scholarly journals Robotic quantification of upper extremity loss of independent joint control or flexion synergy in individuals with hemiparetic stroke: a review of paradigms addressing the effects of shoulder abduction loading

2016 ◽  
Vol 13 (1) ◽  
Author(s):  
Michael D. Ellis ◽  
Yiyun Lan ◽  
Jun Yao ◽  
Julius P. A. Dewald
Keyword(s):  
Upper Extremity ◽  
Shoulder Abduction ◽  
Joint Control ◽  
Hemiparetic Stroke ◽  
Flexion Synergy

scholarly journals Assessing the usage of indirect motor pathways following a hemiparetic stroke

2020 ◽  
Author(s):  
Runfeng Tian ◽  
Julius P.A. Dewald ◽  
Yuan Yang
Keyword(s):  
Model Simulation ◽  
Brain Activity ◽  
Shoulder Abduction ◽  
Joint Control ◽  
Motor Pathways ◽  
Co Activation ◽  
Shoulder Abductor ◽  
Hemiparetic Stroke ◽  
Muscle Connectivity ◽  
Flexion Synergy

AbstractA hallmark impairment in a hemiparetic stroke is a loss of independent joint control resulting in abnormal co-activation of shoulder abductor and elbow flexor muscles in their paretic arm, clinically known as the flexion synergy. The flexion synergy appears while generating shoulder abduction (SABD) torques as lifting the paretic arm. This likely be caused by an increased reliance on contralesional indirect motor pathways following damage to direct corticospinal projections. The assessment of functional connectivity between brain and muscle signals, i.e., brain-muscle connectivity (BMC), may provide insight into such changes to the usage of motor pathways. Our previous model simulation shows that multi-synaptic connections along the indirect motor pathway can generate nonlinear connectivity. We hypothesize that increased usage of indirect motor pathways (as increasing SABD load) will lead to an increase of nonlinear BMC. To test this hypothesis, we measured brain activity, muscle activity from shoulder abductors when stroke participants generate 20% and 40% of maximum SABD torque with their paretic arm. We computed both linear and nonlinear BMC between EEG and EMG. We found dominant nonlinear BMC at contralesional/ipsilateral hemisphere for stroke, whose magnitude increased with the SABD load. These results supported our hypothesis and indicated that nonlinear BMC could provide a quantitative indicator for determining the usage of indirect motor pathways following a hemiparetic stroke.

scholarly journals Neck rotation modulates flexion synergy torques, indicating an ipsilateral reticulospinal source for impairment in stroke

2012 ◽  
Vol 108 (11) ◽  
pp. 3096-3104 ◽  
Author(s):  
Michael D. Ellis ◽  
Justin Drogos ◽  
Carolina Carmona ◽  
Thierry Keller ◽  
Julius P. A. Dewald
Keyword(s):  
Reticular Formation ◽  
Muscle Activation ◽  
External Rotation ◽  
Statistical Design ◽  
Head Rotation ◽  
Elbow Flexion ◽  
Shoulder Abduction ◽  
Joint Control ◽  
Age Range ◽  
Flexion Synergy

The effect of reticular formation excitability on maximum voluntary torque (MVT) generation and associated muscle activation at the shoulder and elbow was investigated through natural elicitation (active head rotation) of the asymmetric tonic neck reflex (ATNR) in 26 individuals with stroke and 9 age-range-matched controls. Isometric MVT generation at the shoulder and elbow was quantified with the head rotated (face pointing) contralateral and ipsilateral to the paretic (stroke) and dominant (control) arm. Given the dominance of abnormal torque coupling of elbow flexion with shoulder abduction (flexion synergy) in stroke and well-developed animal models demonstrating a linkage between reticular formation and ipsilateral elbow flexors and shoulder abductors, we hypothesized that constituent torques of flexion synergy, specifically elbow flexion and shoulder abduction, would increase with contralateral head rotation. The findings of this investigation support this hypothesis. Increases in MVT for three of four flexion synergy constituents (elbow flexion, shoulder abduction, and shoulder external rotation) were observed during contralateral head rotation only in individuals with stroke. Electromyographic data of the associated muscle coactivations were nonsignificant but are presented for consideration in light of a likely underpowered statistical design for this specific variable. This study not only provides evidence for the reemergence of ATNR following stroke but also indicates a common neuroanatomical link, namely, an increased reliance on ipsilateral reticulospinal pathways, as the likely mechanism underlying the expression of both ATNR and flexion synergy that results in the loss of independent joint control.

