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PubMed2002

Role of eye, head, and shoulder geometry in the planning of accurate arm movements.

Eye-hand coordination requires the brain to integrate visual information with the continuous changes in eye, head, and arm positions. This is a geometrically complex process because the eyes, head, and shoulder have different centers of rotation. As a result, head rotation causes the eye to translate with respect to the shoulder. The present study examines the consequences of this geometry for planning accurate arm movements in a pointing task with the head at different orientations. When asked to point at an object, subjects oriented their arm to position the fingertip on the line running from the target to the viewing eye. But this eye-target line shifts when the eyes translate with each new head orientation, thereby requiring a new arm pointing direction. We confirmed that subjects do realign their fingertip with the eye-target line during closed-loop pointing across various horizontal head orientations when gaze is on target. More importantly, subjects also showed this head-position-dependent pattern of pointing responses for the same paradigm performed in complete darkness. However, when gaze was not on target, compensation for these translations in the rotational centers partially broke down. As a result, subjects tended to overshoot the target direction relative to current gaze; perhaps explaining previously reported errors in aiming the arm to retinally peripheral targets. These results suggest that knowledge of head position signals and the resulting relative displacements in the centers of rotation of the eye and shoulder are incorporated using open-loop mechanisms for eye-hand coordination, but these translations are best calibrated for foveated, gaze-on-target movements.

Adult↗
PubMed2002

Neuronal activity related to the visual representation of arm movements in the lateral cerebellar cortex.

Testing the hypothesis that the lateral cerebellum forms a sensory representation of arm movements, we investigated cortical neuronal activity in two monkeys performing visually guided step-tracking movements with a manipulandum. A virtual target and cursor image were viewed co-planar with the manipulandum. In the normal task, manipulandum and cursor moved in the same direction; in the mirror task, the cursor was left-right reversed. In one monkey, 70- and 200-ms time delays were introduced on cursor movement. Significant task-related activity was recorded in 31 cells in one animal and 142 cells in the second: 10.2% increased activity before arm movements onset, 77.1% during arm movement, and 12.7% after the new position was reached. To test for neural representation of the visual outcome of movement, firing rate modulation was compared in normal and mirror step-tracking. Most task-related neurons (68%) showed no significant directional modulation. Of 70 directionally sensitive cells, almost one-half (n = 34, 48%) modulated firing with a consistent cursor movement direction, many fewer responding to the manipulandum direction (n = 9, 13%). For those "cursor-related" cells tested with delayed cursor movement, increased activity onset was time-locked to arm movement and not cursor movement, but activation duration was extended by an amount similar to the applied delay. Hence, activity returned to baseline about when the delayed cursor reached the target. We conclude that many cells in the lateral cerebellar cortex signaled the direction of cursor movement during active step-tracking. Such a predictive representation of the arm movement could be used in the guidance of visuo-motor actions.

Action Potentials↗
PubMed2005

Motor cortex neural correlates of output kinematics and kinetics during isometric-force and arm-reaching tasks.

We recorded the activity of 132 proximal-arm-related neurons in caudal primary motor cortex (M1) of two monkeys while they generated either isometric forces against a rigid handle or arm movements with a heavy movable handle, in the same eight directions in a horizontal plane. The isometric forces increased in monotonic fashion in the direction of the force target. The forces exerted against the handle in the movement task were more complex, including an initial accelerating force in the direction of movement followed by a transient decelerating force opposite to the direction of movement as the hand approached the target. EMG activity of proximal-arm muscles reflected the difference in task dynamics, showing directional ramplike activity changes in the isometric task and reciprocally tuned "triphasic" patterns in the movement task. The apparent instantaneous directionality of muscle activity, when expressed in hand-centered spatial coordinates, remained relatively stable during the isometric ramps but often showed a large transient shift during deceleration of the arm movements. Single-neuron and population-level activity in M1 showed similar task-dependent changes in temporal pattern and instantaneous directionality. The momentary dissociation of the directionality of neuronal discharge and movement kinematics during deceleration indicated that the activity of many arm-related M1 neurons is not coupled only to the direction and speed of hand motion. These results also demonstrate that population-level signals reflecting the dynamics of motor tasks and of interactions with objects in the environment are available in caudal M1. This task-dynamics signal could greatly enhance the performance capabilities of neuroprosthetic controllers.

Animals↗
PubMed2003

Drawing sequences of segments in 3D: kinetic influences on arm configuration.

Complex movements are generally thought to consist of a series of simpler elements. If this is so, how does the sensorimotor system assemble the pieces? This study recorded and evaluated sequences of arm movements to various targets placed in three-dimensional (3D) space. Subjects performed sequences consisting of single, double, or triple segments with the same first target but with different second targets. The data analysis focused on the first movement segment and evaluated hand path curvature, the hand's final approach to the first target, and the whole arm postures at the beginning and end. Although some idiosyncratic differences in approach were observed, only the final arm posture depended, in a consistent way, on which particular movement was to follow as the second segment. This provided evidence for "coarticulation" of the two segments, only at the level of arm posture, and simulations revealed that this anticipatory modification improved the energetic efficiency of the second segment. Data from movements through five consecutive triple segments (i.e., 5 triangles) were assessed to determine whether kinematic constraints, such as Donders' law, apply to repetitive drawing movements. Although such constraints could prevent the accumulation of changes in arm posture, this was not observed. Instead, in most cases, the elbow was a little bit higher at the end of each triangle than at the beginning. Taken together, the results suggest that coarticulation may facilitate the joining of two segments and the efficiency of the second movement, but does not extend over the drawing of several segments.

