The aim of this study is to develop a valid and standardized instrumental analysis of upper limb (UL) motion in stroke patients.
Sixteen controls and 15 hemiparetic subjects (mean age = 54 ± 18,2 years old; Fugl-Meyer Upper Limb 41,4 ± 12,4) underwent kinematic motion analysis (passive markers, Optitrack) of pointing and grasping tasks. We examined the ability to perform a single pointing task and three reach-to-grasp tasks: key turning, reaching and grasping a can, reaching and grasping a cube; at a self-selected speed and as fast as possible. Speed, accuracy and efficiency of each movement were quantified and compared between controls and hemiparetic subjects, and between the ipsilateral of control subjects and the affected side; to describe reaching and grasping.
For reaching, movement time of hemiparetic UL was longer, less smooth (peak velocity, jerk), less direct (higher index path ratio) and associated with more trunk compensation (higher trunk/hand ratio). Movement time, jerks and trunk/hand ratio were the most discriminant variables between hemiparetic UL and ipsilateral/control UL, in any task analysed. Trunk displacement was greater in grasping than in reaching tasks. For grapsing tasks, movement time is the most discriminant factor between hemiparetic and control/ipsilateral UL, especially for the key turn task. Movement alterations were also found for ipsilateral limb. Association between kinematic variables and clinical features during reaching time (Fugl-Meyer, MAL, WFMT, ARAT) was greater for the task “grasping a can”.
Our results are similar to those of the literature, but suggest that we have to privilege some of the most relevant kinematic parameters. This standardization phase emerging after a validation phase of the techniques can make the biomechanical analysis of the upper limb as easy and valid as gait analysis and should help to develop the quantified measurement of prehension. This protocol is currently in process to objectively assess the therapeutic effects of rehabilitation treatments (botulinum toxin, induced constraint therapy).