Augmenting clinical evaluation of hemiparetic arm movement with a laboratory-based quantitative measurement of kinematics as a function of limb loading

Abstract

Background: Kinematic and kinetic measurements used in laboratory settings can quantify upper extremity movement impairment following stroke, but their relationship to clinical methods of evaluating movement impairment is unclear.

Objective: To test whether the Arm Coordination Training 3D device (ACT3D) could provide a repeatable quantitative measurement of range of motion during upper extremity reaching along a range of functional levels of loads on the arm and correlate with clinical assessments of arm impairment.

Methods: Work area during reaching along clockwise and counterclockwise hand paths was measured under 9 limb-loading conditions ranging from no load to twice the weight of the upper extremity in 11 individuals with chronic hemiparetic stroke on 2 separate occasions. Participants were given a battery of clinical assessments that included the Fugl-Meyer Motor Assessment, Chedoke McMaster Stroke Assessment, Reaching Performance Scale, Modified Ashworth Scale, and the Stroke Impact Scale, by a physical therapist who did not know the results of the kinematic studies.

Results: A reproducible test-retest reduction in work area was found when participants were required to support up to and beyond the weight of their limb. Work area was correlated with most upper extremity clinical assessments, suggesting criterion validity.

Conclusions: Reaching work area during various loading conditions is a robust measurement that quantifies the effect of abnormal joint torque coupling and provides useful data that can be applied in the clinical setting.

Figures

Figure 1

Participant seated in the Arm Coordination Training 3D device (ACT3D) system. Straps secure his trunk, and the arm is attached via a lightweight splint. He is looking at the computer monitor for visual feedback.

Figure 2

Graphic representation of the participant's arm illustrated on the visual display.

Figure 3

Hand path tracings for each of 9 different required limb support levels for participants 5 (top) and 7 (bottom). Work area (WA) and normalized work area (WAnorm) have been calculated and are reported for each level.

Figure 4

Normalized work area including standard error bars for each of 9 different required limb support levels of the first and repeated sessions. There was no effect of session (P = .1202) and no interaction effect between session and level (P = .6703).

Figure 5

Fugl-Meyer Motor Assessment (top) and ChedokeMcMaster Stroke Assessment score for the arm (bottom) scores are ordered progressively (left y-axis) and superimposed on normalized work area values at the 100% and 175% levels (right y-axis) for each participant. The correlation between clinical scale and quantitative kinematic measurement is evident; however, additional information is gained and can mostly be appreciated in participants with similar clinical scale scores.