Impairments of the arm and hand are highly correlated during subacute stroke
DOI:
https://doi.org/10.2340/jrm.v55.2174Keywords:
stroke, upper extremity, exoskeleton device, ataxiaAbstract
Background: The classical description of poststroke upper limb impairment follows a proximalto-distal impairment gradient. Previous studies are equivocal on whether the hand is more impaired than the arm.
Objective: To compare impairment of the arm and hand during subacute stroke.
Method: A total of 73 individuals were evaluated for impairment of the upper limb within 30 days (early subacute) and within 90–150 days (late subacute) of stroke. Impairments were quantified using the Chedoke-McMaster Stroke Assessment (CMSA) for the arm and hand, Purdue Pegboard task, and a robotic Visually Guided Reaching task.
Results: In the early phase 42% of participants in the early phase and 59% in the late phase received the same CMSA score for the arm and hand, with 88% and 95% of participants in the early and late phases, respectively, receiving a 1-point difference. Strong correlations exist between the CMSA arm and hand scores (early r = 0.79, late r = 0.75), and moderate – strong correlations exist between CMSA arm and hand scores and Purdue Pegboard and Visually Guided Reaching performances (r = 0.66–0.81). No systematic differences were found between the arm and hand.
Conclusion: Impairments in the arm and hand during subacute stroke are highly correlated and do not support the presence of a proximal-to-distal gradient.
LAY ABSTRACT
Motor impairments are a common occurrence after stroke, and are classically believed to present in a gradient from more impairment in the hand to less impairment in the arm. In this study, participants who had recently had a stroke underwent assessment with the Chedoke-McMaster Stroke Assessment, the Purdue Pegboard task, and a Visually Guided Reaching task to quantify impairment and performance of the arm and hand. Levels of impairment in the arm and hand, as measured with the Chedoke-McMaster Stroke Assessment, were found to be highly correlated. The study also showed strong correlations between quantitative measures of performance for both the arm and hand. Overall, our results do not support the presence of a proximal-to-distal gradient of impairment during subacute stroke.
Downloads
References
Nakayama H, Jørgensen HS, Raaschou HO, Olsen TS. Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil 1994; 75: 394–398. DOI: https://doi.org/10.1016/0003-9993(94)90161-9
Hatem SM, Saussez G, Della Faille M, Prist V, Zhang X, Dispa D, et al. Rehabilitation of motor function after stroke: a multiple systematic review focused on techniques to stimulate upper extremity recovery. Front Hum Neurosci 2016; 10: 442. DOI: https://doi.org/10.3389/fnhum.2016.00442
Kapandji I. The upper limb as logistical support for the hand. The Hand 1981; 1: 94–106.
Twitchell T. The restoration of motor function following hemiplegia in man. Brain 1951; 74: 443–480. DOI: https://doi.org/10.1093/brain/74.4.443
Muellbacher W, Richards C, Ziemann U, Wittenberg G, Weltz D, Boroojerdi B, et al. Improving hand function in chronic stroke. Arch Neurol 2002; 59: 1278–1282. DOI: https://doi.org/10.1001/archneur.59.8.1278
Colebatch J, Gandevia S. The distribution of muscular weakness in upper motor neuron lesions affecting the arm. Brain 1989; 112: 749–763. DOI: https://doi.org/10.1093/brain/112.3.749
Saladin L, Fredericks C. Cerebrovascular disease: stroke. In: Saladin, LK, Fredericks, CM, editors. Pathophysiology of the motor systems: principles and clinical presentations. Philadelphia, PA: F.A. Davis company; 1996, 486–512.
Palmer E, Ashby P. Corticospinal projections to upper limb motoneurones in humans. J Physiol 1992; 448: 397–412. DOI: https://doi.org/10.1113/jphysiol.1992.sp019048
Sanes JN, Donoghue JP, Thangaraj V, Edelman RR, Warach S. Shared neural substrates controlling hand movements in human motor cortex. Science 1995; 268: 1775–1777. DOI: https://doi.org/10.1126/science.7792606
Isa T, Mitsuhashi M, Yamaguchi R. Alternative routes for recovery of hand functions after corticospinal tract injury in primates and rodents. Current Opin Neurol 2019; 32: 836–843. DOI: https://doi.org/10.1097/WCO.0000000000000749
Porter R, Lemon R. Corticospinal function and voluntary movement. New York, NY: Oxford University Press; 1993.
