual field deficits. | Scores improved from both the 1-week and 2-week retest interval groups (reduced performance time and increased Functional Ability and Quality of Movement). The interrater reliability for the Functional Ability and Quality of Movement scales was high. The AMAT is an internally consistent test and sensitive to change in motor status. All 3 components of the AMAT correlated well with FMA total score, with functional ability and quality of movement components correlating somewhat higher than time of performance, demonstrating the concurrent criterion validity of the AMAT. Spearman's correlation coefficients relating FMA total and AMAT components were all greater than 0.90. The hand component of the FMA exhibited the highest correlation with AMAT components, followed by (1) wrist, (2) shoulder, elbow, and forearm, and (3) coordination components. The functional ability component of the AMAT seems to have the highest clinical and experimental utility. Study authors found the AMAT time consuming in its administration (~40 min). Older patients with moderate hemiparesis found the test tedious, fatiguing, and at times, frustrating to complete. |
| The Reaching Performance Scale (RPS) | | |
The purpose of this study was to describe a new impairment scale (the Reaching Performance Scale) that would identify and quantify movement patterns and compensatory movements during reach-to-grasp tasks in patients with upper extremity hemiparesis secondary to a stroke. The scale is used to measure the degree of motor compensation for reaching to grasp objects placed within reach and beyond the reach or the hemiparetic arm. The study enumerates testing of the concurrent and discriminant validity and the intrarrater and interrater reliability of the data obtained using the Reaching Performance Scale. The participant's performance was videotaped with the camera at a 45 degree angle between frontal and sagittal planes on the hemiparetic side. The videotapes were viewed by 2 groups of 6 physical therapists and occupational therapists. These 2 groups and the investigators formed the expert panel that examined the content of the rating scale and made refinements to the scale. The panel agreed that the RPS scale would evaluate 6 movement components including: trunk displacement, movement smoothness, shoulder movements, elbow movements, quality of prehension and the accomplishment of the task. Each of the movement components were rated on a scale from 0 to 3, with 3 indicating the best performance. The total score for reaching performance ranged from 0 to 18, with 18 being the best performance. Once the final version of the scale was produced, validity and reliability studies were initiated. (Levin, 2004) | Observational: Reliability, Validity The scale was used to assess reaching movements in 10 individuals with upper extremity hemiparesis due to stroke. A convenience sample of participants recruited from lists of patients who had been discharged from inpatient rehabilitation was used. The participants were 6 men and 4 women with a mean age of 66.2 years (SD=9.3) who had a stroke between 2 and 5.5 years earlier. | Concurrent validity-Scores on each task of the RPS were correlated with those on the Chedoke-McMaster Stroke Assessment using ANOVA. Scores on the RPS were correlated with the TEMPA and grip force measures using Pearson product moment correlation coefficients. Discriminant validity- ANOVA was performed for subjects grouped into 3 levels (mild, moderate, severe) according to the clinical severity of their condition. The level of severity was determined as the lower of the arm or hand scores on the Chedoke-McMaster Stroke Assessment and multiple post hoc comparisons were done to determine differences between groups. Intrarater and interrater reliability was estimated using ICCs with a confidence level of 95%. Reliability of data for each component of the scale was estimated with the weighted Cohen kappa. RESULTS: The RPS scores correlated highly with the Chedoke-McMaster Stroke Assessment scores (0.90 to 0.95). The correlations between scores on the RPS and on the TEMPA were statistically significant (-0.84 close target, -0.88 far target). The moderate to high correlations between RPS scores and TEMPA is more comparable to current descriptions using the ICF than to Nagi's disablement model. o The table on page 17 of the study compares the discriminant validity of 3 levels of patients. Close target F=26.9, P<0.000 Far target F=25.6, P<0.000. Table 5 and 6 on page 17 of the study compares interrater and intrarater reliability. This data is only meant to be a preliminary guide. A larger study with a more representative sample and a larger number of raters needs to be used to achieve more accurate data. This study was a first step in developing a clinical scale to assess improvements in motor performance for individuals with hemiparesis of the arm due to stroke. |
| Nine Hole Peg Test | | |
An apparatus consisting of small objects labeled as pegs are placed in peg holes of a flat rectangular board. The task is to place as many pegs (maximum of 9) into the peg holes in the allotted time of 100 seconds. The usual time frame consists of 50 seconds rather than 100 seconds. The subjects performed the Nine Hole Peg Test twice; upon release from the hospital and follow-up at 6 months. (Jacob-Lloyd, 2005) | | The completion rate (placing all 9 pegs in the holes within the allotted time) was around 50% 6 months after discharge versus approximately 40% at the time of discharge. o Scoring methods for the Nine Hole Peg Test vary; the parameters need to be clearly defined when documenting use of this test. The Nine Hole Peg Test was found to be sensitive to change. |
| The purpose of this study is to evaluate the reliability of measurements in hand function. An assessment was performed which consisted of an interview and the Short Physical Performance Battery. Hand temperature was measured to ensure the temperature was ~22 degrees Celsius. The testes performed were 1.) two test of dexterity: 9-Hole Peg Test and Box-and-Block Test 2.) grip and pinch strength test with the Grippit 3.) sensation with the Shape Texture Identification Test. (Svensson, 2006) | Observational: Reliability The study population consisted of adults (20-75y/o) with Charcot-Marie-Tooth with no other hand impairments. All subjects were Right hand dominant. | The Box and Block Test showed a very high intraclass correlation coefficient (ICC) (0.87-0.98). The 9-Hole Peg Test showed a very high ICC (0.97-1.00). Subjects were 10secs. slower compared to normative data. In strength testing the subjects were weaker compared with age and sex matched normative data, with a mean difference of ~150-190 N. The sensation testing showed a linear weighted kappa coefficient for the right hand of 0.87 and the left hand of 0.86. |
| Virtual Peg Insertion Test |
