Compensatory Kinematic Movements in Various Directions After Stroke

Compensatory Kinematic Movement for Reaching Task in Various Directions in After Stroke

This is cross-sectional study. By comparing kinematic analysis between stroke and healthy subjects in various directions, this investigation analyzes the compensatory kinematic movement for reaching task in stroke survivors

Study Overview

• Status: Completed
• Conditions: Cerebral Stroke; Hemiplegia, Spastic

Detailed Description

After Institutional Review Board approval, It recruits 2 groups. one group is elderly and another group is stroke survivors. the stroke group that meets the criteria. Another group is age matching of the stroke and not having an orthopedic or neurological disease. Participants of all the groups are assessed for kinematic by motion capture During reaching arm(affected side; stroke group, non-dominant side; healthy group) in 3 directions(medial_45, forward_90 and lateral_135 degrees). Retroreflective markers are placed on 11 anatomical place (3th metacarpal joint, both acromion, elbow lateral and medial epicondyle, lateral and medial styloid process, xyphoid process, sternum, C7, T4). Participants reach to a bell as quickly as possible in three directions. The subject reach to a bell 5 times in each direction and assess clinical evaluation such as Fugl Meyer Assessment, Postural Assessment Scale, Modified Ashworth Scale, shoulder-elbow range of motion and Trunk Instability scale.

• Study Type: Observational
• Enrollment (Actual): 96

Contacts and Locations

Study Locations

• Korea, Republic of
  • Ulju
    • Ulsan, Ulju, Korea, Republic of, 44919
      • Ulsan National Institute of Science and Technology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 40 years to 85 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

Recruit research participants from the healthy group of 61 participants at the gym for the disabled of Ulsan city and Ulsan national institute of science and technology. Another group of 35 patients who enter the largest gym for the disabled of Ulsan city.

Description

Inclusion Criteria:

The inclusion criteria used in the randomized controlled trials were as follows:

Stroke

• Subject consisted of the physician's confirmation of chronic hemiplegia
• onset ≥ 6 months
• Mini-mental state examination≥25
• Biceps ≤2, Triceps≤2
• Ability to Sit on a chair alone
• FMA upper extremity score ≥ 21 points, FMA upper extremity ≤ 66 points

Healthy

• Age of matching the stroke group
• Absence of neurological disease and orthopedic disease

Exclusion Criteria:

Stroke

• Biceps>2, Triceps>2
• Flaccid
• Neglect syndrome
• Have neurological disease and orthopedic disease
• Lack of coordination

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Control
• Time Perspectives: Cross-Sectional

