Quantifying an Upper Extremity Everyday Task With 3D Kinematic Analysis in People With Spinal Cord Injury and Non-disabled Controls

Participation and autonomy, independence in activities of daily living and upper extremity functioning in individuals with spinal cord injury

Improvements in care and rehabilitation have resulted in a higher proportion of people living with spinal cord injury (SCI), which calls for an increased focus on participation and autonomy. This observational cross-sectional study investigated the impact of SCI on autonomy and how it correlates to activity performance and upper extremity functioning. A total of 25 adults (mean age 58 years) with chronic cervical or thoracic SCI were included. Self-perceived autonomy was measured with Impact on Participation and Autonomy questionnaire, independence in activities of daily living (ADL) with Spinal Cord Independence Measure, upper extremity functioning with Action Research Arm Test (ARAT) and kinematic measures of the drinking task. The results showed that most participants perceived injury-related restrictions in outdoor autonomy (80%), family role (76%), and in indoor autonomy (72%). Independence in self-care (r = 0.72), mobility (r = 0.59) and upper extremity kinematics of movement time (r = 0.63) and smoothness (r = 0.49) were correlated to indoors autonomy. Social life autonomy was correlated to self-care (r = 0.50) and ARAT (r = 0.41). In conclusion, autonomy was perceived restricted after SCI in several major life areas and correlated with independence in ADL and upper extremity functioning. The aspects of autonomy should be considered more in goal setting and clinical decision-making.

Kinematic analysis in post-stroke patients with moderate to severe upper limb paresis and non-disabled controls

BACKGROUND

Kinematic analysis has been recommended to quantify the upper limb motor function after stroke. However, previous studies have rarely reported the kinematic data of the post-stroke patients with moderate to severe upper limb paresis due to the poor accomplishment of the complex tasks.

METHODS

27 post-stroke individuals and 20 non-disabled people participated in the study. The trunk and upper limb movements during the Hand-to-mouth task were captured by the motion capture system and upper extremity kinematic analysis software automatically. The subgroup analysis within stroke group were conducted layering by the Fugl-Meyer Assessment for Upper Extremity scores (severe: 16-31; moderate: 32-50).

FINDINGS

The paretic upper limbs in the stroke group tended to use more trunk and shoulder compensatory strategies to offset the impact of spasticity and weakness compared with non-disabled controls. The less-affected limbs in the stroke group also showed abnormal kinematic data. There were significant differences between the kinematic metrics of severe and moderate subgroups.

INTERPRETATION

The Hand-to-mouth task is a good and feasible option for kinematic analysis of these patients. It is essential to layer the severity of the paresis and put more emphasis on trunk movements in the future kinematic studies.

Age- and sex-related differences in upper-body joint and endpoint kinematics during a drinking task in healthy adults

Background

The objective kinematic assessments of activities of daily living are desired. However, the limited knowledge regarding age- and sex-related differences prevents the adaptation of these measurements to clinical settings and in-home exercises. Therefore, this study aimed to determine the effects of age and sex on joint and endpoint kinematics during a common activity of daily living, specifically, drinking from a glass.

Methods

In total, 32 healthy adults (18 males and 14 females) aged 22-77 years performed a drinking task comprising reaching for a glass, bringing it forward and sipping, returning it, and placing the hand back to the starting position, which was recorded using a three-dimensional motion-capturing system. A two-way analysis of variance was used to statistically compare joint angles at five different time points and endpoint kinematic variables in the four drinking phases between older and younger age groups and sexes.

Results

Wrist radial deviation was greater in older adults than in younger participants at all five different time points (F = 5.16-7.34, p ≤ 0.03, η2 = 0.14-0.21). Moreover, lesser shoulder abduction and greater shoulder internal rotation and forearm pronation when moving and returning the hand to the starting position were observed in the female group than in the male group (F = 4.21-20.03, p ≤ 0.0497, η2 = 0.13-0.41). Trunk flexion was lower in the female group than in the male group at all time points (F = 4.25-7.13, p ≤ 0.0485, η2 = 0.12-0.19). Regarding endpoint kinematics, the performance time in the reaching phase was longer in older adults than in younger individuals (F = 4.96, p = 0.03, η2 = 0.14). Furthermore, a shorter time while returning the hand to the starting position was observed in the female group than in the male group (F = 9.55, p < 0.01, η2 = 0.22).

Conclusions

The joint kinematics of drinking were partially characterized by an age effect, whereas endpoint kinematics were scattered in all drinking phases. Sex-related effects in most upper-body motions and postures may cause rapid motions in females. Therefore, clinicians could use this knowledge for precise assessments and to suggest feasible in-home exercises.

Independence and upper extremity functioning after spinal cord injury: a cross-sectional study

Upper extremity functioning is important for achieving independence in activities of daily living (ADL). A better understanding of relationships between different aspects of independence in ADL after spinal cord injury (SCI) and upper extremity functioning is required to guide rehabilitation practices. To determine which aspects of independence in ADL are correlated with upper extremity functioning in individuals with cervical or thoracic SCI. A total of 25 adults (mean age 58.4 years, 72% men) with established cervical or thoracic SCI were recruited. Independence in ADL was assessed by Spinal Cord Independence Measure (SCIM-III) and upper extremity functioning by kinematic measures (movement time, smoothness, and wrist angle during drinking task), grip strength, Upper Extremity Motor and Sensory Score, Box and Block Test (BBT), Action Research Arm Test (ARAT), and Upper Extremity Basic Data Set (ISCI-Hand and ISCI-Shoulder). Spearman correlation coefficients were used for data analyses. The SCIM-self-care subscale, particularly the feeding and dressing items, correlated moderately (r ≥ 0.5) with movement time and smoothness, grip strength, ARAT, BBT, and ISCI-Hand. The SCIM-respiration/sphincter subscale and the SCIM-mobility showed very low and low correlations with upper extremity assessments. However, at item level, respiration and bed/wheelchair mobility showed moderate correlations. Independence in self-care as domain and feeding/dressing, respiration and bed/wheelchair mobility as separate items were dependent on upper extremity functioning in individuals with cervical or thoracic SCI. Movement time and smoothness along with BBT, grip strength, ARAT, and ISCI-Hand can be used as indicators of independence in ADL. These findings can provide guidance to clinical practice in selection of upper extremity assessments in the context for ADL in individuals with SCI.