Validity of Movement Pattern Kinematics as Measures of Arm Motor Impairment Poststroke

Abstract

Background and Purpose-Upper limb motor impairment poststroke is commonly evaluated using clinical outcome measures such as the Fugl-Meyer Assessment. However, most clinical measures provide little information about motor patterns and compensations (eg, trunk displacement) used for task performance. Such information is obtained using movement quality kinematic variables (joint ranges, trunk displacement). Evaluation of movement quality may also help distinguish between levels of motor impairment severity in individuals poststroke. Our objective was to estimate concurrent and discriminant validity of movement quality kinematic variables for pointing and reach-to-grasp tasks. Methods-A retrospective study of kinematic data (sagittal trunk displacement, shoulder flexion, shoulder horizontal adduction, elbow extension) and Fugl-Meyer Assessment scores from 86 subjects (subacute to chronic stroke) performing pointing and reaching tasks was done. Multiple and logistic regression analyses were used to estimate concurrent and discriminant validity respectively. Cutoff points for distinguishing between levels of upper limb motor impairment severity (mild, moderate to severe) were estimated using sensitivity/specificity decision plots. The criterion measure used was the Fugl-Meyer Assessment (upper limb section). Results-The majority of variance in Fugl-Meyer Assessment scores was explained by a combination of trunk displacement and shoulder flexion (51%) for the pointing task and by trunk displacement alone (52%) for the reach-to-grasp task. Trunk displacement was the only variable that distinguished between levels of motor impairment severity. Cutoff points were 4.8 cm for pointing and 10.2 cm for reach-to-grasp movements. Conclusion-Movement

Kinematic analysis of the upper extremity after stroke – how far have we reached and what have we grasped?

“…The most commonly reported clinical tool, FMA-UE has shown significant correlation with movement time, movement smoothness, peak velocity, trunk displacement, elbow extension and shoulder flexion in reaching tasks in different studies. 13,29,[45][46][47][48] Kinematic analysis of reach-to-grasp movements have demonstrated significant correlations between FMA-UE and movement smoothness, movement time and peak velocity (r50.45-0.53). 46 A recent longitudinal study reported that the FMA-UE score was linearly predicted by combination of movement smoothness and time after inclusion during the first 3 months post stroke.…”

Kinematic Motion Analysis and Muscle Activation Patterns of Continuous Reaching in Survivors of Stroke

“…Continuous reaching (CR) incorporates a complex interaction of cyclic and translatory components (Sternad & Dean, 2003) requiring continual interaction between neural processes and the musculoskeletal system (Scott, 2004). Despite the necessity to incorporate CR in daily life, the majority of strokerelated research has focused on discrete reaching paradigms (i.e., a single defined start and end point; Cirstea, Mitnitski, Feldman, & Levin, 2003;Michaelsen, Luta, Roby-Brami, & Levin, 2001;Robertson & Roby-Brami, 2011;Subramanian, Yamanaka, Chilingaryan, & Levin, 2010). The findings of compensatory trunk movement, altered interjoint coordination, and segmented movements (Cirstea & Levin, 2000;Cirstea et al, 2003), among others, have increased the understanding of motor control impairments impacting ballistic and quick movements, yet may not characterize the ability to generate CR.…”

The Functional Recovery and the Associated Cortical Reorganization Following Constraint-Induced Movement Therapies (CIMTs) in Stroke

“…In addition, ceiling effect, particularly for the patients with mild impairment and the presence of some components (such as reflexes) that do not make a significant contribution to the assessment of impairment [48] have been identified as further limitations of FMUE. Furthermore, FMUE scores can be obtained by using combined measures of the trunk and shoulder flexion movements during a reachto-grasp task [49]. Therefore, it may be reasonable to exclude some components, i.e., reflexes and to decompose FMUE score in sub-scores accordingly to proximal and distal segments.…”