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de Andrade FPPV, de Freitas SMSF, Giangiardi VF, Banjai RM, Alouche SR. Aiming Movement After Stroke: Do Time-Since-Injury and Impairment Severity Influence Ipsilateral Performance? Percept Mot Skills 2023; 130:2069-2086. [PMID: 37442542 DOI: 10.1177/00315125231189339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
In this cross-sectional study, we evaluated post-stroke ipsilesional (less affected) upper limb aiming movement in individuals whose strokes were either 2-5 months (n = 16) or >6 months (n = 17) prior to our testing; we also compared both stroke groups to a control group of healthy individuals (n = 14). We evaluated the participants' level of movement impairment in the contralateral upper limb from the site of the cerebrovascular lesion as an indicator of the severity of the participants' impairment. Participants were asked to move a stylus on a tablet with their ipsilesional upper limb according to a visual stimulus seen on a monitor. Those who had experienced more recent strokes showed poorer movement planning and execution, regardless of their impairment level. Since the stroke occurred, the amount of time was significantly associated with the ipsilesional aiming movement, and improvement over time brought performance levels closer to that of healthy controls.
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Affiliation(s)
- Flávia Priscila Paiva Vianna de Andrade
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- School of Physical Therapy, Universidade do Vale do Sapucaí, Pouso Alegre, Brazil
| | | | - Vivian Farahte Giangiardi
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- School of Physical Therapy, Universidade de Ribeirão Preto, Guarujá, Brazil
| | - Renata Morales Banjai
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- School of Physical Therapy, Universidade de Ribeirão Preto, Guarujá, Brazil
- School of Physical Therapy, Universidade Santa Cecília, Santos, Brazil
| | - Sandra Regina Alouche
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
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2
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Šlajpah S, Čebašek E, Munih M, Mihelj M. Time-Based and Path-Based Analysis of Upper-Limb Movements during Activities of Daily Living. SENSORS (BASEL, SWITZERLAND) 2023; 23:1289. [PMID: 36772329 PMCID: PMC9919622 DOI: 10.3390/s23031289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
Patients after stroke need to re-learn functional movements required for independent living throughout the rehabilitation process. In the study, we used a wearable sensory system for monitoring the movement of the upper limbs while performing activities of daily living. We implemented time-based and path-based segmentation of movement trajectories and muscle activity to quantify the activities of the unaffected and the affected upper limbs. While time-based segmentation splits the trajectory in quants of equal duration, path-based segmentation isolates completed movements. We analyzed the hand movement path and forearm muscle activity and introduced a bimanual movement parameter, which enables differentiation between unimanual and bimanual activities. The approach was validated in a study that included a healthy subject and seven patients after stroke with different levels of disabilities. Path-based segmentation provides a more detailed and comprehensive evaluation of upper limb activities, while time-based segmentation is more suitable for real-time assessment and providing feedback to patients. Bimanual movement parameter effectively differentiates between different levels of upper limb involvement and is a clear indicator of the activity of the affected limb relative to the unaffected limb.
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Pohl J, Ryser A, Veerbeek JM, Verheyden G, Vogt JE, Luft AR, Awai Easthope C. Classification of functional and non-functional arm use by inertial measurement units in individuals with upper limb impairment after stroke. Front Physiol 2022; 13:952757. [PMID: 36246133 PMCID: PMC9554104 DOI: 10.3389/fphys.2022.952757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Arm use metrics derived from wrist-mounted movement sensors are widely used to quantify the upper limb performance in real-life conditions of individuals with stroke throughout motor recovery. The calculation of real-world use metrics, such as arm use duration and laterality preferences, relies on accurately identifying functional movements. Hence, classifying upper limb activity into functional and non-functional classes is paramount. Acceleration thresholds are conventionally used to distinguish these classes. However, these methods are challenged by the high inter and intra-individual variability of movement patterns. In this study, we developed and validated a machine learning classifier for this task and compared it to methods using conventional and optimal thresholds. Methods: Individuals after stroke were video-recorded in their home environment performing semi-naturalistic daily tasks while wearing wrist-mounted inertial measurement units. Data were labeled frame-by-frame following the Taxonomy of Functional Upper Limb Motion definitions, excluding whole-body movements, and sequenced into 1-s epochs. Actigraph counts were computed, and an optimal threshold for functional movement was determined by receiver operating characteristic curve analyses on group and individual levels. A logistic regression classifier was trained on the same labels using time and frequency domain features. Performance measures were compared between all classification methods. Results: Video data (6.5 h) of 14 individuals with mild-to-severe upper limb impairment were labeled. Optimal activity count thresholds were ≥20.1 for the affected side and ≥38.6 for the unaffected side and showed high predictive power with an area under the curve (95% CI) of 0.88 (0.87,0.89) and 0.86 (0.85, 0.87), respectively. A classification accuracy of around 80% was equivalent to the optimal threshold and machine learning methods and outperformed the conventional threshold by ∼10%. Optimal thresholds and machine learning methods showed superior specificity (75-82%) to conventional thresholds (58-66%) across unilateral and bilateral activities. Conclusion: This work compares the validity of methods classifying stroke survivors' real-life arm activities measured by wrist-worn sensors excluding whole-body movements. The determined optimal thresholds and machine learning classifiers achieved an equivalent accuracy and higher specificity than conventional thresholds. Our open-sourced classifier or optimal thresholds should be used to specify the intensity and duration of arm use.
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Affiliation(s)
- Johannes Pohl
- Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Leuven, Belgium
| | - Alain Ryser
- Department of Computer Science, ETH Zurich, Zurich, Switzerland
| | | | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Leuven, Belgium
| | | | - Andreas Rüdiger Luft
- Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Chris Awai Easthope
- Cereneo Foundation, Center for Interdisciplinary Research (CEFIR), Vitznau, Switzerland
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4
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Razak RA, Hannanu FF, Naegele B, Hommel MJG, Detante O, Jaillard A. Ipsilateral hand impairment predicts long-term outcome in patients with subacute stroke. Eur J Neurol 2022; 29:1983-1993. [PMID: 35276028 DOI: 10.1111/ene.15323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ipsilateral hand (ILH) impairment is documented following motor stroke, but its impact on long-term outcome remains unknown. We assessed ILH impairment in subacute stroke and tested whether ILH impairment predicted long-term outcome. METHODS We performed a longitudinal study in 209 consecutive patients with unilateral stroke and sensorimotor deficit at admission. ILH impairment was evaluated using Purdue Pegboard Test (PPT) and handgrip strength and defined as mild (z-score <-1) or moderate (z-score <-1.65). We used logistic regression (LR) to predict outcome assessed 9 (7-12) months post-stroke with the modified Rankin scale (mRS) categorized into good (mRS≤1) and poor outcome (mRS≥2). For internal validation, LR-bootstrapping, and cross-validation with Lasso and Random-Forest were performed. RESULTS ILH impairment assessed at 89.04 ±45.82 days post-stroke was moderate in 10.53% (95% CI, 6.7, 14.83) for PPT and 17.22% (95% CI, 11.96, 22.49) for grip, and mild in 21.05% (95% CI, 15.78, 26.79) for PPT and 35.89 (95% CI, 29.67, 42.58) for grip. Good outcome was predicted by ILH-PPT (B=1.03 [95% CI, 0.39, 3.31]), ILH-grip (B=1.16 [95% CI, 0.54, 3.53]), low NIHSS-discharge (B=-1.57, [95% CI, -4.0, -1.19]), and no depression (B=-0.62, [95% CI, -1.63, -0.43]), accounting for stroke delay (B=-0.011, [95% CI, -0.06, 0.01]). Model efficiency was 91.6% (AUC=0.977, 95%CI, 0.959, 0.996). Lasso and Random-Forest methods provided similar results, confirming the LR model robustness. CONCLUSIONS ILH impairment is frequent after motor stroke and predicts long-term outcome. We propose to integrate ILH impairment in rehabilitation programs to improve recovery and serve research interventions such as neuromodulation.
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Affiliation(s)
- Rien Anggraini Razak
- AGEIS, EA 7407, Université Grenoble Alpes (UGA), Grenoble, France.,Unité IRM 3T Recherche - IRMaGe, Inserm-US17-CNRS-UMS-3552, UGA, Centre Hospitalier Universitaire de Grenoble Alpes (CHUGA), France.,Medical Faculty of Hasanuddin University, Makassar, Indonesia
| | - Firdaus Fabrice Hannanu
- AGEIS, EA 7407, Université Grenoble Alpes (UGA), Grenoble, France.,Unité IRM 3T Recherche - IRMaGe, Inserm-US17-CNRS-UMS-3552, UGA, Centre Hospitalier Universitaire de Grenoble Alpes (CHUGA), France.,Medical Faculty of Hasanuddin University, Makassar, Indonesia
| | | | - Marc J G Hommel
- AGEIS, EA 7407, Université Grenoble Alpes (UGA), Grenoble, France
| | | | - Assia Jaillard
- AGEIS, EA 7407, Université Grenoble Alpes (UGA), Grenoble, France.,Unité IRM 3T Recherche - IRMaGe, Inserm-US17-CNRS-UMS-3552, UGA, Centre Hospitalier Universitaire de Grenoble Alpes (CHUGA), France.,Pôle Recherche, CHUGA
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5
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Yamagami M, Junuzovic S, Gonzalez-Franco M, Ofek E, Cutrell E, Porter JR, Wilson AD, Mott ME. Two-In-One: A Design Space for Mapping Unimanual Input into Bimanual Interactions in VR for Users with Limited Movement. ACM TRANSACTIONS ON ACCESSIBLE COMPUTING 2022. [DOI: 10.1145/3510463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Virtual Reality (VR) applications often require users to perform actions with two hands when performing tasks and interacting with objects in virtual environments. Although bimanual interactions in VR can resemble real-world interactions—thus increasing realism and improving immersion—they can also pose significant accessibility challenges to people with limited mobility, such as for people who have full use of only one hand. An opportunity exists to create accessible techniques that take advantage of users’ abilities, but designers currently lack structured tools to consider alternative approaches. To begin filling this gap, we propose Two-in-One, a design space that facilitates the creation of accessible methods for bimanual interactions in VR from unimanual input. Our design space comprises two dimensions, bimanual interactions and computer assistance, and we provide a detailed examination of issues to consider when creating new unimanual input techniques that map to bimanual interactions in VR. We used our design space to create three interaction techniques that we subsequently implemented for a subset of bimanual interactions and received user feedback through a video elicitation study with 17 people with limited mobility. Our findings explore complex tradeoffs associated with autonomy and agency and highlight the need for additional settings and methods to make VR accessible to people with limited mobility.
