scholarly journals Measures of Interjoint Coordination Post-stroke Across Different Upper Limb Movement Tasks

2021 ◽  
Vol 8 ◽  
Author(s):  
Anne Schwarz ◽  
Janne M. Veerbeek ◽  
Jeremia P. O. Held ◽  
Jaap H. Buurke ◽  
Andreas R. Luft
Keyword(s):  
Upper Limb ◽  
Elbow Flexion ◽  
Shoulder Abduction ◽  
Kinematic Parameters ◽  
Limb Function ◽  
Interjoint Coordination ◽  
Upper Limb Function ◽  
Shoulder Flexion ◽  
Flexion Extension ◽  
Median Slope

Background: Deficits in interjoint coordination, such as the inability to move out of synergy, are frequent symptoms in stroke subjects with upper limb impairments that hinder them from regaining normal motor function. Kinematic measurements allow a fine-grained assessment of movement pathologies, thereby complementing clinical scales, like the Fugl–Meyer Motor Assessment of the Upper Extremity (FMMA-UE). The study goal was to investigate the effects of the performed task, the tested arm, the dominant affected hand, upper limb function, and age on spatiotemporal parameters of the elbow, shoulder, and trunk. The construct validity of the metrics was examined by relating them with each other, the FMMA-UE, and its arm section.Methods: This is a cross-sectional observational study including chronic stroke patients with mild to moderate upper limb motor impairment. Kinematic measurements were taken using a wearable sensor suit while performing four movements with both upper limbs: (1) isolated shoulder flexion, (2) pointing, (3) reach-to-grasp a glass, and (4) key insertion. The kinematic parameters included the joint ranges of shoulder abduction/adduction, shoulder flexion/extension, and elbow flexion/extension; trunk displacement; shoulder–elbow correlation coefficient; median slope; and curve efficiency. The effects of the task and tested arm on the metrics were investigated using a mixed-model analysis. The validity of metrics compared to clinically measured interjoint coordination (FMMA-UE) was done by correlation analysis.Results: Twenty-six subjects were included in the analysis. The movement task and tested arm showed significant effects (p < 0.05) on all kinematic parameters. Hand dominance resulted in significant effects on shoulder flexion/extension and curve efficiency. The level of upper limb function showed influences on curve efficiency and the factor age on median slope. Relations with the FMMA-UE revealed the strongest and significant correlation for curve efficiency (r = 0.75), followed by shoulder flexion/extension (r = 0.68), elbow flexion/extension (r = 0.53), and shoulder abduction/adduction (r = 0.49). Curve efficiency additionally correlated significantly with the arm subsection, focusing on synergistic control (r = 0.59).Conclusion: The kinematic parameters of the upper limb after stroke were influenced largely by the task. These results underpin the necessity to assess different relevant functional movements close to real-world conditions rather than relying solely on clinical measures.Study Registration: clinicaltrials.gov, identifier NCT03135093 and BASEC-ID 2016-02075.

scholarly journals Characterization of stroke-related upper limb motor impairments across various upper limb activities by use of kinematic core set measures

2022 ◽  
Vol 19 (1) ◽  
Author(s):  
Anne Schwarz ◽  
Miguel M. C. Bhagubai ◽  
Saskia H. G. Nies ◽  
Jeremia P. O. Held ◽  
Peter H. Veltink ◽  
...  
Keyword(s):  
Upper Limb ◽  
Daily Living ◽  
Healthy Subjects ◽  
Peak Velocity ◽  
Movement Time ◽  
Elbow Flexion ◽  
Wrist Flexion ◽  
Shoulder Flexion ◽  
Flexion Extension

