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1496

ORIGINAL ARTICLE

Predicting Recovery of Upper-Body Dressing Ability


After Stroke
Makoto Suzuki, MA, OT, Mikayo Omori, OT, Mayumi Hatakeyama, OT, Sumio Yamada, PhD, PT,
Kazuhiko Matsushita, PhD, MD, Setsu Iijima, PhD, MD
ABSTRACT. Suzuki M, Omori M, Hatakeyama M, Yamada dent predictor of recovery of upper-body dressing ability after
S, Matsushita K, Iijima S. Predicting recovery of upper-body stroke.
dressing ability after stroke. Arch Phys Med Rehabil 2006;87: Key Words: Activities of daily living; Prognosis; Rehabil-
1496-502. itation; Stroke.
© 2006 by the American Congress of Rehabilitation Medi-
Objective: To identify predictors of the recovery of inde- cine and the American Academy of Physical Medicine and
pendent dressing ability after stroke. Rehabilitation
Design: Prospective cohort study.
Setting: Rehabilitation unit at a university hospital.
Participants: Sixty-three consecutive stroke patients were NDEPENDENCE IN DRESSING enables a person to main-
enrolled in the study. Twelve patients were not able to com-
plete the study because they were discharged or transferred to
Iapiststain 1
a sense of dignity, self-respect, and achievement. Ther-
working with stroke patients spend a large proportion of
another hospital before study completion. the day teaching patients how to put on and take off items of
Intervention: Fifty-one patients underwent and completed clothing.2 Despite such instruction, however, many patients are
15 days of dressing training based on the time-delay method, still unable to dress themselves independently for several
which included the 10 component actions of upper-body dress- weeks after hospital admission.3-6 Dressing is more difficult
ing and 4 cues given by therapists. than undressing, and upper-body dressing requires more ad-
Main Outcome Measures: The dressing item of the FIM vanced recognition than lower-body dressing.1,2
instrument, Brunnstrom motor recovery stages, presence or Many studies1,2,7-13 have shown a relation between difficulty
absence of deep and tactile sensation, Rey-Osterrieth complex in dressing and cognitive and physical impairments. Despite
figure test, Kohs block design test, body image test, Weintraub more than 50 years of research, it is still difficult to predict the
cancellation task, and presence or absence of the visual extinc- extent or duration of loss of dressing ability.7-15 There is no
tion phenomenon and the motor impersistence phenomenon. clear understanding of the effect of early neurologic impair-
Results: The FIM upper-body dressing item score and the ments and early dressing disorder on a stroke patient’s ultimate
cancellation task score at the start of training were significantly recovery from dressing disorder.1,2,7-15 In a single-blind ran-
better in patients who achieved independence in dressing domized controlled trial, Kwakkel et al14 investigated the ef-
within 15 training days than in patients who did not (P⬍.05). fects of different intensities of arm and leg rehabilitation on the
The motor impersistence phenomenon was found less fre- functional recovery of activities of daily living (ADLs) includ-
quently among patients who achieved independence in upper- ing dressing. They found no differences in ADL scores be-
body dressing than among patients who did not (P⬍.05). tween the arm-training and control groups, and they suggested
However, logistic regression analysis showed that only the that stroke patients compensate for the loss of function in the
FIM score for upper-body dressing on the first day of training paretic arm by using the nonparetic arm during ADLs. They
was a significant independent predictor of dressing ability at noted that impairment was not always associated with dressing
the end of training (odds ratio, 4.33; 95% confidence interval, disorder in their patients. Jongbloed15 performed a critical
1.51–12.37). The receiver operating characteristic curve indi- review of 33 studies and concluded that the admission ADL
cated that a cutoff score of 3 would provide the best balance score is a strong predictor of discharge ADL status, but its
between sensitivity and specificity for the FIM upper-body relation to improvement in cognitive and physical impairment
dressing item. The positive predictive value of this cutoff score is unclear.
was .90, and the negative predictive value was .70. Which is a stronger predictor of recovery of dressing ability,
Conclusions: Our findings indicate that the FIM upper-body early neurologic impairments or early dressing disorder? Be-
dressing score on the first day of dressing training is an indepen- cause it is still difficult to identify predictors of dressing ability,
success in training is largely due to the extent of a therapist’s
experience rather than any scientific data. If we could identify
predictors of recovery of dressing ability and predict the extent
From the Departments of Rehabilitation Medicine (Suzuki) and Orthopedics (Mat-
or duration of dressing ability loss, training in upper-body
sushita), Kawasaki Municipal Tama Hospital, Kawasaki, Japan; Department of Re- dressing skills would become more evidence based.
habilitation Medicine, St. Marianna University School of Medicine Hospital, Ka- We conducted a prospective cohort study to identify pre-
wasaki, Japan (Omori); Department of Rehabilitation Medicine, St. Marianna dictors of the recovery of independent dressing ability after
University, Yokohama City Seibu Hospital, Yokohama, Japan (Hatakeyama); School stroke.
of Health Science, Nagoya University, Nagoya, Japan (Yamada); and Institute of
Disability Sciences, University of Tsukuba, Bunkyo, Japan (Iijima).
No commercial party having a direct financial interest in the results of the research METHODS
supporting this article has or will confer a benefit upon the author(s) or upon any
organization with which the author(s) is/are associated. Outcome Measures
Reprint requests to Makoto Suzuki, MA, OT, 1-30-37, Shukugawara, Tama-ku,
Kawasaki-shi, Kanagawa, 214-0021 Japan, e-mail: m-suzuki@marianna-u.ac.jp. The study protocol is shown in figure 1. Each patient’s
0003-9993/06/8711-10708$32.00/0 upper-body dressing ability was assessed according to the FIM
doi:10.1016/j.apmr.2006.07.267 instrument dressing item16 on the first day of dressing training.

