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


DESIGN
Feasibility study, single group design.


SETTING
University rehabilitation research laboratory.


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


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


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


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


CONCLUSIONS
The Fugl-Meyer Assessment of the Upper Extremity keyform is a feasible method to ensure that the difficulty of tasks practiced were well matched to initial and evolving levels of upper extremity motor ability.
['Woodbury|Michelle L|ML|', 'Anderson|Kelly|K|', 'Finetto|Christian|C|', 'Fortune|Andrew|A|', 'Dellenbach|Blair|B|', 'Grattan|Emily|E|', 'Hutchison|Scott|S|']
D000203:Activities of Daily Living D000328:Adult D000368:Aged D001696:Biomechanical Phenomena D004185:Disability Evaluation D005221:Fatigue D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009048:Motor Skills D010146:Pain D016059:Range of Motion, Articular D000071939:Stroke Rehabilitation D034941:Upper Extremity
Stroke Rehabilitation Occupational therapy