Stroke Arm Ladder

Purpose

The StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder was developed from an existing bank of test items used to evaluate upper extremity function in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder incorporates observable tests of capacity or performance and questions aimed at identifying activity and participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. components of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF). The measure includes items that cover a wide range of difficulty levels.

In-Depth Review

Purpose of the measure

The StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder was developed from an existing bank of test items used to evaluate upper extremity function in patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. The measure incorporates observable tests of capacity or performance and questions aimed at identifying activity and participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual's involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. components of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF). The measure includes items that cover a wide range of difficulty levels.

Clinicians and researchers need to use a variety of evaluation measures to assess interventions and constructs related to upper extremity function in patients following strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Administration of a variety of tests can be lengthy, time-consuming and burdensome on clients. The StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder was developed to address this issue by providing a more comprehensive, all-encompassing interval scale measure for evaluation and monitoring"The process of checking the task over time for ‘quality control’ and the adjustment of behavior" (Stuss, 2009, p. 9-10)
of upper extremity.

Available versions

None yet reported

Features of the measure

Items:

The StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder is comprised of 34 items selected from an existing bank of 49 test items used to evaluate upper extremity function in patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. The existing bank of items reflect the domains of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) (body functionsAs defined by the International Classification of Functioning, Disability and Health, body functions are the physiological or psychological functions of body systems (nervous, musculoskeletal, digestive or respiratory and circulatory systems). Impairments are problems in body function or structure as a significant deviation or loss.
; and activity and participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual's involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations.), and was derived from commonly used outcome measures, such as the Chedoke McMaster StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Assessment, Barthel Index and the StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Rehabilitation Assessment of Movement.

Description of tasks:

Staring item: pistol grip, pull trigger then return.

• If patient is unable to perform starting item – then proceed to EASY subtest, start with number 7.
• If patient is able to perform starting item – then proceed to DIFFICULT subtest, start with number 36.

EASY subtest items:

Item	Score/100
1. Tie a scarf around one’s neck (bilateral task). The task is partially executed (more than 25%) or certain steps are executed with major difficulties necessitating repeated efforts. Part of the task may have had to be modified or needed assistance to make it achievable.	3
2. Open a jar and remove a spoonful of coffee (bilateral task). The task is partially executed (more than 25%) or certain steps are executed with major difficulties necessitating repeated efforts. Part of the task may have had to be modified or needed assistance to make it achievable.	4
3. Unlock a lock and open a pill container (bilateral task). The task is partially executed (more than 25%) or certain steps are executed with major difficulties necessitating repeated efforts. Part of the task may have had to be modified or needed assistance to make it achievable.	5
4. Feeding independently. The patient needs some assistance to feed him- or herself a meal from a tray or table when someone places the food within reach. The patient needs assistance to put on an assistive device if required, cut up food, use salt and pepper, spread butter, etc. The patient needs assistance to be able to accomplish this in a reasonable time.	23
5. Write on an envelope and stick a stamp on it (bilateral task). The task is partially executed (more than 25%) or certain steps are executed with major difficulties necessitating repeated efforts. Part of the task may have had to be modified or needed assistance to make it achievable.	29
6. Dressing and undressing. The patient needs some assistance: to put on, remove and fasten all clothing and tie shoelaces (unless it is necessary to use adaptive aids for this). This includes putting on, removing and fastening corsets or braces when they are prescribed.	33
7. Shuffle and deal playing cards (bilateral task). The task is partially executed (more than 25%) or certain steps are executed with major difficulties necessitating repeated efforts. Part of the task may have had to be modified or needed assistance to make it achievable. Able to perform item number 7: Move down until patient is unable to meet the criteria for the specific task. Unable to perform item number 7: Move up until patient is able to meet the specific criteria for the specific task.	34
8. Elbow at side 90 flexion: supination then pronation.	44
9. Finger flexion then extension.	45
10. Extends elbow in supine (starting with elbow fully flexed). Able to complete the movement in a manner that is comparable to the unaffected side.	46
11. Protract scapula in supine. Able to complete the movement in a manner that is comparable to the unaffected side.	48
12. Can the patient prepare their own meals? Cook meals independently?.	49
13. Feeding independently: The patient can feed him- or herself a meal from a tray or table when someone places the food within reach. The patient is able to put on an assistive device if required, cut up food, use salt and pepper, spread butter, etc. The patient must be able to accomplish this in a reasonable time.	51
14. Hand unsupported: opposition of thumb to little finger.	51
15. Handle coins (unilateral task). The task is partially executed (more than 25%) or certain steps are executed with major difficulties necessitating repeated efforts. Part of the task may have had to be modified or needed assistance to make it achievable.	52
16. Place hand on sacrum. Able to complete the movement in a manner that is comparable to the unaffected side.	53
17. Shrug shoulders (scapular elevation). Able to complete the movement in a manner that is comparable to the unaffected side.	55
18. Can patient perform housework? Without help?	56
19. Dressing and undressing independently. Patient is able to put on, remove and fasten all clothing and tie shoelaces (unless it is necessary to use adaptive aids for this). This includes putting on, removing and fastening corsets or braces when they are prescribed.	56
20. Pick up and move small objects (unilateral task). The task is partially executed (more than 25%) or certain steps are executed with major difficulties necessitating repeated efforts. Part of the task may have had to be modified or needed assistance to make it achievable.	57
21. Write on an envelope and stick a stamp on it (bilateral task). The task is successfully completed without hesitation or difficulty, as instructed or demonstrated.	57

