In vivo three-dimensional mandibular kinematics and functional point trajectories during temporomandibular activities using 3d fluoroscopy.

OBJECTIVES: To measure in vivo three-dimensional kinematics of the mandible and associated end-point trajectories and to quantify their relationships during temporomandibular joint activities using 3D fluoroscopy. METHODS: A novel fluoroscopy-based 3D measurement method was used to measure motions of the mandible and the associated end points (i.e. incisors and lateral poles of both condyles) during open close, lateral gliding and protrusion-retraction movements in healthy young individuals. The contributions of each of the rotational and translational components of the mandible to the end-point trajectories were quantified through experiment-based computer simulations. RESULTS: The mandibular rotation was found to account for 91% of the maximal mouth-opening-capacity and 73% of the maximal lateral incisor movement, while the condylar translation contributed to 99% of the anterior protrusion distance. Incisor trajectories were nearly vertical within the first 60% of the maximal opening during the open-close movement. CONCLUSIONS: Similar condylar downward rotation paths but with bilaterally asymmetrical ranges were used to perform basic mandibular movements of different targeted TI trajectories in three dimensions, that is, open-close, lateral-gliding and protrusion-retraction. Mandibular rotations contributed to the majority of the principal displacement components of the incisor, that is, vertical during open-close and towards the working-side-during lateral-gliding, while mandibular translation contributed mainly to the forward movement of the incisor during protrusion-retraction. Owing to the anatomical constraints, the freedom of mandibular translation is limited and mainly in the anteroposterior direction, which is considered helpful for the control and stability of the TMJ during oral activities.

Lower limb kinematics of unicompartmental knee arthroplasty individuals during stair ascent.

OBJECTIVE: Purpose of the study was to compare lower-limb kinematics and interlimb asymmetry during stair ascent in individuals post-medial or lateral unicompartmental knee arthroplasty (UKA). METHODS: 60 patients (20 medial; 10 lateral) post-UKA and 30 matched healthy controls performed stair ascent. Spatio-temporal, lower-limb kinematics and interlimb asymmetries during stair ascent were compared. RESULTS: Medial-UKA group displayed 5° less knee extension of the UKA limb than controls (p = 0.005) and 2° less than the contralateral limb during stance phase. No interlimb asymmetries were found for lateral-UKA. CONCLUSION: Patients post-UKA demonstrate satisfactory lower-limb kinematics and minimal interlimb asymmetry during stair ascent compared to healthy individuals.

Patient-specific instrumentation improves functional kinematics of minimally-invasive total knee replacements as revealed by computerized 3D fluoroscopy.

BACKGROUND AND OBJECTIVES: Minimally-invasive total knee arthroplasty (MIS-TKA) has demonstrated very good short-term success, but its mid- to long-term results remain inconclusive. The success may be related to the tradeoff between a small incision and accurate positioning of the implant components. Patient-specific instrumentation (PSI) aims to improve the accuracy in restoring the knee axis and the clinical outcomes for MIS-TKA, but the results are yet to be confirmed by accurate assessment during functional activities. The purpose of the current study was to measure and compare the in vivo three-dimensional (3D) rigid-body and surface kinematics of MIS-TKA implanted with and without PSI during isolated knee active flexion/extension and sit-to-stand using state-of-the-art 3D model-based fluoroscopy technology. METHODS: Ten patients treated for advanced medial knee osteoarthritis by MIS-TKA without PSI (non-PSI group) and nine with PSI (PSI group) participated in the current study. Each subject performed non-weight-bearing knee flexion/extension and sit-to-stand tasks while the motion of the prosthetic knee was under bi-plane fluoroscopy surveillance. The computer models of each of the knee prosthesis components were registered to the measured fluoroscopy images for each time frame via a novel validated 3D fluoroscopy method. Non-parametric 1-tailed Mann-Whitney tests were performed to detect the differences in the joint and surface kinematic variables every 10° of knee flexion between the non-PSI and PSI groups. The 1-tailed significance level was at α = 0.05. RESULTS: The PSI group showed clear, coupled flexion/internal rotation during activities, while the non-PSI group remained roughly at an externally rotated position with slight internal rotations. The coupled rotation in the PSI group was accompanied by an anterior displacement of the medial contact and a posterior displacement of the lateral contact, which was different from the screw-home mechanism. Neither of the two groups showed the normal roll-back phenomenon, i.e., posterior translation of the femur relative to the tibia during knee flexion. CONCLUSIONS: With the state-of-the-art 3D fluoroscopy method, differences in both the rigid-body and surface kinematics of the prosthetic knees between MIS-TKA with and without PSI were identified. Patients with PSI demonstrated significant positive effects on the reconstructed rigid-body kinematics of the knee, showing clearer coupled flexion/internal rotations - an important kinematic characteristic in healthy knees - than those without PSI during activities with or without weight-bearing. However, none of them showed normal contact patterns. The current findings will be helpful for surgical instrument design, as well as for surgical decision-making in MIS total knee arthroplasty.

