Arm and Trunk Movement Kinematics During Seated Reaching Within and Beyond Arm's Length in People With Stroke: A Validity Study (original) (raw)
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Physical Therapy & Rehabilitation Journal, 2014
Background. Kinematic analysis is commonly used to objectively measure upper extremity movement performance after stroke. However, the concurrent validity and predictive validity of arm-trunk kinematics during reaching within and beyond arm’s length have not been studied. Objective. The aim of this study was to estimate the concurrent validity of kinematic measures before and after treatment and the predictive validity for reaching within and beyond arm’s length after stroke. Design. This was a secondary analysis study. Methods. Ninety-seven participants with stroke (mean age55.9 years [SD10.9]) received intensive treatment every weekday for 3 to 4 weeks. Kinematic reaching tasks and the Wolf Motor Function Test (WMFT) were used before and after treatment. The validity of the kinematic measures was estimated in relation to WMFT scores. Results. Of the 8 kinematic variables that were measured, index movement time before treatment (R2.227–.362) and trunk movement time and trunk displacement after treatment (R2.095–.346) had the strongest association with the WMFT at both reaching distances. Trunk movement time and trunk displacement before treatment explained 6.9% to 14.9% of the variance in the WMFT after treatment. Kinematic variables explained 6.9% to 49.3% and 9.4% to 38.7% of the variance in the WMFT during a task within arm’s length and beyond arm’s length, respectively. Limitations. The study has limited generalizability. Conclusions. Different kinematic variables may partially reflect motor function before and after treatment to a limited degree. Although the predictive validity was modest, trunk movement may be considered a prognostic determinant of motor function after treatment. A reaching task within arm’s length may be a more suitable measure of kinematic performance for describing motor function than a reaching task beyond arm’s length.
Archives of Physical Medicine and Rehabilitation, 2015
3 Objective: This study examined the concurrent and predictive validity of measurements of 4 kinematic variables in reaching tasks with and without a trunk constraint in individuals with 5 stroke. Design: Secondary data analysis from randomized controlled trials. Settings: 6 Participants received training in the hospitals and assessments in the laboratory. Participants: 7 95 individuals with stroke enrolled in previous and ongoing clinical trials. Interventions: 8 Upper limb training protocols were 90 to 120 minutes of intervention every weekday for 3 to 9 4 weeks. Main Outcome Measures: Functional capacity was assessed by the Action 10 Research Arm Test (ARAT) and motor impairment by the Fugl-Meyer Assessment for the 11 Upper Extremities (FMA-UE). Movement kinematics were measured during a reaching task 12 with and without a trunk constraint. We derived 5 end point control variables and 3 joint 13 recruitment variables for estimating concurrent and predictive validity. Results: The adjusted 14 R 2 values for the constraint tasks ranged from .24 to .38 and for the unconstraint ones 15 from .29 to .40. Movement time was the most prominent kinematic variable to the FMA-UE 16 before and after the intervention (P < .05). For ARAT, movement time and end point 17 displacement were the most significant variables pre and post intervention, respectively (P < 18 .05). Conclusions: Obtaining kinematic performance during an unconstrained task is 19 appropriate and possibly sufficient to represent motor impairment and functional capacity of 20 individuals with stroke. Movement time is the dominant variable associated with motor 21 impairment and functional capacity, and end point displacement is unique to reflect 22 functional capacity for individuals with stroke. 23 24 versus bilateral arm training on motor performance, daily functions, and quality of life in stroke survivors. Neurorehabil Neural Repair 2009, 23(5):441-448. 7. Lin KC, Wu CY, Liu JS, Chen YT, Hsu CJ: Constraint-induced therapy versus dose-matched control intervention to improve motor ability, basic/extended daily functions, and quality of life in stroke. Neurorehabil Neural Repair 2009, 23(2):160-165. Clinical Practice. 3 edition. Baltimore, MD: Lippincott Williams & Wilkins; 2007. 15. Adamovich SV, Berkinblit MB, Hening W, Sage J, Poizner H: The interaction of visual and proprioceptive inputs in pointing to actual and remembered targets in Parkinson's disease. Neuroscience 2001, 104(4):1027-1041. 16. Alt Murphy M, Sunnerhagen KS, Johnels B, Willen C: Three-dimensional kinematic motion analysis of a daily activity drinking from a glass: a pilot study. J Neuroeng Rehabil 2006, 3:18. Postural dynamics and the preferred critical boundary for visually guided reaching. J Exp Psychol Hum Percept Perform 1997, 23(5):1365-1379. 