Effects of Stroke on Ipsilesional End-Effector Kinematics in a Multi-Step Activity of Daily Living.
Effects of Stroke on Ipsilesional End-Effector Kinematics in a Multi-Step Activity of Daily Living.
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DOI：
10.3389/fnhum.2017.00042
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发表时间：
2017
影响因子：
2.9
通讯作者：
Hermsdörfer J
中科院分区：
文献类型：
--
作者：
Gulde P;Hughes CM;Hermsdörfer J
背景：卒中经常损害日常生活活动能力(ADL)，损害对侧和患肢的功能。为了分析不受轻瘫或感觉丧失影响的高级运动控制的变化，先前已经分析了中风患者在握持动作和简单的工具使用动作时的自发性上肢运动的运动学。相比之下，多步ADL的运动记录很少见，而且很大程度上缺乏对运动运动学的患者对照比较。特别是在临床研究中，客观量化复杂的外部有效任务可以改善神经损伤的评估。方法：在这项初步研究中，我们使用了三维运动记录和运动学分析在多步骤的ADL(泡茶)中。这些试验检查了错误和次级动作结构、持续时间、路径长度(PL)、峰值速度、相对活跃度(RA)和平稳性。为了检查特定的负担，提取并比较了任务的子动作。为了验证该方法的可行性，我们测定了7名慢性卒中患者(64a±11a，3例右脑损害，4例左脑损害，2例有失用体征，不同程度的轻瘫)的行为和运动学指标，并将结果与14名神经学健康的年龄匹配的对照组参与者(70a±7a)的数据进行了比较。结果：t检验显示，任务的子动作的数量和结构相似。末端执行器的运动学分析能够检测到相关参数的明显组差异。具体表现为试验持续时间(Td)增加(Cohen‘s d=1.77)，RA(Cohen’s d=1.72)和峰值速度参数(Cohen‘s d=1.49/1.97)降低。任务的子动作重复测量方差分析(RmANOVA)显示，子动作的不同需求对患者组的相对绩效没有影响。结论：分析揭示了患手动作的运动学特征。这些缺陷显然是由排序等认知需求引起的，而不是运动限制。末端效应器运动学被证明是检测和量化卒中后受扰的多步ADL表现的一种敏感方法。如果标准化，检查和分析是快速的，并提供支持临床研究的客观数据。
Background: Stroke frequently impairs activities of daily living (ADL) and deteriorates the function of the contra- as well as the ipsilesional limbs. In order to analyze alterations of higher motor control unaffected by paresis or sensory loss, the kinematics of ipsilesional upper limb movements in patients with stroke has previously been analyzed during prehensile movements and simple tool use actions. By contrast, motion recording of multi-step ADL is rare and patient-control comparisons for movement kinematics are largely lacking. Especially in clinical research, objective quantification of complex externally valid tasks can improve the assessment of neurological impairments. Methods: In this preliminary study we employed three-dimensional motion recording and applied kinematic analysis in a multi-step ADL (tea-making). The trials were examined with respect to errors and sub-action structure, durations, path lengths (PLs), peak velocities, relative activity (RA) and smoothness. In order to check for specific burdens the sub-actions of the task were extracted and compared. To examine the feasibility of the approach, we determined the behavioral and kinematic metrics of the (ipsilesional) unimanual performance of seven chronic stroke patients (64a ± 11a, 3 with right/4 with left brain damage (LBD), 2 with signs of apraxia, variable severity of paresis) and compared the results with data of 14 neurologically healthy age-matched control participants (70a ± 7a). Results: T-tests revealed that while the quantity and structure of sub-actions of the task were similar. The analysis of end-effector kinematics was able to detect clear group differences in the associated parameters. Specifically, trial duration (TD) was increased (Cohen’s d = 1.77); the RA (Cohen’s d = 1.72) and the parameters of peak velocities (Cohen’s d = 1.49/1.97) were decreased in the patient group. Analysis of the task’s sub-actions repeated measures analysis of variance (rmANOVA) revealed no impact of the different demands of the sub-actions on the relative performance of the patient group. Conclusion: The analyses revealed kinematic peculiarities in the performance with the ipsilesional hand. These deficits apparently arose from the cognitive demands like sequencing rather than motor constraints. End-effector kinematics proved as a sensitive method to detect and quantify aspects of disturbed multi-step ADL performance after stroke. If standardized, the examination and the analysis are quick and deliver objective data supporting clinical research.