Does kinematics add meaningful information to clinical assessment in upper limb rehabilitation after stroke?

Abstract

Researchquestion:The aimsof this studywere: (a) quantify the upper limb impairments in post-stroke patients; (b) quantitatively evaluate the effectiveness of an upper limb rehabilitation program; (c) gain more clinically meaningful information using kinematic analysis in addition to clinical assessment. Introduction: The motor functions and the effects of rehabilitative treatments are measured using clinical tests and semi-quantitative scale. The samemotor behavior can be analyzed using instrumental kinematic tools that provide qualitative and quantitative information. Materials and methods: A group of 10 post-stroke patients was treated with an integrated rehabilitative program (including upper limb training); a second group of 5 post-stroke patients was treated with conventional physiotherapy. Treatment for both groups includes ten session lasting an hour and a half a day. Kinematic analysis was performed by an optoelectronic system (Vicon, UK). The subjects were asked to reach an object in a standardized setting. The task was repeated 12 times (six movements, right and left). Kinematic analysis was conducted identifying and computing specific parameters of movement duration, velocity, smoothness and upper limbs angles [1,2]. The clinical scales were Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES), Nine HolePegTest (NHPT) andHandGripDynamometer test. All patients were assessed PRE and POST treatment. The comparison between the two sessions was done using non parametric tests (p<0.05). Results: The upper limb kinematics evaluation showed that in PRE session the most of parameters of both groups were different from the normality ranges, with no differences between the two groups. In particular, they executed the movement slower, with higher movement duration, and with lower precision. After the treatment in the first group we found significant improvements in terms of movement duration, in particular during going phase (1.3 vs. 1.0 s; p<0.05; controls: 0.8 s) and total duration (3.6 vs. 2.5 s; p<0.05; controls: 1.9 s), and number of unit movements (15.2 vs. 7.5; p<0.05; controls: 2.8); our data showed higher mean velocity (0.3 vs. 0.5m/s; p<0.05; controls: 0.6m/s) and an increased ROM of shoulder flex-extension (32.9 vs. 36.9 degrees; p<0.05; controls: 43.9 degrees). On the contrary, the group treated with conventional physiotherapy showed no statistically changes. Some significant correlations were found between the clinical outcomes and kinematic evaluation. Discussion: Our data show that integration of clinical assessment with kinematic evaluation is useful to detect quantitative and qualitative changes in performance. The latter are meaningful signsof rehabilitationprogrameffectiveness. Theoptoelectronic system resulted reliable for studyingupper limbs patterns ofmovement (bymeans of integration of speed, coordination and precision indexes).