Reliability of upper extremity kinematics while performing different tasks in individuals with stroke

Assessments of upper extremity performance typically include qualitative rather than quantitative measures of functional ability. Kinematic analysis is an objective, discriminative measure that quantifies movement biomechanics; however, the use within the poststroke impaired upper extremity is not well established. The purpose of this study was to examine the reliability of upper extremity kinematics in 18 individuals with stroke and 9 healthy controls. Participants performed reaching and grasping tasks over 2 separate days and metrics included movement time, peak velocity, index of curvature, trunk displacement, maximum aperture, and percentage of the movement cycle where maximum aperture occurred. The results showed moderate to high intraclass correlation and low standard error of measurement values for most variables, demonstrating that kinematic analysis may be a feasible and useful tool to quantify upper extremity movement after stroke.     

Lower Extremity Kinetics for Balance Control in Children With Cerebral Palsy

The authors examined and compared the effect of support-surface perturbations of various magnitudes on lower extremity kinetics of 7 children with cerebral palsy (CP) and 8 typically developing (TD) children. Results showed that the highest velocity tolerated without stepping was slower in children with CP than in either age-matched TD or younger TD children. Multimodal torque profiles were more frequent in children with CP than in TD controls. TD groups temporally and spatially organized torque activation, whereas children with CP activated all joints simultaneously and showed altered torque contribution patterns among joints. Those results suggest that impairments in reactive postural control in children with CP result not only from developmental delay but also from pathology. Evidence for pathology included increased numbers of torque bursts required to regain stability and less efficient temporal and spatial organization of torque activation patterns.     

Lower extremity kinetics for balance control in children with cerebral palsy

The authors examined and compared the effect of support-surface perturbations of various magnitudes on lower extremity kinetics of 7 children with cerebral palsy (CP) and 8 typically developing (TD) children. Results showed that the highest velocity tolerated without stepping was slower in children with CP than in either age-matched TD or younger TD children. Multimodal torque profiles were more frequent in children with CP than in TD controls. TD groups temporally and spatially organized torque activation, whereas children with CP activated all joints simultaneously and showed altered torque contribution patterns among joints. Those results suggest that impairments in reactive postural control in children with CP result not only from developmental delay but also from pathology. Evidence for pathology included increased numbers of torque bursts required to regain stability and less efficient temporal and spatial organization of torque activation patterns.     

Learning and discrimination of audiovisual events in human infants: the hierarchical relation between intersensory temporal synchrony and rhythmic pattern cues

This study examined 4- to 10-month-old infants' perception of audio-visual (A-V) temporal synchrony cues in the presence or absence of rhythmic pattern cues. Experiment 1 established that infants of all ages could successfully discriminate between two different audiovisual rhythmic events. Experiment 2 showed that only 10-month-old infants detected a desynchronization of the auditory and visual components of a rhythmical event. Experiment 3 showed that 4- to 8-month-old infants could detect A-V desynchronization but only when the audiovisual event was nonrhythmic. These results show that initially in development infants attend to the overall temporal structure of rhythmic audiovisual events but that later in development they become capable of perceiving the embedded intersensory temporal synchrony relations as well.     

Coordination of the upper and lower extremities

Simultaneous walking and hand clapping were utilized to examine the patterns of coordination between upper and lower limbs. Eighteen normal adult subjects were filmed at high speed under instructions to: (a) walk and clap at a self-determined “preferred” speed, (b) walk as fast as possible while clapping at the preferred speed, (c) walk at the preferred speed while clapping as fast as possible and (d) walk and clap as fast as possible. Temporal data and individual patterns of phase relations were analyzed. Results indicated a disruption of the preferred clap cycle when combine with fast walking. The degree of disruption was a function of the individual coordinative pattern at the preferred rate. It is concluded that: (a) the temporal patterning of the clap cycle can be dictated by the step cycle, (b) heel strike is the point about which the clap cycle is modulated, and (c) subjects can select from various modes of phase linkage.     

