Saturated muscle activation contributes to compensatory reaching strategies after stroke. Gains in Upper Extremity Function After Stroke via Recovery or Compensation: Potential Differential Effects on Amount of Real-World Limb Use A robotic device as a sensitive quantitative tool to assess upper limb impairments in stroke patients: a preliminary prospective cohort study. Directional control of reaching is preserved following mild/moderate stroke and stochastically constrained following severe stroke Training-induced changes in the pattern of triceps to biceps activation during reaching tasks after chronic and severe stroke Neuro-Mechanics of Recumbent Leg Cycling in Post-Acute Stroke Patients Contralesional Arm Preference Depends on Hemisphere of Damage and Target Location in Unilateral Stroke Patients Effects of early and intensive neuro-rehabilitative treatment on muscle synergies in acute post-stroke patients: a pilot study Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Feedback and Cognition in Arm Motor Skill Reacquisition After Stroke Kinematics of pointing movements made in a virtual versus a physical 3-dimensional environment in healthy and stroke subjects. Positive effects of robotic exoskeleton training of upper limb reaching movements after stroke Unraveling the interaction between pathological upper limb synergies and compensatory trunk movements during reach-to-grasp after stroke: a cross-sectional study Best Conventional Therapy Versus Modular Impairment-Oriented Training for Arm Paresis After Stroke: A Single-Blind, Multicenter Randomized Controlled Trial Basic features of phasic activation for reaching in vertical planes The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Using the robotic device REAplan as a valid, reliable, and sensitive tool to quantify upper limb impairments in stroke patients. A kinematic study of contextual effects on reaching performance in persons with and without stroke: influences of object availability. Arm–Trunk Coordination for Beyond-the-Reach Movements in Adults With Stroke Using Kinematic Analysis to Evaluate Constraint-Induced Movement Therapy in Chronic Stroke Patients Anticipatory postural adjustments during sitting reach movement in post-stroke subjects. Reduced skilfulness of arm motor behaviour among motor stroke patients with good clinical recovery: does it indicate reduced automaticity? Can it be improved by unilateral or bilateral training? A kinematic motion analysis study Impaired motor preparation and execution during standing reach in people with chronic stroke
The control and execution of movement could potentially be altered by the presence of stroke-induced weakness if muscles are incapable of generating sufficient power . The purpose of this study was to identify compensatory strategies during a forward ( sagittal ) reaching task for 20 persons with chronic stroke and 10 healthy age-matched controls . We hypothesized that the paretic anterior deltoid would be maximally activated ( i.e. , saturated ) during a reaching task and that task completion would require activation of additional muscles , result ing in compensatory movements out of the sagittal plane . For reaching movements by control subjects , joint motion remained largely in the sagittal plane and h and trajectories were smooth and direct . Movement characteristics of the nonparetic arm of stroke subjects were similar to control subjects except for small increases in the abduction angle and the percentage that anterior deltoid was activated . In contrast , reaching movements of the paretic arm of stroke subjects were characterized by increased activation of all muscles , especially the lateral deltoid , in addition to the anterior deltoid , with result ing shoulder abduction power and segmented and indirect h and motion . For the paretic arm of stroke subjects , muscle and kinetic compensations increased with impairment severity and weaker muscles were used at a higher percentage of their available muscle activity . These results suggest that the inability to generate sufficient force with the typical agonists involved during a forward reaching task may necessitate compensatory muscle recruitment strategies to complete the task Abstract In terms of integration of the paretic upper extremity in activities of daily living ( ADLs ) , outcome is poor after stroke . Furthermore , amount of real-world arm use appears only weakly correlated with laboratory motor function scales . Therefore , amount of arm use may depend critically on the location , extent , and type of functional gains , which can be quantified with comprehensive kinematic and EMG analysis of ADL performance . Gains in upper extremity function can occur via compensation or recovery of premorbid movement and EMG patterns , and traditional treatment approaches encourage adoption of compensatory strategies early in the postacute period that can inhibit potential recovery . A new treatment approach called Accelerated Skill Acquisition Program ( ASAP ) focuses on impairment reduction coupled with repetitive , task-specific training of the paretic arm during ADLs . We present pilot data that show recovery in subjects who received the ASAP  , while a usual care