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1.	Alt Murphy, Margit, 1970, et al. (author) Acceleration based Activity Levels during Subacute Inpatient Stroke Rehabilitation 2017 In: Procedia Technology. - : Elsevier BV. - 2212-0173. ; 27, s. 120-121 Journal article (peer-reviewed)abstract People after stroke have difficulties to reach sufficient physical activity level during their rehabilitation and particularly outside the therapy time. We aim to quantify activity levels and investigate differences in motor activity in weekdays and weekends in a subacute stage after stroke. Data from multiple three-axis accelerometers was collected during two 48h sessions in 11 patients. The activity level and symmetry indices were sensitive to variations in weekend and weekdays. This information is valuable in rehabilitation planning and management and enables identification of those in risk of low physical activity and inactivity. (C) 2017 The Authors. Published by Elsevier
2.	Alt Murphy, Margit, 1970, et al. (author) Acceleration based activity metrics during subacute inpatient stroke rehabilitation 2016 In: Procedia Technology, Biosensors 2016, 25-27 May, Göteborg, Sweden.. Conference paper (other academic/artistic)abstract People after stroke have difficulties to reach sufficient physical activity level during their rehabilitation and particularly outside the therapy time. We aim to quantify activity levels and investigate differences in motor activity in weekdays and weekends in a subacute stage after stroke. Data from multiple three-axis accelerometers was collected during two 48h sessions in 11 patients. The activity level and symmetry indices were sensitive to variations in weekend and weekdays. This information is valuable in rehabilitation planning and management and enables identification of those in risk of low physical activity and inactivity.
3.	Alt Murphy, Margit, 1970, et al. (author) An upper body garment with integrated sensors for people with neurological disorders – early development and evaluation 2019 In: BMC Biomedical Engineering. - : Springer Science and Business Media LLC. - 2524-4426. ; 1:3 Journal article (peer-reviewed)abstract Background: To develop a novel wearable garment with integrated sensors for continuous monitoring of physiological and movement related variables to evaluate progression, tailor treatments and improve diagnosis in epilepsy, Parkinson’s disease and stroke. Methods: An iterative development process and evaluation of an upper body garment with integrated sensors included: identification of user needs, specification of technical and garment requirements, garment development and production as well as evaluation of garment design, functionality and usability. The project is a multidisciplinary collaboration with experts from medical, engineering, textile, and material science within the wearITmed consortium. The work was organized in regular meetings, task groups and hands-on workshops. User needs were identified using results from a mixed-methods systematic review, a focus group study and expert groups. Usability was evaluated in 19 individuals (13 controls, 6 patients with Parkinson’s disease) using semi-structured interviews and qualitative content analysis. Results: A prototype designed to monitor movements and heart rate was developed. The garment was well accepted by the users regarding design and comfort, although the users were cautious about the technology and suggested improvements. All electronic components passed a washability test. The most robust data was obtained from accelerometer and gyroscope sensors while the electrodes for heart rate registration were sensitive to motion. artefacts. The algorithm development within the wearITmed consortium has shown promising results. Conclusions: The prototype was accepted by the users. Technical improvements are needed, but preliminary data indicate that the garment has potential to be used as a tool for diagnosis and treatment selection and could provide added value for monitoring seizures in epilepsy, fluctuations in PD and activity levels in stroke. Future work aims to improve the prototype further, develop algorithms, and evaluate the functionality and usability in targeted patient groups. The potential of incorporating blood pressure and heart-rate variability monitoring will also be explored.
4.	Alt Murphy, Margit, 1970, et al. (author) Comparison of Accelerometer-Based Arm, Leg and Trunk Activity at Weekdays and Weekends During Subacute Inpatient Rehabilitation After Stroke 2019 In: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 51:6, s. 426-433 Journal article (peer-reviewed)abstract Objective: To determine whether there are differences in arm, leg and trunk activity measured by acceleration between weekdays and weekends in people undergoing rehabilitation in the subacute stage after stroke. Patients: Twenty-eight individuals with stroke (mean age 55.4 years; severe to mild impairment) and 10 healthy controls. Methods: A set of 5 3-axial accelerometers were used on the trunk, wrists and ankles during 2 48-h sessions at weekdays and over a weekend. Day-time acceleration raw data were expressed as the signal magnitude area. Asymmetry between the affected and less-affected limb was calculated as a ratio. Results: Participants with stroke used their both arms and legs less at weekends than on weekdays (p<0.05, effect size 0.3 2-0.5 7). Asymmetry between the affected and less-affected arm was greater at weekends (p < 0.05, effect size 0.32). All activity measures, apart from the less-affected arm on weekdays, were lower in stroke compared with controls (p<0.05, effect size 0.4-0.8). No statistically significant differences were detected between weekday and weekend activity for the control group. One-third of participants perceived the trunk sensor as inconvenient to wear. Conclusion: Increased focus needs to be applied on activities carried out during weekends at rehabilitation wards.
5.	Alt Murphy, Margit, 1970, et al. (author) Implementation of evidence-based assessment of upper extremity in stroke rehabilitation: From evidence to clinical practice 2021 In: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 53:1 Journal article (peer-reviewed)abstract Objective: There is an evidence-practice gap in assessment of the upper extremities during acute and subacute stroke rehabilitation. The aim of this study was to target this gap by describing and evaluating the implementation of, and adherence to, an evidence-based clinical practice guideline for occupational therapists and physiotherapists. Methods: The upper extremity assessment implementation process at Sahlgrenska University Hospital comprised 5 stages: mapping clinical practice, identifying evidence-based outcome measures, development of a guideline, implementation, and evaluation. A systematic theoretical framework was used to guide and facilitate the implementation process. A survey, answered by 44 clinicians (23 physiotherapists and 21 occupational therapists), was used for evaluation. Results: The guideline includes 6 primary standardized assessments (Shoulder Abduction, Finger Extension (SAFE), 2 items of the Actions Research Arm Test (ARAT-2), Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Box and Block Test (BBT), 9-Hole Peg Test (9HPT), and grip strength (Jamar hand dynamometer)) performed at specified time-points post-stroke. More than 80% (35 to 42) clinicians reported reported being content with the guideline and the implementation process. Approximately 60-90% of the clinicians reported good adherence to specific assessments, and approximately 50% reported good adherence to the agreed time-points. Comprehensive scales were more difficult to implement compared with the shorter screening scales. High levels of work rotation among staff, and the need to prioritize other assessments during the first week after stroke, hindered to implementation. Conclusion: The robustness of evidence, adequate support and receptive context facilitated the implementation process. The guideline enables a more structured, knowledge-based and consistent assessment, and thereby supports clinical decision-making and patient involvement.
6.	Alt Murphy, Margit, 1970, et al. (author) Kinematic analysis using 3D motion capture of drinking task in people with and without upper-extremity impairments 2018 In: Journal of Visualized Experiments. - : MyJove Corporation. - 1940-087X. ; :133 Journal article (peer-reviewed)abstract Kinematic analysis is a powerful method for objective assessment of upper extremity movements in a three-dimensional (3D) space. Three-dimensional motion capture with an optoelectronic camera system is considered as golden standard for kinematic movement analysis and is increasingly used as outcome measure to evaluate the movement performance and quality after an injury or disease involving upper extremity movements. This article describes a standardized protocol for kinematic analysis of drinking task applied in individuals with upper extremity impairments after stroke. The drinking task incorporates reaching, grasping and lifting a cup from a table to take a drink, placing the cup back, and moving the hand back to the edge of the table. The sitting position is standardized to the individual's body size and the task is performed in a comfortable self-paced speed and compensatory movements are not constrained. The intention is to keep the task natural and close to a real-life situation to improve the ecological validity of the protocol. A 5-camera motion capture system is used to gather 3D coordinate positions from 9 retroreflective markers positioned on anatomical landmarks of the arm, trunk, and face. A simple single marker placement is used to ensure the feasibility of the protocol in clinical settings. Custom-made Matlab software provides automated and fast analyses of movement data. Temporal kinematics of movement time, velocity, peak velocity, time of peak velocity, and smoothness (number of movement units) along with spatial angular kinematics of shoulder and elbow joint as well as trunk movements are calculated. The drinking task is a valid assessment for individuals with moderate and mild upper extremity impairment. The construct, discriminative and concurrent validity along with responsiveness (sensitivity to change) of the kinematic variables obtained from the drinking task have been established. © 2018 Journal of Visualized Experiments.
7.	Andersson, Sofi A., 1970, et al. (author) Arm impairment and walking speed explain real-life activity of the affected Arm and leg after stroke 2021 In: Journal of Rehabilitation Medicine. - : Foundation for Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 53:6 Journal article (peer-reviewed)abstract Objective: To determine to what extent accelerometer-based arm, leg and trunk activity is associated with sensorimotor impairments, walking capacity and other factors in subacute stroke. Design: Cross-sectional study. Patients: Twenty-six individuals with stroke (mean age 55.4 years, severe to mild motor impairment). Methods: Data on daytime activity were collected over a period of 4 days from accelerometers placed on the wrists, ankles and trunk. A forward stepwise linear regression was used to determine associations between free-living activity, clinical and demographic variables. Results: Arm motor impairment (Fugl-Meyer Assessment) and walking speed explained more than 60% of the variance in daytime activity of the more-affected arm, while walking speed alone explained 60% of the more-affected leg activity. Activity of the less-affected arm and leg was associated with arm motor impairment (R2=0.40) and independence in walking (R2=0.59). Arm activity ratio was associated with arm impairment (R2=0.63) and leg activity ratio with leg impairment (R2=0.38) and walking speed (R2=0.27). Walking-related variables explained approximately 30% of the variance in trunk activity. Conclusion: Accelerometer-based free-living activity is dependent on motor impairment and walking capacity. The most relevant activity data were obtained from more-affected limbs. Motor impairment and walking speed can provide some information about real-life daytime activity levels.