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Affiliation(s)
| | | | | | - Eyal Ofek
- Microsoft Research, Redmond, Washington, USA
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6
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Bernaldo de Quirós M, Douma E, van den Akker-Scheek I, Lamoth CJC, Maurits NM. Quantification of Movement in Stroke Patients under Free Living Conditions Using Wearable Sensors: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:1050. [PMID: 35161796 PMCID: PMC8840016 DOI: 10.3390/s22031050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 05/06/2023]
Abstract
Stroke is a main cause of long-term disability worldwide, placing a large burden on individuals and health care systems. Wearable technology can potentially objectively assess and monitor patients outside clinical environments, enabling a more detailed evaluation of their impairment and allowing individualization of rehabilitation therapies. The aim of this review is to provide an overview of setups used in literature to measure movement of stroke patients under free living conditions using wearable sensors, and to evaluate the relation between such sensor-based outcomes and the level of functioning as assessed by existing clinical evaluation methods. After a systematic search we included 32 articles, totaling 1076 stroke patients from acute to chronic phases and 236 healthy controls. We summarized the results by type and location of sensors, and by sensor-based outcome measures and their relation with existing clinical evaluation tools. We conclude that sensor-based measures of movement provide additional information in relation to clinical evaluation tools assessing motor functioning and both are needed to gain better insight in patient behavior and recovery. However, there is a strong need for standardization and consensus, regarding clinical assessments, but also regarding the use of specific algorithms and metrics for unsupervised measurements during daily life.
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Affiliation(s)
- Mariano Bernaldo de Quirós
- Department of Neurology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands;
| | - E.H. Douma
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (E.H.D.); (C.J.C.L.)
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands;
| | - Claudine J. C. Lamoth
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (E.H.D.); (C.J.C.L.)
| | - Natasha M. Maurits
- Department of Neurology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands;
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7
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van Dun K, Brinkmann P, Depestele S, Verstraelen S, Meesen R. Cerebellar Activation During Simple and Complex Bimanual Coordination: an Activation Likelihood Estimation (ALE) Meta-analysis. THE CEREBELLUM 2021; 21:987-1013. [PMID: 34595608 DOI: 10.1007/s12311-021-01261-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 11/25/2022]
Abstract
Bimanual coordination is an important part of everyday life and recruits a large neural network, including the cerebellum. The specific role of the cerebellum in bimanual coordination has not yet been studied in depth, although several studies indicate a differential role of the anterior and posterior cerebellum depending on the complexity of the coordination. An activation likelihood estimation (ALE) meta-analysis was used combining the data of several functional MRI studies involving bimanual coordination tasks with varying complexities to unravel the involvement of the different areas of the cerebellum in simple and complex bimanual coordination. This study confirms the general bimanual network as found by Puttemans et al. (Puttemans et al. in J Neurosci 25:4270-4278, 2005) and highlights the differences between preferred in-phase (simultaneous movements of homologous muscle groups) and anti-phase movement conditions (alternating movements of homologous muscle groups), and more complex, non-preferred bimanual movements (e.g., out-of-phase movements). Our results show a differential role for the anterior and posterior vermis in bimanual coordination, with a role for the anterior vermis in anti-phase and complex bimanual coordination, and an exclusive role for the posterior vermis in complex bimanual movements. In addition, the way complexity was manipulated also seems to play a role in the involvement of the anterior and posterior vermis. We hypothesize that the anterior vermis is involved in sequential/spatial control, while the posterior vermis is involved in temporal control of (bimanual) coordination, though other factors such as (visual) feedback and continuity of the movement also seem to have an impact. More studies are needed to unravel the specific role of the cerebellar vermis in bimanual coordination.
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Affiliation(s)
- Kim van Dun
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Agoralaan A, 3590, Diepenbeek, Belgium.
| | - Pia Brinkmann
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - Siel Depestele
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Agoralaan A, 3590, Diepenbeek, Belgium
| | - Stefanie Verstraelen
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Agoralaan A, 3590, Diepenbeek, Belgium
| | - Raf Meesen
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Agoralaan A, 3590, Diepenbeek, Belgium.,Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
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8
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David A, ReethaJanetSureka S, Gayathri S, Annamalai SJ, Samuelkamleshkumar S, Kuruvilla A, Magimairaj HP, Varadhan S, Balasubramanian S. Quantification of the relative arm use in patients with hemiparesis using inertial measurement units. J Rehabil Assist Technol Eng 2021; 8:20556683211019694. [PMID: 34290880 PMCID: PMC8273871 DOI: 10.1177/20556683211019694] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 05/05/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Accelerometry-based activity counting for measuring arm use is prone to overestimation due to non-functional movements. In this paper, we used an inertial measurement unit (IMU)-based gross movement (GM) score to quantify arm use. Methods In this two-part study, we first characterized the GM by comparing it to annotated video recordings of 5 hemiparetic patients and 10 control subjects performing a set of activities. In the second part, we tracked the arm use of 5 patients and 5 controls using two wrist-worn IMUs for 7 and 3 days, respectively. The IMU data was used to develop quantitative measures (total and relative arm use) and a visualization method for arm use. Results From the characterization study, we found that GM detects functional activities with 50–60% accuracy and eliminates non-functional activities with >90% accuracy. Continuous monitoring of arm use showed that the arm use was biased towards the dominant limb and less paretic limb for controls and patients, respectively. Conclusions The gross movement score has good specificity but low sensitivity in identifying functional activity. The at-home study showed that it is feasible to use two IMU-watches to monitor relative arm use and provided design considerations for improving the assessment method. Clinical trial registry number: CTRI/2018/09/015648
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Affiliation(s)
- Ann David
- Department of Applied Mechanics, Indian Institute of Technology, Madras, Tamil Nadu, India.,Department of Bioengineering, Christian Medical College (CMC) Vellore, Tamil Nadu, India
| | | | - Sankaralingam Gayathri
- Department of Physical Medicine and Rehabilitation, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | | | - Selvaraj Samuelkamleshkumar
- Department of Physical Medicine and Rehabilitation, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Anju Kuruvilla
- Department of Psychiatry, Christian Medical College (CMC) Vellore, Tamil Nadu, India
| | - Henry Prakash Magimairaj
- Department of Physical Medicine and Rehabilitation, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Skm Varadhan
- Department of Applied Mechanics, Indian Institute of Technology, Madras, Tamil Nadu, India
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9
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Maenza C, Wagstaff DA, Varghese R, Winstein C, Good DC, Sainburg RL. Remedial Training of the Less-Impaired Arm in Chronic Stroke Survivors With Moderate to Severe Upper-Extremity Paresis Improves Functional Independence: A Pilot Study. Front Hum Neurosci 2021; 15:645714. [PMID: 33776672 PMCID: PMC7994265 DOI: 10.3389/fnhum.2021.645714] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/23/2021] [Indexed: 01/22/2023] Open
Abstract
The ipsilesional arm of stroke patients often has functionally limiting deficits in motor control and dexterity that depend on the side of the brain that is lesioned and that increase with the severity of paretic arm impairment. However, remediation of the ipsilesional arm has yet to be integrated into the usual standard of care for upper limb rehabilitation in stroke, largely due to a lack of translational research examining the effects of ipsilesional-arm intervention. We now ask whether ipsilesional-arm training, tailored to the hemisphere-specific nature of ipsilesional-arm motor deficits in participants with moderate to severe contralesional paresis, improves ipsilesional arm performance and generalizes to improve functional independence. We assessed the effects of this intervention on ipsilesional arm unilateral performance [Jebsen–Taylor Hand Function Test (JHFT)], ipsilesional grip strength, contralesional arm impairment level [Fugl–Meyer Assessment (FM)], and functional independence [Functional independence measure (FIM)] (N = 13). Intervention occurred over a 3 week period for 1.5 h/session, three times each week. All sessions included virtual reality tasks that targeted the specific motor control deficits associated with either left or right hemisphere damage, followed by graded dexterity training in real-world tasks. We also exposed participants to 3 weeks of sham training to control for the non-specific effects of therapy visits and interactions. We conducted five test-sessions: two pre-tests and three post-tests. Our results indicate substantial improvements in the less-impaired arm performance, without detriment to the paretic arm that transferred to improved functional independence in all three posttests, indicating durability of training effects for at least 3 weeks. We provide evidence for establishing the basis of a rehabilitation approach that includes evaluation and remediation of the ipsilesional arm in moderately to severely impaired stroke survivors. This study was originally a crossover design; however, we were unable to complete the second arm of the study due to the COVID-19 pandemic. We report the results from the first arm of the planned design as a longitudinal study.
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Affiliation(s)
- Candice Maenza
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, United States.,Department of Kinesiology, Pennsylvania State University, State College, PA, United States
| | - David A Wagstaff
- Department of Human Development and Family Studies, Pennsylvania State University, State College, PA, United States
| | - Rini Varghese
- Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Carolee Winstein
- Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - David C Good
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Robert L Sainburg
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, United States.,Department of Kinesiology, Pennsylvania State University, State College, PA, United States
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10
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The probability of choosing both hands depends on an interaction between motor capacity and limb-specific control in chronic stroke. Exp Brain Res 2020; 238:2569-2579. [PMID: 32880681 DOI: 10.1007/s00221-020-05909-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
A goal of rehabilitation after stroke is to promote pre-stroke levels of arm use for every day, frequently bimanual, functional activities. We reasoned that, after a stroke, the choice to use one or both hands for bimanual tasks might depend not only on residual motor capacity, but also the specialized demands imposed by the task on the paretic hand. To capture spontaneous, task-specific choices, we covertly observed 50 pre-stroke right-handed chronic stroke survivors (25 each of left, LHD, and right-hemisphere damage, RHD) and 11 age-similar control adults and recorded their hand use strategies for two pairs of bimanual tasks with distinct demands: one with greater precision requirements (photo-album tasks), and another with greater stabilization requirements (letter-envelope tasks). The primary outcome was the choice to use one or both hands. Logistic regression was used to test the two hypotheses that the probability of choosing a bimanual strategy would be greater in those with less severe motor impairment and also in those with LHD. When collapsed across the four tasks, we found support for these hypotheses. Notably, however, the influence of these factors on bimanual choice varied based on task demands. For the photo-album pair, the probability of a bimanual strategy was greater for those with LHD compared to RHD, regardless of the degree of motor impairment. For the letter-envelope pair, we found a significant interaction between impairment and side of lesion in determining the likelihood of choosing both hands. Therefore, the manner in which side of lesion moderates the effect of impairment on hand use depends on the task.
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11
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Lee JP, Chen S, Tsai CT, Chung HC, Chang WD. Characteristics Associated with the Differential Activity of Nondominant and Dominant Affected Hands in Patients with Poststroke Right Hemiparesis. Occup Ther Int 2020; 2020:2387378. [PMID: 32565757 PMCID: PMC7285389 DOI: 10.1155/2020/2387378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/08/2020] [Accepted: 05/14/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Spontaneous arm use in patients with poststroke hemiparesis is crucial to the recovery of functional interaction. Patients with stroke and subsequent right hemiparesis have more difficulty adapting to a right-handed environment. The aim of this study was to use wearable devices to assess the asymmetry and difference in the amount of activity of the nondominant and dominant affected hands among patients with stroke and right hemiparesis. The real activity of both hands was measured to assess the correlation with various aspects of the International Classification of Functioning, Disability and Health (ICF). Subjects and Methods. Patients with stroke and right hemiparesis were recruited. They were divided into two groups according to the affected hand. Groups A and B comprised patients with affected nondominant and dominant hands, respectively. The Fugl-Meyer assessment-Upper Extremity (FM-UE) scores, Motor Activity Log (MAL), and hand function domain scores on the Stroke Impact Scale (SIS) were used for assessment. Patients were asked to wear smart wearable devices on both hands 24 hours a day for a month. The amount of activity in both hands was recorded and analyzed. RESULTS A total of 29 patients with stroke were divided into group A (n = 14) and group B (n = 15). FM-UE scores were significantly and strongly correlated with the amount of use (AOU) in the MAL. The recorded differential real activity of both hands in group B was significantly lower than that in group A. The asymmetry index of hand use was significantly less favorable in group B. However, no significant differences in AOU in the MAL, FM-UE, and hand function domain in the SIS were identified between the nondominant and dominant affected hands. CONCLUSIONS The asymmetry and differential activity of both hands were worse in the patients with poststroke right hemiparesis, whose dominant hand was affected. However, no differences of three aspects of the ICF were found between dominant and nondominant affected hands.
