[Movement analysis of upper extremity hemiparesis in patients with cerebrovascular disease: a pilot study]

Biopsychosocial factors associated with the state of disability after hemiparesis in the chronic phase of stroke: exploratory analysis based on the International Classification of Functioning, Disability and Health

OBJECTIVE

To identify the main biopsychosocial factors associated with disability level after stroke using the International Classification of Functioning, Disability and Health (ICF) model.

METHODS

A cross-sectional study was conducted with chronic stroke survivors. Disability was assessed using the World Health Disability Assessment Schedule 2.0. The independent variables were: Body functions: emotional functioning and whether the dominant upper limb was affected. For the Activities & Participation component, satisfaction regarding the execution of activities and participation were assessed using the SATIS-Stroke, as well as the locomotion ability for adults (ABILOCO), manual ability (ABILHAND) and the return to work. For environmental factors, income and facilitators and obstacles were assessed using the Measure of the Quality of the Environment (MQE). Personal factors: age and sex. Multiple Linear Regression was employed.

RESULTS

Limited locomotor ability (β = -0.281; t = -3.231 p = 0.002), dissatisfaction regarding activities and participation (β = -0.273; t = -3.070 p = 0.003), and the non-return to work (β = 0.162; t = 2.085 p = 0.04) were associated with disability.

CONCLUSION

The reduction in locomotor ability, dissatisfaction regarding activities and participation and the non-return to work were associated with disability in the chronic phase following a stroke.

Biomechanical Assessment of Post-Stroke Patients' Upper Limb before and after Rehabilitation Therapy Based on FES and VR

Stroke is a medical condition characterized by the rapid loss of focal brain function. Post-stroke patients attend rehabilitation training to prevent the degeneration of physical function and improve upper limb movements and functional status after stroke. Promising rehabilitation therapies include functional electrical stimulation (FES), exergaming, and virtual reality (VR). This work presents a biomechanical assessment of 13 post-stroke patients with hemiparesis before and after rehabilitation therapy for two months with these three methods. Patients performed two tests (Maximum Forward Reach and Apley Scratching) where maximum angles, range of motion, angular velocities, and execution times were measured. A Wilcoxon test was performed (p = 0.05) to compare the variables before and after the therapy for paretic and non-paretic limbs. Significant differences were found in range of motion in flexion–extension, adduction–abduction, and internal–external rotation of the shoulder. Increases were found in flexion–extension, 17.98%, and internal–external rotation, 18.12%, after therapy in the Maximum Forward Reach Test. For shoulder adduction–abduction, the increase found was 20.23% in the Apley Scratching Test, supporting the benefits of rehabilitation therapy that combines FES, exergaming, and VR in the literature.

Feasibility and Efficacy of a Virtual Reality Game-Based Upper Extremity Motor Function Rehabilitation Therapy in Patients with Chronic Stroke: A Pilot Study

BACKGROUND

The objective of the present study was to develop a virtual reality protocol based on activities of daily living and conventional rehabilitation, using Leap Motion Controller to improve motor function in upper extremity rehabilitation in stroke patients. At the same time, the purpose was to explore its efficacy in the recovery of upper extremity motor function in chronic stroke survivors, and to determine feasibility, satisfaction and attendance rate; Methods: A prospective pilot experimental clinical trial was conducted. The outcome measures used were the grip strength, the Action Research Arm Test (ARAT), the Block and Box Test (BBT), the Short Form Health Survey-36 Questionnaire, a satisfaction questionnaire and attendance rate; Results: Our results showed statistically significant changes in the variables grip strength, BBT and ARAT as well as high levels of satisfaction and attendance; Conclusions: This virtual reality platform represents an effective tool in aspects of upper extremity functionality rehabilitation in patients with chronic stroke, demonstrating feasibility and high levels of attendance and satisfaction.