Difficult subtest items:

Item	Score/100
22. In the past two weeks, were you able to cut your food with a knife and fork?	58
23. In the past two weeks, were you able to use your hand that was more affected by your strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to turn a doorknob?	59
24. Pick up and move a jar (unilateral task). The task is successfully completed without hesitation or difficulty, as instructed or demonstrated.	59
25. Unlock a lock and open a pill container (bilateral task). The task is successfully completed without hesitation or difficulty, as instructed or demonstrated.	60
26. In the past two weeks, were you able to do light household tasks/chores (e.g. dust, make a bed, take out garbage, do the dishes)? Just a little or not difficult at all.	61
27. Bathing independently. The patient must be able to use a bathtub, a shower or take a complete sponge bath. The patient must be able to perform all the steps involved in any one of these tasks without another person being present.	63
28. Tie a scarf around one’s neck (bilateral task). The task is successfully completed without hesitation or difficulty, as instructed or demonstrated.	63
29. Hand from knee to forehead 5x in 5 seconds.	64
30. Arm resting at side of body: raise arm overhead with full supination.	64
31. Pronation: tap index finger 10x in 5 seconds	65
32. In the past two weeks, were you able to use your hand that was most affected by your strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to carry heavy objects (e.g. bag of groceries)? (Men)	66
33. Open a jar and remove a spoonful of coffee (bilateral task). The task is successfully completed without hesitation or difficulty, as instructed or demonstrated.	71
34. In the past two weeks, were you able to clip your toenails?	73
35. In the past two weeks, were you able to use your hand that was most affected by your strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to carry heavy objects (e.g. bag of groceries)? (women) Just a little or not difficult at all.	73
36. Elbow at side, 90 degrees flexion: resisted shoulder external rotation. Able to perform item number 36: Move down until patient is unable to meet the criteria for the specific task. Unable to perform test item number 36: Move up until patient is able to meet the criteria for the specific task.	76
37. Thumb to finger tips, then reverse 3x in 12 seconds.	78
38. Number of blocks transferred in 60 seconds > 30	82
39. Clap hands overhead then behind back 3x in 5 seconds.	82
40. Bounce ball 4 times in succession then catch.	93
41. Number of blocks transferred in 60 seconds >60	100

Scoring and Score Interpretation:

The StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder is scored out of 100 and is based on completion of test items. For example, if the patient is able to perform the starting test item (pistol grip, pull trigger), they automatically start at item number 36 in the ‘DIFFICULT items subtest’; items are tested in a sequential order (36, 37, 38, 39…etc); if the patient successfully completes the next three items but is unable to complete item 40 then they receive a score of 82 out of 100 (as indicated in the right hand column beside item 39).

