Motor-Equivalent Intersegmental Coordination Is Impaired in Chronic Stroke

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Background Motor coordination, the ability to produce context-dependent organized movements in spatial and temporal domains, is impaired after neurological injuries. Outcome measures assessing coordination mostly quantify endpoint performance variables (ie, temporal qualities of whole arm movement) but not movement quality (ie, trunk and arm joint displacements). Objective To develop an outcome measure to assess coordination of multiple body segments at both endpoint trajectory and movement quality levels, based on observational kinematics, in adults with neurological injuries. Methods A 3-phase study was used to develop the Comprehensive Coordination Scale (CCS): instrument development, Delphi process, and focus group meeting. The CCS was constructed from common tests used in clinical practice and research. Rating scales for different behavioral elements were developed to guide analysis. For content validation, 8 experts (ie, neurological clinicians/researchers) answered questionnaires about relevance, comprehension, and feasibility of each test and rating scale. A focus group conducted with 6 of 8 experts obtained consensus on rating scale and instruction wording, and identified gaps. Three additional experts reviewed the revised CCS content to obtain a final version. Results Experts identified a gap regarding assessment of hand/finger coordination. The CCS final version is composed of 6 complementary tests of coordination: finger-to-nose, arm-trunk, finger, lower extremity, and 2- and 4-limb interlimb coordination. Constructs include spatial and temporal variables totaling 69 points. Higher scores indicate better performance. Conclusions The CCS may be an important, understandable and feasible outcome measure to assess spatial and temporal coordination. CCS measurement properties are presented in the companion article.

Section: Phase 1: Instrument Developmentmentioning

confidence: 99%

Development of a Comprehensive Outcome Measure for Motor Coordination; Step 1: Three-Phase Content Validity Process

Alouche

Molad

Demers

et al. 2020

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“…11 The Comprehensive Coordination Scale (CCS; see the appendix in Alouche et al 11 ) consists of 6 tests used in either clinical practice or research to assess complementary aspects of motor coordination of the trunk, upper limb (UL), lower limb (LL), or combinations of them. These are as follows: Finger-To-Nose (FTN), 12 Arm-Trunk Coordination (ATC), 13 Finger Opposition (FOT), 14 Upper Limb Interlimb Coordination (ILC2), 15 Lower Extremity Motor Coordination (LEMOCOT), 16 and Four-limb Interlimb Coordination (ILC4). 17 The CCS score can be used in adults with neurological disorders to characterize multibody segment coordination or can be broken down into 4 subscales to assess UL, LL, or unilateral or bilateral coordination separately.…”

Section: Introductionmentioning

confidence: 99%

Development of a Comprehensive Outcome Measure for Motor Coordination, Step 2: Reliability and Construct Validity in Chronic Stroke Patients

Molad

Alouche

Demers

et al. 2021

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Background A comprehensive scale assessing motor coordination of multiple body segments was developed using a 3-phase content validation process. The Comprehensive Coordination Scale (CCS) evaluates motor coordination defined as the ability to produce context-dependent movements of multiple effectors in both spatial and temporal domains. The scale assesses motor coordination in individuals with neurological injuries at 2 levels of movement description: the motor performance level describes end point movements (ie, hand, foot), and the movement quality level describes limb joints/trunk movements contributing to end point movement. Objective To determine measurement properties of the scale in people with chronic stroke. Methods Standardized approaches determined the internal consistency (factor loadings), intrarater and interrater reliability (interclass correlation coefficient), measurement error (SEM; minimal detectable change [MDC]), construct validity, and interpretability (ie, ceiling and floor effects) of the CCS. Results Data from 30 patients with chronic stroke were used for the analysis. The internal consistency of the scale was high (0.94), and the scale consisted of separate factors characterizing end point motor performance and movement quality. Intrarater (intraclass correlation coefficient [ICC] = 0.97-0.97) and interrater (ICC=0.76-0.98) reliability of the whole scale and subscales were good to excellent. The CCS had an SEM of 1.80 points (total score = 69 points) and an MDC95 of 4.98 points. The CCS total score was related to Fugl-Meyer Assessment total and motor scores and had no ceiling or floor effects. Conclusions The CCS scale has strong measurement properties and may be a useful measure of spatial and temporal coordination deficits in chronic stroke survivors.

“…This was accompanied by deficits in the ability to reproduce (task 1) or quickly alter (task 2) elbow and shoulder joint excursions when the trunk was unexpectedly blocked. Deficits in rapid motor responses in stroke have been demonstrated previously for reaching in exocentric FRs, 23,38,52,53 but this is the first study to illustrate deficits in egocentric FRs. There are several important differences between the current and previous studies invalidating direct comparisons.…”

Section: Arm Movement In Different Frs In Strokementioning

confidence: 49%

Mild Stroke Affects Pointing Movements Made in Different Frames of Reference

Hasanbarani

Batalla

Feldman

et al. 2021

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Background Motor performance is a complex process controlled in task-specific spatial frames of reference (FRs). Movements can be made within the framework of the body (egocentric FR) or external space (exocentric FR). People with stroke have impaired reaching, which may be related to deficits in movement production in different FRs. Objective To characterize rapid motor responses to changes in the number of degrees of freedom for movements made in different FRs and their relationship with sensorimotor and cognitive impairment in individuals with mild chronic stroke. Methods Healthy and poststroke individuals moved their hand along the contralateral forearm (egocentric task) and between targets in the peripersonal space (exocentric task) without vision while flexing the trunk. Trunk movement was blocked in randomized trials. Results For the egocentric task, controls produced the same endpoint trajectories in both conditions (free- and blocked-trunk) by preserving similar shoulder-elbow interjoint coordination (IJC). However, endpoint trajectories were dissimilar because of altered IJC in stroke. For the exocentric task, controls produced the same endpoint trajectories when the trunk was free or blocked by rapidly changing the IJC, whereas this was not the case in stroke. Deficits in exocentric movement after stroke were related to cognitive but not sensorimotor impairment. Conclusions Individuals with mild stroke have deficits rapidly responding to changing conditions for complex reaching tasks. This may be related to cognitive deficits and limitations in the regulation of tonic stretch reflex thresholds. Such deficits should be considered in rehabilitation programs encouraging the reintegration of the affected arm into activities of daily living.