Concurrent validity and test-rest reliability of the Virtual Peg Insertion Test to quantify upper limb function in patients with chronic stroke A new tool called the Virtual Peg Insertion Test (VPIT) isan alternative to performing the traditional Nine Hole Peg Test (NHPT) and Box and Block Test (BBT). The VPIT is a computer-assisted assessment that allows measurement of three-dimensional hand position and orientation as well as grasp force during the performance of a goal orientated task including grasping, transporting and inserting nine virtual pegs into the nine holes of a virtual pegboard. The grasp force is assessed using an instrument with force sensors on a PHANTOM Omni haptic device. Key outcome measures of the VPIT include the execution time and the number of dropped pegs. (Tobler-Ammann, 2016) | Observational: Validity and ReliabilityIndividuals with stroke diagnosis within last 6 months (n=31), at least 18, communicate in German, ability to sit in wheelchair for at least 90 minutes, hold arm in 90° elbow flexion and 45° shoulder abduction, and grasp a 2.54 cm wooden block On the first day of data collection, all three tests were administered to all subjects, then the VPIT was administered on the second data collection day roughly 3-7 days later. This was to assess the concurrent validity and the test-retest reliability. | Low correlations with the NHPT and Box and BBT Test-retest reliability was good-high (ICC=.83-.94)for time to execute the task, mean grasping force, number of zero-crossings, and mean collision force Test-retest reliability was fair (ICC=.75) for grasp force return and (ICC= .70) outbound trajectory error Test-retest reliability was poor (ICC=.67) for return trajectory error and (ICC=.58) number of dropped pegs Good for assessment of upper limb function when combined with other components of upper extremity motor performance (not including NHPT or BBT) High intra-subject variation Correlations of VPIT were low with NHPT and BBT Test requires a thorough introduction to patients because the test is demanding Provides objective and comprehensive measurements of upper extremity function Easy to administer in patient's home Provides information about smoothness of movement |
| Finger Tapping Test | | |
| Movements of the index finger were measured using tri-axial accelerometry (TAA). The apparatus was attached with a velcro strap to the distal phalanx. Finger movements were recorded at a rate of 1.25 Hz (75 taps/min). Subjects were asked to touch index finger to thumb in response to auditory cues. (Calautti, 2006) | Observational: Reliability, Validity The study population consisted of 20 post-stroke patients (>3 mos) with the following inclusion criteria: right-handedness, first stroke (initial hemiparesis), ability to perform tapping test, <80 years of age. A control group of 20 subjects were also included in the study. | Significant correlation between the Regularity Index (RI) of the affected hand and the European Stroke Scale (ESS). Highest positive correlation between the RI and the IT-Max (maximum number of index-thumb taps in 15 s). Within the patient population, RI of affected hand was significantly lower than that of the unaffected hand (and that of control subjects). Finger Tapping test has been proven to show strong clinical validity in providing objective evidence of sub-cortical damage caused by stroke. Study is also highly reproducible among the patient population. |
| Physical Performance Test for Persons with Parkinson Disease | | |
| The purpose of this study is to evaluate the reliability of the Physical Performance Test for People with Parkinson Disease. The PPT is a 9 item multidimensional measure of function used for clinical assessment. Activities of daily living included in the test are: sentence writing, simulated eating, turning 360degrees, putting on and removing a jacket, lifting and then placing a book on a shelf, picking up a penny from the floor, a 50-foot walk test and 2 measures of stair climbing. The scores of the individual items are summed and can range from 0-36. The higher the summed score the better the performance. The study also looked at the test-retest reliability of the 7-item PPT. 3 of the 5 authors performed all of the testing. Subjects were tested on 2 occasions 1 week apart approximately 2 hours after ingestion of their usual dose of anti-Parkinson's medication for optimal pharmacological effectiveness. (Paschal, 2006) | Observational: Reliability A sample of convenience was provided by the CUMC Department of Neurology. Inclusion criteria included: ability to walk with or without an assistive device, community dwelling, and the ability to follow simple directions. 14 subjects diagnosed with Parkinson's Disease at modified Hoehn and Yahr stage 2-2.5 volunteered for the study. 8 males and 6 females with a mean age of 62.4years. The 7-item and 9-item summary scores were compared between sessions using repeated measures ANOVA. Reliability was assessed using ICC and the method error (ME). All statistics were calculated using SPSS version 12.0. | The ICCs for the 7-item (ICC=0.818) and 9-item (ICC =0.895) indicated good reliability between testing sessions. The 7-item ME =1.2 and the 9-item ME=1.1. The strong test-retest reliability and mid-range scores indicate that the PPT is an appropriate tool to measure change in physical performance over time and is resistant to floor or ceiling effects. The study indicates that the PPT can reliably measure the functional performance of people with Parkinson's Disease. |
The objective of this study is to evaluate a battery of nine simple, inexpensive timed motor test (TMTs) for their ability to monitor motor dysfunction in early PD patients. This motor test is used in comparison to the most widely used scale for clinical evaluation of motor dysfunction in PD, the Unified Parkinson's Disease Rating Scale III (UPDRS-III). (Haaxma, 2008) | Prospectivelongitudinalcohort study Subjects: patients with PD patients who consecutively visited a Movement Disorders Outpatient Clinic. n=288 (63% men); aged 30.9-79.3 (median 54.0); disease duration median is 2.7 years (range 0.4-9.9) | The TMT battery is a valid and reliable instrument to measure motor dysfunction in PD. While highly correlated to the UPDRS-III, the TMTs is more objective and sensitive to change. Nine TMTs based on walking, writing a sentence, single and double handed pegboard performance, finger tapping, and rapid alternating forearm movement were rated using the UPDRS-III Feasibility: The TMTs does not requires extensive training and only takes about 5 minutes to complete which makes it feasible to use in daily clinical practice. The test-retest reliability correlations were 0.93 for interassessment intervals of 3 months, 0.84 (4-6 months), 0.89 (7-12 months), and 0.89 (13-24 months). Sensitivity to change: correlations between scores before and after treatment initiation were 0.85 for the TMT. (0.55 for the UPDRS-III) |
| Test battery including static and dynamic balance, running in figure eight pattern, and rhythm coordination tests. | | |
| This study examined the test-retest reliability of several different measures functioning as a test battery measure. The individual measures included static and dynamic balance, running in a figure eight, and rhythm co-coordination test. (Vartiainen, 2006) | Observational: Reliability Subjects included 34 men with TBI and 36 healthy males. All subjects were tested twice. Statistical analysis included ICC and typical error. Test-retest statistics were also conducted. | Statistical analysis was completed on the data obtained. Balance on one foot presented with good test –retest reliability on the right leg (kappa=0.63) and moderate on the left leg (kappa=0.43) for the group with Traumatic brain injury. Tandem walking was most accurately assessed with a best of three formats. There was a wider variation in the score of the patients with traumatic brain injury. Best of three formats was also the best for tandem walking backwards as well as running in a figure eight pattern. The repeatability of the rhythm test was moderate in the patients with traumatic brain injury. Interrater reliability was assessed with use of videotape footage for additional scoring. Standing on one leg and tandem walking showed moderate interrater reliability. Rhythm coordination also had good interrater reliability. This battery of test proved to be reliable for testing men with traumatic brain injury in a clinical setting. Cohen's kappa coefficient was used as a measure of reliability for categorical test variables. Results demonstrated that balance, rhythm coordination, and agility tests were reliable for use in men with TBI's. |
| Brunel Balance Assessment | | |