8.	Brännmark, Cecilia, et al. (author) FIND Stroke Recovery Study (FIND): rationale and protocol for a longitudinal observational cohort study of trajectories of recovery and biomarkers poststroke 2023 In: Bmj Open. - 2044-6055. ; 13:5 Journal article (peer-reviewed)abstract ntroduction Comprehensive studies mapping domain-specific trajectories of recovery after stroke and biomarkers reflecting these processes are scarce. We, therefore, initiated an exploratory prospective observational study of stroke cases with repeated evaluation, the FIND Stroke Recovery Study. We aim to capture trajectories of recovery from different impairments, including cognition, in combination with broad profiling of blood and imaging biomarkers of the recovery. Methods and analysis We recruit individuals with first-ever stroke at the stroke unit at the Sahlgrenska University Hospital, Sweden, to FIND. The inclusion started early 2018 and we aim to enrol minimum 500 patients. Neurological and cognitive impairments across multiple domains are assessed using validated clinical assessment methods, advanced neuroimaging is performed and blood samples for biomarker measuring (protein, RNA and DNA) at inclusion and follow-up visits at 3 months, 6 months, 1 year, 2 years and 5 years poststroke. At baseline and at each follow-up visit, we also register clinical variables known to influence outcomes such as prestroke functioning, stroke severity, acute interventions, rehabilitation, other treatments, socioeconomic status, infections (including COVID-19) and other comorbidities. Recurrent stroke and other major vascular events are identified continuously in national registers. Ethics and dissemination FIND composes a unique stroke cohort with detailed phenotyping, repetitive assessments of outcomes across multiple neurological and cognitive domains and patient-reported outcomes as well as blood and imaging biomarker profiling. Ethical approval for the FIND study has been obtained from the Regional Ethics Review Board in Gothenburg and the Swedish Ethics Review Board. The results of this exploratory study will provide novel data on the time course of recovery and biomarkers after stroke. The description of this protocol will inform the stroke research community of our ongoing study and facilitate comparisons with other data sets.
9.	Ozanne, Anneli, 1978, et al. (author) Wearables in epilepsy and Parkinson's disease : A focus group study 2018 In: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 137:2, s. 188-194 Journal article (peer-reviewed)abstract OBJECTIVES: Wearable sensors that measure movement and physiological variables are attractive for clinical evaluation of neurological diseases such as epilepsy and Parkinson's disease (PD). The aim of this study was to explore perceptions regarding the use of wearable technology in disease monitoring and management as reported by individuals with epilepsy and Parkinson's disease as well as health professionals working with these patient groups.MATERIALS AND METHODS: Six patient groups (n=25) and two groups with health professionals (n=15) participated in this qualitative, descriptive study with focus group interviews. A manifest qualitative content analysis was used.RESULTS: Four categories and nine subcategories emerged from the analysis. Participants saw possible benefits for improved treatment effect and valued this benefit more than possible inconvenience of wearing the sensors. Discrete design and simplicity were considered as facilitators for improved usability. They emphasized the importance of interactive information between patients and health professionals. However, they were concerned about unclear information and inconclusive recordings and some fears about personal integrity were at odds with the expectations on interactivity.CONCLUSIONS: Patients need to feel well informed and find an added value in using wearables. Wearables need to be user-friendly, have an attractive design, and show clinical efficacy in improving disease management. Variations in perceptions regarding integrity, benefits, and effectiveness of monitoring indicate possible conflicts of expectations among participants. The engagement of end users, patients, and health professionals, in the design and implementation process, is crucial for the development of wearable devices that enhance and facilitate neurological rehabilitation practice.
10.	Alt Murphy, Margit, 1970, et al. (author) An overview of systematic reviews on upper extremity outcome measures after stroke 2015 In: Bmc Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 15 Journal article (peer-reviewed)abstract Background: Although use of standardized and scientifically sound outcome measures is highly encouraged in clinical practice and research, there is still no clear recommendation on which tools should be preferred for upper extremity assessment after stroke. As the aims, objectives and methodology of the existing reviews of the upper extremity outcome measures can vary, there is a need to bring together the evidence from existing multiple reviews. The purpose of this review was to provide an overview of evidence of the psychometric properties and clinical utility of upper extremity outcome measures for use in stroke, by systematically evaluating and summarizing findings from systematic reviews. Methods: A comprehensive systematic search was performed including systematic reviews from 2004 to February 2014. A methodological quality appraisal of the reviews was performed using the AMSTAR-tool. Results: From 13 included systematic reviews, 53 measures were identified of which 13 met the standardized criteria set for the psychometric properties. The strongest level of measurement quality and clinical utility was demonstrated for Fugl-Meyer Assessment, Action Research Arm Test, Box and Block Test, Chedoke Arm and Hand Activity Inventory, Wolf Motor Function Test and ABILHAND. Conclusions: This overview of systematic reviews provides a comprehensive systematic synthesis of evidence on which outcome measures demonstrate a high level of measurement quality and clinical utility and which can be considered as most suitable for upper extremity assessment after stroke. This overview can provide a valuable resource to assist clinicians, researchers and policy makers in selection of appropriate outcome measures.
11.	Alt Murphy, Margit, 1970 (author) Clinically relevant and valid kinematic measures in reach-to-drink task in people with stroke 2014 In: 8th World Congress for NeuroRehabilitation. 8-12 April 2014, Istanbul, Turkiet. Konferens abstrakt bok/CD. Conference paper (other academic/artistic)abstract Kinematic movement analysis can provide an almost unlimited number of variables that could be calculated to evaluate a person’s motor performance. There is no consensus however, among researchers which kinematic measure are to be preferred for upper extremity tasks for people with stroke. The aim of this study was to explore the construct, discriminative and concurrent validity of kinematic measures in reach-to-drink task in people with stroke. Methods In total 90 individuals with stroke and 19 healthy subjects were included. A 5-camera optoelectronic motion capture system was used for analysis. The measures of movement time, velocity, strategy, smoothness, intrejoint coordination, joint angles were calculated. Principal component analysis (PCA) was used for explore measurement contracts of the kinematics. Discriminative validity was studied among subgroups (mild, moderate stroke impairment and healthy), concurrent validity was determined with clinical motor assessment scales of Fugl-Meyer Assessment for Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT). Results Explorative PCA revealed that there were two major conceptual measurements constructs, explaining 95% of total variance of movement performance in reach-to-drink task after stroke. The extracted variables from the two components were: trunk displacement; peak velocity and peak elbow angular velocity in reaching; movement smoothness and time. All extracted variables could discriminate well between subgroups (mild, moderate stroke impairment and healthy) but the highest magnitude of discrimination was found for movement smoothness followed by trunk displacement and elbow angular velocity. In multiple linear regressions the movement smoothness and trunk displacement explained the highest amount of total variance in ARAT, 57% and same measures explained 41% of total variance in FMA-UE. Conclusions The most important kinematic measures to quantify movement performance in reach-to-drink task after stroke are the trunk displacement, movement smoothness and movement time. These three measures are valid for assessment of upper extremity function and activity and can be recommended as key measures when purposeful upper extremity tasks are analyzed in people with stroke.
12.	Alt Murphy, Margit, 1970, et al. (author) Early prediction of upper limb functioning after stroke using clinical bedside assessments: a prospective longitudinal study. 2022 In: Scientific reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 12:1 Journal article (peer-reviewed)abstract Early and accurate prediction of recovery is needed to assist treatment planning and inform patient selection in clinical trials. This study aimed to develop a prediction algorithm using a set of simple early clinical bedside measures to predict upper limb capacity at 3-months post-stroke. A secondary analysis of Stroke Arm Longitudinal Study at Gothenburg University (SALGOT) included 94 adults (mean age 68years) with upper limb impairment admitted to stroke unit). Cluster analysis was used to define the endpoint outcome strata according to the 3-months Action Research Arm Test (ARAT) scores. Modelling was carried out in a training (70%) and testing set (30%) using traditional logistic regression, random forest models. The final algorithm included 3 simple bedside tests performed 3-days post stroke: ability to grasp, to produce any measurable grip strength and abduct/elevate shoulder. An 86-94% model sensitivity, specificity and accuracy was reached for differentiation between poor, limited and good outcome. Additional measurement of grip strength at 4weeks post-stroke and haemorrhagic stroke explained the underestimated classifications. External validation of the model is recommended. Simple bedside assessments have advantages over more lengthy and complex assessments and could thereby be integrated into routine clinical practice to aid therapy decisions, guide patient selection in clinical trials and used in data registries.
