Workspace location influences joint coordination during reaching in post-stroke hemiparesis.

摘要

The purpose of this study was to determine the influence of workspace location on joint coordination in persons with post-stroke hemiparesis when trunk motion was required to complete reaches beyond the arm's functional reach length. Seven subjects with mild right hemiparesis following a stroke and seven age and gender matched control subjects participated. Joint motions and characteristics of hand and trunk movement were measured over multiple repetitions. The variance (across trials) of joint combinations was partitioned into two components at every point in the hand's trajectory using the uncontrolled manifold approach; the first component is a measure of the extent to which equivalent joint combinations are used to control a given hand path, and reflects performance flexibility. The second component of joint variance reflects the use of non-equivalent joint combinations, which lead to hand path error. Compared to the control subjects, persons with hemiparesis demonstrated a significantly greater amount of non-equivalent joint variability related to control of the hand's path and of the hand's position relative to the trunk when reaching toward the hemiparetic side (ipsilaterally), but not when reaching to the less involved side. The relative timing of the hand and trunk was also altered when reaching ipsilaterally. The current findings support the idea that the previously proposed "arm compensatory synergy" may be deficient in subjects with hemiparesis. This deficiency may be due to one or a combination of factors: changes in central commands that are thought to set the gain of the arm compensatory synergy; a limited ability to combine shoulder abduction and elbow extension that limits the expression of an appropriately set arm compensatory synergy; or a reduction of the necessary degrees-of-freedom needed to adequately compensate for poor trunk control when reaching ipsilaterally.