Abstract Background Upper limb kinematic assessments provide quantifiable information on qualitative movement behavior and limitations after stroke. A comprehensive characterization of spatiotemporal kinematics of stroke subjects during upper limb daily living activities is lacking. Herein, kinematic expressions were investigated with respect to different movement types and impairment levels for the entire task as well as for motion subphases. Method Chronic stroke subjects with upper limb movement impairments and healthy subjects performed a set of daily living activities including gesture and grasp movements. Kinematic measures of trunk displacement, shoulder flexion/extension, shoulder abduction/adduction, elbow flexion/extension, forearm pronation/supination, wrist flexion/extension, movement time, hand peak velocity, number of velocity peaks (NVP), and spectral arc length (SPARC) were extracted for the whole movement as well as the subphases of reaching distally and proximally. The effects of the factors gesture versus grasp movements, and the impairment level on the kinematics of the whole task were tested. Similarities considering the metrics expressions and relations were investigated for the subphases of reaching proximally and distally between tasks and subgroups. Results Data of 26 stroke and 5 healthy subjects were included. Gesture and grasp movements were differently expressed across subjects. Gestures were performed with larger shoulder motions besides higher peak velocity. Grasp movements were expressed by larger trunk, forearm, and wrist motions. Trunk displacement, movement time, and NVP increased and shoulder flexion/extension decreased significantly with increased impairment level. Across tasks, phases of reaching distally were comparable in terms of trunk displacement, shoulder motions and peak velocity, while reaching proximally showed comparable expressions in trunk motions. Consistent metric relations during reaching distally were found between shoulder flexion/extension, elbow flexion/extension, peak velocity, and between movement time, NVP, and SPARC. Reaching proximally revealed reproducible correlations between forearm pronation/supination and wrist flexion/extension, movement time and NVP. Conclusion Spatiotemporal differences between gestures versus grasp movements and between different impairment levels were confirmed. The consistencies of metric expressions during movement subphases across tasks can be useful for linking kinematic assessment standards and daily living measures in future research and performing task and study comparisons. Trial registration: ClinicalTrials.gov Identifier NCT03135093. Registered 26 April 2017, https://clinicaltrials.gov/ct2/show/NCT03135093.

scholarly journals Measuring Upper Limb Kinematics of Forehand and Backhand Topspin Drives with IMU Sensors in Wheelchair and Able-Bodied Table Tennis Players

Sensors ◽  
2021 ◽  
Vol 21 (24) ◽  
pp. 8303
Author(s):  
Jia-Wen Yam ◽  
Jing-Wen Pan ◽  
Pui-Wah Kong
Keyword(s):  
Upper Limb ◽  
Wrist Joint ◽  
Elbow Flexion ◽  
Measurement Unit ◽  
Shoulder Abduction ◽  
Table Tennis ◽  
Tennis Players ◽  
Movement Strategies ◽  
Flexion Extension ◽  
Limb Kinematics

To better understand the biomechanics of para-table tennis players, this study compared the shoulder, elbow, and wrist joint kinematics among able-bodied (AB) and wheelchair players in different classifications. Nineteen participants (AB, n = 9; classification 1 (C1), n = 3; C2, n = 3; C3, n = 4) executed 10 forehand and backhand topspin drives. Shoulder abduction/adduction, elbow flexion/extension, wrist extension/flexion, respective range of motion (ROM), and joint patterns were obtained using inertial measurement unit (IMU) sensors. The results showed clear differences in upper limb kinematics between the able-bodied and wheelchair players, especially in the elbow and wrist. For the para-players, noticeable variations in techniques were also observed among the different disability classes. In conclusion, wheelchair players likely adopted distinct movement strategies compared to AB to compensate for their physical impairments and functional limitations. Hence, traditional table tennis programs targeting skills and techniques for able-bodied players are unsuitable for para-players. Future work can investigate how best to customize training programs and to optimize movement strategies for para-players with varied types and degrees of impairment.

scholarly journals Reaching higher: External scapula assistance can improve upper limb function in humans with irreversible scapula alata

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Anna-Maria Georgarakis ◽  
Michele Xiloyannis ◽  
Christian Dettmers ◽  
Michael Joebges ◽  
Peter Wolf ◽  
...  
Keyword(s):  
Upper Limb ◽  
Perceived Exertion ◽  
Daily Life ◽  
Scapular Dyskinesis ◽  
Limb Function ◽  
Surgical Interventions ◽  
Upper Limb Function ◽  
Shoulder Flexion ◽  
Arm Elevation ◽  
Shoulder Blade

