Biomechanical assessment of the ipsilesional upper limb in post-stroke patients during multi-joint reaching tasks: A quantitative study

Abstract

In hemiplegic patients with stroke, investigating the ipsilesional limb may shed light on the upper limb motor control, impairments and mechanisms of functional recovery. Usually investigation of motor impairment and rehabilitative interventions in patients are performed only based on the contralesional limb. Previous studies found that also the ipsilesional limb presents motor deficits, mostly evaluated with clinical scales which could lack of sensibility. To quantitatively evaluate the performance of the ipsilesional limb in patient with stroke, we conducted an observational study in which 49 hemiplegic patients were enrolled, divided in subgroups based on the severity of impairment of the contralesional limb, and assessed with a kinematic, dynamic and motor control evaluation protocol on their ipsilesional upper limb during reaching movements. Measurements were repeated in the acute and subacute phases and compared to healthy controls. Our results showed that the ipsilesional limb presented lower kinematic and dynamic performances with respect to the healthy controls. Patients performed the movements slower and with a reduced range of motion, indicating a difficulty in controlling the motion of the arm. The energy and the power outputs were lower in both shoulder and elbow joint with a high significance level, confirming the limitation found in kinematics. Moreover, we showed that motor deficits were higher in the acute phase with respect to the subacute one and we found higher significant differences in the group with a more severe contralesional limb impairment. Ipsilesional upper limb biomechanics adds significant and more sensible measures for assessments based on multi-joints dynamics, providing a better insight on the upper limb motor control after stroke. These results could have clinical implications while evaluating and treating ipsilesional and contralesional upper limb impairments and dysfunctions in patients with stroke.

Motor and Cognitive Modulation of a Single Session of Transcutaneous Auricular Vagus Nerve Stimulation in Post Stroke Patients: A Pilot Study

“…Moreover, recent findings have demonstrated a strong association between the damaged hemisphere and motor control impairments providing that each hemisphere takes part in a different control mechanism for both upper limbs. Studies suggest that ipsilesional upper limb training improves motor coordination and functional performance not only in the trained side but also in the contralesional, increasing participation in ADL [44] . For this reason, we decided to evaluate not only the contralesional side but also the ipsilesional one.…”

Mapping of the Upper Limb Work-Space: Benchmarking Four Wrist Smoothness Metrics

“…Moreover, smoothness measures can be also used for detailed evaluation of motor performance that cannot easily be assessed with clinical scales. For example, the normalized jerk was sensible enough to identify a limited motor performance of the ipsilesional limb in post-stroke patients [37]. Smith et al [38], instead, found that smoothness metrics could detect motor dysfunctions related to Huntington's disease before clinical tests.…”

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