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Multi-finger coordination in healthy subjects and stroke patients: a mathematical modelling approach.

Carpinella I, Jonsdottir J, Ferrarin M - J Neuroeng Rehabil (2011)

Bottom Line: Test-retest reliability was found to be excellent, with ICC > 0.75 and remarking errors comparable to those obtained with other methods.Comparison with healthy controls revealed that hemiparetic hand movement was impaired not only in joints ROM but also in the temporal aspects of motion: peak velocities were significantly decreased, inter-digit coordination was reduced of more than 50% and inter-joint coordination patterns were highly disrupted.In particular, the stereotypical proximal-to-distal opening sequence (reversed during hand closing) found in healthy subjects, was altered in stroke subjects who showed abnormally high delay between IPJ and MCPJ movement or reversed moving sequences.

View Article: PubMed Central - HTML - PubMed

Affiliation: Biomedical Technology Department, Found, Don C, Gnocchi Onlus, IRCCS, Milan, Italy. icarpinella@dongnocchi.it

ABSTRACT

Background: Approximately 60% of stroke survivors experience hand dysfunction limiting execution of daily activities. Several methods have been proposed to objectively quantify fingers' joints range of motion (ROM), while few studies exist about multi-finger coordination during hand movements. The present work analysed this aspect, by providing a complete characterization of spatial and temporal aspects of hand movement, through the mathematical modelling of multi-joint finger motion in healthy subjects and stroke patients.

Methods: Hand opening and closing movements were examined in 12 healthy volunteers and 14 hemiplegic stroke survivors by means of optoelectronic kinematic analysis. The flexion/extension angles of metacarpophalangeal (MCPJ) and proximal interphalangeal joints (IPJ) of all fingers were computed and mathematically characterized by a four-parameter hyperbolic tangent function. Accuracy of the selected model was analysed by means of coefficient of determination (R2) and root mean square error (RMSE). Test-retest reliability was quantified by intraclass correlation coefficient (ICC) and test-retest errors. Comparison between performances of healthy controls and stroke subjects were performed by analysing possible differences in parameters describing angular and temporal aspects of hand kinematics and inter-joint, inter-digit coordination.

Results: The angular profiles of hand opening and closing were accurately characterized by the selected model, both in healthy controls and in stroke subjects (R2 > 0.973, RMSE < 2.0°). Test-retest reliability was found to be excellent, with ICC > 0.75 and remarking errors comparable to those obtained with other methods. Comparison with healthy controls revealed that hemiparetic hand movement was impaired not only in joints ROM but also in the temporal aspects of motion: peak velocities were significantly decreased, inter-digit coordination was reduced of more than 50% and inter-joint coordination patterns were highly disrupted. In particular, the stereotypical proximal-to-distal opening sequence (reversed during hand closing) found in healthy subjects, was altered in stroke subjects who showed abnormally high delay between IPJ and MCPJ movement or reversed moving sequences.

Conclusions: The proposed method has proven to be a promising tool for a complete objective characterization of spatial and temporal aspects of hand movement in stroke, providing further information for a more targeted planning of the rehabilitation treatment to each specific patient and for a quantitative assessment of therapy's outcome.

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Maximum flexion and extension angles. Maximum extension angles (OPEN) and maximum flexion angles (CLOSED) of MCPJ and IPJ of long fingers (a) and thumb (b) for healthy subjects (CO) and stroke patients (ST). Confidence ellipsoids are shown for controls (grey) and for type 0, type I, type II and type III fingers of stroke subjects (black lines).
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Figure 7: Maximum flexion and extension angles. Maximum extension angles (OPEN) and maximum flexion angles (CLOSED) of MCPJ and IPJ of long fingers (a) and thumb (b) for healthy subjects (CO) and stroke patients (ST). Confidence ellipsoids are shown for controls (grey) and for type 0, type I, type II and type III fingers of stroke subjects (black lines).

Mentions: Considering the high variability of maximum extension angles of long fingers' joints, represented by an inter-subject standard deviation 2 to 3 times greater than that of healthy controls (see Table 3 and Figure 7a), a more specific inspection of each digit was performed. This further analysis was based on the preliminary hypothesis that each finger would show, when hand is maximally open, one of the following four conditions: i) unaltered MCPJ and IPJ extension (type 0 finger); ii) reduced MCPJ extension and normal IPJ extension (type I); iii) reduced IPJ extension and normal MCPJ extension (type II), iv) reduction of both IPJ and MCPJ extension (type III). On the basis of this hypothesis, each hemiparetic hand could show either uniform involvement of all long fingers (type 0, type I, type II and type III hand), or differential impairment among digits (type MIX hand). Application of this scheme to the analysed sample of stroke subjects (see Table 4) revealed that one hand showed unaltered MCPJ and IPJ maximum angles (type 0), one hand showed nearly normal IPJ angles and reduced MCPJ extension (type I), three hands revealed an impairment mainly due to IPJ (type II), three hands showed a high reduction of both MCPJ and IPJ maximum extension angle (type III), while, in the remaining six hands (type MIX), long fingers showed characteristics different among each other, thus belonging to different types. Figure 7a depicts the angles of maximum extension (hand open) and maximum flexion (hand closed) for control subjects and each type of hemiparetic hand. Figure 8 depicts the examples of four stroke subjects showing type I, II, III and MIX hands. Contrarily to maximum extension angles, no differences among different hands were noticed in long finger angles at closed hand (see Figure 7a).