control subject showed increased use of compensation over the same period . Finally , we discuss the advantages of data reduction methods such as principal components analysis , confirmatory factor analysis , and structural equation modeling , which can potentially distill large kinematic and EMG data sets into the key latent variables that predict amount of real-world use OBJECTIVE To compare kinematic indices in age-matched healthy subjects and stroke patients , by evaluating various tasks performed with a robotic device , and to provide an objective and st and ardized protocol to assess upper limb impairments in stroke patients . DESIGN A prospect i ve cohort study . SUBJECTS Age-matched healthy subjects ( n = 10 ) and stroke patients ( n = 10 ) . METHODS Various kinematic indices were analysed from 3 r and omly assigned tasks performed by the affected arm in stroke patients and the dominant arm in healthy subjects . These tasks , composed of large-amplitude , targeted and geometrical movements , were st and ardized and performed with the ReaPLAN robotic device . RESULTS For large-amplitude movements , the stroke patients ' path lengths were less constant in amplitude , less rectilinear and less smooth than those for healthy subjects ( p < 0.001 ) . For the targeted movements , the stroke patients ' path lengths were less rectilinear than those of the healthy subjects ( p < 0.001 ) . For the geometrical movements , the stroke patients had greater difficulty making the requested shapes compared with the healthy subjects ( p < 0.01 ) . CONCLUSION Our study proposes an objective and st and ardized protocol to assess stroke patients ' upper limbs with any robotic device . We suggest that further r and omized controlled trials could use this quantitative tool to assess the efficacy of treatments such as robot-assisted therapy Recent evidence suggests that brain injury can impair the ability to independently activate shoulder and elbow muscles . We hypothesized that if muscle activation patterns are constrained , then brain-injured subjects should not be able to accurately grade initial h and movement direction during reaching toward a broad range of target directions . To test this hypothesis , we measured h and trajectories during reaching in three-space by 16 hemiparetic stroke subjects  to an array of 75 targets distributed throughout the workspace . Contrary to our hypothesis , we found that the ability to grade movement direction was largely preserved following mild and moderate stroke . However , the most severely impaired subjects exhibited a degradation of directional control consistent with a loss of independent muscle control . Initial and final h and movement directions for these subjects were grouped roughly in two opposing directions , in a plane parallel with the coronal plane of the body , rather than distributed across the normal range . Selection between the two movement directions appeared partially r and om , in that subjects initiated over 50 % of movements in the direction generally opposite the intended target , for targets to one side of the body . These results suggest that individuals with severe stroke are constrained to use only two gross , stereotypical muscle coactivation patterns for reaching control , and that selection between these patterns is stochastically influenced as the actual direction of motion is not strictly predictable given the desired direction This exploratory study was undertaken to investigate the mechanisms that contributed to improvements in upper limb function following a novel training program . Surface electromyography ( EMG ) was used to examine training-induced changes in the pattern of triceps and biceps activation during reaching tasks in stroke survivors with severe paresis in the chronic stage of recovery . The EMG data were obtained in the context of a single blind r and omised clinical trial conducted with 42 stroke survivors with minimal upper limb muscle activity and who were more than 6 months post-stroke . Of the 33 participants who completed the study , 10 received training of reaching using a non-robotic upper limb training device , the SMART Arm , with EMG triggered functional electrical stimulation ( EMG-stim ) , 13 received training of reaching using the SMART Arm alone , and 10 received no intervention . Each intervention group engaged in 12 1-h training sessions over a 4-week period . Clinical and laboratory measures of upper limb function were administered prior to training ( 0 weeks ) , at completion ( 4 weeks ) and 2 months ( 12 weeks ) after training . The primary outcome measure was ‘ upper arm function ’ which is Item 6 of the Motor Assessment Scale ( MAS ) . Laboratory measures consisted of two multijoint reaching tasks to assess ‘ maximum isometric force ’ and ‘ maximum distance reached ’ . Surface EMG  was used to monitor triceps brachii and biceps brachii during the two reaching tasks . To provide a comparison with normal values , seven healthy adults were tested on one of the reaching tasks according to the same procedure . Study findings demonstrated a statistically significant improvement in upper limb function for stroke participants in the two training groups