Gains in Upper Extremity Function After Stroke via Recovery or Compensation: Potential Differential Effects on Amount of Real-World Limb Use
- 1 July 2009
- journal article
- research article
- Published by Informa UK Limited in Topics in Stroke Rehabilitation
- Vol. 16 (4), 237-253
- https://doi.org/10.1310/tsr1604-237
Abstract
In terms of integration of the paretic upper extremity in activities of daily living (ADLs), outcome is poor after stroke. Furthermore, amount of real-world arm use appears only weakly correlated with laboratory motor function scales. Therefore, amount of arm use may depend critically on the location, extent, and type of functional gains, which can be quantified with comprehensive kinematic and EMG analysis of ADL performance. Gains in upper extremity function can occur via compensation or recovery of premorbid movement and EMG patterns, and traditional treatment approaches encourage adoption of compensatory strategies early in the postacute period that can inhibit potential recovery. A new treatment approach called Accelerated Skill Acquisition Program (ASAP) focuses on impairment reduction coupled with repetitive, task-specific training of the paretic arm during ADLs. We present pilot data that show recovery in subjects who received the ASAP, while a usual care control subject showed increased use of compensation over the same period. Finally, we discuss the advantages of data reduction methods such as principal components analysis, confirmatory factor analysis, and structural equation modeling, which can potentially distill large kinematic and EMG data sets into the key latent variables that predict amount of real-world use.Keywords
This publication has 87 references indexed in Scilit:
- What Do Motor “Recovery” and “Compensation” Mean in Patients Following Stroke?Neurorehabilitation and Neural Repair, 2008
- Validity of Accelerometry for Monitoring Real-World Arm Activity in Patients With Subacute Stroke: Evidence From the Extremity Constraint-Induced Therapy Evaluation TrialArchives Of Physical Medicine and Rehabilitation, 2006
- The Motor Activity Log-28Neurology, 2006
- A Placebo-Controlled Trial of Constraint-Induced Movement Therapy for Upper Extremity After StrokeStroke, 2006
- Factors Influencing Stroke Survivors’ Quality of Life During Subacute RecoveryStroke, 2005
- Rehabilitation after StrokeThe New England Journal of Medicine, 2005
- Treatment Interventions for the Paretic Upper Limb of Stroke Survivors: A Critical ReviewNeurorehabilitation and Neural Repair, 2003
- Probability of Regaining Dexterity in the Flaccid Upper LimbStroke, 2003
- Rehabilitation outcome following initial unilateral hemispheric stroke. Life table analysis approach.Stroke, 1988
- The hemiplegic arm after stroke: measurement and recovery.Journal of Neurology, Neurosurgery & Psychiatry, 1983