The aim of this study was to examine the influence of balance disability on function and recovery of function after stroke and to assess the predictive validity of the Brunel Balance Assessment (BBA). Participants were recruited and tested 2 to 4 weeks after their stroke in a single assessment session. The following data were recorded upon assessment: age, sex, side of hemiplegia, stroke severity (using Oxford Community Stroke Project Classification), balance disability (using BBA), weakness (using Motricity Index), sensation (using Rivermead Assessment of Somata-sensory Perception), visuo-spatial neglect(using Star Cancellation and Line Bisection Tests), recovery of function in terms of independence in ADLs (using modified Barthel Index) and mobility disability (using the Rivermead Mobility Index). Barthel Index and Rivermead Mobility Index forms were completed 3 months after onset of stroke. (Tyson, 2007) | A prospective cross-sectional hospital-based survey of stroke patients recruited from 6 National Health Service Trusts in Greater Manchester (UK) over a 12-month period. Patients experiencing a previous stroke, confusion, aphasia, illness that prevented participation or a premorbid condition that could affect balance or mobility were excluded. One hundred and two participants were recruited and 75 completed the study with follow-up assessments. Of the 75 participants, 45 were men and 30 women. The mean age was 71with SD12.2. The levels of balance disability used for cross-tabulations were: limited sitting balance, limited standing balance and limited walking as defined according to the BBA score. The 3 key mobility activities used were: ability to perform transfers, walk independently, and negotiate stairs independently. The mobility data was obtained from the respective sections of the Barthel Index. | |
| Computerized Dynamic Posturograhy (CDP) | | |
| Each patient was asked if they had fallen within the past 6 months. Patients were tested using rotational chair, positional, and caloric testing. A trained physical therapist tested patients' performance on the SOT portion of the CDP evaluation. Patients were tested on 2 force platforms with eyes open and eyes closed under various described conditions. (Whitney, 2006) | A total of 100 patient charts were reviewed. The inclusion criteria were as follows: referral to PT for vestibular disorders, documented information concerning previous fall history within past 6 mos, previous CDP examination upon 1st PT visit. | Multiple group comparisons showed a direct correlation between low mean SOT scores and recurrent falls within past 6 mos. Age proved to be a significant confounding variable in the results of this study. Study results showed a sensitivity value of 53% and a specificity value of 87%. The clinician may use the information derived from the SOT scores of the CDP examination for guidance in developing a rehabilitation plan for patients with vestibular dysfunction. However, the CDP results should be used in conjunction with other neurological tests used in the examination process. |
| Portable telerehabilitation system | | |
| This study examined the use of a portable tele-assessment designed for remote evaluation of elbow impairments in patients with a neurological diagnosis. The device included a master device and a slave device used to drive a mannequin arm and patient's arm respectively. Measurements of elbow flexion and torque were measured on both devices and sent to each other for teleoperation. (Park, 2008) | Observational: Reliability, Validity Four subject post stroke were included all with an average of 2.25 on the Modified Ashworth Scale. During the teleassessment sessions the subjects and examiners were able to communicate via teleconferencing. PROM, AROM, muscle strength, and spasticity (velocity dependence of resistance torque and catch angle measurement) were assessed using the device. | Pearson Correlation Coefficients for in person assessment and teleassessment were significant >0.961 with a p value <0.05. There were some limitations discussed but he author in implementing input through the device at high speeds. The real time teleassessment is dependent on network speed and affected by network latency. |
| Servomechanism (MIME) with a PUMA 260 robot | | |
| Abnormal upper limb motor performance in subject post stoke presenting with hemiparesis was measured by a servomechanism (MIME) which incorporates a PUMA 260 robot. The MIME moved the forearm in simple planes controlling hand position and forearm orientation. In passive movements the MIME passively moves the subjects arm in selected kinematic patterns. The external forces measures would reflect the overall effects of gravity, inertia, centrifugal forces, Coriolis forces, passive mechanical properties, and forces related to hyperreflexia and abnormal descending commands. Active movements allow for the inclusion of voluntary descending commands which directly affect muscle activity and external forces. (Lum, 1999) | Observational: Reliability, Validity Six neurologically normal and 13 subjects post stroke were assessed with this tool. Testing required subjects to sit in a wheelchair with forearm support. A chest strap was secured. Tasks including grabbing a 6.4 cm diameter ball and six different point to point reaching activities. Each test also included a FM examination of motor function (reliability and validity previously established) prior to MIME assessment. | The kinematics of active and passive movements is the same, therefore, all forces not related to muscle activity common to both are eliminated through subtraction. Abnormalities in forces are thought to be due to abnormal muscle activity. The performance of stroke subjects reflected their level of recovery. Variations in performance across subjects were examined with correlation analysis. There was greater resistance to movement in the impaired arm. No difference was noted between the non-involved arm of subjects post –stroke and typical subjects. The sensitivity was somewhat low at 0.62% per FM point. Test-retest reliability was significant in all subjects. |
| This study examined the early eye and arm movement and the level of closed head injury manifested in motor control related to overall level of recovery at 1 and 6 months post injury. (Heitger, 2007) | Observational: Validity There were 37 subjects of whom 13 were female and 24 were male with closed-head injury. o The GCS needs to be within 13 and 15 on the first assessment. All patients had experienced some level of post-traumatic amnesia. The subjects were evaluated through the use of oculomotor testing, upper level visuomotor testing, neurpsychological test, and several health assessment measures. | Statistical analysis was conducted. Results showed that improvement in health status across the first six months was statistically significant on all measures. Overall motor performance at 1 week post injury demonstrated stronger associations with clinical outcomes at 3 months than early health status and neuropsychological testing. Statistical analysis also revealed a strong correlation between motor performance at 1 week and clinical presentation at 6 months/ However, the oculomotor assessment was not as predictive as upper extremity motor function. Recommendations were made for future studies to examine validity in larger size samples. |
| V-scope System | | |
V-scope system analysis was used to examine maximal range of active elbow flexion/extension and shoulder abduction/flexion in children with obstetric brachial plexus palsy (OBPP). Two physiotherapists (pediatric and generalist) collected data for each child on two occasions, one week apart. (Bialocerkowski, 2006) | Observational: Reliability Thirty children (18 females, 12 males; age range 6mo-4yr7mo; mean age 2y 6mo) participated in the study. Thirteen participants had an OBPP involving C5, C6 lesion, eleven participants had a C5, C6, C7 lesion, and six had a total brachial plexus lesion. | Data collection and equipment set up for the V-scope system is feasible to undertake in the clinical setting and produces reliable quantification of elbow flexion/extension and shoulder flexion/abduction movement in young children with OBPP. Average intraclass correlation coefficient (ICC) of intrarater reliability of the V-scope system measuring elbow flexion, extension and shoulder flexion, abduction was 0.69. Average ICC of interrater reliability of the V-scope system was 0.7. |
