Dynamic Perturbation Training for Home-Based Upper Limb Rehabilitation in Chronic Stroke

An assessment scale designed to quantify upper limb function in patients with brain damage resulting in hemiparesis. It identifies the subject's ability to handle objects of different shapes, sizes, and materials, and is considered an indirect measure of activity limitation. It consists of 19 items in total, and the score ranges from 0 to 57. Higher scores indicate better motor performance.

Standardised and objective assessment test for hand motor function; allows both precision and gross tasks to be assessed during the simulation of everyday tasks. It consists of seven activities (writing, turning a page, lifting small objects and placing them in a container, stacking blocks, simulated feeding, moving an empty container, moving a full container). The total score is calculated based on the time taken for each individual test (shorter times indicate better performance).

It assesses finger dexterity in patients with various types of neurological disorders, including stroke, Parkinson's disease, multiple sclerosis, etc. The equipment consists of: a wooden or plastic board with 9 holes (diameter 10 or 15 mm) spaced 32 or 50 mm apart; 9 pegs (diameter 7 mm, length 32 mm); a container for the pegs; a stopwatch. The patient is asked to place each peg in the holes in the board and then remove them and reposition them in the container as quickly as possible. During the test, the time taken to complete the task is calculated, from the moment the first peg is picked up to when the last one is placed back in the container. Alternatively, the number of pegs placed in 50 or 100 seconds is counted. Longer completion times (or fewer pegs moved, depending on the assessment method) indicate poorer performance.

Hand movement dexterity assessment test measures the ability to grasp large objects that do not require fine motor control. It is used with a wide range of patients with neurological disorders, including motor deficits caused by stroke. It consists of a wooden box divided into two halves and 150 wooden cubes placed in the same half. The patient is asked to move as many cubes as possible, one at a time, within 60 seconds. The score is calculated based on the number of cubes the patient manages to transfer. The test is repeated after a period of time to assess the patient's progress. A higher number of cubes indicates better performance.

Unit of Measure: % of maximum stimulator output Resting Motor Threshold (RMT) will be defined as the minimum stimulation intensity (expressed as a percentage of the maximum stimulator output) required to elicit motor evoked potentials (MEPs) of at least 50 μV in 5 out of 10 consecutive trials from the first dorsal interosseous (FDI) muscle of the paretic limb. Measurements will be performed using a Bistim stimulator (Magstim, UK) with participants at rest. The same stimulation parameters will be applied consistently across sessions.

A scale for assessing muscle tone alteration following central nervous system injury in the upper limbs; it is a test of resistance to passive movements of a body segment, and the score ranges from 0 to 4 (the higher the score, the greater the spasticity).

It assesses the types and intensity of support that a person with disabilities may need to best manage relevant activities of daily living. It consists of three sections comprising: i) 49 activities of living, with 49 items, grouped into 6 subscales (activities in the home or community, learning activities throughout life, activities related to employment, health, safety and social activities); ii) an additional scale of legal protection, with 8 items; iii) non-ordinary medical and behavioural support needs divided into two parts with 29 items (medical support needs, behavioural support needs). Sections 1 and 2 require the use of a 5-point Likert scale (0 to 4) that assesses frequency (0 - less than once a month; 4 - every hour or more), daily duration of support (0 - never; 4 - 4 hours or more), and type of support (0 - none; 4 - total physical assistance). A higher number indicates a significant impact of stroke on quality of life.

A simple tool for assessing the parameter of 'fatigue'. The patient is asked to quantify the fatigue experienced by indicating the corresponding number on a scale ranging from 0 (no perceived fatigue) to 10 (maximum fatigue imaginable). Higher scores indicate a higher level of perceived fatigue.

Each participant will be asked to complete a satisfaction questionnaire in order to assess the feasibility, tolerability, and satisfaction in relation to the proposed rehabilitation method.

Unit of Measure: microvolts (μV) Corticospinal excitability will also be assessed by recording Motor Evoked Potential (MEP) amplitudes from the FDI muscle following 10 single-pulse TMS stimuli delivered over the primary motor cortex (M1) of the affected hemisphere at an intensity of resting motor threshold (RMT) + 20%. Muscle relaxation will be visually confirmed through electromyography (EMG) monitoring before each stimulus.