(Stroke. 1997;28:2162-2168.)
© 1997 American Heart Association, Inc.
Articles |
Computerized Measurement of Motor Performance After Stroke
From the Department of Neurology, Massachusetts General Hospital (S.C.C., G.N., J.D.K., S.P.F.); Spaulding Rehabilitation Hospital, Harvard Medical School (G.N., J.D.K.); Northeastern University, Bouvé College of Pharmacy and Health Sciences (J.D.S.); The Clinical Investigator Training Program, Harvard-MIT Division of Health Sciences and Technology and the Beth Israel–Deaconess Medical Center, in collaboration with Pfizer Inc (S.C.C.); and Massachusetts General Hospital/Spaulding NeuroRecovery Program (S.C.C., G.N., J.D.S., J.D.K., S.P.F.), Boston, Mass.
Correspondence to Steven C. Cramer, MD, VA Medical Center, Department of Neurology (127), 1660 S Columbian Way, Seattle, WA 98108. E-mail cramers{at}u.washington.edu
Background and Purpose Stroke scales usually convert motor status to a score along an ordinal scale and do not provide a permanent recording of motor performance. Computerized methods sensitive to small changes in neurological status may be of value for studying and measuring stroke recovery.
Methods We developed a computerized dynamometer and tested 23 stroke subjects and 12 elderly control subjects on three motor tasks: sustained squeezing, repetitive squeezing, and index finger tapping. For each subject, scores on the Fugl-Meyer and National Institutes of Health stroke scales were also obtained.
Results Sustained squeezing by the paretic hand of stroke
subjects was weaker (9.2 kg) than the unaffected hand (20.2 kg;
P<.0005), as well as control dominant (23.1 kg;
P<.0005) and nondominant (19.9 kg;
P<.005) hands. Paretic index finger tapping was slower
(2.5 Hz) than the unaffected hand (4.2 Hz; P<.01), as
well as control dominant (4.7 Hz; P<.0005) and
nondominant (4.9 Hz; P<.0005) hands. Many features of
dynamometer data correlated significantly with stroke subjects'
Fugl-Meyer scores, including sustained squeeze maximum force (
=.91)
and integral of force over 5 seconds (=.91); repetitive squeeze mean
force (=.92) and mean frequency (=.73); and index finger tap mean
frequency (=.83). Correlation of these motor parameters
with National Institutes of Health stroke scale score was weaker in all
cases, a consequence of the scoring of nonmotor deficits on this scale.
Dynamometer measurements showed excellent interrater
(r=.99) and intrarater (r=.97)
reliability.
Conclusions The degree of motor deficit quantitated with the dynamometer is strongly associated with the extent of neurological abnormality measured with the use of two standardized stroke scales. The computerized dynamometer rapidly measures motor function along a continuous, linear scale and produces a permanent recording of hand motor performance accessible for subsequent analyses.
Key Words: diagnosis • motor activity • stroke assessment
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