Quantifying Quality of Reaching Movements Longitudinally Post-Stroke: A Systematic Review

Abstract

Background: Disambiguation of behavioral restitution from compensation is important to better understand recovery of upper limb motor control post-stroke and subsequently design better interventions. Measuring quality of movement (QoM) during standardized performance assays and functional tasks using kinematic and kinetic metrics potentially allows for this disambiguation.

Objectives: To identify longitudinal studies that used kinematic and/or kinetic metrics to investigate post-stroke recovery of reaching and assess whether these studies distinguish behavioral restitution from compensation.

Methods: A systematic literature search was conducted using the databases PubMed, Embase, Scopus, and Wiley/Cochrane Library up to July 1st, 2020. Studies were identified if they performed longitudinal kinematic and/or kinetic measurements during reaching, starting within the first 6 months post-stroke.

Results: Thirty-two longitudinal studies were identified, which reported a total of forty-six different kinematic metrics. Although the majority investigated improvements in kinetics or kinematics to quantify recovery of QoM, none of these studies explicitly addressed the distinction between behavioral restitution and compensation. One study obtained kinematic metrics for both performance assays and a functional task.

Conclusions: Despite the growing number of kinematic and kinetic studies on post-stroke recovery, longitudinal studies that explicitly seek to delineate between behavioral restitution and compensation are still lacking in the literature. To rectify this situation, future studies should measure kinematics and/or kinetics during performance assays to isolate restitution and during a standardized functional task to determine the contributions of restitution and compensation.

Keywords: behavioral restitution; biomechanics; compensation; kinematics; longitudinal studies; reaching; recovery; stroke; systematic review; upper extremity.

Figure 1.

PRISMA flow diagram of included studies.

Figure 2.

(A) (adapted from Van Kordelaar et al, 2014) Reaching trajectories of the hand of one patient in weeks 1, 5, and 26 after stroke onset. Patients move their hand from the start position to a block, in this figure visualized as a black square. Each trace represents one reach-to-grasp movement. (B) (adapted from Rohrer et al, 2004) Typical velocity profile of a stroke patient during a point-to-point movement at the first day of therapy and after 4–6 weeks of therapy.

Figure 3.

Percentage of studies which investigated a particular metric. ‘Yes’ (green) denotes the percentage of studies that included the metric in their analysis.