Multi-finger coordination in healthy subjects and stroke patients: a mathematical modelling approach.

Carpinella I, Jonsdottir J, Ferrarin M - J Neuroeng Rehabil (2011)

Maximum flexion and extension angles. Maximum extension angles (OPEN) and maximum flexion angles (CLOSED) of MCPJ and IPJ of long fingers (a) and thumb (b) for healthy subjects (CO) and stroke patients (ST). Confidence ellipsoids are shown for controls (grey) and for type 0, type I, type II and type III fingers of stroke subjects (black lines).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3113947&req=5

Figure 7: Maximum flexion and extension angles. Maximum extension angles (OPEN) and maximum flexion angles (CLOSED) of MCPJ and IPJ of long fingers (a) and thumb (b) for healthy subjects (CO) and stroke patients (ST). Confidence ellipsoids are shown for controls (grey) and for type 0, type I, type II and type III fingers of stroke subjects (black lines).
Mentions: Considering the high variability of maximum extension angles of long fingers' joints, represented by an inter-subject standard deviation 2 to 3 times greater than that of healthy controls (see Table 3 and Figure 7a), a more specific inspection of each digit was performed. This further analysis was based on the preliminary hypothesis that each finger would show, when hand is maximally open, one of the following four conditions: i) unaltered MCPJ and IPJ extension (type 0 finger); ii) reduced MCPJ extension and normal IPJ extension (type I); iii) reduced IPJ extension and normal MCPJ extension (type II), iv) reduction of both IPJ and MCPJ extension (type III). On the basis of this hypothesis, each hemiparetic hand could show either uniform involvement of all long fingers (type 0, type I, type II and type III hand), or differential impairment among digits (type MIX hand). Application of this scheme to the analysed sample of stroke subjects (see Table 4) revealed that one hand showed unaltered MCPJ and IPJ maximum angles (type 0), one hand showed nearly normal IPJ angles and reduced MCPJ extension (type I), three hands revealed an impairment mainly due to IPJ (type II), three hands showed a high reduction of both MCPJ and IPJ maximum extension angle (type III), while, in the remaining six hands (type MIX), long fingers showed characteristics different among each other, thus belonging to different types. Figure 7a depicts the angles of maximum extension (hand open) and maximum flexion (hand closed) for control subjects and each type of hemiparetic hand. Figure 8 depicts the examples of four stroke subjects showing type I, II, III and MIX hands. Contrarily to maximum extension angles, no differences among different hands were noticed in long finger angles at closed hand (see Figure 7a).

Bottom Line: Test-retest reliability was found to be excellent, with ICC > 0.75 and remarking errors comparable to those obtained with other methods.Comparison with healthy controls revealed that hemiparetic hand movement was impaired not only in joints ROM but also in the temporal aspects of motion: peak velocities were significantly decreased, inter-digit coordination was reduced of more than 50% and inter-joint coordination patterns were highly disrupted.In particular, the stereotypical proximal-to-distal opening sequence (reversed during hand closing) found in healthy subjects, was altered in stroke subjects who showed abnormally high delay between IPJ and MCPJ movement or reversed moving sequences.

View Article: PubMed Central - HTML - PubMed

Affiliation: Biomedical Technology Department, Found, Don C, Gnocchi Onlus, IRCCS, Milan, Italy. icarpinella@dongnocchi.it

ABSTRACT

Background: Approximately 60% of stroke survivors experience hand dysfunction limiting execution of daily activities. Several methods have been proposed to objectively quantify fingers' joints range of motion (ROM), while few studies exist about multi-finger coordination during hand movements. The present work analysed this aspect, by providing a complete characterization of spatial and temporal aspects of hand movement, through the mathematical modelling of multi-joint finger motion in healthy subjects and stroke patients.

Methods: Hand opening and closing movements were examined in 12 healthy volunteers and 14 hemiplegic stroke survivors by means of optoelectronic kinematic analysis. The flexion/extension angles of metacarpophalangeal (MCPJ) and proximal interphalangeal joints (IPJ) of all fingers were computed and mathematically characterized by a four-parameter hyperbolic tangent function. Accuracy of the selected model was analysed by means of coefficient of determination (R2) and root mean square error (RMSE). Test-retest reliability was quantified by intraclass correlation coefficient (ICC) and test-retest errors. Comparison between performances of healthy controls and stroke subjects were performed by analysing possible differences in parameters describing angular and temporal aspects of hand kinematics and inter-joint, inter-digit coordination.

Results: The angular profiles of hand opening and closing were accurately characterized by the selected model, both in healthy controls and in stroke subjects (R2 > 0.973, RMSE < 2.0°). Test-retest reliability was found to be excellent, with ICC > 0.75 and remarking errors comparable to those obtained with other methods. Comparison with healthy controls revealed that hemiparetic hand movement was impaired not only in joints ROM but also in the temporal aspects of motion: peak velocities were significantly decreased, inter-digit coordination was reduced of more than 50% and inter-joint coordination patterns were highly disrupted. In particular, the stereotypical proximal-to-distal opening sequence (reversed during hand closing) found in healthy subjects, was altered in stroke subjects who showed abnormally high delay between IPJ and MCPJ movement or reversed moving sequences.

Conclusions: The proposed method has proven to be a promising tool for a complete objective characterization of spatial and temporal aspects of hand movement in stroke, providing further information for a more targeted planning of the rehabilitation treatment to each specific patient and for a quantitative assessment of therapy's outcome.

Show MeSH
Related in: MedlinePlus