compared to those who received no training however no difference was found between the two training groups . For the reaching tasks , all stroke participants , when compared to normal healthy adults , exhibited lower triceps and biceps activation and a lower ratio of triceps to biceps activation . Following training , stroke participants demonstrated increased triceps activation and an increased ratio of triceps to biceps activation for the task that was trained . Better performance was associated with greater triceps activation and a higher ratio of triceps to biceps activation . The findings suggest that increased activation of triceps as an agonist and an improved coordination between triceps and biceps could have mediated the observed changes in arm function . The changes in EMG activity were small relative to the changes in arm function indicating that factors , such as the contribution of other muscles of reaching , may also be implicated Cycling training is strongly applied in post-stroke rehabilitation , but how its modular control is altered soon after stroke has been not analyzed yet .  EMG signals from 9 leg muscles and pedal forces were measured bilaterally during recumbent pedaling in 16 post-acute stroke patients and 12 age-matched healthy controls . Patients were asked to walk over a GaitRite mat and st and ard gait parameters  were computed . Four muscle synergies were extracted through nonnegative matrix factorization in healthy subjects and patients unaffected legs . Two to four synergies were identified in the affected sides and the number of synergies significantly correlated with the Motricity Index ( Spearman ’s coefficient = 0.521 ) . The reduced coordination complexity result ed in a reduced biomechanical performance , with the two-module sub-group showing the lowest work production and mechanical effectiveness in the affected side . These patients also exhibited locomotor impairments ( reduced gait speed , asymmetrical stance time , prolonged double support time ) . Significant correlations were found between cycling-based metrics and gait parameters , suggesting that neuro-mechanical quantities of pedaling can inform on walking dysfunctions . Our findings support the use of pedaling as a rehabilitation method and an assessment tool after stroke , mainly in the early phase , when patients can be unable to perform a safe and active gait training Background . Previous research has shown that during simulated activities of daily living , right-h and ed stroke patients use their contralesional arm more after left- than right-hemisphere stroke . These findings were attributed to a h and preference effect . However , these decisions about when to use the contralesional arm may be modulated by where in the work space the task is performed , a factor that could be used in physical rehabilitation to influence recovery by decreasing learned nonuse . Objective . To examine how target location and side of stroke influences arm selection choices for simple reaching movements . Methods . A total of 14 right-h and ed stroke patients ( 7 with left-hemisphere and 7 with right-hemisphere damage [ RHD ] ) , with similar degrees of hemiparesis ( Fugl-Meyer motor score ) , and 16 right-h and ed controls  participated in this experiment . In a pseudor and om fashion , 32 targets were presented throughout the reachable horizontal plane work space , and the participants were asked to select 1 h and to reach the target on each trial . Results . The group with left-hemisphere damage chose their contralesional arm significantly more often than the group with RHD . Patients with RHD also chose their left ( contralesional ) arm significantly less often than the control group . However , these patterns of choice were most pronounced in the center of the workspace . Conclusion . Both the side of hemisphere damage and work space location played a significant role in the choice of whether to use the contralesional arm for reaching . These findings have implication s for structuring rehabilitation for unilateral stroke patients Background After a stroke , patients show significant modifications of neural control of movement , such as abnormal muscle co-activation , and reduced selectivity and modulation of muscle activity . Nonetheless , results reported in literature do not allow to unequivocally explain whether and , in case , how a cerebrovascular accident affects muscle synergies underlying the control of the upper limb . These discrepancies suggest that a complete underst and ing of the modular re-organization of muscle activity due to a stroke is still lacking . This pilot study aim ed at investigating the effects of the conjunction between the natural ongoing of the pathology and the intense robot-mediated treatment on muscle synergies of the paretic upper limb of subacute post-stroke patients . Methods Six subacute patients , homogenous with respect to the age and the time elapsed from the trauma , and ten healthy age-matched subjects were enrolled . The protocol consisted in achieving planar movement of the upper limb while h and ling the end-effector of a robotic platform . Patients underwent 6 weeks long treatment while clinical scores , kinematics