Learning Effects of the Lower Extremity Motor Coordination Test in Individuals with Stroke

Special Article – Stroke Rehabilitation

Phys Med Rehabil Int. 2017; 4(1): 1111.

Learning Effects of the Lower Extremity Motor Coordination Test in Individuals with Stroke?

Menezes KKP, Avelino PR, Scianni AA, Faria- Fortini I, Faria CDCM, Nascimento LR and Teixeira-Salmela LF*

Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil

*Corresponding author: Luci Fuscaldi Teixeira- Salmela, Department of Physical Therapy, Universidade Federal de Minas Gerais. Avenida Antônio Carlos, 6627, Campus Pampulha, 31270-901 Belo Horizonte, Minas Gerais, Brazil

Received: March 02, 2017; Accepted: March 29, 2017; Published: April 04, 2017

Abstract

Background: The Lower Extremity Motor Coordination Test (LEMOCOT) is a simple test that requires the ability to execute movements with maximal capacity. Thus, it is possible that people would improve performance, due to the task learning. If the effects of learning during the repetition of tests are not considered, the results may lead to wrong conclusions regarding the benefits of interventions.

Objective: To evaluate the learning effects of the LEMOCOT in people with stroke.

Materials and Methods: The participants performed the LEMOCOT three times, first with their non-paretic, followed by their paretic lower limbs. The learning effects on the consecutive three trials of both lower limbs were assessed by investigating the differences in the LEMOCOT scores across the trials, using repeated measure ANOVAs with a significance level of 5%.

Results: Forty-one individuals with stroke, 23 men, who had a mean age of 62 years (SD 12) and a mean time since the onset of the stroke of 56 months (SD 65), were evaluated. For both limbs, the LEMOCOT scores gradually increased, from the first to the third trial. Statistically significant differences in the LEMOCOT scores were found across the trials, for both the paretic and nonparetic lower limbs (5.34<F<24.31, p<0.05). However, the maximal differences found between the three trials for both limbs were lower than the smallest real difference values reported for the LEMOCOT.

Conclusions: Although the LEMOCOT showed statistically significant learning effects, the differences due to learning appeared to be small and not clinically relevant.

Keywords: Learning Effect; Motor Skills; Lower Extremity; Stroke

Abbreviations

LEMOCOT: Lower Extremity Motor Coordination Test

Introduction

Adequate coordination of the lower limbs is important for the performance of daily living activities and for an independent life [1]. Loss of coordination is one of the main impairments, that contributes to disability after a stroke [1,2]. Usually, motor coordination is tested under conditions, in which some temporal and spatial accuracies are required [3]. In this line, the Lower Extremity Motor Coordination Test (LEMOCOT) was developed to quantitatively measure motor coordination of the lower extremity. It is simple, has good clinical utility, and showed to be the most suitable test to measure motor coordination of the lower limbs [3,4]. Recently, its psychometric properties were investigated and the results indicated that the LEMOCOT showed to be a valid and reliable measure of motor coordination for individuals with stroke [5].

The LEMOCOT consists of moving the lower extremity, as fast as possible, from one target to another for 20 seconds and the number of on-touched targets constitutes the final score [3]. During the test, the individuals are instructed not to sacrifice the accuracy of the touches, nor the quality of the movement to increase speed [3]. Thus, besides understanding the task, the subjects need the ability to execute the movements with their maximal capacity. Although a familiarization trial is allowed, it is possible that learning effects would occur, if the subjects increase their practice [6-8].

The effect of learning or practice is defined as an improvement in performance on the test by the subject, without having been offered any intervention or condition that could justify it [9]. Various reasons have been discussed to explain improvements induced by practice, such as reduced anxiety or increased familiarity with the testing environment and procedures [9]. Studies which do not consider the possibility of learning effects on the repetition of the tests, may lead to wrong conclusions regarding the benefits of interventions and even mask the presence of cognitive decline, primarily with the elderly population [10].

Therefore, to provide effective interventions to reduce lower limb motor coordination impairments after stroke, it is necessary to use valid and reliable measures. Considering that the LEMOCOT was considered the most suitable test for this purpose, the aim of the present study was to evaluate the learning effects of the LEMOCOT in people with stroke.

Materials and Methods

Participants

Community-dwelling people with stroke, who were living in a metropolitan city, were recruited from the general community, by screening out-patient clinics and University hospitals. The inclusion criteria were: =20 years of age; at least three months since the onset of the stroke; weakness and/or increased tonus of the paretic lower limb muscles, as determined by 15% strength differences between the paretic and non-paretic limbs [11] and/or scores different from zero on the modified Ashworth Scale [12]; and absence of cognitive impairments, as determined by the education-adjusted cut-off scores on the Mini-mental state examination [13].

Procedures

Based upon previous approval from the University ethical review board, eligible participants were informed about the objectives of the study and provided written consent. The data were collected by welltrained physical therapists.

The participants performed the LEMOCOT three times, first with their non-paretic, followed by their paretic lower limb. They sat on an adjustable chair with their feet resting flat on thin rigid foam, heels on the proximal target, and with knees and hips at 90° of flexion [3]. Then, after a familiarization trial, they were instructed to alternately touch the proximal and distal targets, placed 30cm apart, with their big toe, for 20s, as fast as possible, without sacrificing the accuracy to increase speed [3]. The number of touched targets was counted and registered for analyses.

Statistical analyses

The analyses were carried-out with the SPSS software for Windows with a significance level of 5%. Descriptive statistics and tests for normality and equality of variances were calculated for all outcomes. The learning effects were evaluated, using Repeatedmeasure ANOVA to investigate differences in the LEMOCOT scores between the three trials for both the paretic and non-paretic lower limbs.

Results and Discussion

Forty-one individuals with stroke, 23 men, who had a mean age of 62 years (SD 12) and a mean time since the onset of the stroke of 56 (65) months, were evaluated. Their descriptive data are summarized in Table 1. The LEMOCOT scores of both limbs gradually increased from the first to the third trial. ANOVA revealed significant differences regarding the LEMOCOT scores across the three trials, for both the paretic and non-paretic lower limbs, as shown in Table 2 (5.34<F<24.31, p<0.05).

Citation: Menezes KKP, Avelino PR, Scianni AA, Faria-Fortini I, Faria CDCM, Nascimento LR, et al. Learning Effects of the Lower Extremity Motor Coordination Test in Individuals with Stroke. Phys Med Rehabil Int. 2017; 4(1): 1111. ISSN : 2471-0377