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A low-dimensional representation of arm movements and hand grip forces in post-stroke individuals.

ABSTRACT: Characterizing post-stroke impairments in the sensorimotor control of arm and hand is essential to better understand altered mechanisms of movement generation. Herein, we used a decomposition algorithm to characterize impairments in end-effector velocity and hand grip force data collected from an instrumented functional task in 83 healthy control and 27 chronic post-stroke individuals with mild-to-moderate impairments. According to kinematic and kinetic raw data, post-stroke individuals showed reduced functional performance during all task phases. After applying the decomposition algorithm, we observed that the behavioural data from healthy controls relies on a low-dimensional representation and demonstrated that this representation is mostly preserved post-stroke. Further, it emerged that reduced functional performance post-stroke correlates to an abnormal variance distribution of the behavioural representation, except when reducing hand grip forces. This suggests that the behavioural repertoire in these post-stroke individuals is mostly preserved, thereby pointing towards therapeutic strategies that optimize movement quality and the reduction of grip forces to improve performance of daily life activities post-stroke.

SUBMITTER: Kanzler CM

PROVIDER: S-EPMC9085765 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature

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A low-dimensional representation of arm movements and hand grip forces in post-stroke individuals.

Kanzler Christoph M CM Averta Giuseppe G Schwarz Anne A Held Jeremia P O JPO Gassert Roger R Bicchi Antonio A Santello Marco M Lambercy Olivier O Bianchi Matteo M

Scientific reports 20220509 1

Characterizing post-stroke impairments in the sensorimotor control of arm and hand is essential to better understand altered mechanisms of movement generation. Herein, we used a decomposition algorithm to characterize impairments in end-effector velocity and hand grip force data collected from an instrumented functional task in 83 healthy control and 27 chronic post-stroke individuals with mild-to-moderate impairments. According to kinematic and kinetic raw data, post-stroke individuals showed r ...[more]

PMID: 35534629

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Project description:BackgroundAssessing arm and hand sensorimotor impairments that are functionally relevant is essential to optimize the impact of neurorehabilitation interventions. Technology-aided assessments should provide a sensitive and objective characterization of upper limb impairments, but often provide arm weight support and neglect the importance of the hand, thereby questioning their functional relevance. The Virtual Peg Insertion Test (VPIT) addresses these limitations by quantifying arm and hand movements as well as grip forces during a goal-directed manipulation task requiring active lifting of the upper limb against gravity. The aim of this work was to evaluate the ability of the VPIT metrics to characterize arm and hand sensorimotor impairments that are relevant for performing functional tasks.MethodsArm and hand sensorimotor impairments were systematically characterized in 30 chronic stroke patients using conventional clinical scales and the VPIT. For the latter, ten previously established kinematic and kinetic core metrics were extracted. The validity and robustness of these metrics was investigated by analyzing their clinimetric properties (test-retest reliability, measurement error, learning effects, concurrent validity).ResultsTwenty-three of the participants, the ones with mild to moderate sensorimotor impairments and without strong cognitive deficits, were able to successfully complete the VPIT protocol (duration 16.6 min). The VPIT metrics detected impairments in arm and hand in 90.0% of the participants, and were sensitive to increased muscle tone and pathological joint coupling. Most importantly, significant moderate to high correlations between conventional scales of activity limitations and the VPIT metrics were found, thereby indicating their functional relevance when grasping and transporting objects, and when performing dexterous finger manipulations. Lastly, the robustness of three out of the ten VPIT core metrics in post-stroke individuals was confirmed.ConclusionsThis work provides evidence that technology-aided assessments requiring goal-directed manipulations without arm weight support can provide an objective, robust, and clinically feasible way to assess functionally relevant sensorimotor impairments in arm and hand in chronic post-stroke individuals with mild to moderate deficits. This allows for a better identification of impairments with high functional relevance and can contribute to optimizing the functional benefits of neurorehabilitation interventions.

Project description:BACKGROUND:The Hand Extension Robot Orthosis (HERO) Grip Glove was iteratively designed to meet requests from therapists and persons after a stroke who have severe hand impairment to create a device that extends all five fingers, enhances grip strength and is portable, lightweight, easy to put on, comfortable and affordable. METHODS:Eleven persons who have minimal or no active finger extension (Chedoke McMaster Stage of Hand 1-4) post-stroke were recruited to evaluate how well they could perform activities of daily living and finger function assessments with and without wearing the HERO Grip Glove. RESULTS:The 11 participants showed statistically significant improvements (p < 0.01), while wearing the HERO Grip Glove, in the water bottle grasp and manipulation task (increase of 2.3 points, SD 1.2, scored using the Chedoke Hand and Arm Inventory scale from 1 to 7) and in index finger extension (increase of 147o, SD 44) and range of motion (increase of 145o, SD 36). The HERO Grip Glove provided 12.7 N (SD 8.9 N) of grip force and 11.0 N (SD 4.8) of pinch force to their affected hands, which enabled those without grip strength to grasp and manipulate blocks, a fork and a water bottle, as well as write with a pen. The participants were 'more or less satisfied' with the HERO Grip Glove as an assistive device (average of 3.3 out of 5 on the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 Scale). The highest satisfaction scores were given for safety and security (4.6) and ease of use (3.8) and the lowest satisfaction scores were given for ease of donning (2.3), which required under 5 min with assistance. The most common requests were for greater grip strength and a smaller glove size for small hands. CONCLUSIONS:The HERO Grip Glove is a safe and effective tool for enabling persons with a stroke that have severe hand impairment to incorporate their affected hand into activities of daily living, which may motivate greater use of the affected upper extremity in daily life to stimulate neuromuscular recovery.

Project description:Neurologic music therapy in rehabilitation of stroke patients has been shown to be a promising supplement to the often strenuous conventional rehabilitation strategies. The aim of this study was threefold: (i) replicate results from a previous study with a sample from one clinic (henceforth called Site 1; N = 12) using an already established recording system, and (ii) conceptually replicate previous findings with a less costly hand-tracking system in Site 2 (N = 30), and (iii) compare both sub-studies' outcomes to estimate the efficiency of neurologic music therapy. Stroke patients in both sites were randomly assigned to treatment or control groups and received daily training of guided sequential upper limb movements additional to their standard stroke rehabilitation protocol. Treatment groups received sonification (i.e., changes in musical pitch) of their movements when they moved their affected hand up and down to reproduce a sequence of the first six notes of a C major scale. Controls received the same movement protocol, however, without auditory feedback. Sensors at the upper arm and the forearm (Xsens) or an optic sensor device (Leapmotion) allowed to measure kinematics of movements and movement smoothness. Behavioral measures pre and post intervention included the Fugl-Meyer assessment (FMA) and the Stroke Impact Scale (SIS) and movement data. Bayesian regression did not show evidence supporting an additional effect of sonification on clinical mobility assessments. However, combined movement data from both sites showed slight improvements in movement smoothness for the treatment group, and an advantage for one of the two motion capturing systems. Exploratory analyses of EEG-EMG phase coherence during movement of the paretic arm in a subset of patients suggested increases in cortico-muscular phase coherence specifically in the ipsilesional hemisphere after sonification therapy, but not after standard rehabilitation therapy. Our findings show that musical sonification is a viable treatment supplement to current neurorehabilitation methods, with limited clinical benefits. However, given patients' enthusiasm during training and the low hardware price of one of the systems it may be considered as an add-on home-based neurorehabilitation therapy.

Dataset Information

A low-dimensional representation of arm movements and hand grip forces in post-stroke individuals.

Publications

A low-dimensional representation of arm movements and hand grip forces in post-stroke individuals.

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