of the end-effector and muscle activity were recorded . Then we verified whether muscle coordination underlying the motor task was significantly affected by the cerebrovascular accident and how muscle synergies were modified along the treatment . Results Results show that although muscle synergies in subacute stroke patients were qualitatively comparable to those of healthy subjects , those underlying the movement of the shoulder can reflect the functional deficit induced by the pathology . Moreover , the improvement of motor performance due to the treatment was achieved in conjunction with slight modifications of muscle synergies . In this regard , modifications of muscle synergies appeared to be influenced by the different recovering mechanisms across patients presumably due to the heterogeneity of lesions , sides and location of the accident . Conclusions The results support the hypothesis that muscle synergies reflect the injury of the cerebrovascular accident and could document the effects of the functional recovery due to a suitable and customized treatment . Therefore , they open up new possibilities for the development of more effective neuro-rehabilitation protocol BACKGROUND AND PURPOSE To improve the accuracy of early postonset prediction of motor recovery in the flaccid hemiplegic arm , the effects of change in motor function over time on the accuracy of prediction were evaluated , and a prediction model for the probability of regaining dexterity at 6 months was developed . METHODS In 102 stroke patients , dexterity and paresis were measured with the  Action Research Arm Test , Motricity Index , and Fugl-Meyer motor evaluation .  For model development , 23 c and i date determinants were selected . Logistic regression analysis was used for prognostic factors and model development . RESULTS At 6 months , some dexterity in the paretic arm was found in 38 % , and complete functional recovery was seen in 11.6 % of the patients . Total anterior circulation infa rcts , right hemisphere strokes , homonymous hemianopia , visual gaze deficit , visual inattention , and paresis were statistically significant related to a poor arm function . Motricity Index leg scores of at least 25 points in the first week and Fugl-Meyer arm scores of 11 points in the second week increasing to 19 points in the fourth week raised the probability of developing some dexterity ( Action Research Arm Test > or=10 points ) from 74 % ( positive predictive value [ PPV ] , 0.74 ; 95 % confidence interval [ CI ] , 0.63 to 0.86 ) to 94 % ( PPV , 0.83 ; 95 % CI , 0.76 to 0.91 ) at 6 months . No change in probabilities of prediction dexterity was found after 4 weeks . CONCLUSIONS Based on the Fugl-Meyer scores of the flaccid arm , optimal prediction of arm function outcome at 6 months can be made within 4 weeks after onset . Lack of voluntary motor control of the leg in the first week with no emergence of arm synergies at 4 weeks is associated with poor outcome at 6 months Background and Purpose — A debated subject in stroke rehabilitation relates to the best type of training approach for motor recovery . First , we analyzed the effects of repetitive movement practice in 2 feedback conditions ( knowledge of results [ KR ] ; knowledge of performance , [ KP ] ) on reacquisition of reaching . Second , we evaluated the impact of cognitive impairment on motor relearning ability . Methods — A r and omized controlled clinical trial was conducted in Montreal-area rehabilitation centers between 1998 and 2003 with 37 patients with chronic hemiparesis . Patients were r and omly assigned to 3 groups : ( 1 ) KR ( n=14 ) practice d a reaching task involving 75 repetitions per day , 5 days per week for 2 weeks , with 20 % KR about movement precision ; ( 2 ) KP ( n=14 ) trained on the same task and schedule as KR but with faded KP about joint motions ; and ( 3 ) control ( C ; n=9 ) practice d a nonreaching task .  Physical ( motor impairment , function ) and kinematic ( movement time , precision , segmentation , variability ) variables were assessed before and after ( immediately , 1 month ) practice . Cognitive functions ( memory , attention , mental flexibility , planning ) were also evaluated . Results — Kinematic gains in KR ( precision ) and KP ( time , variability ) exceeded those in C and depended on memory and mental flexibility deficits . In KP , more severely impaired patients made the most clinical gains ( > 2 × C ) , which were related to memory and planning abilities . Conclusions — Use of KP during repetitive movement practice result ed in better motor outcomes . Stroke severity together with cognitive impairments are important factors for choosing motor rehabilitation interventions after stroke OBJECTIVE To compare kinematics of 3-dimensional pointing movements performed in a virtual environment ( VE ) displayed through a head-mounted display with those made in a physical environment . DESIGN Observational study of movement in poststroke and healthy subjects . SETTING Motion analysis laboratory . PARTICIPANTS Adults ( n=15 ; 4 women ; 59+/-15.4y ) with chronic poststroke hemiparesis were recruited . Participants had moderate upper-limb impairment with Chedoke-McMaster Arm Scores ranging from 3 to 6 out of 7 . Twelve healthy subjects ( 6 women ; 53.3+/-17.1y ) were recruited from the community . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Arm and trunk kinematics were recorded in similar virtual and physical environments with an Optotrak System ( 6 markers ; 100Hz ; 5s ) . Subjects pointed as quickly and as accurately as possible to 6 targets ( 12 trials/target in a r and omized sequence ) placed in arm workspace areas requiring different arm movement patterns and levels of difficulty . Movements were analyzed in terms of performance outcome measures ( endpoint precision , trajectory , peak velocity ) and arm and trunk movement patterns ( elbow and shoulder ranges of motion , elbow/shoulder coordination , trunk displacement , rotation ) . RESULTS For healthy subjects , precision and trajectory straightness were higher in VE when pointing to contralateral targets , and movements were slower for all targets in VE . Stroke participants made less accurate and more curved movements in VE and used less trunk displacement . Elbow/shoulder coordination differed when pointing to the lower ipsilateral target . There were no group-by-environment interactions . CONCLUSIONS Movements in both environments were sufficiently similar to consider VE a valid environment for clinical interventions and motor control studies This study , conducted in a group of nine chronic patients with right-side hemiparesis after stroke , investigated the effects of a robotic-assisted rehabilitation training with an upper limb robotic exoskeleton for the restoration of motor function in spatial reaching movements . The robotic assisted rehabilitation training was administered for a period of 6 weeks including reaching and spatial antigravity movements . To assess the carry-over of the observed improvements in movement during training into improved function , a kinesiologic assessment of the effects of the training was performed by means of motion and dynamic electromyographic analysis of reaching movements performed before and after training . The same kinesiologic measurements were performed in a healthy control group of seven volunteers , to determine a benchmark for the experimental observations in the patients ’ group . Moreover degree of functional impairment at the enrolment and discharge was measured by clinical evaluation with upper limb Fugl-Meyer Assessment scale ( FMA , 0–66 points ) , Modified Ashworth scale ( MA , 0–60 pts ) and active ranges of motion . The robot aided training induced , independently by time of stroke , statistical significant improvements of kinesiologic ( movement time , smoothness of motion ) and clinical ( 4.6 ± 4.2 increase in FMA , 3.2 ± 2.1 decrease in MA ) parameters , as a result of the increased active ranges of motion and improved co-contraction index for shoulder extension/flexion . Kinesiologic parameters correlated significantly with clinical assessment values , and their changes after the training were affected by the direction of motion ( inward vs. outward movement ) and position of target to be reached ( ipsilateral , central and contralateral peripersonal space ) . These changes can be explained as a result of the motor recovery induced by the robotic training , in terms of regained ability to execute single joint movements and of improved interjoint coordination of elbow and shoulder joints The aim of the present study was to identify how pathological limb synergies between shoulder and elbow movements interact with compensatory trunk movements during a functional movement with the paretic upper limb after stroke .  3D kinematic joint and trunk angles were measured during a reach-to-grasp movement in 46 patients with stroke and 12 healthy individuals . We used principal component analyses ( PCA ) to identify components representing linear relations between the degrees of freedom of the upper limb and trunk across patients with stroke and healthy participants . Using multivariate logistic regression analysis , we investigated whether component scores were related to the presence or absence of basic limb synergies as indicated by the arm section of the Fugl-Meyer motor assessment  ( FMA ) . Four and three principal components were extracted in patients with stroke and healthy individuals , respectively . Visual inspection revealed that the contribution of joint and trunk angles to each component differed substantially between groups . The presence of the flexion synergy ( Shoulder Abduction and Elbow Flexion ) was reflected by component 1 , whereas the compensatory role of trunk movements for lack of shoulder and elbow movements was reflected by components 2 and 3 respectively . The presence or absence of basic limb synergies as determined by means of the FMA was significantly related to components 2 ( p = 0.014 ) and 3 ( p = 0.003 ) in patients with stroke . These significant relations indicate that PCA is a useful tool to identify clinical ly meaningful interactions between compensatory trunk movements and pathological synergies in the elbow and shoulder during reach-to-grasp after stroke Background . The study investigated whether passive splinting or active motor training as either