Information on score interpretation is not yet available.

Time:

Not reported.

Training requirements:

None reported.

Equipment:

• Scarf
• Jar with lid
• Coffee
• Pill container
• Manual lock
• Feeding utensils
• Plate, bowl, glass, mug
• Salt and pepper shakers
• Envelope
• Stamp
• Clothing (shirt and pants with buttons)
• Deck of cards
• Coins
• Pen or pencil
• Access to a kitchen and bathroom if observation of tasks is required

Alternative forms of the assessment

None yet reported

Client suitability

Can be used with:

• Clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (mild, moderate and severe) in the acute and sub-acute phase.

Should not be used with:

• Patients greater than 7 months post-stroke until further validation testing is completed.

In what languages is the measure available?

English

Summary

What does the tool measure?	Upper extremity function following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
What types of clients can the tool be used for?	Can be used with clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Is this a screeningTesting for disease in people without symptoms. or assessment tool?	Assessment tool
Time to administer	Not yet reported.
Versions	There are no alternative versions.
Other Languages	There are no official translations.
Measurement Properties
ReliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of “true” variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to “noise” in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .	Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.: One study examined the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder and found internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. to be excellent.
ValidityThe degree to which an assessment measures what it is supposed to measure.	Content: One study examined the content validityRefers to the extent to which a measure represents all aspects of a given social concept. Example: A depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension. of the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder and confirmed the hierarchial sequencing“The coordination and proper ordering of the steps that comprise the task, requiring a proper allotment of attention to each step” (Lezak, 1989; as cited in (Baum, Morrison, Hahn & Edwards, 2007)) of the items using Rasch analysisRasch analysis is a statistical measurement method that allows the measurement of an attribute – such as upper limb function – independently of particular tests or indices.   It creates a linear representation using many individual items, ranked by item difficulty (e.g. picking up a very small item, versus a task requiring a very gross grasp) and person ability.   A well performing Rasch model will have items hierarchically placed from simple to more difficult, and individuals with high abilities should be able to perform all the items below a level of difficulty.  The Rasch model is statistically strong because it enables ordinal measures to be converted into meaningful interval measures. It also allows information from various tests or tools with different scoring systems to be applied using the Rasch model. . Construct: Convergent/Discriminant: One study examined convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other. of the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder and reported excellent correlations between the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder and the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Rehabilitation Assessment of Movement; and poor correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. between the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder and the mental and emotional health subsets of the Medical Outcomes Study Short Form 36. Known Groups: One study examined known groups validityKnown groups validity is a form of construct validation in which the validity is determined by the degree to which an instrument can demonstate different scores for groups know to vary on the variables being measured. and found that the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder could differentiate between the two extremes of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. severity: mild and severe.
Floor/Ceiling Effects	One study examined the floor and ceiling effects and found no floor or ceiling effects in a sample population of patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. ranging from mild to severe. Note: The StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder has only been tested on patients up to 7 months post-stroke.
Does the tool detect change in patients?	Not yet assessed.
Acceptability	Results support preliminary validation of the psychometric properties, however further research is needed before the tool is ready for use clinically.
Feasibility	The administration of the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder is easy and simple to administer. The StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder provides a more comprehensive all-encompassing evaluation tool for evaluation and monitoring“The process of checking the task over time for ‘quality control’ and the adjustment of behavior” (Stuss, 2009, p. 9-10) of upper extremity function.
How to obtain the tool?	Information on the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder can be obtained from the Higgins, Finch, Kopec & Mayo (2011) study.

Psychometric Properties

Overview

A literature search was conducted to identify all relevant publications on the psychometric properties of the StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder and revealed only the initial validation study. Results support preliminary validation of the psychometric properties, however further research is needed before the tool is ready for use clinically.

Floor/Ceiling Effects

Higgins, Finch, Kopec and Mayo (2011) examined the floor and ceiling effects of the StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder in patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. and found no floor or ceiling effects, as no patients scored below or above the easiest and hardest items (respectively).

Note: This sample only included patients up to 7 months post-stroke and thus, the StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder should not be used for patients past 7 months post-stroke until further validation testing is completed.