Analysis of Upper Limbs Target-Reaching Movement and Muscle Co-Activation in Patients with First Time Stroke for Rehabilitation Progress Monitoring

In this paper, the authors analysed changes occurring during the rehabilitation processes in patients after early stroke based on analysis of their upper limbs’ target-reaching movement and muscle co-activation. Ischemic stroke often results in reduced mobility of the upper extremities and frequently is a cause for long-term disability. The ever-developing technology of 3D movement analysis and miniaturisation of equipment for testing the bioelectrical activity of muscles can help to assess the progress of rehabilitation. The aim of this study was to examine the use of analysis of target-reaching movement indicators and muscle co-activation for diagnosing the rehabilitation process in post-stroke patients. Twenty ischemic stroke patients in the early post-stroke phase (up to three months after the stroke), and twenty healthy subjects (the control group) took part in the experiments. The novel approach of the proposed research proved the usefulness of this approach in the diagnosis of the rehabilitation efficiency of rehabilitation in early post-stroke phase patients.

Portable Sensors Add Reliable Kinematic Measures to the Assessment of Upper Extremity Function

Ordinal scales with low resolution are used to assess arm function in clinic. These scales may be improved by adding objective kinematic measures. The aim was to analyze within-subject, inter-rater and overall reliability (i.e., including within-subject and inter-rater reliability) and check the system’s validity of kinematic measures from inertial sensors for two such protocols on one person. Twenty healthy volunteers repeatedly performed two tasks, finger-to-nose and drinking, during two test sessions with two different raters. Five inertial sensors, on the forearms, upper arms and xiphoid process were used. Comparisons against an optical camera system evaluated the measurement validity. Cycle time, range of motion (ROM) in shoulder and elbow were calculated. Bland–Altman plots and linear mixed models including the generalizability (G) coefficient evaluated the reliability of the measures. Within-subject reliability was good to excellent in both tests (G = 0.80–0.97) and may serve as a baseline when assessing upper extremities in future patient groups. Overall reliability was acceptable to excellent (G = 0.77–0.94) for all parameters except elbow axial rotation in finger-to-nose task and both elbow axial rotation and flexion/extension in drinking task, mainly due to poor inter-rater reliability in these parameters. The low to good reliability for elbow ROM probably relates to high within-subject variability. The sensors provided good to excellent measures of cycle time and shoulder ROM in non-disabled individuals and thus have the potential to improve today’s assessment of arm function.

[The restoration of the shoulder joint function in the patients presenting with hemiparesis during the acute phase of hemispheric stroke]

The impaired function of the shoulder joint resulting from cerebral stroke is a common disorder involving permanent total disability as well as impaired capability of self-care. The functional pathological changes in the shoulder joint and the dynamics of the patients' health status during the acute period of cerebral stroke remain virtually unexplored.

AIM

The objective of the present study was to obtain a deeper insight into the process of recovery of the movements in the shoulder joint of the patients presenting with hemiparesis during the acute period of hemispheric stroke based on the results of the analysis of the biomechanical data and the targeted training with biofeedback (BFB).

MATERIAL AND METHODS

The study included three groups comprised of 25 subjects each. One (control) group included the subjects having neither neurological nor orthopedic pathology. The second group consisted of the patients receiving the conventional treatment in the combination with therapeutic physical exercises (TPE). Group 3 was composed of the patients given the standard course of conventional and physical (TPE) therapy complemented by biofeedback training (the TPE/BFB group). The study included clinical investigations and biomechanical registration of the movements of the shoulder joints and trunk.

RESULTS

The results of the study gave evidence that the patients presenting with hemiparesis during the acute period of hemispheric ischemic stroke including those treated with the application of the active means and methods of rehabilitation, such as BFB training, showed no appreciable dynamics of the parameters being evaluated with the use of the relevant clinical scales. The biomechanical study has demonstrated that the movements in the shoulder joints (in a single plain) of the patients comprising the control group are characterized by the presence of the main component with a maximum amplitude in the plane of this movement and additional components (in other planes with a significantly lower amplitude); they are accompanied by the ancillary movements of the trunk. Functionally, the condition of paresis at the level of the shoulder joint is characterized by a decrease in the amplitude of the primary movement and the increase of one of the additional amplitudes, with the growing amplitude of the auxiliary movements of the trunk. The biomechanical methods for the objective assessment have revealed the following functional changes in the shoulder joints: the 6% improvement of flexion in the group of the patients treated with the use of therapeutic physical exercises and the 10% improvement in those treated with the combination of TPE and BFB. Moreover, abduction in the patients of these two groups improved by 4% and 9% respectively.

