Brain Advance Access originally published online on February 19, 2004
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Brain, Vol. 127, No. 5, 1035-1046, 2004
© 2004 Guarantors of Brain
doi: 10.1093/brain/awh116
How do strength, sensation, spasticity and joint individuation relate to the reaching deficits of people with chronic hemiparesis?
1 Kennedy Krieger Institute and 2 Department of Neurology, Johns Hopkins University, Baltimore, MD, 3 Department of Neurology, 4 Program in Physical Therapy, and 5 Department of Anatomy and Neurobiology, Washington University, St. Louis, MO, USA
Correspondence to: Kathleen Zackowski, Kennedy Krieger Institute, Johns Hopkins University, 707 N. Broadway, G-05 Baltimore, MD 21205, USA E-mail: zackowski{at}kennedykrieger.org
Hemiparetic subjects present with movement deficits including weakness, spasticity and an inability to isolate movement to one or a few joints. Voluntary attempts to move a single joint often result in excessive motion at adjacent joints. We investigated whether the inability to individuate joint movements is associated with deficits in functional reaching. Controls and hemiparetic subjects performed two different reaching movements and three individuated arm movements, all in the parasagittal plane. The reaching movements were a sagittal ‘reach up’ (shoulder flexion and elbow flexion) and ‘reach out’ (shoulder flexion and elbow extension). Joint individuation was assessed by getting each subject to perform an isolated flexion–extension movement at each of the shoulder, elbow and wrist joints. In addition, we measured strength, muscle tone and sensation using standard clinical instruments. Hemiparetic subjects showed varying degrees of impairment when performing reaching movements and individuated joint movements. Reaching impairments (hand path curvature, velocity) were worse in the reach out versus the reach up condition. Typical joint individuation abnormalities were excessive flexion of joints that should have been held fixed during movement of the instructed joint. Hemiparetic subjects tended to produce concurrent flexion motions of shoulder and elbow joints when attempting any movement, one explanation for why they were better at the ‘reach up’ than the ‘reach out’ task. Hierarchical regression analysis showed that impaired joint individuation explained most of the variance in the reach path curvature and end point error; strength explained most of the variance in reaching velocity. Sensation also contributed significantly, but spasticity and strength were not significant in the model. We conclude that the deficit in joint individuation reflects a fundamental motor control problem that largely explains some aspects of voluntary reaching deficits of hemiparetic subjects.
Key Words: movement; fractionation; hemiparesis; stroke; upper extremity
Abbreviations:
Received August 18, 2003. Revised December 16, 2003. Accepted December 19, 2003.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. D. Ellis, T. Sukal, T. DeMott, and J. P. A. Dewald Augmenting Clinical Evaluation of Hemiparetic Arm Movement With a Laboratory-Based Quantitative Measurement of Kinematics as a Function of Limb Loading Neurorehabil Neural Repair, July 1, 2008; 22(4): 321 - 329. [Abstract] [PDF]
|
|
|
|
 |
|
 J. M Wagner, J. A Rhodes, and C. Patten Reproducibility and Minimal Detectable Change of Three-Dimensional Kinematic Analysis of Reaching Tasks in People With Hemiparesis After Stroke Physical Therapy, May 1, 2008; 88(5): 652 - 663. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M Wagner, C. E Lang, S. A Sahrmann, D. F Edwards, and A. W Dromerick Sensorimotor Impairments and Reaching Performance in Subjects With Poststroke Hemiparesis During the First Few Months of Recovery Physical Therapy, June 1, 2007; 87(6): 751 - 765. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. E. Lang and J. A. Beebe Relating Movement Control at 9 Upper Extremity Segments to Loss of Hand Function in People with Chronic Hemiparesis Neurorehabil Neural Repair, May 1, 2007; 21(3): 279 - 291. [Abstract] [PDF]
|
|
|
|
 |
|
 R. A. Scheidt and T. Stoeckmann Reach Adaptation and Final Position Control Amid Environmental Uncertainty After Stroke J Neurophysiol, April 1, 2007; 97(4): 2824 - 2836. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Wagner, C. E. Lang, S. A. Sahrmann, Q. Hu, A. J. Bastian, D. F. Edwards, and A. W. Dromerick Relationships between Sensorimotor Impairments and Reaching Deficits in Acute Hemiparesis. Neurorehabil Neural Repair, September 1, 2006; 20(3): 406 - 416. [Abstract] [PDF]
|
|
|
|
|
|
P. H. McCrea, J. J. Eng, and A. J. Hodgson Saturated Muscle Activation Contributes to Compensatory Reaching Strategies After Stroke J Neurophysiol, November 1, 2005; 94(5): 2999 - 3008. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Mercier, A M Bertrand, and D Bourbonnais Comparison of strength measurements under single-joint and multi-joint conditions in hemiparetic individuals Clinical Rehabilitation, May 1, 2005; 19(5): 523 - 530. [Abstract] [PDF]
|
|