Rathelot J-A, Strick PL. Subdivisions of primary motor cortex based on cortico-motoneuronal cells. Proc Nat Acad Sci 2009; 106: 918–923. DOI: https://doi.org/10.1073/pnas.0808362106
Schambra HM, Xu J, Branscheidt M, Lindquist M, Uddin J, Steiner L, et al. Differential poststroke motor recovery in an arm versus hand muscle in the absence of motor evoked potentials. Neurorehabil Neural Repair 2019; 33: 568–580. DOI: https://doi.org/10.1177/1545968319850138
Lang CE, Beebe JA. Relating movement control at 9 upper extremity segments to loss of hand function in people with chronic hemiparesis. Neurorehabil Neural Repair 2007; 21: 279–291. DOI: https://doi.org/10.1177/1545968306296964
Andrews AW, Bohannon RW. Distribution of muscle strength impairments following stroke. Clin Rehabil 2000; 14: 79–87. DOI: https://doi.org/10.1191/026921500673950113
Beebe JA, Lang CE. Absence of a proximal to distal gradient of motor deficits in the upper extremity early after stroke. Clin Neurophysiol 2008; 119: 2074–2085. DOI: https://doi.org/10.1016/j.clinph.2008.04.293
Gowland C, Stratford P, Ward M, Moreland J, Torresin W, Hullenaar SV, et al. Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment. Stroke 1993; 24: 58–63. DOI: https://doi.org/10.1161/01.STR.24.1.58
Tiffin J, Asher EJ. The Purdue pegboard; norms and studies of reliability and validity. J Appl Psychol 1948; 32: 234–247. DOI: https://doi.org/10.1037/h0061266
Coderre AM, Abou Zeid A, Dukelow SP, Demmer MJ, Moore KD, Demers MJ, et al. Assessment of upper-limb sensorimotor function of subacute stroke patients using visually guided reaching. Neurorehabil Neural Repair 2010; 24: 528–541. DOI: https://doi.org/10.1177/1545968309356091
Eng JJ, Bird M-L, Godecke E, Hoffmann TC, Laurin C, Olaoye OA, et al. Moving stroke rehabilitation research evidence into clinical practice: consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2019; 14: 766–773. DOI: https://doi.org/10.1177/1747493019873597
Mostafavi SM, Glasgow JI, Dukelow SP, Scott SH, Mousavi P. Prediction of stroke-related diagnostic and prognostic measures using robot-based evaluation. 2013 IEEE 13th International Conference on Rehabilitation Robotics (ICORR) 2013; 1–6. DOI: https://doi.org/10.1109/ICORR.2013.6650457
Semrau JA, Herter TM, Scott SH, Dukelow SP. Examining differences in patterns of sensory and motor recovery after stroke with robotics. Stroke 2015; 46: 3459–3469. DOI: https://doi.org/10.1161/STROKEAHA.115.010750
Mostafavi SM, Dukelow SP, Glasgow JI, Scott SH, Mousavi P. Reduction of stroke assessment time for visually guided reaching task on KINARM exoskeleton robot. 2014 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society 2014; 5296–5299. DOI: https://doi.org/10.1109/EMBC.2014.6944821
Box GE, Cox DR. An analysis of transformations. J Roy Statist Soc 1964; 26: 211–243. DOI: https://doi.org/10.1111/j.2517-6161.1964.tb00553.x
Simmatis L, Krett J, Scott SH, Jin AY. Robotic exoskeleton assessment of transient ischemic attack. PLOS One 2017; 12: e0188786. DOI: https://doi.org/10.1371/journal.pone.0188786
Kinarm. Dexterit-E 3.9 user guide. 2021; Kingston, ON, Canada 2021.
