I got nothing out of this, hopefully your doctor can explain how this is going to get you 100% recovered. If you get my upper arm and hand spasticity cured this problem would cease to exist. Solve the correct problem, spasticity, not this secondary effect of spasticity. THIS is why we need a stroke strategy, we wouldn't be wasting time on secondary issues, we would solve the primary problem.
The nature and extent of upper limb associated reactions during walking in people with acquired brain injury
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.Background
People
with acquired brain injury (ABI) often present with movement
abnormalities including upper limb associated reactions (ARs) during
walking [1, 2]. Associated reactions are prevalent, recently being reported as a key goal area in 43% of people in a large stroke cohort (n = 964) [3].
Associated reactions are an effort-dependent phenomenon causing an
involuntary increase in upper limb muscle tone, with awkward and
uncomfortable postures [4]. Normal arm swing in walking is important to reduce energy expenditure [5], enhance gait stability and balance [6] and facilitate leg swing for faster walking speeds [7,8,9]. Abnormal upper limb kinematics resulting from ARs may negatively impact gait [10], balance [11], dynamic upper limb function [12, 13] and activities of daily living [10] for people with ABI. The treatment of ARs is therefore commonly a focus for physical and pharmacological management [3, 14].
Despite the prevalence and significance of ARs, there are many issues that exist in this field, such as, inconsistent terminology, no gold-standard assessment, unconfirmed contributing factors and varied treatment without supporting evidence [15]. In regards to assessment, there is currently no gold-standard outcome measure, with most having poor ecological validity for walking, involving stationary tests performed in a seated position [4]. The elbow joint is frequently the focus of assessment [4], despite literature suggesting that ARs affect all joints of the upper limb [16, 17]. Therefore, investigation into the upper limb movement abnormalities caused by ARs during walking is required.
Instrumented three-dimensional motion analysis (3DMA) is the criterion-reference for objective evaluation of joint kinematics during walking [18]. Despite the potential for 3DMA to fulfil the requirements of detailed dynamic upper limb assessment, it is not yet widely integrated into research or clinical practice. To date there have only been a few studies that have developed upper limb marker sets. These have been used for evaluation of arm posture during walking in healthy controls (HCs) [19, 20], paediatric cerebral palsy [21,22,23] and adults with stroke [2, 24]. While these studies have refined the use of upper body marker sets in gait analysis there has been no research to date in applying 3DMA specifically for the evaluation of ARs. Given that clinically, people with ARs and their therapists often describe ARs in terms of the visual impact, 3DMA is an appropriate methodology to quantify ARs.
A comprehensive assessment of the kinematics of upper limb ARs during walking in ABI may provide insight into the key abnormalities, facilitate the development of a criterion-reference outcome measure, help guide assessment, and clinical decision-making regarding therapeutic interventions. The aim of this study was therefore to determine the upper limb kinematic variables most frequently affected by ARs in people with ABI compared with a healthy cohort.
Despite the prevalence and significance of ARs, there are many issues that exist in this field, such as, inconsistent terminology, no gold-standard assessment, unconfirmed contributing factors and varied treatment without supporting evidence [15]. In regards to assessment, there is currently no gold-standard outcome measure, with most having poor ecological validity for walking, involving stationary tests performed in a seated position [4]. The elbow joint is frequently the focus of assessment [4], despite literature suggesting that ARs affect all joints of the upper limb [16, 17]. Therefore, investigation into the upper limb movement abnormalities caused by ARs during walking is required.
Instrumented three-dimensional motion analysis (3DMA) is the criterion-reference for objective evaluation of joint kinematics during walking [18]. Despite the potential for 3DMA to fulfil the requirements of detailed dynamic upper limb assessment, it is not yet widely integrated into research or clinical practice. To date there have only been a few studies that have developed upper limb marker sets. These have been used for evaluation of arm posture during walking in healthy controls (HCs) [19, 20], paediatric cerebral palsy [21,22,23] and adults with stroke [2, 24]. While these studies have refined the use of upper body marker sets in gait analysis there has been no research to date in applying 3DMA specifically for the evaluation of ARs. Given that clinically, people with ARs and their therapists often describe ARs in terms of the visual impact, 3DMA is an appropriate methodology to quantify ARs.
A comprehensive assessment of the kinematics of upper limb ARs during walking in ABI may provide insight into the key abnormalities, facilitate the development of a criterion-reference outcome measure, help guide assessment, and clinical decision-making regarding therapeutic interventions. The aim of this study was therefore to determine the upper limb kinematic variables most frequently affected by ARs in people with ABI compared with a healthy cohort.
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