INVESTIGATION OF THE RELATIONSHIP BETWEEN COGNITIVE LEVEL AND UPPER EXTREMITY FUNCTIONS IN PATIENTS WITH CHRONIC STROKE

Yıl 2024, Cilt: 5 Sayı: 1, 22 - 27, 30.04.2024

Hilal Aslan , Emre Baskan

https://doi.org/10.52831/kjhs.1407836

Öz

Objective: Cognitive impairment and loss of upper limb functions are common after stroke and these two components can influence each other in anatomical and functional contexts. In this study, it was aimed to examine the relationship between cognitive level and upper extremity functions in patients with chronic stroke.
Method: The study included 39 individuals diagnosed with stroke, in the chronic phase and with a mean age of 61.33±12.71 years, who were evaluated at Pamukkale University Hospital. Standardized Mini Mental Test (SMMT) and Stroop Test Basic Sciences Research Group (TBAG) Form were used to evaluate the cognitive levels of individuals. Fugl Meyer Upper Extremity Rating Scale, Frenchay Arm Test and Box-Block Test were used to evaluate upper extremity functions.
Results: When the findings of the study were examined, statistically significant relationships were found between the Standardized Mini Mental Test and the Fugl Meyer Upper Extremity Rating Scale, Frenchay Arm Test and Box-Block Test (p<0.05). Between SMMT and ‘Flexor synergy’ and ‘Normal reflex activity’, which are sub-titles of Fugl Meyer Upper Extremity Rating Scale a statistically significant correlation was found (p<0.05). In addition, between the subtitles of the Stroop Test TBAG form ‘Chapter 3 Error’ and the subtitles of the Fugl Meyer Upper Extremity Evaluation Scale ‘Reflex Activity’; statistically significant relationships were also found between ‘Chapter 2 Correction’ and ‘Reflex activity’, ‘Extensor synergy’ and ‘Non-synergy movement’(p<0.05). No statistically significant correlation was found between the other parts of the Stroop Test TBAG Form and the scales assessing upper extremity functions (p>0.05).
Conclusion: The results obtained from this study show that there is a relationship between the cognitive level and upper extremity functions in patients with chronic stroke. More efficiency can be obtained by taking ocnsider these two components as two components that may affect each other in the evaluation stages of patients and may help to create more personalized and successful programs.

Anahtar Kelimeler

Chronic Stroke, Cognitive Level, Upper Extremity, Function

Investigation Of The Relationship Between Cognitive Level and Upper Extremity Functions in Patients With Chronic Stroke

Öz

Objective: Cognitive impairment and loss of upper limb functions are common after stroke and these two components can influence each other in anatomical and functional contexts. In this study, it was aimed to examine the relationship between cognitive level and upper extremity functions in patients with chronic stroke.
Methods: The study included 39 individuals diagnosed with stroke, in the chronic phase and with a mean age of 61.33 years, who were evaluated at Pamukkale University Hospital. Standardized Mini Mental Test (SMMT) and Stroop Test Basic Sciences Research Group (TBAG) Form were used to evaluate the cognitive levels of individuals. Fugl Meyer Upper Extremity Rating Scale, Frenchay Arm Test and Box-Block Test were used to evaluate upper extremity functions.
Results: When the findings of the study were examined, statistically significant relationships were found between the Standardized Mini Mental Test and the Fugl Meyer Upper Extremity Rating Scale, Frenchay Arm Test and Box-Block Test (p<0.05). Between SMMT and ‘Flexor synergy’ and ‘Normal reflex activity’, which are sub-titles of Fugl Meyer Upper Extremity Rating Scale a statistically significant correlation was found (p<0.05). In addition, between the subtitles of the Stroop Test TBAG form ‘Chapter 3 Error’ and the subtitles of the Fugl Meyer Upper Extremity Evaluation Scale ‘Reflex Activity’; statistically significant relationships were also found between ‘Chapter 2 Correction’ and ‘Reflex activity’, ‘Extensor synergy’ and ‘Non-synergy movement’(p<0.05). No statistically significant correlation was found between the other parts of the Stroop Test TBAG Form and the scales assessing upper extremity functions (p>0.05).
Conclusions: The results obtained from this study show that there is a relationship between the cognitive level and upper extremity functions in patients with chronic stroke, and that more efficiency can be obtained from the treatment by applying cognitive therapies and techniques to improve upper extremity functions together in the rehabilitation process.

Anahtar Kelimeler

Kronik inme, kognitif düzey, üst ekstremite, fonksiyon

Etik Beyan

Ethics committee approval required for the study was obtained from Pamukkale University Non-Interventional Clinical Research Ethics Committee on 29/07/2020.

