Abstract
There is little consensus in the literature regarding the best motor performance outcome measure or treatment intervention for a patient with stroke. There is agreement that data be collected and treatment outcomes evaluated. This review includes measures of motor function impairment and disability. An overview of interventions to improve motor function after stroke and relevant guidelines are discussed. It is clear that one measure or treatment is not adequate and that impairments, disability, handicap, and quality of life should be addressed. Stroke severity and degree of deficits will greatly impact the utility and efficacy of outcome measures and interventions.
COMPREHENSIVE ASSESSMENTS and treatments are essential for evidence-based clinical decision-making, research, and appropriate clinical management of individuals with stroke. 1 The Agency for Health Care Policy and Research (AHCPR) Post-Stroke Rehabilitation Panel recommended that clinicians use examination tools that are reliable, valid, feasible, and sensitive. 2 Yet, inconsistencies in research methods and the heterogeneity of stroke severity make the selection of examinations and interventions challenging. 3 Impairments, functional limitations, and disabilities vary after stroke. Forty percent of the 4.4 million stroke survivors have moderate impairments and functional limitations related to motor function and basic mobility and 15%-30% are severely disabled. 4 These problems are commonly the most important to patients in rehabilitation. 5
The purpose of this article is to summarize evidence for the climimetric properties of measures and the efficacy of therapeutic interventions focused on motor performance and function following stroke. Motor function is defined as the ability to learn or demonstrate the skillful and efficient assumption, maintenance, modification, and control of voluntary postures and movement patterns 6; motor performance is defined as the observable attempt of an individual to produce a voluntary action. 7 Both terms are used interchangeably hereafter. The selected studies address motor performance or function of stroke survivors. Examination measures and interventions included are those that can be implemented in most settings and that are practical in terms of required time, training, and equipment. Information related to gait is covered in another article by Hesse.
This article is based on previous systematic reviews 2,3,8-12 and original research dealing with reliability, validity, and sensitivity of outcome measures and treatment efficacy. For clarification of measurement issues, the reader is referred to Wade's "Measurement in Neurological Rehabilitation." 12