Dynamics of post-stroke hand paresis kinematic pattern during rehabilitation

About authors

Research Center of Neurology, Moscow, Russia

Correspondence should be addressed: Anastasia E. Khizhnikova
Volokolamskoye Shosse 80, Moscow, 125367; moc.liamg@lapakhsutsan

About paper

Funding: the study was performed as a part of the public contract № 0512-2014-0036.

Author contribution: Khizhnikova AE — research planning, literature analysis, data acquisition, analysis and interpretation, manuscript draft writing; Klochkov AS — research planning, literature analysis, data interpretation, manuscript writing; Kotov–Smolenskiy AM — training of surveyed patients, patients examination using clinical scales; Suponeva NA — research planning, data interpretation, manuscript writing; Piradov MA — manuscript writing.

Received: 2019-08-16 Accepted: 2019-08-30 Published online: 2019-08-31

According to the literature data, only 5–20% of post-stroke patients are able to restore the hand motor function completely. Correct goal setting and individual approach to the patient's functional recovery are important. Our study aimed to develop an algorithm of impaired hand motor functioning assessment for post-stroke patients and to determine the principles of the rehabilitation tactics choosing based on the biomechanical analysis. Twenty five patients with hemispheric stroke and 10 healthy volunteers participated in the study. Formal clinical observation scales (Fugl–Meyer Assessment, Ashworth Scale, ARAT) and video motion analysis were used for evaluation of the hand motor function. Patients were divided into 2 groups according to the hand paresis severity (mild/moderate and pronounced/severe). Rehabilitation was carried out in both groups, including mechanotherapy, massage and physical therapy. It was revealed that in the 1st group of patients the motor function recovery in the paretic hand was due to movement performance recovery: biomechanical parameters restoration directly correlated with a decrease in the paresis degree according to the Fugl–Meyer Assessment Scale (r = 0.94; p = 0.01). In the 2nd group of patients, the motor function recovery in the paretic hand was due to motor deficit compensation: according to biomechanical analysis, the pathological motor synergies inversely correlated with a decrease in the paresis degree (r = –0.9; p = 0.03). As a result of the study, an algorithm for selecting the patient management tactics based on the baseline clinical indicators was developed.

Keywords: stroke, neurorehabilitation, adaptation, hand paresis, motor relearning, movement biomechanics, motion capture, abnormal synergy