Horstink, K. (Koen) (2020) Evaluating upper extremity coordination and functional performance in chronic stroke patients after a home-based task-specific training using the ArmAssist. thesis, Human Movement Sciences.
Full text available on request.Abstract
Aim of the study: Stroke leads to deficits in upper extremity functioning, characterized by the presence of pathological synergies. Pathological synergies disturb inter-joint coordination, resulting in problems during activities of daily living. The pathological flexion synergy, characterized by the coupling between elbow flexion and shoulder abduction, is the main disruption of inter-joint coordination during reaching and retrieving an object. The aim of this study was to evaluate the effects of a 6-week home-based task-specific training using a robot-assistive device, called the ArmAssist, on upper extremity coordination. The focus is on inter-joint coordination between shoulder abduction-adduction and elbow flexion-extension, which can describe the presence of the pathological flexion synergy. The second aim of this study was to evaluate effects of the intervention on the ‘Body functions & structures’ and ‘Activity’ domains of the International Classification of Functioning, Disability and Health (ICF), reflected by the Fugl-Meyer Assessment upper extremity part (FMA) and Wolf Motor Function Test (WMFT) respectively. Methods: Only participants in the chronic phase after stroke were included and received 6-weeks of home-based task-specific training using the ArmAssist. Coordination was measured using inertial measurement units (Xsens) during the WMFT. The primary outcome measure was Continuous Relative Phase (CRP) between shoulder abduction-adduction and elbow flexion-extension angles measured with Xsens. Secondary outcome measures were the scores on the FMA and WMFT, which were statistically tested using the Wilcoxon matched-pairs test. Results: Five participants were included in this study. The CRP showed overall more negative values after the intervention, indicating that the shoulder joint has a larger role in leading the movement after the intervention. In addition, the movement patterns suggest reductions in the pathological flexion synergy after the intervention. The FMA showed a non-significant increase of 6.0 (Z = -1.461; p = 0.144; Cohen’s d = 0.51) with medium effect size and the WMFT showed a non-significant increase of 5.0 (Z = -1.761; p = 0.078; Cohen’s d = 0.35) points with small to medium effect size. Discussion/Conclusions: The participants showed improved upper extremity coordination after the intervention, reflected by the leading joint shift from elbow to shoulder and reductions in the pathological flexion synergy. The ArmAssist training showed a non-significant increase in FMA and WFMT, however, both increases were considered real and clinically relevant for stroke patients. The results found in this study provides evidence for clinicians that the use of home-based task-specific robot-assisted training can be used for improving coordination.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Murgia, dr. A. |
| Faculty: | Medical Sciences |
| Date Deposited: | 18 May 2022 10:11 |
| Last Modified: | 18 May 2022 10:11 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3356 |
Actions (login required)
 |
View Item |