13.	Alt Murphy, Margit, 1970, et al. (author) Kinematic analysis of the upper extremity after stroke : how far have we reached and what have we grasped? 2015 In: Physical Therapy Reviews. - 1083-3196 .- 1743-288X. ; 20:3, s. 137-155 Journal article (peer-reviewed)abstract Background: Consequences of stroke frequently comprise reduced movement ability of the upper extremity (UE) and subsequent long-term disability. Clinical scales are used to monitor and evaluate rehabilitation but are often insufficient, while technological advances in 3D motion capture provide detailed kinematics to more objectively quantify and interpret movement deficits. Objectives: To provide a comprehensive overview of research using kinematic movement analysis of the UE in individuals post-stroke with focus on objectives, methodology and findings while highlighting clinical implications and future directions. Major Findings: A literature search yielded 93 studies categorised into four groups: comparative (healthy, stroke, task condition), intervention (clinical trials), methodological and longitudinal. The majority of studies used optoelectronic systems, investigated discrete reaching and involved mainly individuals with moderate or mild stroke impairment in chronic stage. About 80% of the studies were published after year 2004. Speed-related variables were most frequently addressed followed by smoothness indicators, joint angles and trunk displacement. Movements in the hemiparetic side are generally slower, less smooth and show a compensatory movement pattern. Task specificity is crucial for kinematic outcomes. Tables summarising the main characteristics, objectives and results of all included studies are provided. Conclusions: There is still a lack of studies addressing reliability and responsiveness and involving more complex, everyday UE tasks with ecological validity. To facilitate the use of UE kinematic movement analysis in clinics, a research-based simpler data handling with pre-defined output for the results, as commonly used in gait analysis, is warranted.
14.	Alt Murphy, Margit, 1970 (author) Kinematic analysis of the upper extremity after stroke - How far have we reached and what have we grasped? 2015 In: Fysioterapi 2015. 21-23 oktober 2015, Stockholm, Sverige.. ; 2015 Conference paper (other academic/artistic)
15.	Alt Murphy, Margit, 1970, et al. (author) Kinematic analysis of upper extremity performance and its relationship to sensorimotor functioning after stroke 2011 In: Nordic Stroke, 28/9-1/10, Tallinn, Estonia. Conference paper (other academic/artistic)
16.	Alt Murphy, Margit, 1970, et al. (author) Kinematic analysis of upper extremity performance and its relationship to sensorimotor impairments after stroke 2012 In: NeuroRehabilitation and Neural Repair. - 1552-6844. ; 26:6, s. 695-804 Conference paper (peer-reviewed)
17.	Alt Murphy, Margit, 1970, et al. (author) Kinematic Variables Quantifying Upper-Extremity Performance After Stroke During Reaching and Drinking From a Glass. 2011 In: Neurorehabilitation and Neural Repair. - : SAGE Publications. - 1552-6844 .- 1545-9683. ; 25:1, s. 71-80 Journal article (peer-reviewed)abstract BACKGROUND: . Three-dimensional kinematic analysis provides quantitative and qualitative assessment of upper-limb motion and is used as an outcome measure to evaluate impaired movement after stroke. The number of kinematic variables used, however, is diverse, and models for upper-extremity motion analysis vary. OBJECTIVE: . The authors aim to identify a set of clinically useful and sensitive kinematic variables to quantify upper-extremity motor control during a purposeful daily activity, that is, drinking from a glass. METHODS: . For this purpose, 19 participants with chronic stroke and 19 healthy controls reached for a glass of water, took a sip, and placed it back on a table in a standardized way. An optoelectronic system captured 3-dimensional kinematics. Kinematical parameters describing movement time, velocity, strategy and smoothness, interjoint coordination, and compensatory movements were analyzed between groups. RESULTS: . The majority of kinematic variables showed significant differences between study groups. The number of movement units, total movement time, and peak angular velocity of elbow discriminated best between healthy participants and those with stroke as well as between those with moderate (Fugl-Meyer scores of 39-57) versus mild (Fugl-Meyer scores of 58-64) arm impairment. In addition, the measures of compensatory trunk and arm movements discriminated between those with moderate and mild stroke impairment. CONCLUSION: . Kinematic analysis in this study identified a set of movement variables during a functional task that may serve as an objective assessment of upper-extremity motor performance in persons who can complete a task, such as reaching and drinking, after stroke.
18.	Alt Murphy, Margit, 1970, et al. (author) Letter by Murphy et al regarding article, "Fugl-Meyer assessment of sensorimotor function after stroke: standardized training procedure for clinical practice and clinical trials". 2011 In: Stroke; a journal of cerebral circulation. - 1524-4628. ; 42:6 Journal article (other academic/artistic)
19.	Alt Murphy, Margit, 1970, et al. (author) Movement deficits in the ipsilesional “less-affected” arm after stroke. Part of the Stroke Arm Longitudinal study at Gothenburg University, SALGOT-study 2016 In: Neurorehabilitation and Neural Repair. - 1545-9683. Conference paper (other academic/artistic)abstract Objectives Increasing body of literature indicates that motor function at the ipsilesional side after stroke can be affected, but these deficits can be difficult to detect using traditional clinical scales. In addition, the ipsilesional side is commonly used as reference, representing a normal movement in assessments, which may affect the test results. The study aims to determine whether and to what extent the movements in the ipsilesional upper limb are affected after stroke. Methods In total, 44 individuals with stroke and 20 healthy controls were included. An optoelectronic motion capture system was used to measure kinematics and Fugl-Meyer Assessment for Upper Extremity to assess sensorimotor impairment in to subgroups (moderate 32-57, mild 58-66). Kinematic measures describing movement time, velocity, smoothness, strategy and compensatory movements in drinking task at two time points, early during the first month and at 3 months after stroke, were analyzed. Results The entire stroke group showed ipsilesional deficits in 6 and the subgroup of moderate impairment in 9 of the 12 kinematic measures early after stroke. In moderate impairment group the movements were slower, less smooth, the deceleration phase was longer and a larger abduction of the arm was used during drinking activity compared to healthy controls. A statistically significant improvement was also detected over time in 6 kinematic measures, but a deficit was still present in angular velocity of elbow and deceleration time in reaching 3 months poststroke. Conclusions This study demonstrates that motor deficits are common in ipsilesional upper extremity early after stroke and these deficits are more prominent in persons with poor controlesional motor function. The ipsilesional arm should be assessed early after stroke, preferably using measures that are sensitive to detect minor deficits. Clinical scales using the “less-affected” arm as reference, indicating normal movement, should be used with caution early after stroke.
20.	Alt Murphy, Margit, 1970, et al. (author) Movement kinematics during a drinking task are associated with the activity capacity level after stroke. 2012 In: Neurorehabilitation and neural repair. - : SAGE Publications. - 1552-6844 .- 1545-9683. ; 26:9, s. 1106-15 Journal article (peer-reviewed)abstract Kinematic analysis is a powerful method for an objective assessment of movements and is increasingly used as an outcome measure after stroke. Little is known about how the actual movement performance measured with kinematics is related to the common traditional assessment scales. The aim of this study was to determine the relationships between movement kinematics from a drinking task and the impairment or activity limitation level after stroke.
21.	Alt Murphy, Margit, 1970, et al. (author) Perceptuo-motor planning during functional reaching after stroke. 2016 In: 9th World Congress for Neurorehabilitation, WCNR-0340. Conference paper (other academic/artistic)abstract Objectives Healthy young people adjust their grasp position on an object depending on the future position of the object, a phenomenon described as the end-state comfort effect. This aspect of motor planning may be affected by stroke, especially in the presence of perceptual deficits. Thus, the aim of the study was to determine to what extent motor planning for reaches to different heights is affected by stroke. Methods Thirty-three adults (18 healthy, 15 chronic stroke with mild/moderate motor impairment) performed a functional goal-directed task, which included reaching, grasping and transporting a cylindrical object (a plunger) from a standard height to 4 different target heights, relative to the body. The relationship between grasp heights on the object shaft and the heights of target shelves was the primary outcome. This relationship, expressed as a slope, signifies the degree of perceptuo-motor coupling. An optoelectronic camera system recorded kinematics of the endpoint, arm and trunk. Sensorimotor impairment and perceptual deficits were measured with standardized validated clinical measures. Results A clear and strong linear relationship between grasp height and the target height was found in both groups. The mean values of the slopes for the affected and less-affected arm in stroke (-53.1 and -42.2) were not statistically different from healthy controls (-60.0). However, for the less-affected arm in the subgroup with visuo-perceptual impairments, the slopes were significantly lower than in healthy controls, indicating deficits in perceptuo-motor planning. Conclusions Results suggest that perceptuo-motor planning is relatively preserved in people with mild and moderate stroke, although visuo-perceptual impairment may influence this planning as indicated by the smaller end-state comfort effect in this subgroup of patients. In those without visuo-perceptual impairment, the system may preserve end-state comfort by incorporating compensations for the existing movement deficits.
