BART: A novel laboratory-based instrument to quantify preferred limb use in patients after stroke

陳淑雅 (南加州大學/生物肌動暨物理治療研究所博士班)

 

http://www.sfn.org/am2008/

 

An objective, reliable and valid measure to capture paretic limb use post stroke is critical to investigations seeking to determine a threshold of limb performance that can be used to predict long-term use. The Motor Activity Log (MAL) is a widely used subjective interview of voluntary arm use in daily life. However, there are limitations: (1) it relies on patients' recall; (2) it takes at least 1 hour to administer; (3) most testing items are not appropriate for discordant (paretic ≠ dominant) arm use. A novel laboratory-based measure was developed to quantify limb preference during aiming in a semi-circle workspace, the Bilateral Arm Reaching Test (BART). Twofold Purpose: (1) to develop and parameterize BART; (2) to establish test-retest reliability and concurrent validity of BART in patients post-stroke. The high test-retest reliability suggested that BART is a stable measure. BART has an acceptable validity for capturing voluntary arm use in daily life as indicated by a moderate correlation between AOR and MAL AOU. BART is an objective quantification of voluntary arm use in daily life after stroke. It is easy to administer and may be appropriate for discordant post-stroke patients. Future work: quantification of learned nonuse in patients post-stroke.

 

一個客觀及兼具信效度可測量日常生活中手功能效用的評估工具，對量化中風治療劑量以決定治療效果門檻的研究來說是非常重要的。近十幾年來，主觀的動態活動日誌(Motor Activity Log; MAL)被廣泛使用來評估日常生活中手功能效用。但是這個評估工具有一些缺點：(1) MAL需要仰賴中風病人的回憶能力；(2) 完成一次MAL所需時間超過1個小時；(3) MAL問卷中大部分的問題不適用在中風後患側手非慣用手的病人身上。在這前提之下，我們發展了一個全新量化中風後日常生活中手功能效用的實驗室評估工具，稱為BART (Bilateral Arm Reaching Test)：兩側上肢伸展測試。本實驗主要目的有二：第一，發展可立即迅速調整參數的評估工具BART；第二，建立中風病人使用BART的測試再測試效度及同時效度。實驗結果發現，中風病人使用BART評估手功能效用時，測試再測試信度很高，顯示BART是一個很穩定的實驗室評估工具。此外，以MAL作為同時效度測量指標，我們建立了可接受的評估中風病人手功能效用的效度。整體來說，BART是一個可客觀量化中風病人日常生活中手功能效用的評估工具，且BART是一個簡單操作並可短時間完成測試的實驗室工具，再者BART可能更適用於中風後患側手非慣用手的病人。未來我們來繼續朝著定量中風病人手功能恢復的目標前進。