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Clinical Trial
. 2012 Jul 23:9:44.
doi: 10.1186/1743-0003-9-44.

Influence of gravity compensation training on synergistic movement patterns of the upper extremity after stroke, a pilot study

Thijs Krabben  1 , Gerdienke B Prange, Birgit I Molier, Arno H A Stienen, Michiel J A Jannink, Jaap H Buurke, Johan S Rietman
Affiliations
Clinical Trial

Influence of gravity compensation training on synergistic movement patterns of the upper extremity after stroke, a pilot study

Thijs Krabben et al. J Neuroeng Rehabil. .

Abstract

Background: The majority of stroke patients have to cope with impaired arm function. Gravity compensation of the arm instantaneously affects abnormal synergistic movement patterns. The goal of the present study is to examine whether gravity compensated training improves unsupported arm function.

Methods: Seven chronic stroke patients received 18 half-hour sessions of gravity compensated reach training, in a period of six weeks. During training a motivating computer game was played. Before and after training arm function was assessed with the Fugl-Meyer assessment and a standardized, unsupported circle drawing task. Synergistic movement patterns were identified based on concurrent changes in shoulder elevation and elbow flexion/extension angles.

Results: Median increase of Fugl-Meyer scores was 3 points after training. The training led to significantly increased work area of the hemiparetic arm, as indicated by the normalized circle area. Roundness of the drawn circles and the occurrence of synergistic movement patterns remained similar after the training.

Conclusions: A decreased strength of involuntary coupling might contribute to the increased arm function after training. More research is needed to study working mechanisms involved in post stroke rehabilitation training. The used training setup is simple and affordable and is therefore suitable to use in clinical settings.

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Figures

Figure 1
Figure 1
Training setup with FurballHunt and Freebal.
Figure 2
Figure 2
Typical example of circles drawn before (Pre) and after (Post) training. Roundness (Rness) is calculated as the quotient of the length of the minor axis (Rminor) and the major axis (Rmajor) of the fitted ellipse (green).
Figure 3
Figure 3
Visual representation of the joint angles of the upper arm. Arrows indicate positive rotations. EP = Elevation Plane, EA = Elevation Angle, AR = Axial rotation, EF = Elbow Flexion.
Figure 4
Figure 4
Level of gravity compensation in % of the arm weight (left) and training intensity (right) throughout the training. Blue solid lines are median values. Red dashed lines indicate 25th and 75th percentile.
Figure 5
Figure 5
Scores of the proximal part of the upper extremity part of the Fugl-Meyer assessment (FMp) per subject and group before (Pre) and after (Post) training. Changes in FMp are displayed above the bars. † Indicates a statistically significant change.
Figure 6
Figure 6
Normalized circle area (normA) per subject and group mean before (Pre) and after (Post) training. Changes in normA are displayed above the bars. † Indicates a statistically significant change.
Figure 7
Figure 7
Roundness (Rness) of the circles drawn before (Pre) and after (Post) training.
Figure 8
Figure 8
Joint excursions during circle drawing before (Pre) and after (Post) training. EP = Elevation Plane, EA = Elevation Angle, AR = Axial Rotation, EF = Elbow Flexion/extension. † Indicates a statistically significant change.
Figure 9
Figure 9
Occurence of synergistic movement patterns before (Pre) and after (Post) training.
See this image and copyright information in PMC

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