Revised version of the ability for basic movement scale (ABMS II) as an early predictor of functioning related to activities of daily living in patients after stroke

The Clinical Variables Predicting the Acquisition of Independent Ambulation in the Acute Phase of Stroke: A Retrospective Study

BACKGROUND

Predictive factors associated with independent ambulation post-stroke are less commonly reported for patients during the acute phase of stroke. This study aimed to identify the clinical variables predicting ambulation independence in the acute phase of stroke and test the superiority of their prediction accuracy.

METHODS

Sixty-nine patients, hospitalized in the acute phase for an initial unilateral, supratentorial stroke lesion, were divided into independent (n = 24) and dependent ambulation (n = 45) groups, with functional ambulation category scores of 4-5 and ≤ 3, respectively. They were evaluated upon admission using the modified Rankin scale (mRS), Stroke Impairment Assessment Set (SIAS) concerning the motor function of the lower extremities, Ability for Basic Movement Scale modified version 2 (ABMS2), and Functional Independence Measure (FIM).

RESULTS

The scores of the four measures were significantly different between the groups. A univariate logistic regression analysis identified these variables as prognostic factors for independent ambulation. A receiver operating characteristic curve analysis identified the cutoff values (area under the curve) for the mRS, SIAS, FIM, and ABMS2 as 3 (0.74), 12 (0.73), 55 (0.85), and 23 (0.84), respectively.

CONCLUSION

In summary, the FIM and ABMS2 may be more accurate in predicting ambulation independence in patients with stroke during the acute phase.

Predictive factors for walking in acute stroke patients: a multicenter study using classification and regression tree analysis

[Purpose] Walking ability should be predicted as early as possible in acute stroke patients. The purpose is to construct a prediction model for independent walking from bedside assessments using classification and regression tree analysis. [Participants and Methods] We conducted a multicenter case-control study with 240 stroke patients. Survey items included age, gender, injured hemisphere, the National Institute of Health Stroke Scale, the Brunnstrom Recovery Stage for lower extremities, and "turn over from a supine position" from the Ability for Basic Movement Scale. The National Institute of Health Stroke Scale items, such as language, extinction, and inattention, were grouped under higher brain dysfunction. We used the Functional Ambulation Categories to classify patients into independent (four or more the Functional Ambulation Categories; n=120) and dependent (three or fewer the Functional Ambulation Categories; n=120) walking groups. A classification and regression tree analysis was used to create a model to predict independent walking. [Results] The Brunnstrom Recovery Stage for lower extremities, "turn over from a supine position" from the Ability for Basic Movement Scale, and higher brain dysfunction were the splitting criteria for classifying patients into four categories: Category 1 (0%), severe motor paresis; Category 2 (10.0%), mild motor paresis and could not turn over; Category 3 (52.5%), with mild motor paresis, could turn over, and had higher brain dysfunction; and Category 4 (82.5%), with mild motor paresis, could turn over, and no higher brain dysfunction. [Conclusion] We constructed a useful prediction model for independent walking based on the three criteria.

Predictors of high dose of massed practice following stroke

Objective

The aim of this study is to determine the factors that affect patients' ability to carry out high dose of massed practice.

Methods

Patients with stroke were included in the study if they had no severe impairment in motor and cognitive functions. Dose of massed practice, motor function, perceived amount and quality of use of the arm in the real world, wrist and elbow flexors spasticity, dominant hand stroke, presence of shoulder pain, and central post-stroke pain were assessed on the first day. Dose of massed practice was assessed again on the second day. The data were analyzed using descriptive statistics and linear multiple regression.

Results

Only motor function (β = -0.310, r = 0.787, P < 0.001), perceived amount of use (β = 0.300, r = 0.823; 95% CI = 0.34-107.224, P = 0.049), severity of shoulder pain (β = -0.155, r = -0.472, P = 0.019), wrist flexors spasticity (β = -0.154, r = -0.421, P = 0.002), age (β = -0.129, r = -0.366, P = 0.018), dominant hand stroke (β = -0.091, r = -0.075, P = 0.041), and sex (β = -0.090, r = -0.161, P = 0.036) significantly influenced patients' ability to carry out high dose of massed practice.

Conclusion

Many factors affect patients' ability to carry out high dose of massed practice. Understanding these factors can help in designing appropriate rehabilitation.

Utility of the ability for basic movement scale II as a prediction method of ambulation ability in patients after the hip fracture surgery

BACKGROUND

This study was to investigate whether the Ability for Basic Movement Scale II (ABMS II) at admission of the convalescent rehabilitation ward (CRW) could predict the ambulation ability in patients after hip fracture surgery.