Postural control of individuals with spinal fusion for adolescent idiopathic scoliosis.

BACKGROUND: The purpose of the study was to assess the postural stability and complexity of postural control for moderately physically active individuals with spinal fusion for adolescent idiopathic scoliosis at two years post-operation. METHODS: Limit of stability test and sensory organization test were conducted for 10 moderately physically-active participants with spinal fusion and 10 controls pair-matched for mass, height and physical activity level. During the limit of stability test, participants were instructed to lean the center of gravity as far as possible toward 8 predetermined directions and the maximum excursion and direction control were analyzed. During the sensory organization test, participants were instructed to maintain as still as possible in six test conditions and equilibrium scores and sway area of center of pressure were analyzed. Multi-scale entropy of center of pressure was calculated to quantify sway complexity. FINDINGS: Most postural stability outcomes of spinal fusion participants were comparable to controls except for significantly reduced equilibrium scores (p = 0.039, partial η2 = 0.217). Moreover, spinal fusion participants exhibited tendencies of reduced direction control (p = 0.053) during the limit of stability test and greater sway area (p = 0.052) during the sensory organization test. INTERPRETATION: Although the center of gravity control might be affected, spinal fusion individuals who were moderately physically active likely progressively learned to adapt postoperatively to their fused spine to meet the postural demands required when performing physical movements. We suggest that spinal fusion is a satisfactory treatment in regard to the recovery of postural stability.

Knee strength, power and stair performance of the elderly 5 years after unicompartmental knee arthroplasty.

BACKGROUND: Unicompartmental knee arthroplasty (UKA) has been shown to demonstrate some satisfactory short-term outcomes. However, to our knowledge, there have been no reports on midterm or long-term knee extensor strength and leg extensor power post-UKA. AIMS: Therefore, the purposes of this study were: (1) to assess the isokinetic knee extensor strength, leg extensor power and stair performance of elderly participants at 5 years UKA post-operation; (2) to compare the differences in knee extensor strength and leg extensor power between the UKA and contralateral healthy limbs. METHODS: Nineteen elderly participants (75 ± 5 years) who had a medial or a lateral compartment UKA at 5 years post-operation were recruited. The isokinetic knee extensor strength and leg extensor power were measured. The stair performance was tested on a 4-step stair, and ascent and descent velocities were calculated. The pain level was assessed. RESULTS: The UKA limbs' knee extensor strength and leg extensor power were 1.01 ± 0.39 Nm/kg and 0.98 ± 0.27 W/kg, respectively. The stair ascent and descent velocities were 0.37 ± 0.07 and 0.38 ± 0.11 m/s, respectively. In addition, the UKA limbs exhibited comparable knee strength and leg power relative to the contralateral limbs. DISCUSSION: In general, the knee extensor strength and leg extensor power exhibited by the UKA limbs at 5 years post-operation may be typical in comparison with the normative data. CONCLUSIONS: We suggest that UKA is a satisfactory treatment in regard to the recovery of knee strength, leg power and ability to climb up and down stairs.

