Rlative shoulder fexor and handgrip strength is related to upper limb function after stroke

Mercier, Catherine; Bourbonnais, Daniel

doi:10.1191/0269215504cr724oa

Cited by 113 publications

(78 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our findings build upon the existing literature that examines one or a few segments post stroke (Bourbonnais et al, 1989;Dewald et al, 1995;Boissy et al, 1999;Lang and Schieber, 2003;Lang and Schieber, 2004;Mercier and Bourbonnais, 2004;Zackowski et al, 2004;Mirbagheri et al, 2005), by examining the ability to move at nine upper extremity segments in the same sample. Previous work looking across more than a few upper extremity segments has been done on samples of people with chronic hemiparesis post stroke (Colebatch and Gandevia, 1989;Lang and Beebe, 2007).…”

Section: Discussionsupporting

confidence: 56%

“…We were surprised that such a large proportion of the variance was explained by a single variable, and surprised that it was shoulder AROM. Although the relationships were somewhat weaker, we were able to find a precedent for this in the literature, where the strength of the shoulder flexor muscles was correlated with scores on hand function tests in a sample of people with chronic hemiparesis (Mercier and Bourbonnais, 2004). The ability to move the shoulder appears to be a vital component of hand function (Kapandji, 1981).…”

Section: Shoulder Arom Alone Acts As a Simple Predictor Of Hand Functionmentioning

confidence: 69%

See 1 more Smart Citation

Absence of a proximal to distal gradient of motor deficits in the upper extremity early after stroke

Beebe¹,

Lang²

2008

Clinical Neurophysiology

View full text Add to dashboard Cite

Objective-Our first purpose was to determine whether there was a proximal to distal gradient in motor deficits in nine segments of the affected upper extremity (shoulder, elbow, forearm, wrist, and 5 fingers) post stroke. Our second purpose was to determine which upper extremity segments made the greatest contributions to hand function.Methods-33 subjects were tested on average 18.6 (± 5.6) days after stroke. The ability to move each segment was measured by active range of motion (AROM). Hand function was measured by a battery of standardized clinical tests which were synthesized into a single, sensitive score for hand function using principal components analysis.Results-AROM at all nine segments of the upper extremity was reduced and there was no evidence of a proximal to distal gradient in AROM values. Strength of each segment was reduced and there was also no evidence of a gradient in strength values. AROM at each segment was strongly correlated with hand function scores (range 0.76 -0.94). General multiple regression analysis showed that AROM explained 82% of the variance in hand function, with most of the variance shared across proximal, middle, and distal segments. Hierarchical regression analysis showed that shoulder AROM alone could explain 88% of the variance in hand function.Conclusion-Early after stroke a proximal to distal gradient of motor deficits was not present, and loss of hand function was due to a loss of ability to move many segments of the upper extremity and not just the distal ones.Significance-These results suggest that a change in the clinical perception of motor deficits post stroke is needed. Our finding that shoulder AROM predicted almost all the variance in hand function opens up the possibility that this quick, simple measure may be predictive of future hand function. This would be of high economic and clinical utility compared to other ongoing efforts attempting to predict outcomes post stroke (e.g. fMRI, MEG).

show abstract

Section: Discussionsupporting

confidence: 56%

Section: Shoulder Arom Alone Acts As a Simple Predictor Of Hand Functionmentioning

confidence: 69%

Absence of a proximal to distal gradient of motor deficits in the upper extremity early after stroke

Beebe¹,

Lang²

2008

Clinical Neurophysiology

View full text Add to dashboard Cite

show abstract

“…After a hemiparetic stroke, the proximal limb is less affected than the distal limb (Colebatch and Gandevia 1989), nevertheless, normal function of the proximal upper arm is frequently severely impaired. Proximal upper limb impairment is characterized by weakness (Adams et al 1990;Bohannon and Smith 1987;Colebatch and Gandevia 1989;Lum et al 2003;Mercier and Bourbonnais 2004) and abnormal coordination between elbow and shoulder muscles expressed as flexor and extensor synergies (Twitchell 1951;Brunnstrom 1970;Beer et al 1999;Dewald and Beer 2001;Dewald et al 1995;). These impairments significantly affect reaching abilities in stroke survivors with poor recovery (Beer et al 2004(Beer et al , 2007Sukal et al 2007).…”

Section: Introductionmentioning

confidence: 99%

Ipsilateral versus contralateral cortical motor projections to a shoulder adductor in chronic hemiparetic stroke: implications for the expression of arm synergies

et al. 2007

View full text Add to dashboard Cite

An increase in ipsilateral descending motor pathway activity has been reported following hemiparetic stroke. In axial muscles, increased ipsilateral cortical activity has been correlated with good recovery whereas in distal arm muscles it is correlated with poor recovery. Currently, little is known about the control of proximal upper limb muscles following stroke. This muscle group is less impaired than the distal arm muscles following stroke, yet contributes to the abnormal motor coordination patterns associated with movements of the arm which can severely impair reaching ability. This study used transcranial magnetic stimulation (TMS) to evaluate the presence and magnitude of ipsilateral and contralateral projections to the pectoralis major (PMJ) muscle in stroke survivors. A laterality index (LI) was used to investigate the relationship between ipsilateral and contralateral projections and strength, clinical impairment level, and the degree of abnormal coordination expressed in the arm. The ipsilateral and contralateral hemispheres were stimulated using 90% TMS intensity while the subject generated shoulder adduction torques in both arms. Motor evoked potentials (MEPs) were measured in the paretic and non-paretic PMJ. The secondary torque at the elbow was measured during maximal adduction as an indicator of the degree of extensor synergy. Ipsilateral MEPs were most common in stroke survivors with moderate to severe motor deficits. The LI was correlated with clinical impairment level (P = 0.05) and the degree of extension synergy expressed in the arm (P = 0.03). The LI was not correlated with strength. These results suggest that increased excitability of ipsilateral pathways projecting to the proximal upper arm may contribute to the expression of the Correspondence to: Susan Schwerin, sc.schwerin@yahoo.com. extension synergy following stroke. These findings are discussed in relation to a possible unmasking or upregulation of oligosynaptic cortico-bulbospinal pathways following stroke. NIH Public Access

show abstract

“…Nevertheless, most studies are performed at one point in time (Kim & Eng, 2003;Mercier & Bourbonnais, 2004;Ada et al, 2006;Bohannon, 2007b;Patterson et al, 2007;Horstman et al, 2008). It is not fully elucidated whether the improvements in functional performance at the activity level of patients with stroke during rehabilitation relate to changes in specific contractile function of the thigh muscles.…”

mentioning

confidence: 99%

Functional recovery and muscle properties after stroke: a preleminary longitudinal study

Horstman¹,

Haan²,

Konijnenbelt³

et al. 2012

Rehabilitation Medicine

View full text Add to dashboard Cite

Rlative shoulder fexor and handgrip strength is related to upper limb function after stroke

Abstract: These results do not confirm classical clinical teaching regarding the distribution of weakness following stroke (e.g., proximal to distal gradient; extensors more affected than flexors) but support the hypothesis that strength is related to the function of the paretic upper limb.

Cited by 113 publications

References 29 publications

Absence of a proximal to distal gradient of motor deficits in the upper extremity early after stroke

Absence of a proximal to distal gradient of motor deficits in the upper extremity early after stroke

Ipsilateral versus contralateral cortical motor projections to a shoulder adductor in chronic hemiparetic stroke: implications for the expression of arm synergies

Functional recovery and muscle properties after stroke: a preleminary longitudinal study

Contact Info

Product

Resources

About