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This study aimed to assess the following in individuals after stroke: (1) relationship between upper limb (UL) use by direct observation at home with use perceived and measured by accelerometers; (2) complementarity of these three measurements; and (3) relationship between UL bilateral capacity and bilateral use. Thirty-one individuals with chronic hemiparesis participated in this cross-sectional study. UL use was assessed using a behavioral map (BM), the Motor Activity Log-Amount of Use (MAL-AOU), and accelerometers, while UL capacity was assessed using the Test d'Evaluation des Membres Supérieurs des Personnes Âgées (TEMPA). The BM was strongly correlated with perceived use (MAL-AOU, ρ = 0.76) and accelerometer (ρ = 0.70). Bilateral UL use (BM) was moderately (ρ = 0.65) correlated with bilateral MAL-AOU and bilateral use by accelerometers (ρ = 0.62). The BM aided our understanding of how the paretic UL was used. The correlation between bilateral capacity (TEMPA bilateral) and bilateral use (BM) was significant (ρ = 0.49), while that with bilateral MAL-AOU and accelerometer were ρ = 0.68 and ρ = 0.50, respectively. A BM is a valid way to quantify UL use and can complement information assessed regarding perceived use and by accelerometers. Behavioral maps may be valuable to complement information assessed by perceived UL use and accelerometers. Quantifying bilateral capacity will reflect in a better understanding of actual paretic UL use after stroke. Accelerometers can underestimate the amount of paretic UL use in asymmetrical bilateral tasks. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background and Purpose: Regarding people with stroke, simple outcome measures in clinical settings capable of representing the actual use of the upper extremity (UE) would be useful to rehabilitation professionals for the purposes of goal setting. This study seeks to describe the relative levels of paretic UE use, investigate the association between manual dexterity and task-related UE use, and to establish the manual dexterity cutoff points that correspond to relative levels of paretic UE use. Methods: Forty-six adults with chronic hemiparesis participated in this cross-sectional study. Behavioral mapping was employed to ascertain the actual amount of UE use by the identifying the unimanual and bimanual activities performed in the participants' homes within a 4-hour period. Participants were classified into 4 levels of paretic UE integration into activities considering the data from the behavioral mapping (activity, hand function, and type of grasp). The Box and Block Test (BBT) and the Nine Hole Peg Test (NHPT) were used to evaluate dexterity. The Spearman test was used to evaluate the correlations. In analyzing the receiver operating characteristic curve, we applied the Youden index to determine the cutoff points. Results: Participants with full/almost full (n = 11), partial (n = 12), and limited (n = 12) integration of the paretic UE into activities and with little/no use (n = 11) were identified. Unimanual and total paretic UE activities were found to have a high correlation with the BBT scores. The boundaries between the integration levels were between full/almost full and partial integration, BBT greater than 30 blocks or NHPT of 41 seconds and less; between partial and limited, BBT greater than 16 blocks; and between limited and little/no use, BBT greater than 3 blocks. Both tests show good accuracy (≥0.81). Discussion and Conclusions: The BBT presents a positive high correlation with paretic UE use at home and was shown to be better able to identify "limited" and "partial" integration of the paretic UE. Both tests can identify when the paretic UE is fully/almost fully integrated into activities at home. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A354). [ABSTRACT FROM AUTHOR]

Background: Knowledge of paretic upper limb (UL) use in the actual environment is crucial for defining treatment strategies that are likely to enhance performance. Objective: To quantify the hand function and type of grasp performed in the actual environment following stroke and determine if any differences in hand use are dependent on the degree of motor impairment. Method: This cross-sectional study enrolled 41 participants with chronic hemiparesis classified as having either mild (11), moderate (20), or severe (10) UL impairment. A behavioral map was used while observing hand use over the 4-h experimental period, during which we checked: activity- unimanual, bimanual or non-task-related; hand function- stabilization, manipulation, reach-to-grasp, gesture, support or push; and type of grasp- digital or whole-hand. Results: Participants with severe impairment did not use the paretic UL spontaneously; analyzing the moderate and mild subgroup together, the predominant UL hand functions were stabilization and manipulation, the paretic UL performs the stabilization function using the whole-hand more frequently (71.2%) than digital (28.8%) grasp. In the subgroup analysis, the paretic and non-paretic UL in the moderate and the paretic UL in the mild subgroup perform the whole-hand stabilization more frequently than digital. Digital grasp is more accomplished by the non-paretic UL in reach-to-grasp hand function, particularly in the mild subgroup. Conclusion: The paretic UL is predominantly employed for stabilization function using a whole-hand grasp. The type of grasp in the actual environment is affected by motor impairment, and greater motor impairment leads to the performance of less complex tasks. [ABSTRACT FROM AUTHOR]

Purpose:To evaluate the feasibility and effectiveness of adding object-related bilateral symmetrical training to mirror therapy (MT) to improve upper limb (UL) activity in chronic stroke patients.Method:Sixteen patients with moderate UL impairment were randomly allocated to either the experimental (EG) or control (CG) group. Both groups performed 1 hour sessions, 3 days/week for 4 weeks, involving object-related bilateral symmetrical training. EG performed the tasks observing their nonparetic UL reflected in the mirror, while CG observed the paretic UL directly. The primary outcome measure was unilateral and bilateral UL activity according to the Test d’Évaluation des Membres Supérieurs de Personnes Âgées (TEMPA). All measurements were taken at baseline, post-training, and follow-up (2 weeks).Results:TEMPA total score showed the main effect of time. Significant improvement was found for bilateral but not unilateral tasks. Both groups showed gains after training, with no differences between them.Conclusions:This study showed the feasibility of adding object-related bilateral training to MT. Both types of training improved UL bilateral activity; however, a larger sample is required for a definitive study. Other studies need to be carried out to evaluate the effectiveness of combining more distal-oriented movements and object-related unilateral training to improve these effects in chronic stroke patients. [ABSTRACT FROM PUBLISHER]