CONCLUSIONS

The method for the study of kinematics of the movements in the shoulder joints appears to be most sensitive and informative for the purpose of diagnostics of disorders of the motor function and assessment of the process of its restoration in the patients presenting with hemiparesis during the acute period of hemispheric stroke.

Influence of Gender Differences on Range of Motion and Joint Angles During Eating in Young, Healthy Japanese Adults

Objective

Eating is important in rehabilitation and is evaluated using joint angles that serve as kinematic information. Joint angles of the upper extremities during eating have been reported for men and for women; however, no study has investigated these joint angles in terms of gender differences. At present, no information is available on gender differences as individual factors of upper extremity joint angles during eating. Therefore, the present study investigated gender differences in upper limb joint angles during eating tasks involving a spoon or chopsticks.

Methods

We examined eating motions in 12 healthy Japanese men and 13 healthy Japanese women (aged 20-39 years) and compared the two groups. Motions were assessed using inertial sensors and three-dimensional motion analysis.

Results

We established, separately for men and women, the maximum angle and the range of motion (RoM) for each upper limb joint. Women generally had greater RoMs for all upper limb joints than men did. When subjects used a spoon, statistically significant differences and large effect sizes were observed for the maximum elbow joint flexion angle and the RoMs of the shoulder joint in abduction, flexion, and internal rotation. When subjects used chopsticks, statistically significant differences and large effect sizes were observed for maximum angles of shoulder joint internal rotation, elbow joint flexion, and wrist joint radial flexion and for the RoM of shoulder joint abduction.

Conclusions

We concluded that there are significant gender differences in upper limb joint angles during eating, and that these differences are influenced by numerous factors.

Bilateral changes in 3-D scapular kinematics in individuals with chronic stroke

BACKGROUND

Stroke can lead to altered scapular motion that may limit the ability to perform activities of daily living. The aims were to evaluate scapular kinematics of individuals with chronic stroke and the correlation with paretic arm function.

METHODS

Scapular kinematics was assessed in thirty-four individuals (Chronic stroke=17; controls=17) during arm elevation and lowering in scapular and self-selected planes, and during hair combing. The use of the paretic arm to perform activities of daily living was assessed by the Motor Activity Log (MAL-30). Scapular kinematics was compared among paretic and non-paretic arms, and controls. Correlation between scapular kinematics and MAL-30 was also verified.

FINDINGS

Paretic and non-paretic arms showed increased scapular internal rotation (p<0.05) during arm lowering in the scapular plane, and during arm elevation and lowering in the self-selected plane compared to controls. Increased internal rotation (p<0.05) was also found in the paretic arm during hair combing compared to controls. Increased scapular anterior tilt (p<0.05) was observed in the paretic arm during arm elevation while performing the activity of hair combing and during arm elevation and lowering in the scapular and self-selected planes compared to controls. The non-paretic arm showed increased anterior tilt (p<0.05) during arm elevation and lowering in self-selected plane compared to controls. No difference in scapular upward rotation among neither arms, nor correlation between scapular kinematics and MAL-30 were found (p>0.05).

INTERPRETATION

Individuals with chronic stroke showed bilateral scapular kinematics alterations. However, these alterations are not correlated with paretic arm function.

The Use of Functional Electrical Stimulation on the Upper Limb and Interscapular Muscles of Patients with Stroke for the Improvement of Reaching Movements: A Feasibility Study

Introduction

Reaching movements in stroke patients are characterized by decreased amplitudes at the shoulder and elbow joints and greater displacements of the trunk, compared to healthy subjects. The importance of an appropriate and specific contraction of the interscapular and upper limb (UL) muscles is crucial to achieving proper reaching movements. Functional electrical stimulation (FES) is used to activate the paretic muscles using short-duration electrical pulses.