Effects of Jaw Clenching and Jaw Alignment Mouthpiece Use on Force Production During Vertical Jump and Isometric Clean Pull.

Allen, CR, Fu, Y-C, Cazas-Moreno, V, Valliant, MW, Gdovin, JR, Williams, CC, and Garner, JC. Effects of jaw clenching and jaw alignment mouthpiece use on force production during vertical jump and isometric clean pull. J Strength Cond Res 32(1): 237-243, 2018-This study examined the effects of jaw clenching, a self-adapted, jaw-repositioning mouthpiece on force production during maximum countermovement vertical jump and maximum isometric midthigh clean pull assessments in an attempt to determine any ergogenic effect attributable to clenching, jaw-repositioning mouthpiece use, or the combination of both. Thirty-six male subjects performed vertical jump and isometric clean pull assessments from a force platform under various mouthpiece and clench conditions. A 3 × 2 (mouthpiece × clench) repeated-measures analysis of variance was conducted to analyze each of the following force production variables for both assessments: peak force, normalized peak force, and rate of force development. In addition, jump height was analyzed for the vertical jump. Results revealed improvements in peak force (F1,35 = 15.84, p ≤ 0.001, (Equation is included in full-text article.)= 0.31), normalized peak force (F1,35 = 16.28, p ≤ 0.001, (Equation is included in full-text article.)= 0.32), and rate of force development (F1,35 = 12.89, p = 0.001, (Equation is included in full-text article.)= 0.27) during the isometric clean pull assessment when participants maximally clenched their jaw, regardless of mouthpiece condition. There were no statistically significant differences in jump height, peak force, normalized peak force, or rate of force development during the vertical jump for any treatment condition. This study supports previous research demonstrating that the implementation of remote voluntary contractions such as jaw clenching can lead to concurrent activation potentiation and a resulting ergogenic effect during activities involving and requiring high-force production.

Intratrunk Coordination During High-Effort Treadmill Running in Individuals With Spinal Fusion for Adolescent Idiopathic Scoliosis.

The purpose of the study was to determine if the intratrunk coordination of axial rotation exhibited by individuals with spinal fusion for adolescent idiopathic scoliosis (SF-AIS) during running varies from healthy individuals and how the coordination differs among adjacent trunk-segment pairs. Axial rotations of trunk segments (upper, middle, lower trunk) and pelvis were collected for 11 SF-AIS participants and 11 matched controls during running. Cross-correlation determined the phase lag between the adjacent segment motions. The coupling angle was generated using the vector coding method and classified into 1 of the 4 major, modified coordination patterns: in-phase, anti-phase, superior, and inferior phase. Two-way, mixed-model ANCOVA was employed to test phase lag, cross-correlation r, and time spent in each major coordination pattern. A significantly lower phase lag for SF-AIS was observed compared with controls. Qualitatively, there was a tendency that SF-AIS participants spent less time in anti-phase for middle-lower trunk and lower trunk-pelvis coordinations compared to controls. Phase lag and anti-phase time was significantly increased from cephalic to caudal segment pairs, regardless of group. In conclusion, SF-AIS participants and controls displayed similar patterns of intra-trunk coordination; however, the spinal fusion hindered decoupling of intra-trunk motions particularly between the lower trunk-pelvic motion.

Pelvic limb kinematics in the dog with and without a stifle orthosis.