| Surface EMG-based Voluntary Response Index (VRI) | | |
AIS scores were given to subjects with incomplete spinal cord lesions. Surface EMG studies were performed on the same subjects. VRI was calculated from the sEMG scores. VRI and AIS scores were compared with a receiver operating characteristic curve. (Lim, 2005) | Observational: Reliability, Validity Patients included 67 subjects with incomplete spinal cord injury. Average patient age was 49.5 years, and average months post-injury were 57. These patients presented primarily with cervical level lesions (60%), with 27% between T1 and T9 and 13% below T10. | VRI values for AIS subscale D were much higher than for AIS subscale C. This shows that the VRI is sensitive to AIS classification. VRI cannot effectively differentiate between AIS-B and AIS-A, nor AIS-D and AIS-C. VRI is a standard measure of motor control that can compare SCI subjects. |
| Kinematic Aiming Tasks (KAT) | | |
This KAT consisted of 2 tasks: Discrete task which focused on precision and accuracy via moving an object (puppet) with the spastic hand a specific distance and placing it on a specific target; 4 different conditions for the task were specified: a) movement of 10 cm to a 5 cm target b) movement of 10 cm to a 2..5 cm target c) movement of 20 cm to a 5 cm target d) movement of 20 cm to a 2.5 cm target The goal of the task is to place object accurately on target which was located on a digitizer (LCD monitor—which records the x and y coordinates of the position of the object (puppet); 10 reps/condition were performed. Continuous task which focused on movement speed; moving the object to the target as quickly as possible within 20 seconds Baseline tests were performed and then follow-up testing performed 1 month later (approximately 14 days following Botox-A injections in the treatment group). (Rameckers, 2007) | Observational: Reliability, Validity 20 children diagnosed with hemiplegia with a mean age of 9.5 years (ages ranging from 4-16 years). 10 receiving Botox injections in the upper arm and forearm as the treatment group. 10 receiving no injections as the control group. | The ICC's of the KAT (baseline compared to the follow-up) of the non-treatment group were very high indicating reproducibility (0.05 level). An increase in END (spread of end points) occurred following BTX-A demonstrating that larger amplitudes led to poorer accuracy and when accuracy was the requirement it appeared that the task occurred slower allowing for more hypertonia (p<0.03) in the discrete task. An increase in speed was noted in the treatment group following Botox especially for the continuous task due to the increased range and less spasticity noted. |
| Symbol Digit Modalities Test (SDMT) | | |
| Each subject completed the Minimal Assessment of Cognitive Function in MS (MACFIMS) battery, under the supervision of a clinical neuropsychologist. The MACFIMS includes the Symbol Digit Modalities Test (SDMT), and this test was analyzed independently. The researchers investigated the correlations between the SDMT and the various tests included in the MACFIMS. (Parmenter, 2007) | Observational: Validity, Diagnositic accuracy This study included 100 patients with Multiple Sclerosis (mean age 44.6 years) that were either volunteers or referred for a routine baseline examination. Fifty healthy controls also participated (mean age 43.9 years). There were no significant differences between the two groups in terms of age, gender, race, or education. Exclusion criteria included: steroid treatment within the last six months, drug or alcohol dependence, history of a neurologic disease other than MS, and/or psychological problems not attributable to MS. | Compared to the control group, subjects with MS showed decreased performance on the SDMT (mean scores: 62.16 for control group, 47.66 for MS group). A score of 67 or less on the SDMT resulted in maximum sensitivity (Sn = 1.00). Specificity of 1.00 was observed with a SDMT score of 35 or lower. Due to the fact that the SDMT only requires five minutes per patient to administer and score, this study suggests that the SDMT is an effective and practical screening tool to detect cognitive impairments in patients with MS. |
| Functional Ambulation Categories (FAC) | | |
| Each subject began the research protocol within 14 days of stroke onset and their final outcome was determined at 26 weeks post stroke. Based on the Functional Ambulation Categories, independent gait was the outcome variable measured in this study. The FAC was organized into two groups: unable to walk independently (FAC < 4), and able to walk independently (FAC >4). The subjects performed numerous tests and a prediction of likelihood of independent gait at six months post stroke was formulated. (Kollen, 2006) | Observational: Reliability, Validity, Diagnostic Accuracy This was a prospective cohort study that included 100 patients who had suffered a primary ischemic middle cerebral artery stroke that was verified by a CAT scan or MRI. Patient ages ranged from 30 to 80 years old (mean 65.9 years). Inclusion criteria included: impaired motor function of the upper and lower extremities; no severe deficits in memory, communication, or understanding; no extensive past medical history that may have decreased level of activity prior to stroke. | Using the FAC, the accuracy of gait predictions in stroke patients during the first 10 weeks post stroke ranged from 75-86%. Using the FAC to predict gait status, the sensitivity during the first ten weeks post stroke ranged from 89-96%. The FAC has been shown to be valid and reliable in determining hemiplegic gait. |
All subjects received 20 minutes of locomotor training on an electromechanical gait trainer and 25 minutes of physical therapy or 45 minutes of physical therapy without locomotor training for 4 weeks. Subjects were assessed at baseline, 2 and 4 weeks, and 6 months. The assessment consisted of the FAC, gait speed, stride length, and walking distance. (Mehrholz, 2007) | Observational: Reliability, Validity Subjects were first-time supratentorial CVA patients within 60 days of occurrence. Age range was from 18 to 80 y/o. | Test-retest and intrarater reliability for the FAC with kappas were 0.950 and 0.905. An FAC score of 4 or more was sensitive (100%) in predicting community ambulation in 6 months. Concurrent validity of the FAC compared to the gait speed, step length, and walking distance were 0.901, 0.877 and 0.906 respectively. |
| Swedish version of the Modified Elderly Mobility Scale for acute stroke | | |
