Assessment of functional improvement in the hemiparetic arm following focal rehabilitation intervention

    Student thesis: Doctoral ThesisDoctor of Philosophy


    The complex nature of upper limb function presents a challenge for rehabilitation following neurological injury. Some patients, with relatively mild injury, have potential to recover useful function such as the ability to use the hand to hold and manipulate objects (active function). Others with more severe injury will continue to have a non-functional upper limb, and may require assistance from another person (or their own non-affected arm) to care for the affected limb (passive function). The aim of this thesis was to develop and evaluate a self-report upper limb measure of active and passive function – the Arm Activity measure (ArmA) for use in focal spasticity management.

    A systematic review demonstrated that no suitable measure was available, but provided possible items for inclusion in the ArmA. Patient-selected items were also included from goal setting for spasticity intervention. A modified Delphi consultation was undertaken to reduce the number of items, followed by item confirmation with a larger group of clinicians and pilot testing with patients and carers. The resulting twenty-item measure has two sub-scales of ‘active’ and ‘passive’ function.

    Two inter-linked studies were undertaken, firstly to evaluate the psychometric properties of the ArmA, and secondly to undertake a hypothesis-generating cohort investigation of the course of functional changes following spasticity intervention.

    Internal consistency evaluated by Cronbach’s alpha was >0.85 for both sub-scales. Kappa coefficients for test-retest reliability were >0.90. Mokken analysis demonstrated unidimensionality for both subscales (Item H >0.5 for all items). Expected convergent and divergent relationships were seen with comparison measures (rho 0.5-0.63). The passive function sub-scale was responsive to change following spasticity intervention. In the cohort study, spasticity initially reduced following intervention and then increased again. Passive function improved and was maintained despite the increase in spasticity.

    Adequate psychometric properties were demonstrated for the passive function sub-scale although further evaluation is indicated, particularly for the active function sub-scale.
    Date of Award1 Jun 2012
    Original languageEnglish
    Awarding Institution
    • King's College London
    SupervisorLynne Turner-Stokes (Supervisor) & Mike Slade (Supervisor)

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