Arch Phys Med Rehabil Vol 87, November 2006


PREDICTING RECOVERY OF DRESSING ABILITY, Suzuki 1497

was derived by insertion of 1-power (.05), ␣ (.05), and standard


effect size (.66) values in the Hulley matrix.33 We therefore
planned to recruit about 50 stroke patients.
Between May 1, 2001, and May 1, 2004, 63 consecutive stroke
patients from the Department of Rehabilitation Medicine, St.
Marianna University School of Medicine Hospital, were enrolled
in the study. Stroke was diagnosed according to the World Health
Organization definition.34 Eligibility criteria included hemiple-
gia, dependence on spoken cues or physical assistance to
accomplish upper-body dressing, ability to sit up with a back-
rest for more than 30 minutes, lucid consciousness, a period of
less than 3 months since the stroke event, absence of severe
cardiopulmonary or respiratory insufficiency, and a desire to
participate in the study. Baseline characteristics of patients who
satisfied the inclusion criteria are presented in table 1. The
mean age of participants was 69.4⫾10.6 years. There were 25
women and 38 men, 45 patients with cerebral infarction and 18
with cerebral hemorrhage, and 27 patients with right hemiple-
gia and 36 with left hemiplegia. The average time since the
Fig 1. Study protocol. stroke event was 23.0⫾17.2 days.
Twelve patients (6 with right hemiplegia, 6 with left hemi-
plegia) withdrew from the study because they were discharged
or transferred to another hospital before study completion.
The ability to dress the upper body is precisely defined by the The study was approved by the St. Marianna University
FIM, and scores range from 1 to 7, with 1 indicating complete School of Medicine Institutional Committee on Human Re-
dependence during an activity and 7 indicating complete inde- search. Informed consent was obtained from each patient be-
pendence. fore his/her participation in the study.
Many studies1,2,7-12 have shown a relation between difficulty
in dressing and cognitive and physical function impairments Intervention
including motor palsy, sensory disturbance, constructional dis- ADLs such as dressing are considered behavioral chains of
order, body image disturbance, visual inattention, unilateral component actions.35 Such chains have been learned and per-
spatial neglect, and motor impersistence. Therefore, the pres- formed since childhood. A patient with hemiplegia cannot
ence or absence of these impairments was also determined. The dress by means of the behavioral chains of component actions
severity of motor palsy was assessed according to the 6 motor used by a healthy person and thus has to learn new behavioral
recovery stages of Brunnstrom17 representing muscle condi- chains of component actions to achieve independence in dress-
tions ranging from the initial flaccidity of palsy to normal ing. It is necessary to control the cue stimulations and rewards
coordination. Sensory disturbance was evaluated according to
the presence or absence of deep and tactile sensation. Con-
