Upper limb motor function and activities of daily living (ADL) are related in chronic stroke patients. This study investigated this relationship after removal of the influence of motor function of the affected lower limb, which until now has remained unclear.
Methods
This retrospective cross-sectional study included 53 patients with chronic stroke. Upper and lower limb motor function and ADL were assessed using the Fugl-Meyer assessment of the upper (FMA-UL) and lower limbs (FMA-LL) and functional independence measure motor score (FIM-M). To clarify the relationship between FMA-UL and total FIM-M before and after removal of the influence of FMA-LL, Spearman’s rank correlation coefficient and partial correlation analysis were used. The relationship between FMA-UL and each item of FIM-M after removal of the influence of FMA-LL was assessed using partial correlation analysis.
Results
Before the influence of FMA-LL was removed, FMA-UL was moderately to well correlated with total FIM-M. This became weak after the influence was removed. Regarding each item of FIM-M, FMA-UL was correlated with dressing (upper body), toileting, and walking or wheelchair after removal of the influence.
Conclusion
The relationship between upper limb motor function and ADL is strongly influenced by lower limb motor function.
Al-DughmiMAl-SharmanAStevensS, et al. (2015) Sleep characteristics of individuals with chronic stroke: a pilot study. Nature and Science of Sleep21(7): 139–145.
2.
BroeksJLankhorstGJRumpingK, et al. (1999) The long-term outcome of arm function after stroke: results of a follow-up study. Disability and Rehabilitation21(8): 357–364.
3.
ChanubolRWongphaetPOtNC, et al. (2012) Correlation between the action research arm test and the box and block test of upper extremity function in stroke patients. Journal of the Medical Association of Thailand95(4): 590–597.
4.
DettmannMALinderMTSepicSB (1987) Relationships among walking performance, postural stability, and functional assessments of the hemiplegic patient. American Journal of Physical Medicine & Rehabilitation66: 77–90.
5.
DuncanPWPropstMNelsonSG (1983) Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. Physical Therapy63(10): 1606–1610.
6.
FiliatraultJArsenaultABDutilE, et al. (1991) Motor function and activities of daily living assessments: a study of three tests for persons with hemiplegia. American Journal of Occupational Therapy45(9): 806–810.
7.
FongKNKChanCCHAuDK (2001) Relationship of motor and cognitive abilities to functional performance in stroke rehabilitation. Brain Injury15(5): 443–453.
8.
FujitaTSatoATogashiY, et al. (2015) Identification of the affected lower limb and unaffected side motor functions as determinants of activities of daily living performance in stroke patients using partial correlation analysis. Journal of Physical Therapy Science27(7): 2217–2220.
9.
GrangerCVHamiltonBB (1992) UDS REPORT. The uniform data system for medical rehabilitation report of first admissions for 1990. American Journal of Physical Medicine & Rehabilitation71(2): 108–113.
10.
HamiltonBBGrangerCV (1994) Disability outcomes following inpatient rehabilitation for stroke. Physical Therapy74(5): 494–503.
11.
HankeyGJJamrozikKBroadhurstRJ, et al. (2002) Long-term disability after first-ever stroke and related prognostic factors in the Perth community stroke study, 1989–1990. Stroke33(4): 1034–1040.
12.
HobbsBArtemiadisP (2020) A review of robot-assisted lower-limb stroke therapy: unexplored paths and future directions in gait rehabilitation. Frontiers in Neurorobotics14: 19.
13.
HsuehIPLinJHJengJS, et al. (2002) Comparison of the psychometric characteristics of the functional independence measure, 5 item Barthel index, and 10 item Barthel index in patients with stroke. Journal of Neurology, Neurosurgery, and Psychiatry73(2): 188–190.
14.
KawanabeESuzukiMTanakaS, et al. (2018) Impairment in toileting behavior after a stroke. Geriatrics & Gerontology International18(8): 1166–1172.
15.
