If confirmed by other studies, particularly with objective measures of arm use, this could have serious implications for therapy decisions. All of the participants had the potential to achieve meaningful improvements in function with training14; after 4
weeks of TST, functional ability and amount of use rating increased significantly. Change in the ARAT score was found to predict 30.8% of the change in MAL www.selleckchem.com/products/MDV3100.html amount of use, further supporting the idea that functional improvement is necessary for increased arm use. The predictive model was strengthened by the inclusion of the baseline FMA wrist subcomponent score, indicating that the ability to make movements at the wrist is an important factor for making gains in arm use after therapy. This is a stronger model than those reported previously after CIMT5 and 6 and confirms that prioritizing physical therapy for survivors of stroke with some degree of distal hand function could enhance the possibility Selleckchem Compound C of making gains in paretic arm use. This may be particularly so for participants with the dominant hand affected, in which the baseline FMA wrist score was found to be the main predictor of change in the amount of use. This study has explored potential predictors
of self-reported paretic arm use rather than actual arm use. Although the MAL has been found to be reliable and valid,13 it is a subjective measure rather than an objective one. One advantage of a self-report measure over those from other devices (eg, accelerometers) includes the ability to capture the stroke survivor’s perspective of how his or her arm use has changed. Even if not truly reflective of actual arm use, his or her opinion is important. However, results could be affected by a participant’s desire to please the investigator or poor recall of actual use. The perspective of the survivor of stroke is increasingly considered as an important way to measure the impact of stroke and outcomes after rehabilitation. One limitation is
that all participants were in the chronic phase of stroke recovery (range, 3–130mo) and had completed and been discharged from standard upper limb rehabilitation. It remains to be determined whether the predictors Roflumilast of change in MAL score will be the same in the early period after brain injury when more spontaneous recovery will occur. Interestingly, time since stroke did not correlate with the baseline MAL score or predict either the baseline MAL score or change after TST. In addition, the regression model explains a small-to-moderate proportion of the variance in self-reported arm use; therefore, there are other possible factors that may determine a patient’s perception of his or her arm use. It is important to continue to investigate other possible determinants to help guide rehabilitation goals. These could include aspects such as living situation, cognitive status, work, or other activity requirements.