Changes in coordination and variability during running as a function of head stability demands

The purpose of this study was to identify changes in segment/joint coordination and coordination variability in running with increasing head stability requirements. Fifteen strides from twelve recreational runners while running on a treadmill at their preferred speed were collected. Head stability demands were manipulated through real-time visual feedback that required head-gaze orientation to be contained within boxes of different sizes, ranging from 21 to 3 degrees of visual angle in 3-degree decrements. Coordination patterns and coordination variability were assessed between head and trunk segments, hip and knee joints, and knee and ankle joints in the three cardinal planes, respectively. Mean coupling angles and the standard deviation of the coupling angles at each individual point of the stance phase were calculated using a modified vector coding technique and circular statistics. As head stability demands increased, transverse plane head-trunk coordination was more anti-phase and showed increased head‑leading and decreased trunk‑leading patterns; for the lower extremity, there was increased in-phase and decreased anti-phase sagittal plane coordination. Increased head stability demands also resulted in an increase in coordination variability for both upper body and lower extremity couplings during the second half of the stance phase. Overall, the results provide evidence that coordinative adaptations to increasing head stability demands occur throughout the entire body: 1) through more independent control of the head relative to the trunk; 2) by increasing in-phase coordination between lower extremity joints, and 3) through increased coordination variability in the second half of stance in both upper body segmental and lower extremity joint couplings. These adaptations likely contribute to the reduction of the range of motion of the trunk in vertical direction.     

Kinematic descriptions of upper limb function using simulated tasks in activities of daily living after stroke

Assessment of upper limb function poststroke is critical for clinical management and determining the efficacy of interventions. We designed a unilateral upper limb task to simulate activities of daily living to examine how chronic stroke survivors manage reaching, grasping and handling skills simultaneously to perform the functional task using kinematic analysis. The aim of the study was to compare the motor strategies for performing a functional task between paretic and nonparetic arms. Sixteen chronic stroke survivors were instructed to control an ergonomic spoon to transfer liquid from a large bowl to a small bowl using paretic or nonparetic arm. Kinematic data were recorded using a Vicon motion capture system. Outcome measures included movement duration, relative timing, path length, joint excursions, and trial-to-trial variability. Results showed that movement duration, spoon path length, and trunk path length increased significantly when participants used paretic arm to perform the task. Participants tended to reduce shoulder and elbow excursions, and increase trunk excursions to perform the task with paretic arm and altered the relative timing of the task. Although participants used different motor strategies to perform the task with their paretic arms, we did not find the significant differences in trial-to trial variability of joint excursions between paretic and nonparetic arms. The results revealed differences in temporal and spatial aspects of motor strategies between paretic and nonparetic arms. Clinicians should explore the underlying causes of pathological movement patterns and facilitate preferred movement patterns of paretic arm.     

Influence of target uncertainty on reaching movements while standing in stroke

Stroke individuals frequently have balance problems and impaired arm movements that affect their daily activities. We investigated the influence of target uncertainty and the side of the brain lesion on the performance of arm movements and postural adjustments during reaching in a standing position by stroke individuals. Participants stood on force plates and reached a target displayed on the center of a monitor screen under conditions differentiated by the prior knowledge of the target location at the beginning of the movement. Individuals who had a stroke in the right side of the brain performed the tasks with the ipsilesional, right upper limb while the individuals with a left stroke performed with the ipsilesional, left upper limb. Healthy individuals performed with right and left limbs, which data were later averaged for statistical analysis. Kinematic analysis of the arm and lower limb joints and displacements of the center of pressure of each lower limb were compared between target conditions and groups. Stroke individuals showed larger center of pressure displacements of the contralesional compared to the ipsilesional limb while these displacements were symmetrical between lower limbs for the healthy individuals, regardless of the target condition. The target uncertainty affected both the characteristics of the arm movements and postural adjustments before movement onset. Right stroke individuals used more ankle joint movements under the uncertain compared to the certain condition. The uncertainty in target location affects the arm reaching in upright standing, but the effects depend on the side of the brain lesion.     

Upper Extremity Proprioception After Stroke: Bridging the Gap Between Neuroscience and Rehabilitation

Proprioception is an important aspect of function that is often impaired in the upper extremity following stroke. Unfortunately, neurorehabilitation has few evidence based treatment options for those with proprioceptive deficits. The authors consider potential reasons for this disparity. In doing so, typical assessments and proprioceptive intervention studies are discussed. Relevant evidence from the field of neuroscience is examined. Such evidence may be used to guide the development of targeted interventions for upper extremity proprioceptive deficits after stroke. As researchers become more aware of the impact of proprioceptive deficits on upper extremity motor performance after stroke, it is imperative to find successful rehabilitation interventions to target these deficits and ultimately improve daily function.     

