Improvement of hand function using different surfaces and identification of difficult movement post stroke in the Box and Block Test

Slota, Gregory P.; Enders, Leah R.; Seo, Na Jin

doi:10.1016/j.apergo.2013.10.014

Cited by 23 publications

(14 citation statements)

References 32 publications

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“…Furthermore, since an altered muscle activation pattern with EDC and FDI underactivation could have contributed to increasing the phalanx force deviation, a muscle specific strength training program such as resistance training (Laidlaw et al 1999; Barry and Carson 2004) or neuromuscular electrical stimulation could improve activation of the specific underactivated muscles (Chae et al 1998) and reduce the phalanx force deviation thereby potentially improving stroke survivors’ grip. In addition, design modification for commonly used household items could assist in accommodating stroke survivors’ altered force direction (Slota et al 2014). …”

Section: Discussionmentioning

confidence: 99%

Altered phalanx force direction during power grip following stroke

Enders

Seo

2015

Exp Brain Res

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Many stroke survivors with severe impairment can grasp only with a power grip. Yet, little knowledge is available on altered power grip after stroke, other than reduced power grip strength. This study characterized stroke survivors’ static power grip during 100% and 50% maximum grip. Each phalanx force’s angular deviation from the normal direction and its contribution to total normal force was compared for 11 stroke survivors and 11 age-matched controls. Muscle activities and skin coefficient of friction (COF) were additionally compared for another 20 stroke and 13 age-matched control subjects. The main finding was that stroke survivors gripped with a 34% greater phalanx force angular deviation of 19±2° compared to controls of 14±1° (p<.05). Stroke survivors’ phalanx force angular deviation was closer to the 23° threshold of slippage between the phalanx and grip surface, which may explain increased likelihood of object dropping in stroke survivors. In addition, this altered phalanx force direction decreases normal grip force by tilting the force vector, indicating a partial role of phalanx force angular deviation in reduced grip strength post stroke. Greater phalanx force angular deviation may biomechanically result from more severe underactivation of stroke survivors’ first dorsal interosseous (FDI) and extensor digitorum communis (EDC) muscles compared to their flexor digitorum superficialis (FDS) or somatosensory deficit. While stroke survivors’ maximum power grip strength was approximately half of the controls’, the distribution of their remaining strength over the fingers and phalanges did not differ, indicating evenly distributed grip force reduction over the entire hand.

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Section: Discussionmentioning

confidence: 99%

Altered phalanx force direction during power grip following stroke

Enders

Seo

2015

Exp Brain Res

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“…In this study, when the first bead was picked up, the therapist started the stopwatch. After 60 seconds, the beads that had been moved to the other side of the box were counted (7,8). A reliability test retesting these tools was conducted in patients with stroke (results: 0.97 -0.89) (6).…”

Section: Methodsmentioning

confidence: 99%

Comparison of Fine Motor Skills in Patients With Chronic Stroke in Final Stages of Bronestrum and Healthy Adults

Mirshoja

Pahlevanian

Khalili

2015

Middle East J Rehabil Health

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Background: One of the main problems of chronic stroke patients is the inability to move the fingers separately despite the passing of an extended period of time since the onset of the disease. Dexterity is a fine motor skill that allows one to manipulate objects through voluntary movement. Objectives: The aim of this study was to compare the fine motor skills of patients with chronic stroke to those of healthy controls. Patients and Methods: This analytic and descriptive cross-sectional study was carried out randomly on 50 patients with chronic stroke with a mean age of 57.8 years suffering for 46 -72 months and on 50 healthy people with a mean age of 51.16 years. Patients did not receive any intervention before or after one week of assessment. The function of both hands of each patient was measured with the nineholepegtest (NHPT) and the box and block test (BBT). Results:The results showed that the mean variation of speed in the BBT test (standard deviation [SD]) in the left hands of the patients (recessive limb) was 57.8 (12.75), greater than in their right hand (dominant limb) (54.76 [8.67]). The rate of speed in healthy people's right hands was 68.58 (8.31), greater than in their left hands (63.5 [8.54]). In addition, the results of the NHPT showed that the stroke patients needed more time to manipulate the objects than the healthy ones. For the NHPT, the mean (SD) of the right hand (dominant limb) patients (4.89) and healthy controls 36.7 (14.5) 21.98, mean (SD) of the left hand (dominant limb) patients (4.45) and 30.4 in healthy subjects (4.09) 24.18 respectively. Independent T-test showed P < 0.05 in all the results obtained, respectively. Conclusions:The results showed that the dexterity fingers of patients suffering from stroke at the final stages of Bronestrum is much closer to the dexterity of healthy controls.

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“…Correcting digit force direction or muscle activation pattern using neuromuscular electrical stimulation and muscle strengthening (Santos et al, 2006; Dean et al, 2007) may directly help improve hand grip function. Alternatively, daily objects may be modified with high-friction surfaces (Seo and Enders, 2012; Slota et al, 2014) or adaptive shapes to accommodate stroke survivors’ altered digit force direction and reduce finger-object slips, thereby improving hand function.…”

Section: Discussionmentioning

confidence: 99%

The extent of altered digit force direction correlates with clinical upper extremity impairment in chronic stroke survivors

Seo

Enders

Motawar

et al. 2015

Journal of Biomechanics

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Many stroke survivors suffer from impaired hand function. Biomechanics of hand grip suggests that abnormally directed grip force can hamper gripping abilities and hand function. This study examined the relation between the ability to precisely direct fingertip force and clinical hand function scores among individuals affected by stroke. Specifically, clinical hand function tests of the Fugl-Meyer, Chedoke McMaster, and Box and Block Test were used, since they involve various hand movements required for activities of daily living. Digit force direction during static grip was recorded using multiaxial load cells. Data for 59 chronic stroke survivors were analyzed. We found that larger angular deviation of digit force from the normal direction was significantly associated with lower hand functional levels (p<.001 for all three clinical tests). Particularly, stroke survivors whose digit force deviated more than 21° from the normal direction could not achieve the normal level of Fugl-Meyer or Chedoke or move more than 4 blocks in a minute. The biomechanics of the way digit force direction affects hand grip function is described. In addition, underlying mechanisms for altered digit force direction post stroke are postulated, including impaired somatosensation and abnormal neural input to muscles. In summary, this study identifies a new biomechanical marker for hand functional level and recovery. Future interventions may focus on correcting digit force direction to improve hand functional outcome.

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Improvement of hand function using different surfaces and identification of difficult movement post stroke in the Box and Block Test

Cited by 23 publications

References 32 publications

Altered phalanx force direction during power grip following stroke

Altered phalanx force direction during power grip following stroke

Comparison of Fine Motor Skills in Patients With Chronic Stroke in Final Stages of Bronestrum and Healthy Adults

The extent of altered digit force direction correlates with clinical upper extremity impairment in chronic stroke survivors

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