Objective measurement of synergistic movement patterns of the upper extremity following stroke: An explorative study

The majority of stroke survivors have to cope with deficits in arm function, which is often monitored with subjective clinical scales during stroke rehabilitation. The aim of this study is to examine whether robotic outcome measures obtained during circle drawing are suitable to objectively measure upper extremity function of stroke survivors, especially regarding synergistic movement patterns. Stroke survivors (n = 16) and healthy subjects (n = 20) drew circles, as big and as round as possible, above a table top. Joint angles and positions of the shoulder and elbow were measured. Synergistic movement patterns were identified based on simultaneous changes of the shoulder elevation angle and elbow angle. Stroke survivors moved significantly more within synergistic movement patterns, compared to healthy subjects. Strong correlations between the proximal upper extremity part of the Fugl-Meyer (FM) scale and the use of synergistic movement patterns were found. The proposed outcome measures seem to be suitable measures to objectively quantify the occurrence of synergistic movement patterns of the upper extremity following stroke.

[1]  Bryan Buchholz,et al.  ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion--Part II: shoulder, elbow, wrist and hand. , 2005, Journal of biomechanics.

[2]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[3]  W. Rymer,et al.  Target-dependent differences between free and constrained arm movements in chronic hemiparesis , 2004, Experimental Brain Research.

[4]  L Dipietro,et al.  Changing motor synergies in chronic stroke. , 2007, Journal of neurophysiology.

[5]  T. Twitchell.  The restoration of motor function following hemiplegia in man. , 1951, Brain : a journal of neurology.

[6]  P. Lachenbruch.  Statistical Power Analysis for the Behavioral Sciences (2nd ed.) , 1989 .

[7]  W Z Rymer,et al.  Reorganization of flexion reflexes in the upper extremity of hemiparetic subjects , 1999, Muscle & nerve.

[8]  A. Fugl-Meyer,et al.  The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. , 1975, Scandinavian journal of rehabilitation medicine.

[9]  G. Kwakkel,et al.  Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. , 2003, Stroke.

[10]  J. Dewald,et al.  Augmenting Clinical Evaluation of Hemiparetic Arm Movement With a Laboratory-Based Quantitative Measurement of Kinematics as a Function of Limb Loading , 2008, Neurorehabilitation and neural repair.

[11]  C. Burgar,et al.  Evidence for strength imbalances as a significant contributor to abnormal synergies in hemiparetic subjects , 2003, Muscle & nerve.

[12]  W. Rymer,et al.  Abnormal muscle coactivation patterns during isometric torque generation at the elbow and shoulder in hemiparetic subjects. , 1995, Brain : a journal of neurology.

[13]  Frans C. T. van der Helm,et al.  Dampace: Design of an Exoskeleton for Force-Coordination Training in Upper-Extremity Rehabilitation , 2009 .

[14]  J. Dewald,et al.  Impact of gravity loading on post‐stroke reaching and its relationship to weakness , 2007, Muscle & nerve.

[15]  J P Dewald,et al.  Upper-Limb Discoordination in Hemiparetic Stroke: Implications for Neurorehabilitation , 2001, Topics in stroke rehabilitation.

[16]  H. van der Kooij,et al.  Increased range of motion and decreased muscle activity during maximal reach with gravity compensation in stroke patients , 2007, 2007 IEEE 10th International Conference on Rehabilitation Robotics.

[17]  H. Hislop,et al.  Movement therapy in hemiplegia : a neurophysiological approach , 1970 .

[18]  J. Dewald,et al.  Progressive Shoulder Abduction Loading is a Crucial Element of Arm Rehabilitation in Chronic Stroke , 2009, Neurorehabilitation and neural repair.

[19]  J. Dewald,et al.  Task-dependent weakness at the elbow in patients with hemiparesis. , 1999, Archives of physical medicine and rehabilitation.

[20]  S. Black,et al.  The Fugl-Meyer Assessment of Motor Recovery after Stroke: A Critical Review of Its Measurement Properties , 2002, Neurorehabilitation and neural repair.