Change of Strength and Rate of Rise of Tension Relate to Functional Arm Recovery After Stroke Caroline I.E. Renner, MD, Peggy Bungert-Kahl, MD, Horst.

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Change of Strength and Rate of Rise of Tension Relate to Functional Arm Recovery After Stroke Caroline I.E. Renner, MD, Peggy Bungert-Kahl, MD, Horst Hummelsheim, MD Archives of Physical Medicine and Rehabilitation Volume 90, Issue 9, Pages 1548-1556 (September 2009) DOI: 10.1016/j.apmr.2009.02.024 Copyright © 2009 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 1 Representative measurements of (A) isometric wrist extension force and (B) of RRT of isometric wrist extension force in 2 different patients. (A) Measurement of isometric wrist extension force. Patient 8: infarct in right basal ganglia at t0. Rivermead Motor Assessment score (arm section) is 5. delta T (40): 4.12s, max (40): 37.06345N, SD (40): 9.86552N, mean (40): 22.18644N. (B) Measurement of RRT wrist extension. Patient 9: left subcortical infarct at t2. Rivermead Motor Assessment score (arm section) is 14. delta T (40): 1.74s, max (40): 67.950N, SD (40): 25.914N, mean (40): 38.374N. Abbreviation: RRT, rate of rise of tension. Archives of Physical Medicine and Rehabilitation 2009 90, 1548-1556DOI: (10.1016/j.apmr.2009.02.024) Copyright © 2009 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 2 (A) Normalized peak values, (B) normalized values of clinical tests. Normalized mean improvement of strength and rate of rise of tension of the different muscle contractions and the ARAT sum and subscores and score RMA at 3 weeks (t1) and 6 weeks (t2) after enrollment (*P<.05). Abbreviations: B&B, Box and Block test; RMA, Rivermead Motor Assessment; RRT, rate of rise of tension. Archives of Physical Medicine and Rehabilitation 2009 90, 1548-1556DOI: (10.1016/j.apmr.2009.02.024) Copyright © 2009 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 3 Multiple regression of normalized maximal voluntary force of hand grip, isometric wrist extension, and isometric elbow extension with the normalized ARAT sum score. The coefficients of determination r2 are shown. Hand grip and wrist extension are significant (P<.05), while elbow extension is not significant. Archives of Physical Medicine and Rehabilitation 2009 90, 1548-1556DOI: (10.1016/j.apmr.2009.02.024) Copyright © 2009 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 4 Multiple regression of normalized rate of rise of tension of hand grip and isometric wrist extension with the normalized ARAT sum score. The coefficients of determination r2 are shown. Hand grip and wrist extension are significant (P<.001). Archives of Physical Medicine and Rehabilitation 2009 90, 1548-1556DOI: (10.1016/j.apmr.2009.02.024) Copyright © 2009 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 5 Multiple regression of normalized maximal voluntary force of hand grip, isometric wrist extension, and isometric elbow extension with the normalized ARAT subscores. The coefficients of determination r2 are shown. (A) The independent variable is the subscore “grasp.” Hand grip and wrist extension are significant (P<.001); elbow extension is not significant. (B) The independent variable is the subscore “grip.” Wrist extension and elbow extension are significant (P<.05); hand grip is not significant. (C) The independent variable is the subscore “pinch.” Hand grip is significant (P<.05); wrist extension and elbow extension are not significant. (D) The independent variable is the subscore “gross movement.” Hand grip, wrist extension, and elbow extension are all significant (P<.05). Archives of Physical Medicine and Rehabilitation 2009 90, 1548-1556DOI: (10.1016/j.apmr.2009.02.024) Copyright © 2009 American Congress of Rehabilitation Medicine Terms and Conditions