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The first is that this is a particularly novel movement that is unfamiliar to most individuals, whereas thumb opposition to all the digits is a movement sequence that many stroke patients may intuitively practice as they recover motor innervation to the intrinsic thenar muscles. A second possible reason why this particular movement may be more difficult than timed thumb opposition is that, in order to flex the MCP joints while simultaneously extending the IP joints of digits 2�C4, the individual is faced with a dual motor challenge��to recruit the intrinsic lumbrical and interossei muscles while also inhibiting contraction of the extrinsic finger flexors. 4.2. Hand Activities Item The hierarchical arrangement of behavioral criteria in the hand activities item provides information regarding the difficulties of various grasp patterns. Overall, selleck compound we found that movements created by extrinsic hand muscles are easier than movements requiring intrinsic muscle function. Specifically, using the thumb to depress a key on a remote control device can be performed through use of Flexor Pollicis Longus��which is consistent with reports from data collectors that ��any thumb motion�� (on the movements item) was, most typically, flexion at the first MCP and PIP joints. In the sample of stroke survivors we tested, lateral pinch was the next easiest grasp pattern, Fostamatinib chemical structure followed, in order of successive difficulty, by cylindrical grasp, pad to pad pinch, tip to tip pinch, and skilled control of a pencil for untimed, and finally timed writing tasks. 4.3. Scoring the Items To conform to the 0�C6-point ordinal scoring system used by all other items on the MAS, we propose the following scoring system for the hand movements and hand activities items (see Tables ?Tables77 and ?and8).8). As in other items on the original MAS, individuals will score 6 points for successfully performing the most difficult motor behavior and 3 points if they are able to perform the behavior associated with the midpoint of motor abilities assessed by the item. Other scores are prorated to provide appropriate increments for achievement of increasingly more demanding behaviors on the 10-level hand movements item and the 8-level INSRR hand activities item. This scoring system permits clinicians and researchers to comply with the MAS' intended score range of 0�C48 points [2] and/or the score range of 0�C18 points for the upper limb subscale [20]. Table 7 Scoring the hand movements item. Table 8 Scoring the hand activities item. 4.4. Study Limitations and Recommendations Although the sample reflects a normal distribution of demographic variables, there is no way of knowing whether it reflects a representative sample of motor abilities after stroke. Since the final scale compositions were determined by removing and adding items with the criteria of achieving unidimensionality and a person separation of 2.