22.	Alt Murphy, Margit, 1970, et al. (author) Perceptuo-motor planning during functional reaching after stroke 2017 In: Experimental Brain Research. - : Springer Science and Business Media LLC. - 0014-4819 .- 1432-1106. ; 235:11, s. 3295-3306 Journal article (peer-reviewed)abstract In healthy young adults, reaching movements are planned such that the initial grasp position on the object is modulated based on the final task goal. This perceptuo-motor coupling has been described as the end-state comfort effect. This study aimed to determine the extent to which visuo-perceptual and motor deficits, but not neglect, due to stroke impact end-state comfort measured as the grasp-height effect. Thirty-four older adults (17 controls, 17 chronic stroke) performed a functional goal-directed two-sequence task with each arm, consisting of reaching and moving a cylindrical object (drain plunger) from an initial to four target platform heights, standardized to body height, in a block randomized sequence. Arm motor impairment (Fugl-Meyer Assessment) and visual-perceptual deficits (Motor-Free Visual Perception Test) were assessed in stroke subjects, and arm and trunk kinematics were assessed in all subjects. The primary outcome measure of the grasp-height effect was the relationship between the grasp heights used at the home position and the final target platform heights. Mixed model analysis was used for data analysis. The grasp-height effect was present in all participants, but decreased in stroke subjects with visuo-perceptual impairments compared to controls. In stroke subjects with sensorimotor impairments alone, indicated by altered kinematics, the grasp-height effect was comparable to controls. This first study examining the grasp-height effect in individuals with stroke provides new knowledge of the impact of visuo-perceptual deficits on movement planning and execution, which may assist clinicians in selecting more effective treatment strategies to improve perceptuo-motor skills and enhance motor recovery.
23.	Alt Murphy, Margit, 1970, et al. (author) RELATIONSHIPS BETWEEN KINEMATICS OF UPPER EXTREMITY MOVEMENTS AND IMPAIRMENT SEVERITY AS WELL ACTIVITY LIMITATIONS AFTER STROKE 2011 In: Physiotherapy. ; 97:Supplement S1 Conference paper (peer-reviewed)
24.	Alt Murphy, Margit, 1970, et al. (author) Responsiveness of Upper Extremity Kinematic Measures and Clinical Improvement During the First Three Months After Stroke. 2013 In: Neurorehabilitation and neural repair. - : SAGE Publications. - 1552-6844 .- 1545-9683. ; 27:9, s. 844-853 Journal article (peer-reviewed)abstract BACKGROUND: . Kinematic movement analysis is increasingly used as an outcome measure in evaluation of upper extremity function after stroke. Little is known, however, about what observed longitudinal changes in kinematics mean in the context of an individual's functioning. In this study, the responsiveness and expected change in kinematic measures associated with clinically meaningful improvement in the upper extremity were evaluated. METHODS: . Kinematic movement analysis of a drinking task and Action Research Arm Test (ARAT) were performed early (9 days poststroke) and at 3 months after stroke in 51 subjects. The receiver-operating characteristic curve and linear regression analyses were used to evaluate responsiveness of kinematic parameters. RESULTS: . Movement time, smoothness, and trunk displacement discriminated those subjects demonstrating clinically meaningful improvements. Significant associations of 31% to 36% were found between the change in ARAT and kinematic measures. A real clinical improvement in kinematics lies in the range of 2.5 to 5 seconds, 3 to 7 units, and 2 to 5 cm in movement time, smoothness, and trunk displacement, respectively. CONCLUSIONS: . All kinematic measures reported in this study are responsive measures for capturing improvements in the upper extremity during the first 3 months after stroke. Approximate estimates for the expected change in kinematics associated with clinically meaningful improvement in upper extremity activity capacity illustrate the usefulness of the linear regression analysis for assessing responsiveness. This knowledge facilitates the selection of kinematic measures for clinical and movement analysis research as well as for technology-based devices.
25.	Alt Murphy, Margit, 1970, et al. (author) SALGOT - Stroke Arm Longitudinal study at the University of Gothenburg, prospective cohort study protocol. 2011 In: BMC neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 11 Journal article (peer-reviewed)abstract BACKGROUND: Recovery patterns of upper extremity motor function have been described in several longitudinal studies, but most of these studies have had selected samples, short follow up times or insufficient outcomes on motor function. The general understanding is that improvements in upper extremity occur mainly during the first month after the stroke incident and little if any, significant recovery can be gained after 3-6 months. The purpose of this study is to describe the recovery of upper extremity function longitudinally in a non-selected sample initially admitted to a stroke unit with first ever stroke, living in Gothenburg urban area. METHODS/DESIGN: A sample of 120 participants with a first-ever stroke and impaired upper extremity function will be consecutively included from an acute stroke unit and followed longitudinally for one year. Assessments are performed at eight occasions: at day 3 and 10, week 3, 4 and 6, month 3, 6 and 12 after onset of stroke. The primary clinical outcome measures are Action Research Arm Test and Fugl-Meyer Assessment for Upper Extremity. As additional measures, two new computer based objective methods with kinematic analysis of arm movements are used. The ABILHAND questionnaire of manual ability, Stroke Impact Scale, grip strength, spasticity, pain, passive range of motion and cognitive function will be assessed as well. At one year follow up, two patient reported outcomes, Impact on Participation and Autonomy and EuroQol Quality of Life Scale, will be added to cover the status of participation and aspects of health related quality of life. DISCUSSION: This study comprises a non-selected population with first ever stroke and impaired arm function. Measurements are performed both using traditional clinical assessments as well as computer based measurement systems providing objective kinematic data. The ICF classification of functioning, disability and health is used as framework for the selection of assessment measures. The study design with several repeated measurements on motor function will give us more confident information about the recovery patterns after stroke. This knowledge is essential both for optimizing rehabilitation planning as well as providing important information to the patient about the recovery perspectives. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01115348.
26.	Alt Murphy, Margit, 1970, et al. (author) Three-dimensional kinematic motion analysis of a daily activity drinking from a glass: a pilot study. 2006 In: Journal of neuroengineering and rehabilitation. - : Springer Science and Business Media LLC. - 1743-0003. ; 3 Journal article (peer-reviewed)abstract BACKGROUND: Development of reliable and objective evaluation methods is required, particularly for natural and goal-oriented upper-extremity tasks. Three-dimensional imaging measurement techniques have turned out to be a powerful tool for a quantitative and qualitative assessment of multijoint movements. The purpose of this study was to develop and test a method of three-dimensional motion analysis for the activity "drinking from a glass" and describe the drinking task with kinematic variables in control subjects. METHODS: A protocol was developed for the drinking activity including the set-up of cameras and positions of the markers and the subject. The drinking task included reaching, forward transport with glass, drinking, back transport and returning the hand to the initial position. An optoelectronic system was used for the three-dimensional kinematic motion capture. Movement times, velocities, joint angles and interjoint coordination for shoulder and elbow were computed and analyzed for twenty control subjects. Test-retest consistency was evaluated for six subjects. RESULTS: The test protocol showed good consistency in test-retest. Phase definitions for the drinking task were defined and verified. Descriptive kinematic variables were obtained for movement times, positions, velocities and joint angles for shoulder and elbow joint. Interjoint coordination between shoulder and elbow joint in reaching phase showed a high correlation. CONCLUSION: This study provides a detailed description of the three-dimensional kinematic analysis of the drinking task. Our approach to investigate and analyze a goal-oriented daily activity has a great clinical potential. Consequently, the next step is to use and test this protocol on persons with impairments and disabilities from upper extremities.
27.	Alt Murphy, Margit, 1970 (author) What has been gained from the recent advances in kinematic analysis of the upper extremity after stroke? 2015 In: World Conference in Physical Therapy, Singapore; 05/2015. Conference paper (other academic/artistic)
28.	Barbosa, Nubia E, et al. (author) Translation and cultural validation of clinical observational scales - the Fugl-Meyer assessment for post stroke sensorimotor function in Colombian Spanish. 2019 In: Disability and rehabilitation. - : Informa UK Limited. - 1464-5165 .- 0963-8288. ; 41:19, s. 2317-2323 Journal article (peer-reviewed)abstract Fugl-Meyer Assessment (FMA) is the most widely used and recommended clinical scale for evaluation of sensorimotor impairment post stroke, but an official Spanish version is not available today. This study aimed to establish methodological structure for translation and cultural adaptation process and perform a transcultural validation of the upper and lower extremity FMA to Colombian Spanish.Procedures included forward and backward translation, step-wise reviewing by bilingual and professional experts to ensure conceptual and semantic equivalence. Validation included a pilot evaluation of item-level agreement on 10 individuals with stroke at the Central Military Hospital of Colombia.Comprehensive step-wise procedure for transcultural validation was established. Low agreement (less than 70%) was detected for items assessing arm movements within synergies and for coordination/speed subscale. All points of disagreement were systematically reviewed and agreed upon when drafting the final version of the Spanish FMA.Use of FMA will allow unified description of stroke severity and motor recovery in Spanish speaking countries. This will open up possibility to compare stroke and rehabilitation outcomes with other countries and regions world-wide. Comprehensive methodological procedures provided can facilitate introduction of well-established clinical scales in other languages. Implications for Rehabilitation The Fugl-Meyer Assessment (FMA) of upper and lower extremity is the most used and recommended clinical scale for evaluation of sensorimotor impairment after stroke. The Spanish version of FMA, validated in this study, is now first time available for use in research and clinical practice. Use of FMA will allow unified description of stroke severity and motor recovery in Spanish speaking countries, which in turn opens up possibility to compare stroke and rehabilitation outcomes with other countries and regions world-wide.
