Abstract
BackgroundApproximately 60% of stroke survivors experience hand dysfunction limiting execution of daily activities. Several methods have been proposed to objectively quantify fingers' joints range of motion (ROM), while few studies exist about multi-finger coordination during hand movements. The present work analysed this aspect, by providing a complete characterization of spatial and temporal aspects of hand movement, through the mathematical modelling of multi-joint finger motion in healthy subjects and stroke patients.MethodsHand opening and closing movements were examined in 12 healthy volunteers and 14 hemiplegic stroke survivors by means of optoelectronic kinematic analysis. The flexion/extension angles of metacarpophalangeal (MCPJ) and proximal interphalangeal joints (IPJ) of all fingers were computed and mathematically characterized by a four-parameter hyperbolic tangent function. Accuracy of the selected model was analysed by means of coefficient of determination (R2) and root mean square error (RMSE). Test-retest reliability was quantified by intraclass correlation coefficient (ICC) and test-retest errors. Comparison between performances of healthy controls and stroke subjects were performed by analysing possible differences in parameters describing angular and temporal aspects of hand kinematics and inter-joint, inter-digit coordination.ResultsThe angular profiles of hand opening and closing were accurately characterized by the selected model, both in healthy controls and in stroke subjects (R2 > 0.973, RMSE < 2.0°). Test-retest reliability was found to be excellent, with ICC > 0.75 and remarking errors comparable to those obtained with other methods. Comparison with healthy controls revealed that hemiparetic hand movement was impaired not only in joints ROM but also in the temporal aspects of motion: peak velocities were significantly decreased, inter-digit coordination was reduced of more than 50% and inter-joint coordination patterns were highly disrupted. In particular, the stereotypical proximal-to-distal opening sequence (reversed during hand closing) found in healthy subjects, was altered in stroke subjects who showed abnormally high delay between IPJ and MCPJ movement or reversed moving sequences.ConclusionsThe proposed method has proven to be a promising tool for a complete objective characterization of spatial and temporal aspects of hand movement in stroke, providing further information for a more targeted planning of the rehabilitation treatment to each specific patient and for a quantitative assessment of therapy's outcome.
Highlights
60% of stroke survivors experience hand dysfunction limiting execution of daily activities
Model accuracy Analysis of all hand opening/closing movements performed by healthy subjects confirmed that the selected mathematical model accurately characterized the shape of angular profiles of metacarpophalangeal joints (MCPJ) and interphalangeal joints (IPJ) of long fingers and thumb
This was confirmed by R2 and root mean square error (RMSE) mean (± SD) values which were, respectively, 0.996 (± 0.009) and 1.6° (± 0.6°) for hand opening and 0.995 (± 0.009) and 1.7°(± 0.7°) for hand closing
Summary
60% of stroke survivors experience hand dysfunction limiting execution of daily activities. Some of these methods have been used for the evaluation of anomalies in hand kinematics due to hand injury [9], focal dystonia [13] and stroke [8,11,14] Most of these studies are mainly focused on the analysis of initial and final position of fingers during a specific movement to evaluate active range of motion, while there is still a lack of studies aimed at analysing temporal aspects of hand motion (i.e. the movement process) and multi-finger coordination that is highly impaired in people with stroke [15]. Temporal coordination of finger motion during the movement to grasp an object was analysed by Santello et al [19] in unimpaired individuals Their results demonstrated a high degree of covariation among the rotations of the MCPJ and IPJ of long fingers. All joint of the same type (i.e. MCPJ and IPJ) tended to extend and flex together, simultaneously reaching a maximum excursion
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