Effect of post-stroke spasticity on voluntary movement of the upper limb

Journal of NeuroEngineering and Rehabilitation

Hadar Lackritz¹  Yisrael Parmet¹  Sigal Berman²  Nachum Soroker³  Dario G. Liebermann⁴  John M. Solomon⁵  Silvi Frenkel-Toledo⁶  Mindy F. Levin⁷  Melanie C. Baniña⁷ 

[1] Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel;Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel;The Zlotowski Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel;Department of Neurological Rehabilitation, Loewenstein Hospital, Ra’anana, Israel;Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India;Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, Karnataka, India;Faculty of Health Sciences, Department of Physical Therapy, Ariel University, Ariel, Israel;Department of Neurological Rehabilitation, Loewenstein Hospital, Ra’anana, Israel;School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada;Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada;

关键词: Stroke;    Spasticity;    Hemiparesis;    Kinematics;    Stochastic model;    Gaussian mixture model;    Hellinger’s distance;    Kullback–Liebler divergence;   

DOI  :  10.1186/s12984-021-00876-6

来源: Springer

【 摘 要 】

BackgroundHemiparesis following stroke is often accompanied by spasticity. Spasticity is one factor among the multiple components of the upper motor neuron syndrome that contributes to movement impairment. However, the specific contribution of spasticity is difficult to isolate and quantify. We propose a new method of quantification and evaluation of the impact of spasticity on the quality of movement following stroke.MethodsSpasticity was assessed using the Tonic Stretch Reflex Threshold (TSRT). TSRT was analyzed in relation to stochastic models of motion to quantify the deviation of the hemiparetic upper limb motion from the normal motion patterns during a reaching task. Specifically, we assessed the impact of spasticity in the elbow flexors on reaching motion patterns using two distinct measures of the ‘distance’ between pathological and normal movement, (a) the bidirectional Kullback–Liebler divergence (BKLD) and (b) Hellinger’s distance (HD). These measures differ in their sensitivity to different confounding variables. Motor impairment was assessed clinically by the Fugl-Meyer assessment scale for the upper extremity (FMA-UE). Forty-two first-event stroke patients in the subacute phase and 13 healthy controls of similar age participated in the study. Elbow motion was analyzed in the context of repeated reach-to-grasp movements towards four differently located targets. Log-BKLD and HD along with movement time, final elbow extension angle, mean elbow velocity, peak elbow velocity, and the number of velocity peaks of the elbow motion were computed.ResultsUpper limb kinematics in patients with lower FMA-UE scores (greater impairment) showed greater deviation from normality when the distance between impaired and normal elbow motion was analyzed either with the BKLD or HD measures. The severity of spasticity, reflected by the TSRT, was related to the distance between impaired and normal elbow motion analyzed with either distance measure. Mean elbow velocity differed between targets, however HD was not sensitive to target location. This may point at effects of spasticity on motion quality that go beyond effects on velocity.ConclusionsThe two methods for analyzing pathological movement post-stroke provide new options for studying the relationship between spasticity and movement quality under different spatiotemporal constraints.

【 授权许可】

CC BY