Table 4.
Contemporary assessments of stroke impact.
| Description | |
|---|---|
| Primary outcome measure | |
| Action Research Arm Test (ARAT) (Lyle, 1981; Lang et al., 2006) | The ARAT is designed for evaluation of upper extremity function. This test consists of total of 19 items divided into four sections for Grasp, Grip, Pinch and Gross Movements. Item in each section is graded on a 4-point ordinal scale (zero cannot perform any part of the test, three performs normally). The maximum possible total score is 57. |
| Secondary outcome measures | |
| Barthel Index (Collin et al., 1988) | The Barthel Index measure a person's daily functioning (activities of daily living and mobility). |
| Center for Epidemiologic Studies-Depression Scale (CES-D): (Radloff, 1977) | The CES-D is a self-report scale and includes 20 items that survey mood, somatic complaints, interactions with others, and motor functioning. Responses are recorded using a 4-point Likert scale ranging from rarely (scored 0) to all of the time (scored 3), and points are summed across the 20 items to provide a total CES-D score. |
| DSST Mesulam and Weintraub Cancellation task for hemispatial neglect (Weintraub and Mesulam, 1985) | The Mesulam–Weintraub Cancellation task consists of four test forms utilizing structured and unstructured arrays of verbal and non-verbal stimuli. Subjects are asked to circle all of the targets they can find using different colored pencils so that after every ten targets or a specified time the participant changes pencils so that their search pattern may be identified. The targets are the letter “A” in the verbal and the symbol “” in the non-verbal arrays (~ 10 min). |
| Electromyography (Kauffman et al., 2021) | EMG is the recording of changes in skin voltage caused by contraction of the underlying muscles. This recording (Kauffman et al.) will be obtained using the EMG recording equipment of the BIOPAC systems (http://www.biopac.com/researchApplications.asp?Aid=41andLevel=1). |
| Flanker task (Eriksen and Eriksen, 1974) | Flanker task is an executive function/attention task. Subjects are presented with visual stimuli and asked to respond to the direction of a left or right pointing arrow and ignore flanking arrows that point in the opposite direction as the target arrow. |
| The Fugl-Meyer (FM) motor assessment (Fugl-Meyer et al., 1975) | The FM motor assessment is used to measure voluntary limb movement. It includes the upper extremity (UE) subscale (33 items; score range, 0–66) and the lower extremity (LE) subscale (17 items; score range, 0–34) for a total motor FM score of 100.1. |
| Geriatric Depression Scale (Yesavage et al., 1982) | Depression Screening: For subjects 65 and older, we use the Geriatric Depression Scale-15 Item. The GDS or the Mood Assessment Scale screens for depression in the elderly. The GDS taps affective and neuropsychological symptoms of depression and consists of 30 yes/no questions. For subjects younger than 65, we use the Center for Epidemiological Studies-Depression Scale. The CES-D is a self-report scale and includes 20 items that survey mood, somatic complaints, interactions with others, and motor functioning. The final score spans from 0 to 60, with a higher score indicating greater impairment (~10 min). |
| Hand-grip Strength (Boissy et al., 1999) | Hand grip strength is assessed with a dynamometer. Participants are asked to squeeze as hard as possible and then release. Three trials are performed with the affected and unaffected hand. |
| Hopkins Verbal Learning Test (HVLT) (Benedict et al., 1998) | The HVLT is a brief test of verbal learning and memory and consists of a list of 12 nouns (targets) with four words drawn from each of three semantic categories (~ 10 min). |
| Mini-Mental Status Examination (MMSE) (Tombaugh and McIntyre, 1992) | The MMSE is a screening tool that provides a brief, objective measure of cognitive function. |
| Modified Ashworth Scale (Gregson et al., 1999) | MAS assesses spasticity in wrist, elbow, and finger flexion/extension muscles, on a six-point scale (0, no increase in muscle tone to 4, limb rigid in flexion or extension). |
| Montreal Cognitive Assessment (MOCA) (Toglia et al., 2011) | MOCA to test subjects for cognitive impairments (~10 min). |
| Motor Activity Log (MAL) (Van der Lee et al., 2004) | MAL is a structured interview developed to assess the use of the more affected upper extremity in real-world daily activities. Participants are asked to rate how well (Quality of Movement) and how much (Amount of Use) they use their affected arm to accomplish 14 activities of daily living. |
| Modified Health Questionnaire | Modified Health Questionnaire to document the general physical health and social habits of all subjects. |
| The National Institute of Health stroke scale (NIHSS) (Lyden et al., 2009) | The NIHSS is a standardized method to measure the level of impairment caused by a stroke. |
| Nine-hole peg test (9HPT) (Mathiowetz et al., 1985; Beebe and Lang, 2009) | The participant sits at a table and is asked to take nine dowels (9 mm diameter, 32 mm long) from the tabletop and put them into 9 holes (10 mm diameter, 15 mm deep) spaced 50 mm apart on a board. The time to complete this is recorded. |
| Pain Scale (Wong and Baker, 1988) | Pain Scale: Participants is asked to rate their degree of pain on a scale of 0 (no pain) to 5 (in tears). |
| Sensory motor computerized task (Chiu et al., 2011) | Sensory motor computerized task: A computerized task testing participants speed and response time is developed in-house. The task requires participants to watch the appearance of a target on the left or right of the screen and to click the target as soon as it appears |
| The Short-Blessed Test (Katzman et al., 1983) | The Short-Blessed Test, a six-item test, is used as a diagnostic tool to differentiate participants with cognitive impairments from healthy controls. Subjects are asked to answer the items year and month, time of day, count backward 20-1, recite months backwards, and the memory phrase. This test is administered in addition to the MMSE, which also tests for cognitive impairment because the Short-Blessed Test is more sensitive to differences in levels of education and is quicker to administer (~3–4 min). |
| Span measures (Tulsky et al., 1997) | Participants recite digit span, forward and backward (measure of working memory) |
| Stroke Impact Scale (SIS) (Duncan et al., 1999) | The Stroke Impact Scale, or SIS, assesses changes in impairments, activities and participation following a stroke. Scores on the SIS provide an index of clinically “meaningful” change representing the change in the participant's mental and physical abilities concurrent with their performance on the verbal fluency and memory tasks. The four physical function domains (strength, hand function, ADL/IADL, and mobility) is collapsed to a physical function subscale. All domain scores range from 0 to 100 with 100 being the best. |
| Stroop Task (Golden et al., 2003) | Stroop task is an executive function/conflict resolution task. In this task the participant tries to name the color of the ink in which a word is printed when the word itself is the name of a color other than that of the ink. Typically, one is slower in this situation than if the color word and the name of the color coincide. |
| Trail Making Tests (Reitan and Wolfson, 1986) | Trail Making Tests provide information on visual search, scanning, speed of processing, mental flexibility, and executive functions. |
This noncomprehensive list of validated subjective and objective measures may be used to measure both stroke's potential impact on a participant, as well as a means for measuring change resulting from a BCI-FES intervention in stroke survivors. Included are suggested measures of cognition, affect, motor function and capacity, and activities of daily living (ADLs), all of which cover domains of function potentially impacted by stroke insult.