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Research Objectives To determine whether self-perceived performance of upper limb movement makes an independent contribution and to quantify its relative contribution to the performance of functional activity of upper limb in patients with stroke. Design This is a cross-sectional design. Setting This study was held in the neurorehabilitation laboratory in the university. Participants Total 87 subjects (50 males, 37 females, mean age=61.12±6.88 years, time post-stroke=6.31±2.84 years) were recruited. Interventions No intervention Main Outcome Measures The paretic hand control was assessed by hand section in Fugl-Meyer Assessment (FMA-hand). The performance of functional activity of upper limb was assessed by Action Research Arm Test (ARAT). The self-perceived performance was assessed by Quality of Movement section in Motor Activity Log (MAL-QOM). The relative contributions of the independent variables in predicting the ARAT scores was determined by multiple linear regressions with the forced entry method. Results The mean ARAT score of 23.8±16.6. The mean FMA-hand score was 7.6±2.8. The mean MAL-QOM score was 39.4±37.8. After controlling for age, gender and body mass index, results of multiple linear regression analysis indicated that the FMA-hand score could independently predict 41.6% of the variance in the ARAT scores. The MAL-QOM score could predict an extra 16.9% variance in the ARAT scores after controlling the demographic information and the FMA-hand score. A total of 65.0% variance of the ARAT score was explained by the final regression model. Conclusions Self-perceived performance of upper limb motor function (MAL-QOM score) is a significant predictor of performance of functional activity of upper limb in patients with stroke. Strategies in improving the self-perceived performance of using paretic upper limb, (e.g. incorporate “graded” activity training into customary physical training, and give positive feedback on functionally relevant improvements), could be implemented in order to enhance upper limb motor function after a stroke. Author(s) Disclosures The authors received research support from the Health and Medical Research Fund 12131821 from the Food and Health Bureau, HKSAR.

Objective To examine whether selection of the nonparetic or paretic leg as the weight-bearing leg in item 13 (standing unsupported one foot in front) and item 14 (standing on one leg) of the Berg Balance Scale (BBS) influences the item scores, and thus the total score. Design Cross-sectional study. Setting University-based rehabilitation laboratory. Participants Community-dwelling people (N=63, aged ≥50y) with chronic stroke. Interventions Not applicable. Main Outcome Measure BBS. Results The 4 BBS total scores ranged from 48.4 to 50.7. The total score was significantly lower when a participant was asked to step forward with the nonparetic leg in item 13, and stand on the paretic leg in item 14. Fewer participants received a maximum score with the BBS 1 formulation than the others. In addition, the correlations with walking speed and Activities-specific Balance Confidence Scale scores were greatest with the BBS 1 score. Conclusions Our findings suggest that BBS 1 was the most challenging formulation for our participants; this might serve to minimize the ceiling effect of the BBS. These findings provide a rationale for amending the BBS administration guidelines with the BBS 1 formulation.

Objectives To investigate (1) the intrarater, interrater, and test-retest reliability of the timed 360° turn test in subjects with stroke; (2) the concurrent validity of the timed 360° turn test by exploring its correlation with other measures of stroke-specific impairments; and (3) the cutoff times that best discriminate individuals with stroke from healthy older adults. Design Cross-sectional study. Setting University-based rehabilitation center. Participants Individuals with chronic stroke (n=72) and healthy individuals (n=35) of similar age (N=107). Interventions Not applicable. Main Outcome Measures The timed 360° turn test was administered along with the Fugl-Meyer assessment of the lower extremity, measurement of muscle strength of ankle dorsiflexors and plantarflexors using a handheld dynamometer, Berg Balance Scale, limit of stability test, five times sit-to-stand (FTSTS) test, 10-m walk test, and timed Up and Go (TUG) test. Results The 360° turn times showed excellent intrarater, interrater, and test-retest reliability in individuals with stroke. A minimal detectable change of .76 seconds was found for subjects turning toward the affected side and 1.22 seconds for subjects turning toward the unaffected side. The 360° turn times were found to correlate significantly with Fugl-Meyer assessment of the lower extremity scores, dosiflexor strength of the affected ankle, plantarflexor strength of both ankles, FTSTS test times, balance performance, gait speed, and TUG test times. The 360° turn times of 3.43 to 3.49 seconds were shown to discriminate reliably between individuals with stroke and healthy older adults. Conclusions The timed 360° turn test is a reliable and an easily administered clinical tool to assess the turning ability of subjects with chronic stroke.

Objective To examine the contribution of walking endurance, subjective balance confidence, and fear avoidance behavior to community reintegration among community-dwelling stroke survivors. Design Cross-sectional study. Setting University-based rehabilitation center. Participants Patients with chronic stroke (N=57) aged ≥50 years. Interventions None. Main Outcome Measure The Chinese version of the Community Integration Measure (CIM). Results Our correlation analyses revealed that fear avoidance behavior as measured by the Chinese version of the Survey of Activities and Fear of Falling in the Elderly (SAFE) scores had the highest significant negative correlation with CIM scores among all the variables tested. Our regression analyses also revealed that walking endurance and subjective balance confidence were not significant predictors of CIM scores. Based on scores on the number of falls in the previous 6 months, Chinese version of the Geriatric Depression Scale scores, distance covered in the 6-minute walk test, and Chinese versions of the Activities-specific Balance Confidence Scale scores and SAFE scores, our final regression model predicted 49.7% of the variance in the Chinese version of the CIM scores. Conclusions The levels of walking endurance and subjective balance confidence are not significant predictors of community reintegration of community-dwelling stroke survivors but the fear avoidance behavior. Future studies addressing fear avoidance behavior is clearly warranted for stroke rehabilitation.