Objective Assessment of Upper Extremity Functioning of Stroke Patients Before and After Rehabilitation
Condition: Stroke
MeSH terms: Stroke
Study type: Observational [Patient Registry]

Summary: 
      The purpose of this study is to evaluate by objective measures the improvement in upper
      extremity functioning, as reflection of motor learning, in stroke patients in the sub acute
      phase. The investigators hypothesize that the improvements in daily functioning are partially
      due to compensation strategies and partially due to motor learning.
    

Detailed description: 
      Background: Most stroke patients continue to suffer from upper extremity motor deficiencies
      even after prolonged and intense rehabilitation in hospital. Even though guidelines and other
      studies recommend to apply a rehabilitation programs as patient reception. As opposed to that
      there is a scarce evidence for the efficacy of the rehabilitation.

      Objectives: To evaluate by objective measures the improvement in motor performance of the
      upper extremity of stroke patients in the sub acute period. Secondary objective is to
      describe the correlation between proximal and distal motor deficiencies of the upper
      extremity.

      Hypothesis: Patients will show better hand performance at the end of hospitalization. Part of
      it can be attributed to the rehabilitation and part to a spontaneous recovery. Correlation
      will be found for proximal and distal upper extremity motor deficiencies.

      Methods:

      Trial began only after the IRB research approval. All treatment sessions will implemented by
      the physical and occupational staff of the hospital. Assessments for the measures will be
      carry out by a certified physical therapist which is coinvestigator. The coinvestigator
      collect the raw data for analysis in Excel and than in SPSS.

      20 stroke patients who meet the inclusion criteria will participate in the study, after
      signing an informed consent.Patients will undergo the first assessment of all measures, e.g:
      motor abilities by Fugl-Meyer test, handwriting kinematic and kinetic measures and surface
      electromyography for measurement of muscle synergy.Patients will be treated by standard
      rehabilitation of physical and occupational therapy for a period of 3-4 weeks. Before
      discharge from hospital patients will undergo another assessment of all measures, in order to
      evaluate the progression in their upper limb motor abilities from reception. Part of the
      patients will be assessed again two to three weeks after discharge as follow up.

      Outcome Measures: upper limb Fugl-Meyer assessment, handwriting Air-time, pressure and
      velocity, EMG (i.e., muscle onset, muscle amplitude, muscle co-activation ratio).

      Statistical analysis: ANOVA analysis will be used to measure time effect. Correlation between
      measures will be measured by Pearson's correlation. Sample size (n=20) was calculated based
      on 5 points improvement in Fugl-Meyer test as minimal significant change with power of 0.8
      and p-level under 0.05 for significance.

      Key words: Stroke, Muscle synergy, Handwriting, Fugl-Meyer
    

Intervention name(s): stroke; Healthy controls
Intervention type(s): Other; Other
Intervention description(s): task-oriented therapy: physical and occupational therapy emphasizing integration of the patients needs, environment and context; no treatment
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Cohort will be selected from Fliman Rehabilitation Geriatric Center. Healthy subjects, age
        and gender-matched will be served as a control group.