Biomechanical Contributions of the Trunk and Upper Extremity in Discrete Versus Cyclic Reaching in Survivors of Stroke

Abstract

Background: Stroke rehabilitation interventions and assessments incorporate discrete and/or cyclic reaching tasks, yet no biomechanical comparison exists between these 2 movements in survivors of stroke. Objective: To characterize the differences between discrete (movements bounded by stationary periods) and cyclic (continuous repetitive movements) reaching in survivors of stroke. Methods: Seventeen survivors of stroke underwent kinematic motion analysis of discrete and cyclic reaching movements. Outcomes collected for each side included shoulder, elbow, and trunk range of motion (ROM); peak velocity; movement time; and spatial variability at target contact. Results: Participants used significantly less shoulder and elbow ROM and significantly more trunk flexion ROM when reaching with the stroke-affected side compared with the less-affected side (P < .001). Participants used significantly more trunk rotation during cyclic reaching than discrete reaching with the stroke-affected side (P = .01). No post hoc differences were observed between tasks within the stroke-affected side for elbow, shoulder, and trunk flexion ROM. Peak velocity, movement time, and spatial variability were not different between discrete and cyclic reaching in the stroke-affected side. Conclusions: Survivors of stroke reached with altered kinematics when the stroke-affected side was compared with the less-affected side, yet there were few differences between discrete and cyclic reaching within the stroke-affected side. The greater trunk rotation during cyclic reaching represents a unique segmental strategy when using the stroke-affected side without consequences to end-point kinematics. These findings suggest that clinicians should consider the type of reaching required in therapeutic activities because of the continuous movement demands required with cyclic reaching.