Portable Myoelectric Brace Use Increases Upper Extremity Recovery and Participation But Does Not Impact Kinematics in Chronic,Poststroke Hemiparesis

The authors examined the efficacy of an 8-week regimen combining repetitive task-specific practice (RTP) with a myoelectric brace (RTP+Myomo) on paretic upper extremity (UE; use in valued activities, perceived recovery, and reaching kinematics) in 12 subjects (4 men; M age = 53.5 years; mean time poststroke = 61.7 months). Seven subjects were administered RTP+Myomo therapy, and 5 were administered RTP only. Both groups participated in individualized, 45-min therapy sessions occurring 3 days/week over an 8-week period. The arm, hand ability, activities of daily living, and perceptions of recovery subscales of the Stroke Impact Scale (SIS), as well as UE reaching kinematics, assessed before and after the intervention. Subjects in the RTP+Myomo group showed greater improvements on all SIS subscales, with the recovery scale reaching statistical significance (p = .03). Subjects in the RTP-only group showed a greater increase in hand velocity in the reach up task (p = .02), but no changes were observed in the range of shoulder flexion or elbow extension during reaching. None of the changes in kinematic outcome measures significantly correlated with any of the changes in SIS subscales. RTP integrating myoelectric bracing may be more beneficial than RTP only in improving self-reported function and perceptions of overall recovery. The authors observed no changes in the range of elbow extension, and no relationship between self-reported improvements and changes in reaching kinematics.     

The power of representation and interpretation: Doubling statistical reasoning performance with icons and frequentist interpretations of ambiguous numbers

Abstract

Six highly familiar melodies were submitted to three transformations: reduction and two rhythmic group transformations. These three transformations offered the opportunity to compare the role of various means of melody recognition: melodic contour, harmonic structure, local surface cues. If melody recognition relies on melodic contour, an original melody would be easier to recognise after rhythmic group transformation than after reduction; the rhythmic group transformation, but not the reduction, preserves the melodic contour. If melody recognition depends on the harmonic structure, an original melody would be easier to recognise after reduction than after a rhythmic group transformation; the reduction, but not the rhythmic group transformation, respects the underlying harmonic structure. The results of two experiments, one with children and one with adults, showed that recognition was better for rhythmic group transformation but only when local surface cues were preserved, a result that could neither be predicted by the melodic contour hypothesis nor by the harmonic structure hypothesis. The results give support to the cue abstraction hypothesis, which suggests that melody recognition relies on the recognition of certain surface cues abstracted while hearing and which are then memorised. Recognition performances and speed of recognition served as dependent variables.     

Temporal Regularity of Tapping by the Left and Right Hands in Timed and Untimed Finger Tapping

The temporal characteristics of repetitive finger tapping by the left and right hands were examined in two experiments. In the first experiment, interresponse intervals (IRIs) were recorded while right-handed male subjects tapped in synchrony with an auditory timing pulse (the synchronization phase) and then attempted to maintain the same tapping rate without the timing pulses (the continuation phase). The left and right hands performed separately, at four different rates (interpulse intervals of 250, 500, 750, and 1500 ms). There was no asymmetry of the asynchronies of the timing pulses and the associated responses in the synchronization phase or of the IRIs in either phase, but there was an asymmetry in the temporal dispersion of the responses in both phases. In the second experiment, right-handed males tapped separately with each hand at three different speeds: as quickly as possible, at a fast but steady rate, and at a slow rhythmical rate. The speed asymmetry present when tapping as quickly as possible (with the preferred hand tapping more quickly) was reduced when tapping at the fast steady rate and was absent when tapping at the slow rhythmical rate. The temporal dispersion of the IRIs produced by the nonpreferred hand was greater than the temporal dispersion of those produced by the preferred hand in all speed conditions. These results show smaller temporal dispersion of tapping by the preferred hand in right-handed males under different conditions, including submaximal speeds at which both hands respond at the same rate. This suggests that the motor system controlling the preferred hand in right-handers has more precise timing of response output than that controlling the nonpreferred hand.     

Temporal regularity of tapping by the left and right hands in timed and untimed finger tapping

The temporal characteristics of repetitive finger tapping by the left and right hands were examined in two experiments. In the first experiment, interresponse intervals (IRIs) were recorded while right-handed male subjects tapped in synchrony with an auditory timing pulse (the synchronization phase) and then attempted to maintain the same tapping rate without the timing pulses (the continuation phase). The left and right hands performed separately, at four different rates (interpulse intervals of 250, 500, 750, and 1500 ms). There was no asymmetry of the asynchronies of the timing pulses and the associated responses in the synchronization phase or of the IRIs in either phase, but there was an asymmetry of chronization phase or of the IRIs in either phase, but there was an asymmetry in the temporal dispersion of the responses in both phases. in the second experiment, right-handed males tapped separately with each hand at three different speeds: as quickly as possible, at a fast but steady rate, and at a slow rhythmical rate. The speed asymmetry present when tapping as quickly as possible (with the preferred hand tapping more quickly ) was reduced when tapping at the fast steady rate and was absent when tapping at the slow rhythmical rate. The temporal dispersion of the IRIs produced by the nonpreferred hand was greater than the temporal dispersion of those produced by the preferred hand in all speed conditions. These results show smaller temporal dispersion of tapping by the preferred hand in right-handed males under different conditions, including submaximal speeds at which both hands respond at the same rate. This suggests that the motor system controlling the preferred hand in right-handers had more precise timing of response output than that controlling the nonpreferred hand.     