Bishara AJ, Hittner JB. Confidence intervals for correlations when data are not normal. Behav Res Meth 2017; 49: 294–309. DOI: https://doi.org/10.3758/s13428-016-0702-8
Koo TK, Li MY. A Guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 2016; 15: 155–163. DOI: https://doi.org/10.1016/j.jcm.2016.02.012
Barreca SR, Stratford PW, Lambert CL, Masters LM, Streiner DL. Test-retest reliability, validity, and sensitivity of the chedoke arm and hand activity inventory: a new measure of upper-limb function for survivors of stroke. Arch Phys Med Rehabil 2005; 86: 1616–1622. DOI: https://doi.org/10.1016/j.apmr.2005.03.017
Chestnut C, Haaland KY. Functional significance of ipsilesional motor deficits after unilateral stroke. Arch Phys Med Rehabil 2008; 89: 62–68. DOI: https://doi.org/10.1016/j.apmr.2007.08.125
Semrau JA, Herter TM, Kenzie JM, Findlater SE, Scott SH, Dukelow SP. Robotic characterization of ipsilesional motor function in subacute stroke. Neurorehabil Neural Repair 2017; 31: 571–582. DOI: https://doi.org/10.1177/1545968317704903
Brunnstrom S. Movement therapy in hemiplegia. A neurophysiological approach. Open Journal of Nursing 1970: 113–122.
Birchenall J, Térémetz M, Roca P, Lamy J-C, Oppenheim C, Maier MA, et al. Individual recovery profiles of manual dexterity, and relation to corticospinal lesion load and excitability after stroke –a longitudinal pilot study. Neurophysiol Cliniq 2019; 49: 149–164. DOI: https://doi.org/10.1016/j.neucli.2018.10.065
Maraka S, Jiang Q, Jafari-Khouzani K, Li L, Malik S, Hamidian H, et al. Degree of corticospinal tract damage correlates with motor function after stroke. Ann Clin Transl Neurol 2014; 1: 891–899. DOI: https://doi.org/10.1002/acn3.132
Pineiro R, Pendlebury S, Smith S, Flitney D, Blamire A, Styles P, et al. Relating MRI changes to motor deficit after ischemic stroke by segmentation of functional motor pathways. Stroke 2000; 31: 672–679. DOI: https://doi.org/10.1161/01.STR.31.3.672
Li S, Chen Y-T, Francisco GE, Zhou P, Rymer WZ. A unifying pathophysiological account for post-stroke spasticity and disordered motor control. Front Neurol 2019; 10: 468. DOI: https://doi.org/10.3389/fneur.2019.00468
Hammerbeck U, Tyson SF, Samraj P, Hollands K, Krakauer JW, Rothwell J. The strength of the corticospinal tract not the reticulospinal tract determines upper-limb impairment level and capacity for skill-acquisition in the sub-acute post-stroke period. Neurorehabil Neural Repair 2021; 35: 812–822. DOI: https://doi.org/10.1177/15459683211028243
Maitland S, Baker SN. Ipsilateral motor evoked potentials as a measure of the reticulospinal tract in age-related strength changes. Front Aging Neurosci 2021; 13: 612352. DOI: https://doi.org/10.3389/fnagi.2021.612352
Balasubramanian S, Colombo R, Sterpi I, Sanguineti V, Burdet E. Robotic assessment of upper limb motor function after stroke. Am J Phys Med Rehabil 2012; 91: S255–S269. DOI: https://doi.org/10.1097/PHM.0b013e31826bcdc1
Hidler J, Nichols D, Pelliccio M, Brady K. Advances in the understanding and treatment of stroke impairment using robotic devices. Top Stroke Rehabil 2005; 12: 22–35. DOI: https://doi.org/10.1310/RYT5-62N4-CTVX-8JTE
Otaka E, Otaka Y, Kasuga S, Nishimoto A, Yamazaki K, Kawakami M, et al. Clinical usefulness and validity of robotic measures of reaching movement in hemiparetic stroke patients. J Neuroeng Rehabil 2015; 12: 66. DOI: https://doi.org/10.1186/s12984-015-0059-8
Scott SH, Dukelow SP. Potential of robots as next-generation technology for clinical assessment of neurological disorders and upper-limb therapy. J Rehabil Res Dev 2011; 48: 335–353. DOI: https://doi.org/10.1682/JRRD.2010.04.0057
Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scand J Rehabil Med 1975; 7: 13–31. DOI: https://doi.org/10.2340/1650197771331
Published
How to Cite
License
Copyright (c) 2023 Lydia N. Reid, Sean P. Dukelow, Stephen H Scott
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.
