Measures of Interjoint Coordination Post-stroke Across Different Upper Limb Movement Tasks

Anne Schwarz, Janne M Veerbeek, Jeremia P O Held, Jaap H Buurke, Andreas R Luft, Anne Schwarz, Janne M Veerbeek, Jeremia P O Held, Jaap H Buurke, Andreas R Luft

Abstract

Background: Deficits in interjoint coordination, such as the inability to move out of synergy, are frequent symptoms in stroke subjects with upper limb impairments that hinder them from regaining normal motor function. Kinematic measurements allow a fine-grained assessment of movement pathologies, thereby complementing clinical scales, like the Fugl-Meyer Motor Assessment of the Upper Extremity (FMMA-UE). The study goal was to investigate the effects of the performed task, the tested arm, the dominant affected hand, upper limb function, and age on spatiotemporal parameters of the elbow, shoulder, and trunk. The construct validity of the metrics was examined by relating them with each other, the FMMA-UE, and its arm section. Methods: This is a cross-sectional observational study including chronic stroke patients with mild to moderate upper limb motor impairment. Kinematic measurements were taken using a wearable sensor suit while performing four movements with both upper limbs: (1) isolated shoulder flexion, (2) pointing, (3) reach-to-grasp a glass, and (4) key insertion. The kinematic parameters included the joint ranges of shoulder abduction/adduction, shoulder flexion/extension, and elbow flexion/extension; trunk displacement; shoulder-elbow correlation coefficient; median slope; and curve efficiency. The effects of the task and tested arm on the metrics were investigated using a mixed-model analysis. The validity of metrics compared to clinically measured interjoint coordination (FMMA-UE) was done by correlation analysis. Results: Twenty-six subjects were included in the analysis. The movement task and tested arm showed significant effects (p < 0.05) on all kinematic parameters. Hand dominance resulted in significant effects on shoulder flexion/extension and curve efficiency. The level of upper limb function showed influences on curve efficiency and the factor age on median slope. Relations with the FMMA-UE revealed the strongest and significant correlation for curve efficiency (r = 0.75), followed by shoulder flexion/extension (r = 0.68), elbow flexion/extension (r = 0.53), and shoulder abduction/adduction (r = 0.49). Curve efficiency additionally correlated significantly with the arm subsection, focusing on synergistic control (r = 0.59). Conclusion: The kinematic parameters of the upper limb after stroke were influenced largely by the task. These results underpin the necessity to assess different relevant functional movements close to real-world conditions rather than relying solely on clinical measures. Study Registration: clinicaltrials.gov, identifier NCT03135093 and BASEC-ID 2016-02075.

Keywords: biomechanical phenomena; interjoint coordination; kinematics; stroke; upper extremity.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Schwarz, Veerbeek, Held, Buurke and Luft.

Figures

Figure 1
Figure 1
Measurement system set-up.
Figure 2
Figure 2
Schematic of shoulder–elbow coordination measures.
Figure 3
Figure 3
Study flow of the participants.
Figure 4
Figure 4
Spatial measures of the affected and less-affected arm per task across subjects (N = 26). AS, affected side; EFlexExt, elbow flexion/extension; LAS, less-affected side; SFlexExt, shoulder flexion/extension; SAbdAdd, shoulder abduction/adduction; TrunkDP, trunk displacement. (A) Shoulder flexion. (B) Pointing ahead. (C) reach-to-grasp a glass. (D) Key insertion.
Figure 5
Figure 5
Shoulder–elbow mean curve per tested arm and task across subjects (N = 26). (A) Shoulder flexion. (B) Pointing ahead. (C) reach-to-grasp a glass. (D) Key insertion.
Figure 6
Figure 6
Relation between shoulder–elbow coordination metrics and the Fugl–Meyer Motor Assessment of the Upper Extremity arm subsection (19-35/36) per subject and task. (A) Shoulder-elbow correlation coefficient per subject FMMA-UE arm subsection and task. (B) Shoulder-elbow median slope per subject FMMA-UE arm subsection and task. (C) Shoulder-elbow curve efficiency per subject FMMA-UE arm subsection and task.

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