OBJECTIVE: To report a method of evaluating 3-dimensional joint motion in dogs with a stifle orthosis. STUDY DESIGN: Experimental. ANIMALS: Six healthy dogs. METHODS: Three-dimensional pelvic limb joint motion was recorded with and without a stifle orthosis. Kinematic data were collected from dogs at a walk and trot for the hip, stifle, and tarsus prior to, and after application of, a stifle orthosis. Data were also obtained for the orthosis alone. Comparisons were made between the braced and unbraced limb, and between the braced limb and the orthosis alone. Complete waveforms, kinematic, and temporospatial variables were compared. RESULTS: Gait waveforms differed between braced and unbraced limbs for all joints and planes of motion (P < .05), as well as between the braced stifles and the orthosis alone at both a walk and trot. However, joint ROM was inconsistently altered. The effect of bracing on stifle ROM was limited to a reduced extension at the end of stance. Adjacent joint ROM was affected by the stifle orthosis. Temporospatial variables were predominantly affected while walking. CONCLUSIONS: The restrictive motion of the stifle orthosis is not fully translated to the underlying joint, based on the limited differences between the motion of braced and unbraced stifles. This effect varies with plane of motion and phase of the gait cycle, with most changes in stifle motion being detected during the stance phase. The stifle orthosis had an equal or greater effect on the motion of adjacent joints, especially the tarsus.

Early motor skill competence as a mediator of child and adult physical activity.

OBJECTIVE: In order to effectively promote physical activity (PA) during childhood, and across the lifespan, a better understanding of the role of early motor skill development on child and adult PA is needed. METHODS: Here, we propose a conceptual model delineating the hypothesized influence of motor skill development on child and adult PA, while providing an overview of the current empirical research related to this model. RESULTS: There is consistent and emerging evidence showing that adequate motor skill competence, particularly locomotor and gross motor skills, is associated with increased PA levels during the preschool, child, and adolescent years, with early motor skill development also influencing enjoyment of PA as well as long-term PA and motor skill performance. The physical education setting appears to be a well-suited environment for motor skill development. CONCLUSION: Employing appropriate strategies to target motor skill development across the childhood years is of paramount interest in helping shape children's PA behavior, their experiences related to PA, as well as maintain their PA.

The Effect of Examiner Variability on Multiple Canine Stifle Kinematic Gait Collections in a 3-Dimensional Model.

OBJECTIVE: To evaluate examiner variability in a superficial skin marker model of canine stifle kinematics. STUDY DESIGN: Experimental. ANIMALS: Six clinically normal dogs. METHODS: Dogs had 11 retroreflective markers fixed to the skin on the right hindlimb. Dogs were trotted 5 times through the calibrated testing space and this was repeated on 4 different testing days. Examiner A applied all markers to a dog and collected 6 good trials for analysis. The markers were then removed and Examiner B immediately repeated the process on the same dog. This was repeated for each dog on the 4 testing days. The dogs were trotted at a velocity of 1.70-2.10 m/s through the testing space to obtain the dynamic data sets. Comparisons were performed with Fourier analysis and Generalized Indicator Function Analysis (GIFA). Significance was set at P < .05 for all comparisons. RESULTS: Fourier analysis and GIFA found differences within and between examiners. Fourier analysis found no differences in sagittal and transverse planes for the experienced (A) and novice examiner (B), respectively. Fourier analysis detected fewer differences for the experienced examiner (A). CONCLUSION: Variability occurs within and between examiners using the same kinematic model. Transverse and frontal plane kinematics produce variable results between examiners. Prior experience with the model reduces the amount of variability and results in consistent and repeatable sagittal plane kinematic data collection.

Knee moments after unicompartmental knee arthroplasty during stair ascent.

