Kinematic descriptions of upper limb function using simulated tasks in activities of daily living after stroke

 Describing something without having protocols to fix anything is ABSOLUTELY FUCKING WORTHLESS!

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? No excuses are allowed! You're medically trained; it should be simple to precisely state EXACTLY WHAT GOOD 'Kinematic descriptions' do for recovery with NO EXCUSES! Your definition of competence in stroke is obviously much lower than stroke survivors' definition of your competence! Swearing at me is allowed, I'll return the favor. Don't even attempt to use the excuse that brain research is hard.

Kinematic descriptions of upper limb function using simulated tasks in activities of daily living after stroke

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https://doi.org/10.1016/j.humov.2021.102834

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Highlights

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  Stroke survivors show impairment of spatial and temporal upper limb control.
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  Upper limb function is assessed by a simulated task in activities of daily living.
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  Changes in relative timing of the task suggest changes in motor strategies.
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  Increased variability could imply the tendency toward less stable patterns.
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  Improving temporal control of movements should be considered in rehabilitation.

Abstract

Assessment of upper limb function poststroke is critical for clinical management and determining the efficacy of interventions. We designed a unilateral upper limb task to simulate activities of daily living to examine how chronic stroke survivors manage reaching, grasping and handling skills simultaneously to perform the functional task using kinematic analysis. The aim of the study was to compare the motor strategies for performing a functional task between paretic and nonparetic arms. Sixteen chronic stroke survivors were instructed to control an ergonomic spoon to transfer liquid from a large bowl to a small bowl using paretic or nonparetic arm. Kinematic data were recorded using a Vicon motion capture system. Outcome measures included movement duration, relative timing, path length, joint excursions, and trial-to-trial variability. Results showed that movement duration, spoon path length, and trunk path length increased significantly when participants used paretic arm to perform the task. Participants tended to reduce shoulder and elbow excursions, and increase trunk excursions to perform the task with paretic arm and altered the relative timing of the task. Although participants used different motor strategies to perform the task with their paretic arms, we did not find the significant differences in trial-to trial variability of joint excursions between paretic and nonparetic arms. The results revealed differences in temporal and spatial aspects of motor strategies between paretic and nonparetic arms. Clinicians should explore the underlying causes of pathological movement patterns and facilitate preferred movement patterns of paretic arm.(And what are the EXACT PROTOCOLS TO DO THAT? You don't seem to have any, so fucking worthless! I'd have you all fired for incompetence!)

Introduction

Stroke is a leading cause of long-term disability and most stroke survivors have chronic upper limb dysfunction. Dysfunction in upper limbs is a combination of muscle weakness, paralysis, spasticity, sensory loss and abnormal motor synergies, which impairs the performance of activities of daily living (ADLs). Therefore, assessment of upper limb function is critical for clinical management and determining the efficacy of interventions.

Assessment of upper limb function in stroke patients is usually performed using standardized clinical scales, such as Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and Action Research Arm Test (ARAT). These clinical scales are reliable measures, but could lack sensitivity to detect minor changes in motor performance due to the nature of ordinal scales, especially when patients are close to full recovery. Detecting minor changes in motor performance could provide a more comprehensive view of recovery process and help clinicians evaluate the efficacy of interventions (van Dokkum et al., 2014).

Apart from clinical scales, researchers use motion capture systems to evaluate upper limb function via kinematic analysis. Over the past decade, there was an increasing trend of using kinematic analysis, which provides detailed spatiotemporal information of limbs movements (Santisteban et al., 2016). Kinematic analysis represents the best way to distinguish behavioral restitution from substitution, which is essential to assess motor performance in stroke recovery(Kwakkel et al., 2017; Schwarz Anne, Kanzler, Olivier, Luft, & Veerbeek, 2019). Behavioral restitution is defined as a return pre-lesion movement pattern or function of the affected limb. Behavioral substitution is defined as the emergence of new movement strategies that differ from the original, which is referred to as compensation. Unlike gait analysis which primarily examine cyclical movements of the lower limbs, assessment of upper limb movements is challenging due to a large repertoire of upper limbs movement for ADLs. Previous studies used forward reaching (Massie, Malcolm, Greene, & Browning, 2012; Robertson & Roby-Brami, 2011), side reaching (Verheyden et al., 2011), and grasping (Alt Murphy, Willén, & Sunnerhagen, 2012) to measure upper limb kinematics. Results showed that stroke patients had greater movement duration, greater reach path ratio, reduced shoulder and elbow excursions, and greater trunk displacement during reaching tasks with paretic arms(Collins, Kennedy, Clark, & Pomeroy, 2018). While these studies contain a wealth of information about upper limb control, there is a gap between real-life activities and the simple tasks used in research settings. Those simple tasks may not reflect the level of abilities to perform ADLs because movements in simple tasks are primarily performed in two-dimensional plane and one or two steps. Since most ADLs involving upper limbs are performed in three-dimensional space and multi-steps, three-dimensional tasks that require the coordination of shoulder, elbow and hand should be favored to assess behavioral restitution(Schwarz Anne et al., 2019). Here, we designed a unilateral upper limb task to simulate ADLs and examined how chronic stroke survivors control serial movements of reaching, grasping and handling an ergonomic spoon to transfer liquid from a large bowl to a small personal bowl in three-dimensional space. Moreover, we intended to examine both temporal and spatial aspects of kinematics between paretic and nonparetic arms when chronic stroke survivors perform the unilateral upper limb task with an ergonomic spoon.

A movement pattern is coordinated if individuals can perform the movement pattern consistently in repeated trials to accomplish a desired task, reflecting the stability of a movement pattern (Magill, 2011). The term “stability” refers to the consistency of the spatiotemporal pattern of movement, which can be measured by the variability of kinematic variables. If the motor system is perturbed due to stroke, the variability of kinematic variables may be increased (Thies et al., 2009). We intended to examine the variability of kinematic variables by testing whether the movement patterns of upper limbs could be reproduced with consistency when participants use their paretic arm to perform the task.

The purpose of this study was to 1) examine temporal aspects of kinematics between paretic and nonparetic arms when chronic stroke survivors perform the unilateral upper limb task with an ergonomic spoon, 2) examine the spatial aspects of kinematics between paretic and nonparetic arms during the task, and 3) compare the kinematic variability of paretic arm movements to the kinematic variability of nonparetic arm movements during the task. Outcome measures included movement duration, relative timing, path length, joint excursions, and trial-to-trial variability.