[Case Study] Does kinematics add meaningful information to clinical assessment in post-stroke upper limb rehabilitation? A case report

Abstract.

[Purpose] The aims of this case study were to:

  1. quantify the impairment and activity restriction of the upper limb in a hemiparetic patient;
  2. quantitatively evaluate rehabilitation program effectiveness; and
  3. discuss whether more clinically meaningful information can be gained with the use of kinematic analysis in addition to clinical assessment.

The rehabilitation program consisted of the combined use of different traditional physiotherapy techniques, occupational therapy sessions, and the so-called task-oriented approach.

[Subject and Methods] Subject was a one hemiplegic patient. The patient was assessed at the beginning and after 1 month of daily rehabilitation using the Medical Research Council scale, Nine Hole Peg Test, Motor Evaluation Scale for Upper Extremity in Stroke Patients, and Hand Grip Dynamometer test as well as a kinematic analysis using an optoelectronic system.

[Results] After treatment, significant improvements were evident in terms of total movement duration, movement completion velocity, and some smoothness parameters.

[Conclusion] Our case report showed that the integration of clinical assessment with kinematic evaluation appears to be useful for quantitatively assessing performance changes.

INTRODUCTION

Stroke is a leading cause of long-term disability in Western countries1): approximately 70–80% of stroke survivors have limited activities of daily living (ADL) due to motor impairment of the more affected upper limb. Many patients do not regain functional use of the paretic arm, and by 6 months post-stroke, a large proportion (25–50%) remains dependent on others for at least one ADL2). The effects of rehabilitative interventions are usually measured using clinical assessment tools and functional scales probing specific aspects of a subject’s motor behavior. Existing clinical measures are widely accepted, standardized, and validated. However, these evaluations tend to be subjective and depend on the therapist who observes and rates the motor pattern using ordinal measurements scales. Other limits of clinical scales include low resolution and sensitivity3) as well as the time required to perform them, all of which discourage their routine administration. Quantitative measurements of movement using movement analysis, on the other hand, convey a wealth of information about the quantity of motor behavior that is not evident from clinical evaluations. Instrumental analysis can be used to measure each segment and joint as well as kinematic parameters such as displacement, speed, and acceleration, but most importantly, it allows assessment of repeatability4, 5) and some particular feature such as movement smoothness6, 7). This is a very important advance in the evaluation of motor capacity because repeatability and smoothness are strictly linked to the patient’s capacity for coordination and, consequently, selective motor control8). While for gait quantitative analysis of movement has reached almost universal standardization and represents an objective assessment used to measure clinical outcomes9, 10) in different pathologies in both children and adults, upper-limb kinematics is a much less frequently published topic, especially in stroke patients. Most of the studies on upper-limb kinematics are, in fact, on children with cerebral palsy11, 12), and to our knowledge, only a few studies in stroke patients2, 3, 7) have been published to date.

Accordingly, and from the clinical need to quantitatively evaluate patients with stroke, the aims of this case study were to: (a) quantify the impairment and activity restriction of the upper limb in a hemiplegic patient after stroke using both clinicalfunctional scales and upper-limb kinematics; (b) quantitatively evaluate upper-limb rehabilitation program effectiveness over time; and (c) discuss whether more clinically meaningful information can be gained with the use of kinematic analysis in addition to clinical assessment compared to the latter alone.

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