KINEMATICS OF A 3D REACH-TO-GRASP-TO-MOUTH TASK IN SUB-ACUTE PHASE TO DIFFERENTIATE ACROSS MILD, MODERATE AND SEVERE GROUPS OF STROKE SURVIVORS

S. Sardesai¹, J.M. Solomon¹, A. Arumugam², E.D. Nazareth³, S.D. Kumaran¹

¹Manipal College of Health Professions, Department of Physiotherapy, Manipal, India, ²College of Health Sciences, Department of Physiotherapy, Sharjah, United Arab Emirates, ³Manipal Institute of Technology, Department of Thermodynamics, Manipal, India

Background: The best way to measure true motor recovery is through kinematics. The Stroke Recovery and Rehabilitation Roundtable (SRRR) Taskforce has recommended the use of performance assays such as grip and pinch strength, 2D and 3D kinematic analysis and finger individuation, that predict post-stroke recovery. However, not much is known about the differences across various groups based on stroke severity.

Purpose: The purpose of this study was to determine whether the kinematic parameters of total time, total displacement, average velocity, shoulder angles (flexion, extension, abduction, adduction), elbow angles (flexion and extension), path straightness, reaction time and trunk displacement were able to distinguish upper extremity movement capacity in individuals with varying levels of stroke severity.

Methods: This is a cross-sectional study, which is part of a large cohort study. Seventy-one sub-acute stroke survivors (59.6 ± 11.5 years; categorized into mild (51-66), moderate (25-50) and severe (<25) Fugl Meyer Assessment categories) performed a 3D reach-to-grasp-to-mouth task. We used the G4 Polhemus kinematic analysis system consisting of 5 sensors. The participants were instructed to perform 20 trials of a reach-to-grasp-to-mouth task with a cone of 6 cm diameter. Both, near and far targets were given. An algorithm was built using MATLAB to determine the kinematic parameters. One-way ANOVA test was used to differentiate across the three severity groups.

Results: Significant differences were noted between mild and severe as well as between mild and moderate severity of stroke in adults for total time (p= 0.05; p= 0.04), average velocity (p <0.001; p<0.018), total displacement (p <0.001; p<0.001), shoulder flexion (p= 0.004; p=0.005), shoulder extension (p= 0.02; 0.05), elbow flexion (p= 0.02; p= 0.03) and elbow extension (p= 0.02; p=0.02) during the task. These kinematic parameters were observed to be reduced by 11-42% in participants with severe and moderate stroke. Maximum right displacement (p= 0.02) of the hand was also found to be significantly less in participants with severe stroke compared to those who were mildly affected. We also observed a significant difference in average velocity (0.01) between moderate and severe stroke survivors, where severely affected participants exhibited lower velocity. Kinematic parameters of maximum left displacement of the hand, path straightness, reaction time, shoulder adduction and abduction and trunk displacement did not show any significant differences across participants with different stroke severity.

Conclusions: Kinematic analysis of a reach-to-grasp-to-mouth task helps to successfully differentiate between compensation and restitution strategies of the upper extremity post-stroke.

Implications: This ability to differentiate across stroke severity groups would enable us to objectively quantify post-stroke recovery and help in realistic goal setting and planning rehabilitation.

Funding acknowledgements: Society of Indian Physiotherapists (Partial funding)

Keywords:
Hemiparesis
Kinematics
Recovery prediction

Topics:
Neurology: stroke
Research methodology, knowledge translation & implementation science
Disability & rehabilitation

Did this work require ethics approval? Yes

Institution: Manipal College of Health Professions

Committee: Kasturba Hospital

Ethics number: IEC- 812/2018