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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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Inter-joint coordination in stroke subjects. Delay between IPJ and MCPJ of thumb (TH) and long fingers (LF) for stroke subjects, during hand opening (a, b) and hand closing (c, d). Columns and whiskers represent mean and standard deviation, respectively. Dashed horizontal lines represent healthy control range (± SD). *p < 0.05, **p < 0.01, ***p < 0.001 (Stroke Type vs Control, Mann-Whitney U test). Significant differences among stroke types are shown.
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Figure 9: Inter-joint coordination in stroke subjects. Delay between IPJ and MCPJ of thumb (TH) and long fingers (LF) for stroke subjects, during hand opening (a, b) and hand closing (c, d). Columns and whiskers represent mean and standard deviation, respectively. Dashed horizontal lines represent healthy control range (± SD). *p < 0.05, **p < 0.01, ***p < 0.001 (Stroke Type vs Control, Mann-Whitney U test). Significant differences among stroke types are shown.

Mentions: Results related to IPJ-MCPJ delay revealed that the proximal-to-distal sequence typical of controls during hand opening was highly disrupted in stroke subjects. Figure 9a shows the mean (± SD) values of delay parameter for the different types of long fingers. Delay of type 0 digits (i.e. unaltered extension of both MCPJ and IPJ) was in the control range (see also Figure 10b). Type I fingers (i.e. impairment of MCPJ extension only) showed a negative average delay (Figure 9a) which indicated a reversed opening sequence (i.e. MCPJ followed by IPJ in reaching peak speed). This was caused, in 30% of the digits, by a delayed motion of MCPJ (Figure 10c), while in the remaining 70%, by a significantly slowed movement of MCPJ (Figure 10d). Type II digits (i.e. impairment of IPJ extension only) revealed a significantly higher delay with respect to healthy subjects (Figure 9a), which was due, in 30% of the cases, to a segmented movement in which IPJ started moving after MCPJ had already reached full extension (Figure 10e) and, in 70% of the cases, to a significantly slower movement of IPJ with respect to MCPJ (Figure 10f). In type III digits (i.e. impairment of both MCPJ and IPJ extension), MCPJ and IPJ contemporarily reached peak velocity as indicated by the delay value approximately equal to 0 (Figure 9a and Figure 10g). Impairment of inter-joint coordination was noticed also in the thumb of type II and type III hands which showed a reversed sequence of movement (MCPJ first followed by IPJ), as shown in Figure 9b. Inter-joint coordination was altered also during hand closing. Even though inter-digit variability was extremely high, mean values showed a reduced delay in long fingers, with MCPJ and IPJ which flexed almost synchronously (Figure 9c). Thumb, instead, revealed an abnormally high delay with respect to controls (see Figure 9d).


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

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

Inter-joint coordination in stroke subjects. Delay between IPJ and MCPJ of thumb (TH) and long fingers (LF) for stroke subjects, during hand opening (a, b) and hand closing (c, d). Columns and whiskers represent mean and standard deviation, respectively. Dashed horizontal lines represent healthy control range (± SD). *p < 0.05, **p < 0.01, ***p < 0.001 (Stroke Type vs Control, Mann-Whitney U test). Significant differences among stroke types are shown.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 9: Inter-joint coordination in stroke subjects. Delay between IPJ and MCPJ of thumb (TH) and long fingers (LF) for stroke subjects, during hand opening (a, b) and hand closing (c, d). Columns and whiskers represent mean and standard deviation, respectively. Dashed horizontal lines represent healthy control range (± SD). *p < 0.05, **p < 0.01, ***p < 0.001 (Stroke Type vs Control, Mann-Whitney U test). Significant differences among stroke types are shown.
Mentions: Results related to IPJ-MCPJ delay revealed that the proximal-to-distal sequence typical of controls during hand opening was highly disrupted in stroke subjects. Figure 9a shows the mean (± SD) values of delay parameter for the different types of long fingers. Delay of type 0 digits (i.e. unaltered extension of both MCPJ and IPJ) was in the control range (see also Figure 10b). Type I fingers (i.e. impairment of MCPJ extension only) showed a negative average delay (Figure 9a) which indicated a reversed opening sequence (i.e. MCPJ followed by IPJ in reaching peak speed). This was caused, in 30% of the digits, by a delayed motion of MCPJ (Figure 10c), while in the remaining 70%, by a significantly slowed movement of MCPJ (Figure 10d). Type II digits (i.e. impairment of IPJ extension only) revealed a significantly higher delay with respect to healthy subjects (Figure 9a), which was due, in 30% of the cases, to a segmented movement in which IPJ started moving after MCPJ had already reached full extension (Figure 10e) and, in 70% of the cases, to a significantly slower movement of IPJ with respect to MCPJ (Figure 10f). In type III digits (i.e. impairment of both MCPJ and IPJ extension), MCPJ and IPJ contemporarily reached peak velocity as indicated by the delay value approximately equal to 0 (Figure 9a and Figure 10g). Impairment of inter-joint coordination was noticed also in the thumb of type II and type III hands which showed a reversed sequence of movement (MCPJ first followed by IPJ), as shown in Figure 9b. Inter-joint coordination was altered also during hand closing. Even though inter-digit variability was extremely high, mean values showed a reduced delay in long fingers, with MCPJ and IPJ which flexed almost synchronously (Figure 9c). Thumb, instead, revealed an abnormally high delay with respect to controls (see Figure 9d).

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