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van Ravestyn C, Gerardin E, Térémetz M, Hamdoun S, Baron JC, Calvet D, Vandermeeren Y, Turc G, Maier MA, Rosso C, Mas JL, Dupin L, Lindberg PG. Post-Stroke Impairments of Manual Dexterity and Finger Proprioception: Their Contribution to Upper Limb Activity Capacity. Neurorehabil Neural Repair 2024; 38:373-385. [PMID: 38572686 DOI: 10.1177/15459683241245416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
BACKGROUND Knowing how impaired manual dexterity and finger proprioception affect upper limb activity capacity is important for delineating targeted post-stroke interventions for upper limb recovery. OBJECTIVES To investigate whether impaired manual dexterity and finger proprioception explain variance in post-stroke activity capacity, and whether they explain more variance than conventional clinical assessments of upper limb sensorimotor impairments. METHODS Activity capacity and hand sensorimotor impairments were assessed using clinical measures in N = 42 late subacute/chronic hemiparetic stroke patients. Dexterity was evaluated using the Dextrain Manipulandum to quantify accuracy of visuomotor finger force-tracking (N = 36), timing of rhythmic tapping (N = 36), and finger individuation (N = 24), as well as proprioception (N = 27). Stepwise multivariate and hierarchical linear regression models were used to identify impairments best explaining activity capacity. RESULTS Dexterity and proprioceptive components significantly increased the variance explained in activity capacity: (i) Box and Block Test was best explained by baseline tonic force during force-tracking and tapping frequency (adjusted R2 = .51); (ii) Motor Activity Log was best explained by success rate in finger individuation (adjusted R2 = .46); (iii) Action Research Arm Test was best explained by release of finger force and proprioceptive measures (improved reaction time related to use of proprioception; adjusted R2 = .52); and (iv) Moberg Pick-Up test was best explained by proprioceptive function (adjusted R2 = .18). Models excluding dexterity and proprioception variables explained up to 19% less variance. CONCLUSIONS Manual dexterity and finger proprioception explain unique variance in activity capacity not captured by conventional impairment measures and should be assessed when considering the underlying causes of post-stroke activity capacity limitations.URL: https://www.clinicaltrials.gov. Unique identifier: NCT03934073.
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Affiliation(s)
- Coralie van Ravestyn
- Department of Neurology, Stroke Unit, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- NEUR Division, Institute of NeuroScience, UCLouvain, Brussels, Belgium
| | - Eloïse Gerardin
- Department of Neurology, Stroke Unit, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- NEUR Division, Institute of NeuroScience, UCLouvain, Brussels, Belgium
| | - Maxime Térémetz
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1226, F-75014 Paris, France
| | - Sonia Hamdoun
- Service de Médecine Physique et de Réadaptation, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Jean-Claude Baron
- GHU-Paris Psychiatrie & Neurosciences, FHU NeuroVasc, Hôpital Sainte Anne, F-75014 Paris, France
| | - David Calvet
- GHU-Paris Psychiatrie & Neurosciences, FHU NeuroVasc, Hôpital Sainte Anne, F-75014 Paris, France
| | - Yves Vandermeeren
- Department of Neurology, Stroke Unit, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- NEUR Division, Institute of NeuroScience, UCLouvain, Brussels, Belgium
| | - Guillaume Turc
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1226, F-75014 Paris, France
- GHU-Paris Psychiatrie & Neurosciences, FHU NeuroVasc, Hôpital Sainte Anne, F-75014 Paris, France
| | - Marc A Maier
- Université Paris Cité, INCC UMR 8002, CNRS, Paris, France
| | - Charlotte Rosso
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Louis Mas
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1226, F-75014 Paris, France
- GHU-Paris Psychiatrie & Neurosciences, FHU NeuroVasc, Hôpital Sainte Anne, F-75014 Paris, France
| | - Lucile Dupin
- Université Paris Cité, INCC UMR 8002, CNRS, Paris, France
| | - Påvel G Lindberg
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1226, F-75014 Paris, France
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Gerardin E, Regnier M, Dricot L, Lambert J, van Ravestyn C, De Coene B, Bihin B, Lindberg P, Vandermeeren Y. Dexterity in the Acute Phase of Stroke: Impairments and Neural Substrates. Neurorehabil Neural Repair 2024; 38:229-239. [PMID: 38329006 DOI: 10.1177/15459683241230029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Stroke can impair manual dexterity, leading to loss of independence following incomplete recovery. Enhancing our understanding of dexterity impairment may improve neurorehabilitation. OBJECTIVES The study aimed to measure dexterity components in acute stroke patients with and without hand motor deficits, compare them to those of healthy controls (HC), and to explore the neural substrates involved in specific components of dexterity. METHODS We used the Dextrain Manipulandum to quantify fine finger force control, finger selection accuracy, coactivation, and reaction time (RT). Dexterity was evaluated twice (2 days apart) in 74 patients and 14 HC. Voxel-Lesion-Symptom-Mapping (VLSM) was used to analyze the relationship between tissue damage and dexterity. Results. Due to severe paresis or fatigue, 24 patients could not perform these tasks. In 50 patients (included 4.6 ± 3.3 days post-stroke), finger force control improved (P < .001), as it did in HC (P = .03) who performed better than patients on both evaluations. Accuracy of finger selection did not improve significantly in any group, but the HC performed better on both evaluations. Unexpectedly, coactivation was better in patients than in HC at D3 (P = .03). There were no between-group differences in RT. VLSM showed that damage to the superior temporal gyrus (STG) impaired finger force control while damage to the posterior limb of the internal capsule (PLIC) impaired finger selectivity. CONCLUSIONS Acute stroke affecting the STG or PLIC impaired selective components of dexterity. Patients with mild to moderate impairment showed better finger force control and accuracy selection within 48 hours, suggesting the feasibility of detecting early dexterity improvements.
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Affiliation(s)
- Eloïse Gerardin
- UCLouvain/CHU UCL Namur (Godinne), Neurology Department, Stroke Unit, Yvoir, Belgium
- UClouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
| | - Maxime Regnier
- UCLouvain, CHU UCL Namur (Godinne), Scientific Support Unit (USS), Yvoir, Belgium
| | - Laurence Dricot
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
| | - Julien Lambert
- UCLouvain, Institute of NeuroScience (IoNS), COSY Division, Brussels, Belgium
| | - Coralie van Ravestyn
- UCLouvain/CHU UCL Namur (Godinne), Neurology Department, Stroke Unit, Yvoir, Belgium
- UClouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
| | - Béatrice De Coene
- UCLouvain/CHU UCL Namur (Godinne), Radiology Department, Yvoir, Belgium
| | - Benoît Bihin
- UCLouvain, CHU UCL Namur (Godinne), Scientific Support Unit (USS), Yvoir, Belgium
| | - Påvel Lindberg
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
| | - Yves Vandermeeren
- UCLouvain/CHU UCL Namur (Godinne), Neurology Department, Stroke Unit, Yvoir, Belgium
- UClouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
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