structional disorder was assessed by the Rey-Osterrieth com-
plex figure test18 and Kohs block design test19; these are 36-point Table 1: Baseline Characteristics of Patients Who Satisfied the
Inclusion Criteria
and 131-point scales, respectively. Body image disturbance was
assessed by an unpublished test of each patient’s ability to dis- Characteristics Values
criminate the head, nose, right shoulder, left shoulder, abdomen, Age (y) 69.4⫾10.9
and back of the neck (6-point scale). Visual inattention was Sex (n)
evaluated by a cancellation task involving a sheet of paper con- Male 38
taining 360 randomly arranged shapes, 60 of which were target Female 25
stimuli.20 Unilateral spatial neglect was measured by the presence Diagnosis (n)
or absence of the visual extinction phenomenon.21 Motor imper- Infarction 45
sistence was assessed by each patient’s ability to sustain tongue Hemorrhage 18
protrusion and eye closure simultaneously for 20 seconds.22 The Time poststroke at assessment (d) 23.0⫾7.2
reliability and validity of the 4 tests (FIM, Brunnstrom stages, Paralysis side (n)
Rey-Osterrieth complex figure test, Kohs block design test) have Right 27
been established.21,23-32 We assessed 2 tests for their test-retest Left 36
reliability in 15 stroke patients with an interval of 5 days Sensory disturbance (n)
between measurements. The intraclass correlation coefficients Tactile sense 21
were .78 for the target cancellation task (P⬍.01) and 1.00 for Deep sense 17
the body image test (P⬍.01). Visual extinction phenomenon (n) 28
Motor impersistence (n) 23
Participants
FIM dressing item 2.0 (2.0–3.0)
Sample size calculation was based on a desired 95% statis- Brunnstrom motor recovery stage 3.0 (2.0–4.0)
tical power to detect a 1-point difference in the FIM dressing Kohs block design test score 0.0 (0.0–17.0)
item score, with a 2-sided ␣ of 5%. The average value and Rey-Osterrieth complex figure test score 4.0 (0.0–21.4)
standard deviation (SD) of FIM dressing item scores in 20 Target cancellation task 21.0 (0.0–49.0)
stroke patients were assessed to determine the standard effect Disturbance of body image 6.0 (4.0–6.0)
size. The average FIM dressing item score was 2.45⫾1.50
points, and the standard effect size was .66. A sample size of 53 NOTE. Values are mean ⫾ SD, n, or median (interquartile range [IQR]).

Arch Phys Med Rehabil Vol 87, November 2006


1498 PREDICTING RECOVERY OF DRESSING ABILITY, Suzuki

Action Stage Cue Stimulation

Paralyzed upper-extremity is inserted into the sleeve No cue

Sleeve is pulled up beyond the elbow joint


Indication by verbal cue

Sleeve is pulled up beyond the shoulder joint

Shirt is pulled across the back to the opposite shoulder joint Indication by gesturing

Intact upper extremity is inserted into the other sleeve

Indication by tapping

Collar is arranged

First button is fastened Indication by guiding the patient’s hand

Second button is fastened

Third button is fastened

Fig 2. Upper-body dressing train-


Fourth button is fastened
ing by the time-delay method.