individualized best conventional therapy or as st and ardized impairment-oriented training ( IOT ) would be superior in promoting motor recovery in subacute stroke patients with mildly or severely paretic arms . Methods . A total of 148 anterior circulation ischemic stroke patients were r and omly assigned to 45 minutes of additional daily arm therapy over 3 to 4 weeks as either ( a ) passive therapy with inflatable splints or active arm motor therapy as either ( b ) individualized best conventional therapy ( CONV ) or ( c ) st and ardized IOT , that is Arm BASIS training for severe paresis or Arm Ability training for mild paresis . Main outcome measures included the following : Fugl-Meyer arm motor score ( severely paretic arms ) and the TEMPA time scores ( mildly affected arms ) . Pre — post ( immediate effects ) and pre—4 weeks follow-up analyses ( long-term effects ) were performed . Results . Overall improvements were documented ( mean baseline and change scores efficacy : Fugl-Meyer , arm motor scores , 24.4 , + 9.1 points ; TEMPA , 119 , −26.6 seconds ; P < .0001 ) , but with no differential effects between splint therapy and the combined active motor rehabilitation groups . Both efficacy and effectiveness analyses indicated , however , bigger immediate motor improvements after IOT as compared with best conventional therapy ( Fugl-Meyer , arm motor scores : IOT + 12.3 , CONV + 9.2 points ; TEMPA : IOT −31.1 seconds , CONV −20.5 seconds ; P = .0363 ) ; for mildly affected patients long-term effects could also be substantiated . Conclusions . Specificity of active training seemed more important for motor recovery than intensity ( therapy time ) . The comprehensive modular IOT approach promoted motor recovery in patients with either severe or mild arm paresis The purpose of this study was to fully characterize the timing and intensity of the phasic portion of the  electromyographic ( EMG ) waveform for reaching movements in vertical planes . Electromyographic activity was simultaneously recorded from nine superficial elbow and /or shoulder muscles while human subjects made rapid arm movements . H and paths comprised 20 directions in a sagittal plane and 20 directions in a frontal plane . In order to focus on the more phasic aspects of muscle activation , estimates of postural EMG activity were subtracted from the EMG traces recorded during rapid reaches . These postural estimates were obtained from activity recorded during very slow reaches to the same targets . After subtraction of this postural activity , agonist or antagonist burst patterns were often observed in the phasic EMG traces . For nearly all muscles and all subjects , the relation between phasic EMG intensity and movement direction was a function with multiple peaks . For all muscles , the timing of phasic EMG bursts varied as a function of movement direction : the data from each muscle exhibited a gradual temporal shift of activity over a certain range of directions . This gradual temporal shift has no obvious correspondence to the mechanical requirements of the task and might represent a neuromuscular control strategy in which burst timing contributes to the specification of movement direction OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity OBJECTIVE To vali date a protocol assessing upper limb kinematics using a planar robot  among stroke patients . DESIGN Prospect i ve cohort study . SUBJECTS Age-matched healthy subjects ( n = 25 ) and stroke patients ( n = 25 ) . METHODS Various kinematic indices ( n = 44 ) were obtained from 4 tasks performed by subjects with REAplan , a planar end-effector robotic device . The metrological properties of this protocol were studied . RESULTS In stroke patients , 43 kinematic indices showed moderate to excellent reliability ( intraclass correlation coefficients ( ICC ) range 0.40 - 0.95 ; and minimal detectable changes range 9.9 - 121.1 % ) . In healthy subjects , 25 kinematic indices showed moderate to excellent reliability ( ICC range 0.40 - 0.91 ) and 3 indices showed a laterality effect ( p < 0.05 ) . Many of these indices ( 27 of 44 ) were altered in stroke patients in comparison with healthy subjects ( p < 0.05 ) . The Box and Block test ( manual dexterity ) and Upper Limb Sub-score of the Fugl-Meyer Assessment ( motor control ) showed moderate to good correlations with , respectively , 13 and 4 indices ( r > 0.40 ) . Finally , a principal component analysis allowed the elaboration of a short version of the protocol , reducing the number of indices to 5 ( i.e. Amplitude , CVstraightness , Speed Metric , CVjerk metric and CVspeed metric ) . CONCLUSION This study provides a st and ardized , valid , reliable and sensitive protocol to quantify upper limb impairments in stroke patients , using a planar robot OBJECTIVE To examine the effects of context on reaching performance in neurologically impaired and intact population s. Context was varied by the presence or absence of objects used to complete a task . DESIGN A counterbalanced repeated- measures design . SETTING A motor control laboratory in a university setting . PARTICIPANTS Fourteen persons with stroke and 25 neurologically intact adults . INTERVENTIONS Each participant was tested