UE Assessment - Strokecertification

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11/27/2021UE Assessment1Certificate in Motor Rehabilitationof the Neurological Upper Extremity2Where Can I FindThe “Best” StrokeMeasures?31

11/27/2021Web sites for stroke specific outcome measures StrokEngine AssessThe Internet Stroke Center, Washington University, St. ures5The Brunnstrom stages(according to Brunnstrum) Stage 1: The first stage is flaccidity. Thewhole hemiparetic side is completely limp.The arm, the leg, the torso, the faceincluding the mouth and tongue, thewhole body on one side is flaccid or limp. Stage 2: The second step is wherespasticity starts to creep into the effectedside of the body. Spasticity is generallyseen as a positive step because it signalsthe beginning of some sort of messagesgetting through to the limbs. There maybe some small amount of voluntarysynergistic movement available. Stage 3: Spasticity may become severeduring this stage. That is the bad part ofstage 3. The good part is that voluntarycontrol of synergies develops.Movement Therapy in Hemiplegia: a Neurophysiological Approach62

11/27/2021TheBrunnstromstages Stage 4 During stage 4, spasticity beginsto decline. Stage 4 also is the stagewhere some movement outside ofsynergy is possible. Stage 5 Synergies continue to decline.Folks in stage 5 are able to have morevoluntary controlout of synergy and spasticity continuesto decline. Stage 6 This is the final stage and, if thisstage is achieved, movements are nearnormal and spasticity absent exceptwhen fatigued or performing rapidmovements. Individual jointmovements become possible andcoordination approaches normal.Movement Therapy in Hemiplegia: a Neurophysiological Approach7The Brunnström stages simplified8The Fugl-MeyerCaptures Most Levels93

11/27/2021Characteristics ofthe Fugl-Meyer– All parts of the UE– Well-established (1975) Insurance likes it– “Highly Recommended” in allsettings (StrokeEdge)– Any time post stroke– Correlated with functionaloutcomes (but notfunctional)– Hierarchical fast– Few equipment 1011ARM MOTOR FUGL-MEYER Unaffected side is assessed first: 2 reasonsTester can see what “normal” looks likeParticipant can demonstrate they understand Up to three attempts are allowed and the bestperformance is scored Use as a “dive in” to other measures Most items are scored on a 3-point scale:0 cannot perform1 performs partially2 performs fully124

11/27/2021ARM MOTOR FUGL-MEYERReflex-Activity0 NO reflex activity2 YES reflex activityThis is the only task that isscored 0 or 2;Everything else is 0,1, 213ARM MOTORFUGL-MEYERDynamicMovement WithinFlexor Synergy14ARM MOTOR FUGL-MEYERFlexor Synergy Retraction of the shoulder girdle Elevation of the shoulder girdle Abduction of the GH joint External rotation at the GH joint Elbow flexion Supination of the forearm0 cannot perform1 performs partially2 performs fully155

11/27/2021Flexor synergy testing: Anterior16Flexor synergy: Posterior17ARM MOTORFUGL-MEYERDynamicMovement WithinExtensor Synergy186

11/27/2021ARM MOTOR FUGL-MEYERExtensor Synergy Adduction/Internal Rotation ofthe shoulder Elbow extension Pronation of the forearm.0 cannot perform1 performs partially2 performs fully19Extensor synergy20ARM MOTOR FUGL-MEYERHand to lumbar spineScore:0 Hand does not move posteriorto the ASIS1 Hand does move posterior tothe plane2 Hand is placed on the small ofthe back equal to the unaffectedsideHand FROM WRIST CREASE ON217

11/27/2021Hand to back22ARM MOTOR FUGL-MEYERShoulder flexion to 90 with elbow at 0 Score:0 Participant cannot achieve the testingpositionOR elbow flexion occurs at the onset ofshoulder flexionOR there is no shoulder flexion1 Elbow flexion occurs following the onsetof shoulder flexion OR shoulder flexion doesnot reach 90 2 Elbow remains fully extended equal to orgreater than the unaffected side andshoulder flexes to 90 23ARM MOTOR FUGL-MEYERThe “shake hands” positionIf necessary, theexaminer may providesupport at the midforearm by with thepalmer surface of anopen hand.248

