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The Sødring Motor Evaluation of Stroke patients is an instrument for physiotherapists to evaluate motor function and activities in stroke patients. The rating reflects quality as well as quantity of the patient's unassisted performance within three domains: leg, arm and gross function. The inter-rater reliability of the method was studied in a sample of 30 patients admitted to a stroke rehabilitation unit. Three therapists were involved in the study; two therapists assessed the same patient on two consecutive days in a balanced design. Cohen's weighted kappa and McNemar's test of symmetry were used as measures of item reliability, and the intraclass correlation coefficient was used to express the reliability of the sumscores. For 24 out of 32 items the weighted kappa statistic was excellent (0.75-0.98), while 7 items had a kappa statistic within the range 0.53-0.74 (fair to good). The reliability of one item was poor (0.13). The intraclass correlation coefficient for the three sumscores was 0.97, 0.91 and 0.97. We conclude that the Sødring Motor Evaluation of Stroke patients is a reliable measure of motor function in stroke patients undergoing rehabilitation.

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PURPOSE: To explore how motor and cognitive impairments relate to physical activities of daily living (PADL) and social activities after stroke. METHOD: The data related to 65 patients (mean age 74.4 years, 43% females), assessed 1 year after stroke by means of the Sødring Motor Evaluation of Stroke patients and the Assessment of Stroke and other Brain damage instruments. The self-care and social activities scales applied were the Barthel ADL Index and the Frenchay Activities Index (FAI). The association between impairment variables on the one hand and PADL and FAI scores on the other was estimated using Kendall rank correlations. RESULTS: Arm motor function correlated most strongly with the Barthel score (tau = 0.76), and visuospatial function came second (tau = 0.58). Factor analysis of the FAI produced three subscales: a 'domestic' factor most strongly related to arm motor function (tau = 0.49); 'outdoor' related to visuospatial ability (tau = 0.48); and 'hobby' which had no significant correlates. CONCLUSION: In the chronic phase of stroke, self-care and involvement in social activities relate most strongly to arm motor function and visuospatial ability. Outdoor activities depend mainly on visuospatial function.

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BACKGROUND AND PURPOSE: Full neuropsychological assessment is time-consuming and exhausting for the patient in the early phase of stroke. The screening instrument for neuropsychological impairment in stroke (SINS) is a brief, bedside-applicable instrument designed to screen perceptual and cognitive dysfunction related to functional activities in stroke. It has been developed by physiotherapists to be incorporated in the general assessment of the patient. This study evaluates the validity of the method against a more extensive reference method assessing cognitive function. METHODS AND RESULTS: An unselected group of hospitalized stroke patients (N = 87) was assessed 10 days and 12 months after stroke. Factor analyses (52% explained variance), identified three factors: 'aphasia', 'apraxia' and 'visuocognitive dysfunction'. Receiver operating characteristics (ROC) curves demonstrated that for all factors, high specificity was maintained at the high sensitivity needed for a screening method. Kendall rank correlation coefficients between the scorings on the new instrument and the reference method were high. Effect size analysis showed that the ability of the new instrument to detect change in cognitive functioning during the first year was of the same magnitude as the reference method. CONCLUSIONS: SINS has a high sensitivity regarding cognitive dysfunction, as diagnosed by the more comprehensive and time-consuming reference method. The instrument would be useful as an initial step in the assessment of neuropsychological impairment in stroke patients.

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OBJECTIVE: To compare the subjective well-being of stroke patients with that of a reference group, and to study its relationship to patient characteristics. DESIGN: Cross-sectional study. SETTING: Interviews performed in the respondents' homes, tests performed at the outpatient clinic. SUBJECTS: Sixty patients one year after stroke (median age 74 years, interquartile range (IQR) 68-80), and 419 reference individuals (median age 75 years, IQR 71-80). MEASURES: Subjective well-being assessed with the General Health Questionnaire (GHQ-20). Explanatory variables were demographic and medical characteristics of the individuals and scores on validated tests: Barthel Index, Frenchay Activities Index (FAI), Sødring Motor Evaluation of Stroke Patients, Assessment of Cerebral Stroke and other Brain Damage, and Mini-Mental State Examination (MMSE). RESULTS: A significantly higher proportion of the stroke patients than of the controls rated their subjective well-being as low, also after adjustment for age and gender (adjusted odds ratio 20.1, 95% confidence interval 9.6-42.0 by logistic regression). In bivariate analyses, leg and arm motor impairment, visuospatial impairment, apraxia, aphasia, low Barthel score, low FAI score, low MMSE score, and institutionalization were highly significant predictors of low subjective well-being (p-values < 0.01). In multiple linear regression, a model with gender (p = 0.3) and upper extremity motor score (p < 0.01) fitted the data well, and explained 48% of the variance in GHQ. CONCLUSION: Subjective well-being is decreased one year after stroke, and this is mainly attributed to arm motor impairments.

