Structured Abstract
Stroke Structured Abstract - S #8
Reaching for an object elicits better quality of movement in stroke patients than reaching for no object
CITATION: Wu, C-Y., Trombly, C. A., Lin, K-C., & Tickle-Degnen, L. (2000). A kinematic study of contextual effects on reaching performance in persons with and without stroke: Influences of object availability. Archives of Physical Medicine and Rehabilition, 81, 95-101.
LEVEL OF EVIDENCE: IC1c
RESEARCH QUESTION
What are the effects of context on reaching performance in stroke patients and healthy persons? Context was varied by the presence or absence of objects used to complete a task.
DESIGN
Counterbalanced repeated-measures design (RCT)
Subjects were randomly assigned to one of two sequences: AB or BA.
SAMPLING PROCEDURE/INCLUSION CRITERIA
All subjects were right-handed, were able to understand and respond to instructions given by the experimenter, and had movement in the proximal part of the impaired arm.
SAMPLE
|
N:
Stroke = 14
Control = 25 |
Male:
Stroke = 9
Control = 8 |
Female:
Stroke = 5
control = 17 |
Mean age:
Stroke = 61.8
control = 63.8 |
|
LCVA = 8 |
RCVA = 5 |
Other = 1 |
Attrition = 0 (1% of data lost) |
| |
Acute |
x |
Chronic |
One subject was not recorded as LCVA or RCVA.
OUTCOME MEASURES
Reaching kinematics calculated from data collected by OPTOTRAK/3020, three-dimensional infrared motion analysis system.
Intraclass correlation (ICC) > .99
Total movement time (MT) [speed]
Total displacement (TD) [amount of reach]
Percentage of reach where peak velocity occurs (PPV) [strategy]
Number of movement units (MU) [smoothness]
Amplitude of peak velocity (PV) [force]
INTERVENTION DESCRIPTION
Condition 1: Object present condition (A) - one quarter and one dime were placed on the table in front of the subject. With the affected arm, the subject reached forward to scoop the coins off the table into the other hand.
Condition 2: Object absent condition (B) - the subject reached forward to the spot where the coins should be placed in the condition of object present, and then brought his or her arm back to the starting point.
WHO DELIVERED INTERVENTION
OT
SETTING
Laboratory
FREQUENCY & DURATION
Each subject performed ten trials of each condition with rest between conditions, within one day.
RESULTS
Between Groups/Conditions/Times:
- The statistical analysis for stroke subjects indicated significant object presence effect for:
-
movement time (F[1,12] = 11.40, p = .0028, r = .70),
total displacement (F[1,12] = 12.82, p = .0019, r = .72),
percentage of reach where peak velocity occurs (F[1,12 = 15.12, p = .0011, r = .75)
movement units (F[1,12 = 9.05, p = .0055, r = .66).
- A nonsignificant effect was found for:
-
the variable of peak velocity (F[1,12] = .36, p = .2791,r = .17).
- The overall effect of object present was r = .63, a strong effect.
Within Groups/Conditions/Times: Not tested
THREATS TO VALIDITY
None
AUTHORS' CONCLUSIONS
The results of this study showed that the condition of object present elicited better performance of movement, represented by kinematic variables, than the condition of object absent. The clinical implication is that the use of real and functional objects might be an effective way of facilitating efficient, smooth, and coordinated movement of the impaired arm in persons with stroke.
REVIEWERS' CONCLUSIONS
The object-present condition elicited better quality of movement, as measured by kinematic analysis, than the object-absent condition. The study suggests that therapists could advantageously use real objects to improve patients' movement quality.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice-Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Hui-ing Ma, ScD, OTR, and Catherine A. Trombly, ScD, OTR/L, FAOTA.
For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.
