Defining and Measuring Residual Deficits of the Upper Extremity Following Stroke: A New Perspective

Purpose: To propose and test a new measure to quantify residual deficits (Rd) following stroke and provide preliminary evidence supporting its usefulness. Methods: Patients (N=46) were stratified based on projected rate of upper extremity recovery and were randomly assigned to task-oriented (control) or task-oriented plus functional electrical stimulation (FES) training groups. All performed the Box & Blocks and the Jebsen-Taylor light object lift tests with the nonparetic and paretic upper extremities. A modified Fugl-Meyer test was performed on the paretic upper extremity. The calculation Rd=100-(paretic/nonpareticx100) was made for each subgroup: task-specific training alone (control subgroup) or task-specific training plus functional electrical stimulation (FES subgroup). Data from each of these two groups were analyzed separately. Results: Intrasession and between-sessions tests of the nonparetic or paretic extremity yielded interclass correlation (ICC) values between 0.77 and 0.99. After training for 12 weeks, the Rd of the paretic upper extremity of patients who used the FES was significantly less compared to the control group (p<.05). The deficits of patients with slow recovery profile were as expected much greater. Conclusions: Rd is a valid, highly reproducible, and dimensionless outcome measure. It should permit objective comparison of effectiveness between and within various rehabilitative intervention options regardless of the outcome measure(s) used.