Effects of task goal on movement kinematics and line bisection performance in adults without disabilities

Outcomes after occupational therapy intervention for traumatic brachial plexus injury: A prospective longitudinal cohort study

STUDY DESIGN

Prospective longitudinal cohort study.

INTRODUCTION

Traumatic brachial plexus injuries (BPIs) can be devastating and negatively impact daily function and quality of life. Occupational therapists play an important role in rehabilitation; however, studies identifying outcomes are lacking.

PURPOSE

This study aims to describe outcomes including motor recovery, upper limb function, participation, pain, and quality of life for people receiving occupational therapy intervention.

METHODS

A convenience sample of English-speaking adults (n = 30) with a traumatic BPI, attending the clinic between December 1, 2014, to November 30, 2016, participated. Participants received occupational therapy focusing on sensorimotor retraining and activity-based rehabilitation. Data on active range of motion (goniometry), strength (Medical Research Council (MRC)), upper-limb function (UEFI15, QuickDASH), participation (PSFS), pain (Brief Pain Inventory), and quality of life (EQ-5D-3L) were collected at baseline, 3, 6, 9, and 12 months.

RESULTS

Elbow flexion strength showed significant improvement at all time-points, average increase 2.17 (MRC) (95% confidence interval: 1.29-3.04; P < .001) and mean final MRC grading 3.86 (standard error: 0.44). Significant improvements at 12 months were seen in: shoulder abduction strength and range, flexion strength and range, external rotation range; elbow extension strength and flexion range; thumb flexion and extension strength. Upper limb function (QuickDASH) showed significant improvement (mean change = 18.85; 95% confidence interval: 4.12-33.59; P = .02). Forearm protonation range and finger flexion strength were significantly worse. Remaining outcomes did not show significant improvement.

CONCLUSIONS

Occupational therapy with surgical intervention can improve strength, range, and upper limb function with people following traumatic BPI. Further investigations into impact on participation, pain, and quality of life are required.

Kinematic Components of the Reach-to-Target Movement After Stroke for Focused Rehabilitation Interventions: Systematic Review and Meta-Analysis

Background: Better upper limb recovery after stroke could be achieved through tailoring rehabilitation interventions directly at movement deficits. Aim: To identify potential; targets for therapy by synthesizing findings of differences in kinematics and muscle activity between stroke survivors and healthy adults performing reach-to-target tasks. Methods: A systematic review with identification of studies, data extraction, and potential risk of bias was completed independently by two reviewers. Online databases were searched from their inception to November 2017 to find studies of reach-to-target in people-with-stroke and healthy adults. Potential risk-of-bias was assessed using the Down's and Black Tool. Synthesis was undertaken via: (a) meta-analysis of kinematic characteristics utilizing the standardized mean difference (SMD) [95% confidence intervals]; and (b), narrative synthesis of muscle activation. Results: Forty-six studies met the review criteria but 14 had insufficient data for extraction. Consequently, 32 studies were included in the meta-analysis. Potential risk-of-bias was low for one study, unclear for 30, and high for one. Reach-to-target was investigated with 618 people-with-stroke and 429 healthy adults. The meta-analysis found, in all areas of workspace, that people-with-stroke had: greater movement times (seconds) e.g., SMD 2.57 [0.89, 4.25]; lower peak velocity (millimeters/second) e.g., SMD -1.76 [-2.29, -1.24]; greater trunk displacement (millimeters) e.g. SMD 1.42 [0.90, 1.93]; a more curved reach-path-ratio e.g., SMD 0.77 [0.32, 1.22] and reduced movement smoothness e.g., SMD 0.92 [0.32, 1.52]. In the ipsilateral and contralateral workspace, people-with-stroke exhibited: larger errors in target accuracy e.g., SMD 0.70 [0.39, 1.01]. In contralateral workspace, stroke survivors had: reduced elbow extension and shoulder flexion (degrees) e.g., elbow extension SMD -1.10 [-1.62, -0.58] and reduced shoulder flexion SMD -1.91 [-1.96, -0.42]. Narrative synthesis of muscle activation found that people-with-stroke, compared with healthy adults, exhibited: delayed muscle activation; reduced coherence between muscle pairs; and use of a greater percentage of muscle power. Conclusions: This first-ever meta-analysis of the kinematic differences between people with stroke and healthy adults performing reach-to-target found statistically significant differences for 21 of the 26 comparisons. The differences identified and values provided are potential foci for tailored rehabilitation interventions to improve upper limb recovery after stroke.

