Abstract
This study aimed to identify and qualify grasp-types used by patients with stroke and determine the clinical parameters that could explain the use of each grasp. Thirty-eight patients with chronic stroke-related hemiparesis and a range of motor and functional capacities (17 females and 21 males, aged 25–78), and 10 healthy subjects were included. Four objects were used (tissue packet, teaspoon, bottle and tennis ball). Participants were instructed to “grasp the object as if you are going to use it”. Three trials were video-recorded for each object. A total of 456 grasps were analysed and rated using a custom-designed Functional Grasp Scale. Eight grasp-types were identified from the analysis: healthy subjects used Multi-pulpar, Pluri-digital, Lateral-pinch and Palmar grasps (Standard Grasps). Patients used the same grasps with in addition Digito-palmar, Raking, Ulnar and Interdigital grasps (Alternative Grasps). Only patients with a moderate or relatively good functional ability used Standard grasps. The correlation and regression analyses showed this was conditioned by sufficient finger and elbow extensor strength (Pluri-digital grasp); thumb extensor and wrist flexor strength (Lateral pinch) or in forearm supinator strength (Palmar grasp). By contrast, the patients who had severe impairment used Alternative grasps that did not involve the thumb. These strategies likely compensate specific impairments. Regression and correlation analyses suggested that weakness had a greater influence over grasp strategy than spasticity. This would imply that treatment should focus on improving hand strength and control although reducing spasticity may be useful in some cases.
Highlights
Stroke is the leading cause of morbidity and the third cause of mortality (50000 deaths per year) in industrialised countries
Grasp strategies in hemiplegic patients carry out activities of daily living (ADL)
Eight grasp-types were identified from the whole database of 576 grasps (456 for the patients and 120 for the controls): multi-pulpar, pluri-digital, lateral pinch, palmar, digitopalmar, raking, ulnar grasp and inter-digital
Summary
Stroke is the leading cause of morbidity and the third cause of mortality (50000 deaths per year) in industrialised countries. Around half of survivors are left with some disability [1] as a result of multiple impairments that often involve a loss of strength, stereotyped movements and changes in muscle tone. The upper limb is affected with 30% of patients left with a ‘plegic’ upper limb These patients are unable to move the limb and are partially or totally dependent for ADL such as dressing, washing and feeding. Another 40% of patients have some proximal recovery and are able to move their shoulder and sometimes the elbow. Because of altered motor control, both reaching and grasping are often impaired. [2]
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