One year after ischemic stroke: Changes in leg movement path stability in a speed–accuracy task but no major effects on the hands

First year after the stroke is essential for motor recovery. The main motor control strategy (i.e., faster movement production at the expense of lower movement accuracy and stability, or greater movement accuracy and stability at the expense of slower movement) selected by poststroke patients during a unilateral speed–accuracy task (SAT) remains unclear. We aimed to investigate the poststroke (12 months after stroke) effects on the trade-off between movement speed and accuracy, and intraindividual variability during a motor performance task. Healthy right-handed men (n = 20; age ∼ 66 years) and right-handed men after ischemic stroke during their post rehabilitation period (n = 20; age ∼ 69 years) were asked to perform a simple reaction task, a maximal velocity performance task and a SAT with the right and left hand, and with the right and left leg. In the hand movement trial, reaction time and movement velocity (V_max) in the SAT were slower and time to V_max in the SAT was longer in the poststroke group (P < .01). In the leg movement trial, poststroke participants reached a greater V_max in the SAT than the healthy participants (P < .01). The greatest poststroke effect on intraindividual variability in movements was found for movement path in the SAT, which was significantly greater in the legs than in the hands. Poststroke patients in the first year after stroke mainly selected an impulsive strategy for speed over hand and leg motor control, but at the expense of lower movement accuracy and greater variability in movement.     

The Effect of Auditory Cueing on the Spatial and Temporal Gait Coordination in Healthy Adults

Walk ratio, defined as step length divided by cadence, indicates the coordination of gait. During free walking, deviation from the preferential walk ratio may reveal abnormalities of walking patterns. The purpose of this study was to examine the impact of rhythmic auditory cueing (metronome) on the neuromotor control of gait at different walking speeds. Forty adults (mean age 26.6 ± 6.0 years) participated in the study. Gait characteristics were collected using a computerized walkway. In the preferred walking speed, there was no significant difference in walk ratio between uncued (walk ratio = .0064 ± .0007 m/steps/min) and metronome-cued walking (walk ratio = .0064 ± .0007 m/steps/min; p = .791). A higher value of walk ratio at the slower speed was observed with metronome-cued (walk ratio = .0071 ± .0008 m/steps/min) compared to uncued walking (walk ratio = .0068 ± .0007 m/steps/min; p < .001). The walk ratio was less at faster speed with metronome-cued (walk ratio = .0060 ± .0009 m/steps/min) compared to uncued walking (walk ratio = .0062 ± .0009 m/steps/min; p = .005). In healthy adults, the metronome cues may become an attentional demanding task, and thereby disrupt the spatial and temporal integration of gait at nonpreferred speeds.     

Moving the Arm at Different Rates: Slow Movements are Avoided

Qualitative and quantitative changes characterize locomotion and rhythmic interlimb coordination at different speeds. Legs and hands do not move more or less quickly; they also adopt different relative coordination patterns. In the present article, the authors asked whether similar transitions occur for unimanual hand movements when speed is slowed below the preferred speed. Participants moved a handheld dowel back and forth between 2 large circular targets in time with a metronome at periods between 370 ms and 1667 ms. The authors analyzed the kinematics of participants’ movements at each period and found that proportional dwell time and number of peaks in the velocity profile increased as driving periods increased. Path lengths and peak velocities remained relatively constant for driving periods exceeding 800 ms. Participants made only gradual changes to their movement parameters, so that they went from a continuous mode to a more discrete mode of behavior for longer driving periods. Thus, unlike for rhythmic bimanual movements or locomotory patterns, there are quantitative but no clear qualitative changes for unimanual movements. The results suggest that participants tried to move close to their preferred tempo at different rates, and that they avoided moving slowly.     

