The impact of time on quality of motor control of the paretic upper limb after stroke

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The impact of time on quality of motor control of the paretic upper limb after stroke

Joost van Kordelaar, Erwin E.H. van Wegen, Gert Kwakkel Arch Phys Med Rehabil 2014; 95:338-44

Chapter 5100

ABSTRACT

Objective. 
To establish the time course of recovery regarding smoothness of upper limb movements in the first 6 months after stroke. 
Design. 
Cohort study with 3D kinematic measurements in week 1, 2, 3, 4, 5, 8, 12 and 26 after stroke. Setting. On-site 3D kinematic measurements in stroke units, rehabilitation centers, nursing homes and patents’ homes. Participants. Forty-four patients (19 women, 25 men; mean age: 58 ± 12 years) with a first-ever unilateral ischemic stroke and incomplete upper limb paresis (27 leftsided, 17 right sided) were included.
Main Outcome Measures. 
In each measurement, an electromagnetic motion tracker acquired hand and finger trajectories during a reach-to-grasp task. Movement duration was determined, and smoothness of hand transport and grasp aperture were quantified by normalized jerk. Using random coefficient analysis, the effect of progress of tme on smoothness of hand transport and grasp aperture was investigated. Results. During the first 5 weeks after stroke, there was a significant contribution of progress of time to reductions in movement duration and normalized jerk of hand transport and grasp aperture (p < 0.01). 
Conclusions. 
The present longitudinal 3D kinematic study showed that smoothness of paretic upper limb movements improves in the first 8 weeks after stroke. This improvement suggests that motor control normalizes in the first 8 weeks after stroke and can be mostly explained by spontaneous neurological recovery that occurs typically in the first weeks after stroke. Future 3D kinematic studies should investigate whether therapies starting early after stroke can improve the quality of motor control beyond spontaneous neurological recovery.

Recovery of upper limb control afer stroke 101 5 INTRODUCTION Time poststroke is one of the most neglected features in explaining recovery