AUTHOR=Kim Sujin , Park Hyeshin , Han Cheol E. , Winstein Carolee J. , Schweighofer Nicolas 

TITLE=Measuring Habitual Arm Use Post-stroke With a Bilateral Time-Constrained Reaching Task

JOURNAL=Frontiers in Neurology

VOLUME=9

YEAR=2018

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2018.00883

DOI=10.3389/fneur.2018.00883

ISSN=1664-2295

ABSTRACT=<p><bold>Background:</bold> Spontaneous use of the more-affected arm is a meaningful indicator of stroke recovery. The Bilateral Arm Reaching Test (BART) was previously developed to quantify arm use by measuring arm choice to targets projected over a horizontal hemi-workspace. In order to improve clinical validity, we constrained the available movement time, thereby promoting more spontaneous decision making when selecting between the more-affected and less affected arm during the BART.</p><p><bold>Methods:</bold> Twenty-two individuals with mild to moderate hemiparesis were tested with the time-based BART in three time-constraint conditions: no-time constraint, medium, and fast conditions. Arm use was measured across three sessions with a 2-week interval in a spontaneous choice block, in which participants were instructed to use either the more-affected or the less-affected arm to reach targets. We tested the effect of time-constraint condition on the more-affected arm use, external validity of the BART with the Actual Amount of Use Test (AAUT), and test-retest reliability across the three test sessions.</p><p><bold>Results:</bold> The fast condition in the time-based BART showed reduced use of the more-affected arm compared to the no-time constraint condition <italic>P</italic> &lt; 0.0001) and the medium condition <italic>P</italic> = 0.0006; Tukey <italic>post hoc</italic> analysis after mixed-effect linear regression). In addition, the fast condition showed strong correlation with the AAUT <italic>r</italic> = 0.829, <italic>P</italic> &lt; 0.001), and excellent test-retest reliability (ICC = 0.960, <italic>P</italic> &lt; 0.0001).</p><p><bold>Conclusion:</bold> The revised BART with a time-restricted fast condition provides an objective, accurate, and repeatable measure of spontaneous arm use in individuals with chronic stroke hemiparesis.</p>