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PURPOSE: To study gender differences in functional outcome unexpectedly observed in a follow-up study of stroke patients. DESIGN: Prospective study of hospitalized stroke patients, with evaluations in the subacute phase and after one year. SETTING: Geriatric and general medical wards, and geriatric outpatient clinic of a university hospital serving as general hospital for a defined population. SUBJECTS: All stroke patients admitted during a six-month period (n = 165) were considered for inclusion, of whom 87 could be assessed in the subacute phase and 65 after one year. MAIN OUTCOME MEASURES: Motor function assessed by the Sødring Motor Evaluation of Stroke Patients; cognitive function by the Assessment of Stroke and other Brain Damage; and activities of daily living (ADL) function by the Barthel Index. Nursing-home residency registered after one year. RESULTS: Men achieved a significantly better score than women on most of the scales used. The age-adjusted odds for a man to have a higher Barthel score than a woman was 3.1 (95% confidence interval (CI) 1.3-7.0) in the subacute phase and 3.3 (95% CI 1.2-9.0) after one year. Differences of the same magnitude were seen on the subscales of the motor and cognitive tests. The same trend was observed on all items of the Barthel Index. The males had a lower likelihood to be permanent nursing-home residents after one year, the age-adjusted odds ratio for nursing-home residency for females versus males being 6.3 (95% CI 1.2-65.3). CONCLUSION: Women seem to be functionally more impaired by stroke than men.

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The Sødring Motor Evaluation of Stroke Patients (SMES) has been developed as an instrument for the evaluation by physiotherapists of motor function and activities in stroke patients. The predictive validity of the instrument was studied in a consecutive sample of 93 acute stroke patients, assessed in the acute phase and after one year. The outcome measures were: survival, residence at home or in institution, the Barthel ADL index (dichotomized at 19/20), and the Frenchay Activities Index (FAI) (dichotomized at 9/10). The SMES, scored in the acute phase, demonstrated a marginally significant predictive power regarding survival, but was a highly significant predictor regarding the other outcomes. The adjusted odds ratio for a good versus a poor outcome for patients in the upper versus the lower tertile of the SMES arm subscore was 5.4 (95% confidence interval 0.9-59) for survival, 11.5 (2.1-88) for living at home, 86.3 (11-infinity) for a high Barthel score, and 31.4 (5.2-288) for a high FAI score. We conclude that SMES has high predictive validity.

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A new method (The Sødring Motor Evaluation of Stroke Patients) has been developed for physiotherapists to evaluate motor function and activities in stroke patients. Its main characteristics are the assessment of motor activity without assisting the patient, and the use of a rating which reflects quantity as well as quality in motor performance. A hospitalised group of stroke patients (n = 93) was assessed three times after the acute event, by means of SMES. The data were analysed regarding construct validity as well as concurrent validity against another assessment method. Factor analyses showed a reasonably stable three-factor pattern ("arm", "gross motor function", and "leg") which explained 84, 89 and 90%, respectively, of the variance at the three study points, with Factor 1 ("arm") as the dominant factor. The ordinality of the rating scale was assessed by means of linear regression analysis and found to be acceptable. The correlation coefficients were high between comparable parts of the new and the reference methods.

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The painful shoulder in the paralysed stroke patient, is a great problem in the field of physical medicine. Certain pathological changes are taking place in the patients with extensive paralysis in the upper limb. These changes are: (1) lesions or rupture of the rotatorcuff, (2) displacement of caput humeri in a caudal direction, (3) neuropathy of plexus brachialis with peripheral paresis. Careless handling of the patients' arm and the passive pull of the heavy, paralytic arm are claimed to be the main cause for these lesions. Correct handling of the patient and support of the shoulder is necessary to prevent these injuries from taking place. The different arm-slings used for this purpose, are not good enough. The article describes an orthosis which supports the shoulder joint and reposition caput humeri (if this has been luxated). It also gives the patient a better balance by straightening the trunk and letting the arm hang extended and slightly abducted along the side of the body. The orthosis is only tested in a few patients. Further development and testing on several patients are now being planned.

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