| The main purpose of this study was to evaluate whether the Swedish version of the Modified Elderly Mobility Scale is a valuable evaluation instrument in a group of patients with acute stroke. The Swedish modified Elderly Mobility Scale consists of seven items with a total score of 20. The items include: lying to sitting, sitting to lying, sitting to standing, standing balance, gait, timed walk and modified Functional Reach. The results of the instrument were compared to two scales already used for patients with acute stroke. These scales were the Modified Motor Assessment Scale of Uppsala Akademiska Sjukhus-95 and the Berg Balance Scale. One physical therapist assessed all the patients using the three evaluation instruments and a second physical therapist assessed the patients with the Swedish version of the Modified Elderly Mobility Scale. Assessments were performed on admission within the first 4 days, once a week during the hospital stay and at discharge. (Linder, 2006) | Observational: Reliability, Validity 30 consecutive patients (17women and 13 men) suffering a first time stroke, who were admitted to the stroke unit at Northern Alvsborg County Hospital, Sweden, were included in the study. Patients with a previous history of stroke, TIA or subarachnoid/subdural hemorrhage were excluded. The median age was 79 years old, with a range from 41-92. 15 patients had right-sided weakness, 14 had left side weakness and one was diagnosed as unspecified weakness. The median length of stay was 21 days, with a range from 8-35 days. | SPSS version 11.5 was used to analyze the data. Intraclass correlation (ICC) was used for inter-rater reliability. Spearman's rank correlation was used to analyze the correlation between the parameters in the three evaluation instruments. Wilcoxon's analysis was use to analyze changes over time. The inter-rater reliability between the two assessors was ICC=0.98 on admission and ICC=0.99 at discharge. The correlation between the Swedish modified Elderly Mobility Scale and the Modified Motor Assessment Scale of UAS are as follows: Admission am rs =0.88 Admission pm rs =0.82 Discharge am rs = 0.73 Discharge pm rs =0.69 The correlation between the Swedish Modified Elderly Mobility Scale and the Berg Balance Scale are as follows: Admission am rs = 0.94 Admission pm rs =0.90 Discharge am rs = 0.86 Discharge pm rs = 0.89 Weaknesses of the study include: not all patients at the stroke unit were included in the study; some were excluded based on their functional and cognitive status. A small number of patients participated in the study. So many patients achieved the highest score in a few weeks using the tested instrument that it indicates the instrument is not sensitive enough to be used as a single instrument in evaluating improvement of a patient with acute stroke. |
| Stroke Rehabilitation Assessment of Movement (STREAM) | | |
| STREAM is an instrument that consists of 30 items that are divided into 3 subscales: upper limb movements; lower limb movements; basic mobility skills. The purpose of the study was to determine inter-rater reliability and the validity of the STREAM regarding movement. The test was administered by 2 trained physical therapists with the PT's blinded to the other therapist's results. Another therapist also was used to evaluate using the Fugl-Meyer UE/LE components and the Reivermead Mobility Index (RMI) to determine validity of the STREAM results. (Wang, 2002) | Observational: Reliability, Validity 54 patients Median length of time since stroke occurred was 74 days (ranging from 25-361 days). | Inter-rater reliability of the scores of the STREAM was determined via the use of the intra-class correlation coefficient. The ICC of the total score on the STREAM was 0.96 with p<0.0001-very high inter-rater reliability. The correlation analysis via the Spearman rank order correlation coefficient regarding the subscale scores of the STREAM were closely associated with the FMUE, FMLE and the RMI (p<0.001). |
| The Rivermead Mobility Index (RMI) and the Mobility subscale of the Stroke Rehabilitation Assessment of Movement (M-STREAM) |
| The purpose of the study was to examine the test-retest agreement and measurement errors of the RMI and M-STREAM on a large cohort of chronic stroke patients. The aim was to establish relative and absolute test-retest reliability of the 2 mobility measures. The RMI and the M-STREAM were administered twice with the tests 1 week apart. The tests were administered by a specially trained occupational therapist. Each patient was also interviewed with the Barthel Index at the first test session by an independent physical therapist to establish classification. (Chen, 2007) | Experimental study Chronic stroke patients were recruited at 2 rehabilitation departments of the Kaohsiung Medical University Hospital and the Kaohsiung Municipal Hsiao-Kang Hospital. The subjects had suffered a stroke more than 6 months prior to the recruitment. Patients were excluded from the study if they were medically unstable or had any major diseases (cancer, dementia, rheumatoid arthritis). 50 chronic stroke patients met the selection criteria and agreed to participate in the study. | SPSS version 11.0 was used for calculation. ICC was used to determine relative reliability. Measurement errors were quantified through the use of standard error of measure (SEM) A paired t test was used to examine the difference between test and retest scores for each of the 2 mobility measures. The ICCs for both the RMI and M-STREAM were 0.96 (95% CI) indicating excellent test-retest reliability. The study revealed a SEM of 0.8 for RMI and 1.5 for M-STREAM, which indicates good absolute reliability. The SRDs(smallest real differences) of RMI and M-STREAM were 2.2 and 4.2, respectively. The 2 mobility measures are highly reliable. There is excellent agreement between repeated measurements. The SEM & SRD values for both measures indicate that the thresholds for both measures to detect real changes are low. The conclusion of this study is that the 2 mobility measures can be used for clinicians and researchers to assess the mobility performance and monitor mobility changes over time in chronic stroke patients. |
| Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES) | | |
Purpose of the study was to determine the validity of the MESUPES via Rasch analysis as well as item fit and if the MESUPES measures the "quality of movement" of the upper extremity. this is what it was developed to do. Inter-rater reliability was also measured. The MESUPES contains 10 arm function items, 9 hand function items and 3 functional tasks. The muscle tone, muscle contraction and independent movements of the UE are documented within this test. 7 raters were trained for 1 hour to become familiar with the assessment protocol. For the inter-rater reliability study, the participants were tested approximately 24 hours apart by 2 different therapists. (van de Winckel, 2006) | Observational: Reliability, Validity 396 patients (avg age 63.38 + 12.89 yrs); avg time post- stroke CVA 7.18 +16.36 mos) with unilateral hemiparesis/hemiplegia. due to stroke. 56/396 patients were selected randomly for the inter-rater reliability study. | MESUPES was divided into 2 dimensions: MESUPES-arm and MESUPES-hand due to the Rasch analysis determining multidimensionality. Rasch analysis was then able to be performed on the separate scales. Fit statistics confirmed that both scales are unidimensional. DIF (differential item functioning)— establishes stability of items when comparing to various subgroups such as male vs. female; age; gender; side of lesion; type of stroke, etc. Inter-rater reliability is very high with ICC of 0.95 for total arm test and 0.97 for total hand test. |
| Muscular Dystrophy-Specific Functional Rating Scale (MDFRS) | | |
The development of the MDFRS occurred in 3 stages. Stage 1 was the item generation stage which included a literature search on MD and interviews with children diagnosed with MD to determine the specific measurements. and also research regarding these items. Stage 2 was the item reduction and scale formation using another set of subjects. Stage 3 was the scale evaluation where another set of subjects was used to assess the scale and determine its reliability and validity. Inter-rater reliability was assessed by using some of the subjects within the Stage 3 subject group and the subjects were tested within 1 day of previous test. Test-retest reliability occurred during a 1-week time span. Validity was assessed by comparing the MDFRS to the Bathel Index, Brooke Scale and Vignos Scale using the Spearman rank correlation coefficient. (Lue, 2006) | Observational: Reliability, Validity Stage 1 consisted of 25 patients diagnosed with MD. Stage 2 consisted of 85 patients age 6 yrs and above with a confirmed diagnosis of MD by 2 neurologists. The subjects were selected via their classification by the Brooke scale to ensure patients from the entire spectrum of severity of the condition were represented. Stage 3 consisted of 121 patients not including any patients from Stage 2. | Test-retest was high with ICC of .99 for all domains and total score. Inter-rater reliability was high with ICC of 0.98 for all domains and total score. Construct validity demonstrated moderate to high correlations with Barthel Index (rho=0.91); Brooke scale (rho=-0.75). Author's conclusion is that the MDFRS is a reliable and valid disease-specific assessment of functional status of patients diagnosed with MD. |