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Affiliation(s)
- Jen-Pei Lee
- Department of Neurosurgery, Da-Chien General Hospital, Miaoli, Taiwan
| | - Shuya Chen
- Department of Physical Therapy, China Medical University, Taichung, Taiwan
| | - Chien-Tsung Tsai
- Department of Rehabilitation, Da-Chien General Hospital, Miaoli, Taiwan
| | - Hsu-Chih Chung
- Department of Rehabilitation, Da-Chien General Hospital, Miaoli, Taiwan
| | - Wen-Dien Chang
- Department of Sport Performance, National Taiwan University of Sport, Taichung, Taiwan
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12
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Yamagami M, Steele KM, Burden SA. Decoding Intent With Control Theory: Comparing Muscle Versus Manual Interface Performance. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2020; 2020:10.1145/3313831.3376224. [PMID: 35342901 PMCID: PMC8956205 DOI: 10.1145/3313831.3376224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Manual device interaction requires precise coordination which may be difficult for users with motor impairments. Muscle interfaces provide alternative interaction methods that may enhance performance, but have not yet been evaluated for simple (eg. mouse tracking) and complex (eg. driving) continuous tasks. Control theory enables us to probe continuous task performance by separating user input into intent and error correction to quantify how motor impairments impact device interaction. We compared the effectiveness of a manual versus a muscle interface for eleven users without and three users with motor impairments performing continuous tasks. Both user groups preferred and performed better with the muscle versus the manual interface for the complex continuous task. These results suggest muscle interfaces and algorithms that can detect and augment user intent may be especially useful for future design of interfaces for continuous tasks.
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Maenza C, Good DC, Winstein CJ, Wagstaff DA, Sainburg RL. Functional Deficits in the Less-Impaired Arm of Stroke Survivors Depend on Hemisphere of Damage and Extent of Paretic Arm Impairment. Neurorehabil Neural Repair 2019; 34:39-50. [PMID: 31538852 DOI: 10.1177/1545968319875951] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Previous research has detailed the hemisphere dependence and specific kinematic deficits observed for the less-affected arm of patients with unilateral stroke. Objective. We now examine whether functional motor deficits in the less-affected arm, measured by standardized clinical measures of motor function, also depend on the hemisphere that was damaged and on the severity of contralesional impairment. Methods. We recruited 48 left-hemisphere-damaged (LHD) participants, 62 right-hemisphere-damaged participants, and 54 age-matched control participants. Measures of motor function included the following: (1) Jebsen-Taylor Hand Function Test (JHFT), (2) Grooved Pegboard Test (GPT), and (3) grip strength. We measured the extent of contralesional arm impairment with the upper-extremity component of the Fugl-Meyer (UEFM) assessment of motor impairment. Results. Ipsilesional limb functional performance deficits (JHFT) varied with both the damaged hemisphere and severity of contralesional arm impairment, with the most severe deficits expressed in LHD participants with severe contralesional impairment (UEFM). GPT and grip strength varied with severity of contralesional impairment but not with hemisphere. Conclusions. Stroke survivors with the most severe paretic arm impairment, who must rely on their ipsilesional arm for performing daily activities, have the greatest motor deficit in the less-affected arm. We recommend remediation of this arm to improve functional independence in this group of stroke patients.
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Affiliation(s)
- Candice Maenza
- The Pennsylvania State University, University Park, PA, USA
- Pennsylvania State College of Medicine, Hershey, PA, USA
| | - David C Good
- Pennsylvania State College of Medicine, Hershey, PA, USA
| | | | | | - Robert L Sainburg
- The Pennsylvania State University, University Park, PA, USA
- Pennsylvania State College of Medicine, Hershey, PA, USA
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14
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Liu G, Tan S, Peng K, Dang C, Xing S, Xie C, Zeng J. Network change in the ipsilesional cerebellum is correlated with motor recovery following unilateral pontine infarction. Eur J Neurol 2019; 26:1266-1273. [PMID: 31021033 DOI: 10.1111/ene.13974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 04/23/2019] [Indexed: 10/27/2022]
Affiliation(s)
- G. Liu
- Department of Neurology and Stroke Center The First Affiliated Hospital Sun Yat‐Sen University GuangzhouChina
| | - S. Tan
- Department of Neurology and Stroke Center The First Affiliated Hospital Sun Yat‐Sen University GuangzhouChina
| | - K. Peng
- Department of Medical Imaging State Key Laboratory of Oncology in Southern China Collaborative Innovation Center for Cancer Medicine Sun Yat‐Sen University Cancer Center Guangzhou China
| | - C. Dang
- Department of Neurology and Stroke Center The First Affiliated Hospital Sun Yat‐Sen University GuangzhouChina
| | - S. Xing
- Department of Neurology and Stroke Center The First Affiliated Hospital Sun Yat‐Sen University GuangzhouChina
| | - C. Xie
- Department of Medical Imaging State Key Laboratory of Oncology in Southern China Collaborative Innovation Center for Cancer Medicine Sun Yat‐Sen University Cancer Center Guangzhou China
| | - J. Zeng
- Department of Neurology and Stroke Center The First Affiliated Hospital Sun Yat‐Sen University GuangzhouChina
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15
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Franck JA, Smeets RJEM, Seelen HAM. Changes in actual arm-hand use in stroke patients during and after clinical rehabilitation involving a well-defined arm-hand rehabilitation program: A prospective cohort study. PLoS One 2019; 14:e0214651. [PMID: 30934015 PMCID: PMC6443150 DOI: 10.1371/journal.pone.0214651] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/18/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Improvement of arm-hand function and arm-hand skill performance in stroke patients is reported by many authors. However, therapy content often is poorly described, data on actual arm-hand use are scarce, and, as follow-up time often is very short, little information on patients’ mid- and long-term progression is available. Also, outcome data mainly stem from either a general patient group, unstratified for the severity of arm-hand impairment, or a very specific patient group. Objectives To investigate to what extent the rate of improvement or deterioration of actual arm-hand use differs between stroke patients with either a severely, moderately or mildly affected arm-hand, during and after rehabilitation involving a well-defined rehabilitation program. Methods Design: single–armed prospective cohort study. Outcome measure: affected arm-hand use during daily tasks (accelerometry), expressed as ‘Intensity-of arm-hand-use’ and ‘Duration-of-arm-hand-use’ during waking hours. Measurement dates: at admission, clinical discharge and 3, 6, 9, and 12 months post-discharge. Statistics: Two-way repeated measures ANOVAs. Results Seventy-six patients (63 males); mean age: 57.6 years (sd:10.6); post-stroke time: 29.8 days (sd:20.1) participated. Between baseline and 1-year follow-up, Intensity-of-arm-hand-use on the affected side increased by 51%, 114% and 14% (p < .000) in the mildly, moderately and severely affected patients, respectively. Similarly, Duration-of-arm-hand-use increased by 26%, 220% and 161% (p < .000). Regarding bimanual arm-hand use: Intensity-of-arm-hand-use increased by 44%, 74% and 30% (p < .000), whereas Duration-of-arm-hand-use increased by 10%, 22% and 16% (p < .000). Conclusion Stroke survivors with a severely, moderately or mildly affected arm-hand showed different, though (clinically) important, improvements in actual arm-hand use during the rehabilitation phase. Intensity-of-arm-hand-use and Duration-of-arm-hand-use significantly improved in both unimanual and bimanual tasks/skills. These improvements were maintained until at least 1 year post-discharge.
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Affiliation(s)
- Johan Anton Franck
- Adelante Rehabilitation Centre, dept. of Brain Injury Rehabilitation, Hoensbroek, the Netherlands
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
- * E-mail:
| | | | - Henk Alexander Maria Seelen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
- Maastricht University, Research School CAPHRI, dept. of Rehabilitation Medicine, Maastricht, the Netherlands
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16
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Ranganathan R, Gebara R, Andary M, Sylvain J. Chronic stroke survivors show task-dependent modulation of motor variability during bimanual coordination. J Neurophysiol 2019; 121:756-763. [PMID: 30601671 DOI: 10.1152/jn.00218.2018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Stroke often results in hemiparesis, leaving one side of the body "affected" relative to the other side. Prior research has shown that the affected arm has higher variability; however, the extent to which this variability can be modulated is unclear. Here we used a shared bimanual task to examine the degree to which participants could modulate the variability in the affected arm after stroke. Participants with chronic stroke ( n = 11) and age-matched controls ( n = 11) performed unimanual and bimanual reaching movements to move a cursor on a screen to different targets. In the unimanual condition, the cursor was controlled only by the movement of a single arm, whereas, in the bimanual condition, the cursor position was "shared" between the two arms by using a weighted average of the two hand positions. Unknown to the participants, we altered the weightings of the affected and unaffected arms to cursor motion and examined how the movement variability on each arm changed depending on its contribution to the task. Results showed that stroke survivors had higher movement variability on the affected arm; however, like age-matched controls, they were able to modulate the variability in both the affected and unaffected arms according to the weighting condition. Specifically, as the weighting on a particular arm increased (i.e., it became more important to the task), the movement variability decreased. These results show that stroke survivors are capable of modulating variability depending on the task context, and this feature may potentially be exploited for rehabilitation paradigms. NEW & NOTEWORTHY We show that chronic stroke survivors, similar to age-matched controls, are able to modulate variability in their affected and unaffected limbs in redundant bimanual tasks as a function of how these limbs contribute to the task. Specifically, in both affected and unaffected limbs, the variability of the limb increases as its contribution to the task decreases. This feature may potentially be exploited in rehabilitation paradigms using bimanual tasks.
