Abstract
BackgroundPostural strategies of the trunk and the lower limbs are linked to upper limb motor activities. The objective was to analyze the postural organization at the lower limbs as well as the inter-limb coordination during isometric maximal bilateral pushing of upper limbs. MethodsFifteen individuals after stroke and 17 healthy participants were assessed with an instrumented exerciser paired with an instrumented sitting surface while they executed isometric bilateral pushes with the upper limbs. The anteroposterior, vertical and mediolateral forces were recorded at the handles, the thighs and the feet. Force values at maximal bilateral pushing efforts at each segment and inter-limb coordination between sides were compared. FindingsDuring the isometric pushes, the paretic maximal forces at the handles for stroke participants were lower than the nonparetic side and lower than both sides of the control participants (p < 0.036). The control and stroke participants had moderate to good coordination for the anteroposterior forces (hands and thighs). While they used similar postural strategies to the controls except for a decreased weight on the paretic foot, vertical forces were less coordinated at the handles and feet in the stroke group (p < 0.050). The inter-trial variability was also higher in the stroke group. InterpretationBilateral pushing with gradual efforts induces impaired postural strategies and coordination between limbs in individuals after stroke. It may reveal to be a promising strategy to assess and train post-stroke individuals in a clinical setting. Also, providing feedback would help better control symmetry during efforts.
Highlights
Recovery of motor function of the paretic upper limb is crucial for individuals after stroke because 50% of the reduction in quality of life after stroke is due to the inability to use their arm effectively in actions of daily living (Kantak et al, 2017)
Individuals with stroke were included if they had a first unilateral stroke more than 6 months ago, an upper limb paresis, an active wrist flexion superior to 10◦ and they were able to hold the handle of the exerciser
An electromyographic analysis would have helped understand motor strategies used during pushing tasks and should be included in future studied. This original study showed the relevance of posture analysis and coordination when producing maximum isometric upper limb pushing efforts
Summary
Recovery of motor function of the paretic upper limb is crucial for individuals after stroke because 50% of the reduction in quality of life after stroke is due to the inability to use their arm effectively in actions of daily living (Kantak et al, 2017). A systematic review of upper limb interventions for persons with stroke (Wattchow et al, 2018) highlights that only constraint-induced move ment therapy and task-specific training are supported by clinical guidelines and by studies of moderate quality of evidence These reha bilitation approaches focus on the paretic upper limb and rarely take into consideration other components of task achievement such as postural organization, the adjustments of the whole body to execute the distal movement (Bouisset et al, 2002). The control and stroke participants had moderate to good coordination for the anteroposterior forces (hands and thighs) While they used similar postural strategies to the controls except for a decreased weight on the paretic foot, vertical forces were less coordinated at the handles and feet in the stroke group (p < 0.050). Providing feedback would help better control symmetry during efforts
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