Quantitative evaluation of movement disorder of wrist joint in patients with cerebral, thalamic and cerebellar stroke

Abstract

Background: It is necessary to make objective and quantitative evaluation ofmotor disorders caused by brain damage such as stroke. Purpose: In this study, using quantitative analysis system of wrist joint movement which we devised, we aimed to compare the characteristics of disorder of wrist joint movement in the patients with cerebral, thalamic and cerebellar stroke. Methods: Five healthy subjects, four patients with cerebral stroke, two with thalamic and two with cerebellar stroke participated in this study. Concerning the upper limb motor function, motion Brunnstrom-Recovery Stage of afflicted side of all the patients was at the stage of V or more. The subjects were asked to sit in front of personal computer screen and to perform two movement tasks; (1) a step-tracking movement inwhich the subjectsmovedwrist joint of afflicted side to follow cursor according to the movement of the small circle to left and right and up and down from the center of the screen and (2) a smooth pursuit movement to follow a target drawing the shape “2”. In these movement tasks, we measured the motion time, average and maximum motion velocities, pursuit ratio, error distance, and smoothness of the trajectory. Results: In the step tracking task, the most characteristic feature was the slowest maximum velocity (47.9± 13.5deg/sec) in cerebral stroke patients. The maximum velocity in healthy subjects, in patients with thalamic and cerebellar stroke was 96.7± 19.9deg/sec, 74.1± 34.7deg/sec, and 90.1± 25.8deg/sec, respectively. In the smooth pursuit movement task, the smoothness of the trajectory was most remarkably disturbed in cerebellar and thalamic group, namely 2.5× 1010± 5 × 109deg in healthy subjects, 3.4 × 1010 ± 8.6× 109deg in cerebral group, 1.1× 1011 ± 4× 1010deg, 1.1× 1011± 4.6× 1010deg in thalamic and cerebellar group, respectively. Conclusion(s): In the cerebral stroke patients, the weakness of muscle caused the elongation of movement time and lowered the maximum velocity. In the cerebellar thalamic stroke patients, smoothness of the movement was mainly disturbed rather than muscle weakness. Implications: This analysis system should be useful tool to evaluate quantitatively the disorder and the training effect in wrist movement during the course of rehabilitation. The analysis system enabled us to display objectively the state of motor control of wrist movement and evaluate the disorder during the course of rehabilitation.