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. 2018 Aug 12:5:2055668318779301.
doi: 10.1177/2055668318779301. eCollection 2018 Jan-Dec.

Strong relations of elbow excursion and grip strength with post-stroke arm function and activities: Should we aim for this in technology-supported training?

Sharon M Nijenhuis  1   2 , Gerdienke B Prange-Lasonder  1   2 , Judith Fm Fleuren  1 , Jan Wagenaar  1   3 , Jaap H Buurke  1   4   5 , Johan S Rietman  1   2   4
Affiliations

Strong relations of elbow excursion and grip strength with post-stroke arm function and activities: Should we aim for this in technology-supported training?

Sharon M Nijenhuis et al. J Rehabil Assist Technol Eng. .

Abstract

Objective: To investigate the relationships between an extensive set of objective movement execution kinematics of the upper extremity and clinical outcome measures in chronic stroke patients: at baseline and after technology-supported training at home.

Methods: Twenty mildly to severely affected chronic stroke patients participated in the baseline evaluation, 15 were re-evaluated after six weeks of intensive technology-supported or conventional arm/hand training at home. Grip strength, 3D motion analysis of a reach and grasp task, and clinical scales (Fugl-Meyer assessment (FM), Action Research Arm Test (ARAT) and Motor Activity Log (MAL)) were assessed pre- and post-training.

Results: Most movement execution parameters showed moderate-to-strong relationships with FM and ARAT, and to a smaller degree with MAL. Elbow excursion explained the largest amount of variance in FM and ARAT, together with grip strength. The only strong association after training was found between changes in ARAT and improvements in hand opening (conventional) or grip strength (technology-supported).

Conclusions: Elbow excursion and grip strength showed strongest association with post-stroke arm function and activities. Improved functional ability after training at home was associated with increased hand function. Addressing both reaching and hand function are indicated as valuable targets for (technological) treatment applications to stimulate functional improvements after stroke.

Keywords: Stroke; clinical outcome measures; kinematics; reaching and grasping; recovery of function; upper extremity.

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Conflict of interest statement

The author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Measurement setup during reach and grasp task.
Figure 2.
Figure 2.
Four phases of the reach and grasp task. Shown is the velocity profile (mm/s) of the hand marker. The blue dot and square represent the start and end of the reach to grasp phase, respectively. MCP3: metacarpophalangeal 3.
Figure 3.
Figure 3.
Joint angles of the shoulder and marker positions. Source: adapted from Krabben et al. EP: elevation plane, EA: elevation angle, AR: axial rotation; PX: processus xiphoideus; C7: 7th cervical vertebra; T8: 8th thoracal vertebra; Th: thorax markers on a triangular frame with Th1 = upper marker on incisura jugularis, Th2 = middle marker on sternum, Th3 = lower marker on sternum; AC: acromioclavicular joint; EL: lateral epicondyle; EM2: medial epicondyle (proximal marker on pointer); EM1: medial epicondyle (distal marker on pointer); US: ulnar styloid; RS: radial styloid; MCP3: metacarpophalangeal 3; FT1: distal phalanx of the thumb; FT3: distal phalanx of the third finger.
Figure 4.
Figure 4.
Scatterplots of Fugl-Meyer score with elbow excursion (left) and Action Research Arm Test with Grip strength (right).
See this image and copyright information in PMC

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