| Frederick's Ataxia Rating Scale (FARS) | | |
| The FARS was assessed to determine if it is a valid clinical tool in assessing the disease progression of ataxia. The FARS, 9-hole-peg test, and timed 25 foot walk test were used for comparison. Composite scores from these tests were calculated and used to determine the ICC. (Lynch, 2006) | | FARS correlated highly with ADL'S, disability and duration. The FARS captures the neurological features of the phenotype associated with FA. FARS captures the disease progression equal to or greater than a neurologic examination. |
| Spinal Cord Independence Measure II | | |
| The SCIM II was compared to ASIA motor scores to determine its usefulness in capturing changes in functional recovery after the first year of SCI. (Wirth, 2008) | Observational: Validity Subjects included 64 patients with complete motor paraplegia and 36 patients with complete motor quadriplegia. Patients were classified according to motor level. Data was collected at 1, 3, 6 and 12 month time periods after injury. n-parametric statistical tests were applied due to the ordinal nature of both the ASIA and the SCIM. Additional statistical analysis was performed to analyze if there were significant differences between the 4 measurements. | Results demonstrated the total score of the SCIM II in patients with complete motor paraplegia increased during the rehabilitation process. Similar changes were seen in patients with complete motor quadriplegia. Results indicated that the bulk of recovery took place in the first three months after injury; however, improvements did continue. Median ASIA scores remained the same showing little recovery. The SCIM II was established as a measurement tool for individuals with SCI that is responsive to change. It was seen to have complementary value to the ASIA. |
| Virtual Reality (VR) and Haptics | | |
With the availability of virtual reality technology, it becomes possible to examine and train human motor behavior in computer-generated scenarios that can be easily adapted to the individual motor skills of single subjects according to various degrees of difficulty. Recently, training with haptic devices, which provide some sensory feedback to users when they touch virtual objects, has been suggested to enhance stroke rehabilitation when combined with virtual reality. The aim of the present study was to assess motor training with haptics and VR in the chronic phase after stroke. The second aim was to identify whether any improvement detected in the VR environment was reflected in ADLs. (Broeren, 2007) | Observational: Descriptive A pretest, posttest AB, plus follow-up C design study involving 5 hemiparetic, post-stroke subjects (mean age = 59 [range 53-63]) consecutively recruited from Sahlgrenska University Hospital. Inclusion criteria: >6 mos s/p CVA, severe hemiparesis in one of the upper extremities, no signs of neglect, and minimum age =18. Exclusion criteria: joint problems or primary injury to arm/hand, language difficulty affecting information reception (need of an interpreter), other neurological disease, or clinically overt depression of symptoms requiring medication. The subjects played a computer game, 3D Bricks, which entails striking a virtual ball to knock over bricks in a pile. The game operated at 7 levels of speed, with all subjects starting at the easiest and progressing once they reached a pre-determined score in 3 consecutive games. Fifteen 45-min treatment sessions were conducted over 5 weeks. | All subjects showed improvement in movement velocity and efficiency. However, due to the small number of data points accumulated, the results should be viewed with caution. Improvements in ADL functional measures were limited at best, but the authors contribute some of this to the fact that subjects began using their affected limbs for ADLs, which decreased their scores on those measures. |
| General Movement Assessment using the Prechtl Classification | | |
| The purpose of the study was to determine the reliability and specificity of the general movement assessment for prediction of cerebral palsy. (Adde, 2007) | Observational: Reliability, Diagnostic Accuracy 74 infants representing both low and high risk for neurological impairment were assessed using the General Movement Assessment. The absence or presence of CP was reported at 23 months by the child's physician. Statistics were calculated for sensitivity and specificity. | |
| Gross Motor Function Measure (GMFM) | | |
| The purpose of the study was to validate the GMFM for use with pediatric patient's s/p TBI. (Linder-Lucht, 2007) | Observational: Reliability, Validity 73 patients (mean age = 11.4) with moderate to severe TBI were recruited from 12 rehabilitation centers in Germany and Switzerland and assessed twice with the GMFM-88 over 4-6 weeks. Standard appraisals of change made by parents, PTs, and independent video assessors were used as an external standard for comparison, assuming that this measure reflects clinically relevant change in motor function. | Correlations between the total GMFM-88 change score and video rating were best (r=0.737 and r=0.657 for 2 video raters), followed by correlation with PTs (r=0.555) and parents (r=0.531). Interrater reliability was high (r=0.704). Changes in gross motor function became fewer as the time interval between TBI and initial testing increased. Change scores of the GMFM-88 and GMFM-66 were higher during the first year of rehab after TBI. Test-retest reliability in a small sample of patients was high, indicating that both versions of the GMFM are consistent over a short period of time when no significant change in function occurred. |
| The purpose of this study was to evaluate the responsiveness to change in the two versions of the GMFM in children with cerebral palsy. (Wang, 2006a) | Observational: Descriptive A convenience sample of 65 children with cerebral palsy (37 boys, 28 girls) was recruited for this study. Ages ranged from 0.5 years to 9.4 years. 17 therapists were included in the study. The children's gross motor skills were assessed twice within an average of 3.5 months. The therapist also reported their professional judgment on a scale of 3 categories regarding the child's progress. | Data analysis included receiver operating characteristic curves to determine the performance of both versions of the GMFM. Paired t test showed that the children who had been judged as having made gross motor gains showed improvements on both versions of the GMFM. The specificity of the GMFM 66 was better than the GMFM 88. The GMFM 66 also showed improved consistency of scores with clinical judgment. |
| Selective Control Assessment of the Lower Extremity (SCALE) | | |
| Prior to this study, a reliable and valid tool to evaluate Selective Voluntary Motor Control (SVMC) was not available to clinicians. SVMC refers to the patient's ability to perform isolated movements without undesired movement at other joints. Therefore, the purpose of this study was to examine the development, validation, and interrater reliability of the Selective Control Assessment of the Lower Extremity (SCALE) in quantifying SVMC in patients with cerebral palsy. (Fowler, 2009) | Observational: Descriptive Individuals with spastic cerebral palsy were recruited from the UCLA/Orthopaedic Hospital Center for Cerebral Palsy, and participating clinicians were recruited from physical therapy clinics, hospitals, and universities. Twenty participants, including 7 males and 13 females ranging from 7 to 23 years of age, were evaluated by six clinicians using SCALE. | The mean agreement for statements about content, administration, and grading, reviewed by 14 experienced clinicians, was 91.9%. Intraclass correlation coefficients ranging from 0.88 to 0.91 (p < 0.001) demonstrate high interrater reliability. Conclusions drawn indicate that assessment of SVMC using SCALE should provide clinicians with indications for appropriate intervention. |
