Arm and Trunk Movement Kinematics During Seated Reaching Within and Beyond Arm's Length in People With Stroke: A Validity Study (original) (raw)
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...
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 ...
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.
Systematic Review on Kinematic Assessments of Upper Limb Movements After Stroke
Stroke, 2019
Background and Purpose— Assessing upper limb movements poststroke is crucial to monitor and understand sensorimotor recovery. Kinematic assessments are expected to enable a sensitive quantification of movement quality and distinguish between restitution and compensation. The nature and practice of these assessments are highly variable and used without knowledge of their clinimetric properties. This presents a challenge when interpreting and comparing results. The purpose of this review was to summarize the state of the art regarding kinematic upper limb assessments poststroke with respect to the assessment task, measurement system, and performance metrics with their clinimetric properties. Subsequently, we aimed to provide evidence-based recommendations for future applications of upper limb kinematics in stroke recovery research. Methods— A systematic search was conducted in PubMed, Embase, CINAHL, and IEEE Xplore. Studies investigating clinimetric properties of applied metrics were...
BioMed Research International, 2014
Advanced rehabilitation strategies of the upper limb in stroke patients focus on the recovery of the most important daily activities. In this study we analyzed quantitatively and qualitatively the motor strategies employed by stroke patients when reaching and drinking from a glass. We enrolled 6 hemiparetic poststroke patients and 6 healthy subjects. Motion analysis of the task proposed (reaching for the glass, bringing it to the mouth, and putting it back on the table) with the affected limb was performed. Clinical assessment using the Fugl-Meyer Assessment for Upper Extremity was also included. During the reaching for the glass the patients showed a reduced arm elongation and trunk axial rotation due to motor deficit. For this reason, as observed, they carried out compensatory strategies which included trunk forward displacement and head movements. These preliminary data should be considered to address rehabilitation treatment. Moreover, the kinematic analysis protocol developed might represent an outcome measure of upper limb rehabilitation processes.
Journal of NeuroEngineering and Rehabilitation, 2022
Background Upper limb kinematic assessments provide quantifiable information on qualitative movement behavior and limitations after stroke. A comprehensive characterization of spatiotemporal kinematics of stroke subjects during upper limb daily living activities is lacking. Herein, kinematic expressions were investigated with respect to different movement types and impairment levels for the entire task as well as for motion subphases. Method Chronic stroke subjects with upper limb movement impairments and healthy subjects performed a set of daily living activities including gesture and grasp movements. Kinematic measures of trunk displacement, shoulder flexion/extension, shoulder abduction/adduction, elbow flexion/extension, forearm pronation/supination, wrist flexion/extension, movement time, hand peak velocity, number of velocity peaks (NVP), and spectral arc length (SPARC) were extracted for the whole movement as well as the subphases of reaching distally and proximally. The effe...
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.
Journal of neuroengineering and rehabilitation, 2015
Various robotic technologies have been developed recently for objective and quantitative assessment of movement. Among them, robotic measures derived from a reaching task in the KINARM Exoskeleton device are characterized by their potential to reveal underlying motor control in reaching movements. The aim of this study was to examine the clinical usefulness and validity of these robot-derived measures in hemiparetic stroke patients. Fifty-six participants with a hemiparetic arm due to chronic stroke were enrolled. The robotic assessment was performed using the Visually Guided Reaching (VGR) task in the KINARM Exoskeleton, which allows free arm movements in the horizontal plane. Twelve parameters were derived based on motor control theory. The following clinical assessments were also administered: the proximal upper limb section in the Fugl-Meyer Assessment (FMA-UE(A)), the proximal upper limb part in the Stroke Impairment Assessment Set (SIAS-KM), the Modified Ashworth Scale for the...