Post-Stroke Movement Assessment Basics

Sep 17, 2024

Post-Stroke Movement Assessment and Fugl-Meyer Procedure

Key Concepts

  • The assessment focuses on measuring post-stroke motor recovery.
  • Constructs measured: movement in/out of synergy, grasp, function, coordination, reflex activity.
  • Recovery stages (Brunnstrom stages) typically start with flaccidity, followed by spasticity or synergistic movement, then fractionated movement.

Fugl-Meyer Assessment

  • Purpose: Measures motor recovery post-stroke.
  • Procedure:
    • Perform movement on the unaffected side first to demonstrate.
    • Check passive range of motion on the affected side.
    • Patient attempts the movement three times on the affected side.
    • Score based on highest performance (opposite of most tests).
    • Protocol allows fewer trials for practical time constraints.

Practical Considerations

  • Always do passive range of motion and at least one trial on the unaffected side.
  • Active movement is always attempted.
  • Clinical practice may focus on fewer trials due to time constraints, unlike research studies.

Scoring

  • Scale: Mostly a three-point Likert scale (0, 1, 2) with some dichotomous items.
    • 0 = Cannot perform
    • 1 = Performs partly
    • 2 = Performs faultlessly
  • Items: Reflex activity, movement within synergy (flexor and extensor), and more.

Reflex Activity

  • Dichotomous Scoring:
    • No reflex activity
    • Reflex activity observed

Movement in Synergy

Flexor Synergy

  • Starting Position: Hand on knee, move to salute-like position.
  • Movements Scored:
    • Shoulder elevation, retraction, abduction
    • Shoulder flexion, elbow flexion, forearm supination

Extension Synergy

  • Starting Position: Hand in salute, move to opposite knee.
  • Movements Scored:
    • Shoulder adduction/internal rotation
    • Elbow extension
    • Forearm pronation

Observations and Analysis

  • Use observational skills to score accurately.
  • Compare affected side to the unaffected side for 'faultless' assessment.
  • Scoring involves individual movement analysis per joint.
  • Total score per item based on individual movement scores.

Clinical and Practical Applications

  • Clinical application may simplify the procedure due to time limits.
  • For research, follow strict protocol for consistency.
  • In practical exams, understanding and application of the procedure are more important than performing all trials.