METHODS

The data of the ABMS II and Functional Ambulation Category (FAC) of 118 postsurgical patients with hip fracture who were transferred to the CRW were retrospectively analyzed (mean age 82.7 ± 7.9, female/male: 89/29). Binary logistic regression analysis and receiver operating characteristic (ROC) analysis were used to investigate the predictive value of ABMS II for walking ability at discharge.

RESULTS

Spearman's correlation analysis showed that there were significantly positive correlations between the ABMS II score at admission and FAC score at discharge (ρ = 0.70, P < 0.05). Logistic regression analysis showed that ABMS II and BMI can be the predictor in both FAC <4 or ≥4 groups. ROC analysis indicated that an optimal cutoff of 24.5 points of ABMS II score predicted independent walking ability (area under the Curve (AUC) 0.87, P < 0.05).

CONCLUSIONS

The ABMS II at admission in CRW can be a prediction method of ambulation recovery for the patients after hip fracture surgery.

STUDY DESIGN

Retrospective clinical study.

Factors Influencing Sitting Ability During the Acute Post-Stroke Phase: A Multicenter Prospective Cohort Study in Japan

OBJECTIVES

Sitting ability during the acute phase after stroke is a useful indicator of functional outcomes; however, factors that affect this ability have not been evaluated. Therefore, this study aimed to identify and evaluate factors that affect sitting ability in the acute phase after stroke.

MATERIALS AND METHODS

This multicenter prospective cohort study included hemispheric stroke patients who underwent an inpatient rehabilitation program after acute stroke from five acute care hospitals. The effect of age, sex, lesion side, etiology, consciousness disorder, stroke and dementia history, stroke-related complications, National Institutes of Health Stroke Scale score, hemiparalysis, turn-over movement from the supine position and sit-up movement, and Scale for Contraversive Pushing on the "remain sitting" item in the revised version of the Ability of Basic Movement Scale at the time of acute hospital discharge were investigated. Factors affecting sitting ability were identified using binomial logistic regression analysis.

RESULTS

We included 293 stroke patients. Age (odds ratio: 0.943, 95% confidence interval: 0.910-0.977, p=0.001), National Institutes of Health Stroke Scale score (odds ratio: 0.862, 95% confidence interval: 0.811-0.916, p<0.001), and Scale for Contraversive Pushing score (odds ratio: 0.543, 95% confidence interval: 0.419-0.705, p<0.001) were identified as independent predictors of sitting ability at the time of hospital discharge (median; 23.0 days).

CONCLUSIONS

Older patients and those with high Scale for Contraversive Pushing and National Institutes of Health Stroke Scale scores experienced difficulties in regaining sitting ability. These results may guide physical therapy for patients with impaired sitting ability due to hemispheric stroke.

Prediction of Independent Gait in Acute Stroke Patients with Hemiplegia Using the Ability for Basic Movement Scale II Score

INTRODUCTION

Since independent gait is an important factor for home discharge, early prediction of independent gait after stroke is essential. The revised version of the Ability for Basic Movement Scale II (ABMS II) has been developed and validated for assessment of basic movements poststroke.

OBJECTIVE

The purpose of this study was to investigate the predictive value of the ABMS II score for independent gait in acute stroke patients with hemiplegia.

METHODS

We included 67 patients with first stroke and a unilateral lesion who were admitted to the stroke care unit. We evaluated the gait on the 14th and 90th days from admission.

RESULTS

The ABMS II score was significantly higher in patients with independent gait on both the 14th and 90th days from admission. On receiver operating characteristic curve analysis, a minimum score of 26 points was predictive of independent gait on the 14th day from admission. Similarly, a score of 15 points was predictive of independent gait on the 90th day from admission.

CONCLUSIONS

The ABMS II score is a useful predictor of independent gait in acute stroke patients with hemiplegia.

The Ability for Basic Movement Scale II Can Predict Functional Outcome and Discharge Destination in Stroke Patients

OBJECTIVES

This study aims to identify whether the Ability for Basic Movement Scale II (ABMS II) at admission would predict the functional status and discharge destination in convalescent stroke patients.

METHODS

Ninety-four stroke patients admitted to convalescent rehabilitation ward were investigated. Their functions were evaluated by the ABMS II and Functional Independence Measure (FIM) at admission, FIM and Functional Ambulation Category at discharge. Furthermore, the age, gender, diagnosis, lesion side, onset type, interval between onset and convalescent admission, length of stay (LOS) and discharge destination were recorded. Discharge destination was divided into home and facility.