presented in training to support the organization of new behav- Statistical Analysis


ioral chains.35,36 For the purpose of the study, upper-body Patients were classified into 2 groups: those who could
dressing was viewed in 10 separate stages: (1) the paralyzed perform the upper-body dressing tasks independently after the
upper extremity is inserted into the sleeve, (2) the sleeve is 15 days of training and those who required assistance. Cogni-
pulled up beyond the elbow joint, (3) the sleeve is pulled up tive and physical function and upper-body dressing ability on
beyond the shoulder joint, (4) the shirt is pulled across the back the first day of dressing training were compared between the 2
to the opposite shoulder joint, (5) the intact upper extremity is groups. Differences in categoric variables were analyzed by the
inserted into the other sleeve, (6) the collar is arranged, (7) the chi-square test or Fisher exact test. The Mann-Whitney U test
first button is fastened, (8) the second button is fastened, (9) the was used to analyze ordinal variables. Logistic regression anal-
third button is fastened, and (10) the fourth button is fastened ysis was used to identify the best independent predictors of
(fig 2). These 10 component actions describe the entire process independent upper-body dressing ability after 15 days of train-
of upper-body dressing. The list was developed after observa- ing. All statistical procedures were performed with SPSS
tion of the behavioral chains of upper-body dressing used by 33 softwarea with a significance level set at P equal to .05. A
stroke patients with hemiplegia. The 22 stroke patients (66.7%) receiver operating characteristic (ROC) curve was used to
who achieved the greatest independence in upper-body dress- assess the clinical utility of the independent predictors.39
ing used these 10 component actions as a behavioral chain. Constructing the ROC curve involved setting several cutoff
Thus, these actions were selected for use in our current study. points for significant variables and calculating sensitivity,
The study patients underwent 15 days of training based on specificity, positive predictive value, and negative predic-
the time-delay method,37 which is a recognized and effective tive value at each point.
training method.38 In the time-delay method, cues are given
after a set interval of time has elapsed, in this case 10 seconds.
RESULTS
The starting position for dressing training was the patient
grasping the shirt collar. Dressing training began with the Statistics related to subjects’ performances of each task are
verbal instruction, “Please put on the shirt.” If the patient presented in table 2. Upper-body dressing ability and visual
responded with inadequate component actions or if the patient attention at the start of training were significantly better in
did nothing for 10 seconds, the therapist offered cues at 4 levels patients who achieved independence in dressing within 15
in the following order: (1) verbal cue, (2) gesturing, (3) tap- training days than in patients who did not. The FIM upper-body
ping, and (4) physical assistance. Verbal cues were instructions dressing item score for independent patients was higher than
such as, “Can you pass your right hand into the sleeve?” or that for dependent patients (median score, 3 points; interquar-
“Can you pull the sleeve up to your elbow?” Gesturing con- tile range [IQR], 2–3 points vs median score, 2 points; IQR,
sisted of the therapist mimicking the component action of 1–2 points; P⬍.001). The target cancellation task score for
upper-body dressing. Tapping consisted of the therapist independent patients was higher than that for dependent pa-
tapping the patient’s clothes and body. Physical assistance tients (median score, 40 points; IQR, 10.5–57.5 points vs
consisted of the therapist taking the patient’s hand and median score, 2 points; IQR, 0 –21 points; P⫽.004). In addi-
guiding it in the appropriate direction. When the patient tion, motor impersistence was found less frequently among
performed each component action, the therapist praised him/ patients who achieved independence in upper-body dressing
her. After 15 days of training, each patient was assessed for than among patients who did not. There were 4 (14.3%) inde-
his/her ability to dress the upper half of the body indepen- pendent patients and 12 (54.2%) dependent patients (P⫽.014)
dently. with motor impersistence. Independence in dressing was not