Reliability

Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.:
Higgins, Finch, Kopec and Mayo (2011) investigated the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder and found excellent internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. (Cronbach’s alpha = 0.97).

Test-retest:
Test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
has not been examined.

Intra-rater:
Intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater’s subsequent ratings are contaminated by knowledge of earlier ratings.
has not been examined.

Inter-rater:
Inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
has not been examined.

Validity

Content:

Higgins, Finch, Kopec and Mayo (2011) investigated the content validityRefers to the extent to which a measure represents all aspects of a given social concept. Example: A depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension.
of the StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder in clients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. In the development of the StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder, 49 items from validated tests and indices used to assess upper extremity function and movement, such as the Box and Block Tests, were selected. Fifteen items were deleted for reasons such as redundancy and lack of fit to the model. When validating the 34 items selected for the final version of the measure, all patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. had fit residuals between -2.0 and +2.0. The hierarchical sequencing"The coordination and proper ordering of the steps that comprise the task, requiring a proper allotment of attention to each step" (Lezak, 1989; as cited in (Baum, Morrison, Hahn & Edwards, 2007))
of the items was confirmed using Rasch analysisRasch analysis is a statistical measurement method that allows the measurement of an attribute - such as upper limb function - independently of particular tests or indices.   It creates a linear representation using many individual items, ranked by item difficulty (e.g. picking up a very small item, versus a task requiring a very gross grasp) and person ability.   A well performing Rasch model will have items hierarchically placed from simple to more difficult, and individuals with high abilities should be able to perform all the items below a level of difficulty.  The Rasch model is statistically strong because it enables ordinal measures to be converted into meaningful interval measures. It also allows information from various tests or tools with different scoring systems to be applied using the Rasch model.
. The results from this study suggest that all 34 items in the StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. and Arm Ladder reflect the same construct.

Criterion:

Concurrent:
Concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.”
has not been examined.

Predictive:
Predictive validityA form of criterion validity that examines a measure's ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.
has not been examined.

Construct:

Convergent/Discriminant:
Higgins, Finch, Kopec and Mayo (2011) investigated the convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
of the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder by comparing it to the index of global functional recovery (total score on the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Rehabilitation Assessment of Movement). Excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
was found between the two measures (r=0.6, P<0.0001). The authors also reviewed the correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
between the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder and the mental and emotional subsets of the Medical Outcomes Study Short Form 36 (SF-36), and found poor correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
(r=0.2, P<0.0001). Results from this study indicate that the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder adequately measures the construct of upper extremity function, with limited ability to assess mental and emotional status following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., as intended by the developers.

Known Groups:
Higgins, Finch, Koppec and Mayo (2011) examined known groups validityKnown groups validity is a form of construct validation in which the validity is determined by the degree to which an instrument can demonstate different scores for groups know to vary on the variables being measured.
of the StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder in patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. were classified as having mild, mild-moderate, moderate or severe strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. using the Canadian Neurological Scale (CNS). Results revealed that the StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder was able to differentiate two out of four different levels of strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. severity: mild and severe Patients classified as having either moderate or severe strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. scored similarly on the measure, as did patients classified as having mild and mild-moderate strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Patients classified as having moderate or severe strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. differed significantly from those classified as having mild or mild-moderate strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., indicating the ability of the StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder to differentiate between the two extremes (mild versus severe).

Sensitivity/ Specificity

Sensititive or specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
has not been examined.

Responsiveness

ResponsivenessThe ability of an instrument to detect clinically important change over time.
has not been examined.

References

• Higgins, J., Finch, L.E., Kopec, J. & Mayo, N.E. (2011). Development and initial psychometric evaluation of the Stroke Arm Ladder: A measure of upper extremity function post stroke. Clinical Rehabilitation, 25(8), 740-759.

See the measure

How to obtain the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder?

The StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Arm Ladder is available in the following article:

Higgins, J., Finch, L.E., Kopec, J. & Mayo, N.E. (2011). Development and initial psychometric evaluation of the Stroke Arm Ladder: A measure of upper extremity function post stroke. Clinical Rehabilitation, 25(8), 740-759.