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Affiliation(s)
- Rajiv Ranganathan
- Department of Kinesiology, Michigan State University, East Lansing, Michigan.,Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan
| | - Rani Gebara
- Department of Physical Medicine and Rehabilitation, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Michael Andary
- Department of Physical Medicine and Rehabilitation, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Jim Sylvain
- Department of Physical Medicine and Rehabilitation, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
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17
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Cunha BP, Freitas SMSF, Gomes GFO, de Freitas PB. Hand Grip and Load Force Coordination of the Ipsilesional Hand of Chronic Stroke Individuals. J Mot Behav 2019; 51:610-621. [PMID: 30600789 DOI: 10.1080/00222895.2018.1547892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Object manipulation depends on a refined control of grip force (GF) and load force (LF). After a brain injury, the GF control is altered in the paretic hand but what happens with the non-paretic hand is still unclear. In this study, we compared the GF control and GF-LF coordination of the non-paretic hand of 10 stroke individuals who suffered right brain damage (RBD) and 10 who suffered left brain damage (LBD), with 20 healthy individuals during lifting and oscillation task, using an instrumented object. GF was recorded with a force transducer, and LF was estimated from the object weight and acceleration. Overall, the ipsilesional hand of stroke individuals, independent of the lesion side, presented similar GF control and GF-LF coordination. However, LBD individuals took longer to start lifting the object, which may be due to the need of more time to obtain somatosensory information from the contact with the object. The findings indicate that stroke individuals preserve their ability to control and coordinate GF and LF when using their ipsilesional hand for object manipulation and the left hemisphere may play an essential role in the processing of somatosensory information needed for the GF control.
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Affiliation(s)
- Bianca P Cunha
- Interdisciplinary Graduate Program in Health Sciences, Cruzeiro do Sul University , São Paulo , SP , Brazil
| | - Sandra M S F Freitas
- Masters and Doctoral Programs in Physical Therapy, São Paulo City University , São Paulo , SP , Brazil .,Department of Neurology, Milton S. Hershey Medical Center, The Pennsylvania State University , Hershey , PA , USA .,Department of Kinesiology, The Pennsylvania State University , University Park , PA , USA
| | - Georgia F O Gomes
- Masters and Doctoral Programs in Physical Therapy, São Paulo City University , São Paulo , SP , Brazil
| | - Paulo B de Freitas
- Interdisciplinary Graduate Program in Health Sciences, Cruzeiro do Sul University , São Paulo , SP , Brazil .,Department of Neurology, Milton S. Hershey Medical Center, The Pennsylvania State University , Hershey , PA , USA .,Department of Kinesiology, The Pennsylvania State University , University Park , PA , USA
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18
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Boisgontier MP, Cheval B, van Ruitenbeek P, Cuypers K, Leunissen I, Sunaert S, Meesen R, Zivari Adab H, Renaud O, Swinnen SP. Cerebellar gray matter explains bimanual coordination performance in children and older adults. Neurobiol Aging 2018; 65:109-120. [DOI: 10.1016/j.neurobiolaging.2018.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 01/12/2018] [Accepted: 01/21/2018] [Indexed: 02/02/2023]
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19
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Zivari Adab H, Chalavi S, Beets IAM, Gooijers J, Leunissen I, Cheval B, Collier Q, Sijbers J, Jeurissen B, Swinnen SP, Boisgontier MP. White matter microstructural organisation of interhemispheric pathways predicts different stages of bimanual coordination learning in young and older adults. Eur J Neurosci 2018; 47:446-459. [DOI: 10.1111/ejn.13841] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/22/2017] [Accepted: 01/17/2018] [Indexed: 01/30/2023]
Affiliation(s)
- Hamed Zivari Adab
- Movement Control and Neuroplasticity Research Group; Department of Movement Sciences; KU Leuven; Tervuurse Vest 101 Leuven Belgium
| | - Sima Chalavi
- Movement Control and Neuroplasticity Research Group; Department of Movement Sciences; KU Leuven; Tervuurse Vest 101 Leuven Belgium
| | - Iseult A. M. Beets
- Movement Control and Neuroplasticity Research Group; Department of Movement Sciences; KU Leuven; Tervuurse Vest 101 Leuven Belgium
- BrainCTR; Lilid bvba; Diest Belgium
| | - Jolien Gooijers
- Movement Control and Neuroplasticity Research Group; Department of Movement Sciences; KU Leuven; Tervuurse Vest 101 Leuven Belgium
| | - Inge Leunissen
- Movement Control and Neuroplasticity Research Group; Department of Movement Sciences; KU Leuven; Tervuurse Vest 101 Leuven Belgium
| | - Boris Cheval
- Department of General Internal Medicine, Rehabilitation and Geriatrics; University of Geneva; Geneva Switzerland
- Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives”; University of Geneva; Geneva Switzerland
| | | | - Jan Sijbers
- iMinds Vision Lab; University of Antwerp; Antwerp Belgium
| | - Ben Jeurissen
- iMinds Vision Lab; University of Antwerp; Antwerp Belgium
| | - Stephan P. Swinnen
- Movement Control and Neuroplasticity Research Group; Department of Movement Sciences; KU Leuven; Tervuurse Vest 101 Leuven Belgium
| | - Matthieu P. Boisgontier
- Movement Control and Neuroplasticity Research Group; Department of Movement Sciences; KU Leuven; Tervuurse Vest 101 Leuven Belgium
- Brain Behavior Laboratory; University of British Columbia; Vancouver BC Canada
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20
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van Dokkum LEH, le Bars E, Mottet D, Bonafé A, Menjot de Champfleur N, Laffont I. Modified Brain Activations of the Nondamaged Hemisphere During Ipsilesional Upper-Limb Movement in Persons With Initial Severe Motor Deficits Poststroke. Neurorehabil Neural Repair 2017; 32:34-45. [PMID: 29276841 DOI: 10.1177/1545968317746783] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Poststroke, the ipsilesional upper limb shows slight but substantial and long-term motor deficits. OBJECTIVE To define brain activation patterns during a gross motor flexion/extension task of the ipsilesional elbow early poststroke before and after rehabilitation, in relation to the corresponding kinematic characteristics at each time point. METHOD Simultaneous analysis of kinematic features (amplitude, frequency, smoothness, and trajectory of movement) and of corresponding functional magnetic resonance imaging activations (block-design). A total of 21 persons with subacute initial severe stroke (Fugl-Meyer score <30/66) participated twice: within the first 2 months poststroke (V0) and after 6 weeks of rehabilitation (V1). Results at both time points were compared with activation patterns and kinematics of 13 healthy controls. RESULTS Compared with controls ( a) movements of the ipsilesional upper-limb poststroke were smaller (V0 + V1) and less smooth (V0 + V1) and ( b) participants poststroke showed additional recruitment of the contralesional middle temporal gyrus (V0) and rolandic opercularis involved in movement visualization (V0 + V1), whereas they lacked activation of the supramarginal gyrus (V0 + V1). Over time, participants poststroke showed an extended activation of the contralesional sensorimotor cortex at V0. CONCLUSION Movements of the ipsilesional upper limb within an initially severe stroke group were not only atypical in motor outcome, but seemed to be controlled differently. Together the observed changes pointed toward an overall disturbance of the bihemispheric motor network poststroke, marked by ( a) a possible despecialization of the nondamaged hemisphere and ( b) the employment of alternative control strategies to ensure optimal task execution.
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Affiliation(s)
- Liesjet E H van Dokkum
- 1 Montpellier University Hospital, Montpellier, France.,2 Charles Coulomb Laboratory, Montpellier University, Montpellier, France
| | | | - Denis Mottet
- 3 EuroMov, of Montpellier University, Montpellier, France
| | - Alain Bonafé
- 1 Montpellier University Hospital, Montpellier, France
| | | | - Isabelle Laffont
- 1 Montpellier University Hospital, Montpellier, France.,3 EuroMov, of Montpellier University, Montpellier, France
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21
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de Paiva Silva FP, Freitas SMSF, Banjai RM, Alouche SR. Ipsilesional Arm Aiming Movements After Stroke: Influence of the Degree of Contralesional Impairment. J Mot Behav 2017; 50:104-115. [PMID: 28521636 DOI: 10.1080/00222895.2017.1306479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The authors examined the effects of the degree of impairment of the contralesional upper limb and the side of the hemispheric damage on ipsilesional upper limb performance in chronic stroke individuals. Right- and left-side stroke resulting in mild-to-severe impairment and healthy participants took part in simple and choice reaction time tasks involving aiming movements. The stroke individuals performed the aiming movements with the ipsilesional upper limb using a digitizing tablet to ipsi- or contralateral targets presented in a monitor. The global performance of the group with severe right hemispheric damage was worse than that of the other groups, indicating that the side of hemispheric damage and degree of motor impairment can adversely affect aiming movement performance.
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Affiliation(s)
- Flavia Priscila de Paiva Silva
- a Master's and Doctoral Program in Physical Therapy , Universidade Cidade de São Paulo , Brazil.,b School of Physical Therapy , Universidade do Vale do Sapucaí , São Paulo , Brazil
| | | | - Renata Morales Banjai
- a Master's and Doctoral Program in Physical Therapy , Universidade Cidade de São Paulo , Brazil.,c School of Physical Therapy , Universidade Santa Cecília , São Paulo , Brazil
| | - Sandra Regina Alouche
- a Master's and Doctoral Program in Physical Therapy , Universidade Cidade de São Paulo , Brazil
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22
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Lang CE, Waddell KJ, Klaesner JW, Bland MD. A Method for Quantifying Upper Limb Performance in Daily Life Using Accelerometers. J Vis Exp 2017. [PMID: 28518079 PMCID: PMC5565027 DOI: 10.3791/55673] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A key reason for referral to rehabilitation services after stroke and other neurological conditions is to improve one's ability to function in daily life. It has become important to measure a person's activities in daily life, and not just measure their capacity for activity in the structured environment of a clinic or laboratory. A wearable sensor that is now enabling measurement of daily movement is the accelerometer. Accelerometers are commercially-available devices resembling large wrist watches that can be worn throughout the day. Data from accelerometers can quantify how the limbs are engaged to perform activities in peoples' homes and communities. This report describes a methodology to collect accelerometry data and turn it into clinically-relevant information. First, data are collected by having the participant wear two accelerometers (one on each wrist) for 24 h or longer. The accelerometry data are then downloaded and processed to produce four different variables that describe key aspects of upper limb activity in daily life: hours of use, use ratio, magnitude ratio, and the bilateral magnitude. Density plots can be constructed that visually represent the data from the 24 h wearing period. The variables and their resultant density plots are highly consistent in neurologically-intact, community-dwelling adults. This striking consistency makes them a useful tool for determining if upper limb daily performance is different from normal. This methodology is appropriate for research studies investigating upper limb dysfunction and interventions designed to improve upper limb performance in daily life in people with stroke and other patient populations. Because of its relative simplicity, it may not be long before it is also incorporated in clinical neurorehabilitation practice.
