Upper limb kinematics after cervical spinal cord injury: a review

Abstract

Although a number of upper limb kinematic studies have been conducted, no review actually addresses the key-features of open-chain upper limb movements after cervical spinal cord injury (SCI). The aim of this literature review is to provide a clear understanding of motor control and kinematic changes during open-chain upper limb reaching, reach-to-grasp, overhead movements, and fast elbow flexion movements after tetraplegia. Using data from MEDLINE between 1966 and December 2014, we examined temporal and spatial kinematic measures and when available electromyographic recordings. We included fifteen control case and three series case studies with a total of 164 SCI participants and 131 healthy control participants. SCI participants efficiently performed a broad range of tasks with their upper limb and movements were planned and executed with strong kinematic invariants like movement endpoint accuracy and minimal cost. Our review revealed that elbow extension without triceps brachii relies on increased scapulothoracic and glenohumeral movements providing a dynamic coupling between shoulder and elbow. Furthermore, contrary to normal grasping patterns where grasping is prepared during the transport phase, reaching and grasping are performed successively after SCI. The prolonged transport phase ensures correct hand placement while the grasping relies on wrist extension eliciting either whole hand or lateral grip. One of the main kinematic characteristics observed after tetraplegia is motor slowing attested by increased movement time. This could be caused by (i) decreased strength, (ii) triceps brachii paralysis which disrupts normal agonist–antagonist co-contractions, (iii) accuracy preservation at movement endpoint, and/or (iv) grasping relying on tenodesis. Another feature is a reduction of maximal superior reaching during overhead movements which could be caused by i) strength deficit in agonist muscles like pectoralis major, ii) strength deficit in proximal synergic muscles responsible for scapulothoracic and glenohumeral joint stability, iii) strength deficit in distal synergic muscles preventing the maintenance of elbow extension by shoulder elbow dynamic coupling, iv) shoulder joint ankyloses, and/or v) shoulder pain. Further studies on open chain movements are needed to identify the contribution of each of these factors in order to tailor upper limb rehabilitation programs for SCI individuals.

Bimanual reach to grasp movements after cervical spinal cord injury

“…The longer movement time was primarily due to a prolonged deceleration phase when compared to UP and final adjustment phase when compared to YA (Fig 2c and 2d). The prolonged low velocity phase suggests a more corrective mode of movement control, possibly mediated by visual feedback [28], while the overall motor slowing following cSCI, has been thought to occur in order to maintain end-point accuracy and due to declines in triceps strength [10]. …”

“…Compared to uninjured participants (UP), the transport phase of a unimanual reach-to-grasp in individuals with a cSCI, is slower [10], longer in duration [11–13], with a longer deceleration phase; which is suggested to represent the need to use visual feedback to guide the hand to the object [11–14]. During grasping, maximal grasp aperture is scaled to object size [15], but performed earlier in the transport phase, resulting in the reach and grasp being performed sequentially [11].…”

Hand-in-hand advances in biomedical engineering and sensorimotor restoration

“…With an almost infinite number of different configurations and functions, hand mobility likely involves complex brain control. Indeed, the straightforward execution of highly skilled manual movements can be severely impaired if the connection between the central nervous system and the periphery is damaged (review in Mateo et al, 2015).…”

Priming for Improved Hand Strength in Persons with Chronic Tetraplegia: A Comparison of Priming-Augmented Functional Task Practice, Priming Alone, and Conventional Exercise Training

“…While lateral prehension can serve both precision and power functions, it is among the most common grips for picking up small objects (42), and also represents a type of grip that is more frequently used by person with tetraplegia compared to tip-to-tip grip (43). During testing, the UE was stabilized on an adjustable height table in a standardized position with forearm resting, shoulder at 30°–40° flexion, adduction, and neutral rotation, elbow flexed to 90°, wrist in neutral.…”