This Article Full Text (PDF) All Versions of this Article: 1545968306296964v1 21/3/279    most recent References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Lang, C. E. Articles by Beebe, J. A. Search for Related Content PubMed PubMed Citation Articles by Lang, C. E. Articles by Beebe, J. A. Pubmed/NCBI databases Medline Plus Health Information Movement Disorders Social Bookmarking                         What's this?

Relating Movement Control at 9 Upper Extremity Segments to Loss of Hand Function in People with Chronic Hemiparesis

Program in Physical Therapy, Washington University, St. Louis, MO, langc{at}wustl.edu, Program in Occupational Therapy, Washington University, St. Louis, MO, Department of Neurology, Washington University, St. Louis, MO

Justin A. Beebe, MSPT

Program in Physical Therapy, Washington University, St. Louis, MO

Background and Objective . Loss of hand function in people with hemiparesis is a major contributor to disability poststroke. To use the hand for functional activities, a person may need control of the more proximal upper extremity segments to position and orient the hand with respect to the environment and may need control of the fingers to manipulate objects within the environment. The purpose of this project was to investigate how movement control at proximal, middle, and distal upper extremity segments contributed to loss of hand function in people with chronic hemiparesis. Methods. 32 patients with hemiparesis (avg 21.4 months postlesion) were studied making isolated movements of shoulder flexion, elbow flexion, forearm pronation/supination, wrist flexion/extension, and individual finger flexion using 3D kinematic techniques. For each segment, 3 variables were obtained: how far a segment could move (active range of motion [AROM]), how well a segment could move by itself (individuation index), and how well a segment could remain still when it was not supposed to move (stationary index). Hand function was measured with a battery of clinical tests, and principal components analysis was used to create a single hand function score for each patient from the test battery. Correlation and regression analyses were used to examine relationships between segmental movement control and hand function. Results. Movement control at all 9 segments of the upper extremity was related to hand function. Of the 9 segments, the thumb tended to have the weakest relationship with hand function. Of the 3 measures of movement control, AROM had strong relationships with and predicted the most variance in hand function (73%). Most of this variance was shared across segments, such that, for AROM, there were no unique contributions provided by proximal, middle, or distal segments. Conclusions. These data support the idea that loss of movement control covaries across segments and that loss of hand function is due to loss of movement control at all segments, not just at distal ones.

Key Words: Stroke • Upper extremity • Human • Function • Hand.

This version was published on May 1, 2007

Neurorehabilitation and Neural Repair, Vol. 21, No. 3, 279-291 (2007)
DOI: 10.1177/1545968306296964


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				C. E. Lang, S. L. DeJong, and J. A. Beebe Recovery of Thumb and Finger Extension and Its Relation to Grasp Performance After Stroke J Neurophysiol, July 1, 2009; 102(1): 451 - 459. [Abstract] [Full Text] [PDF]

				H.-M. Chen, C. C. Chen, I-P. Hsueh, S.-L. Huang, and C.-L. Hsieh Test-Retest Reproducibility and Smallest Real Difference of 5 Hand Function Tests in Patients With Stroke Neurorehabil Neural Repair, June 1, 2009; 23(5): 435 - 440. [Abstract] [PDF]

				C. Rudhe and H. J. A. van Hedel Upper Extremity Function in Persons with Tetraplegia: Relationships Between Strength, Capacity, and the Spinal Cord Independence Measure Neurorehabil Neural Repair, June 1, 2009; 23(5): 413 - 421. [Abstract] [PDF]

				J. A. Beebe and C. E. Lang Active Range of Motion Predicts Upper Extremity Function 3 Months After Stroke Stroke, May 1, 2009; 40(5): 1772 - 1779. [Abstract] [Full Text] [PDF]

				M. L. Woodbury, D. R. Howland, T. E. McGuirk, S. B. Davis, C. R. Senesac, S. Kautz, and L. G. Richards Effects of Trunk Restraint Combined With Intensive Task Practice on Poststroke Upper Extremity Reach and Function: A Pilot Study Neurorehabil Neural Repair, January 1, 2009; 23(1): 78 - 91. [Abstract] [PDF]

				M. D. Ellis, T. Sukal, T. DeMott, and J. P. A. Dewald Augmenting Clinical Evaluation of Hemiparetic Arm Movement With a Laboratory-Based Quantitative Measurement of Kinematics as a Function of Limb Loading Neurorehabil Neural Repair, July 1, 2008; 22(4): 321 - 329. [Abstract] [PDF]