24. Levin MF, Michaelsen SM, Cirstea CM, Roby-Brami A: Use of the trunk for reaching targets placed within and beyond the reach in adult hemiparesis. Exp Brain Res 2002, 143(2):171-180. 25. Michaelsen SM, Luta A, Roby-Brami A, Levin MF: Effect of trunk restraint on the recovery of reaching movements in hemiparetic patients. Stroke 2001, 32(8):1875-1883. Marshall RS, Mazzoni P, Lennihan L et al: Improvement after constraint-induced movement therapy: recovery of normal motor control or task-specific compensation? Neurorehabil Neural Repair 2013, 27(2):99-109. 27. Wagner JM, Dromerick AW, Sahrmann SA, Lang CE: Upper extremity muscle activation during recovery of reaching in subjects with post-stroke hemiparesis. Clin Neurophysiol 2007, 118(1):164-176. 28. Wu CY, Chuang LL, Lin KC, Chen HC, Tsay PK: Randomized trial of distributed constraint-induced therapy versus bilateral arm training for the rehabilitation of upper-limb motor control and function after stroke. Neurorehabil Neural Repair 2011, 25(2):130-139. 29. van Dokkum L, Hauret I, Mottet D, Froger J, Metrot J, Laffont I: The contribution of kinematics in the assessment of upper limb motor recovery early after stroke. Neurorehabil Neural Repair 2014, 28(1):4-12. 30. Wu CY, Chen YA, Chen HC, Lin KC, Yeh IL: Pilot trial of distributed constraint-induced therapy with trunk restraint to improve poststroke reach to grasp and trunk kinematics. Neurorehabil Neural Repair 2012, 26(3):247-255. 31. Ellis MD, Sukal T, DeMott T, Dewald JP: Augmenting clinical evaluation of hemiparetic arm movement with a laboratory-based quantitative measurement of kinematics as a function of limb loading. Neurorehabil Neural Repair 2008, 22(4):321-329. 32. Alt Murphy M, Willen C, Sunnerhagen KS: Movement kinematics during a drinking task are associated with the activity capacity level after stroke. Neurorehabil Neural Repair 2012, 26(9):1106-1115. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 21 33. Bosecker C, Dipietro L, Volpe B, Krebs HI: Kinematic robot-based evaluation scales and clinical counterparts to measure upper limb motor performance in patients with chronic stroke. Neurorehabil Neural Repair 2010, 24(1):62-69. 34. Chang JJ, Yang YH, Wu WL, Guo LY, Su FC: The Constructs of Kinematic Measures for Reaching Performance in Stroke Patients. Journal of Medical and Biological Engineering 2008, 28(2):65-70. 35. Metrot J, Froger J, Hauret I, Mottet D, van Dokkum L, Laffont I: Motor recovery of the ipsilesional upper limb in subacute stroke. Arch Phys Med Rehabil 2013, 94(11):2283-2290.
American journal of physical medicine & rehabilitation, 2017
The aim of this study was to examine the effect of target distance (within vs. beyond arm's length) on arm and trunk movements during symmetric bilateral reaching in patients with stroke. Eighteen stroke patients and 18 age-matched control participants reached bilaterally to press desk bells placed at 90% and 125% of arm's length. The kinematics of paretic arm and trunk movements and trunk contribution slopes were measured in the start, mid, and end phases of reaching. Target distance significantly affected arm (shoulder flexion and abduction, elbow extension) and trunk (flexion, rotation, and lateral shift) movements in patients with stroke. Significant group differences were also found in trunk contribution slopes in the start and mid phases of reaching to targets beyond arm's length. Bilateral reaching for targets beyond arm's length may increase shoulder flexion, shoulder abduction, elbow extension, and trunk flexion, but it may also induce unsymmetric trunk rota...
Kinematic Manifestation of Arm-Trunk Performance during Symmetric Bilateral Reaching After Stroke
Am J Phys Med Rehabil, 2017
The aim of this study was to examine the effect of target distance (within vs. beyond arm's length) on arm and trunk movements during symmetric bilateral reaching in patients with stroke. Design: Eighteen stroke patients and 18 age-matched control participants reached bilaterally to press desk bells placed at 90% and 125% of arm's length. The kinematics of paretic arm and trunk movements and trunk contribution slopes were measured in the start, mid, and end phases of reaching. Results: Target distance significantly affected arm (shoulder flexion and abduction, elbow extension) and trunk (flexion, rotation, and lateral shift) movements in patients with stroke. Significant group differences were also found in trunk contribution slopes in the start and mid phases of reaching to targets beyond arm's length. Conclusions: Bilateral reaching for targets beyond arm's length may increase shoulder flexion, shoulder abduction, elbow extension, and trunk flexion, but it may also induce unsymmetric trunk rotation and lateral shift to the paretic side, as well as early and excessive trunk contributions in patients with stroke. The findings suggest that for beyond-arm-length reaching, therapists may restrain the trunk until the end phase of reaching and prevent trunk rotation and lateral shift to the paretic side.