Objective

To evaluate whether the application of FES in the UL and interscapular muscles of stroke patients with motor impairments of the UL modifies patients’ reaching patterns, measured using instrumental movement analysis systems.

Design

A cross-sectional study was carried out.

Setting

The VICON Motion System^® was used to conduct motion analysis.

Participants

Twenty-one patients with chronic stroke.

Intervention

The Compex^® electric stimulator was used to provide muscle stimulation during two conditions: a placebo condition and a FES condition.

Main outcome measures

We analyzed the joint kinematics (trunk, shoulder, and elbow) from the starting position until the affected hand reached the glass.

Results

Participants receiving FES carried out the movement with less trunk flexion, while shoulder flexion elbow extension was increased, compared to placebo conditions.

Conclusion

The application of FES to the UL and interscapular muscles of stroke patients with motor impairment of the UL has improved reaching movements.

Improvement in arm and hand function after a stroke with task-oriented training

A man aged 77 years sustained a left-hemisphere stroke with right hemiparesis. After spending 10 days in the hospital, he was referred to an area rehabilitation centre. There he carried out daily physical, occupational and speech therapy, with an emphasis on task-oriented treatment. The patient's upper-extremity motor performance was evaluated at admission to the rehabilitation centre and before leaving the hospital by 3 different measurement tools: the upper-extremity motor part of the Fugl-Meyer assessment scale, electromyography in hand-reach and grasp and object manipulation and handwriting tasks. Significant improvement in hand function was observed in proximal as well as in distal skills. Significant improvement in handwriting skills and decreased impairment level of the upper extremity had considerable effects on the quality of life of the patient. The case report emphasises the importance of intensive task-oriented training during the first 3 months after stroke to support the natural recovery of the lesioned area.

Normative Data for an Instrumental Assessment of the Upper-Limb Functionality

Upper-limb movement analysis is important to monitor objectively rehabilitation interventions, contributing to improving the overall treatments outcomes. Simple, fast, easy-to-use, and applicable methods are required to allow routinely functional evaluation of patients with different pathologies and clinical conditions. This paper describes the Reaching and Hand-to-Mouth Evaluation Method, a fast procedure to assess the upper-limb motor control and functional ability, providing a set of normative data from 42 healthy subjects of different ages, evaluated for both the dominant and the nondominant limb motor performance. Sixteen of them were reevaluated after two weeks to perform test-retest reliability analysis. Data were clustered into three subgroups of different ages to test the method sensitivity to motor control differences. Experimental data show notable test-retest reliability in all tasks. Data from older and younger subjects show significant differences in the measures related to the ability for coordination thus showing the high sensitivity of the method to motor control differences. The presented method, provided with control data from healthy subjects, appears to be a suitable and reliable tool for the upper-limb functional assessment in the clinical environment.

Upper extremity muscle activation during drinking from a glass in subjects with chronic stroke

[Purpose] The purpose of this study was to compare the muscle activities of upper extremities during a drinking task between the stroke-affected and less-affected sides. [Subjects] Eight stroke patients (8 men; age 45.3 years; stroke duration 21.9 months) participated in this study. [Methods] Electromyography (EMG) was used to measure nine muscle activities of the upper extremity. The drinking task was divided into 5 phases. [Results] Analysis of the EMG data showed that the percentage of maximum voluntary isometric contraction (%MVIC) across all phases of drinking differed between the affected and less-affected sides. Participants used relatively higher levels of %MVIC in the anterior deltoid, flexor muscles, brachioradialis, and infraspinatus on the stoke-affected side. [Conclusion] The difference in muscle activation across all phases of the drinking movement allowed us to determine how upper extremity muscle activation may influence drinking performance on the stroke-affected and less-affected sides.