BACKGROUND: For unicompartmental knee arthroplasty (UKA), abnormal loading on the tibiofemoral joint could exacerbate knee osteoarthritis or implant wear. Joint moments are an indirect measure of such loading. However, little is known about knee moments of patients with UKA, tempering enthusiasm for its use. QUESTIONS/PURPOSES: In patients with UKAs performing stair ascent, we (1) determined whether interlimb differences for knee moments are demonstrated, (2) described the knee kinetics of patients with medial and lateral UKAs, and (3) investigated possible factors that might influence the knee abductor moments. METHODS: In our cross-sectional study, we recruited 26 patients with UKA with nondiseased contralateral limbs who performed stair ascent. Seventeen patients had medial UKAs and nine had lateral UKAs. Paired t-tests and CIs were applied to determine interlimb differences within each UKA group for peak knee moments and times to peak moments. RESULTS: During stair ascent, the medial UKA group displayed greater peak extensor moments for the nondiseased compared to the UKA limb (p = 0.030), whereas the lateral UKA group did not (p = 0.087). For both medial and lateral UKA groups, the UKA limb demonstrated greater internal peak abductor moments (p = 0.005 and 0.013, respectively). Both UKA groups exhibited knee moments similar to those in the literature. Limb dominance and postoperative time were correlated for both UKA groups. CONCLUSIONS: Reduced knee extensor moments of limbs with UKA displayed by some participants may indicate less compressive loading on the tibiofemoral joint surfaces, whereas the increased abductor moments suggest increased compression on the medial compartment. These findings suggest UKA knees may not be subjected to excessive loads regardless of the side reconstructed.

Comparison of overground and treadmill-based gaits of dogs.

OBJECTIVE: To compare overground and treadmill-based gaits of dogs. ANIMALS: 5 clinically normal adult mixed-breed dogs. PROCEDURES: To obtain dynamic gait data, 30 retroreflective markers were affixed bilaterally to specific regions of the hind limbs and pelvis of each dog. For each dog, 3-D joint motion data (sagittal [flexion and extension], transverse [internal and external rotation], and frontal [abduction and adduction] planes of motion) for the hip, femorotibial, and tarsal joints were acquired during walking and trotting through a calibrated testing space overground or on a treadmill. Comparison of data was performed via generalized indicator function analysis and Fourier analysis. RESULTS: Both overground and treadmill-based gaits produced similar waveforms in all planes of motion. Fourier analysis revealed no difference between overground and treadmill-based gaits in the sagittal plane of motion; however, small differences were detected between overground and treadmill-based gaits in the other 2 planes of motion. Additionally, femorotibial joint motion during walking did not differ among planes of motion. Generalized indicator function analysis was able to detect differences between overground and treadmill-based gait waveforms in all planes of motion for all joints during walking and trotting. CONCLUSIONS AND CLINICAL RELEVANCE: In dogs, overground and treadmill-based gaits produced similar waveform shapes. Of the 3 planes of motion evaluated, only sagittal plane kinematic gait data were unaffected by mode of ambulation as determined via Fourier analysis. Sagittal kinematic gait data collected from dogs during overground or treadmill-based ambulation were comparable. However, analysis methods may affect data comparisons.

Does interlimb knee symmetry exist after unicompartmental knee arthroplasty?

BACKGROUND: Unicompartmental knee arthroplasty (UKA) has long been a treatment option for patients with disease limited primarily to one compartment with small, correctable deformities. However, some surgeons presume that normal kinematics of a lateral compartment UKA are difficult to achieve. Furthermore, it is unclear whether UKA restores normal knee kinematics and interlimb symmetry. QUESTIONS/PURPOSES: We determined knee kinematics exhibited during stair ascent by patients with medial- (MED-UKA) or lateral-UKA (LAT-UKA) and if the knee kinematics of the operated and nonoperated limbs were symmetrical. METHODS: Participants were 17 individuals with MED-UKA and nine with LAT-UKA, all with nondiseased contralateral limbs. For each limb, participants walked up four stairs for five trials while a motion-capture system obtained reflective marker locations. Temporal events were determined by force platform signals. Interlimb symmetry was classified for temporal gait and knee angular kinematics by comparing observed interlimb differences with clinically meaningful differences set at 5% of stride time for temporal variables and 5° for angular variables. The minimum postoperative followup was 6 months (median, 24 months; range, 6-53 months). RESULTS: Neither group demonstrated clinically meaningful mean interlimb differences. However, approximately half of participants of each UKA group displayed asymmetry favoring the operative or nonoperative limb with similar frequency. CONCLUSIONS: Many patients undergoing UKA demonstrate kinematic interlimb symmetry during stair ascent. Interlimb asymmetry may be affected by a variety of factors unrelated to the UKA. CLINICAL RELEVANCE: A MED- or LAT-UKA can potentially restore normal knee function for a demanding task of daily life.

