Recovery of grasp versus reach in people with hemiparesis poststroke.

Full Abstract

BACKGROUND

AND OBJECTIVE:
The authors recently found that grasping was not relatively more disrupted than reaching in people with acute hemiparesis. They now extend this work to the recovery of reach versus grasp.

METHODS:
Hemiparetic subjects were tested acutely, after 90 days, and then after 1 year poststroke, and a control group was evaluated once. Using kinematic techniques, subjects were studied performing reach and reach-to-grasp movements. The authors quantified 3 characteristics of performance for each movement:
speed, accuracy, and efficiency, where an efficient movement was defined as a movement directly to the target without extraneous or abnormally circuitous movements. To evaluate the relative deficits and recovery in reach versus grasp, performance measures were converted to z scores using control group means and standard deviations.

RESULTS:
The authors' results showed that, starting with small deficits in speed acutely, both reach speed and grasp speed improved over time. Deficits in accuracy were greater in the reach than the grasp acutely, and these deficits lessened such that by the 90-day time point, the relative accuracy of the 2 movements was the same. In contrast, deficits in efficiency were greater in the grasp than the reach acutely, and grasp efficiency did not recover. The majority of recovery in reaching and grasping occurred by the 90-day time point, with little change occurring between the 90-day and 1-year time points.

CONCLUSIONS:
The authors hypothesize that, in chronic hemiparesis, purposeful movements requiring distal control may be more impaired than purposeful movements requiring proximal control, not because of the initial lesion, but because, over the course of recovery, spared components of the descending motor systems may be able to compensate for the accuracy deficits in reaching (proximal control) but not the efficiency deficits in grasping (distal muscular control).

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Author information

Author/s: Lang, Catherine E (CE); Wagner, Joanne M (JM); Edwards, Dorothy F (DF); Sahrmann, Shirley A (SA); Dromerick, Alexander W (AW);

Affiliation: Program in Physical Therapy, Department of Neurology, Washington University, St. Louis, MO 63108, USA. langc(-atsign-)wustl.edu

Grants: HD47669 (Agency:NICHD NIH HHS) ; NS41261 (Agency:NINDS NIH HHS)

Journal and publication information

Publication Type: Clinical Trial; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't

Journal: Neurorehabilitation and neural repair (Neurorehabil Neural Repair), published in United States. (Language: eng)

Reference: 2006-Dec; vol 20 (issue 4) : pp 444-54

Dates: Created 2006/11/03; Completed 2007/01/05; Revised 2007/11/15;

PMID: 17082499, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adaptation, Physiological - physiology
Aged
Biomechanics
Efferent Pathways - physiopathology
Female
Hand - innervation; physiopathology
Hand Strength - physiology
Humans
Male
Middle Aged
Motor Cortex - physiopathology

Motor Cortex - physiopathology
Movement - physiology
Muscle, Skeletal - innervation; physiopathology
Neuronal Plasticity - physiology
Paresis - physiopathology; rehabilitation
Physical Fitness - physiology
Physical Therapy Modalities
Psychomotor Performance - physiology
Pyramidal Tracts - physiopathology
Recovery of Function - physiology
Stroke - physiopathology; rehabilitation

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