1st Joint ESMAC-GCMAS Meeting - Análise de Marcha

O-24
KINEMATIC UPPER LIMB ANALYSIS IN STROKE PATIENTS UNDERGOING
CONSTRAINT-INDUCED MOVEMENT THERAPY: 3-MONTH FOLLOW-UP
Molteni F MD, Caimmi M IR, Carda S MD, Giovanzana C MD, Magoni L IR, Rossini M IR
H. Villa Beretta, Costamasnaga, (LC), Italy
Summary/conclusions
The feasibility of our kinematic upper limb evaluation protocol on monitoring the effects of
CIMT was tested on 6 chronic stroke patients. CIMT has shown to enhance motor function.
Our data confirm motor enhancement up to 3-month follow-up. They also indicate that motor
functional recovery is associated with improvement of the selective motor control. This may be
a first step for understanding the mechanism underlying improvements due to CIMT. More
studies are needed to clarify mechanism of CIMT-induced improvements.
Introduction
A large part of stroke patients are limited in the performance of activities of daily living due to
motor impairment of the affected upper limb. One approach to improve motor performance is
Constraint-Induced Movement Therapy (CIMT) [1], a rehabilitation regime that has already
been shown to enhance motor function in chronic hemiparetic stroke patients [2]. The
underlying mechanism(s) responsible for improved motor function of patients undergoing
CIMT is still not clear. A possible reason for this lack of understanding may lie in the methods
used in assessing upper extremity functions. Most studies rely on clinical tests as Wolf Motor
Functional Test (WMFT), Fugl-Meyer, Motor Activity Log (MAL) while more objective
outcome measures should be necessary to understand the mechanisms underlying stroke motor
deficits and CIMT [3]. Hence, the purpose of this study is to verify if kinematic upper limb
analysis may be a feasible method for studying the intrinsic processes underlying motor
function improvement in stroke patients after CIMT and for monitoring the results of the
therapy in the follow-up.
Statement of Clinical Significance
The proposed kinematic evaluation protocol provides objective measures of upper limb daily
living movements like bringing the hand to the mouth [4] and reaching for an object [5].
Particularly, it allows us to quantify the degree of coordination through the computation of
normalized jerk [6]. These measures may be helpful to better characterize the functional
recovery following CIMT and to gain insight in the mechanisms leading to the improvement.
Methods
Six chronic hemiparetic stroke patients (3 left, 3 right, 4 female, 2 males, average age 49±4
years, 21±5 months since stroke) were selected for this study following the criteria described in
Winstein et al. [7]. The group underwent two weeks of CIMT in which the unaffected hand
was placed in a mitt. Patients were clinically and instrumentally evaluated before treatment,
after 2 weeks of CIMT and again 3 months after.
Clinical evaluation: WMFT (score and time of execution) [8], (MAL) Amount Of Use (AOU)
and Quality Of Use (QOU) [1]
Instrumental evaluation: kinematic upper limb analysis during consecutive cyclic Hand To
Mouth (HTM) and Reaching (RCH) movements. Instrumentation, kinematic model and
acquisition protocol are described elsewhere. [4][5].
Results
In Table 1 clinical and main kinematic outcome measures (average and 1 standard deviation)
are shown. Particularly, Movement Duration (MD), Angle at Elbow at end movement (AE),
mean Angular Velocity at Elbow (AVE), Coefficient of Periodicity of the Acceleration (CPA)
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