Does wearing a prophylactic ankle brace during drop landings affect lower extremity kinematics and ground reaction forces?

The objective of the study was to determine if prophylactic ankle bracing worn by females during landings produces abnormal lower extremity mechanics. Angular kinematic and ground reaction force (GRF) data were obtained for 16 athletically experienced females who performed brace and no-brace drop landings. The brace condition displayed reduced in/external rotation and flexion displacements about the ankle and knee joints and increased vertical and mediolateral GRF peak magnitudes and rate of vertical GRF application (paired t test, P < .05). The ankle and knee joints landed in a less plantar flexed and more flexed position, respectively. No significant ab/adduction outcomes may have occurred due to interparticipant variability and/or a lack of brace restriction. Conclusion: During typical landings, this lace-up brace increases vertical GRF, decreases ankle and knee joint displacements of flexion and int/external rotation, but minimally affects ab/adduction displacements.

The effect of marker location variability on noninvasive canine stifle kinematics.

OBJECTIVE: Evaluate the effect of marker placement on kinematics of the canine stifle in 3 distinct hindlimb models. STUDY DESIGN: In vivo biomechanical study. ANIMALS: Normal adult mixed-breed dogs (n=5). METHODS: Ten retroreflective markers were affixed to the skin on the right rear leg of each dog to establish normal stifle kinematics. Four additional markers were placed around the greater trochanter (GT), 2 m cranial, caudal, dorsal, and ventral to evaluate single marker placement variability on kinematic model data. Dogs were walked and trotted 5 times through the calibrated space. Sagittal flexion and extension angle waveforms were acquired during each trial with 3 models that were produced simultaneously during each gait. The GT marker was reassigned to 1 of the 4 additional locations (cranial, caudal, dorsal, and ventral) to alter the kinematic model. Comparison of sagittal flexion and extension angle waveforms was performed with Generalized Indicator Function Analysis. RESULTS: Each model provided consistent equivalent sagittal flexion-extension data. Analysis revealed statistically significant differences between all GT locations. The differences were greatest in the cranial and caudal locations for all models. CONCLUSIONS: Deviation of the GT marker in the cranial/caudal direction from an anatomically normal position produces a greater degree of difference than deviation in a dorsal/ventral direction.

Evaluation of a three-dimensional kinematic model for canine gait analysis.

OBJECTIVE: To evaluate a 3-D kinematic model of the hind limb developed by use of a joint coordinate system in dogs. ANIMALS: 6 clinically normal adult mixed-breed dogs. PROCEDURES: 17 retroreflective markers were affixed to the skin on the right hind limb of each dog. Eight infrared cameras were arranged around a gait platform to record marker locations as dogs were recorded moving through the calibrated space 5 times during a walk and trot at velocities of 0.9 to 1.2 m/s and 1.7 to 2.1 m/s, respectively. Local and global coordinate systems were established, and a segmental rigid-body model of the canine hind limb was produced. Dynamic 3-D joint kinematic measurements were collected for the hip, stifle, and tarsal joints. RESULTS: Sagittal (flexion-extension), transverse (internal-external rotation), and frontal (abduction-adduction) plane kinematic measurements were acquired during each trial for the hip, stifle, and tarsal joints. CONCLUSIONS AND CLINICAL RELEVANCE: The joint coordinate system allowed acquisition of 3-D kinematic measurements of the hip, stifle, and tarsal joints of the canine hind limb. Methods were described to model 3-D joint motion of the canine hind limb.