Arch Phys Med Rehabil Vol 87, November 2006


PREDICTING RECOVERY OF DRESSING ABILITY, Suzuki 1499

Table 2: Predictors of Upper-Body Dressing Ability After Stroke


Characteristics Independent (n⫽28) Dependent (n⫽23) P* Odds Ratio (95% CI)

Age* (y) 69.8⫾10.0 70.3⫾10.0 .837 NS


Sex (% male) 53.6 65.2 .580 NS
Diagnosis (% cerebral infarction) 71.4 69.6 .758 NS
Paralysis side (% right hemiplegia) 46.4 34.8 .259 NS
Tactile sense disturbance (% positive cases) 25.0 34.8 .543 NS
Deep sense disturbance (% positive cases) 17.9 26.1 .732 NS
Visual extinction phenomenon (% positive cases) 28.6 60.9 .079 NS
Motor impersistence (% positive cases) 14.3 54.2 .014 NS
FIM dressing item 3.0 (2.0–3.0) 2.0 (1.0–2.0) ⬍.001 4.33 (1.51–12.37)
Brunnstrom motor recovery stage 3.0 (3.0–4.3) 3.0 (2.0–3.5) .163 NS
Kohs block design test score 7.0 (0.0–18.8) 0.0 (0.0–1.0) .063 NS
Rey-Osterrieth complex figure test score 13.5 (1.3–24.5) 2.5 (0.0–6.5) .088 NS
Target cancellation task 40.0 (10.5–57.5) 2.0 (0.0–21.0) .004 NS
Disturbance of body image 6.0 (4.0–6.0) 6.0 (4.0–6.0) .668 NS

NOTE. Values are mean ⫾ SD, median (IQR), or as otherwise indicated. Odds ratios show logistic regression analysis.
Abbreviations: CI, confidence interval; NS, not significant.
*␹2 test or Fisher exact test (categoric variables), Mann-Whitney U test (ordinal variables).

significantly associated with the severity of motor palsy or of recovery of upper-body dressing ability after stroke. Wil-
body image disturbance. Logistic regression analysis of the 14 liams8 correlated the constructional abilities of 136 hemiplegic
variables showed only the FIM upper-body dressing score to be patients with their abilities to relearn upper-extremity dressing
a significant predictor of the recovery of dressing ability (odds skills. Patients with normal constructional ability were more
ratio, 4.33; 95% confidence interval, 1.51–12.37). likely to be independent in upper-extremity dressing or had a
FIM upper-body dressing scores were plotted as an ROC greater capacity to achieve this skill than patients with a con-
curve (fig 3). Sensitivity, specificity, and predictive value at structional disorder. In an evaluation of 60 stroke patients by
several cutoff points are presented in table 3. The curve indi- the Nottingham Stroke Dressing Assessment and other physical
cated that a cutoff score of 3 being “moderate” would provide and cognitive assessments, Walker and Lincoln2 found that
the best balance between sensitivity and specificity for the FIM difficulty in lower-body dressing was associated with physical
upper-body dressing item (sensitivity, .68; 1 – specificity, .09). impairment and that difficulty in upper-body dressing was
The positive predictive value of this cutoff score was .90, and associated with visual inattention and sensory disturbance.
the negative predictive value was .70. Characteristics of pa- Chen et al11 investigated the relation between patterns of visuo-
tients who withdrew from the study were similar to those of spatial inattention and performance of ADLs by means of the
patients who completed the study (table 4). Klein-Bell ADL Scale and the Random Chinese World Can-
cellation Test in 64 patients with a right brain lesion. They
DISCUSSION found that hemi-inattention was highly related to poor ADL
Our results indicate that the FIM upper-body dressing score performance and that independence in dressing appeared to be
on the first day of dressing training is an independent predictor more adversely affected by hemi-inattention than was indepen-
dence in bathing and hygiene, eating, or use of the telephone.
Hier et al12 evaluated 41 patients with unilateral right hemi-
sphere stroke for hemiparesis, hemianopia, constructional apraxia,
spatial neglect, dressing disorder, and motor impersistence. Dress-
ing disorder was associated with severe constructional apraxia,
spatial neglect, motor impersistence, and hemianopia.
In marked contrast to the findings of earlier studies,1,2,7-12
the final regression model in our study showed no significant
relation between the recovery of upper-body dressing ability
and any underlying cognitive or physical impairment assessed
in this study. As noted above, patients with hemiplegia are
unable to use the same behavioral chains that are used by
healthy people to accomplish dressing tasks. However, if a new
behavioral chain is learned, patients can achieve a degree of

