http://nnr.sagepub.com/content/27/3/251.abstract?etoc
Abstract
Background. Better understanding of how
bimanual coordination changes over the first weeks of recovery after
stroke is required to address
the potential utility for bimanual rehabilitation.
Three-dimensional kinematic analysis can provide quantitative assessment
of unimanual and bimanual movements. Objective.
To assess the natural evolution of reaching kinematics during standard
poststroke rehabilitation, focusing on bimanual coordination.
Methods. A total of 12 hemiparetic,
moderately impaired patients were included within 30 days after a first
unilateral ischemic/hemorrhagic
stroke; 7 kinematic assessments were performed once
a week for 6 weeks and at 3 months after inclusion. The reach-to-grasp
task was performed in 3 different conditions:
unimanual with the healthy limb (UN), unimanual with the paretic limb
(UP),
and bimanual (BN/BP). Results. For the
paretic limb, movement fluency (number of movement units and total
movement time) was lower for bimanual reaching
compared with unimanual reaching. For bimanual
reaching, (1) movement kinematics were similar for both limbs, (2)
recovery
patterns of both limbs followed a similar profile
with a plateau phase at 6 weeks poststroke, and (3) intertrial
variability
of between-hands synchronization decreased over
sessions, although the mean delays remained the same. Conclusions.
Bimanual coordination started to become efficient 6 weeks after onset
of stroke, so for patients such as those we tested,
this time could be most opportune to start
bimanual-oriented rehabilitation. The challenge in future research
includes determining
the characteristics of patients who may best
benefit from bimanual therapy.
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