Destekleyen Kurum

none

Teşekkür

We would like to thank all the volunteer participants who participated in our research.

Kaynakça

• Sudlow CL, Warlow CP. Comparing stroke incidence worldwide: what makes studies comparable? Stroke. 1996;27:550-558.
• Truelsen T, Mahonen M, Tolonen H, Asplund K, Bonita R, Vanuzzo D. Trends in stroke and coronary heart disease in the WHO Monica Project. Stroke. 2003;34(6):1346-1352.
• Otman AS, Karaduman A, Livanelioğlu A. Cerebrovascular accident. Neurophysiological approaches in hemiplegia rehabilitation. Ankara; HU School of Physical Therapy and Rehabilitation Publications. 2001;1-15.
• Harvey RL, Macko RF, Stein J, Winstein CJ, Zorowitz RD. Stroke Recovery and Rehabilitation. New York; Demos Medical Publishing. 2008.
• Haring HP. Cognitive impairment after stroke. Curr Opin Neurol. 2002;15(1):79-84.
• Hoffmann T, Bennett S, Koh, CL, McKenna K. A systematic review of cognitive interventions to improve functional ability in people who have cognitive impairment following stroke. Top Stroke Rehabil. 2010;17(2):99-107.
• Quintana LA. Evaluation of Perception and Cognition. In: Trombly CA (ed). Occupational Therapy for Physical Dysfunction, 4rd edn. Baltimore; Williams& Wilkins; 1977;201-223.
• Reed KL. Cognitive-Perceptual Disorders. In: Zukas RR (ed). Quick Reference to Occupational Therapy. 2rd edn. Texas; Proed; 2001;689-758.
• Cumming TB, Marshall RS, Lazar RM. Stroke, cognitive deficits, and rehabilitation: still an incomplete picture. Int J Stroke. 2013;8:38-45.
• Parker VM, Wade DT, Langton-Hewer R. Loss of arm function after stroke: measurement, frequency, and recovery. Int Rehabil Med. 1986;8:69-73.
• Higgins J, Mayo NE, Desrosiers J, Salbach NM, Ahmed S. Upper-limb function and recovery in the acute phase poststroke. J Rehabil Res Dev. 2005;42:65-76.
• Haywood K, Getchell N. Life span motor development, 6rd edn. Human Kinetics, Champaign; 2014.
• Mulder T. A process-oriented model of human motor behavior: toward a theory-based rehabilitation approach. Phys Ther. 1991;71:157-164.
• Platz T, Bock S, Prass K. Reduced skilfulness of arm motor behaviour among motor stroke patients with good clinical recovery: does it indicate reduced automaticity? Can it be improved by unilateral or bilateral training? A kinematic motion analysis study. Neuropsychologia. 2001;39:687-698.
• Meehan, SK, Randhawa B, Wessel B, Boyd LA. Implicit sequencespecific motor learning after subcortical stroke is associated with increased prefrontal brain activations: an fMRI study. Hum Brain Mapp. 2011;290-303.
• Dennis A, Bosnell R, Dawes H et al. Cognitive context determines premotor and prefrontal brain activity during hand movement in patients after stroke. Stroke. 2011;42(4):1056-1061.
• Mullick AA, Subramanian SK, Levin MF. Emerging evidence of the association between cognitive deficits and arm motor recovery after stroke: a meta-analysis. Restor Neurol Neurosci. 2015;33:389-403.
• Alt Murphy M, Baniña MC, Levin MF. Perceptuo-motor planning during functional reaching after stroke. Exp Brain Res. 2017;235:3295-3306.
• Cirstea MC, Levin MF. Improvement of arm movement patterns and endpoint control depends on type of feedback during practice in stroke survivors. Neurorehabil Neural Repair. 2007;21(5):398-411.
• Barker-Collo S, Feigin V. The impact of neuropsychological deficits on functional stroke outcomes. Neuropsychol Rev. 2006;16(2):53-64.
• Fong Kenneth NK, Chan Chetwyn CH, AU Derrick KS. Relationship of motor and cognitive abilities to functional performance in stroke rehabilitation. Brain Injury. 2001;15(5):443-453.
• Herndon R. Handbook of Neurologic Rating Scales. New York; Demos Vermande; 1997.
• Güngen C, Ertan T, Eker E Yaşar R, Engin F. Validity and Reliability of the Standardized Mini Mental Test in the Diagnosis of Mild Dementia in Turkish Population. Turkish Journal of Psychiatry. 2002;273-282.
• Folstein MF, Folstein SE, McHugh PR. ‘Mini Mental State’. A practical method for granding the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189-198.
• MacLeod CM. Half a century of research on the Stroop effect: an integrative review. Psychol Bull. 1991;109(2):163-203.
