Deans' stroke musings: Faster Reaching in Chronic Spastic Stroke Patients Comes at the Expense of Arm-Trunk Coordination

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, February 12, 2016

Faster Reaching in Chronic Spastic Stroke Patients Comes at the Expense of Arm-Trunk Coordination

Precisely how is this knowledge going to change your stroke protocols to recover better? No answer, then what the fuck use is this research?
http://nnr.sagepub.com/content/30/3/209?etoc

¹Raymond Poincaré Hospital, Garches, France
²GRCTH, EA4497, CIC-IT 805, CHU Raymond Poincaré, UVSQ, Garches, France
³CNRS, UMR 7222, ISIR, Paris, France
⁴Sorbonne Universités, UPMC University Pierre et Marie Curie, UMR 7222, Paris, France
⁵INSERM, U1150, Agathe-ISIR, Paris, France

Agnès Roby-Brami, MD, PhD, UPMC University Pierre et Marie Curie, 4 place Jussieu, Paris, 75005, France. Email: roby-brami@isir.upmc.fr

Abstract

Background. The velocity of reaching movements is often reduced in patients with stroke-related hemiparesis; however, they are able to voluntarily increase paretic hand velocity. Previous studies have proposed that faster speed improves movement quality.

Objective. To investigate the combined effects of reaching distance and speed instruction on trunk and paretic upper-limb coordination. The hypothesis was that increased speed would reduce elbow extension and increase compensatory trunk movement.

Methods. A single session study in which reaching kinematics were recorded in a group of 14 patients with spastic hemiparesis. A 3-dimensional motion analysis system was used to track the trajectories of 5 reflective markers fixed on the finger, wrist, elbow, acromion, and sternum. The reaching movements were performed to 2 targets at 60% and 90% arm length, respectively, at preferred and maximum velocity. The experiment was repeated with the trunk restrained by a strap. Results. All the patients were able to voluntarily increase reaching velocity. In the trunk free, faster speed condition, elbow extension velocity increased but elbow extension amplitude decreased and trunk movement increased. In the trunk restraint condition, elbow extension amplitude did not decrease with faster speed. Seven patients scaled elbow extension and elbow extension velocity as a function of reach distance, the other 7 mainly increased trunk compensation with increased task constraints. There were no clear clinical characteristics that could explain this difference. Conclusions. Faster speed may encourage some patients to use compensation. Individual indications for therapy could be based on a quantitative analysis of reaching coordination.