Abstract TP147: Quantitative Measures of Strength and Synergy Differentiate Individuals With Chronic Stroke With and Without Clinically Detectable Elbow Contracture

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Grace C Bellinger ◽  
Michael D Ellis
Keyword(s):  
Quantitative Measure ◽  
Chronic Stroke ◽  
Future Research ◽  
Emg Activity ◽  
Shoulder Abduction ◽  
Joint Control ◽  
Elbow Extension ◽  
Unaffected Side ◽  
Elbow Contracture ◽  
Flexion Synergy

Many individuals with chronic stroke demonstrate contracture of the elbow flexors. The development of contracture may be attributable to underlying impairments such as weakness, flexion synergy, and hyperactive reflexes. This study explored differences in motor impairment and function between 17 individuals with clinically detectable elbow flexor contracture and 17 individuals with full passive range of motion. The groups did not differ in age (61.61 ± 7.99, 55.06 ± 12.48, p = 0.078), years post-stroke (12.92 ± 9.34, 10.60 ± 7.16, p = 0.423), or Fugl-Meyer Motor Assessment score (FMA, 26.35 ± 5.86, 26.47 ± 8.70, p = 0.963). The passive range limitation in the contracture group was 3 to 36° (11.65 ± 8.30°). Kinetics, kinematics, and EMG were used to quantify four motor impairments and reaching function. Shoulder abduction and elbow extension strength were measured isometrically and normalized to the unaffected side. Flexion synergy was quantified as a force-based measure assessing independent joint control. Flexor spasticity was quantified while reaching at 50% of maximum shoulder abduction as the change in biceps EMG from reach onset to peak angular velocity, normalized by maximal EMG activity. Reaching function was defined as maximum reaching distance against gravity and normalized by target distance (-10° of full extension). The groups differed in elbow extension strength (Contracture, 0.315 ± 0.129; No contracture, 0.559 ± 0.153; p < 0.001) and flexion synergy (0.146 ± 0.186, 0.397 ± 0.229, p = 0.009). The groups did not differ in shoulder abduction strength (0.500 ± 0.174, 0.615 ± 0.199, p = 0.080), flexor spasticity (0.079 ± 0.090, 0.056 ± 0.115, p = 0.523), or reaching function (0.501 ± 0.391, 0.714 ± 0.296, p = 0.082). The findings of this study suggest a relationship between elbow contracture and the concurrent presence of elbow extension weakness and flexion synergy. The quantitative measure of reaching function will likely differentiate individuals with and without contracture if the assessment is modified so that the standardized reaching target is located at 0° of elbow extension (normal range). Future research should use quantitative metrics to further explore the temporal recovery of impairments in order to prevent the development of contracture.

scholarly journals The Impact of Shoulder Abduction Loading on Volitional Hand Opening and Grasping in Chronic Hemiparetic Stroke

2017 ◽  
Vol 31 (6) ◽  
pp. 521-529 ◽  
Author(s):  
Yiyun Lan ◽  
Jun Yao ◽  
Julius P. A. Dewald
Keyword(s):  
Shoulder Abduction ◽  
Grasping Forces ◽  
Finger Flexion ◽  
Enhanced Expression ◽  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke ◽  
And Control ◽  
The Impact ◽  
Hand Opening ◽  
Flexion Synergy

Background. Up to 60% of individuals with moderate to severe chronic hemiparetic stroke experience excessive involuntary wrist/finger flexion that constrains functional hand movements including hand opening. It’s not known how stroke-induced brain injury impacts volitional hand opening and grasping forces as a result of the expression of abnormal coupling between shoulder abduction and wrist/finger flexion or the flexion synergy. Objective. The goal of this study is to understand how shoulder abduction loading affects volitional hand opening and grasping forces in individuals with moderate to severe chronic hemiparetic stroke. Methods. Thirty-six individuals (stroke, 26; control, 10) were recruited for this study. Each participant was instructed to perform maximal hand opening and grasping forces while the arm was either fully supported or lifted with a weight equal to 25% or 50% of the participant’s maximal shoulder abduction torque. Hand pentagon area, defined as the area formed by the tips of thumb and fingers, was calculated during hand opening. Forces were recorded during grasping. Results. In individuals with moderate stroke, increasing shoulder abduction loading reduced the ability to maximally open the hand. In individuals with severe stroke, who were not able to open the hand, grasping forces were generated and increased with shoulder abduction loading. Stroke individuals also showed a reduced ability to control volitional grasping forces due to the enhanced expression of flexion synergy. Conclusions. Shoulder abduction loading reduced the ability to volitionally open the hand and control grasping forces after stroke. Neural mechanisms and clinical implications of these findings are discussed.

