Beyond stroke: Impact of the lesion side on the recovery of between-hands coordination

ObjectiveOne-fit-all post-stroke rehabilitation has limited plausibility. Better understanding the effects of the lesion location on the recovery process may help to develop new tailored therapeutic strategies to individuals. The purpose of this study was to assess the natural evolution of bimanual coordination over standard rehabilitation according to the lesion side, aiming to identify a potential responder-profile for bimanual-oriented therapy.Material/patientsTwelve hemiparetic, moderately impaired patients were included within 30 days after a first unilateral stroke. The kinematic and clinical assessments were performed once a week for 6 weeks and at 3 months after inclusion. The patients performed a reach-to-grasp task in unimanual condition followed by a synchronous bimanual condition. The clinical evaluation included the Fugl-Meyer Assessment, Box and Block Test, 9-Hole Peg Test and Barthel Index.ResultsThe clinical scores indicated no difference in motor function between left- (LHD) and right-hemispheric damaged (RHD) patients over time. Interestingly, the LHD patients produced smoother bimanual reaching movements than the RHD patients while we found no effect of the lesion side on reaching kinematics of the paretic UL in unimanual condition. These inter-group differences disappeared after 5 weeks of standard therapy, likely indicating a time lag in motor recovery.DiscussionBecause the RHD patients were less prematurely coordinated again during bimanual movements than the LHD patients, they may benefit differently from a bimanual rehabilitation, and especially from the simultaneous involvement of the ipsilesional UL. It becomes necessary to investigate to what extent this difference due to lesion side may be integrated into the design of rehabilitation protocols

Recovery of kinematic arm function in well-performing people with subacute stroke: A longitudinal cohort study

Background: Most motor function improvements in people who have experienced strokes occur within the first 3 months. However, individuals showing complete or nearly complete arm function recovery, as assessed using clinical scales, still show certain movement kinematic deficits at 3 months, post-stroke. This study evaluated the changes in upper extremity kinematics, in individuals demonstrating minor clinical motor impairments, 3–12 months post-stroke, and also examined the association between kinematics and the subjects’s self-perceived hand abilities during the chronic stage, 12 months post-stroke. Methods: Forty-two subjects recovering from strokes and having Fugl-Meyer upper extremity motor assessment scores ≥60 were included from the Stroke Arm Longitudinal Study at the University of Gothenburg (SALGOT). Kinematic analyses of a drinking task, performed 3, 6, and 12 months post-stroke, were compared with kinematic analyses performed in 35 healthy controls. The Stroke Impact Scale-Hand domain was evaluated at the 12-month follow-up. Results: There were no significant changes in kinematic performance between 3 and 12 months, post-stroke. The patients recovering from stroke showed lower peak elbow extension velocities, and increased shoulder abduction and trunk displacement during drinking than did healthy controls, at all time points. At 12 months, post-stroke, better self-perceived arm functions correlated with improved trunk displacements, movement times, movement units, and time to peak velocity percentages. Conclusion: Kinematic movement deficits, observed at 3 months post-stroke, remained unchanged at 12 months. Movement kinematics were associated with the patient’s self-perceived ability to use their more affected hand. Trial registration: ClinicalTrials: NCT01115348