Aiming Movement After Stroke: Do Time-Since-Injury and Impairment Severity Influence Ipsilateral Performance?

In this cross-sectional study, we evaluated post-stroke ipsilesional (less affected) upper limb aiming movement in individuals whose strokes were either 2-5 months (n = 16) or >6 months (n = 17) prior to our testing; we also compared both stroke groups to a control group of healthy individuals (n = 14). We evaluated the participants' level of movement impairment in the contralateral upper limb from the site of the cerebrovascular lesion as an indicator of the severity of the participants' impairment. Participants were asked to move a stylus on a tablet with their ipsilesional upper limb according to a visual stimulus seen on a monitor. Those who had experienced more recent strokes showed poorer movement planning and execution, regardless of their impairment level. Since the stroke occurred, the amount of time was significantly associated with the ipsilesional aiming movement, and improvement over time brought performance levels closer to that of healthy controls.

Ipsilesional arm reaching movements are not affected by the postural configuration adopted by individuals with stroke.

Individuals with stroke present several impairments in the ipsilesional arm reaching movements that can limit the execution of daily living activities. These impairments depend on the side of the brain lesion. The present study aimed to compare the arm reaching movements performed in sitting and standing positions and to examine whether the effects of the adopted posture configuration depend on the side of the brain lesion. Twenty right-handed individuals with stroke (half with right hemiparesis and a half with left hemiparesis) and twenty healthy adults (half used the left arm) reached toward a target displayed on a monitor screen placed in one of three heights (i.e., upper, central, or lower targets). Participants performed the reaches in sitting and standing positions under conditions where the target location was either well-known in advance (certainty condition) or unknown until the movement onset (uncertainty condition). The values of movement onset time, movement time, and constant error were compared across conditions (posture configuration and uncertainty) and groups for each target height. Individuals with stroke were slower and spent more time to start to move than healthy participants, mainly when they reached the superior target in the upright position and under the uncertainty condition. Individuals who have suffered a right stroke were more affected by the task conditions and those who suffered a left stroke showed less accurate reaches. Overall, these results were observed regardless of the adopted posture. The current findings suggested that ipsilesional arm reaching movements are not affected by the postural configuration adopted by individuals with stroke. The central nervous system modulates the reaching movements according to the target position, adopted posture, and the uncertainty in the final target position to be reached.

The walking cane length influences the postural sway of community-dwelling older women.

BACKGROUND: Mobility-related problems in older people may be relieved by the use of walking canes. However, the influence of the cane length on the postural stability of cane users has not been explored. OBJECTIVE: The objective of this study is to examine the influence of a single-point cane with different lengths on the postural sway of regular cane users, older women during two stance positions, with feet parallel and semi-tandem stance. METHODS: Eighteen older women, who used a single-point walking cane for at least 6 months, stood on a force plate with feet parallel or in semitandem position for 40 s. They always used a cane that was adjusted to one of three different lengths resulting from the distance between the wrist crease and the floor, named WF, or this distance plus 7.5 or 10 cm. Amplitude and speed of the centre of pressure (COP) and its components (rambling and trembling) in the anterior-posterior and medial-lateral directions and mean vertical force applied to the cane were compared across cane lengths. RESULTS: The amplitude and velocity of COP, rambling and trembling increased with the cane length. This effect was observed for the anterior-posterior with the feet parallel and in the medial-lateral direction with the semi-tandem position. More force was applied on the shorter cane (WF) in semitandem position. CONCLUSION: Longer canes increased the postural sway in the older women and restricted the body weight loaded on the cane. Improper cane length influences the postural sway particularly in a semitandem stance of regular cane users. This may cause a negative impact on postural stability required in daily life activities. The current findings may contribute to the prescription of this assistive device for older adults.

Combined effects of the light touch and cognitive task affect the components of postural sway.

The light touch (LT) of the fingertip on a rigid surface and the performance of a cognitive task (CT) affect the postural control. The current study examined the mechanisms involved in the control of postural sway (i.e., Rambling and Trembling components of the center of pressure) with the LT and CT performed individually or simultaneously. Thirteen adults stood on a force plate for 70 s while performed the LT, CT (visual searching of specific letters) or both tasks simultaneously. COP, Rambling, and Trembling mean amplitude and speed were computed. COP and Rambling trajectories were highly and Trembling moderately reduced with LT. The CT affected mainly the Rambling component, supporting the role of supraspinal control of postural sway. These findings suggested that while LT influences both supraspinal and peripheral control mechanisms, CT influences mostly the supraspinal mechanisms involved in postural sway. The combined effects of LT and CT improve the postural control with no negative consequences on CT performance.

Electromyographic activity of the erector spinae: The short-effect of one workday for welders with nonspecific chronic low back pain, an observational study.