115 The Impact of Burn Injury on Upper Extremity Prosthesis Users

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S77-S77
Author(s):  
Jill M Cancio ◽  
Matthew Borgia ◽  
Leopoldo C Cancio ◽  
Linda Resnik
Keyword(s):  
Quality Of Life ◽  
Upper Extremity ◽  
Performance Testing ◽  
Hospital Length Of Stay ◽  
Shoulder Abduction ◽  
Phantom Pain ◽  
Assessment Procedure ◽  
Full Time ◽  
The Impact

Abstract Introduction Burns with upper extremity (UE) amputation present a unique rehabilitation challenge. The purpose of this study of UE amputees who are active prosthesis users was to compare outcomes for those with and without burns. Methods This is part of a larger nationwide study of U.S. military members and veterans with UE amputations. In-person data were collected at 5 sites. An therapist measured passive and active range of motion (PROM, AROM); administered the Quick Disability of the Arm, Shoulder, and Hand; Community Reintegration of Injured Service Members-Computer Adaptive-Test; Trinity Amputation and Prosthetic Experience Scale; health-related quality of life (VR-12); Activities Measure for Upper Extremity Amputees; Southampton Assessment Procedure; 9-Hole Peg Test; and Jebsen-Taylor Hand Function Test (JTHF); and recorded residual and phantom pain; timing of prosthesis receipt; and current prosthesis use. The IRB approved this study. Results Data were collected on 126 individuals with UE amputation, of whom 105 had data on etiology and were included. Of these, 13 (12.4%) had burns (B) vs non-burn (NB). The majority were unilateral amputees (69% B, 90% NB). Most were transradial (TR) amputees (B 84.6%, NB 66.3%) as opposed to transhumeral (TH). A minority received their prosthetics within the first 3 months post-amputation (11.1% B, 28.8% NB) (p=0.15). Average age was 57.6 (SD 15.6) years for NB and 53.0 (20.6) years for B. Mean time since amputation was 22.5 (18.0) years for NB and 25.2 (17.3) years for B. The following non-significant differences in outcomes between B and NB were observed. Thirty-nine percent of B were employed full-time vs 18.9% of NB (p=0.15). The primary prosthesis was, for NB, a body-powered prosthesis (66.7%); for B, myoelectric (50%) or body-powered (50%). For unilateral UE amputees, there were no differences between B and NB on performance testing for dexterity and functional tasks or in self-reported disability, quality of life or prevalence or intensity of pain. B trended towards more moderate to severe PROM deficits with shoulder forward flexion (TH B 50%, TH NB 23.1% [p=0.444]; TR B 20%, TR NB 5.6% [p=0.197]) and shoulder abduction (TH B 50%, TH NB 26.9% [p=0.497]; TR B 30%, TR NB 16.4% [p=0.376]). Also, TR amputees with burns trended towards more PROM deficits with elbow flexion (B 20%, NB 6.9% [p=0.212]) and elbow extension (B 20%, NB 8.6% [p=0.272]). AROM deficits also trended greater in B. Conclusions We did not observe differences in physical function, pain levels, or quality of life between those with and without burns. Further studies with larger samples are needed, to include analysis of burn location, burn size, hospital length of stay, and rehabilitation care.

scholarly journals Motion Analytics of Trapezius Muscle Activity in an 18-Year-Old Female with Extended Upper Brachial Plexus Birth Palsy

2021 ◽  
Vol 16 (01) ◽  
pp. e51-e55
Author(s):  
Jasmine J. Lin ◽  
Gromit Y.Y. Chan ◽  
Cláudio T. Silva ◽  
Luis G. Nonato ◽  
Preeti Raghavan ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Upper Extremity ◽  
Muscle Activity ◽  
Visual Analytics ◽  
Three Dimensional ◽  
Trapezius Muscle ◽  
Shoulder Abduction ◽  
Upper Trapezius ◽  
Brachial Plexus Birth Palsy ◽  
Birth Palsy

Abstract Background The trapezius muscle is often utilized as a muscle or nerve donor for repairing shoulder function in those with brachial plexus birth palsy (BPBP). To evaluate the native role of the trapezius in the affected limb, we demonstrate use of the Motion Browser, a novel visual analytics system to assess an adolescent with BPBP. Method An 18-year-old female with extended upper trunk (C5–6–7) BPBP underwent bilateral upper extremity three-dimensional motion analysis with Motion Browser. Surface electromyography (EMG) from eight muscles in each limb which was recorded during six upper extremity movements, distinguishing between upper trapezius (UT) and lower trapezius (LT). The Motion Browser calculated active range of motion (AROM), compiled the EMG data into measures of muscle activity, and displayed the results in charts. Results All movements, excluding shoulder abduction, had similar AROM in affected and unaffected limbs. In the unaffected limb, LT was more active in proximal movements of shoulder abduction, and shoulder external and internal rotations. In the affected limb, LT was more active in distal movements of forearm pronation and supination; UT was more active in shoulder abduction. Conclusion In this female with BPBP, Motion Browser demonstrated that the native LT in the affected limb contributed to distal movements. Her results suggest that sacrificing her trapezius as a muscle or nerve donor may affect her distal functionality. Clinicians should exercise caution when considering nerve transfers in children with BPBP and consider individualized assessment of functionality before pursuing surgery.