• Karakaş S, Erdoğan E, Sak L et al. Stroop Test TBAG Form: Standardization Studies for Turkish Culture, Reliability and Validity. Clinical Psychiatry. 1999;2:75-88.
• Gladstone DJ, Danells CJ, Black SE. The fugl-meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair. 2002;16:232-240.
• Van Wijck FM, Pandyan AD, Johnson GR, Barnes MP. Assessing motor deficits in neurological rehabilitation: patterns of instrument usage. Neurorehabil Neural Repair. 2001;15:23-30.
• Deakin A, Hill H, Pomeroy VM. Rough Guide to the Fugl-Meyer Assessment: Upper limb section. Physiotherapy. 2003;89:751-763.
• Sullivan KJ, Tilson JK, Cen SY et al. Fugl-Meyer assessment of sensorimotor function after stroke: standardized training procedure for clinical practice and clinical trials. Stroke. 2011;42:427-432.
• Soyuer F. Examination of upper extremity functions in hemiplegic patients [Master’s thesis]. Ankara: Hacettepe University Institute of Health Sciences. 2000;20.
• Mathiowetz V, Volland G, Kashman N, Weber K. Adult norms for the box and block test of manual dexterity. Am J Occup Ther Jun. 1985;39:386-391.
• Altman DG. Practical statistics for medical research. London; Chapman and Hall. 2013.
• Schluter ND, Krams M, Rushworth MF, Passingham RE . Cerebral dominance for action in the human brain: The selection of actions. Neuropsychologia. 2001;39:105.
• Nguyen JD, Duong H. Neurosurgery, Sensory Homunculus. Florida; StatPearls Publishing; 2021.
• Lin DJ, Erler KS, Snider SB, et al. Cognitive demands influence upper extremity motor performance during recovery from acute stroke. Neurology. 2021;96(21):e2576-e2586.
• Roh HL, Kim CW. Cognition and upper-extremity function influence on performance of activities of daily living in patients with chronic stroke. J Korean Soc Phys Med. 2019;14(4):115-123.
• Hyndman D, Pickering RM, Ashburn A. The influence of attention deficits on functional recovery post stroke during the first 12 months after discharge from hospital. J Neurol Neurosurg Psychiatry. 2008;79:656-663.
• Robertson IH, Ridgeway V, Greenfield E, Parr A. Motor recovery after stroke depends on intact sustained attention: a 2-year followup study. Neuropsychology. 1997;11:290-295.
• Sveen U, Bautz-Holter E, Sodring KM, Bruun WT, Laake K. Association between impairments, selfcare ability and social activities 1 year after stroke. Disabil Rehabil. 1999;21:372-327.
• Sunderland A, Bowers MP, Sluman SM, Wilcock DJ, Ardron ME. Impaired dexterity of the ipsilateral hand after stroke and the relationship to cognitive deficit. Stroke. 1999;30:949-955.
• Levin MF, Subramanian SK, Chilingaryan G, Sveistrup H. Influence of depression and cognitive deficits on use of feedback for upper limb recovery in chronic stroke. Neurorehabil Neural Repair. 2014;28(9):924.
• Elliott R. Executive functions and their disorders. Br Med Bull. 2003;65(1):49-59.
• Saverino A, Waller D, Rantell K, Parry R, Moriarty A, Playford ED. The role of cognitive factors in predicting balance and fall risk in a neuro-rehabilitation setting. PLoS One. 2016;11:e0153469.
• Zhang X, Tse T, Li T, Zoghi M. Is there an association between traumatic peripheral lesions and cognitive impairments in adults? A scoping review. Adv Rehabil. 2023;37(1):1-11.
• Desrosiers J, Malouin F, Richards C, Bourbonnais D, Rochette A, Bravo G. Comparison of changes in upper and lower extremity impairments and disabilities after stroke. Int J Rehabil Res. 2003;26:109-116.
• Arciniegas DB, Kellermeyer GF, Bonifer NM, Anderson-Salvi KM, Anderson CA. Screening for cognitive decline following single known stroke using the Mini-Mental State Examination. Neuropsychiatr Dis Treat. 2011;189-196.
• Timmermans AA, Verbunt JA, van Woerden R, Moennekens M, Pernot DH, Seelen HA. Effect of mental practice on the improvement of function and daily activity performance of the upper extremity in patients with subacute stroke: a randomized clinical trial. J Am Med Dir Assoc. 2013;14(3):204-212.
• Lin DJ, Erler KS, Snider SB. Cognitive demands influence upper extremity motor performance during recovery from acute stroke. Neurology. 2021;96(21):e2576-e2586.