Abstract Background Scapular dyskinesis, i.e., the deviant mobility or function of the scapula, hampers upper limb function in daily life. A typical sign of scapular dyskinesis is a scapula alata—a protrusion of the shoulder blade during arm elevation. While some reversible causes of scapula alata can be treated with therapy, other, irreversible causes require invasive surgical interventions. When surgery is not an option, however, severe limitations arise as standard approaches for assisting the scapula in daily life do not exist. The aim of this study was to quantify functional improvements when external, i.e., non-invasive, scapula assistance is provided. Methods The study was designed as a randomized controlled crossover trial. Eight participants with a scapula alata due to muscular dystrophy performed arm elevations in shoulder flexion and abduction while unassisted (baseline), externally assisted by a trained therapist, and externally assisted by a novel, textile-based scapula orthosis. Results With therapist assistance, average arm elevation increased by 17.3° in flexion (p < 0.001, 95% confidence interval of the mean $$C{I}_{95\%}=\hspace{0.17em}\left[9.8^\circ , 24.9^\circ \right]$$ C I 95 % = 9 . 8 ∘ , 24 . 9 ∘ ), and by 11.2° in abduction (p < 0.01, $$C{I}_{95\%}=\left[4.7^\circ , 17.7^\circ \right]$$ C I 95 % = 4 . 7 ∘ , 17 . 7 ∘ ), constituting the potential of external scapula assistance. With orthosis assistance, average arm elevation increased by 6.2° in flexion ($$C{I}_{95\%}=\left[0.4^\circ ,11.9^\circ \right]$$ C I 95 % = 0 . 4 ∘ , 11 . 9 ∘ ) and by 5.8° in abduction ($$C{I}_{95\%}=\left[3.0^\circ ,8.5^\circ \right]$$ C I 95 % = 3 . 0 ∘ , 8 . 5 ∘ ). Remarkably, in three participants, the orthosis was at least as effective as the therapist. Moreover, orthosis assistance reduced average perceived exertion by 1.25 points (Borg Scale) when elevating a filled bottle during a simulated daily living task. Conclusion These findings indicate a large potential for future advancements in orthotics. Already now, the textile-based scapula orthosis presented here is a feasible tool for leveraging the benefits of external scapula assistance when a therapist is unavailable, as encountered in daily life scenarios. Trial Registration ClincalTrials.gov (ID NCT04154098). Registered: November 6th 2019, https://clinicaltrials.gov/ct2/show/NCT04154098?term=scapula+orthosis&draw=2&rank=1 Graphic abstract

Influence of the Sampling Rate on the Measurements of the Upper Limb Movements

2014 ◽  
Vol 601 ◽  
pp. 163-166 ◽  
Author(s):  
Mirela Toth-Taşcău ◽  
Dan Ioan Stoia ◽  
Flavia Bălănean
Keyword(s):  
Upper Limb ◽  
Sampling Rate ◽  
Elbow Flexion ◽  
Measuring System ◽  
Shoulder Abduction ◽  
Limb Movements ◽  
Flexion Extension ◽  
Upper Limb Movements ◽  
Left And Right

The main objective of the study consists in determination of the most appropriate sampling rate of the measurements in instrumented kinematic analysis of the upper limb movements. The measuring system involved in the study is Zebris CMS-HS Measuring System, whose configuration was defined by ultrasound markers attached to specific body sites. The sampling rate interval was set from 10 to 25 Hz, according to the system’s range of frequencies. The kinematic parameters which have been analyzed are shoulder and elbow flexion-extension and shoulder abduction-adduction. A comparative kinematical analysis of the angle variations of flexion-extension and abduction-adduction in shoulder joint and flexion-extension in elbow joint was performed for both left and right upper limbs at each sampling rate.

scholarly journals Does Transcranial Magnetic Stimulation Have an Added Value to Clinical Assessment in Predicting Upper-Limb Function Very Early After Severe Stroke?

2018 ◽  
Vol 32 (8) ◽  
pp. 682-690 ◽  
Author(s):  
Maurits H. J. Hoonhorst ◽  
Rinske H. M. Nijland ◽  
Peter J. S. van den Berg ◽  
Cornelis H. Emmelot ◽  
Boudewijn J. Kollen ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Upper Limb ◽  
Predictive Value ◽  
Magnetic Stimulation ◽  
Prognostic Value ◽  
Motor Evoked Potentials ◽  
Added Value ◽  
Shoulder Abduction ◽  
Limb Function ◽  
Upper Limb Function

Background. The added prognostic value of transcranial magnetic stimulation (TMS)-induced motor-evoked potentials (MEPs) to clinical modeling for the upper limb is still unknown early poststroke. Objective. To determine the added prognostic value of TMS of the adductor digiti minimi (TMS-ADM) to the clinical model based on voluntary shoulder abduction (SA) and finger extension (FE) during the first 48 hours and at 11 days after stroke. Methods. This was a prospective cohort study with 3 logistic regression models, developed to predict upper-limb function at 6 months poststroke. The first model showed the predictive value of SA and FE measured within 48 hours and at 11 days poststroke. The second model included TMS-ADM, whereas the third model combined clinical and TMS-ADM information. Differences between derived models were tested with receiver operating characteristic curve analyses. Results. A total of 51 patients with severe, first-ever ischemic stroke were included. Within 48 hours, no significant added value of TMS-ADM to clinical modeling was found ( P = .369). Both models suffered from a relatively low negative predictive value within 48 hours poststroke. TMS-ADM combined with SA and FE (SAFE) showed significantly more accuracy than TMS-ADM alone at 11 days poststroke ( P = .039). Conclusion. TMS-ADM showed no added value to clinical modeling when measured within first 48 hours poststroke, whereas optimal prediction is achieved by SAFE combined with TMS-ADM at 11 days poststroke. Our findings suggest that accuracy of predicting upper-limb motor function by TMS-ADM is mainly determined by the time of assessment early after stroke onset.

