This study evaluated the effects of personalized goal setting using Goal Attainment Scaling (GAS) from practical and functional perspectives, along with regular video feedback, on improving upper limb function and usage frequency in a chronic stroke patient. Additionally, the relationship between improvements in Fugl-Meyer Assessment (FMA) scores and Motor Activity Log (MAL) scores was investigated.
A single chronic stroke patient, 3 years and 7 months post-onset, participated in this study. Focusing on eating activities, the following two GAS goals were set:
- Practical Goal (GAS①): Improvement of fork manipulation ability to accurately hold food items.
- Functional Goal (GAS②): Improvement of shoulder abduction without synergy patterns, elbow joint flexion and extension, and dexterity of the wrist and fingers required for fork manipulation.
During a two-month intervention period, interviews, video recordings, and manual interventions focusing on the set goals were conducted every two weeks. Progress was evaluated using the FMA for motor function, the MAL for usage frequency and quality, and the GAS for goal attainment levels.
After the intervention, the FMA score increased from 40 to 45 points. The MAL's Amount of Use (AOU) improved from 1.6 to 2.1, and the Quality of Movement (QOM) improved from 1.25 to 1.9. The patient achieved the expected level (0) in both GAS goals, indicating improvements in practical tasks and functional abilities.
Personalized goal setting and regular feedback simultaneously improved motor function (FMA score) and usage frequency of the paretic upper limb (MAL score) in a chronic stroke patient. A previous study by Hirayama et al. (2023) reported a turning point in increased upper limb usage frequency at an FMA score of approximately 45 points in subacute stroke patients. Similarly, in this study, improvements in MAL scores were observed when the FMA score reached 45 points, suggesting a similar trend even in chronic stroke patients. However, given that only one subject was involved, there are limitations in generalizing the relationship between FMA and MAL scores or the existence of a turning point in chronic stroke patients. Further research is needed to examine how FMA and MAL change in chronic patients and whether the turning point reported in previous studies applies.
This study suggests that combining personalized goal setting with regular feedback may enhance rehabilitation outcomes by counteracting learned non-use in chronic stroke patients. By addressing both practical and functional perspectives, effective interventions can be developed to promote active use of the paretic upper limb, improving ADL and the patient's quality of life. Future research should examine the long-term effects of this approach and its applicability to a broader patient population.
Upper Limb Rehabilitation
Goal Attainment Scaling (GAS)
