Abstract
BackgroundUpper limb kinematic assessments provide quantifiable information on qualitative movement behavior and limitations after stroke. A comprehensive characterization of spatiotemporal kinematics of stroke subjects during upper limb daily living activities is lacking. Herein, kinematic expressions were investigated with respect to different movement types and impairment levels for the entire task as well as for motion subphases.MethodChronic stroke subjects with upper limb movement impairments and healthy subjects performed a set of daily living activities including gesture and grasp movements. Kinematic measures of trunk displacement, shoulder flexion/extension, shoulder abduction/adduction, elbow flexion/extension, forearm pronation/supination, wrist flexion/extension, movement time, hand peak velocity, number of velocity peaks (NVP), and spectral arc length (SPARC) were extracted for the whole movement as well as the subphases of reaching distally and proximally. The effects of the factors gesture versus grasp movements, and the impairment level on the kinematics of the whole task were tested. Similarities considering the metrics expressions and relations were investigated for the subphases of reaching proximally and distally between tasks and subgroups.ResultsData of 26 stroke and 5 healthy subjects were included. Gesture and grasp movements were differently expressed across subjects. Gestures were performed with larger shoulder motions besides higher peak velocity. Grasp movements were expressed by larger trunk, forearm, and wrist motions. Trunk displacement, movement time, and NVP increased and shoulder flexion/extension decreased significantly with increased impairment level. Across tasks, phases of reaching distally were comparable in terms of trunk displacement, shoulder motions and peak velocity, while reaching proximally showed comparable expressions in trunk motions. Consistent metric relations during reaching distally were found between shoulder flexion/extension, elbow flexion/extension, peak velocity, and between movement time, NVP, and SPARC. Reaching proximally revealed reproducible correlations between forearm pronation/supination and wrist flexion/extension, movement time and NVP.ConclusionSpatiotemporal differences between gestures versus grasp movements and between different impairment levels were confirmed. The consistencies of metric expressions during movement subphases across tasks can be useful for linking kinematic assessment standards and daily living measures in future research and performing task and study comparisons.Trial registration: ClinicalTrials.gov Identifier NCT03135093. Registered 26 April 2017, https://clinicaltrials.gov/ct2/show/NCT03135093.
Highlights
The human upper limb can be expressed by seven main degrees of freedom, excluding the hand, that allow for highly variable movements and interactions with the environment
To address the third research question on comparability of kinematic expressions during movement subphases across different tasks and impairment subgroups, we considered the metrics during the subphases of reaching distally and proximally that were extracted from the tasks T02, T05, T06, T07, T08, T10, T12, T13, T14, T15, T16, and T18
The whole dataset consisted of 775 kinematic sets of the affected upper limb, represented by the mean values of the three repetitions per subject and task that has been published online [54]
Summary
The human upper limb can be expressed by seven main degrees of freedom, excluding the hand, that allow for highly variable movements and interactions with the environment. Upper limb kinematic assessments have been investigated to test the effectiveness of different therapies, namely constraint induced movement therapy [14,15,16], trunk restraint training [17], robotic-assisted training [18,19,20], virtual reality training [21, 22], bilateral arm training [23,24,25], Botulinum toxin [26] and mirror therapy [27] This tendency demonstrates the additional value of kinematic assessments to complement the standard clinical assessments and their broad evaluation level of movement quality. It has further been shown that upper limb kinematic measurements after stroke were frequently assessed in relatively fixed measurement surroundings such as camera-based motion laboratories or robot-based measurement systems These measurements have the strong disadvantage that the movements the patients have to perform are device-specific and often restricted to simple reachto-point, or tracking motions [30]. Kinematic expressions were investigated with respect to different movement types and impairment levels for the entire task as well as for motion subphases
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