29.	Bernhardt, Julie, et al. (author) The International Stroke Recovery and Rehabilitation Alliance 2023 In: The Lancet Neurology. - 1474-4422 .- 1474-4465. ; 22:4, s. 295-296 Journal article (other academic/artistic)
30.	Burridge, J., et al. (author) A systematic review of international clinical guidelines for rehabilitation of people with neurological conditions: What recommendations are made for upperlimb assessment? 2019 In: Frontiers in Neurology. - : Frontiers Media SA. - 1664-2295. ; 10 Journal article (peer-reviewed)abstract Background: Upper limb impairment is a common problem for people with neurological disabilities, affecting activity, performance, quality of life, and independence. Accurate, timely assessments are required for effective rehabilitation, and development of novel interventions. International consensus on upper limb assessment is needed to make research findings more meaningful, provide a benchmark for quality in clinical practice, more cost-effective neurorehabilitation and improved outcomes for neurological patients undergoing rehabilitation. Aim: To conduct a systematic review, as part of the output of a European COST Action, to identify what recommendations are made for upper limb assessment. Methods: We systematically reviewed published guidance on measures and protocols for assessment of upper limb function in neurological rehabilitation via electronic databases from January 2007-December 2017. Additional records were then identified through other sources. Records were selected for inclusion based on scanning of titles, abstracts and full text by two authors working independently, and a third author if there was disagreement. Records were included if they referred to "rehabilitation" and "assessment" or "measurement". Reasons for exclusion were documented. Results: From the initial 552 records identified (after duplicates were removed), 34 satisfied our criteria for inclusion, and only six recommended specific outcome measures and /or protocols. Records were divided into National Guidelines and other practice guidelines published in peer reviewed Journals. There was agreement that assessment is critical, should be conducted early and at regular intervals and that there is a need for standardized measures. Assessments should be conducted by a healthcare professional trained in using the measure and should encompass body function and structure, activity and participation. Conclusions: We present a comprehensive, critical, and original summary of current recommendations. Defining a core set of measures and agreed protocols requires international consensus between experts representing the diverse and multi-disciplinary field of neurorehabilitation including clinical researchers and practitioners, rehabilitation technology researchers, and commercial developers. Current lack of guidance may hold-back progress in understanding function and recovery. Together with a Delphi consensus study and an overview of systematic reviews of outcome measures it will contribute to the development of international guidelines for upper limb assessment in neurological conditions. © 2019 Burridge, Alt Murphy, Buurke, Feys, Keller, Klamroth-Marganska, Lamers, McNicholas, Prange, Tarkka, Timmermans and Hughes.
31.	Burridge, Jane, et al. (author) Development of European evidence-based recommendations for evaluation of the upper limb neurorehabilitation 2015 In: 4th Baltic and North Sea Conference on Physical and Rehabilitation Medicine. Riga, Latvia September 16–18, 2015. Journal of Rehabilitation Medicine.. - 1650-1977. Conference paper (other academic/artistic)abstract Background Although use of standardized and scientifically sound outcome measures is highly encouraged in clinical practice and research, there is still no clear recommendation on which tools should be preferred for upper limb assessment. Agreement on measures in neurorehabilitation is also required to facilitate multi-center research and meta-analysis. The European Network on Robotics for Neurorehabilitation, funded by the European Co-operation in science and technology (COST) action is developing evidence-based recommendations for evaluation of the upper limb in neurorehabilitation. The primary aim of the recommendations is to improve the quality of upper limb neurorehabilitation through the adoption of standardized, agreed protocols for assessment and choice of measurement tools in research and clinical practice. The secondary aim is to inform and influence the development of new upper limb neurorehabilitation technologies both as therapies and assessment tools and to translate useful technologies into clinical practice. Methods The Recommendations will incorporate 3 sources of evidence: systematic reviews of upper limb outcome measures, current clinical guidelines and Delphi consensus methodology in stroke and neurorehabilitation. Results Systematic reviews: From 13 systematic reviews, 53 measures were identified of which 13 met the standardized criteria for the psychometric properties. The strongest level of measurement quality and clinical utility was demonstrated for Fugl-Meyer Assessment, Action Research Arm Test, Box and Block Test, Chedoke Arm and Hand Activity Inventory, Wolf Motor Function Test and ABILHAND. Clinical guidelines: Both National and published guidelines recommend assessment within the ICF framework. The National Guidelines provide little guidance on assessment beyond that valid, reliable and responsive measurement tools should be used by trained personnel. Delphi consensus: Consensus recommends a framework for assessment including categories and, where possible, specific measures (clinical and technology-based), definition of a minimum set of measures, duration and frequency for assessments. Conclusions The final recommendations will include the purpose of assessment, recommendations on when and by whom assessments should be conducted, how long an assessment should take and what measures and tools should be used. Recommendations are made for clinical practice and research separately. A minimum set of measures will be recommended for use with all patients undergoing upper limb neurorehabilitation.
32.	Busk, H., et al. (author) Cross-cultural translation and adaptation of the Danish version of the Fugl-Meyer assessment for post stroke sensorimotor function 2022 In: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 44:17, s. 4888-4895 Journal article (peer-reviewed)abstract Purpose The Fugl-Meyer assessment (FMA) is the most widely used and recommended clinical assessment scale for evaluating sensorimotor impairments in stroke patients, but an official Danish version has not been available. This study aimed to perform a standardized translation and cross-cultural adaptation (TCCA) of the FMA into Danish. Methods First, a comprehensive eight-step TCCA procedure including forward and backward translation and step-wise reviewing by proof-reader and bilingual physiotherapists, to ensure conceptual and semantic equivalence was applied to develop a Danish version of the FMA. Second, inter-rater reliability of the Danish FMA was assessed in 10 subacute stroke patients. Svensson's statistical method designed for rank-based paired ordinal data to identify items showing non-systematic or systematic disagreements in relative position or concentration was used to make further improvements on translation. Results A Danish FMA version was successfully made by the step-wise TCCA procedure. The clinical validation revealed satisfactory to excellent inter-tester reliability across all items (70-100%). Significant systematic disagreement either in position or concentration or both were observed in about 20% of the items. Conclusions The Danish version of the FMA was translated and adapted allowing for a wider standardized use of the FMA in stroke rehabilitation in Denmark.
33.	Bustrén, Eva-Lena, et al. (author) Movement Kinematics of the Ipsilesional Upper Extremity in Persons With Moderate or Mild Stroke. 2017 In: Neurorehabilitation and neural repair. - : SAGE Publications. - 1552-6844 .- 1545-9683. ; 31:4, s. 376-386 Journal article (peer-reviewed)abstract An increasing number of studies have indicated that the ipsilesional arm may be impaired after stroke. There is, however, a lack of knowledge whether ipsilesional deficits influence movement performance during purposeful daily tasks.The aim of this study was to investigate whether, and to what extent, movement impairments are present while performing an ipsilesional upper extremity task during the first 3 months after stroke.Movement kinematics describing movement time, smoothness, velocity, strategy, and pattern were captured during a standardized drinking task in 40 persons with first-ever stroke and 20 controls. Kinematics were measured early and at 3 months poststroke, and sensorimotor impairment was assessed with Fugl-Meyer Assessment in stroke.Half of the ipsilesional kinematics showed significant deficits early after stroke compared to controls, and the stroke severity had a significant impact on the kinematics. Movements of the ipsilesional arm were slower, less smooth, demonstrated prolonged relative time in deceleration, and increased arm abduction during drinking. Kinematics improved over time and reached a level comparable with controls at 3 months, except for angular velocity of the elbow and deceleration time in reaching for those with more severe motor impairment.This study demonstrates that movements of the ipsilesional arm, during a purposeful daily task, are impaired after stroke. These deficits are more prominent early after stroke and when the motor impairment is more severe. In clinical studies and praxis, the use of less-affected arm as a reference may underestimate the level of impairment and extent of recovery.
34.	Cecchi, F., et al. (author) Transcultural translation and validation of Fugl–Meyer assessment to Italian 2021 In: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 43:25, s. 3717-3722 Journal article (peer-reviewed)abstract Purpose: The Fugl–Meyer Assessment is the most used and highly recommended clinical assessment of sensorimotor function after stroke. A standardized use of the scale in different countries requires translation and cultural validation to the target language. The objective of the study was to develop an official Italian version of the scale by transcultural translation and validation. Methods: A standardized multistep translation protocol was adopted to achieve optimal conceptual and semantic equivalence. The developed Italian version was validated in 10 post-stroke hemiparetic patients. Items with low intra- and interrater agreement, quantified as percentage of agreement <70% and/or statistically significant disagreement in relative position or concentration, between different raters were identified and revised. Results: All motor items received a high level of agreement with values well above 70%. Disagreements were observed in 6 items in the sensory, joint range and pain domains and 1 in one reflex item. Items showing disagreements were discussed and revised to establish the final Italian version. Conclusions: The culturally validated Italian Fugl–Meyer Assessment can reliably be used in research and in clinical practice. A standardized use will improve the quality of sensorimotor assessment in stroke across Italy and allow reliable comparisons of stroke populations internationally.Implications for rehabilitation The Fugl–Meyer Assessment is the gold standard for evaluation of sensorimotor impairment after stroke. Having access to a transculturally validated official Italian version of Fugl–Meyer Assessment will improve the quality of sensorimotor assessment after stroke among Italian health professionals and researchers. A wider standardized use of the Fugl–Meyer Assessment in Italy will allow reliable international comparison of stroke rehabilitation outcomes. © 2020, © 2020 Informa UK Limited, trading as Taylor & Francis Group.
