Nineteen Years of Modified CIMT in a Clinical Setting, to Improve Arm and Hand Function After Stroke

The Patient-Specific Functional Scale is a self-reporting tool meticulously designed to capture and document activity performance challenges identified as significant by the patient. The patients rate their performance on a numeric rating scale from 0 to 10 (0, unable to perform activity; 10, able to perform activity without difficulties or at pre-injury level). In this study, patients autonomously selected 1-5 activities aligned with their personal goals and rated their performance using the PSFS (a mean score for the self-identified activities was labelled PSFS-self). Additionally, patients assessed a single predetermined activity, namely eating with a knife and fork; which was included in the exercise programme for all patients on a daily basis (labelled PSFS-KF).

MAL evaluates daily hand use. MAL consists of two assessment subscales including 30 common daily tasks (0, no use of the affected extremity; 5, normal use). The results are presented as mean values. One subscale concerns the quality of movement (QOM) and one subscale concerns the amount of use. In this study, only the MAL QOM subscale was applied.

The Box and Block Test (BBT) was used to measure gross manual dexterity. The test consists of a box with two compartments and 150 small blocks. The patient grasps and transport the blocks from one compartment to the other. The test score is the number of blocks transported in 60 s.

BL motor assessment is a measurement of motor function after stroke, modified after the Fugl-Meyer Assessment Scale. It includes assessment of the ability to perform active movements and rapid movement changes, balance, sensation, mobility, joint pain and passive range of motion. The test includes several parts but only the upper extremity active movements subpart for the affected side (maximum score 57 points) was used in this study. Each item score from 0 (no ability) to 3 (normal function) and the sum score is used with a maximum score for each side of 57 points for an upper extremity.

Active range of motion (AROM) was measured using a conventional goniometric technique (Hoppenfeld & Hutton, 1976). The following joint movements were selected because of their big impact on daily activities: shoulder flexion, shoulder abduction, shoulder external rotation, elbow extension, supination and wrist extension. With no compensatory movements allowed, in a sitting position, the maximum AROM was measured and recorded in degrees.

Spasticity in elbow and wrist flexors was assessed with the 6-level modified Ashworth Scale. The therapist measures the resistance to passive movement of a relaxed group of muscles and characterizes change in muscle tone (0, no increase in spasticity; 5, affected part is rigid in flexion or extension).