The Analysis and Control of Exoskeleton Upper-Limb Rehabilitation Robot

2013 ◽  
Vol 572 ◽  
pp. 619-623 ◽  
Author(s):  
Lan Wang ◽  
Zheng Qian Yin ◽  
Yuan Hang Sun
Keyword(s):  
Upper Limb ◽  
Shoulder Abduction ◽  
Rehabilitation Robot ◽  
Upper Limb Rehabilitation ◽  
Upper Limb Exoskeleton ◽  
Revolute Joints ◽  
Shoulder Flexion ◽  
Flexion Extension ◽  
Active Rehabilitation ◽  
Limb Rehabilitation

Based on the analysis of the methods for upper limb rehabilitation training, an anthropomorphic upper-limb exoskeleton was developed. Anatomical and physiological characteristics and upper limb joint ranges of motion are also considered. The rehabilitation robot is achieved by 4 single-axis revolute joints which are shoulder abduction-adduction (abd-add), shoulder flexion-extension (flx-ext), elbow flx-ext and wrist flx-ext. Kinematics and dynamics analysis of the rehabilitation robot are made. The passive rehabilitation mode and active rehabilitation mode are researched, and the result of experenment is shown that the robot can finish the rehabilitation task well.

scholarly journals The nature and extent of upper limb associated reactions during walking in people with acquired brain injury

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Michelle B. Kahn ◽  
Ross A. Clark ◽  
Gavin Williams ◽  
Kelly J. Bower ◽  
Megan Banky ◽  
...  
Keyword(s):  
Upper Limb ◽  
Walking Speed ◽  
Outcome Measure ◽  
Acquired Brain Injury ◽  
Elbow Flexion ◽  
Group Differences ◽  
Shoulder Abduction ◽  
Wrist Flexion ◽  
Forearm Rotation ◽  
Shoulder Flexion

Abstract Background Upper limb associated reactions (ARs) are common in people with acquired brain injury (ABI). Despite this, there is no gold-standard outcome measure and no kinematic description of this movement disorder. The aim of this study was to determine the upper limb kinematic variables most frequently affected by ARs in people with ABI compared with a healthy cohort at matched walking speed intention. Methods A convenience sample of 36 healthy control adults (HCs) and 42 people with ABI who had upper limb ARs during walking were recruited and underwent assessment of their self-selected walking speed using the criterion-reference three dimensional motion analysis (3DMA) at Epworth Hospital, Melbourne. Shoulder flexion, abduction and rotation, elbow flexion, forearm rotation and wrist flexion were assessed. The mean angle, standard deviation (SD), peak joint angles and total joint angle range of motion (ROM) were calculated for each axis across the gait cycle. On a group level, ANCOVA was used to assess the between-group differences for each upper limb kinematic outcome variable. To quantify abnormality prevalence on an individual participant level, the percentage of ABI participants that were outside of the 95% confidence interval of the HC sample for each variable were calculated. Results There were significant between-group differences for all elbow and shoulder abduction outcome variables (p < 0.01), most shoulder flexion variables (except for shoulder extension peak), forearm rotation SD and ROM and for wrist flexion ROM. Elbow flexion and shoulder abduction were the axes most frequently affected by ARs. Despite the elbow being the most prevalently affected (38/42, 90%), a large proportion of participants had abnormality, defined as ±1.96 SD of the HC mean, present at the shoulder (32/42, 76%), forearm (20/42, 48%) and wrist joints (10/42, 24%). Conclusion This study provides valuable information on ARs, and highlights the need for clinical assessment of ARs to include all of the major joints of the upper limb. This may inform the development of a criterion-reference outcome measure or classification system specific to ARs.

