Movement kinematics and proprioception in post-stroke spasticity: assessment using the Kinarm robotic exoskeleton

Abstract Background Motor impairment after stroke interferes with performance of everyday activities. Upper limb spasticity may further disrupt the movement patterns that enable optimal function; however, the specific features of these altered movement patterns, which differentiate individuals with and without spasticity, have not been fully identified. This study aimed to characterize the kinematic and proprioceptive deficits of individuals with upper limb spasticity after stroke using the Kinarm robotic exoskeleton. Methods Upper limb function was characterized using two tasks: Visually Guided Reaching, in which participants moved the limb from a central target to 1 of 4 or 1 of 8 outer targets when cued (measuring reaching function) and Arm Position Matching, in which participants moved the less-affected arm to mirror match the position of the affected arm (measuring proprioception), which was passively moved to 1 of 4 or 1 of 9 different positions. Comparisons were made between individuals with (n = 35) and without (n = 35) upper limb post-stroke spasticity. Results Statistically significant differences in affected limb performance between groups were observed in reaching-specific measures characterizing movement time and movement speed, as well as an overall metric for the Visually Guided Reaching task. While both groups demonstrated deficits in proprioception compared to normative values, no differences were observed between groups. Modified Ashworth Scale score was significantly correlated with these same measures. Conclusions The findings indicate that individuals with spasticity experience greater deficits in temporal features of movement while reaching, but not in proprioception in comparison to individuals with post-stroke motor impairment without spasticity. Temporal features of movement can be potential targets for rehabilitation in individuals with upper limb spasticity after stroke.

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MEDITOXIN® Treatment in Subjects With Post-Stroke Upper Limb Spasticity

Case Medical Research ◽

10.31525/ct1-nct03908580 ◽

2019 ◽

Author(s):

Keyword(s):

Upper Limb ◽

Post Stroke ◽

Limb Spasticity

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Effect of post-stroke spasticity on voluntary movement of the upper limb

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-021-00876-6 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Hadar Lackritz ◽

Yisrael Parmet ◽

Silvi Frenkel-Toledo ◽

Melanie C. Baniña ◽

Nachum Soroker ◽

...

Keyword(s):

Upper Limb ◽

Target Location ◽

Distance Measure ◽

Movement Time ◽

Motor Impairment ◽

Reach To Grasp ◽

Motion Patterns ◽

Post Stroke ◽

The Impact ◽

Elbow Motion

Abstract Background Hemiparesis following stroke is often accompanied by spasticity. Spasticity is one factor among the multiple components of the upper motor neuron syndrome that contributes to movement impairment. However, the specific contribution of spasticity is difficult to isolate and quantify. We propose a new method of quantification and evaluation of the impact of spasticity on the quality of movement following stroke. Methods Spasticity was assessed using the Tonic Stretch Reflex Threshold (TSRT). TSRT was analyzed in relation to stochastic models of motion to quantify the deviation of the hemiparetic upper limb motion from the normal motion patterns during a reaching task. Specifically, we assessed the impact of spasticity in the elbow flexors on reaching motion patterns using two distinct measures of the ‘distance’ between pathological and normal movement, (a) the bidirectional Kullback–Liebler divergence (BKLD) and (b) Hellinger’s distance (HD). These measures differ in their sensitivity to different confounding variables. Motor impairment was assessed clinically by the Fugl-Meyer assessment scale for the upper extremity (FMA-UE). Forty-two first-event stroke patients in the subacute phase and 13 healthy controls of similar age participated in the study. Elbow motion was analyzed in the context of repeated reach-to-grasp movements towards four differently located targets. Log-BKLD and HD along with movement time, final elbow extension angle, mean elbow velocity, peak elbow velocity, and the number of velocity peaks of the elbow motion were computed. Results Upper limb kinematics in patients with lower FMA-UE scores (greater impairment) showed greater deviation from normality when the distance between impaired and normal elbow motion was analyzed either with the BKLD or HD measures. The severity of spasticity, reflected by the TSRT, was related to the distance between impaired and normal elbow motion analyzed with either distance measure. Mean elbow velocity differed between targets, however HD was not sensitive to target location. This may point at effects of spasticity on motion quality that go beyond effects on velocity. Conclusions The two methods for analyzing pathological movement post-stroke provide new options for studying the relationship between spasticity and movement quality under different spatiotemporal constraints.

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Duration of effect of abobotulinumtoxinA (Dysport) in adult patients with upper limb spasticity (ULS) post stroke or traumatic brain injury

Toxicon ◽

10.1016/j.toxicon.2016.11.100 ◽

2016 ◽

Vol 123 ◽

pp. S35 ◽

Cited By ~ 1

Author(s):

Jean-Michel Gracies ◽

Allison Brashear ◽

Christina Marciniak ◽

Robert Jech ◽

Marta Banach ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Upper Limb ◽

Adult Patients ◽

Post Stroke ◽

Duration Of Effect ◽

Limb Spasticity

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Cost-Effectiveness of Treating Romanian Post-Stroke Patients with Upper Limb Spasticity With Incobotulinumtoxin-A Against Conventional Therapy

Value in Health ◽

10.1016/j.jval.2018.04.1405 ◽

2018 ◽

Vol 21 ◽

pp. S206-S207 ◽

Cited By ~ 1

Author(s):