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
chronic stroke; The subject consisted of the physician's confirmation of chronic hemiplegia onset ≥ 6 months Mini-mental state examination≥25 Biceps ≤2, Triceps≤2 Ability to Sit on a chair alone FMA upper extremity score ≥ 21points, FMA upper extremity score ≤ 66 points The symptom is mild or moderate level (MAS≤2) and can sit alone. The subject reaches to target by affected arm in 3 directions(medial_45, forward_90 and lateral_135 degrees)
Healthy; Matching aged people, not having neurological system or orthopedic disease on Upper extremity. The subject reaches to target by non-dominant arm in 3 directions(medial_45, forward_90 and lateral_135 degrees)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Differences in Spatial Measurements of Trunk Dislocation Components During 3-directional Bell-reaching Task Between Healthy Subjects and Stroke Patients	Trunk dislocation (reaching phase in millimetre; mm) in reaching task. The measurements are detected in 3 directions (Forward_90, Lateral_135, Medial_45 degree). Participants reach to a bell as quickly as possible. 3rd joint is calculated for quantitative measurements.	1 time (Baseline)
Differences in Spatial Measurements of Elbow and Shoulder Angle Components During 3-directional Bell-reaching Task Between Healthy Subjects and Stroke Patients	Elbow extension and shoulder flexion angle (degree) in reaching task. The measurements are detected in 3 directions (Forward_90, Lateral_135, Medial_45 degree). Participants reach to a bell as quickly as possible. 3rd joint is calculated for quantitative measurements.	1 time (Baseline)
Differences in Temporal Measurements of Movement Unit Components During 3-directional Bell-reaching Task Between Healthy Subjects and Stroke Patients	Movement units are quantified by counting velocity peaks during the reaching task. A movement unit is defined as a velocity profile segment between a local minimum and the following maximum velocity that exceeds 20 mm/s, with a minimum time interval of 150 ms between subsequent peaks. This measure represents the smoothness of movement, where fewer movement units indicate smoother motion The measurements are detected in 3 directions (Forward_90, Lateral_135, Medial_45 degree). Participants reach to a bell as quickly as possible. 3rd joint is calculated for quantitative measurements.	1 time (Baseline)
Differences in Temporal Measurements of Hand Movement Time Components During 3-directional Bell-reaching Task Between Healthy Subjects and Stroke Patients	The period from hand tangential velocity movement onset to offset was the total time (entire time of reach and return phase [second]). The period when the tangential velocity exceeded 10% of its peak was termed hand movement onset, whereas that when the tangential velocity stayed below 10% of its peak was termed hand movement offset. The measurements are detected in 3 directions (Forward_90, Lateral_135, Medial_45 degree). Participants reach to a bell as quickly as possible. 3rd joint is calculated for quantitative measurements.	1 time (Baseline)
Differences in Temporal Measurements of Hand Velocity Components During 3-directional Bell-reaching Task Between Healthy Subjects and Stroke Patients	Tangential velocity was computed for the hand marker's velocity. Peak elbow angular velocity (rad/s) during elbow extension were measured The measurements are detected in 3 directions (Forward_90, Lateral_135, Medial_45 degree). Participants reach to a bell as quickly as possible. 3rd joint is calculated for quantitative measurements.	1 time (Baseline)
Differences in Temporal Measurements of Elbow Extension Acceleration Components During 3-directional Bell-reaching Task Between Healthy Subjects and Stroke Patients	Acceleration (rad/s2) during elbow extension was measured The measurements are detected in 3 directions (Forward_90, Lateral_135, Medial_45 degree). Participants reach to a bell as quickly as possible. 3rd joint is calculated for quantitative measurements.	1 time (Baseline)
Difference of the Components Temporal Measurements Between Healthy and Stroke	Tangential velocity was computed for the hand marker's velocity. The period when the tangential velocity exceeded 10% of its peak was termed hand movement onset, whereas that when the tangential velocity stayed below 10% of its peak was termed hand movement offset. Peak hand velocity (mm/s) was analyzed. The measurements are detected in 3 directions (Forward_90, Lateral_135, Medial_45 degree). Participants reach to a bell as quickly as possible. 3rd joint is calculated for quantitative measurements.	1 time (Baseline)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Comparison of Fugl-Meyer Assessment Scores Between Chronic Stroke Patients and Healthy	Related Fugl-Meyer Assessment score(dependent) to predictors(independent) in three directions. In sitting position, the sum of each subtotal score is 66 (maximum) and the minimum is 0. Subscales were summed to compute a total score. Cutoff scores defined 0~20: severe, 21 ~ 50: moderate, 51~66: mild 1) Reflex activity_max 4 score, 2) Volitional movement within synergies_ max 18, 3) Volitional movement mixing synergies_ max 6, 4) Volitional movement with little or no synergy_ max 6, 5) Normal reflex activity_max 2, 6) Wrist movement_ max 10, 7) Hand movement with grasp_ max 14, 8) coordination/speed_max 6.	Baseline