RESULTS

Multiple linear regression identified the ABMS II at admission as a significant predicator of discharge FIM in convalescent stroke patients (β = .747, P < .05). Binary logistic regression analysis showed the ABMS II significantly predicting basic walk ability (odds ratio 1.29) and home discharge (odds ratio 1.241) of these patients. Receiver operating characteristic analysis indicated that an optimal cutoff of 18 points of ABMS II predicted basic walk ability (area under the curve = .863, P < .05) and home discharge (area under the curve = .827, P < .05). Moreover, a significant negative correlation between the ABSM II at admission and LOS was found (Correlation coefficients -.680, P < .05).

CONCLUSIONS

Higher score of the ABMS II at admission predicted better functional recovery, shorter LOS and more possibility to home in convalescent stroke patients. This new, easy scale is expected to be widely used for stroke patients.

Assessment of attention function recovery in patients after stroke using sequential desk-top tasks

Background/Aims:

The course of recovery of performance with attention function has not been sufficiently investigated during the period for rehabilitation after stroke. A sequential desk-top task was applied, whose performance required the spatiotemporal attention function step by step, to patients after stroke. The relationship between the sequential task and conventional assessments of cognitive function was also assessed.

Methods:

A sequential desk-top task with 13 levels of peg-carrying performance, which involved attention function, was applied to 24 patients with a disturbance of attention function after stroke. The outcomes of the sequential task were compared with the results of the Mini-Mental State Examination, Trail Making Test Part A and B, Hamamatsu type Japanese syllabary selection test sentence (Syllabary), Paced Auditory Serial Addition Test, Ponsford's Attentional Rating Scale, and Functional Independence Measure.

Findings:

All participants showed significant progress in the level of the sequential desk-top task. The levels achieved in the sequential task were correlated with the scores of Mini-Mental State Examination, Trail Making Test Part A, Paced Auditory Serial Addition Test, Syllabary, and Functional Independence Measure.

Conclusions:

The results of the sequential desk-top task suggested the recovery course of the attention function, and the results of the task predicted the functional recovery revealed by other test batteries.

Therapeutic Application of Transcranial Magnetic Stimulation Combined with Rehabilitative Training for Incomplete Spinal Cord Injury: A Case Report

Background

Only a few researchers have therapeutically applied transcranial magnetic stimulation (TMS) for patients with spinal cord injury. The purpose of this case study was to evaluate the safety, feasibility, and efficacy of therapeutic TMS combined with rehabilitative training for a patient with tetraparesis resulting from incomplete spinal cord injury.

Case

An 82-year-old male patient with incomplete spinal cord injury was admitted to our department for long-term rehabilitation. Eighteen days prior to admission, the patient sustained the injury in a fall. At admission to our department, the patient was diagnosed as having injury of the spinal cord at the C6 level. From the 76th day after admission, when the patient was considered to have attained a plateau state of recovery, application of therapeutic TMS was initiated using a double-cone coil. Two 15-min sessions of 10-Hz TMS were scheduled for daily application. Simultaneously, rehabilitative training was continuously provided. This patient received a total of 30 sessions of TMS over 19 days. Neither adverse effects nor deterioration of neurological symptoms was recognized during the intervention period. With this application of TMS, some improvements were evident in the American Spinal Injury Association motor score, the knee muscle strength, and the calf circumference.

Discussion

This case study demonstrated the safety and feasibility of TMS combined with rehabilitative training in a patient with incomplete spinal cord injury. Our protocol featuring TMS might constitute a novel neurorehabilitation intervention for such patients; however, the efficacy of the protocol should be confirmed in a large number of patients.

Relationship between white matter fiber damage and revised version of the ability for basic movement scale in patients with stroke: a diffusion tensor tract-based spatial statistic study

[Purpose] To clarify the relationship between white matter fiber damage and the Ability for Basic Movement Scale (ABMS) II in patients with stroke in a diffusion tensor tract-based spatial statistic study. [Subjects and Methods] Twelve patients with stroke (seven men and five women, mean age ± SD: 61.6 ± 8.5 years) were evaluated using the ABMS II. The patients were divided into the ABMS II good group and the ABMS II poor group. Tract-based spatial statistical analysis was performed using diffusion tensor images in both groups. [Results] Patients in the ABMS II good group had significantly higher fractional anisotropy values of the anterior thalamic radiation (ATR), superior longitudinal fasciculus (SLF), inferior occipitofrontal fasciculus (IOF), and uncinate fasciculus (UF) of the lesion-containing hemisphere than patients in the ABMS II poor group. [Conclusion] ATR, SLF, and IOF damage may affect ABMS II scores in patients with stroke.

Utility of the Revised Version of the Ability for Basic Movement Scale in Predicting Ambulation during Rehabilitation in Poststroke Patients

OBJECTIVE

This study aims to test the hypothesis that the Revised Version of the Ability for Basic Movement Scale (ABMSII) can predict ambulation during rehabilitation in poststroke patients.