Table 3: Sensitivity, Specificity, and Predictive Values at 3


Cutoff Points
Cutoff Positive Negative
Point Sensitivity Specificity Predictive Value Predictive Value

2 0.893 0.391 0.641 0.750


3 0.679 0.913 0.905 0.700
4 0.143 1.000 1.000 0.489
Fig 3. ROC curve for the FIM upper-body dressing item.

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1500 PREDICTING RECOVERY OF DRESSING ABILITY, Suzuki

Table 4: Characteristics of Subjects Who Completed the Study and Those Who Withdrew
Patients Who Completed Patients Who Withdrew
Characteristics the Study From the Study P

Age (y) 70.0⫾9.9 66.6⫾15.4 .716


Sex (% male) 60.8 58.3 .383
Diagnosis (% cerebral infarction) 70.6 75.0 .563
Paralysis side (% right hemiplegia) 41.2 50.0 .290
Tactile sense disturbance (% positive cases) 29.4 50.0 .218
Deep sense disturbance (% positive cases) 21.6 50.0 .281
Visual extinction phenomenon (% positive cases) 43.1 50.0 .021
Motor impersistence (% positive cases) 31.4 0.7 .002
Period from crisis to measurement (d) 23.0⫾16.5 22.8⫾21.8 .620
FIM dressing item 2.0 (2.0–3.0) 2.0 (2.0–3.5) .446
Brunnstrom motor recovery stage 3.0 (2.5–4.0) 2.0 (2.0–3.5) .104
Kohs block design test score 0.0 (0.0–17.0) 0.0 (0.0–17.5) .932
Rey-Osterrieth complex figure test score 4.0 (0.5–22.5) 0.0 (0.0–6.0) .092
Target cancellation task 21.0 (0.0–50.5) 15.0 (0.5–23.0) .453
Disturbance of body image 6.0 (4.0–6.0) 6.0 (2.5–6.0) .617

NOTE. Values are mean ⫾ SD, median (IQR), or as otherwise indicated.

