Background
An increasing number of studies have shown that not only the contralesional upper extremity (UE), the ipsilesional UE is also affected after stroke by several bilateral neural mechanisms. Ipsilesional impairments are usualy subtle, and not well represented by the usual assessment tools. The aim of this study is to evaluate ipsilesional UE movements of hemiplegic stroke patients using 3-dimentional motion analysis.
Methods
This prospective study included 15 poststroke hemiplegic patients and 15 age-matched healthy individuals. Inclusion criteria was: (1) first onset ischemic/hemorrhagic stroke, (2) over 3 months after onset, (3) 19 to 80 years old, (4) UE Brunnstrom stage IV to VI. For the 3-dimentional motion analysis, retroreflective markers were place on the trunk and bilateral upper limbs following the international society of biomechanics guideline. Demographic data included age, gender, BMI, spasticity, Brunnstrom stage, UE-FMA score, MBI, ARAT, DASH score. Eight movements (described in table 1) were repeated 3 times in both sides and the average values were used for statistical analysis. We collected joint angle trajectories, joint range motion, maximal velocity in each phases, total time to completion, peak velocity timing and linear velocity of each joints.
Results
The kinematic variables of ipsilesional UE were compared with the non-dominant side of the healthy individuals using paired t-test (Table 2). In the stroke group, maximal tangential velocity of the hand (MHV) was lower in 12 of total 18 phases, and the differences were noted in all the first phase (going phase). Completion time (CT) was longer in the stroke group in 16 of total 18 phases. There was no significant nor consistent difference in ROM of shoulder and elbow joint and displacement of trunk in any plane. Correlation analysis was performed to identify a correlation between clinical characteristics and kinematic variables. Among the clinical assessments, the UE-FMA and ARAT scores showed the highst correlation with MHV and CT, which have a positive correlation with the MHV and a negative correlation with the CT. Table 3 shows a comparison of the correlation efficients between the UE-FMA and ARAT in the going phase (P1) and returning phase (P2 in M1 to M6, and P3 in M7 and M8). The ARAT score showed statistically significant correlations in more items than the UE-FMA score. Moreover, correlation coefficients were consistently higher in the ARAT than the UE-FMA.
Conclusion
In this study, we found out how the ipsilesional UE kinematics of hemiplegic poststroke patients differs from the healthy individuals in 8 UE movements common in an activity of daily living. In the stroke patients, the MHV was lower and CT was longer compared to the control group in each phase. Also, the MHV and CT were most correlated by ARAT score, followed by the UE-FMA score. |