Promoting Translational Research Among Movement Science, Occupational Science, and Occupational Therapy

Integration of research in the fields of neural control of movement and biomechanics (collectively referred to as movement science) with the field of human occupation directly benefits both areas of study. Specifically, incorporating many of the quantitative scientific methods and analyses employed in movement science can help accelerate the development of rehabilitation-relevant research in occupational therapy (OT) and occupational science (OS). Reciprocally, OT and OS, which focus on the performance of everyday activities (occupations) to promote health and well-being, provide theoretical frameworks to guide research on the performance of actions in the context of social, psychological, and environmental factors. Given both fields' mutual interest in the study of movement as it relates to health and disease, the authors posit that combining OS and OT theories and principles with the theories and methods in movement science may lead to new, impactful, and clinically relevant knowledge. The first step is to ensure that individuals with OS or OT backgrounds are academically prepared to pursue advanced study in movement science. In this article, the authors propose 2 strategies to address this need.

Context and Goal-Directed Movement: The Effect of Materials-Based Occupation

This exploratory study investigated whether materials-based occupation elicited significantly better movement organization in the ipsilateral arm following left hemisphere stroke than imagery-based occupation. Five persons with left cerebrovascular accident (CVA) and 5 control participants performed functional tasks (e.g., slicing bread) under four conditions. During the materials-based condition, needed tools and objects were available for task completion. In the three imagery-based conditions, either the tool or object of the tool's action was present, or the participant was asked to simulate the task without objects. For all tasks, motor performance of persons with and without CVA was significantly more direct and less forceful during materials-based occupation. Movement time was significantly faster under this condition in three of the four tasks. The relationship between motor performance and context was reinforced. Persons with and without CVA adjusted their motor actions according to the affordances offered during materials-based occupation.

Occupational Embeddedness during a Reaching and Placing Task with Survivors of Cerebral Vascular Accident

This study examined the effects of enhanced occupational embeddedness on the upper extremity movement dynamics in survivors of a cerebral vascular accident (CVA). Seventeen persons who survived a CVA participated in this repeated measures study with two conditions. The occupationally embedded (OE) condition involved three labeled soup cans; the nonoccupationally embedded (NOE) condition involved three nonrepresentational clay masses. The task consisted of moving the objects from a kitchen counter to the cabinet with each limb. Movement dynamics were recorded using an electronic goniometer that was attached to each elbow. Dependent variables were movement time, displacement, movement units, peak velocity, and percentage of movement time at which the peak velocity occurred. It was hypothesized that the OE condition would result in significantly different movement dynamics than the NOE condition. It was also hypothesized that the movement dynamics of the affected limb would be significantly different than those of the unaffected limb. During the OE condition, there were significantly fewer movement units and smaller movement times. No significance was found with displacement, peak velocity, or percentage of movement time to peak velocity. Further, there were no significant differences between the two limbs' movement dynamics. The results of this study support the concept that greater occupational embeddedness can promote enhanced motor performance. Specifically, this study suggests that occupationally embedded occupational forms can enhance performance of movement units and movement time in a reaching and placing task with individuals who survived a stroke. Additionally, OE occupational forms do not appear to influence the affected limb differently than the unaffected limb.

Development of the Chedoke Arm and Hand Activity Inventory: Theoretical Constructs, Item Generation, and Selection

The Chedoke Arm and Hand Activity Inventory (CAHAI) was developed to address the need for a valid, clinically relevant, responsive functional assessment of the recovering paretic upper limb. The purpose of this article is to describe the development of the measure including its theoretical constructs, item generation, and item selection. From the literature, survivors of stroke, and their caregivers, 751 items were generated. Using factor analyses stem leaf plots, clinical judgment, and pilot testing on individuals with stroke, the list was reduced to 13 bilateral, real-life items. Research continues to provide evidence of the CAHAI's test-retest and interrater reliability as well as construct, concurrent, and longitudinal validity.

Neurorehabilitation: are we doing all that we can?

Occupational therapists have many intervention tools available for working with clients having a neurological injury; however, some of the most innovative and effective methods have not gained acceptance by many clinicians. Emerging research and new technologies provide occupational therapists with a multitude of treatment strategies and novel devices, but incorporation of those tools into clinical practice appears to be limited by the time necessary to learn about the intervention, educational requirements associated with implementation, or lack of awareness regarding the evidence supporting the use of such tools. Strategies to combat this trend include educating clinicians on evidence-based methods for neurological rehabilitation, aligning academics with practitioners to translate evidence into practical treatment strategies, and accepting that occupational therapy can use these innovations as a means toward state-of-the art, occupation-based practice.

Using Purposeful Tasks to Improve Motor Performance: Does Object Affordance Matter?

Introduction:

Purposeful activity is believed to yield better results than meaningless exercises during motor rehabilitation. The objective of this paper is to provide a narrative review of the literature regarding the influence of object affordance on motor performance, a factor that contributes to the purposefulness of a task.