Prognostic relevance of quantitative topographical EEG in patients with poststroke aphasia

In this prospective study we analyzed the prognostic value of topographical quantitative EEG (qEEG) in poststroke aphasia. Twenty-three right-handed patients (ages 56 +/- 12 years) with different types of aphasia were studied. Quantitative EEG under resting conditions and an aphasia test battery were applied twice, 2 and 8 weeks after a stroke. EEG power fast Fourier transform was performed for delta (2-3.5 Hz), theta (4-7.5 Hz), alpha (8-13 Hz), and beta (13.5-20 Hz) frequency bands. EEG abnormalities within and outside speech relevant areas are related to restitution of poststroke aphasia. In the ischemic regions they indicate local disturbances; outside they reflect failures in neuronal networks involved in the generation and propagation of the alpha rhythm.     

Biomechanical analysis of gait termination in 11–17 year old youth at preferred and fast walking speeds

In populations where walking and/or stopping can be difficult, such as in children with cerebral palsy, the ability to quickly stop walking may be beyond the child’s capabilities. Gait termination may be improved with physical therapy. However, without a greater understanding of the mechanical requirements of this skill, treatment planning is difficult. The purpose of this study was to understand how healthy children successfully terminate gait in one step when walking quickly, which can be challenging even for healthy children. Lower extremity kinematic and kinetic data were collected from 15 youth as they performed walking, planned, and unplanned stopping tasks. Each stopping task was performed as the subject walked at his/her preferred speed and a fast speed. The most significant changes in mechanics between speed conditions (preferred and fast) of the same stopping task were greater knee flexion angles (unplanned: +16.49 ± 0.54°, p = 0.00; planned: +15.75 ± 1.1°, p = 0.00) and knee extension moments (unplanned: +0.67 ± 0.02 N/kgm, p = 0.00; planned: +0.57 ± 0.23 N/kgm, p = 0.00) at faster speeds. The extra range of motion in the joints and extra muscle strength required to maintain the stopping position suggests that stretching and strengthening the muscles surrounding the joints of the lower extremity, particularly the knee, may be a useful intervention.     

Properties of internal speed control and psychophysiological response during continuous forearm rotation movement.

This study investigated the properties of speed control and psychophysiological response when subjects changed movement speed internally. The task consisted of a continuous forearm rotational movement, which 14 women performed under 3 conditions, namely, (1) Preferred: the subject performed the task at a freely selected speed, (2) Slow: the subject changed the speed in two steps from preferred to a slower pace (slow, then very slow), (3) Fast: the subject changed the speed in two steps from preferred to a faster pace (fast, then very fast). Rotation speed and the coefficient of variation were measured to evaluate within-subject variability. Under the Preferred condition, there were no significant differences in rotation speed or coefficient of variation during the trials. However, under Slow and Fast conditions, the standard variation scores and coefficient of variation indicated different tendencies. Under the Fast condition, although the standard variation increased with the faster speed, the coefficient of variation decreased. On the other hand, the coefficient of variation increased under the Slow condition. Preferred speed had a significant positive relationship to the slow, very slow, fast, and very fast speeds. Heart rate (R-R interval) and EEG spectral intensity measurements showed no significant changes among the three conditions: however, respiration frequency significantly increased during Fast as compared to Preferred and Slow conditions. These results suggest that a preferred speed for continuous movement exists and that it is closely related to internal speed control as a psychological criterion. Furthermore, different movement speeds may reflect different psychophysiological responses.     

Effect of movement speed on lower and upper body biomechanics during sit-to-stand-to-sit transfers: Self-selected speed vs. fast imposed speed

Preferred and fast speed sit-to-stand and stand-to-sit (STS) tests are prevalent in literature, but biomechanical changes between the different speeds of STS have never been studied. Understanding differences between these STS techniques will better inform experimental design for research assessing functional ability in clinical populations. The purpose of this study was to investigate the effect of different speeds of STS transfers on lower body and trunk kinematics and kinetics in healthy adults. Nineteen healthy middle-aged and older adults participated in this study. Two different speeds of STS were tested: self-selected speed and fast speed (as quickly as possible). Ten Vicon cameras and two AMTI force platforms were used to collect three-dimensional kinematic and kinetic data. During sit-to-stand transfer, peak knee extension velocity and knee extension moment were significantly increased for the fast speed STS as compared to the preferred speed STS. During stand-to-sit transfer, peak knee extension moment and lower back moment were significantly increased while STS time was decreased for the fast speed STS as compared to the preferred speed STS. Our results indicate that the fast speed STS could be more challenging for participants compared to the preferred speed STS evidenced by greater knee and lower back joint movements. Therefore, fast STS tests should be reconsidered when testing middle-aged and older adults with chronic low back pain and knee joint problems.