Impaired Visuo-Motor Skills in the Unaffected Lower Limb of Patients With Stroke

Kawahira, Kazumi; Shimodozono, Megumi; Ogata, Atsuko; Etoh, Seiji; Ikeda, Satoshi; Yoshida, Akira; Tanaka, Nobuyuki; Tsujio, Showzow

doi:10.1080/00207450590934561

Cited by 8 publications

(3 citation statements)

References 20 publications

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“…Impaired isometric strength and force control in the lessaffected knee extensors are consistent with previously reported bilateral changes after stroke (31,34,36,43,47,58,66). Several factors may contribute to impaired motor function of the less-affected limbs, including hemispheric lateralization for the executed tasks and hemispheric asymmetry (36) or evolving maladaptive changes in the intact hemisphere (38).…”

Section: Discussionsupporting

confidence: 76%

Force control of quadriceps muscle is bilaterally impaired in subacute stroke

Chow

Stokić

2011

Journal of Applied Physiology

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Chow JW, Stokic DS. Force control of quadriceps muscle is bilaterally impaired in subacute stroke. J Appl Physiol 111: 1290-1295, 2011. First published September 1, 2011 doi:10.1152/japplphysiol.00462.2011.-We tested the hypothesis that force variability and error during maintenance of submaximal isometric knee extension are greater in subacute stroke patients than in controls and are related to motor impairments. Contralesional (more-affected) and ipsilesional (less-affected) legs of 33 stroke patients with sufficiently high motor abilities (62 Ϯ 13 yr, 16 Ϯ 2 days postinjury) and the dominant leg of 20 controls (62 Ϯ 10 yr) were tested in sitting position. After peak knee extension torque [maximum voluntary contraction (MVC)] was established, subjects maintained 10, 20, 30, and 50% of MVC as steady and accurate as possible for 10 s by matching voluntary force to the target level displayed on a monitor. Coefficient of variation (CV) and root-meansquare error (RMSE) were used to quantify force variability and error, respectively. The MVC was significantly smaller in the more-affected than less-affected leg, and both were significantly lower than in controls. The CV was significantly larger in the more-affected than less-affected leg at 20 and 50% MVC, whereas both were significantly larger compared with controls across all force levels. Both moreaffected and less-affected legs of patients showed significantly greater RMSE than controls at 30 and 50% MVC. The CV and RMSE were not related to the Fugl-Meyer motor score or to the Rivermead Mobility Index. The CV negatively correlated with MVC in controls but only in the less-affected leg of patients. It is concluded that isometric knee extension strength and force control are bilaterally impaired soon after stroke but more so in the more-affected leg. Future studies should examine possible mechanisms and the evolution of these changes. force steadiness; force variability; force accuracy; knee extension strength; hemiparesis NEGATIVE EFFECTS OF STROKE on motor function are well documented, including reduced strength and slower rate of torque generation (8), deficits in postural control during quiet standing (22), abnormal muscle activation patterns during gait (35), impaired manual tracking (9), and grip force control (5). Strength testing after stroke typically involves measurement of force (torque, power) during maximal voluntary effort. This is in stark contrast to the actual use of muscles in daily activities, which requires production of submaximal and finely graded forces.Force control generally refers to the ability to produce accurate and steady muscle output under static or dynamic conditions. Characteristics of force control have been extensively studied in the elderly (16,25). When asked to maintain a submaximal isometric force, especially at a low level [i.e., Յ10% of maximum voluntary contraction (MVC)], older healthy subjects show greater force variability than young adults in various muscles (63). Force (targeting) error is also greater in elderly com...

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Section: Discussionsupporting

confidence: 76%

Force control of quadriceps muscle is bilaterally impaired in subacute stroke

Chow

Stokić

2011

Journal of Applied Physiology

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“…The unaffected LE of the patients with stroke showed a significantly larger RMS error than the control subjects during the force-tracking task, indicating a deficit in dexterity in the unaffected limb. These results support those of a previous study using trajectory tracking (Kawahira et al, 2005) and target movement tasks . A significant difference was not observed between the unaffected limb and the control subjects in the MVC force, but the unaffected limb showed 16% lower MVC force than the control subjects.…”

Section: Discussionsupporting

confidence: 91%

The Loss of Dexterity in the Bilateral Lower Extremities in Patients With Stroke

Kiyama

Fukudome²,

Hiyoshi³

et al. 2011

Journal of Applied Biomechanics

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The aim of this study was to examine the dexterity of both lower extremities in patients with stroke. Twenty patients with stroke and 20 age-matched control subjects participated in this study. To determine the dexterity of the lower extremities, we examined the ability to control muscle force during submaximal contractions in the knee extensor muscles using a force tracking task. The root mean square errors were calculated from the difference between the target and response force. The root mean square error was significantly greater in the affected limb of patients with stroke compared with those of the unaffected limb and the control subjects, and in the unaffected limb compared with that of the control subjects. Furthermore, the root mean square error of the affected limb was related significantly to motor function as determined by Fugl-Myer assessment. These results demonstrate impairment of the dexterity of both the affected and the unaffected lower extremities in patients with stroke.

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“…The ability of ipsilateral foot tracking was also found to be impaired, i.e. slower and less accurate, in the subacute stage of stroke [28]. In the chronic stage, when performing fast repeated target tapping with the ipsilateral foot, stroke patients were found to require longer time between landing and liftoff [20].…”

Section: Introductionmentioning

confidence: 99%

Ipsilateral lower limb motor performance and its association with gait after stroke

Lee,

Chen,

Tseng

et al. 2024

PLoS ONE

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Background and purpose Motor deficits of the ipsilateral lower limb could occur after stroke and may be associated with walking performance. This study aimed to determine whether the accuracy and movement path of targeted movement in the ipsilateral lower limb would be impaired in the chronic stage of stroke and whether this impairment would contribution to gait. Methods Twenty adults with chronic stroke and 20 age-matched controls went through Mini Mental Status Examination (MMSE), and a series of sensorimotor tests. The targeted movement tasks were to place the big toe ipsilateral to the lesion at an external visual target (EXT) or a proprioceptive target (PRO, contralateral big toe) with eyes open (EO) or closed (EC) in a seated position. A motion analysis system was used to obtain the data for the calculation of error distance, deviation from a straight path, and peak toe-height during the targeted movement tasks and gait velocity, step length, step width and step length symmetry of the lower limb ipsilateral to the brain lesion during walking. Results The stroke group had significantly lower MMSE and poorer visual acuity on the ipsilateral side, but did not differ in age or other sensorimotor functions when compared to the controls. For the targeted movement performance, only the deviation in PRO-EC showed significant between-group differences (p = 0.02). Toe-height in both EXT-EO and in PRO-EO was a significant predictor of step length (R2 = 0.294, p = 0.026) and step length symmetry (R2 = 0.359, p = 0.014), respectively. Discussion and conclusions The performance of ipsilateral lower limb targeted movement could be impaired after stroke and was associated with step length and its symmetry. The training of ipsilateral targeted movement with unseen proprioceptive target may be considered in stroke rehabilitation.

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Impaired Visuo-Motor Skills in the Unaffected Lower Limb of Patients With Stroke

Cited by 8 publications

References 20 publications

Force control of quadriceps muscle is bilaterally impaired in subacute stroke

Force control of quadriceps muscle is bilaterally impaired in subacute stroke

The Loss of Dexterity in the Bilateral Lower Extremities in Patients With Stroke

Ipsilateral lower limb motor performance and its association with gait after stroke

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