Method:

Thirty-five reviewed articles were selected following an online search on PubMed, Cinahl and Google Scholar and an inspection of their references. Results of reviewed studies are discussed in relation to (1) the different approaches used to increase object affordance; (2) the influence of clinical conditions on the relationship between object affordance and motor performance; and (3) the influence of object affordance on immediate motor performance vs motor learning.

Findings:

The three main approaches used to increase object affordance relate to (a) the number of objects used during the task; (b) the functional information that these objects convey; and (c) the functional goals of the task. Reviewed results suggest that increasing object affordance can produce beneficial effects on immediate motor performance and motor learning, and especially support the effect of varying the number of objects. However, most evidence on object affordance has not come from high quality research.

Conclusion:

Clinicians should favour the use of tasks with high object affordance during both clinical assessment and therapy in order to promote optimal motor performance. More high quality research is needed to assess the influence of object affordance during therapy and on long-term motor learning and clinical outcomes.

A pointing task to improve reaching performance in older adults

OBJECTIVE

The objective of this study was to evaluate whether adding a pointing task would influence functional reach test performance in younger and older adults.

DESIGN

While standing on a force plate, 20 older (73 ± 8 yrs) and 20 younger (23 ± 1 yrs) adults were randomly administered a modification of the functional reach test and the functional point test. Functional pointing involved reaching and pointing at the farthest possible target in a series of 1.27-cm colored craft pom-poms attached at 2.54-cm intervals on a yardstick.

RESULTS

Both older adults (P = 0.001) and younger adults (P = 0.043) reached farther using the functional point test. Older adults also increased their anterior center of pressure displacement with this test (P = 0.037).

CONCLUSIONS

The addition of a pointing task can make the original clinical test more functional and increase reaching distance in both older and younger adults. Further research is needed to determine whether functional pointing challenges subjects' stability limits more than the traditional test does and offers greater sensitivity in the evaluation of functional balance and fall risk.

Children with cerebral palsy exhibit greater and more regular postural sway than typically developing children

Following recent advances in the analysis of centre-of-pressure (COP) recordings, we examined the structure of COP trajectories in ten children (nine in the analyses) with cerebral palsy (CP) and nine typically developing (TD) children while standing quietly with eyes open (EO) and eyes closed (EC) and with concurrent visual COP feedback (FB). In particular, we quantified COP trajectories in terms of both the amount and regularity of sway. We hypothesised that: (1) compared to TD children, CP children exhibit a greater amount of sway and more regular sway and (2) concurrent visual feedback (creating an external functional context for postural control, inducing a more external focus of attention) decreases both the amount of sway and sway regularity in TD and CP children alike, while closing the eyes has opposite effects. The data were largely in agreement with both hypotheses. Compared to TD children, the amount of sway tended to be larger in CP children, while sway was more regular. Furthermore, the presence of concurrent visual feedback resulted in less regular sway compared to the EO and EC conditions. This effect was less pronounced in the CP group where posturograms were most regular in the EO condition rather than in the EC condition, as in the control group. Nonetheless, we concluded that CP children might benefit from therapies involving postural tasks with an external functional context for postural control.

Effect of task context on reaching performance in children with spastic hemiparesis

OBJECTIVE

To investigate the effect of task context on the quality of reaching movements in children with spastic hemiparesis.

DESIGN

Randomized controlled experimental trial.

SETTING

Institute for the Study of Education and Human Development (ISED).

SUBJECTS

Twelve children (8-14 years of age) with spastic hemiplegic cerebral palsy.

INTERVENTIONS

Subjects made fast reaching movements with the affected or nonaffected arm on a digitizer in three context conditions: (a) reach to press a light switch to turn on a red light (functional), (b) reach to press the light switch; no light (semi-functional), and (c) reach to a marker (nonfunctional).

MAIN OUTCOME MEASURES

Kinematics of reaching movements of affected and nonaffected arms: movement time (MT), peak velocity (PV), time to PV, percentage of MT where peak velocity occurred (PPV), and smoothness (i.e. number of movement units (MU)).

RESULTS

The functional condition elicited better quality of reaching for the nonaffected, but particularly the affected arm. Reaching of the affected arm was faster (larger MT; F = 10.21, p < 0.01), smoother (fewer MU; F = 19.95, p < 0.001), and better-controlled (right shift of PPV; F = 16.03, p < 0.001) compared with the semi- and nonfunctional condition. Reaching of the nonaffected arm was also faster (longer MT, F = 4.81, p < 0.05), and more smooth (fewer MU, F = 7.23, p < 0.05).

CONCLUSIONS

These findings suggest that providing a functional context to perform a task may enhance the quality of reaching movements of the affected arm in children with spastic hemiparesis.