A Turcu-Stiolica ◽

M Subtirelu

Keyword(s):

Cost Effectiveness ◽

Upper Limb ◽

Conventional Therapy ◽

Stroke Patients ◽

Post Stroke ◽

Limb Spasticity ◽

Incobotulinumtoxin A

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Abstract 100: A Simple Bedside Grading Scale Can Effectively Predict Severe Post-stroke Upper-extremity Spasticity

Stroke ◽

10.1161/str.48.suppl_1.100 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Hernan F Bayona ◽

Pratik Y Chhatbar ◽

Gottfried Schlaug ◽

Wayne Feng

Keyword(s):

Upper Limb ◽

Assessment Tool ◽

Infarct Volume ◽

Imaging Biomarker ◽

Lesion Volume ◽

Post Stroke ◽

Severe Spasticity ◽

Limb Spasticity ◽

Grading Scale ◽

Simple Bedside

Introduction: Upper-limb spasticity is a very disabling complication after stroke. There has been no simple clinical standard scale to predict spasticity immediately after stroke. This study aims to develop a simple bedside grading scale with the information collected during the acute phase to predict spasticity at 3 month post-stroke Methods: This is a prospective cohort study (Prediction and Imaging Biomarker of Post-stroke Motor Recovery) of patients with first-ever acute ischemic stroke with various degrees of motor impairment. NIH stroke scale (NIHSS) was assessed 2-7 days after onset of stroke symptoms. Modified Ashworth Spasticity Scale was used as an assessment tool in biceps, wrist flexors and finger flexors at 90 days (± 15 days) and score ≥2 at any muscle was considered as severe spasticity. Infarction volume was measured based on the lesion on MRI/DWI. Independent predictors of upper-limb spasticity at 90 days were identified by multivariate logistic regression. A risk stratification scale was developed with weighting independent predictors based on beta coefficient. Results: One hundred twenty three patients were recruited for this study. Covariates associated with upper-limb spasticity are NIHSS arm score (p<0.0001), sub-cortical location (p=0.004) and lesion volume >65 cc (p=0.025). The proposed grading scale is summation of individual points as followed: NIHSS Arm Score: =4 (2 point), <4 (0 point); infarct location: sub-cortical (1 point), non sub-cortical (0 point); infarct volume: ≥65 cc (1 point), <65cc (0 point). The rates of severe upper limb spasticity for the bedside spasticity scale, in order 0-4, are 8.9%, 29.2%, 65%, 88.7%, 96.2%. In other words, the likelihood of developing severe spasticity increases steadily using the score. Conclusion: A simple bedside grading scale can effectively predict severe post-stroke upper-limb spasticity at 90 days. Validation with an independent external dataset is a planned next step.

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Impact of therapeutic input on goal achievement in patients treated with botulinum-toxin a (BoNT-A/INS;) for post-stroke upper-limb-spasticity (ULIS-2 study)

Journal of the Neurological Sciences ◽

10.1016/j.jns.2013.07.1936 ◽

2013 ◽

Vol 333 ◽

pp. e551-e552

Author(s):

K. Fheodoroff ◽

J.J. Jacinto ◽

L. Turner-Stokes

Keyword(s):

Botulinum Toxin ◽

Upper Limb ◽

Botulinum Toxin A ◽

Goal Achievement ◽

Toxin A ◽

Post Stroke ◽

Limb Spasticity

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Post-stroke upper limb spasticity incidence for different cerebral infarction site

Open Medicine ◽

10.1515/med-2018-0035 ◽

2018 ◽

Vol 13 (1) ◽

pp. 227-231 ◽

Cited By ~ 3

Author(s):

Yi Jin ◽

Yuan Zhao

Keyword(s):

Basal Ganglia ◽

Cerebral Infarction ◽

Incidence Rate ◽

Upper Extremity ◽

Upper Limb ◽

Internal Capsule ◽

Post Stroke ◽

Total Incidence ◽

Limb Spasticity

AbstractObjectiveThe purpose of this study was to evaluate the incidence rate of post-stroke upper limb spasticity and its correlation with cerebral infarction site.MethodsA total of 498 inpatient and outpatient cases are included in the present study. The post-stroke upper limb spasticity rate of different cerebral infarction site was calculated.ResultsA total of 498 patients with cerebral infarction are enrolled in this study. Of these patients, 91 have dropped out and 407 have completed the study. Of the completed cases, 172 are in the spasm group and 235 are in the non-spasm group. The total incidence of upper limb spasticity is 34.5%. The incidences of upper extremity spasms are 12.5%, 20%, 22.5%, 35%, 40%, and 42.5% in 2 weeks, 1 month, 2 months, 3 months, 6 months, and 12 months, respectively. The incidence of upper extremity spasms increases with time. The incidences of upper limb spasticity are 12.1%, 63.3%, 58.5%, 9.4% and 8.3% when cerebral infarction occurs in the cortical and subcortical mixed areas, basal ganglia and internal capsule, cerebralcortex, brainstem and cerebellum respectively. The incidence of upper limb spasticity varies in different infarction sites (P < 0.05).ConclusionThe post-stroke upper limb spasticity rates were different according to the different cerebral infarction site. Patients with the ganglia and internal capsule infarctions had the highest risk of developing post-stroke upper limb spasticity.

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