Impairment and Compensation in Dexterous Upper-Limb Function After Stroke. From the Direct Consequences of Pyramidal Tract Lesions to Behavioral Involvement of Both Upper-Limbs in Daily Activities

Abstract

Impairments in dexterous upper limb function are a significant cause of disability following stroke. While the physiological basis of movement deficits consequent to a lesion in the pyramidal tract is well demonstrated, specific mechanisms contributing to optimal recovery are less apparent. Various upper limb interventions (motor learning methods, neurostimulation techniques, robotics, virtual reality, and serious games) are associated with improvements in motor performance, but many patients continue to experience significant limitations with object handling in everyday activities. Exactly how we go about consolidating adaptive motor behaviors through the rehabilitation process thus remains a considerable challenge. An important part of this problem is the ability to successfully distinguish the extent to which a given gesture is determined by the neuromotor impairment and that which is determined by a compensatory mechanism. This question is particularly complicated in tasks involving manual dexterity where prehensile movements are contingent upon the task (individual digit movement, grasping, and manipulation…) and its objective (placing, two step actions…), as well as personal factors (motivation, acquired skills, and life habits…) and contextual cues related to the environment (presence of tools or assistive devices…). Presently, there remains a lack of integrative studies which differentiate processes related to structural changes associated with the neurological lesion and those related to behavioral change in response to situational constraints. In this text, we shall question the link between impairments, motor strategies and individual performance in object handling tasks. This scoping review will be based on clinical studies, and discussed in relation to more general findings about hand and upper limb function (manipulation of objects, tool use in daily life activity). We shall discuss how further quantitative studies on human manipulation in ecological contexts may provide greater insight into compensatory motor behavior in patients with a neurological impairment of dexterous upper-limb function.

Case Report: True Motor Recovery of Upper Limb Beyond 5 Years Post-stroke

“…The left CST displayed signs of injury but presumably regained some functionality, as demonstrated by the motor evoked potentials. This finding is in line with the literature showing that recovery of selective finger movements is dependent on CST integrity ( 23 , 24 ).…”

Das „Wie“ ist entscheidend – Die Renaissance der Bewegungsqualität

“…Die moderne motorische Neuroreha war die letzten Jahre primär an der Zielerreichung interessiert, also am funktionellen Outcome und nicht an der Art und Weise, wie sich Patient*innen bewegen bzw. wie sie ein Bewegungsziel erreichen 2 . Neurowissenschaftler*innen waren bislang sogar der Ansicht, dass kompensatorische Bewegungsmuster der Logik eines „Ökonomieprinzips“ folgen, demzufolge Menschen mit einer Schädigung des ZNS (Schlaganfall, Multiple Sklerose etc.)…”

Intra-limb Coordination and Control in Individuals with Stroke: Conceptual and Methodological Considerations

“…To date, numerous descriptive and intervention-based research studies have been published. Also, numerous reviews have been published which provided a thoughtful and extensive overview of the nature of the emerging actions [11][12][13]. Nevertheless, some important issues still remain equivocal and require further overview.…”