Upper limb assessment in tetraplegia

Abstract

The aim of this study was to correlate clinical and functional evaluations with kinematic variables of upper limp reach-to-grasp movement in patients with tetraplegia. Twenty chronic patients were selected to perform reach-to-grasp kinematic assessment using a target placed at a distance equal to the arm's length. Kinematic variables (hand peak velocity, movement time, percent time-to-maximal velocity, index of curvature, number of peaks, and joint range of motion) were correlated to clinical (Standard Neurological Classification of Spinal Cord Injury-American Spinal Injury Association) and functional [Functional Independence Measure (FIM) and Spinal Cord Independence Measure II (SCIM II)] evaluation scores. Twenty control participants were also selected to obtain normal reference parameters. There was a positive correlation between total motor index and FIM (r=0.6089; P=0.0044) and SCIM II (r=0.5229; P=0.018). Both functional scores showed positive correlation with each other (r=0.8283; P<0.0001). A correlation was also observed between the right and left motor indices, the motor FIM, and the SCIM II in most of the reach-to-grasp kinematic variables studied (hand peak velocity, movement time, index of curvature, and number of peaks). In contrast, for the joint range of motion (shoulder, elbow, and wrist), only the wrist in the horizontal plane showed correlation with clinical variables. This study shows that muscle strength assessed by the American Spinal Injury Association motor index influences the reach-to-grasp kinematic variables of patients with tetraplegia. However, the functional assessments did not present the same influence.

Kinematic Metrics Based on the Virtual Reality System Toyra as an Assessment of the Upper Limb Rehabilitation in People with Spinal Cord Injury

“…In a previous study in which correlations between kinematics and clinical scales were also studied [22], no correlation was found between shoulder range of motion and any clinical scales. However, the methodology that was used in that study is quite different than the one presented here, because the patients performed only one kind of reaching and grasp task, without using any VR system, so that the reaching and grasp task did not encourage them to reach their maximum values of range of motion in all directions.…”

Bimanual reach to grasp movements after cervical spinal cord injury

“…We calculated several parameters related to the transport and grasp phases in line with past research[11,28,31–34]. From the wrist marker we computed: (1) Movement time (MT): the duration between movement onset and end, with movement onset (MO) defined as when the velocity of the wrist reached 50mm/s, and movement end (END) once the object moved in the vertical direction (z), (2) Peak velocity (PV): maximal velocity of the wrist during the reach, (3) Percentage of MT spent decelerating (PropDT): the time between PV and END expressed as a percentage of total MT, (4) Final adjustment phase (FAP): the time between the velocity of the wrist reaching 50 mm/s during the deceleration phase and END, as a percentage of total MT (PropFAP), (5) ‘Interlimb synchrony’ the absolute difference in time between the P/LI and NP/MI limbs at MO, PV, start of FAP and END.…”

Upper limb kinematics after cervical spinal cord injury: a review

“…We thus examined 25 articles and rejected 7 of these 25 since they did not fulfill at least one of the inclusion criteria: incomplete lesions (AIS D) [ 16 ]; single case-study [ 21 , 22 ]; no kinematic recordings [ 30 – 32 ]; human cadavers [ 33 ]. The 18 included studies addressed modifications in upper limb motor control during (i) reaching [ 3 , 24 – 27 , 34 – 36 ], (ii) reach-to-grasp [ 3 , 14 , 15 , 29 , 35 , 37 ] and (iii) overhead movements such as shoulder flexion or abduction [ 17 , 38 – 41 ]. One study focused on kinematics during fast elbow flexion [ 28 ].…”

“…In all studies, the SCI participants sat in their wheelchair while control participants, when included, sat on a standard chair. One study provided no information about trunk stabilization [ 27 ], but in all other studies a strap stabilized the chest to the back of the seat except in two studies [ 34 , 37 ] where the trunk had no restriction for anterior motion. Systems used to record 3D motion were electromagnetic, electro-goniometric, optoelectronic, or videographic (see Table 2 ).…”

“…After C6 and C7 SCI MT increased [ 3 , 14 , 35 , 37 ] and PV decreased [ 3 , 14 , 29 , 35 ]. When compared with control participants, MT was nearly twice as long and PV was around 11% lower (see Table 3 ).…”