| Selective Control of the Upper Extremity Scale (SCUES) | | |
This study's purpose was to describe the development of the SCUES and assess the validity and reliability. Similar to the SCALE tool, its purpose is to evaluate children with cerebral palsy and assess the selective motor control of the UEs. The test can be performed in less than 15 minutes by a physical or therapist. The only technological equipment necessary is a video camera that is used to assess 5 joints (shoulder, elbow, forearm, wrist, fingers) of the UE. Administration of the assessment includes 4 steps: 1. Demonstration of the motion 2. PROM through desired plane 3. Participant performs the same motion 4. Grading by examiner from video. Patient is scored based on their performance of the motion. Four characteristics are graded at each joint level: 1. Presence of mirrored movements (both limbs performing the requested task) 2. Movement of additional joints other than target joint 3. Presence of trunk movement 4. Actual motion vs. passive range. Each characteristic is subjectively graded on a four-point scale of specified parameters (no SMC [selective motor control], moderately diminished SMC, mildly diminished SMC, normal SMC). The SCUES is composed of SMC tasks to be quantitatively scored on the above scale. It is thought that lack SMC correlates with functional impairments, which can be addressed through various interventions. (Wagner, 2016) | | The SCUES was strongly correlated (p=0.003) with the SHUEE (Shriners Hospitals Upper Extremity Evaluation) resulting in good construct validity. |
| Peabody Developmental Motor Scales-Second Edition for Children with Cerebral Palsy | | |
| The purpose of this study was to investigate the responsiveness of the PDMS-2 for children with CP and to examine the test-retest reliability and standard error of measure for children with CP. (Wang, 2006b) | Observational: Descriptive Children were recruited from 2 developmental centers and 7 hospitals in Taiwan. Inclusion criteria were: a confirmed medical diagnosis of CP from the attending pediatrician, 24 to 65 months of age at first evaluation, receiving physical or occupational therapy at least twice per month during the study period. Exclusion criteria were: a medical problem that would prevent participation and expected progress in therapy over a 3-month period. The severity of CP was measured according to the Gross Motor Function Classification System and was rated by the physical therapist treating those children and confirmed by one senior physical therapist. One physical therapist assessed each child 3 times. The first and second tests were 1 week apart and the first and third test was 3 months apart. | SPSS version 10.0 was used for statistical analyses. ICC was used to analyze test-retest reliability. The standard error of measure was calculated for GM, FM and TM composites. Four statistical analyses were performed to calculate the sensitivity-to-change: the paired t test, the effect size (ES), the standardized response mean and the Guyatt responsiveness index. The GRI for responsiveness was used to determine responsiveness of the PDMS-2. The ICCs for developmental quotients range from 0.979 to 0.988, for percentile scores 0.878 to 0.954, for raw scores 0.993 to 0.996 and for percentage scores 0.993 to 0.995 (P<.0001). The results indicate good test-retest reliability for the PDMS-2. The paired t test scores were significantly different between the first and third test t values of 4.98 to 7.35(P<0.001). The ES value was 0.2 for GM, FM and TM composites which met minimum standard and indicated a small change. The standardized response mean values of the percentage scores on the PDMS-2 were 1.3 for the TM composite, indicating a small change, 0.9 for the GM composite, indicating a trivial to small change and 1.0 for the FM composite, indicating a small change in children with CP. The GRI responsiveness values range from 1.7 to 2.3 which is considered acceptable as compared to values obtained for other outcome measures. In conclusion, the study shows good test-retest reliability, acceptable sensitivity to change and responsiveness. The PDMS-2 can be used to measure motor skill and motor development change over time for children with CP aged 2-5 years old and the standard error of measure could be used to determine if an individual achieves real change. |
| Selective Motor Control Assessment in Children with Cerebral Palsy | | |
The objective of the study was to determine the inter-rater and test retest reliability of a scale for assessing selective motor control (SMC) in the dorsiflexors of the ankle in children with Cerebral Palsy in a clinical setting. | Observational reliability study Children (n=40) aged 3-16 years (median 7 years) including 30 with bilateral CP, and 10 unilateral;all classified as Gross Motor Classification System levels I-V. recruited from a Children's Hospital. | The test retest reliability was found to be strong (Kw .88) and was achieved through a second assessment of 29 of the 40 children. Inter-rater reliability showed fair/good to strong agreement between pairs of raters (Kw 0.58 0.77). It is concluded that repeated evaluations should preferably be performed by the same rater. Scale is a criterion-referenced, observational measure assessing which muscles the child primarily activates to achieve dorsiflexion of the ankle. Selective motor control was measured with the Boyd & Graham scale which ranges from 0 (indicating no ankle movement) to 4 (indicating isolated SMC through available ROM with balanced activity in tibialis anterior). |
| Dubowitz Neonatal Examination | | |
| The purpose of this study was to examine the Dubowitz and establish reference values for the neurological examination of low risk pre-term infants. (Ricci, 2008) | Observational: Reliability, Validity The subjects included prospectively enrolled preterm infants born before 34 weeks and two cohorts were established. The first cohort included children born between 25 and 34.9 weeks gestation, normal presentation on cranial ultrasound, complete neurological examination at the term equivalent age, and determined neurologically normal at 24 months. The second cohorts included infants of the same gestational ages; however, they presented with significant neurological lesions on ultrasound. The children in the second cohort were evaluated by a pediatric neurologist at 2 years of age to determine outcome (normal, hemiplegic, diplegic, or tetraplegic). | Range and median scores were determined for individual items. Comparisons were made between the low risk preterm infants median scores with those of the infants with major lesions. Differences in the median scores were seen in 6/34 (17.6%) items in the infants who later present with a normal motor outcome, 12/34(35.3%) in those developing hemiplegia, 18/34 (52.9%) of those developing diplegia, and 24/34 (70.6%) in those developing tetraplegia. The infants with a major lesion had a greater number of items that fell outside the 90th centile obtained from the low risk cohort. Over 90% of the low risk infants had fewer four items that fell out of the 90thcentile. All of the infants with lesions and a normal outcome had fewer than 7 items outside of the 90% centile. 7 or more items scored outside of the 90% centile was found in 15% of infants later diagnosed with hemiplegia, 40% who later developed diplegia, and 80% who developed tetrapelgia. The authors concluded this may be a tool useful in identifying children at risk for serious long term sequelae. |
