Summary physiotherapeutic theory: upper limb function

Rehab tech.: trunk rehabilitation after stroke
 Vraag: hoe min. Klinisch ≠ weten
- FM&ARAT= geweten
- 10% = veilige marge indien niet geweten
- Varabilietit in patho

1. MEET THE PATIENT
 P in een vrij acute fase
 Patient is not able to sit upright and to straighten the trunk
 Sitting on the edge of the bed is very difficult
 Cognition can also limit the outcome
 This case is a very severely affected patient -> you don’t see these in studies…


CLINICAL OUTCOME MEASURES
 understand theory & application of clinical outcome measures for trunk function in neurorehabilitation
- Trunk impairment scale
- Trunk control test, …
 To measure is to know – what can an outcome measure do for me?
- Only when we measure our patient we can know what to do with the patient
- Starting point for rehabilitation

1. WHY SHOULD WE USE OM?
 WCPT Core Standards
- WCP= world confederation physiotherapy
- Core standard 6: P problems, published, standardized, valid, reliable & responsive outcome
 Standerized = guideline
- measure is used to evaluate the change in the patient’s problem.
 Relevant selection
o Focus on what you want to improve for your patient
o Make a relevant selection for your patient
 Acceptable to the patient and having the skill and experience to use, administer and interpret
 Result is recorded immediately
o Same measure is used at the end episode of care!!

2. OUTCOME MEASURES FOR TRUNK FUNTION
 Clinical tools to measure trunk performance after stroke: a systematic
review of the literature
- Red = not available, it doesn’t mean it is not good  don’t know…
- Be critical -> is it useful for the patient/function?
- Laatste kolom= spec trunk testen
- Voor 2/3 schalen veel gegevens niet beschikbaar
 Zijn wel bruikbaar
.
3. TRUNK CONTROL TEST – TCT
 Rolling to paretic/most affected side vanuit supine
 Rolling to non-paretic/less affected side vanuit supine
 Sitting for 30 sec with pushing (T pushes from different sides)
- Voeten los van de vloer
- Manier niet gestandariseert Zelfde proberen dien bij elke P
 From supine to sitting
 For each item: enkel deze opties, niets ertussen
- 0: not able to perform
- 12: able with compensations (something that is abnormal)
- 25: normal
 Total score: min 0 – max 100 Hogere score is beter
 Gross motor movement
4. TRUNK IMPAIRMENT SCALE – TIS

Nala Melis Pagina 1

, Rehab tech.: trunk rehabilitation after stroke
 The trunk impairment scale: a new tool to measure motor impairment of the trunk after stroke
- 3 subscales:
 Static sitting balance (/7)
 Dynamic sitting balance (/10)
 Coordination (/6)
- Score between 0 and 23
 Higher = better
- Trunk stability as well as selective movements of upper and lower part of the trunk
- KOE! TCT: rolling -> not only using the trunk, so we need a more specific trunk evaluation = TIS

 STATIC SITTING BALANCE
- Keeping upright
- Narrow BOS -> stay upright
- Kan P zitten
 Normaal
 Gekruiste benen

 DYNAMIC SITTING BALANCE
- LF romp geintegreerd van
 Boven
 onder

 COORDINATION
- Rotation of shoulder & pelvic girdle -> one girdle
stays stable & other girdle will move
- Rotatie vanuit
 BL
 OL= Vooruit schuifelen io tafel/stoel met poep
 Selectiviteit
- Breaking down different movements


2. TRUNK IMPAIRMENT SCALE – TIS (FUJIWARA ET AL) niet in detail kennen
 Development of a new measure to assess trunk impairment after stroke (TIS)
- 7 items
 Perception of trunk verticality
 Trunk rotation muscle strength on the affected side
 Trunk rotation muscle strength on the unaffected side
 Righting reflex on the affected side
 Righting reflex on the unaffected side
 Stroke impairment assessment set verticality
 Stroke impairment assessment set abdominal muscle strength
- Min 0 – max 21
 Higher = better
- TCT -> Functional items
- TIS -> mixed items (function and strength)

3. OTHER OPINIONS
 How to measure balance in clinical practice. A systematic review of the psychometrics and clinical utility of
measures of balance activity for neurological conditions
- METHODOLOGY
 Assessment of psychometric properties – 3 times ‘good’ needed
o Reliability
o Validity
o Sensitivity

 Evaluation of clinical utility – 9 or 10 out of 10 → recommended for clinical use

Nala Melis Pagina 2