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Affiliation(s)
- Catherine E Lang
- Program in Physical Therapy, Washington University School of Medicine; Program in Occupational Therapy, Washington University School of Medicine; Department of Neurology, Washington University School of Medicine;
| | | | - Joseph W Klaesner
- Program in Physical Therapy, Washington University School of Medicine; Mallinckrodt Institute of Radiology, Washington University School of Medicine; Department of Biomedical Engineering, Washington University
| | - Marghuretta D Bland
- Program in Physical Therapy, Washington University School of Medicine; Program in Occupational Therapy, Washington University School of Medicine; Department of Neurology, Washington University School of Medicine
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23
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Bruder AM, McClelland JA, Shields N, Dodd KJ, Hau R, van de Water ATM, Taylor NF. Validity and reliability of an activity monitor to quantify arm movements and activity in adults following distal radius fracture. Disabil Rehabil 2017. [PMID: 28637143 DOI: 10.1080/09638288.2017.1288764] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To examine the validity and reliability of an activity monitor to estimate upper limb activity. METHODS Thirty-two adults after distal radial fracture were recruited. 15 adults performed five upper limb activities during two testing sessions, one week apart to investigate criterion validity against the criterion reference of three-dimensional motion analysis, convergent validity, and test-retest reliability. 17 adults in two therapy groups wore monitors for three consecutive days at baseline and six weeks post-intervention. Hypothesis testing (noninferiority) assessed comparison of group differences. RESULTS There were large, significant positive correlations between monitor counts and motion analysis for affected/unaffected wrists during the grocery shelving [r = 0.82, r = 0.73, respectively] and floor sweeping activities [r = 0.54, r = 0.59, respectively]. Large confidence intervals relative to means suggests the monitor could not accurately predict motion analysis distance or acceleration. Relative reliability was excellent in affected/unaffected wrists for crank ergometer [ICC(2,1) = 0.91, ICC(2,1) = 0.88, respectively], grocery shelving [ICC(2,1) = 0.83, ICC(2,1) = 0.89, respectively], and table dusting activities [ICC(2,1) = 0.77, ICC(2,1) = 0.83, respectively]. Correlations and reliability for typing were poor; hypothesis testing of group equivalence was not confirmed. CONCLUSIONS There is preliminary evidence that an activity monitor is a valid and reliable tool to measure gross arm activity after distal radial fracture. Implications for Rehabilitation Distal radius fractures are one of the most common upper limb fractures that cause activity limitations and participation restrictions. After a distal radius fracture patients are often referred to therapy (physiotherapy, occupational therapy, hand therapy) for rehabilitation to return to pre-injury function and activity levels. Activity monitors may be a valid and reliable measurement tool that therapists can use with their patients to quantify gross arm activity to enable monitoring of injury recovery and rehabilitation adherence. Activity monitors may not be sufficiently reliable and valid to monitor fine movements of the wrist and hand after distal radius fracture.
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Affiliation(s)
- Andrea M Bruder
- a School of Allied Health, La Trobe University , Melbourne , Australia
| | | | - Nora Shields
- a School of Allied Health, La Trobe University , Melbourne , Australia.,b Department of Allied Health , Northern Health , Melbourne , Australia
| | - Karen J Dodd
- c College of Science, Health and Engineering, La Trobe University , Melbourne , Australia
| | - Raphael Hau
- d Northern Clinical School, Melbourne Medical School , Melbourne , Australia
| | - Alexander T M van de Water
- a School of Allied Health, La Trobe University , Melbourne , Australia.,e Physiotherapy Department , Saxion University of Applied Science , Enschede , Netherlands
| | - Nicholas F Taylor
- a School of Allied Health, La Trobe University , Melbourne , Australia.,f Allied Health Clinical Research Office, Eastern Health , Melbourne , Australia
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24
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Leuenberger K, Gonzenbach R, Wachter S, Luft A, Gassert R. A method to qualitatively assess arm use in stroke survivors in the home environment. Med Biol Eng Comput 2017; 55:141-150. [PMID: 27106757 PMCID: PMC5222943 DOI: 10.1007/s11517-016-1496-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/24/2016] [Indexed: 11/25/2022]
Abstract
Wearable sensor technology has enabled unobtrusive monitoring of arm movements of stroke survivors in the home environment. However, the most widely established method, based on activity counts, provides quantitative rather than qualitative information on arm without functional insights, and is sensitive to passive arm movements during ambulatory activities. We propose a method to quantify functionally relevant arm use in stroke survivors relying on a single wrist-worn inertial measurement unit. Orientation of the forearm during movements is measured in order identify gross arm movements. The method is validated in 10 subacute/chronic stroke survivors wearing inertial sensors at 5 anatomical locations for 48 h. Measurements are compared to conventional activity counts and to a test for gross manual dexterity. Duration of gross arm movements of the paretic arm correlated significantly better with the Box and Block Test ([Formula: see text]) than conventional activity counts when walking phases were included ([Formula: see text]), and similar results were found when comparing ratios of paretic and non-paretic arms for gross movements and activity counts. The proposed gross arm movement metric is robust against passive arm movements during ambulatory activities and requires only a single-sensor module placed at the paretic wrist for the assessment of functionally relevant arm use.
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Affiliation(s)
- Kaspar Leuenberger
- Department of Health Science and Technology, ETH Zürich, Zurich, Switzerland.
| | - Roman Gonzenbach
- Department of Neurology, University Hospital Zürich, Zurich, Switzerland
| | | | - Andreas Luft
- Department of Neurology, University Hospital Zürich, Zurich, Switzerland
| | - Roger Gassert
- Department of Health Science and Technology, ETH Zürich, Zurich, Switzerland
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25
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van Meulen FB, Klaassen B, Held J, Reenalda J, Buurke JH, van Beijnum BJF, Luft A, Veltink PH. Objective Evaluation of the Quality of Movement in Daily Life after Stroke. Front Bioeng Biotechnol 2016; 3:210. [PMID: 26793705 PMCID: PMC4710748 DOI: 10.3389/fbioe.2015.00210] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/22/2015] [Indexed: 11/23/2022] Open
Abstract
Background Stroke survivors are commonly left with disabilities that impair activities of daily living. The main objective of their rehabilitation program is to maximize the functional performance at home. However, the actual performance of patients in their home environment is unknown. Therefore, objective evaluation of daily life activities of stroke survivors in their physical interaction with the environment is essential for optimal guidance of rehabilitation therapy. Monitoring daily life movements could be very challenging, as it may result in large amounts of data, without any context. Therefore, suitable metrics are necessary to quantify relevant aspects of movement performance during daily life. The objective of this study is to develop data processing methods, which can be used to process movement data into relevant metrics for the evaluation of intra-patient differences in quality of movements in a daily life setting. Methods Based on an iterative requirement process, functional and technical requirements were formulated. These were prioritized resulting in a coherent set of metrics. An activity monitor was developed to give context to captured movement data at home. Finally, the metrics will be demonstrated in two stroke participants during and after their rehabilitation phases. Results By using the final set of metrics, quality of movement can be evaluated in a daily life setting. As example to demonstrate potential of presented methods, data of two stroke patients were successfully analyzed. Differences between in-clinic measurements and measurements during daily life are observed by applying the presented metrics and visualization methods. Heel height profiles show intra-patient differences in height, distance, stride profile, and variability between strides during a 10-m walk test in the clinic and walking at home. Differences in distance and stride profile between both feet were larger at home, than in clinic. For the upper extremities, the participant was able to reach further away from the pelvis and cover a larger area. Discussion Presented methods can be used for the objective evaluation of intra-patient differences in movement quality between in-clinic and daily life measurements. Any observed progression or deterioration of movement quality could be used to decide on continuing, stopping, or adjusting rehabilitation programs.
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Affiliation(s)
- Fokke B van Meulen
- Biomedical Signals and Systems, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente , Enschede , Netherlands
| | - Bart Klaassen
- Biomedical Signals and Systems, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands; Centre for Telematics and Information Technology, University of Twente, Enschede, Netherlands
| | - Jeremia Held
- Biomedical Signals and Systems, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands; Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Jasper Reenalda
- Roessingh Research and Development, Roessingh Rehabilitation Hospital, Enschede, Netherlands; Biomechanical Engineering, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands
| | - Jaap H Buurke
- Biomedical Signals and Systems, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands; Roessingh Research and Development, Roessingh Rehabilitation Hospital, Enschede, Netherlands
| | - Bert-Jan F van Beijnum
- Biomedical Signals and Systems, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands; Centre for Telematics and Information Technology, University of Twente, Enschede, Netherlands
| | - Andreas Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich , Zurich , Switzerland
| | - Peter H Veltink
- Biomedical Signals and Systems, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente , Enschede , Netherlands
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Exploring the Role of Accelerometers in the Measurement of Real World Upper-Limb Use After Stroke. BRAIN IMPAIR 2015. [DOI: 10.1017/brimp.2015.21] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The ultimate goal of upper-limb rehabilitation after stroke is to promote real-world use, that is, use of the paretic upper-limb in everyday activities outside the clinic or laboratory. Although real-world use can be collected through self-report questionnaires, an objective indicator is preferred. Accelerometers are a promising tool. The current paper aims to explore the feasibility of accelerometers to measure upper-limb use after stroke and discuss the translation of this measurement tool into clinical practice. Accelerometers are non-invasive, wearable sensors that measure movement in arbitrary units called activity counts. Research to date indicates that activity counts are a reliable and valid index of upper-limb use. While most accelerometers are unable to distinguish between the type and quality of movements performed, recent advancements have used accelerometry data to produce clinically meaningful information for clinicians, patients, family and care givers. Despite this, widespread uptake in research and clinical environments remains limited. If uptake was enhanced, we could build a deeper understanding of how people with stroke use their arm in real-world environments. In order to facilitate greater uptake, however, there is a need for greater consistency in protocol development, accelerometer application and data interpretation.
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Alteration and recovery of arm usage in daily activities after rotator cuff surgery. J Shoulder Elbow Surg 2015; 24:1346-52. [PMID: 25825140 DOI: 10.1016/j.jse.2015.01.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/30/2015] [Accepted: 01/31/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The objective measurement of dominant/nondominant arm use proportion in daily life may provide relevant information on healthy and pathologic arm behavior. This prospective case-control study explored the potential of such measurements as indicators of upper limb functional recovery after rotator cuff surgery. METHODS Data on dominant/nondominant arm usage were acquired with body-worn sensors for 7 hours. The postsurgical arm usage of 21 patients was collected at 3, 6, and 12 months after rotator cuff surgery in the sitting, walking, and standing postures and compared with a reference established with 41 healthy subjects. The results were calculated for the dominant and nondominant surgical side subgroups at all stages. The correlations with clinical scores were calculated. RESULTS Healthy right-handed and left-handed dominant arm usage was 60.2% (±6.3%) and 53.4% (±6.6%), respectively. Differences in use of the dominant side were significant between the right- and left-handed subgroups for sitting (P = .014) and standing (P = .009) but not for walking (P = .328). The patient group showed a significant underuse of 10.7% (±8.9%) at 3 months after surgery (P < .001). The patients recovered normal arm usage within 12 months, regardless of surgical side. The arm underuse measurement was weakly related to function and pain scores. CONCLUSION This study provided new information on arm recovery after rotator cuff surgery using an innovative measurement method. It highlighted that objective arm underuse measurement is a valuable indicator of upper limb postsurgical outcome that captures a complementary feature to clinical scores.