Abstract 99: Prep2: A Refined Algorithm for Predicting REcovery Potential of Upper Limb Function After Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Cathy M Stinear ◽  
Winston D Byblow ◽  
Marie-Claire Smith ◽  
Suzanne J Ackerley ◽  
P Alan Barber
Keyword(s):  
Upper Limb ◽  
Right Hemisphere ◽  
Economic Benefits ◽  
Good Prognosis ◽  
Asymmetry Index ◽  
Shoulder Abduction ◽  
Limb Function ◽  
Upper Limb Function ◽  
Recovery Potential ◽  
Capacity For Consent

Independence after stroke depends on the recovery of motor function, but this is difficult to accurately predict for individual patients. We have previously described an algorithm for predicting potential for recovery of upper limb function for individual patients after stroke. The Predict REcovery Potential (PREP) algorithm begins with a bedside assessment of paretic shoulder abduction and finger extension strength (SAFE score out of 10), followed by transcranial magnetic stimulation (TMS), and magnetic resonance imaging (MRI), as required. Patients are predicted to have potential for an Excellent, Good, Limited or Poor recovery of upper limb function within 12 weeks. The algorithm was developed with data from 40 patients with first-ever ischaemic stroke. This study evaluated and refined the algorithm with a larger, more heterogeneous cohort. Inclusion criteria were confirmed stroke (ischaemic or haemorrhagic), new upper limb motor symptoms, and age at least 18 years. Previous stroke, thrombolysis and thrombectomy were allowed. Exclusion criteria were cerebellar stroke, contraindications to TMS and MRI for those patients who required these tests, and reduced capacity for consent. The Action Research Arm Test was used to measure paretic upper limb function 12 weeks post-stroke. A sample of 192 patients was recruited within 3 days of stroke (106 men, mean age 72 y, 100 right hemisphere), and 157 patients completed the 12 week assessment. The algorithm was refined by combining the SAFE score with age (<80, ≥80 years) to more accurately distinguish between patients with an Excellent or Good prognosis; and by revising the MRI asymmetry index threshold from 0.15 to 0.125 to more accurately distinguish between patients with a Limited or Poor prognosis. These revisions improved accuracy from 59% to 75%. With the revised algorithm, the proportion of patients who need TMS is reduced from over half to around one third. The revised algorithm is therefore more accurate and more efficient. Alternative versions of the PREP2 algorithm will also be presented, which can be used when TMS and/or MRI are unavailable. The potential clinical and economic benefits of implementing the PREP2 algorithm will be discussed.

Abstract 112: Predicting REcovery Potential of Upper Limb Function After Stroke to Increase Rehabilitation Efficiency

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Cathy M Stinear ◽  
Suzanne J Ackerley ◽  
Winston D Byblow ◽  
P A Barber ◽  
Anna McRae ◽  
...  
Keyword(s):  
Upper Limb ◽  
Diffusion Tensor ◽  
Shoulder Abduction ◽  
Limb Function ◽  
Limb Weakness ◽  
Implementation Phase ◽  
Upper Limb Function ◽  
Therapy Program ◽  
Recovery Potential ◽  
Two Phases

Introduction: The PREP algorithm combines clinical assessment [Shoulder Abduction Finger Extension (SAFE) score], transcranial magnetic stimulation (TMS) and diffusion-tensor imaging to predict potential for upper limb recovery following stroke. Patients’ recovery potential is predicted to be Complete, Notable, Limited or None. Hypothesis: The PREP algorithm may be used in a ‘real world’ clinical setting to set individual rehabilitation goals. Methods: This study recruited 194 patients with upper limb weakness within 3 days of stroke. Assessments were made at baseline and 12 weeks by assessors blinded to PREP algorithm prediction. The initial benchmarking phase recruited 85 patients and PREP algorithm information was not shared with clinical teams or patients. The results were used to refine the algorithm and guide implementation in three ways. First, patients with a SAFE score > 7, predicted to have Complete upper limb recovery, were given a self-directed therapy program. Second, patients with a SAFE score of 5-7 could be given a Notable recovery prognosis, without requiring TMS. Third, 19% of patients exceeded their predicted upper limb recovery, so this possibility was conveyed to patients and clinical teams. The implementation phase recruited 109 patients, and PREP algorithm predictions were shared with patients and clinical teams. Results: Interim analyses (n = 135) find that the PREP algorithm correctly predicted upper limb function at 12 weeks for 85% of patients. Implementation of the algorithm decreased length of stay by 7 days (95%CI 2 - 15 days, p < 0.05) and increased the proportion of patients discharged home from the acute stroke unit from 28% to 49% (p < 0.01). Implementation also decreased upper limb therapy dose (p < 0.01), yet patient outcomes were similar between the two phases. Primary endpoint analysis will be complete in November 2015. Conclusions: Making predictions about the potential for recovery of upper limb function, and setting individual rehabilitation goals accordingly, may increase the efficiency of post-stroke rehabilitation.

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