KimHJMinKLeeCH, et al. (2017) Clinical applicability and psychometric properties of manual function test for patients with stroke. The Tohoku Journal of Experimental Medicine243(2): 85–93.
16.
LeeY-CYiE-SChoiW-H, et al. (2015) A study on the effect of self bedside exercise program on resilience and activities of daily living for patients with hemiplegia. Journal of Exercise Rehabilitation11(1): 30–35.
17.
LinacreJMHeinemannAWWrightBD, et al. (1994) The structure and stability of the functional independence measure. Archives of Physical Medicine and Rehabilitation75(2): 127–132.
18.
MaJ-SKimHJ (2014) The effect of arm swing exercise on gait and balance in stroke patients. American Journal of Clinical and Experimental Medicine2(6): 151.
19.
MercierLAudetTHebertR, et al. (2001) Impact of motor, cognitive, and perceptual disorders on ability to perform activities of daily living after stroke. Stroke32(11): 2602–2608.
20.
MichaelsenSMRochaASKnabbenRJ, et al. (2011) Translation, adaptation and inter-rater reliability of the administration manual for the Fugl-Meyer assessment. Revista Brasileira de Fisioterapia15(1): 80–88.
21.
MsenganaZDe WittPOwenA, et al. (2019) Upper limb mobility and personal management in patients with stroke attending occupational therapy at a tertiary hospital in Gauteng. South African Journal of Occupational Therapy49(3): 6–16.
22.
NaEHwangHWooY (2016) Study of acceleration of center of mass during sit-to-stand and stand-to-sit in patients with stroke. Journal of Physical Therapy Science28(9): 2457–2460.
23.
Nichols-LarsenDSClarkPCZeringueA, et al. (2005) Factors influencing stroke survivors’ quality of life during subacute recovery. Stroke36(7): 1480–1484.
24.
OrosRIPopescuCAIovaCA, et al. (2016) The impact of cognitive impairment after stroke on activities of daily living. Human & Veterinary Medicine8(1): 41–44.
25.
OttenbacherKJMannWCGrangerCV, et al. (1994) Inter-rater agreement and stability of functional assessment in the community-based elderly. Archives of Physical Medicine and Rehabilitation75(12): 1297–1301.
26.
PerryJGarrettMGronleyJK, et al. (1995) Classification of walking handicap in the stroke population. Stroke26(6): 982–989.
27.
SanfordJMorelandJSwansonLR, et al. (1993) Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke. Physical Therapy73(7): 447–454.
28.
SilvaESMPereiraNDGianlorençoACL, et al. (2018) The evaluation of non-use of the upper limb in chronic hemiparesis is influenced by the level of motor impairment and difficulty of the activities–proposal of a new version of the motor activity log. Physiotherapy Theory and Practice35(10): 964–974.
29.
SivanMO’ConnorRJMakowerS, et al. (2011) Systematic review of outcome measures used in the evaluation of robot-assisted upper limb exercise in stroke. Journal of Rehabilitation Medicine43(3): 181–189.
30.
Van der PuttenJJHobartJCFreemanJA, et al. (1999) Measuring change in disability after inpatient rehabilitation: comparison of the responsiveness of the Barthel index and the Functional Independence Measure. Journal of Neurology, Neurosurgery, and Psychiatry66(4): 480–484.
31.
von ElmEAltmanDGEggerM, et al. (2014) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. International Journal of Surgery12(12): 1495–1499.
32.
WeiX-JTongK-YHuX-L (2011) The responsiveness and correlation between Fugl-Meyer assessment, motor status scale, and the action research arm test in chronic stroke with upper-extremity rehabilitation robotic training. International Journal of Rehabilitation Research34(4): 349–356.
33.
WondergemRPistersMFWoutersEJ, et al. (2017) The course of activities in daily living: who is at risk for decline after first ever stroke?Cerebrovascular Diseases43(1–2): 1–8.