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Deficits of reach-to-grasp coordination following stroke: Comparison of instructed and natural movements. Neuropsychologia 2015; 77:1-9. [PMID: 26189872 DOI: 10.1016/j.neuropsychologia.2015.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 05/28/2015] [Accepted: 07/15/2015] [Indexed: 11/22/2022]
Abstract
The present work evaluates whether stroke-induced deficits of reach-to-grasp movements, established by typical laboratory paradigms, transfer unconditionally to more natural situations. Sixteen patients with a stroke to the motor-dominant left hemisphere and 16 age- and gender-matched healthy control subjects executed grasping movements with their left (ipsilesional, non-dominant) hand. All movements started in the same position, were aimed at the same object positioned in the same location, and were followed by forward displacement of that object along the same path. Twenty movements were performed as a repetitive, externally triggered task executed for their own sake (context L, as in typical laboratory tasks). Twenty movements were performed as part of a self-initiated action sequence aimed at winning a reward (context E, similar to many everyday situations). The kinematics and dynamics of the transport, grasp and manipulation component of each reach-to-grasp movement were quantified by 41 parameters. Analyses of variance yielded a significant effect of Context for 29 parameters, a significant effect of Group for 9 parameters (mostly related to the coupling of hand transport and grip aperture), and a significant interaction for 5 parameters (all related to the coupling of hand transport and grip aperture). The interaction reflected the fact that stroke patients' movement parameters were more abnormal in context E than in context L. Our data indicate that unilateral stroke degrades the grasp-transport coupling, and that stroke-related motor deficits may be more pronounced in a natural than in a laboratory context. Thus, for stroke patients, assessments and rehabilitation regimes should mainly use activities that are as natural as possible.
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Shim S, Jung J. Effects of bilateral training on motor function, amount of activity and activity intensity measured with an accelerometer of patients with stroke. J Phys Ther Sci 2015; 27:751-4. [PMID: 25931723 PMCID: PMC4395707 DOI: 10.1589/jpts.27.751] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 10/21/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated the recovery of arm function and the functional use of
the affected limb in real life of stroke patients after bilateral arm training. [Subjects]
Twenty patients with stroke were randomly allocated to the BT (bilateral training group,
n=10) and UT (unilateral training group, n=10) groups. [Methods] The BT group performed
functional tasks with both hand symmetrically, the UT group performed tasks with only the
affected hand for 30 minutes a session 5 times a week over 6 weeks. Before and after the
intervention, accelerometers (Actisleep), functional independence measure (FIM) and manual
function test (MFT) were used to assess subjects’ abilities. [Results] The BT group showed
a significant improvement in FIM total score, motor subtotal score and MFT score of
affected side compared to the UT group. The BT group showed a more quantitative increase
in the amount of activity of the affected side than the UT group. Regarding activity
intensity, the BT group showed a decrease in the sedentary level and an increase of the
moderate level on the affected side compared to the UT group. [Conclusion] We found that
programs tailored to the characteristics of stroke patients and continuous monitoring of
physical activity using an accelerometer minimized possible future disability and improved
the patients’ quality of life.
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Affiliation(s)
- Sunhwa Shim
- Department of Occupational Therapy, Yonsei University, Republic of Korea
| | - Jinhwa Jung
- Department of Occupational Therapy, Semyung University, Republic of Korea
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Green LB. Assessment of Habitual Physical Activity and Paretic Arm Mobility Among Stroke Survivors by Accelerometry. Top Stroke Rehabil 2014; 14:9-21. [DOI: 10.1310/tsr1406-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rand D, Eng JJ. Predicting daily use of the affected upper extremity 1 year after stroke. J Stroke Cerebrovasc Dis 2014; 24:274-83. [PMID: 25533758 DOI: 10.1016/j.jstrokecerebrovasdis.2014.07.039] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/16/2014] [Accepted: 07/28/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The ultimate goal of upper extremity (UE) stroke rehabilitation is for the individual with stroke to return using their arms and hands during daily activities in their own environment. No studies have monitored arm use as individuals with stroke transition from rehabilitation to the home setting. This longitudinal study compared the functional ability and daily use of the affected UE of individuals with stroke between discharge to home and 12 months after stroke and predicted the UE daily use 12 months after stroke. METHODS Participants were assessed on discharge to home from rehabilitation and at 12 months after stroke. UE daily use was measured by wrist accelerometers and self-report by the Motor Activity Log (MAL). Multivariate logistic regression models were used to predict UE daily use 12 months after stroke. RESULTS The UE functional ability improved significantly from discharge to 12 months after stroke. The amount of self-report UE daily use significantly improved (z = -2.9, P = .004), but accelerometer activity counts did not (z = -0.15, P = .88), and the daily use of the nonaffected UE was 3 times more than the affected UE. After controlling for age and accelerometer daily use on discharge, UE variables of movement, function, dexterity, and strength accounted for an additional 10.9%-13.6% of the variance for accelerometer readings. After controlling for gender and MAL daily use on discharge, UE variables accounted for an additional 7%-12% of the variance for the MAL. CONCLUSIONS UE daily use 12 months after stroke is very limited despite the motor and functional improvement. Enhanced motor and functional ability at discharge predicts more UE daily use at 12 months after stroke. Interventions that monitor and encourage these individuals to use their UE are required to ensure that functional gains translate to daily use.
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Affiliation(s)
- Debbie Rand
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia & Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada.
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Wolf A, Scheiderer R, Napolitan N, Belden C, Shaub L, Whitford M. Efficacy and task structure of bimanual training post stroke: a systematic review. Top Stroke Rehabil 2014; 21:181-96. [PMID: 24985386 DOI: 10.1310/tsr2103-181] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Bimanual training has been shown to be as effective as, but not superior to, unimanual paretic upper extremity (UE) training interventions in improving paretic UE function and use post stroke. However, it is still unclear whether different training interventions or task structures within bimanual interventions may differentially affect the outcomes. OBJECTIVE The objectives of this review were to (1) systematically determine the efficacy of bimanual training in relation to the International Classification of Functioning, Disability and Health model components and (2) explore the structure of current bimanual training interventions. METHOD A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eleven studies were accepted for review. RESULTS Three main types of bimanual training emerged: functional task training (FTT), bilateral training with rhythmic auditory cues (BATRAC), and robot-assisted training (RAT). Bimanual training is generally efficacious overall in improving paretic UE movement in individuals with subacute and/or chronic stroke as compared with other interventions. FTT, BATRAC, and RAT showed no significant differences compared with conventional therapy. Bimanual training may have greater proximal control benefits but fewer benefits in terms of subjects' perceived amount and quality of use as compared with constraint-induced movement therapy. CONCLUSION There were not enough data to draw any conclusions about the effects of bimanual task symmetry or commonality of goal.
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Affiliation(s)
- Angela Wolf
- Department of Physical Therapy, Walsh University, North Canton, Ohio
| | - Rachel Scheiderer
- Department of Physical Therapy, Walsh University, North Canton, Ohio
| | | | - Courtney Belden
- Department of Physical Therapy, Walsh University, North Canton, Ohio
| | - Lauren Shaub
- Department of Physical Therapy, Walsh University, North Canton, Ohio
| | - Maureen Whitford
- Department of Physical Therapy, Walsh University, North Canton, Ohio
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Shim S, Kim H, Jung J. Comparison of upper extremity motor recovery of stroke patients with actual physical activity in their daily lives measured with accelerometers. J Phys Ther Sci 2014; 26:1009-11. [PMID: 25140084 PMCID: PMC4135185 DOI: 10.1589/jpts.26.1009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/08/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study compared the upper extremity recovery of stroke patients with the amount of their upper extremity use in real life as measured by accelerometers. [Subjects] Forty inpatients who had had a stroke were recruited. [Methods] The subjects were divided into two groups by the Fugl-Meyer Assessment of Motor Function (FMA) score, a moderately recovered group and a well recovered group. The amount of upper extremity physical activity and its ratio in daily time periods were analyzed for the affected and unaffected sides. [Results] The well recovered group showed significantly higher affected arm use and use ratio than the moderately recovered group in all time periods. [Conclusion] The upper extremity recovery level of the affected side is similar to the physical activity level according to the amount of upper extremity physical activity in actual life measured with an accelerometer. Overuse of the normal side regardless of the recovery level of upper extremity proves the International Classification of Functioning (ICF) concept of differentiating between capacity and performance, and rehabilitation treatments should focus on improving performance.
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Affiliation(s)
- Sunhwa Shim
- Department of Occupational Therapy, Yonsei University, Republic of Korea
| | - Hee Kim
- Department of Occupational Therapy, Yonsei University, Republic of Korea
| | - Jinhwa Jung
- Department of Occupational Therapy, Semyung University, Republic of Korea
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Mani S, Przybyla A, Good DC, Haaland KY, Sainburg RL. Contralesional Arm Preference Depends on Hemisphere of Damage and Target Location in Unilateral Stroke Patients. Neurorehabil Neural Repair 2014; 28:584-93. [PMID: 24523143 DOI: 10.1177/1545968314520720] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Previous research has shown that during simulated activities of daily living, right-handed stroke patients use their contralesional arm more after left- than right-hemisphere stroke. These findings were attributed to a hand preference effect. However, these decisions about when to use the contralesional arm may be modulated by where in the work space the task is performed, a factor that could be used in physical rehabilitation to influence recovery by decreasing learned nonuse. Objective To examine how target location and side of stroke influences arm selection choices for simple reaching movements. Methods A total of 14 right-handed stroke patients (7 with left-hemisphere and 7 with right-hemisphere damage [RHD]), with similar degrees of hemiparesis (Fugl-Meyer motor score), and 16 right-handed controls participated in this experiment. In a pseudorandom fashion, 32 targets were presented throughout the reachable horizontal plane work space, and the participants were asked to select 1 hand to reach the target on each trial. Results The group with left-hemisphere damage chose their contralesional arm significantly more often than the group with RHD. Patients with RHD also chose their left (contralesional) arm significantly less often than the control group. However, these patterns of choice were most pronounced in the center of the workspace. Conclusion Both the side of hemisphere damage and work space location played a significant role in the choice of whether to use the contralesional arm for reaching. These findings have implications for structuring rehabilitation for unilateral stroke patients.
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Affiliation(s)
- Saandeep Mani
- Pennsylvania State University, University Park, PA, USA
| | | | - David C Good
- Penn State College of Medicine, Hershey, PA, USA
| | - Kathleen Y Haaland
- NM VA Healthcare System, Albuquerque, NM, USA University of New Mexico, Albuquerque, NM, USA
| | - Robert L Sainburg
- Pennsylvania State University, University Park, PA, USA Penn State College of Medicine, Hershey, PA, USA
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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; 94:2283-90. [PMID: 23796686 DOI: 10.1016/j.apmr.2013.05.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 05/25/2013] [Accepted: 05/28/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate the time-related changes in motor performance of the ipsilesional upper limb in subacute poststroke patients by using clinical and kinematic assessments. DESIGN Observational, longitudinal, prospective, monocentric study. SETTING Physical medicine and rehabilitation department. PARTICIPANTS Stroke patients (n=19; mean age, 62.9y) were included less than 30 days after a first unilateral ischemic/hemorrhagic stroke. The control group was composed of age-matched, healthy volunteers (n=9; mean age, 63.1y). INTERVENTIONS Clinical and kinematic assessments were conducted once a week during 6 weeks and 3 months after inclusion. Clinical measures consisted of Fugl-Meyer Assessment, Box and Block Test (BBT), Nine-Hole Peg Test (9HPT), and Barthel Index. We used a 3-dimensional motion recording system during a reach-to-grasp task to analyze movement smoothness, movement time, and peak velocity of the hand. Healthy controls performed both clinical (BBT and 9HPT) and kinematic evaluation within a single session. MAIN OUTCOME MEASURES BBT and 9HPT. RESULTS Recovery of ipsilesional upper arm capacities increased over time and leveled off after a 6-week period of rehabilitation, corresponding to 9 weeks poststroke. At study discharge, patients demonstrated similar ipsilesional clinical scores to controls but exhibited less smooth reaching movements. We found no effect of the hemispheric side of the lesion on ipsilesional motor deficits. CONCLUSIONS Our findings provide evidence that ipsilesional motor capacities remain impaired at least 3 months after stroke, even if clinical tests fail to detect the impairment. Focusing on this lasting ipsilesional impairment through a more detailed kinematic analysis could be of interest to understand the specific neural network underlying ipsilesional upper-limb impairment.