35.	Ekstrand, Elisabeth, et al. (author) Clinical interpretation and cutoff scores for manual ability measured by the ABILHAND questionnaire in people with stroke. 2023 In: Topics in stroke rehabilitation. - : Informa UK Limited. - 1945-5119 .- 1074-9357. ; 30:1, s. 21-31 Journal article (peer-reviewed)abstract The ABILHAND questionnaire is recommended to assess perceived manual ability after stroke; however, more knowledge on interpretability is needed to improve the clinical applicability.To determine clinically meaningful cutoff scores for different levels of perceived manual ability, assessed by ABILHAND, corresponding to established observed and perceived upper extremity assessments post stroke.This cross-sectional study, part of the Stroke Arm Longitudinal Study (SALGOT) at the University of Gothenburg, included 80 participants with upper extremity impairments after stroke. The self-reported upper extremity functioning was assessed with ABILHAND and Stroke Impact Scale Hand (SIS Hand), and the observed functioning was assessed by Fugl-Meyer Assessment for Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT) at 3months after stroke. Receiver operating characteristic curve, sensitivity, and specificity analyses were used to determine the cutoffs.The overall discriminating accuracy was excellent (AUC > 0.90) for most of the cutoffs and sensitivity and specificity values ranged from 0.73 to 1.0. The ABILHAND cutoff score 1.78 discriminated well between low and good functioning resulting in a 95% match with SIS Hand and 87.5% match with ARAT and FMA-UE.The determined cutoff scores of the ABILHAND, validated through established upper extremity assessments, will provide a useful tool to clinicians when interpreting the logit scores and when selecting individualized treatment options. ABILHAND matched well with self-reported SIS Hand, but discrepancies found with observed scales implies that self-perceived assessments should be complemented with observed assessments.
36.	Ekstrand, Elisabeth, et al. (author) Longitudinal changes of self-perceived manual ability the first year after stroke : A cohort study 2020 In: BMC Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 20:1 Journal article (peer-reviewed)abstract Background: Recovery patterns of motor function and activity capacity of the upper extremity after stroke have been described, but less is known about longitudinal changes of perceived manual activity performance. The aim of this study was to investigate longitudinal changes of self-perceived manual ability at several timepoints from onset until 12 months post-stroke in a cohort of consecutively recruited individuals with mild, moderate and severe stroke. Methods: The study included 106 participants from a non-selected cohort with first-ever mild, moderate or severe stroke and impaired upper extremity function (Stroke Arm Longitudinal Study at the University of Gothenburg, SALGOT). Self-perceived manual ability was assessed with the ABILHAND Questionnaire at 3 and 10 days, 4 weeks, 3, 6 and 12 months after stroke. Longitudinal change was assessed by linear mixed models (fixed and random effects) and adjusted models were built by adding effects of cofactors age, gender, stroke severity, living condition and affected hand. Results: Self-perceived manual ability increased over time the first year after stroke for the total group and the subgroups. The final adjusted model for the total group included fix-effects of time (expected mean change 0.24 logits per month) adjusted by age (-0.06 per year) and stroke severity (-0.19 per NIHSS-score). In addition to significant effect of time, the adjusted models for moderate stroke subgroup included fixed effect of age, and for mild and severe subgroups there was an interaction effect between time and age. Further analyses between time-points showed that no significant change of self-perceived manual ability was detected beyond 3 months post-stroke. Conclusions: Self-perceived manual ability increased over time the first year after stroke, and this change was to some degree modulated by age and stroke severity at onset. Most of the improvements occurred early, predominantly within the first three months after stroke.
37.	Ekstrand, Elisabeth, et al. (author) Which clinical and sociodemographic determinants are associated with self-perceived manual ability at one year after stroke? 2020 In: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 42:16, s. 2279-2286 Journal article (peer-reviewed)abstract Purpose: To evaluate the impact of multiple potential sociodemographic and clinical stroke-related determinants on self-perceived manual ability in an unselected sample of individuals 12 months after first-ever stroke. Methods: A cross-sectional sample of 68 participants (mean age 66) with UE impairments were followed up at 12 months post stroke. Stroke severity at onset was moderate for the majority. Manual ability was assessed by the patient-reported outcome measure ABILHAND Questionnaire. Determinants included in the multivariate regression analysis were age, gender, living situation, vocational situation, affected hand, stroke severity at onset and UE disability (motor function, sensory function, joint motion, pain, grip strength, spasticity and activity capacity) at 12 months post stroke. Results: The strongest associated determinants with self-perceived manual ability were UE motor function and UE activity capacity at 12 months post-stroke. UE motor function together with age and grip strength explained 65% of the variance in one final multivariate model. UE activity capacity and grip strength explained 62% of the variance in a second final model. Conclusion: In order to understand self-perceived difficulties in manual ability in daily activities in persons with stroke, assessments of UE motor function and activity capacity are recommended. Implications for rehabilitation The ultimate goal of the upper extremity rehabilitation after stroke is to regain ability to use the UE in daily activities that are important to the individual in his or her own environment. This requires a good understanding of factors that are associated with self-perceived manual ability in order to tailor effective rehabilitation interventions. Upper extremity motor function and activity capacity are the strongest determinants associated with self-perceived manual ability one year after stroke. These factors are recommended to be included in the assessment battery in stroke to fully understand the disability in daily life.
38.	Elmgren Frykberg, Gunilla, 1957-, et al. (author) How many trials are needed in kinematic analysis of reach-to-grasp? : A study of the drinking task in persons with stroke and non-disabled controls 2021 In: Journal of NeuroEngineering and Rehabilitation. - : BioMed Central (BMC). - 1743-0003. ; 18:1 Journal article (peer-reviewed)abstract Background: Kinematic analysis of the 3D reach-to-grasp drinking task is recommended in stroke rehabilitation research. The number of trials required to reach performance stability, as an important aspect of reliability, has not been investigated for this task. Thus, the aims of this study were to determine the number of trials needed for the drinking task to reach within-session performance stability and to investigate trends in performance over a set of trials in non-disabled people and in a sample of individuals with chronic stroke. In addition, the between-sessions test–retest reliability in persons with stroke was established.Methods: The drinking task was performed at least 10 times, following a standardized protocol, in 44 non-disabled and 8 post-stroke individuals. A marker-based motion capture system registered arm and trunk movements during 5 pre-defined phases of the drinking task. Intra class correlation statistics were used to determine the number of trials needed to reach performance stability as well as to establish test–retest reliability. Systematic within-session trends over multiple trials were analyzed with a paired t-test.Results: For most of the kinematic variables 2 to 3 trials were needed to reach good performance stability in both investigated groups. More trials were needed for movement times in reaching and returning phase, movement smoothness, time to peak velocity and inter-joint-coordination. A small but significant trend of improvement in movement time over multiple trials was demonstrated in the non-disabled group, but not in the stroke group. A mean of 3 trials was sufficient to reach good to excellent test–retest reliability for most of the kinematic variables in the stroke sample.Conclusions: This is the first study that determines the number of trials needed for good performance stability (non-disabled and stroke) and test–retest reliability (stroke) for temporal, endpoint and angular metrics of the drinking task. For most kinematic variables, 3–5 trials are sufficient to reach good reliability. This knowledge can be used to guide future kinematic studies.
39.	Erhardsson, Mattias, et al. (author) Commercial head-mounted display virtual reality for upper extremity rehabilitation in chronic stroke: a single-case design study 2020 In: Journal of NeuroEngineering and Rehabilitation. - : Springer Science and Business Media LLC. - 1743-0003. ; 17 Journal article (peer-reviewed)abstract © 2020, The Author(s). Background: Rehabilitation is crucial for maximizing recovery after stroke. Rehabilitation activities that are fun and rewarding by themselves can be more effective than those who are not. Gamification with virtual reality (VR) exploits this principle. This single-case design study probes the potential for using commercial off-the-shelf, room-scale head-mounted virtual reality for upper extremity rehabilitation in individuals with chronic stroke, the insights of which can inform further research. Methods: A heterogeneous volunteer sample of seven participants living with stroke were recruited through advertisement. A single-case design was employed with a 5-week baseline (A), followed by a 10-week intervention (B) and a 6-month follow-up. Upper extremity motor function was assessed with validated kinematic analysis of drinking task. Activity capacity was assessed with Action Research Arm Test, Box and Block Test and ABILHAND questionnaire. Assessments were done weekly and at follow-up. Playing games on a VR-system with head-mounted display (HTC Vive) was used as rehabilitation intervention. Approximately 300 games were screened and 6 tested. Visual analysis and Tau-U statistics were used to interpret the results. Results: Visual analysis of trend, level shift and overlap as well as Tau-U statistics indicated improvement of Action Research Arm Test in six participants. Four of these had at least a moderate Tau-U score (0.50–0.92), in at least half of the assessed outcomes. These four participants trained a total of 361 to 935min. Two out of four participants who were able to perform the drinking task, had the highest training dose (> 900min) and showed also improvements in kinematics. The predominant game played was Beat Saber. No serious adverse effects related to the study were observed, one participant interrupted the intervention phase due to a fall at home. Conclusions: This first study of combining commercial games, a commercial head-mounted VR, and commercial haptic hand controls, showed promising results for upper extremity rehabilitation in individuals with chronic stroke. By being affordable yet having high production values, as well as being an easily accessible off-the-shelf product, this variant of VR technology might facilitate widespread adaption. Insights garnered in this study can facilitate the execution of future studies. Trial registration The study was registered at researchweb.org (project number 262331, registered 2019-01-30, https://www.researchweb.org/is/vgr/project/262331) prior to participant enrolment.