independence in dressing. The reason why early dressing dis- an average of 2 to 5 minutes of help from another person per
order is a stronger predictor of the recovery of dressing ability day.25-27 Rogers et al38 examined the effectiveness of a behavioral
than cognitive or physical impairment is related to the degree rehabilitation intervention based on the time-delay method for
of change to the original behavioral chain. improving the performance of morning care routines by nurs-
According to univariate analysis, visual attention at the start ing home residents with dementia. In their study,38 physical
of training was significantly better in patients who achieved assistance were provided for significantly smaller proportions
independence in dressing within 15 training days than in pa- of a morning care session during the behavioral rehabilitation
tients who did not. Also, motor impersistence was found less intervention. However, the intervention took considerably
frequently among patients who achieved independence in up- more time than was needed for the usual care. Our results
per-body dressing than among patients who did not. These indicated that the time spent in nonassisted dressing in-
findings corroborate those reported by Walker and Lincoln2 creased for patients who could perform upper-body dressing
and Hier et al.12 There is still no clear understanding of the independently after the 15 days of training. However, a
effect of underlying neurologic impairments on a stroke pa- therapist may spend more time with a patient who requires
tient’s ability to relearn to dress. Prior studies1,2,7-12 have failed only partial assistance after the 15 days of training than with
to answer this question for several reasons. In some cases, patients who require full assistance. Therefore, therapists
multivariate analysis was not performed, and in others, vari- should devise a method in which assistance and promotion
ables were not tested for independent prediction. In addition, of independence are balanced.
no prospective cohort study to identify the predictors of recov-
ery of independent dressing ability has been conducted. In the Study Limitations
present study, the target cancellation task score and motor Because this was a prospective cohort study, we did not
impersistence on the first day of dressing training were inde- randomize patients into groups before the training. Patients
pendent predictors of recovery of upper-body dressing ability were classified into 2 groups after training: those who could
after stroke. However, the recovery of independent dressing perform the upper-body dressing tasks independently after the
ability was more strongly related to the FIM upper-body dress- 15 days of training and those who required assistance. We also
ing score than to the target cancellation task score and motor did not evaluate cognitive or physical function of patients
impersistence. after training. Therefore, the effect of dressing training
Our analysis indicated that the FIM upper-body dressing based on the time-delay method is not clear in this study. If
score can serve as a valuable predictor of the ability to dress the patients were allocated before or re-evaluated after the train-
upper body independently after stroke. Ninety percent of pa- ing, the effect of any natural recovery could be excluded.
tients with a FIM upper-body dressing score of 3 or more on Further research in a randomized controlled trial is needed
the first training day recovered the ability to dress the upper to verify the effect of dressing training based on the time-
body independently within 15 training days. However, 70% of delay method.
patients with a score of 2 or less could not perform this task The FIM upper-body dressing item used in this study is part
independently after 15 days of training. Such patients require of a standardized ADL test. However, this item does not
other solutions, such as different types of training or changes in distinguish the component actions of upper-body dressing, and
materials or types of clothes. In addition, therapists should be it does not account for cues given by the therapist during
consulted about the appropriate method for assisting these evaluation of upper-body dressing ability. The difficulty of
patients. Therapists can predict the recovery of independent upper-body dressing varies according to the dressing com-
dressing ability after stroke scientifically by an initial assess- ponents and is also affected by cues given during evaluation.
ment with the FIM dressing item. Our findings will contribute Thus, the FIM upper-body dressing item cannot be used to
to an increasingly evidence-based approach to upper-body evaluate details of upper-body dressing or the level of
dressing training for stroke patients. assistance required. Therefore, further research is needed to
The FIM score was investigated in relation to the burden of develop an upper-body dressing assessment scale that ac-
care; a 1-point change in the total FIM score was equivalent to counts for the individual components of dressing activities

Arch Phys Med Rehabil Vol 87, November 2006


PREDICTING RECOVERY OF DRESSING ABILITY, Suzuki 1501

and controls for cue stimulation during any evaluation of 10. Tsai IJ, Howe TH, Lien IN. Visuospatial deficits in stroke patients
dressing skills. and their relationship to dressing performance. J Formos Med
The number of participants in our study was determined on Assoc 1983;82:353-9.
the basis of Hulley’s matrix for sample-size estimation.33 How- 11. Chen SM, Henderson A, Cermak SA. Patterns of visual spatial
ever, a larger number of participants will be needed in further inattention and their functional significance in stroke patients.
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20. Weintraub S, Mesulam MM. Right cerebral dominance in spatial
between the recovery of upper-body dressing ability and any
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Acknowledgments: We thank Mihoko Nakadate, OT, Sachiko of the functional independence measure: a quantitative review.
Izawa, OT, Yuko Matsumoto, OT, Ari Watanabe, OT, Akiko Kataoka, Arch Phys Med Rehabil 1996;77:1226-32.
OT, Eriko Musha, OT, Seiko Sugano, OT, Junko Matsumoto, OT, 24. Hamilton BB, Laughlin JA, Fiedler RC, Granger CV. Interrater
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