Comparison of canine stifle kinematic data collected with three different targeting models.

OBJECTIVE: To model the kinematics of the canine stifle in 3 dimensions using the Joint Coordinate System (JCS) and compare the JCS method with linear and segmental models. STUDY DESIGN: In vivo biomechanical study. ANIMALS: Normal adult mixed breed dogs (n=6). METHODS: Dogs had 10 retroreflective markers affixed to the skin on the right pelvic limb. Dogs were walked and trotted 5 times through the calibrated space and the procedure was repeated 5 days later. Sagittal flexion and extension angle waveforms acquired during each trial with all 3 models (JCS, Linear, and Segmental) were produced simultaneously during each gait. The JCS method provided additional internal/external and abduction/adduction angles. Comparison of sagittal flexion and extension angle waveforms was performed with generalized indicator function analysis (GIFA) and Fourier analysis. A normalization procedure was performed. RESULTS: Each model provided consistent equivalent sagittal flexion-extension data. The JCS provided consistent additional internal/external and abduction/adduction. Sagittal waveform differences were found between methods and testing days for each dog at a walk and a trot with both GIFA and Fourier analysis. After normalization, differences were less with Fourier analysis and were unaltered with GIFA. CONCLUSIONS: Whereas all methods produced similar flexion-extension waveforms, JCS provided additional valuable data. CLINICAL RELEVANCE: The JCS model provided sagittal plane flexion/extension data as well as internal/external rotation and abduction/adduction data.

Kinematic analysis of a functional and sequential bimanual task in patients with left hemiparesis: intra-limb and interlimb coordination.

PURPOSE: To characterise upper limb performance of each hand (intra-limb coordination) and interlimb coordination on a functional, sequential bimanual task in patients with left hemiparesis and age-matched controls. METHOD: Fourteen patients with left hemiparesis (age: 60.01 +/- 9.09 years) and 13 adults without neurological impairments (age: 59.14 +/- 10.59 years) were instructed to reach-to-grasp a jar with the affected/left limb and to unscrew the jar cap with the unaffected/right limb. Reaching and grasping kinematics were analysed for intra-limb coordination and bimanual synchronisation and temporal correlation for interlimb coordination. RESULTS: The patients showed significantly less efficient, less smooth, and less forceful movement and spent significantly more time for on-line error correction with the affected hand than the healthy controls. Interlimb coordination was disrupted at movement onset but was preserved at movement end in the hemiparetic patients. CONCLUSIONS: The major deficits of the left hemiparetic patients involved heavy reliance on feedback control with the affected hand, and poor bimanual coordination at movement onset, which might be specifically retrained during stroke rehabilitation. Preservation ofinterlimb coordination at movement end in stroke patients suggested that they retained flexibility in response to the impaired temporal performance of the affected hand to achieve the end goal.

Effects of object size on intralimb and interlimb coordination during a bimanual prehension task in patients with left cerebral vascular accidents.

Stroke patients are often left with hemiplegia or hemiparesis of the upper extremities, severely limiting the ability to perform bimanual and functional activities. No studies have investigated how stroke patients adapt their movements to changes in object size in functionally asymmetric bimanual tasks. The influence of object size on intralimb and interlimb coordination during an asymmetrical, functional bimanual task was examined in patients with left cerebral vascular accidents (LCVA) and healthy controls. Fourteen LCVA patients and 13 age-matched controls were instructed to reach to grasp a large and a small jar with the right/affected hand and to open the cap with the other hand. Movement kinematics was analyzed for intralimb coordination (spatial and temporal planning of reaching and grasping) and interlimb coordination (bimanual synchronization and temporal association of the hands). The results demonstrate a spatial adaptation of reaching in the affected hand to the object size and deficits in temporal planning of grasping with the affected hand to object size in the stroke patients. Movement adaptations of the unaffected hand in the stroke patients were similar to those in the healthy adults. Bimanual coordination was independent of object size for both groups.