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Relationships between Sensorimotor Impairments and Reaching Deficits in Acute Hemiparesis

the Program in Physical Therapy

Catherine E. Lang, PhD, PT

the Program in Physical Therapy, Department of Neurology, Program in Occupational Therapy, langc{at}wustl.edu

Shirley A. Sahrmann, PhD

the Program in Physical Therapy, Department of Neurology

Qungli Hu, MS

Department of Neurology

Amy J. Bastian, PhD

Washington University School of Medicine, St. Louis, MO, and Kennedy Krieiger Institute, Johns Hopkins University, Baltimore, MD

Dorothy F. Edwards, PhD

Department of Neurology, Program in Occupational Therapy

Alexander W. Dromerick, MD

the Program in Physical Therapy, Department of Neurology, Program in Occupational Therapy

To determine the relationships between sensorimotor impairments and upper extremity reaching performance during the acute phase of stroke and to determine which, if any, measures of sensorimotor impairment can predict variance in reaching performance during this phase. Methods. Sensorimotor impairments of upper extremity (UE) strength, active range of motion, isolated movement control, light touch sensation, joint position sense, spasticity, and shoulder pain were evaluated in a group of 46 individuals with acute hemiparesis (mean time since insult = 9.2 days). Subjects performed a reaching task to a target placed on their affected side. Three-dimensional kinematic analyses were used to assess reaching speed, accuracy, and efficiency. Forward stepwise multiple linear regression analyses were used to determine which impairment was the best predictor of variance in reaching performance. Results. Measures of UE strength predicted the largest proportion of variance in the speed, accuracy, and efficiency of forward reaching. Isolated movement control, somatosensory deficits, and elbow spasticity predicted smaller amounts of variance in reaching performance. Conclusions. The authors’ data show that deficits in strength appear to be the most influential sensorimotor impairment associated with limited reaching performance in subjects with acute hemiparesis.

Key Words: Hemiparesis • Upper extremity • Stroke Reaching • Movement

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