| TIMPSI Screen for Motor Development | | |
| The purpose of this study was to compare concurrent TIMPSI scores with those of the TIMP and establish cut off points for clinical decision making. (Campbell, 2008) | Observational: Reliability, Validity Subjects included 990 infants selected to reflect the racial and ethnic diversity of the general population. The TIMPSI and the TIMP were administered to the infants. | Rater reliability was established utilizing the Rasch analysis of rater consistency and severity. Methods based in Rasch analysis were used to calibrate data from both scales using the WINSTEPS software program. The scores from the TIMP were equated to the TIMPSI with a common item anchoring approach. Cutoff scores were established by taking scores from the mean to -1 standard deviation and comparing it with data from the TIMP for accuracy of classification. Results showed the TIMPSI was a valid screening tool when compared to the TIMP. A cutoff score of -0/25 SD appears most beneficial in predicting the best combination of false negatives (5.8%) and false positives (12.5%) and overall accuracy of classification (81.7%). |
| Infant Motor Profile (IMP) | | |
| The purpose of this study was to determine the intra- and interobserver reliability and concurrent validity of the Infant Motor Profile (IMP) with the Alberta Infant Motor Scale (AIMS) and Touwen neurological examination. The IMP is a video-based assessment of motor behavior which evaluates motor abilities, movement variability, the ability to select motor strategies, movement symmetry, and fluency. IMP and AIMS scores were determined by viewing video recordings of each infant. After the video was recorded, each infant was examined by an investigator following a neurological examination according to Touwen. (Heineman, 2008) | Observational: Reliability, Validity Participants consisted of 80 infants, including 31 females and 49 males. Forty infants were term born without pre- or perinatal complications, with the gestational age (GA) at birth ranging from 38-42 weeks and the birthweight ranging from 2730-4220 grams. The other forty infants had a GA at birth ranging from 26-33 weeks with the birthweight ranging from 585-2120 grams. All infants underwent cross-sectional assessment at the corrected ages of 4, 6, 10, 12, and 18 months. | Intra- and interobserver reliability was satisfactory (rho = 0.9) and concurrent validity of the IMP and AIMS was good (rho = .8, p < 0.005). The IMP allowed for differentiation between infants with normal neurological condition, simple minor neurological dysfunction, complex minor neurological dysfunction, and abnormal neurological condition (p < 0.005). Confirmation of the IMP's ability to evaluate neurological integrity in infants needs to be determined by assessing a larger group of infants with varying neurological conditions. |
| Movement Assessment Battery for Children (M-ABC) | | |
| The aim of this study was to determine whether the M-ABC is a reliable tool to discriminate between motor impaired preschool children and typically developing children and to determine whether the measurement error of the M-ABC is acceptable to monitor the motor performance of preschool children. This test was specifically designed to identify children with mild to moderate motor impairments. One trained examiner tested all the children three times with exactly 3 weeks between each session. The test contains 32 items, divided into four sets of eight. The three main categories of testing were: dexterity, ball skills and balance. The summed score ranges between 0-40. Lower scores indicate better performance. (Van Waelvelde, 2007) | Observational: Reliability, Validity Thirteen teachers in seven Flemish mainstream schools were asked to select three children with the worst motor skills in their class. None of the children had known handicaps. A total of 33 children participated in the study. 24 boys and 9 girls. The age of the children ranged between 4years 0 months and 5 years 11 months. | Intraclass correlation coefficients (ICCs) were used to evaluate the test-retest reliability between the three tests. To further assess the test-retest reliability, a standard error of measurement (SEM) was calculated for the total test score. A kappa statistic was used to measure the agreement between different measurements. The ICC between the three total impairment scores was 0.88 with 95% CI which indicated good reliability. The ICC between the three balance subscores was good (0.82), between the dexterity subscores was moderate (0.75) and between the ball skills subscores was poor (0.45). The test-retest reliability was too low for the individual item scores to allow clear interpretation. The SEM of the total M-ABC was 2.4. Generally, the smaller the SEM the more reliable the measurement. The agreement expressed by the kappa coefficient was good at 0.72. Clinicians should be cautious using the M-ABC to evaluate individual item scores and ball skills, because the reliability for these scores was low. The M-ABC for children is reliable for identification of preschool children with mild to moderate motor impairment. The M-ABC should be viewed as part of a comprehensive assessment Frequent testing of preschool children results in improved test performance and should be avoided. |
| Movement Assessment Battery for Children-2 (MABC-2) Checklist | | |
| The purpose of this study was to investigate the validity and reliability of the MABC-2 Checklist, which was designed to identify children with motor difficulties in the age range 5 to 11 years. The internal consistency of the items of the checklist was investigated as a measure of reliability. Validity was examined by conducting correlations between the MABC-2 Checklist, the MABC-2 Test, and the Developmental Disorder Coordination Questionnaire 2007 (DCDQ'07) parental questionnaire; and also by investigating whether children with scores in the clinical range on the MABC-2 Checklist also fail on the MABC-2 Test. Teachers of the chosen students were asked to fill out the MABC-2 Checklist for each student. Sixteen trained therapists then administered the MABC-2 Test to all participants at each child's school, and a parent of one-third of the children was asked to fill out the DCDQ'07. (Schoemaker, 2012) | Observational: Reliability, Validity For standardization, teachers were asked to select five Dutch children aged between 3 and 16 years, which gave a total of 825 students to whom the MABC-2 Checklist was administered. Students age 5 to 8 years were selected for this study (n=500) of which 383 children were included in the final sample. Therapists administered the MABC-2 Test to all 383 participants. A parent of one-third of the 383 students was randomly selected to fill out the DCDQ'07. | To determine the degree of consistency among the items of the Checklist, Cronbach's alpha was0.94, suggesting that all items measure the same construct. A significant correlation was obtained between the Total Motor Score (TMS) and Total Test Score (TTS) for the MABC-2 Checklist and Test respectively (rs=-0.38; p<0.001; n=383). The percentage of agreement for the Checklist and Test was 80% (307/383); and a kappa value of 0.28 was obtained, which is fair. Sensitivity was 0.41 (26/64) and specificity was 0.88 (281/319) across all age groups if the 15th percentile was used as the cut-off for the Test and Checklist Significant but moderate correlations were obtained between the Checklist and the Test scores (-0.38), and between the Checklist and the DCDQ'07 (-0.36), which implies that these instruments assess both overlapping but also slightly distinct motor skills. The Checklist was able to discriminate between the group with motor impairments and the typically developing group across all ages. |