Appendix A. Stroke Factors ↩

Stroke Control

Appendix B. The cost of stroke to health and social care ↩

Stroke Control

Appendix C. Canadian Stroke Best Practice evidence rating ↩

Canadian Stroke Best Practice Therapy evidence rating

Rating Description
A Evidence from a meta-analysis of randomized controlled trials or consistent findings from two or more randomized controlled trials,
where it is obvious the desirable effects outweigh undesirable effects or undesirable effects outweigh desirable effects
B Evidence from a single randomized controlled trial or consistent findings from two or more well- designed non- randomized and/or non-controlled trials,
and large observational studies. Desirable effects outweigh or are closely balanced with undesirable effects
or undesirable effects outweigh or are closely balanced with desirable effects.
C Writing group consensus and/or supported by limited research evidence.
Desirable effects outweigh or are closely balanced with undesirable effects or undesirable effects outweigh or are closely balanced with desirable effects,
as determined by writing group consensus. Recommendations assigned a Level- C evidence may be key system drivers supporting other recommendations,
and some may be expert opinion based on common, new, or emerging evidence or practice patterns.

Canadian Stroke Best Practice Therapy evidence level.

# Specfic Therapy Evidence Level
i ROM exercises (passive and active-assisted) that includes placement of the upper
limb in a variety of appropriate and safe positions within the patient’s visual field
should be provided. Refer to Recommendation ‘‘Recommendations on
management of shoulder pain and complex regional pain syndrome (CRPS)
following stroke’’ for additional information.
 Level C
ii Following assessment to determine if they are suitable candidates, patients should
be encouraged to engage in mental imagery to enhance upper-limb, sensorimotor
recovery.		 Early-Level A;
Late-Level B
iii Functional Electrical Stimulation (FES) targeted at the wrist and forearm muscles
should be considered to reduce motor impairment and improve function.		 Early-Level A;
Late-Level A
iv Traditional or modified constraint-induced movement therapy should require
consideration for a select group of patients who demonstrate at least 200 of active
wrist extension and 100 of active finger extension, with minimal sensory deficits and
normal cognition.		 Early-Level A;
Late-Level A
v Mirror therapy requires consideration as an adjunct to motor therapy for patients
with very severe paresis. It may help to improve upper extremity motor function
and ADLs.		 Early-Level A;
Late-Level A
vi Despite mixed evidence, sensory stimulation (e.g. transcutaneous electrical nerve
stimulation, acupuncture, biofeedback) can be considered as an adjunct to improve
upper extremity function.		 Evidence Level B
vii Virtual reality, including both immersive technologies such as head-mounted or
robotic interfaces and non- immersive technologies such as gaming devices can be
used as adjunct tools to other rehabilitation therapies as a means to provide
additional opportunities for engagement, feedback, repetition, intensity, and task-
oriented training.		 Evidence Level: Early-Level A;
Late-Level A
viii Therapists should consider supplementary training programs aimed at increasing
the active movement and functional use of the affected arm between therapy
sessions, e.g. Graded Repetitive Arm Supplementary Program suitable for use
during hospitalization and at home.		 Evidence Level: Early-Level B;
Late-Level C
ix Strength training requires consideration for persons with mild to moderate upper
extremity impairment for improvement in grip strength. Strength training does not
aggravate tone or pain.		 Grip strength; Early-Level A; Late-Level A,
Strength training; Level A
x Bilateral arm training is not recommended over unilateral arm training to improve
upper extremity motor function.		 Level A
xi Non-invasive brain stimulation, including repetitive transcranial magnetic stimulation (rTMS)
and transcranial direct current stimulation (tDCS) could be
considered as an adjunct to upper extremity therapy.		 Level A (rTMS); Level B (tDCS)
xii For patients who are unable to produce any voluntary muscle activity in the affected
upper limb, the patient (and caregiver) should be taught compensatory techniques
and be provided with adaptive equipment to enable basic ADLs. It is reasonable to
continue teaching compensatory techniques until the patient can manage basic
ADLs independently or until recovery of active movement occurs.
 Adaptive equipment to enable
basic ADLs (Evidence Level B).
until recovery of active movement
occurs (Evidence Level C).

Appendix D. Intervention, grade of evidence for Outcome ↩

Intervention, grade of evidence for Outcome

Appendix E. Queens Square Upper Limb Fugl-Meyer Results ↩

Queens Square Upper Limb Fugl-Meyer Results

Appendix F. Queen Square UL Summary ↩

Queen Square UL Summary

Appendix G. Interventions reported as used in upper extremity home programs ↩

Interventions reported as used in upper extremity home programs

Appendix H. Measurements ↩

Physical Upper Extremity Measurements

  • ABILHAND, Action Research Arm Test (ARAT)
  • Box and Block Test (BBT)
  • Chedoke Arm and Hand Activity Inventory (CAHAI)
  • Chedoke-McMaster Stroke Assessment, Disabilities of the Arm
  • Shoulder and Hand (DASH)
  • Frenchay Arm Test (FAT)
  • Leeds Adult Spasticity Impact Scale (LASIS)
  • Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES)
  • Nine Hole Peg Test (NHPT)
  • Purdue Pegboard Test (PPT)
  • Stroke Arm Ladder, Stroke Impact Scale (SIS)
  • Upper Extremity Function Test (UEFT)
  • Wolf Motor Function Test (WMFT)

Stroke Severity Measurements

  • Canadian Neurological Scale (CNS)
  • Charlson Comorbidity Index (CCI)
  • Modified Rankin Scale (MRS)

Activities of Daily Living Measurements

  • ADL Profile, Assessment of Motor and Process Skills (AMPS)
  • Barthel Index (BI)
  • Frenchay Activities Index (FAI)
  • Functional Independence Measure (FIM)
  • Multiple Errands Test (MET)
  • Reintegration to Normal Living Index (RNLI)
  • Screening for Self-Medication Safety Post-Stroke Scale (S-5)
  • Stroke Impact Scale (SIS)

Cognition Measurements

  • Cambridge Cognition Examination (CAMCOG)
  • Clock Drawing Test (CDT), Color Trails Test (CTT)
  • Executive Function Performance Test, Kettle Test (KT)
  • Mini-Mental State Examination (MMSE)
  • Montreal Cognitive Assessment (MoCA)
  • Multiple Errands Test (MET), Trail Making Test (TMT)

Mood/ Depression Measurements

  • Aphasic Depression Rating Scale (ADRS)
  • Beck Depression Inventory (BDI, BDI-II)
  • General Health Questionnaire (GHQ- 28)
  • Geriatric Depression Scale (GDS)
  • Hospital Anxiety and Depression Scale (HADS)
  • Montgomery Asberg Depression Rating Scale (MADRS)
  • Patient Health Questionnaire (PHQ-9)
  • Stroke Aphasic Depression Questionnaire (SADQ)

Quality of Life Measurements

  • Medical Outcomes Study Short Form 36 (SF-36)
  • Stroke Specific Quality of Life Scale (SS-QOL)
  • Stroke-Adapted Sickness Impact Profile (SA-SIP30)

System Measurements

  • Immersive Tendencies Questionnaire (ITQ)
  • Presence Questionnaire (PQ), Simulator Sickness Questionnaire (SSQ)
  • User Experience Questionnaire (UEQ)