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Reliability and Sensitivity of a Wrist Rig to Measure Motor Control and Spasticity in Post-Stroke Hemiplegia

¹ School of Health Professions and Rehabilitation Sciences, University of Southampton, Southampton, UK
² Institute of Sound and Vibration Research, University of Southampton, Highfield, Southampton, UK
³ Public Health Sciences and Medical Statistics, School of Medicine, University of Southampton,Southampton, UK
⁴ Dept of Clinical Sci and Biomed Engineering, Salisbury District Hospital, Wilshire, and Design, Eng and Computing, Univ of Bournemouth, Poole, Dorset, UK

^* To whom correspondence should be addressed. E-mail: r.turk{at}soton.ac.uk.

	Abstract

Background. Objective assessment of impairments after stroke is vital for evidence-based therapy and progress monitoring. Objective. This study determines the utility of outcome measures obtained from an instrumented wrist rig for future rehabilitation trials. The tests undertaken were evaluated in terms of sensitivity to detect differences between normal and impaired participants, test-retest repeatability (repeatability coefficient and intraclass correlation coefficient [ICC]), and interrater agreement (Bland and Altman limits of agreement). Methods. Twelve participants with chronic poststroke hemiparesis (mean 5.6 years); and 12 unimpaired volunteers performed a series of tasks in the rig. The hemiparetic arm (impaired group) and dominant arm (unimpaired group) were tested in 3 sessions on the same day by 2 assessors. Signals were analyzed to derive a tracking index (motor control), stretch index (spasticity), flexor modulation index (FMI) (muscle activation), force angle index (FAI) (stiffness), range of movement, and isometric force. Results and Conclusions. The means of all tests differed between impaired and unimpaired participants except for range of movement into flexion, the FAI, and the FMI. Repeatability coefficients for each test are presented as benchmark values for use in future trials in which the wrist rig tests may be used to detect change. Test-retest reliability was excellent in the impaired group (ICC = 0.88-0.98) and poor to excellent in the unimpaired group (ICC = 0.06-0.89). The Bland-Altman ranges showed no bias between assessors, and that the interassessor variability was similar to that between repeats by the same assessor for most tests.

First published on September 5, 2008, doi:10.1177/1545968308315599

Neurorehabilitation and Neural Repair 2008;22:684.

A more recent version of this article appeared on November 1, 2008


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