SUBJECTS AND METHODS

The study included first-ever stroke patients who were admitted to the rehabilitation ward and were dependent in walking. ABMSII scores were assessed by physical therapists on admission to the hospital. Functional ambulation category (FAC) was assessed every 2 weeks during hospitalization. The primary outcome was independent ambulation, defined as 4 points or higher on the FAC.

RESULTS

After setting the inclusion criteria, data of 374 stroke patients (mean age: 70 years, 153 women) were eligible for the analysis. Of these, 193 patients achieved independent ambulation during hospitalization. The ABMSII score was significantly higher in the patients who regained independent walking ability than in those who required assistance in walking. Based on receiver operating characteristic curve analysis, an ABMSII score of 16 points or higher had a sensitivity of 93% and a specificity of 71%. Kaplan-Meier curve analysis after log-rank test demonstrated a significantly higher event rate in patients with an ABMSII score of 16 or higher compared to those with an ABMSII score lower than 16. Univariate and multivariate Cox regression analyses identified the ABMSII score as a significant and independent predictor of ambulation during rehabilitation.

CONCLUSION

Our results suggest that the ABMSII score is a potentially useful tool to predict ambulation during rehabilitation in poststroke patients.

High-frequency rTMS on leg motor area in the early phase of stroke

Although repetitive transcranial magnetic stimulation (rTMS) for upper limb motor area in stroke patients is beneficial, it has been poorly investigated in rTMS for leg motor area. Furthermore, no study has examined the usefulness of rTMS for leg motor area in patients in the early phase of stroke. Twenty-one patients with a hemispheric stroke lesion in the early phase were randomly assigned into two groups: the high-frequency (HF)-rTMS group [N = 11] and the sham stimulation group [N = 10]. Patients received rTMS for 5 consecutive days, beginning 10.9 ± 6.6 days on average after the onset. Brunnstrom Recovery Stages (BRS) for the lower limbs and the Ability for Basic Movement Scale Revised (ABMS II) were assessed before and after the intervention. The improvement in BRS for the lower limbs was significant after the intervention in the HF-rTMS group. Although both the HF-rTMS and sham stimulation groups had significant improvements in ABMS II scores, the extent of improvement in the AMBS II was significantly greater in the HF-rTMS group than in the sham stimulation group. Application of HF-rTMS over the bilateral leg motor areas has potential to be a new rehabilitation therapy for patients in the acute phase of stroke.

The body balance training effect on improvement of motor functions in paretic extremities in patients after stroke. A randomized, single blinded trial

OBJECTIVE

Study evaluates movement selectivity improvement in hemiparetic post-stroke patients after balance training.

METHODS

Study included 26 patients and 15 healthy subjects (control group C). Patients were divided into two groups with 20-day balance training (A) and without (B). Normal standing weight distribution was expressed in percentages, center of feet pressure (COP) sway velocities were evaluated in anterior-posterior and medio-lateral (Y, X) directions for normal standing with eyes open and closed (EO, EC) and for tandem. Brunnström scale assessed movement selectivity.

RESULTS

Weight distribution dissymmetry (Δ10%) was found. It was reduced (Δ2%) after training in group A. COP were higher for X direction (±6mm/s vs ±12mm/s) in normal standing. Difference (±12mm/s) was found for Y in tandem. Brunnström score increased in group A from 0.3 to 0.6. It was negatively correlated with average COP for EO and EC in Y and X and for tandem in X.

CONCLUSION

Training reduces weight-bearing dissymmetry and improves movement selectivity.

Validity and reliability of Ability for Basic Movement Scale for Children (ABMS-C) in disabled pediatric patients

The objective of this pilot study was to test the validity and reliability of a new scale, the Ability for Basic Movement Scale for Children (ABMS-C). A total of 45 pediatric patients with disabilities (aged 0.1-8.8 years; 29 males, 16 females) participated in this prospective study. To prove the validity and reliability of the ABMS-C, subjects were administered the ABMS-C at a 2-week interval. In addition to the ABMS-C score, data on age, diagnosis, and results of the Gross Motor Function Classification System (GMFCS) were recorded. Spearman's rank correlation coefficient analysis showed that the ability to perform basic movements according to the scores for each item and the total scores of the ABMS-C correlated significantly with the levels of the GMFCS (r=-0.628-0.784, p<0.001). The five items on the ABMS-C had appropriate internal consistency (Cronbach's α=0.944). Test-retest reliability analysis indicated that the "head control", "sitting", "locomotion on flat surface", "standing" and "walking" items on the ABMS-C had almost perfect reliability (κ=0.865-1.000). This study provides evidence for the validity and reliability of the ABMS-C with regard to assessment of functional ability in disabled pediatric patients.