title: Comprehensive neuromechanical assessment in stroke patients: reliability and responsiveness of a protocol to measure neural and non-neural wrist properties.
abstract: BACKGROUND
  Understanding movement disorder after stroke and providing targeted treatment for post stroke patients requires valid and reliable identification of biomechanical (passive) and neural (active and reflexive) contributors. Aim of this study was to assess test-retest reliability of passive, active and reflexive parameters and to determine clinical responsiveness in a cohort of stroke patients with upper extremity impairments and healthy volunteers.
  
  
  METHODS
  Thirty-two community-residing chronic stroke patients with an impairment of an upper limb and fourteen healthy volunteers were assessed with a comprehensive neuromechanical assessment protocol consisting of active and passive tasks and different stretch reflex-eliciting measuring velocities, using a haptic manipulator and surface electromyography of wrist flexor and extensor muscles (Netherlands Trial Registry number NTR1424). Intraclass correlation coefficients (ICC) and Standard Error of Measurement were calculated to establish relative and absolute test-retest reliability of passive, active and reflexive parameters. Clinical responsiveness was tested with Kruskal Wallis test for differences between groups.
  
  
  RESULTS
  ICC of passive parameters were fair to excellent (0.45 to 0.91). ICC of active parameters were excellent (0.88-0.99). ICC of reflexive parameters were fair to good (0.50-0.74). Only the reflexive loop time of the extensor muscles performed poor (ICC 0.18). Significant differences between chronic stroke patients and healthy volunteers were found in ten out of fourteen parameters.
  
  
  CONCLUSIONS
  Passive, active and reflexive parameters can be assessed with high reliability in post-stroke patients. Parameters were responsive to clinical status. The next step is longitudinal measurement of passive, active and reflexive parameters to establish their predictive value for functional outcome after stroke.
authors.affiliation: Department of Rehabilitation Medicine, Leiden University Medical Center, Postzone B0-Q, P.O. box 9600, 2300 RC, Leiden, the Netherlands. j.m.van_der_krogt@lumc.nl.
authors.forename: Hanneke
authors.initials: H
authors.lastname: van der Krogt
authors.affiliation: Department of Rehabilitation Medicine, Leiden University Medical Center, Postzone B0-Q, P.O. box 9600, 2300 RC, Leiden, the Netherlands. a.klomp@lumc.nl.|Laboratory for Neuromuscular Control, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, the Netherlands. a.klomp@lumc.nl.
authors.forename: Asbjørn
authors.initials: A
authors.lastname: Klomp
authors.affiliation: Department of Rehabilitation Medicine, Leiden University Medical Center, Postzone B0-Q, P.O. box 9600, 2300 RC, Leiden, the Netherlands. j.h.de_groot@lumc.nl.
authors.forename: Jurriaan H
authors.initials: JH
authors.lastname: de Groot
authors.affiliation: Laboratory for Neuromuscular Control, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, the Netherlands. e.devlugt@tudelft.nl.
authors.forename: Erwin
authors.initials: E
authors.lastname: de Vlugt
authors.affiliation: Laboratory for Neuromuscular Control, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, the Netherlands. f.c.t.vanderhelm@tudelft.nl.
authors.forename: Frans Ct
authors.initials: FC
authors.lastname: van der Helm
authors.affiliation: Department of Rehabilitation Medicine, Leiden University Medical Center, Postzone B0-Q, P.O. box 9600, 2300 RC, Leiden, the Netherlands. c.meskers@vumc.nl.|Current address: Department of Rehabilitation Medicine, VU Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands. c.meskers@vumc.nl.
authors.forename: Carel Gm
authors.initials: CG
authors.lastname: Meskers
authors.affiliation: Department of Rehabilitation Medicine, Leiden University Medical Center, Postzone B0-Q, P.O. box 9600, 2300 RC, Leiden, the Netherlands. j.h.arendzen@lumc.nl.
authors.forename: J Hans
authors.initials: JH
authors.lastname: Arendzen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002545:Brain Ischemia / Q000150:complications / Q000503:physiopathology; D015331:Cohort Studies; D004576:Electromyography; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction; D018482:Muscle, Skeletal / Q000503:physiopathology; D016059:Range of Motion, Articular; D012026:Reflex, Stretch; D015203:Reproducibility of Results; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology*; D014953:Wrist / Q000294:innervation* / Q000503:physiopathology*; D014955:Wrist Joint / Q000503:physiopathology; D055815:Young Adult