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Affiliation(s)
- Julien Metrot
- Movement to Health Laboratory, EuroMov, Montpellier-1 University, Montpellier, France
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Distribution of arm velocity and frequency of arm usage during daily activity: objective outcome evaluation after shoulder surgery. Gait Posture 2013; 38:247-52. [PMID: 23266045 DOI: 10.1016/j.gaitpost.2012.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 11/19/2012] [Accepted: 11/25/2012] [Indexed: 02/02/2023]
Abstract
In clinical settings, functional evaluation of shoulder movement is primarily based on what the patient thinks he/she is able to do rather than what he/she is actually performing. We proposed a new approach for shoulder assessment based on inertial sensors to monitor arm movement in the daily routine. The detection of movement of the humerus relative to the trunk was first validated in a laboratory setting (sensitivity>95%, specificity>97%). Then, 41 control subjects and 21 patients suffering from a rotator cuff tear were evaluated (before and after surgery) using clinical questionnaires and a one-day measurement of arm movement. The quantity of movement was estimated with the movement frequency and its symmetry index (SIFr). The quality of movement was assessed using the Kolmogorov-Smirnov distance (KS) between the cumulative distribution of the arm velocity for controls and the same distribution for each patient. SIFr presented differences between patients and controls at 3 month follow-up (p<0.05) while KS showed differences also after 6 months (p<0.01). SIFr illustrated a change in dominance due to the disorder whereas KS, which appeared independent of the dominance and occupation, showed a change in movement velocity. Both parameters were correlated to clinical scores (R(2) reaching 0.5). This approach provides clinicians with new objective parameters for evaluating the functional ability of the shoulder in daily conditions, which could be useful for outcome assessment after surgery.
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Bilateral coupling facilitates recovery of rhythmical movements from perturbation in healthy and post-stroke subjects. Exp Brain Res 2013; 227:263-74. [DOI: 10.1007/s00221-013-3509-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
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Duc C, Salvia P, Lubansu A, Feipel V, Aminian K. Objective evaluation of cervical spine mobility after surgery during free-living activity. Clin Biomech (Bristol, Avon) 2013; 28:364-9. [PMID: 23578604 DOI: 10.1016/j.clinbiomech.2013.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 03/13/2013] [Accepted: 03/19/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Evaluation of cervical spine mobility after surgery is mainly based on the measurement of the range of motion during imposed movements. It can thus be questionable if this assessment represents the mobility experienced during daily life. The goal of this study was to propose a new evaluation tool based on the monitoring of cervical spine movement during daily activities. METHODS The detection of cervical movement and the determination of primary motion component (lateral bending, axial rotation or flexion-extension), using two inertial sensors, were first validated in laboratory settings. Fifteen patients who underwent a cervical arthrodesis and nine healthy control subjects were monitored during their daily activity for half a day. The frequency of cervical movement was quantified according to posture, i.e. static and walking periods. The amplitude and velocity of cervical movement were evaluated using the median and cumulative distribution function. FINDINGS The movement detection and classification showed an excellent performance (sensitivity and specificity>94%). For the daily monitoring, the patients presented a movement frequency similar to controls, whereas the amplitude and velocity in patients were lower than in controls (P<0.05). The differences between patients and controls were larger for the velocity parameters (effect sizes>0.37 and >0.54 for static and walking periods respectively) than for the amplitude parameters. INTERPRETATION Body-worn inertial sensors enable the quantitative evaluation of global cervical movement. The movement amplitude and velocity during free-living conditions can be used as objective parameters to evaluate the cervical spine mobility after treatment.
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Affiliation(s)
- C Duc
- Laboratory of Movement Analysis and Measurement (LMAM), Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland.
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Han J, Waddington G, Adams R, Anson J. Bimanual proprioceptive performance differs for right- and left-handed individuals. Neurosci Lett 2013; 542:37-41. [PMID: 23523925 DOI: 10.1016/j.neulet.2013.03.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 02/12/2013] [Accepted: 03/02/2013] [Indexed: 12/13/2022]
Abstract
It has been proposed that asymmetry between the upper limbs in the utilization of proprioceptive feedback arises from functional differences in the roles of the preferred and non-preferred hands during bimanual tasks. The present study investigated unimanual and bimanual proprioceptive performance in right- and left-handed young adults with an active finger pinch movement discrimination task. With visual information removed, participants were required to make absolute judgments about the extent of pinch movements made to physical stops, either by one hand, or by both hands concurrently, with the sequence of presented movement extents varied randomly. Discrimination accuracy scores were derived from participants' responses using non-parametric signal detection analysis. Consistent with previous findings, a non-dominant hand/hemisphere superiority effect was observed, where the non-dominant hands of right- and left-handed individuals performed overall significantly better than their dominant hands. For all participants, bimanual movement discrimination scores were significantly lower than scores obtained in the unimanual task. However, the magnitude of the performance reduction, from the unimanual to the bimanual task, was significantly greater for left-handed individuals. The effect whereby bimanual proprioception was disproportionately affected in left-handed individuals could be due to enhanced neural communication between hemispheres in left-handed individuals leading to less distinctive separation of information obtained from the two hands in the cerebral cortex.
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Affiliation(s)
- Jia Han
- Shanghai University of Sport, 650 Qingyuanhuan Road, Shanghai 200438, Yangpu District, China.
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Postoperative Analysis of Patients Who Received the Universal 2 Total Wrist Implant System. J Appl Biomech 2012; 28:466-72. [DOI: 10.1123/jab.28.4.466] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Third-generation total wrist arthroplasty devices have provided joint stability, relief from pain and increased wrist motion for patients suffering from severe arthritis. While reports of clinical follow-up appointments describe improved wrist function, the improvement in overall upper extremity function and patient perception remains a question. Therefore, the purpose of this study was to assess the upper extremity function in patients that received the Universal 2 total implant system. Eight patients participated in the complete protocol, which included testing activities of daily living as well as surveys to assess patient perception. The findings of the current study suggest that although patients exhibit motion that exceeds the needed amount, many still have a perceived disability.
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Acuna M, Karduna AR. Wrist activity monitor counts are correlated with dynamic but not static assessments of arm elevation exposure made with a triaxial accelerometer. ERGONOMICS 2012; 55:963-970. [PMID: 22512361 DOI: 10.1080/00140139.2012.676672] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
UNLABELLED There is evidence in the literature of a link between workplace arm elevation exposure and atraumatic shoulder injuries. However, there are several methods that can be used to assess this exposure. The goal of the present study was to compare the outcomes of an activity monitor attached to the wrist and a triaxial accelerometer mounted on the humerus. Twenty-one workers wore both sensors over the course of a full workday. While the activity monitor data was not significantly correlated with any static humeral parameters, it was strongly correlated with all dynamic parameters. The use of a simple, commercially available activity monitor might offer an inexpensive alternative for the assessment of a large number of subjects over multiple workdays to determine the relationship between dynamic motion and occupation shoulder injuries in the future. PRACTITIONER SUMMARY Arm overuse has been linked to occupation-related shoulder injuries. An activity monitor attached to the wrist and a triaxial accelerometer mounted on the humerus were compared in a field trial. The results demonstrate that, under certain conditions, a commercially available activity monitor might be a useful tool for exposure assessment.
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Affiliation(s)
- Miguel Acuna
- Department of Human Physiology, University of Oregon, Eugene, OR 97403, USA
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Lemmens RJM, Timmermans AAA, Janssen-Potten YJM, Smeets RJEM, Seelen HAM. Valid and reliable instruments for arm-hand assessment at ICF activity level in persons with hemiplegia: a systematic review. BMC Neurol 2012; 12:21. [PMID: 22498041 PMCID: PMC3352056 DOI: 10.1186/1471-2377-12-21] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 04/12/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Loss of arm-hand performance due to a hemiparesis as a result of stroke or cerebral palsy (CP), leads to large problems in daily life of these patients. Assessment of arm-hand performance is important in both clinical practice and research. To gain more insight in e.g. effectiveness of common therapies for different patient populations with similar clinical characteristics, consensus regarding the choice and use of outcome measures is paramount. To guide this choice, an overview of available instruments is necessary. The aim of this systematic review is to identify, evaluate and categorize instruments, reported to be valid and reliable, assessing arm-hand performance at the ICF activity level in patients with stroke or cerebral palsy. METHODS A systematic literature search was performed to identify articles containing instruments assessing arm-hand skilled performance in patients with stroke or cerebral palsy. Instruments were identified and divided into the categories capacity, perceived performance and actual performance. A second search was performed to obtain information on their content and psychometrics. RESULTS Regarding capacity, perceived performance and actual performance, 18, 9 and 3 instruments were included respectively. Only 3 of all included instruments were used and tested in both patient populations. The content of the instruments differed widely regarding the ICF levels measured, assessment of the amount of use versus the quality of use, the inclusion of unimanual and/or bimanual tasks and the inclusion of basic and/or extended tasks. CONCLUSIONS Although many instruments assess capacity and perceived performance, a dearth exists of instruments assessing actual performance. In addition, instruments appropriate for more than one patient population are sparse. For actual performance, new instruments have to be developed, with specific focus on the usability in different patient populations and the assessment of quality of use as well as amount of use. Also, consensus about the choice and use of instruments within and across populations is needed.