Sensors, 2021
Effective control of trunk muscles is fundamental to perform most daily activities. Stroke affects this ability also when sitting, and the Modified Functional Reach Test is a simple clinical method to evaluate sitting balance. We characterize the upper body kinematics and muscular activity during this test. Fifteen chronic stroke survivors performed twice, in separate sessions, three repetitions of the test in forward and lateral directions with their ipsilesional arm. We focused our analysis on muscles of the trunk and of the contralesional, not moving, arm. The bilateral activations of latissimi dorsi, trapezii transversalis and oblique externus abdominis were left/right asymmetric, for both test directions, except for the obliquus externus abdominis in the frontal reaching. Stroke survivors had difficulty deactivating the contralesional muscles at the end of each trial, especially the trapezii trasversalis in the lateral direction. The contralesional, non-moving arm had muscular ...
Gait & Posture, 2015
Research question: The aims of this study were: (a) quantify the upper limb impairments in post-stroke patients; (b) quantitatively evaluate the effectiveness of an upper limb rehabilitation program; (c) gain more clinically meaningful information using kinematic analysis in addition to clinical assessment. Introduction: The motor functions and the effects of rehabilitative treatments are measured using clinical tests and semi-quantitative scale. The same motor behavior can be analyzed using instrumental kinematic tools that provide qualitative and quantitative information. Materials and methods: A group of 10 post-stroke patients was treated with an integrated rehabilitative program (including upper limb training); a second group of 5 post-stroke patients was treated with conventional physiotherapy. Treatment for both groups includes ten session lasting an hour and a half a day. Kinematic analysis was performed by an optoelectronic system (Vicon, UK). The subjects were asked to reach an object in a standardized setting. The task was repeated 12 times (six movements, right and left). Kinematic analysis was conducted identifying and computing specific parameters of movement duration, velocity, smoothness and upper limbs angles [1,2]. The clinical scales were Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES), Nine Hole Peg Test (NHPT) and Hand Grip Dynamometer test. All patients were assessed PRE and POST treatment. The comparison between the two sessions was done using non parametric tests (p < 0.05). Results: The upper limb kinematics evaluation showed that in PRE session the most of parameters of both groups were different from the normality ranges, with no differences between the two groups. In particular, they executed the movement slower, with higher movement duration, and with lower precision. After the treatment in the first group we found significant improvements in terms of movement duration, in particular during going phase (1.3 vs. 1.
Elbow Extension Predicts Motor Impairment and Performance after Stroke
Background and Purpose. Kinematic motion analysis has helped to characterize poststroke reaching strategies with the hemiparetic arm. However, the relationships between reaching strategy and performance on common functional outcome measures remain unclear. Methods. Thirty-five participants were tested for motor performance and motor impairment using the Wolf Motor Function Test (time and functional ability measure) and Fugl-Meyer assessment, respectively. Kinematic motion analysis of a forward reaching paradigm provided potential predictors of reaching strategy including shoulder flexion, elbow extension, and trunk displacement. A stepwise linear regression model with three potential predictors was used in addition to Pearson-product moment correlations. Results. Kinematic analysis of elbow extension predicted performance on both the Wolf Motor Function Test and Fugl-Meyer assessment. Shoulder flexion and trunk displacement did not significantly predict functional or reaching time outcomes. The Wolf Motor Function Test and the Fugl-Meyer assessment were highly correlated. Conclusions. The ability to incorporate elbow extension during reach is a significant predictor of motor performance and hemiparetic arm motor capacity after stroke.
Experimental Brain Research, 2003
The effects of short-term, constant practice on the kinematics of a multi-joint pointing movement were studied in the hemiparetic arm of 20 chronic patients with unilateral left cerebro-vascular accident (CVA) and in 10 age-and sex-matched healthy individuals. Practice consisted of a single session of 70 pointing movements made with the right arm. Movements were made from a target located beside the body to one in the contralateral workspace, in front of the body. Vision of the final hand position was allowed after every 5 th trial. At the beginning of practice, stroke patients made slower, less precise and more segmented movements, characterised by smaller active ranges of elbow and shoulder motion, disrupted elbow-shoulder coordination, as well as greater trunk movement compared with healthy subjects. With practice, healthy subjects and some patients made faster and more precise movements. These tendencies were revealed only after many repetitions (up to 55 for those with severe hemiparesis), whereas changes in healthy individuals occurred after fewer trials (approximately 20). In addition, the patients decreased movement segmentation with practice. In healthy subjects, faster movement times may be attributed to better shoulder/elbow movement timing in the first half of the reach, whereas improvement of precision was not correlated with any changes in the movement variables. In patients, improvements were accomplished differently depending on arm motor severity. For some patients with mild-to-moderate clinical symptoms, practice resulted in better timing of shoulder/ elbow movements with less trunk rotation in middle to late reach. Patients with more severe impairment also improved shoulder/elbow movement timing in mid-reach but used more compensatory trunk rotation. The results suggest that even one session of repetitive practice of a multi-joint pointing task leads to improvements in movement performance-based outcome measures, but the mechanisms of improvement may vary with the individual's level of motor impairment.