11/27/2021ARM MOTOR FUGL-MEYERPronation/Supination with elbow at 90 The“shake hands”position25ARM MOTOR FUGL-MEYERAbduction to 90 Assessed by asking theparticipant, “rest your armat your side; withoutbending your elbow bringyour arm out to shoulderheight; be sure not tobend your elbow and keepyour palm facing the floor;do it like this(demonstrate).”0 Participant cannot achievethe testing positionOR elbow position is lost theonset of AB1 Elbow flexion/supinationoccurs following the onsetof ABOR AB does not reach 90 2 Elbow remains fullyextended and forearmremains pronated equal toor greater than theunaffected side and AB isto 90 26Abduction279

11/27/2021ARM MOTOR FUGL-MEYERShoulder flexion 90 to 180 with elbow at 0 andforearm in neutralStarting position: Theparticipant must beginwith the armoutstretched with 90ºof shoulder flexionand with the elbowfully extended to 0º inorder to score 0.28ARM MOTOR FUGL-MEYERPronation/Supination with elbow at 0 andshoulder between 30 and 90 of flexionStarting position: The participantmust begin with the armoutstretched with the elbow fullyextended to 0º. If this is notpossible, support is given justproximal to the elbow to stabilizethe humerus in the correct position.Elbow extension cannot beassisted.29ARM MOTOR FUGL-MEYERWrist stability with wrist in 15 extensionand elbow at 90Slight downwardpressure3010

11/27/2021ARM MOTOR FUGL-MEYERWrist mobility with the elbow at 90 Forearm pronated31ARM MOTOR FUGL-MEYERWrist stability with wrist in 15 extension and elbow at 0 and shoulder between 30 and 90 of flexion The examiner mayprovide support justproximal to the elbowto stabilize thehumerus in the correctposition. Elbow extensioncannot be assisted.32ARM MOTOR FUGL-MEYERWrist mobility with the elbow at 0 and shoulder between 30 and 90 ofForearmpronatedThe examiner may providesupport just proximal to theelbow to stabilize the humerusin the correct position. Elbowextension cannot be assisted.3311

11/27/2021ARM MOTOR FUGL-MEYERCircumduction of the wristResting position on lap34ARM MOTOR FUGL-MEYERMass flexionMass extensionSupport allowed35ARM MOTOR FUGL-MEYERGrasp A (hook) The MCPs areextended and theDIPs and PIPs areflexed. Resistance is appliedin a pulling motiononly if the participantcan achieve thetesting position.The “shake hands”position- supportallowed3612

11/27/2021ARM MOTOR FUGL-MEYERGrasp B (thumb adduction) The MCPs, DIPs, and PIPsare extended to 0 . Paper is placed between thepad of the thumb and theradial surface of the 1st MCPjoint if the participant canachieve the testing position. The paper is pulled awayonly if the participant canachieve the grasp in thecorrect testing position.The “shake hands”position- supportallowed37ARM MOTOR FUGL-MEYERGrasp C (1st and 2nd digit pulpaapproximation) A pencil is presentedhorizontally from theopposite side only if theparticipant can achieve thestandard position. Pulpa of the 1st and 2nddigits grasp the pencilwithout the assistance of the3rd through 5th digits. The pencil is then pulledaway horizontally toward theopposite side only if theparticipant can achieve thegrasp in the correct testingposition.The “shake hands” position- support allowed38ARM MOTOR FUGL-MEYERGrasp D (1st and 2nd digit cylindrical) A can is presented from theopposite side only if the participantcan achieve the standard position. The volar surface of 1st and 2nddigits interpose the can withoutassistance from the 3rd through 5thdigits. Resistance is applied in a pullingmotion toward the opposite sideonly if the participant can achievethe grasp in the correct testingposition.The “shake hands”position- supportallowed3913

