Compensatory Versus Noncompensatory Shoulder Movements Used for Reaching in Stroke

Not sure what use this is going to be to your stroke protocols but you may as well ask.
http://nnr.sagepub.com/content/early/2015/10/27/1545968315613863.abstract?&

1. Mindy F. Levin, PT, MSc, PhD1,2⇑
2. Dario G. Liebermann, MSc, PhD3
3. Yisrael Parmet, MSc, PhD4
4. Sigal Berman, MSc, PhD4

1. ¹McGill University, Montreal, Quebec, Canada
2. ²Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Quebec, Canada
3. ³University of Tel Aviv, Tel Aviv, Israel
4. ⁴Ben-Gurion University of the Negev, Beer-Sheva, Israel

1. Mindy F. Levin, School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, Quebec, H3G 1Y5, Canada. Email: mindy.levin@mcgill.ca

Abstract

Background. The extent to which the upper-limb flexor synergy constrains or compensates for arm motor impairment during reaching is controversial. This synergy can be quantified with a minimal marker set describing movements of the arm-plane.  

Objectives. To determine whether and how (a) upper-limb flexor synergy in patients with chronic stroke contributes to reaching movements to different arm workspace locations and (b) reaching deficits can be characterized by arm-plane motion.  

Methods. Sixteen post-stroke and 8 healthy control subjects made unrestrained reaching movements to targets located in ipsilateral, central, and contralateral arm workspaces. Arm-plane, arm, and trunk motion, and their temporal and spatial linkages were analyzed.  

Results. Individuals with moderate/severe stroke used greater arm-plane movement and compensatory trunk movement compared to those with mild stroke and control subjects. Arm-plane and trunk movements were more temporally coupled in stroke compared with controls. Reaching accuracy was related to different segment and joint combinations for each target and group: arm-plane movement in controls and mild stroke subjects, and trunk and elbow movements in moderate/severe stroke subjects. Arm-plane movement increased with time since stroke and when combined with trunk rotation, discriminated between different subject groups for reaching the central and contralateral targets. Trunk movement and arm-plane angle during target reaches predicted the subject group.  

Conclusions. The upper-limb flexor synergy was used adaptively for reaching accuracy by patients with mild, but not moderate/severe stroke. The flexor synergy, as parameterized by the amount of arm-plane motion, can be used by clinicians to identify levels of motor recovery in patients with stroke.