40.	Ghaziani, Emma, et al. (author) Easily Conducted Tests During the First Week Post-stroke Can Aid the Prediction of Arm Functioning at 6 Months. 2020 In: Frontiers in neurology. - : Frontiers Media SA. - 1664-2295. ; 10 Journal article (peer-reviewed)abstract Background: Prognostic models can estimate the recovery of arm functioning after stroke, guide the selection of individual training strategies, and inform patient selection in clinical trials. Several models for early prediction of arm recovery have been proposed, but their implementation has been hindered by insufficient external validation, limited evidence of their impact on patient outcomes, and reliance on predictors that are not feasible in regular clinical practice. Objectives: To determine the predictive value of new and previously reported tests that can be easily conducted in regular clinical settings for early prognosis of two levels of favorable arm recovery at 6 months post-stroke. Methods: We performed a secondary analysis of merged data (n = 223) from two Scandinavian prospective longitudinal cohorts. The candidate predictors were seven individual tests of motor function and the sensory function measured by the Fugl-Meyer Assessment of Upper Extremity within 7 days post-stroke, and the whole motor section of this assessment. For each candidate predictor, we calculated the adjusted odds ratio (OR) of two levels of residual motor impairment in the affected arm at 6 months post-stroke: moderate-to-mild (≥32 points on the motor section of the Fugl-Meyer Assessment of Upper Extremity, FMA-UE) and mild (FMA-UE ≥ 58 points). Results: Patients with partial shoulder abduction (OR 14.6), elbow extension (OR 15.9), and finger extension (OR 9.5) were more likely to reach FMA-UE ≥ 32. Patients with full function on all individual motor tests (OR 5.5-35.3) or partial elbow extension, pronation/supination, wrist dorsiflexion and grasping ability (OR 2.1-18.3) were more likely to achieve FMA-UE ≥ 58 compared with those with absent function. Intact sensory function (OR 2.0-2.2) and moderate motor impairment on the FMA-UE (OR 7.5) were also associated with favorable outcome. Conclusions: Easily conducted motor tests can be useful for early prediction of arm recovery. The added value of this study is the prediction of two levels of a favorable functional outcome from simple motor tests. This knowledge can be used in the development of prognostic models feasible in regular clinical settings, inform patient selection and stratification in future trials, and guide clinicians in the selection of individualized training strategies for improving arm functioning after stroke. Clinical Trial Registration: ClinicalTrials.gov: NCT02250365, NCT01115348.
41.	Gustavsson, Martha, et al. (author) Virtual reality gaming in rehabilitation after stroke - user experiences and perceptions 2022 In: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 44:22, s. 6759-6765 Journal article (peer-reviewed)abstract Purpose The present study explored participants' experiences with and perceptions of using fully immersive head-mounted virtual reality (VR) gaming as rehabilitation after stroke. Methods Four men and three women (median age 64 years) with chronic stroke and varying motor impairment (mild to severe) were interviewed after 10 weeks of VR training on the commercial HTC Vive system, focusing on the upper extremities. Inductive qualitative thematic analysis was performed. Results The analysis revealed three main themes: playing the game, benefits and effects, and personalizing the game. Playing the game encompasses both the feeling of being immersed in the game and descriptions of the gaming being motivating and fun. Benefits and effects describe the participants' expectations of potential benefits, the importance of getting feed-back, and the impact in daily life. Personalizing the game includes finding the right game and level, and the participants' need for support to achieve full use of the training. Conclusions Participants with chronic stroke described the fully immersive VR gaming intervention as a fun and motivating way to improve their functioning in everyday life. Qualitative studies are needed to explore how people with stroke perceive VR gaming when it is implemented in real clinical environments.Clinical implications VR gaming was perceived as a positive and motivating rehabilitation after stroke. Getting feedback and perceiving benefits are essential parts of VR rehabilitation. Commercial fully immersive VR-games might be an option for stroke rehabilitation when the game can be personalized and support is available.
42.	Haescher, Marian, et al. (author) Automated fall risk assessment of elderly using wearable devices. 2020 In: Journal of rehabilitation and assistive technologies engineering. - : SAGE Publications. - 2055-6683. ; 7 Journal article (peer-reviewed)abstract Falls cause major expenses in the healthcare sector. We investigate the ability of supporting a fall risk assessment by introducing algorithms for automated assessments of standardized fall risk-related tests via wearable devices.In a study, 13 participants conducted the standardized 6-Minutes Walk Test, the Timed-Up-and-Go Test, the 30-Second Sit-to-Stand Test, and the 4-Stage Balance Test repeatedly, producing 226 tests in total. Automatedalgorithms computed by wearable devices, as well as a visual analysis of the recorded data streams, were compared to the observational results conducted by physiotherapists.There was a high congruence between automated assessments and the ground truth for all four test types (ranging from 78.15% to 96.55%), with deviations ranging all well within one standard deviation of the ground truth. Fall risk (assessed by questionnaire) correlated with the individual tests.The automated fall risk assessment using wearable devices and algorithms matches the validity of the ground truth, thus providing a resourceful alternative to the effortful observational assessment, while minimizing the risk of human error. No single test can predict overall fall risk; instead, a much more complex model with additional input parameters (e.g., fall history, medication etc.) is needed.
43.	Hernandez, E. D., et al. (author) INTRA- AND INTER-RATER RELIABILITY OF FUGL-MEYER ASSESSMENT OF UPPER EXTREMITY IN STROKE 2019 In: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977. ; 51:9, s. 652-659 Journal article (peer-reviewed)abstract Objective: The Fugl-Meyer Assessment of Upper Extremity (FMA-UE) is recommended for evaluation of sensorimotor impairment post stroke, but the item-level reliability of the scale is unknown. This study aims to determine intra- and inter-rater reliability of the FMA-UE at item-, subscale- and total score level in patients with early subacute stroke. Design: Intra/inter-rater reliability. Subjects: Sixty consecutively included patients with stroke (mean age 65.9 years) admitted to Central Military Hospital of Colombia, Bogota. Methods: Two physiotherapists scored FMA-UE independently on 2 consecutive days within 10 days post stroke. A rank-based statistical method for paired ordinal data was used to assess the level of agreement, systematic and random disagreements. Results: Systematic disagreements either in position or concentration were detected in 4 items of the shoulder section. The item level intra- and inter-rater agreement was high (79-100%). The 70% agreement was also reached for the subscales and the total score when 1-3-point difference was accepted. Conclusion: The FMA-UE is reliable both within and between raters in patients with stroke in the early subacute phase. A wider international use of FMA-UE will allow comparison of stroke recovery between regions and countries and thereby potentially improve the quality of care and rehabilitation in persons with stroke worldwide.
44.	Hernández, Edgar D, et al. (author) Intra- and interrater reliability of Fugl-Meyer Assessment of Lower Extremity early after stroke. 2021 In: Brazilian journal of physical therapy. - : Elsevier BV. - 1809-9246 .- 1413-3555. ; 25:6, s. 709-718 Journal article (peer-reviewed)abstract The Fugl-Meyer Assessment of Lower Extremity (FMA-LE) is a widely used and recommended scale for evaluation of post-stroke motor impairment. However, the reliability of the scale has only been established by using parametric statistical methods, which ignores the ordinal properties of the scale.To determined intra- and inter-rater reliability of the FMA-LE at item and summed score level early after stroke.Sixty patients (mean age 65.9 years, median FMA-LE 29 points) admitted to the hospital due to stroke were included. The FMA-LE was simultaneously, but independently, scored by three experienced and trained physical therapists randomly assigned into pairs, on two consecutive days, between 4 to 9 days post stroke. A rank-based statistical method for paired ordinal data was used to assess the level of agreement and systematic and random disagreements.The item-level reliability was high (percentage of agreement [PA] ≥75%). Two items (ankle dorsiflexion during flexor synergy and normal reflex activity) showed some systematic disagreement in intrarater analysis. A satisfactory intrarater reliability (PA ≥70%) was reached for all summed scores when a 1- or 2-point difference was accepted between ratings.The FMA-LE is a reliable tool for assessment of motor impairment both within and between raters early after stroke. The scale can be recommended not only for use in Spanish speaking countries, but also internationally. A unified international use of FMA-LE would allow comparison of stroke recovery outcomes worldwide and thereby potentially improve the quality of stroke rehabilitation.