under two conditions : the presence of the object , in which the participant reached forward with the impaired arm ( or corresponding arm ) to scoop coins off the table into the other h and ; and the absence of the object , in which the participant reached forward to the place where the coins would be placed in the condition of object present . MAIN OUTCOME MEASURES Kinematic Variables of movement time , total displacement , peak velocity , percentage of reach where peak velocity occurs , and movement units ( derived from acceleration data ) for reaching tasks . RESULTS The condition of using real objects elicited kinematically better performance of reaching movements than the condition of performing movements without relevant objects present . Better performance was reflected by shorter movement time , less total displacement , higher peak velocity , greater percentage of reach where peak velocity occurs , and fewer movement units . CONCLUSION The results of this study showed that the condition of object present elicited better performance of movements represented by kinematic variables than the condition of object absent . The clinical implication is that the use of real and functional objects might be an effective way of facilitating efficient , smooth , and coordinated movement with the impaired arm in persons with stroke . This study , however , should be replicated and extended to confirm the validity of its findings and to allow for generalization in various functional activities Background . By involving additional degrees of freedom , the nervous system may preserve h and trajectories when making pointing movements with or without trunk displacement . Previous studies indicate that the potential contribution of trunk movement to h and displacement for movements made within arm reach is neutralized by appropriate compensatory shoulder and elbow rotations . For beyond-the-reach movements , compensatory coordination is attenuated after the h and peak velocity , allowing trunk movement to contribute to h and displacement . Objective . To investigate if the timing and spatial coordination of arm and trunk movements during beyond-the-reach movements is preserved in stroke . Methods . Eleven healthy control subjects and 11 individuals with mild-to-moderate chronic unilateral hemiparesis participated .  Arm and trunk kinematics during 60 target reaches to an ipsilaterally placed target were recorded . In 30 % of r and omly chosen trials , trunk movement was unexpectedly prevented ( blocked-trunk trials ) by an electromagnetic device , result ing in divergence of the h and trajectory from that in free-trunk trials . H and trajectories and elbow – shoulder interjoint coordination were compared between trials . Results . In stroke participants , h and trajectory divergence occurred at a shorter movement extent and interjoint coordination patterns diverged at a relatively greater distance compared to controls . Thus , arm movements in stroke participants only partially compensated trunk displacement result ing in the trunk movement contributing to arm movement earlier and to a larger extent during reaching . Conclusion . Individuals with mild-to-moderate stroke have deficits in timing and spatial coordination of arm and trunk movements during different parts of a reaching movement . This deficit may be targeted in therapy to improve upper limb function Objective . This preliminary study aims to verify if the method of kinematic analysis proposed here may be suitable for evaluating the effects of constraint-induced movement therapy ( CIMT ) in chronic stroke patients and may be of help in the study of the mechanisms underlying functional improvement following CIMT . Methods . Clinical and kinematic data were collected from a group of chronic stroke patients and from an age-matched healthy control group . Affected and less affected upper-limb kinematics related to h and -to-mouth and reaching movements were acquired before and immediately after 2 weeks of CIMT . Healthy subjects were su bmi tted to kinematic analysis of the nondominant side and reevaluated after 2 weeks . Results . The clinical results were consistent with those reported in the literature and showed motor function improvement of the hemiparetic limb after CIMT . Kinematic data of the healthy control group showed high test-retest reliability . Statistically significant differences between the affected limb and both the less affected limb and the healthy subjects ' nondominant limb were observed . After CIMT , kinematic data showed improvement in the speed of movement and in measures related to the capacity for coordination . Conclusions . The method of kinematic analysis was sensitive for an assessment of motor recovery induced by CIMT . The kinematic results suggest that the increase in the use of the paretic limb in activities of daily living after the intervention is not only attributable to the patient 's increased attention to it and better h and dexterity , but it is also a consequence of the improved speed of movement and better coordination between shoulder and elbow joints The study assessed the effect of velocity of arm movement on anticipatory postural adjustments ( APAs ) generation in the contralateral and ipsilateral muscles of individuals with stroke in seating . Ten healthy and eight post-stroke subjects were studied in sitting . The task consisted in reaching an object placed at scapular plane and mid-sternum height at self-selected and fast velocities .  