Circle drawing as evaluative movement task in stroke rehabilitation: an explorative study

Abstract

BackgroundThe majority of stroke survivors have to cope with deficits in arm function, which is often measured with subjective clinical scales. The objective of this study is to examine whether circle drawing metrics are suitable objective outcome measures for measuring upper extremity function of stroke survivors.MethodsStroke survivors (n = 16) and healthy subjects (n = 20) drew circles, as big and as round as possible, above a table top. Joint angles and positions were measured. Circle area and roundness were calculated, and synergistic movement patterns were identified based on simultaneous changes of the elevation angle and elbow angle.ResultsStroke survivors had statistically significant lower values for circle area, roundness and joint excursions, compared to healthy subjects. Stroke survivors moved significantly more within synergistic movement patterns, compared to healthy subjects. Strong correlations between the proximal upper extremity part of the Fugl-Meyer scale and circle area, roundness, joint excursions and the use of synergistic movement patterns were found.ConclusionsThe present study showed statistically significant differences in circle area, roundness and the use of synergistic movement patterns between healthy subjects and stroke survivors. These circle metrics are strongly correlated to stroke severity, as indicated by the proximal upper extremity part of the FM score.In clinical practice, circle area and roundness can give useful objective information regarding arm function of stroke survivors. In a research setting, outcome measures addressing the occurrence of synergistic movement patterns can help to increase understanding of mechanisms involved in restoration of post stroke upper extremity function.

Differences in Rheobase and Chronaxie between the Paretic and Non-Paretic Sides of Hemiplegic Stroke Patients: a Pilot Study

“…Stroke involves muscle weakness, spasms, disturbed muscle timing, and a reduced ability to selectively activate muscles5, 6, 9 ) . Quadriceps weakness in particular is a common finding in stroke patients13, 14 ) .…”

“…Especially, lower-extremity muscle weakness, particularly in the quadriceps muscle, has profound functional consequences8 ) . Post-stroke rehabilitation therapy aims to restore partially lost functions9 ) . Electric therapy in particular, such as functional electrical stimulation (FES) of the muscle, is known to be an effective method of improving the motor function of stroke patients10 ) .…”

Robotic quantification of upper extremity loss of independent joint control or flexion synergy in individuals with hemiparetic stroke: a review of paradigms addressing the effects of shoulder abduction loading

“…While there are several electromyographic studies that have reported abnormal muscle synergies in the context of muscle activation patterns [18–20], we focus here on the application of robotics to quantifying the impact on reaching movement as this is the most relevant to enhancing movement problem diagnosis and development of targeted interventions in stroke rehabilitation. It should be noted that other quantitative robotic methods have been reported for quantifying the effects of abnormal muscle co-activations on reaching movements such as circle drawing [21] and outward reaching [22], however these methods are limited to measurement of reaching without the requirement of shoulder abduction torque generation. In other words, reaching movements occurred along a horizontal support surface where the participant was not required to lift the arm up off of the surface during task performance.…”

Neck rotation modulates flexion synergy torques, indicating an ipsilateral reticulospinal source for impairment in stroke

“…The resultant loss of independent joint control caused by synergistic coupling is now understood to severely impair both reaching distance when individuals with stroke attempt to lift the arm against gravity (Beer et al 2000(Beer et al , 2004(Beer et al , 2007 and reaching workspace when individuals lift against various levels of shoulder abduction loading Sukal et al 2007). The loss of independent joint control has also been quantified kinematically by other investigators who either calculated a joint individuation index during an outward reach against gravity (Zackowski et al 2004) or calculated area and roundness during a circle drawing task with the arm supported on a horizontal surface (Krabben et al 2011;Krebs et al 1998). Although the behavioral characteristics and quantitative means for measuring this impairment have been well documented, human data supporting the underlying neurological mechanism responsible for its manifestation are limited.…”