45.	Hochleitner, I., et al. (author) Intra- and inter-rater reliability of the Italian Fugl-Meyer assessment of upper and lower extremity 2023 In: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 45:18, s. 2989-2999 Journal article (peer-reviewed)abstract Purpose To assess the intra- and inter-rater reliability motor and sensory functioning, balance, joint range of motion and joint pain subscales of the Italian Fugl-Meyer Assessment (FMA) Upper Extremity (FMA-UE) and Lower Extremity (FMA-LE) at the item- subtotal- and total-level in patients with sub-acute stroke. Materials and methods The FMA was administered to 60 patients with sub-acute stroke (mean age +/- SD = 75.4 +/- 10.7 years; 58.3% men) and independently rated by two physiotherapists on two consecutive days. Intra- and inter-reliability was studied by a rank-based statistical method for paired ordinal data to detect any systematic or random disagreement. Results The item-level intra- and inter-rater reliability was satisfactory (>70%). Reliability level >70% was achieved at subscale and total score level when one- or two-points difference was considered. Systematic disagreements were reported for five items of the FMA-UE, but not for FMA-LE. Conclusions The Italian version of the FMA showed to be a reliable instrument that can therefore be recommended for clinical and research purposes.
46.	Hughes, A. M., et al. (author) Evaluation of upper extremity neurorehabilitation using technology: a European Delphi consensus study within the EU COST Action Network on Robotics for Neurorehabilitation 2016 In: Journal of Neuroengineering and Rehabilitation. - : Springer Science and Business Media LLC. - 1743-0003. ; 13 Journal article (peer-reviewed)abstract Background: The need for cost-effective neurorehabilitation is driving investment into technologies for patient assessment and treatment. Translation of these technologies into clinical practice is limited by a paucity of evidence for cost-effectiveness. Methodological issues, including lack of agreement on assessment methods, limit the value of meta-analyses of trials. In this paper we report the consensus reached on assessment protocols and outcome measures for evaluation of the upper extremity in neurorehabilitation using technology. The outcomes of this research will be part of the development of European guidelines. Methods: A rigorous, systematic and comprehensive modified Delphi study incorporated questions and statements generation, design and piloting of consensus questionnaire and five consensus experts groups consisting of clinicians, clinical researchers, non-clinical researchers, and engineers, all with working experience of neurological assessments or technologies. For data analysis, two major groups were created: i) clinicians (e.g., practicing therapists and medical doctors) and ii) researchers (clinical and non-clinical researchers (e.g. movement scientists, technology developers and engineers). Results: Fifteen questions or statements were identified during an initial ideas generation round, following which the questionnaire was designed and piloted. Subsequently, questions and statements went through five consensus rounds over 20 months in four European countries. Two hundred eight participants: 60 clinicians (29 %), 35 clinical researchers (17 %), 77 non-clinical researchers (37 %) and 35 engineers (17 %) contributed. At each round questions and statements were added and others removed. Consensus (>= 69 %) was obtained for 22 statements on i) the perceived importance of recommendations; ii) the purpose of measurement; iii) use of a minimum set of measures; iv) minimum number, timing and duration of assessments; v) use of technology-generated assessments and the restriction of clinical assessments to validated outcome measures except in certain circumstances for research. Conclusions: Consensus was reached by a large international multidisciplinary expert panel on measures and protocols for assessment of the upper limb in research and clinical practice. Our results will inform the development of best practice for upper extremity assessment using technologies, and the formulation of evidence-based guidelines for the evaluation of upper extremity neurorehabilitation.
47.	Hussain, Netha, et al. (author) End-point kinematics using virtual reality explaining upper limb impairment and activity capacity in stroke 2019 In: Journal of NeuroEngineering and Rehabilitation. - : Springer Science and Business Media LLC. - 1743-0003. ; 16:1 Journal article (peer-reviewed)abstract Background: For evaluation of upper limb impairment and activity capacity, Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT) are recommended to be included in stroke trials. To improve the understanding of mechanisms of motor recovery, and differentiate between restitution and compensation, kinematic analysis is also recommended for assessment of upper limb function after stroke. Aim: To determine the extent to which end-point kinematic variables obtained from the target-to-target pointing task were associated with upper limb impairment or activity limitation as assessed by traditional clinical scales in individuals with stroke. Methods: Sixty-four individuals, from acute stage up to one year after stroke, were included from the Stroke Arm Longitudinal study at the University of Gothenburg (SALGOT) cohort. They performed a target-to-target pointing task in a virtual environment using a haptic stylus which also captured the kinematic parameters. Multiple linear regression was done to determine the amount of variance explained by kinematic variables on FMA-UE and ARAT scores after controlling for confounding variables. Results: Mean velocity and number of velocity peaks explained 11 and 9% of the FMA-UE score uniquely and 16% when taken together. Movement time and number of velocity peaks explained 13 and 10% of the ARAT score respectively. Conclusion: The kinematic variables of movement time, velocity and smoothness explain only a part of the variance captured by using clinical observational scales, reinforcing the importance of multi-level assessment using both kinematic analysis and clinical scales in upper limb evaluation after stroke. Trial registration: The trial was registered with register number NCT01115348 at clinicaltrials.gov, on May 4, 2010. URL: https://clinicaltrials.gov/ct2/show/NCT01115348. © 2019 The Author(s).
48.	Hussain, Netha, et al. (author) Recovery of arm function during acute to chronic stage of stroke quantified by kinematics. 2021 In: Journal of rehabilitation medicine. - : Medical Journals Sweden AB. - 1651-2081. ; 53:3 Journal article (peer-reviewed)abstract To quantify the longitudinal changes in upper limb kinematics within the first year after stroke and to identify the factors that affect these changes.A total of 66 individuals with stroke from the Stroke Arm Longitudinal Study at the University of Gothenburg (SALGOT) cohort were included if they were able to perform the target-to-target task. Data from a virtual reality haptic target-to-target task at 6 time-points between 3 days and 12 months after stroke were analysed by linear mixed models, while controlling for the impact of cofactors (stroke severity, age, type and side of stroke, sex and presence of diabetes).Kinematic variables of movement time, mean velocity and number of velocity peaks improved overtime and were positively affected by younger age, less severe stroke and ischaemic compared with haemorrhagic stroke. Most of the improvement occurred within 4 weeks after stroke, although movement time and number of velocity peaks also improved between 3 and 6 months after stroke.Kinematic variables of movement time, mean velocity and number of velocity peaks were effective in quantifying the recovery of the upper limb after stroke. The rate of recovery was dependent on age, stroke severity and type of stroke.
49.	Hussain, Netha, et al. (author) Relationship between self-reported and objectively measured manual ability varies during the first year post-stroke. 2020 In: Scientific reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 10:1 Journal article (peer-reviewed)abstract Self-reported outcomes provide unique insights about an individual's perceived manual ability after stroke. This study aimed at determining how the relationship between objective kinematic variables obtained from the target-to-target pointing task and self-reported manual ability varies during the first year in individuals after stroke. Sixty-six individuals from the Stroke Arm Longitudinal study at the University of Gothenburg (SALGOT) cohort were assessed using ABILHAND questionnaire and kinematic analysis at five timepoints between the 10th day and 12th month after stroke. Kinematic analysis was performed using a target-to-target pointing task in a virtual environment. Spearman's correlation was used to determine the extent of correlation between ABILHAND logits and kinematic variables. The correlations varied with time within the first year after stroke. The correlations were low or very low early after stroke and became moderate to high after 6 months for objective measures of movement time and smoothness, but remained low to moderate for mean velocity and low for peak velocity. Due to this discrepancy between self-perceived and objective assessments of arm function, a combination of self-reported and objective assessments of upper limb should be used as outcome measures, especially in the acute and subacute stages after stroke.
50.	Hussain, Netha, et al. (author) Upper Limb Kinematics in Stroke and Healthy Controls Using Target-to-Target Task in Virtual Reality 2018 In: Frontiers in Neurology. - : Frontiers Media SA. - 1664-2295. ; 9 Journal article (peer-reviewed)abstract Background: Kinematic analysis using virtual reality (VR) environment provides quantitative assessment of upper limb movements. This technique has rarely been used in evaluating motor function in stroke despite its availability in stroke rehabilitation. Objective: To determine the discriminative validity of VR-based kinematics during target-to-target pointing task in individuals with mild or moderate arm impairment following stroke and in healthy controls. Methods: Sixty-seven participants with moderate (32-57 points) or mild (58-65 points) stroke impairment as assessed with Fugl-Meyer Assessment for Upper Extremity were included from the Stroke Arm Longitudinal study at the University of Gothenburg- SALGOT cohort of non-selected individuals within the first year of stroke. The stroke groups and 43 healthy controls performed the target-to-target pointing task, where 32 circular targets appear one after the other and disappear when pointed at by the haptic handheld stylus in a three-dimensional VR environment. The kinematic parameters captured by the stylus included movement time, velocities, and smoothness of movement. Results: The movement time, mean velocity, and peak velocity were discriminative between groups with moderate and mild stroke impairment and healthy controls. The movement time was longer and mean and peak velocity were lower for individuals with stroke The number of velocity peaks, representing smoothness, was also discriminative and significantly higher in both stroke groups (mild, moderate) compared to controls. Movement trajectories in stroke more frequently showed clustering (spider's web) close to the target indicating deficits in movement precision. Conclusion: The target-to-target pointing task can provide valuable and specific information about sensorimotor impairment of the upper limb following stroke that might not be captured using traditional clinical scale.

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