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Comparison of Modified Ashworth Scale Between Chronic Stroke Patients and Healthy Controls	Scoring for Biceps; MAS 0: No increase in tone; MAS 1: slight increase in tone giving a catch when slight increase in muscle t-tone, manifested by the limb was moved in flexion or extension.; MAS 1+: slight increase in muscle tone, manifested by a catch followed by minimal resistance throughout (ROM ); MAS 2: more marked increase in tone but more marked increased in muscle tone through most limb easily flexed; MAS 3: considerable increase in tone, passive movement difficult; MAS 4: limb rigid in flexion or extension The Modified Ashworth Scale (MAS) ranges from 0 to 4, where higher scores indicate more severe spasticity/increased muscle tone. A score of 0 represents normal muscle tone, while 4 represents the most severe level of spasticity.	Baseline
Range of motion_Health Status Chronic Stroke	Shoulder and elbow joint range of motion; Shoulder flexion, adduction, abduction, external rotation, internal rotation; Elbow flexion, extension	Baseline
Trunk Impairment Scale(TIS)_Health Status Chronic Stroke	The Trunk Impairment Scale (TIS) for stroke has a total score of 23 points, with higher scores indicating better trunk control ability. TIS components: Static sitting balance - 7 points Dynamic sitting balance - 10 points Coordination - 6 points 23 points = Optimal trunk control ability (normal performance of all items) 0 points = Minimal trunk control ability (unable to perform) Static sitting balance Dynamic sitting balance Co-ordination	1 time(Baseline)
Postural Assessment Scale for Stroke(PASS)_Health Status Chronic Stroke	The Postural Assessment Scale for Stroke (PASS) evaluates postural control in stroke patients, with scores ranging from 0-36 points, where higher scores indicate better functional recovery. 1) Sitting without support 2,3) Standing with(without) support 4,5) Standing on (non)paretic leg 6) Supine to affected side lateral 7) Supine to non-affected side lateral 8) Supine to sitting up on the edge of the table 9) Sitting on the edge of the table to supine 10) Sitting to standing up 11) Standing up to sitting down 12) Standing, picking up a pencil from the floor	Baseline
Fugl_Meyer Assessment(FMA)_Health Status Chronic Stroke	Upper extremity The total score means that severe <20, 20=<moderate<60, 60=<mild. Higher scores on the Fugl-Meyer Assessment indicate better upper limb motor control with reduced synergistic patterns, while lower scores indicate stronger synergistic patterns due to spasticity 1) Reflex activity_max 4 score, 2) Volitional movement within synergies_ max 18, 3) Volitional movement mixing synergies_ max 6, 4) Volitional movement with little or no synergy_ max 6, 5) Normal reflex activity_max 2, 6) Wrist movement_ max 10, 7) Hand movement with grasp_ max 14, 8) coordination/speed_max 6.; Shoulder, Elbow and ForearmReflex activityVolitional movement within synergiesVolitional movement mixing synergiesVolitional movement with little or no synergyNormal reflex activity; Wrist; Hand; Coordination/Speed; Total score is 66 points	Baseline
Modified Ashworth Scale_Stiffness of Chronic Stroke	Scoring for Triceps; MAS 0: No increase in tone; MAS 1: slight increase in tone giving a catch when slight increase in muscle t-tone, manifested by the limb was moved in flexion or extension.; MAS 1+: slight increase in muscle tone, manifested by a catch followed by minimal resistance throughout (ROM ); MAS 2: more marked increase in tone but more marked increased in muscle tone through most limb easily flexed; MAS 3: considerable increase in tone, passive movement difficult; MAS 4: limb rigid in flexion or extension The Modified Ashworth Scale (MAS) ranges from 0 to 4, where higher scores indicate more severe spasticity/increased muscle tone. A score of 0 represents normal muscle tone, while 4 represents the most severe level of spasticity.	Baseline

Collaborators and Investigators

• Sponsor: University of Valencia
• Collaborators: Ulsan National Institute of Science and Technology
• Investigators: Principal Investigator: Jóse Casaña Granell, PhD, University of Valencia; Principal Investigator: Joaquin Calatayud Villalba, PhD, University of Valencia; Principal Investigator: Sang Hoon Kang, PhD, Ulsan National Institute of Science and Technology