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Affiliation(s)
- Ryanne JM Lemmens
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Annick AA Timmermans
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Yvonne JM Janssen-Potten
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Rob JEM Smeets
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
- Department of Rehabilitation Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Henk AM Seelen
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
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Fan F, Zhu C, Chen H, Qin W, Ji X, Wang L, Zhang Y, Zhu L, Yu C. Dynamic brain structural changes after left hemisphere subcortical stroke. Hum Brain Mapp 2012; 34:1872-81. [PMID: 22431281 DOI: 10.1002/hbm.22034] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 12/06/2011] [Accepted: 12/06/2011] [Indexed: 11/07/2022] Open
Abstract
This study aimed to quantify dynamic structural changes in the brain after subcortical stroke and identify brain areas that contribute to motor recovery of affected limbs. High-resolution structural MRI and neurological examinations were conducted at five consecutive time points during the year following stroke in 10 patients with left hemisphere subcortical infarctions involving motor pathways. Gray matter volume (GMV) was calculated using an optimized voxel-based morphometry technique, and dynamic changes in GMV were evaluated using a mixed-effects model. After stroke, GMV was decreased bilaterally in brain areas that directly or indirectly connected with lesions, which suggests the presence of regional damage in these "healthy" brain tissues in stroke patients. Moreover, the GMVs of these brain areas were not correlated with the Motricity Index (MI) scores when controlling for time intervals after stroke, which indicates that these structural changes may reflect an independent process (such as axonal degeneration) but cannot affect the improvement of motor function. In contrast, the GMV was increased in several brain areas associated with motor and cognitive functions after stroke. When controlling for time intervals after stroke, only the GMVs in the cognitive-related brain areas (hippocampus and precuneus) were positively correlated with MI scores, which suggests that the structural reorganization in cognitive-related brain areas may facilitate the recovery of motor function. However, considering the small sample size of this study, further studies are needed to clarify the exact relationships between structural changes and recovery of motor function in stroke patients.
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Affiliation(s)
- Fengmei Fan
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, People's Republic of China
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Perry MA, Hudson HS, Meys S, Norrie O, Ralph T, Warner S. Older adults' experiences regarding discharge from hospital following orthopaedic intervention: a metasynthesis. Disabil Rehabil 2011; 34:267-78. [PMID: 21981113 DOI: 10.3109/09638288.2011.603016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To identify and synthesise qualitative literature on the older adults' perspectives of being discharged from hospital following orthopaedic intervention. METHODS A systematic search of nine databases, for qualitative research published between 1950 and December 2010, exploring the lived experience of older adults being discharged from hospital following orthopaedic surgery was undertaken. Included papers were evaluated using the Critical Appraisal Skills Programme (CASP) quality guidelines. Data were extracted and themes synthesised, using an EXCEL spreadsheet to assist with organisation of data. RESULTS From the 16 papers included in the review, four themes were identified: 1) mental outlook; 2) loss of independence; 3) function and activity limitations; and 4) coping with pain. Mental outlook was central to the other three themes. CONCLUSIONS Older adults' experiences around hospital discharge, collected through qualitative research, provide health authorities with valuable information that could be used in care pathway planning. Health professionals involved in in-patient and community care should be aware that a perceived loss of independence, function and activity limitations, and the ability to cope with pain can influence mental outlook and consequently rehabilitation.
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Affiliation(s)
- Meredith A Perry
- Centre for Physiotherapy Research, University of Otago, New Zealand.
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Abstract
OBJECTIVE Our objectives were (1) to quantify arm-hand use of older adults without a disability and to determine the effects of hand dominance, gender, and day on hand usage and (2) to determine the factors that predict arm-hand use. This information will enhance understanding of the extent of the client's occupational performance. METHOD Twenty men and 20 women, ages 65-85, wore wrist and hip accelerometers for 7 consecutive days. Manual dexterity and grip strength were assessed. A three-way factorial analysis of variance and multiple linear regressions were conducted. RESULTS The activity kilocounts from both wrist accelerometers revealed a significant interaction effect between hand and gender (F[1, 190] = 24.4, p < .001). Enhanced manual dexterity of the right hand was associated with greater right-hand use. CONCLUSION Arm-hand use is a novel dimension of hand function measuring the extent of real-life occupational performance in the client's home.
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Affiliation(s)
- Debbie Rand
- Rehab Research Lab, GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
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Goble DJ, Coxon JP, Van Impe A, De Vos J, Wenderoth N, Swinnen SP. The neural control of bimanual movements in the elderly: Brain regions exhibiting age-related increases in activity, frequency-induced neural modulation, and task-specific compensatory recruitment. Hum Brain Mapp 2010; 31:1281-95. [PMID: 20082331 PMCID: PMC6871108 DOI: 10.1002/hbm.20943] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Revised: 10/04/2009] [Accepted: 10/05/2009] [Indexed: 11/11/2022] Open
Abstract
Coordinated hand use is an essential component of many activities of daily living. Although previous studies have demonstrated age-related behavioral deficits in bimanual tasks, studies that assessed the neural basis underlying such declines in function do not exist. In this fMRI study, 16 old and 16 young healthy adults performed bimanual movements varying in coordination complexity (i.e., in-phase, antiphase) and movement frequency (i.e., 45, 60, 75, 90% of critical antiphase speed) demands. Difficulty was normalized on an individual subject basis leading to group performances (measured by phase accuracy/stability) that were matched for young and old subjects. Despite lower overall movement frequency, the old group "overactivated" brain areas compared with the young adults. These regions included the supplementary motor area, higher order feedback processing areas, and regions typically ascribed to cognitive functions (e.g., inferior parietal cortex/dorsolateral prefrontal cortex). Further, age-related increases in activity in the supplementary motor area and left secondary somatosensory cortex showed positive correlations with coordinative ability in the more complex antiphase task, suggesting a compensation mechanism. Lastly, for both old and young subjects, similar modulation of neural activity was seen with increased movement frequency. Overall, these findings demonstrate for the first time that bimanual movements require greater neural resources for old adults in order to match the level of performance seen in younger subjects. Nevertheless, this increase in neural activity does not preclude frequency-induced neural modulations as a function of increased task demand in the elderly.
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Affiliation(s)
- Daniel J Goble
- Research Center for Movement Control and Neuroplasticity, Department for Biomedical Kinesiology, Katholieke Universiteit Leuven, Heverlee, Belgium.
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Acuna M, Amasay T, Karduna AR. The reliability of side to side measurements of upper extremity activity levels in healthy subjects. BMC Musculoskelet Disord 2010; 11:168. [PMID: 20650006 PMCID: PMC2914700 DOI: 10.1186/1471-2474-11-168] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Accepted: 07/22/2010] [Indexed: 11/23/2022] Open
Abstract
Background In both clinical and occupational settings, ambulatory sensors are becoming common for assessing all day measurements of arm motion. In order for the motion of a healthy, contralateral side to be used as a control for the involved side, the inherent side to side differences in arm usage must be minimal. The goal of the present study was to determine the reliability of side to side measurements of upper extremity activity levels in healthy subjects. Methods Thirty two subjects with no upper extremity pathologies were studied. Each subject wore a triaxial accelerometer on both arms for three and a half hours. Motion was assessed using parameters previously reported in the literature. Side to side differences were compared with the intraclass correlation coefficient, standard error of the mean, minimal detectable change scores and a projected sample size analysis. Results The variables were ranked based on their percentage of minimal detectable change scores and sample sizes needed for paired t-tests. The order of these rankings was found to be identical and the top ranked parameters were activity counts per hour (MDC% = 9.5, n = 5), jerk time (MDC% = 15.8, n = 8) and percent time above 30 degrees (MDC% = 34.7, n = 9). Conclusions In general, the mean activity levels during daily activities were very similar between dominant and non-dominant arms. Specifically, activity counts per hour, jerk time, and percent time above 30 degrees were found to be the variables most likely to reveal significant difference or changes in both individuals and groups of subjects. The use of ambulatory measurements of upper extremity activity has very broad uses for occupational assessments, musculoskeletal injuries of the shoulder, elbow, wrist and hand as well as neurological pathologies.
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Affiliation(s)
- Miguel Acuna
- Department of Human Physiology, University of Oregon, Eugene, Oregon 97403, USA
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Ipsilateral deficits in 1-handed shoe tying after left or right hemisphere stroke. Arch Phys Med Rehabil 2009; 90:1800-5. [PMID: 19801074 DOI: 10.1016/j.apmr.2009.03.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 01/21/2009] [Accepted: 03/05/2009] [Indexed: 11/22/2022]
Abstract
UNLABELLED Poole JL, Sadek J, Haaland KY. Ipsilateral deficits in 1-handed shoe tying after left or right hemisphere stroke. OBJECTIVE To examine 1-handed shoe tying performance and whether cognitive deficits more associated with left or right hemisphere damage differentially affect it after unilateral stroke. DESIGN Observational cohort comparing ipsilesional shoe tying, spatial and language skills, and limb praxis. SETTING Primary care Veterans Affairs and private medical center. INTERVENTIONS Not applicable. PARTICIPANTS Volunteer right-handed sample of adults with left or right hemisphere damage and healthy demographically matched adults. MAIN OUTCOME MEASURE The number of correct trials and the total time to complete 10 trials tying a shoe using the 1-handed method. RESULTS Both stroke groups had fewer correct trials and were significantly slower tying the shoe than the control group. Spatial skills predicted accuracy and speed after right hemisphere damage. After left hemisphere damage, accuracy was predicted by spatial skills and limb praxis, while speed was predicted by limb praxis only. CONCLUSIONS Ipsilesional shoe tying is similarly impaired after left or right hemisphere damage, but for different reasons. Spatial deficits had a greater influence after right hemisphere damage, and limb apraxia had a greater influence after left hemisphere damage. Language deficits did not affect performance, indicating that aphasia does not preclude using this therapy approach. These results suggest that rehabilitation professionals should consider assessment of limb apraxia and ipsilesional skill training in the performance of everyday tasks.
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Schaefer SY, Haaland KY, Sainburg RL. Hemispheric specialization and functional impact of ipsilesional deficits in movement coordination and accuracy. Neuropsychologia 2009; 47:2953-66. [PMID: 19573544 DOI: 10.1016/j.neuropsychologia.2009.06.025] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 05/26/2009] [Accepted: 06/22/2009] [Indexed: 12/24/2022]
Abstract
Previous studies have demonstrated that following unilateral stroke, motor impairment occurs both contralateral, as well as ipsilateral, to the lesion. Although ipsilesional impairments can be functionally limiting, they can also provide important insight into the role of the ipsilateral hemisphere in controlling movement and the lateralization of specific motor control mechanisms, given that unilateral arm movements are thought to recruit processes in each hemisphere. The purpose of this study was to examine whether left and right hemisphere damage following stroke produces different ipsilesional deficits, and whether our dynamic dominance model of motor lateralization can predict such deficits. Specifically, the dynamic dominance model attributes control of multijoint dynamics to the left hemisphere, and control of steady-state position to the right hemisphere. Chronic stroke patients with either left or right hemisphere damage (LHD or RHD) used their ipsilesional arm, and the control subjects used either their left or right arm (LHC or RHC), to perform targeted reaching movements in different directions within the workspace ipsilateral to their reaching arm. We found that the LHD group showed deficits in controlling the arm's trajectory due to impaired multijoint coordination, but no deficits in achieving accurate final positions. In contrast, the RHD group showed deficits in final position accuracy but not in the ability to coordinate multiple joints during movement, thereby providing additional evidence for the hemisphere-specific nature of motor deficits. Furthermore, while both the LHD and RHD groups were functionally impaired to the same degree on the Jebsen Hand Function Test (JHFT), our results suggest that the underlying mechanisms for such impairment may be hemisphere-dependent.
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Affiliation(s)
- Sydney Y Schaefer
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA
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