Physical Therapy and Rehabilitation Science Department, University of Maryland School of Medicine, Baltimore, Maryland.
Occupational Therapy Department, Colorado State University, Fort Collins, Colorado.
Top Stroke Rehabil. 2014 Jan-Feb;21(1):23-32. doi: 10.1310/tsr2101-23.
Stroke rehabilitation interventions and assessments incorporate discrete and/or cyclic reaching tasks, yet no biomechanical comparison exists between these 2 movements in survivors of stroke.
To characterize the differences between discrete (movements bounded by stationary periods) and cyclic (continuous repetitive movements) reaching in survivors of stroke.
Seventeen survivors of stroke underwent kinematic motion analysis of discrete and cyclic reaching movements. Outcomes collected for each side included shoulder, elbow, and trunk range of motion (ROM); peak velocity; movement time; and spatial variability at target contact.
Participants used significantly less shoulder and elbow ROM and significantly more trunk flexion ROM when reaching with the stroke-affected side compared with the less-affected side (P < .001). Participants used significantly more trunk rotation during cyclic reaching than discrete reaching with the stroke-affected side (P = .01). No post hoc differences were observed between tasks within the stroke-affected side for elbow, shoulder, and trunk flexion ROM. Peak velocity, movement time, and spatial variability were not different between discrete and cyclic reaching in the stroke-affected side.
Survivors of stroke reached with altered kinematics when the stroke-affected side was compared with the less-affected side, yet there were few differences between discrete and cyclic reaching within the stroke-affected side. The greater trunk rotation during cyclic reaching represents a unique segmental strategy when using the stroke-affected side without consequences to end-point kinematics. These findings suggest that clinicians should consider the type of reaching required in therapeutic activities because of the continuous movement demands required with cyclic reaching.
中风康复干预和评估包含离散和/或循环的上肢伸展任务，但中风幸存者在这两种运动之间没有生物力学比较。
描述中风幸存者的离散（由静止期界定的运动）和循环（连续重复运动）上肢伸展运动之间的差异。
17 名中风幸存者接受了离散和循环上肢伸展运动的运动学分析。对每侧收集的结果包括肩部、肘部和躯干的运动范围（ROM）；峰值速度；运动时间；以及目标接触时的空间变异性。
与非瘫痪侧相比，中风患者使用瘫痪侧上肢伸展时，肩部和肘部 ROM 明显减少，躯干前屈 ROM 明显增加（P <.001）。与离散上肢伸展相比，中风患者在进行循环上肢伸展时躯干旋转明显更多（P =.01）。在中风患者的患侧，在肘部、肩部和躯干前屈 ROM 方面，没有观察到任务之间的后续差异。在中风患者的患侧，峰值速度、运动时间和空间变异性在离散和循环上肢伸展之间没有差异。
与非瘫痪侧相比，中风患者使用瘫痪侧上肢伸展时的运动学发生了改变，但在中风患者的患侧，离散和循环上肢伸展之间的差异很少。与离散上肢伸展相比，在进行循环上肢伸展时，躯干旋转更大，这是一种独特的节段性策略，而不会对终点运动学产生影响。这些发现表明，由于循环上肢伸展需要连续的运动需求，治疗师应考虑治疗活动中需要的上肢伸展类型。