Publications and helpful links

General Publications

• Cirstea MC, Levin MF. Compensatory strategies for reaching in stroke. Brain. 2000 May;123 ( Pt 5):940-53. doi: 10.1093/brain/123.5.940.
• Wu CY, Liing RJ, Chen HC, Chen CL, Lin KC. Arm and trunk movement kinematics during seated reaching within and beyond arm's length in people with stroke: a validity study. Phys Ther. 2014 Jun;94(6):845-56. doi: 10.2522/ptj.20130101. Epub 2014 Jan 30.
• Hsieh YW, Liing RJ, Lin KC, Wu CY, Liou TH, Lin JC, Hung JW. Sequencing bilateral robot-assisted arm therapy and constraint-induced therapy improves reach to press and trunk kinematics in patients with stroke. J Neuroeng Rehabil. 2016 Mar 22;13:31. doi: 10.1186/s12984-016-0138-5.
• Adamovich SV, Archambault PS, Ghafouri M, Levin MF, Poizner H, Feldman AG. Hand trajectory invariance in reaching movements involving the trunk. Exp Brain Res. 2001 Jun;138(3):288-303. doi: 10.1007/s002210100694.
• Alt Murphy M, Murphy S, Persson HC, Bergstrom UB, Sunnerhagen KS. Kinematic Analysis Using 3D Motion Capture of Drinking Task in People With and Without Upper-extremity Impairments. J Vis Exp. 2018 Mar 28;(133):57228. doi: 10.3791/57228.
• Machado LR, Heathcock J, Carvalho RP, Pereira ND, Tudella E. Kinematic characteristics of arm and trunk when drinking from a glass in children with and without cerebral palsy. Clin Biomech (Bristol). 2019 Mar;63:201-206. doi: 10.1016/j.clinbiomech.2019.03.011. Epub 2019 Mar 19.
• Lobo-Prat J, Font-Llagunes JM, Gomez-Perez C, Medina-Casanovas J, Angulo-Barroso RM. New biomechanical model for clinical evaluation of the upper extremity motion in subjects with neurological disorders: an application case. Comput Methods Biomech Biomed Engin. 2014 Aug;17(10):1144-56. doi: 10.1080/10255842.2012.738199. Epub 2012 Nov 27.
• Levin MF, Michaelsen SM, Cirstea CM, Roby-Brami A. Use of the trunk for reaching targets placed within and beyond the reach in adult hemiparesis. Exp Brain Res. 2002 Mar;143(2):171-80. doi: 10.1007/s00221-001-0976-6. Epub 2002 Jan 8.
• Dean CM, Shepherd RB. Task-related training improves performance of seated reaching tasks after stroke. A randomized controlled trial. Stroke. 1997 Apr;28(4):722-8. doi: 10.1161/01.str.28.4.722.
• Dean C, Shepherd R, Adams R. Sitting balance I: trunk-arm coordination and the contribution of the lower limbs during self-paced reaching in sitting. Gait Posture. 1999 Oct;10(2):135-46. doi: 10.1016/s0966-6362(99)00026-0.
• Thrane G, Sunnerhagen KS, Murphy MA. Upper limb kinematics during the first year after stroke: the stroke arm longitudinal study at the University of Gothenburg (SALGOT). J Neuroeng Rehabil. 2020 Jun 15;17(1):76. doi: 10.1186/s12984-020-00705-2.
• Cirstea MC, Mitnitski AB, Feldman AG, Levin MF. Interjoint coordination dynamics during reaching in stroke. Exp Brain Res. 2003 Aug;151(3):289-300. doi: 10.1007/s00221-003-1438-0. Epub 2003 Jun 19.
• Schwarz A, Veerbeek JM, Held JPO, Buurke JH, Luft AR. Measures of Interjoint Coordination Post-stroke Across Different Upper Limb Movement Tasks. Front Bioeng Biotechnol. 2021 Jan 28;8:620805. doi: 10.3389/fbioe.2020.620805. eCollection 2020.

Study record dates

Study Major Dates

• Study Start (Actual): August 10, 2022
• Primary Completion (Actual): June 30, 2023
• Study Completion (Actual): July 10, 2023

Study Registration Dates

• First Submitted: December 21, 2022
• First Submitted That Met QC Criteria: January 5, 2023
• First Posted (Actual): January 12, 2023

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: February 2, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Keywords: Chronic stroke; Motion capture; Reaching task
• Additional Relevant MeSH Terms: Neurologic Manifestations; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Paralysis; Stroke; Hemiplegia
• Other Study ID Numbers: Kinematic movements of stroke

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No