Responses of the Densely Hemiplegic Upper Extremity to Bilateral Training

2001 ◽  
Vol 15 (2) ◽  
pp. 129-140 ◽  
Author(s):  
M. Heather Mudie ◽  
Thomas A. Matyas
Keyword(s):  
Upper Extremity ◽  
Emg Activity ◽  
Shoulder Abduction ◽  
Training Methods ◽  
Optimal Learning ◽  
Stroke Treatment ◽  
Learning Conditions ◽  
Bilateral Training ◽  
Brain Reorganization ◽  
Extensor Carpi Radialis

Objective: Recovery of movement in the densely hemiplegic upper extremity re mains a problem after stroke. This study aimed to determine whether movement recovery could be improved in the hemiplegic arm with bilateral isokinematic training. Methods: Within and between groups, planned comparisons investigated the effects of bilateral training on attempts at two movements by subjects with acute and chronic problems with one and two bilateral practice phases. Electromyographic (EMG) activity of mid dle deltoid and extensor carpi radialis longus in the hemiplegic arm was recorded dur ing unilateral and bilateral isometric shoulder abduction and wrist extension. Results: Small increases in muscle activity were demonstrated by both experimental and con trol subjects during most bilateral practices in both actions. However, these increases were not significantly different from the previous unilateral trial, and the bilateral ef fect failed to generalize to subsequent trials. Previous studies with less densely hemiplegic subjects had demonstrated generalization of improvements in movement patterns with bilateral training to unimanual actions of the densely hemiplegic arm. Conclusions: Extensive lesions may limit brain reorganization and recover of dense hemiplegia after stroke. Nonetheless, on the basis of findings from other studies in which functional im provements occurred in both acute and chronic severely stroke-affected subjects, out come forecasting for the hemiplegic upper extremity should only eventuate after provi sion of practice under optimal learning conditions. Key Words: Bilateral isokinematic training—Dense hemiplegia—Stroke—Treatment outcomes.

scholarly journals Paretic upper extremity strength at acute rehabilitation evaluation predicts motor function outcome after stroke

2021 ◽  
Author(s):  
Mary Alice Saltão da Silva ◽  
Christine Cook ◽  
Cathy M Stinear ◽  
Steven L Wolf ◽  
Michael R Borich
Keyword(s):  
Functional Outcome ◽  
Upper Extremity ◽  
Motor Function ◽  
Clinical Decision Making ◽  
Classification And Regression Tree ◽  
Shoulder Abduction ◽  
Hospital System ◽  
Acute Hospitalization ◽  
Post Stroke ◽  
Cart Analysis

Objective: The primary objective of this study was to retrospectively assess current care practices to determine the routinely collected measures that are most predictive of paretic upper extremity (PUE) functional outcome post-stroke in patients undergoing acute inpatient rehabilitation (AR). Methods: We conducted a longitudinal chart review of patients post-stroke who received care in the Emory University Hospital system for acute hospitalization, AR, and outpatient therapy in fiscal years 2016-2018. We identified eligible patients using previously established inclusion and exclusion criteria. We extracted demographics, stroke characteristics, and longitudinal documentation of post-stroke motor function from institutional electronic medical records. Serial assessments of PUE strength were estimated using available shoulder abduction and finger extension manual muscle test documentation (E-SAFE). Estimated Action Research Arm Test (E-ARAT) was used to quantify 3-month PUE functional outcome. Metric associations were explored through correlation and cluster analyses, Kruskal-Wallis tests, classification and regression tree (CART) analysis. Results: Thirty-four patients met study eligibility criteria. E-SAFE assessments performed closest to acute hospitalization day-3 (Acute E-SAFE) and upon AR admission (AR E-SAFE) were correlated with E-ARAT. Cluster analysis produced three distinct outcome groups and aligned closely to previous outcome categories. Outcome groups significantly differed in Acute E-SAFE and AR E-SAFE. Exploratory CART analysis selected AR E-SAFE to classify patient outcome with 70.6% accuracy. Conclusions: Current study findings reveal that: PUE E-SAFE, measured both acutely and at AR admission, is associated with PUE motor recovery outcome; categorizations of outcome are consistent with previous studies; and predictive models can identify recovery outcome category in patients undergoing AR. Impact Statement: Our findings highlight the clinical utility of SAFE as an easy-to-acquire, readily implementable screening metric. Early, intentional use of SAFE in AR settings may improve clinical decision-making, enabling therapists to deliver precision-based interventions that serve to speed or enhance recovery outcome for patients post-stroke.

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