Alterations in reaching after stroke and their relation to movement direction and impairment severity.
OBJECTIVE
To examine the effects of stroke severity and target location on reaching (1) to identify regions in space that are difficult to reach, (2) to determine whether specific alterations in reaching are associated with particular clinical impairment levels, and (3) to characterize relationships between reaching alterations.


METHODS
Participants reached toward a screen of 75 targets spanning an approximate range from +/-90 degrees side to side and from waist to head.


METHODS
Rehabilitation research center.


METHODS
Sixteen chronic stroke patients with a wide range in residual arm function and 4 control subjects.


METHODS
Not applicable.


METHODS
Chedoke-McMaster Stroke Arm Assessment, distance, velocity, smoothness, straightness, and direction of the hand path during each reach. Hand position trajectories were recorded with an electromagnetic sensor.


RESULTS
Reaches performed with the impaired arms showed significant degradation in all performance measures. Although only modestly dependent on the target location, these features correlated strongly with impairment level, as well as with each other. Reaching distance showed the strongest correlations with the other parameters.


CONCLUSIONS
Stroke alters a broad array of features of reaching, yet largely the same degree of movement control is preserved across a range of target locations. The only consistently problematic task is to reach far out from the torso, independent of the movement direction. Thus, active range of motion (AROM), rather than control over a specific subset of movement directions, is a logical focus for therapy. In addition, measuring AROM is a simple clinical measure that yields much information.
Kamper
Derek G
DG
Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL 60611, USA. d-kamper@northwestern.edu
McKenna-Cole
Alicia N
AN
Kahn
Leonard E
LE
Reinkensmeyer
David J
DJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011596:Psychomotor Disorders / Q000209:etiology* / Q000503:physiopathology* / Q000534:rehabilitation; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D013647:Task Performance and Analysis