11/27/2021ARM MOTOR FUGL-MEYERGrasp E (spherical) A tennis ball is presented only ifthe participant can achieve thestandard position. Distal and volar surfaces of alldigits interpose a tennis ball. All digits must be in contact withthe ball. Resistance is applied in a pullingmotion toward the opposite sideonly if the participant canachieve the grasp in the correcttesting position.The “shake hands” positionsupport allowed40ARM MOTOR FUGL-MEYERCoordination/SpeedTremor:0 Marked tremor1 Slight tremor2 No tremorDysmetria:0 Pronounced or unsystematic dysmetria1 Slight and systematic dysmetria2 No dysmetriaSpeed:0 At least 6 seconds slower than theunaffected side1 Between 2 and 5 seconds slower2 Less than 2 seconds slowerKnee to nose, 5x,rapidly as possibleADD: distance41The ARAT(in your notes)Captures Distal Mvemnt4214

11/27/2021The Action Research ArmTest Nuray Yozbatiran, Lucy Der-Yeghiaian andSteven C. Cramer A Standardized Approach to Performing theAction Research Arm Test Neurorehabil Neural Repair 2008; 22; 7843Characteristics ofthe ActionResearch Arm Test– Distal parts of the UE (mostly)– Moderate to minimallyimpaired UEs– Well-established (1981)– “Recommended” in all settings(StrokeEdge)– Any time post stroke– Correlated with functionaloutcomes (but not functional)– Moderate equipment needs– Can be used in other es/action-research-arm-test444515

11/27/202146474816

11/27/2021490 – cannot perform the activity atall. Usually no movement.ARAT Scoring,simplified1 – Can initiate and/or performsome pieces of the movement but isvery messy and/or very slow. Maydrop items several times.2 – The performance resembles theless affected UE but is slow and/or alittle clumsy3 – Looks like less affected UE50The AMAT(manual and example in your notes)Captures Distal Mvemnt5117

11/27/2021Arm Motor Ability Test (AMAT)– All parts of the UE– Moderate to minimally impaired UEs (frustrating formax impaired)– Well-established (1997)– “Recommended” in all settings EXCEPT acute(StrokeEdge)– Any time post stroke– Functional– Substantial equipment needs– Can be used in other es/arm-motor-ability-test52AMAT-9(Ohio Modified Arm Ability Test)53AMAT Scoring0 They didn’t even try. No movement.1 Tried and there is some movement. Completelynon-functional, no ability toweight-bear.2 Movement/Task accomplished, but it is ugly.Really ugly.3 Movement/ Task accomplished but with synergyor its uncoordinated4 Movement close to normal, but: slightly slower,or less coordinated of movement5 Normal5418

11/27/2021See AMAT manual to review the following AMAT: The first 41. Cut "meat”55See AMAT manual to review the following AMAT: The first 42. FoamSandwich56See AMAT manual to review the following AMAT: The first 43. Eat withspoon5719

11/27/2021See AMAT manual to review the following AMAT: The first 44. Comb hair58See AMAT manual to review the following AMAT: The last 5 tasks5. Open Jar59See AMAT manual to review the following AMAT: The last 5 tasks6. Tie shoelace6020

11/27/2021See AMAT manual to review the following AMAT: The last 5 tasks7. Use telephone61See AMAT manual to review the following AMAT: The last 5 tasks8. Put oncardigan62See AMAT manual to review the following AMAT: The last 5 tasks9. Put on T-shirt6321

11/27/2021Questions?SPage@Neurorecovery.net6422

0 They didn’t even try. No movement. 1 Tried and there is some movement. Completely non-functional, no ability to weight-bear. 2 Movement/Task accomplished, but it is ugly. Really ugly. 3 Movement/ Task accomplished but with synergy or its uncoordinated 4 Movement close to normal, but: slightly

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