Electromyography was recorded from anterior deltoid ( AD ) , upper ( UT ) and lower trapezius ( LT ) and latissimus dorsi ( LD ) . While kinematic analysis was used to assess peak velocity and trunk displacement . Differences were found between the timing of APAs on ipsi and contralateral LD and LT in both movement speeds and in ipsilateral UT during movement of the non-affected arm at a self-selected velocity . A delay on the contralateral LD to reach movement with the non-affected arm at fast velocity was also observed . The trunk displacement was greater in post-stroke subjects . Individuals with stroke demonstrated a delay of APAs in the muscles on both sides of the body compared to healthy subjects . The delay was observed during performance of the reaching task with the fast and self-selected velocity Functional cortical reorganisation had been demonstrated to accompany recovery from motor stroke . In agreement with a previous study , quantitative kinematic analysis of aim ed movements in 14 almost completely recovered hemiparetic stroke patients and 14 healthy control subjects indicated a reduced skilfulness of both the more ballistic initial movement phase and the more feedback-guided late homing-in phase of aim ed movements . By means of two dual motor tasks it was further investigated whether the reduced skilfulness of patients was due to an increased attentional dem and and thus a reduced automaticity of motor control . Interference effects by dual tasks , however , were similar for patients and control subjects . Thus , the notion of reduced automaticity could not be supported empirically , and reduced skilfulness seemed rather related to residual pyramidal motor deficits . By means of a repetitive daily training for 1 week based on the Arm Ability Training approach , patients were able to reduce their performance deficits in both movement phases significantly . Whether patients practised with the affected arm or simultaneously with both the affected and non-affected arm only marginally modified outcome , unilateral training being slightly more efficacious . These findings demonstrate that even clinical ly minor residual motor deficits can be improved by a structured training for the affected arm Movement preparation of both anticipatory postural adjustments ( APAs ) and goal directed movement during a st and ing reaching task in adults with chronic hemiparesis and healthy controls was investigated . Using a simple reaction time paradigm , while st and ing on two separate force platforms , subjects received a warning light cue to " get ready to reach " followed 2.5s later by an imperative light cue to " reach as quickly as possible " with the paretic arm ( matched arm for controls ) to touch a target in front of them for a total of 90 trials . In 30 of the reaching trials a loud acoustic stimulus ( LAS ) of 123 dB was r and omly - -200 , or 0ms relative to the " go " cue . APA ( postural ) responses were characterized by the onset and maximal posterior displacement of center of pressure ( CoP ) and onset/offset of electromyography ( EMG ) from tibialis anterior ( TA ) , soleus ( SOL ) , while reach was characterized by onset and maximal forward displacement of the reach h and and onset of the anterior ( AD ) , biceps brachii ( BB ) and middle deltoid ( MD ) . Subjects with stroke , demonstrated a marked reduction in the occurrence of the StartReact responses for both APA and forward reach at all LAS time points indicating movement preparation dysfunction . Movement execution during a cued reach showed significant delays in APA and reach onsets , significant reduction in the magnitude of APA ( posterior CoP displacement ) and reach excursion , and an increased latency between the APA and reach compared to controls . EMG activation patterns for the TA and SOL demonstrated co contraction compared to the temporally sequenced pattern of control subjects . When LAS was provided at the " go " there were earlier but not significant differences in APA onset latency compared to reaching without LAS and significant delays in reach onset latency when compared to control subjects with or without LAS . An early burst of EMG in biceps brachii muscles with a further delay of the reach onset compared to reaching without LAS may be indicative of interference of a classical startle reflex activating elbow flexors . Results indicated impairments in movement preparation of both APA 's and goal directed UE movement in individuals with stroke which impact the functional performance of reaching in the st and ing position
Background : Better upper limb recovery after stroke could be achieved through tailoring rehabilitation interventions directly at movement deficits .
Aim : To identify potential ; targets for therapy by synthesizing findings of differences in kinematics and muscle activity between stroke survivors and healthy adults performing reach-to-target tasks .