OBJECTIVE: This study aimed to evaluate the effect of one workday on pain and perceived exertion, muscular strength, and electromyographic activity of the erector spinae muscles in welders with and without low back pain. This is an observational cohort study. PARTICIPANTS: Twenty-two welders, metallurgical shipbuilding, were equally divided into 2 groups: low back pain and no low back pain. Pain and perceived exertion. Muscular strength by maximal voluntary contractions and electromyographic activity of right and left erector spinae muscles during maximal voluntary contractions and in the 3 welding positions for 2 periods of the workday (in the morning and at the end of the workday). RESULTS: At the end of workday, the pain increased significantly for the low back pain group (t(22) = 2.448; P= 0.023). The perceived exertion also increased significantly for both groups at the end of workday groups (F(1,22) = 8.570, P= 0.000) and periods (F(1,22) = 8.142, P= 0.000). There were no significant differences between groups and workday periods for muscular strength and electromyographic activity during maximal voluntary contractions of the erector spinae. There was no significance difference for electromyographic activity between groups and workday period and in the 3 welding positions. CONCLUSION: Although the pain and perceived exertion increased at the end of the workday, these results did not interfere in muscular strength and electromyographic activity of right and left erector spinae muscles. Thus, we can conclude that welders with chronic low back pain had a good physical capacity (muscular strength) and that muscle performance was maintained.

The influence of a real job on upper limb performance in motor skill tests: which abilities are transferred?

To investigate whether the specificities of real jobs create distinctions in the performance of workers in different motor tests for the upper limbs, 24 participants were divided into two groups according to their specific job: fine and repetitive tasks and general tasks. Both groups reproduced tasks related to aiming movements, handling and strength of the upper limbs. There were no significant differences between groups in the dexterity and performance of aiming movements. However, the general tasks group had higher grip strength than the repetitive tasks group, demonstrating differences according to job specificity. The results suggest that a particular motor skill in a specific job cannot improve performance in other tasks with the same motor requirements. The transfer of the fine and gross motor skills from previous experience in a job-specific task is the basis for allocating training and guidance to workers.

Assessment of the Ipsilesional Hand Function in Stroke Survivors: The Effect of Lesion Side.

BACKGROUND: The aim of this study was to examine the effect of the side of brain lesion on the ipsilesional hand function of stroke survivors. METHODS: Twenty-four chronic stroke survivors, equally allocated in 2 groups according to the side of brain lesion (right or left), and 12 sex- and age-matched healthy controls performed the Jebsen-Taylor Hand Function Test (JTHFT), the Nine-Hole Peg Test (9HPT), the maximum power grip strength (PwGSmax) test, and the maximum pinch grip strength (PnGSmax) test. Only the ipsilesional hand of the stroke survivors and both hands (left and right) of the controls were assessed. RESULTS: PwGS max and PnGS max were similar among all tested groups. Performances in JTHFT and 9HPT were affected by the brain injury. Individuals with left brain damage showed better performance in 9HPT than individuals with right brain damage, but performance in JTHFT was similar. CONCLUSIONS: Individuals after a brain injury have the capacity to produce maximum strength preserved when using their ipsilesional hand. However, the dexterity of their hands and digits is affected, in particular for stroke individuals with right brain lesion.

Comparison of Two Methods for Estimating Adjustable One-Point Cane Length in Community-Dwelling Older Adults.

BACKGROUND AND PURPOSE: Our aim is to estimate inter-observer reliability, test-retest reliability, anthropometric and biomechanical adequacy and minimal detectable change when measuring the length of single-point adjustable canes in community-dwelling older adults. METHODS: There are 112 participants in the study. They are men and women, aged 60 years and over, who were attending an outpatient community health centre. An exploratory study design was used. Participants underwent two assessments within the same day by two independent observers and by the same observer at an interval of 15-45 days. Two measures were used to establish the length of a single-point adjustable cane: the distance from the distal wrist crease to the floor (WF) and the distance from the top of the greater trochanter of the femur to the floor (TF). Each individual was fitted according to these two measures, and elbow flexion angle was measured. RESULTS AND DISCUSSION: Inter-observer reliability and the test-retest reliability were high in both TF (ICC3.1 = 0.918 and ICC2.1 = 0.935) and WF measures (ICC3.1 = 0.967 and ICC2.1 = 0.960). Only 1% of the individuals kept an elbow flexion angle within the standard recommendation of 30° ± 10° when the cane length was determined by the TF measure, and 30% of the participants when the cane was determined by the WF measure. The minimal detectable cane length change was 2.2 cm. CONCLUSION: Our results suggest that, even though both measures are reliable, cane length determined by WF distance is more appropriate to keep the elbow flexion angle within the standard recommendation. The minimal detectable change corresponds to approximately a hole in the cane adjustment. Copyright © 2015 John Wiley & Sons, Ltd.

Effects of direction and index of difficulty on aiming movements after stroke.

BACKGROUND: Brain hemispheres play different roles in the control of aiming movements that are impaired after unilateral stroke. It is not clear whether those roles are influenced by the direction and the difficulty of the task. OBJECTIVE: To evaluate the influence of direction and index of difficulty (ID) of the task on performance of ipsilesional aiming movements after unilateral stroke. METHODS: Ten individuals with right hemisphere stroke, ten with left hemisphere stroke, and ten age- and gender-matched controls performed the aiming movements on a digitizing tablet as fast as possible. Stroke individuals used their ipsilesional arm. The direction (ipsilateral or contralateral), size (0.8 or 1.6 cm), and distance (9 or 18 cm) of the targets, presented on a monitor, were manipulated and determined to be of different ID (3.5, 4.5, and 5.5). Results. Individuals with right hemisphere lesion were more sensitive to ID of the task, affecting planning and final position accuracy. Left hemisphere lesion generated slower and less smooth movements and was more influenced by target distance. Contralateral movements and higher ID increased planning demands and hindered movement execution. CONCLUSION: Right and left hemisphere damages are differentially influenced by task constraints which suggest their complementary roles in the control of aiming movements.

The influence of the tasks characteristics in physical performance and psychosocial aspects of workers.

The work and life conditions have influence on the health and life quality of workers. Physically active persons can demonstrate a life style that are and affect the physical performance, psychosocial aspects and work capacity. The purpose of this study was to investigate the physical activity level and work capacity in different tasks characteristics, one with more physical exertion and other with more cognitive exertion. A total of 193 workers from an institution of higher education and 457 workers from a metallurgical industry participated in the current study. All participants completed the International Physical Activity Questionnaire (IPAQ-short) and Work Ability Index (WAI). The results indicated that both groups were classified as having high level of physical activity while only few of them were considered sedentary (less than 27%). However, the group of metallurgical workers had greater indices (82%) than the workers from higher education institution (74%). Overall, the workers reported their work ability as moderate to excellent, suggesting that overall they are satisfied with their working and health conditions. It can be concluded that even though workers performed tasks with different demands (cognitive versus physical), they demonstrated similar level of physical activity as well as work ability.

A comparison of methods for identifying the Jacobian for uncontrolled manifold variance analysis.

Uncontrolled Manifold (UCM) analysis has been used to identify a component of joint variance leading to pointer-tip position variability and a component representing motor abundant joint combinations corresponding to an equivalent pointer-tip position. A Jacobian is required for UCM analysis, typically derived from an analytic model relating joint postures to pointer-tip position. Derivation of the Jacobian is often non-trivial, however, because of the complexity of the system being studied. In this article, we compared the effect of different methods of deriving the Jacobian on results of UCM analyses during reaching. Jacobian matrices were determined at each percentage of the reach across trials using one of three methods: (M1) partial derivatives of the geometric model relating ten joint postures, segment lengths and pointer length to the position of a hand-mounted pointer tip; or (M2-M3) as the coefficients of linear regression between the ten joint postures and either (M2) the pointer tip position measured directly from motion capture or (M3) the pointer-tip position estimated from the geometric model. For all methods, motor abundant joint variance (V(UCM)) was larger than joint variance leading to a variable pointer-tip position (V(ORT)). Results did not differ among methods prior to the time of peak velocity. Thereafter, M2 yielded lower V(ORT) and slightly higher V(UCM) compared to M1. Method M3 was used to disambiguate the possible effect of estimating model parameters for the geometric model on the M1-M2 comparison. The advantages of the use of linear regression method in the UCM approach are discussed.

Effect of motor planning on use of motor abundance.

This study examined the hypothesis that the degree to which motor redundancy is used to coordinate joint motions for reaching is influenced by motor planning and enhanced when the task requires greater movement flexibility. Subjects reached at arm's length to the same centrally placed target under conditions where the target location was either certain or uncertain, using a double-step paradigm. The hypothesis was evaluated by partitioning the across-trials variance of the joint configuration at each percent of the reach into a component corresponding to the use of different joint angle combinations to achieve an equivalent hand position (GEV) and a component leading to a variable hand position (NGEV). Pointer-tip movement variability along the path and variable targeting error did not differ between conditions. Larger overall joint variance was found for the uncertain target condition. Most of this increase was GEV, which was significantly higher in the uncertain condition for control of both movement extent and movement direction. In contrast, NGEV differed between the two conditions only for the control of movement extent early in the reach, suggesting that target uncertainty led to inter-trial timing variability along the movement path. The results suggest that more flexible patterns of joint coordination are used when the nervous system must plan reaching movements to an uncertain target direction.