Adult↗
PubMed1989

Cerebellar neuronal activity related to whole-arm reaching movements in the monkey.

1. Three monkeys were trained to make whole-arm reaching movements from a common central starting position toward eight radially arranged targets disposed at 45 degrees intervals. A sample of 312 cerebellar neurons with proximal-arm receptive fields or discharge related to shoulder or elbow movements was studied in the task. The sample included 69 Purkinje cells, 115 unidentified cortical cells, 65 interpositus neurons, and 63 dentate units. 2. The reaching task was divided into three movement-related epochs: a reaction time, a movement time, and holding over the target. All neurons demonstrated significant changes in discharge during one or more of these three epochs. Almost all of the cells (95%) showed a significant change in activity during the movement, whereas 68-69% of the cells showed significant changes from premovement activity during the reaction time and holding periods. 3. During the combined reaction time-movement period, 231/312 cells were strongly active in the task. Of these, 151 cells (65.4%) demonstrated unimodal directional responses. Sixty-three had a reciprocal relation to movement direction, whereas 88 showed only graded increases or decreases in activity. A further 37 cells (16.0%) were nondirectional, with statistically uniform changes in discharge in all eight directions. The remaining 43 cells (18.6%) showed significant differences in activity for different directions of movement, but their response patterns were not readily classifiable. 4. The proportion of directional versus nondirectional cells was consistent across the four cell populations. However, graded response patterns were more common and reciprocal responses less common among Purkinje and dentate neurons than among unidentified cortical cells and interpositus neurons. 5. The distribution of preferred directions of the population of cerebellar neurons covered all possible movement directions away from the common central starting position in the horizontal plane. When the preferred direction of each cell in the sample population was aligned, the mean direction-related activity of the cerebellar population formed a bell-shaped tuning curve for the activity recorded during both the reaction time and the movement, as well as during the time the arm maintained a fixed posture over the targets. A vector representation also showed that the overall activity of the cerebellar population during normal reaching arm movements generated a signal that varied with movement direction. 6. These results demonstrate that the cerebellum generates a signal that varies with the direction of movement of the proximal arm during normal aimed reaching movements and is consistent with a role in the control of the activity of muscles or muscle groups generating these movements.

Animals↗
PubMed1992

Two components of muscle activation: scaling with the speed of arm movement.

1. The temporal waveform of muscle activity was related to the speed of arm movement. Speed was expressed in terms of the duration of a fixed amplitude movement or the "movement time." 2. Human subjects moved their arms to targets in three-dimensional space. The right arm started at a standard initial position and moved directly to the target in a single stroke. The targets were placed in various directions in a vertical plane. The arm movements consisted of shoulder and elbow rotations. 3. Subjects were required to vary the speed of their movements. In most of the experiments, trials with different movement times were randomly ordered. One of the experiments also included randomly interspersed static trials, in which the subject held the arm still at the initial posture, the final posture, or halfway between the two extremes. 4. Electromyographic (EMG) activity was recorded from several superficial elbow and/or shoulder muscles. The time base of rectified EMG records was normalized for movement time such that records from movements with various speeds were compressed to align the ending times of the movements. 5. A principal component (PC) analysis revealed that the compressed EMG waveforms could be described by a summation of PC1 and PC2 waveforms; each individual EMG waveform was approximated by a weighted sum of these two components. 6. The PC1 weighting coefficients scaled down in a monotonic relationship with movement time such that the fastest movement corresponded to a large positive weighting coefficient and the slowest movement corresponded to a small positive weighting coefficient. The PC2 weighting coefficients exhibited a similar monotonic scaling, but the values ranged from positive to negative. Further analysis demonstrated that these two components can be mathematically transformed into a tonic waveform with a constant mathematically transformed into a tonic waveform with a constant weighting coefficient and a phasic waveform with positive weighting coefficients that scale down with movement time. 7. The amplitude scaling of EMG records cannot be described by a single component, but instead requires a summation of two separate components. The tonic component may correspond to the force element needed to counteract gravity, because the magnitude of this element does not scale with movement speed. The phasic component may correspond to the force element that scales quadratically to produce a linear increase in velocity.

Arm↗
PubMed1994

Tactile activity in primate primary somatosensory cortex during active arm movements: cytoarchitectonic distribution.

1. Cells were recorded in areas 3b and 1 of the primary somatosensory cortex (SI) of three monkeys during active arm movements. Successful reconstructions were made of 46 microelectrode penetrations, and 298 cells with tactile receptive fields (RFs) were located as to cytoarchitectonic area, lamina, or both. 2. Area 3b contained a greater proportion of cells with slowly adapting responses to tactile stimuli and fewer cells with deep modality inputs than did area 1. Area 3b also showed a greater level of movement-related modulation in tactile activity than area 1. Other cell properties were equally distributed in the two areas. 3. The distribution of cells with low-threshold tactile RFs that also responded to lateral stretch of the skin or to passive arm movements was skewed toward deeper laminae than for tactile cells that did not respond to those manipulations. 4. The variation of activity of tactile neurons during arm movements in different directions was weaker in the superficial laminae than in deeper cortical laminae. 5. Cells with only increases in activity during arm movements were preferentially but not exclusively located in middle and superficial layers. Cells with reciprocal responses were found mainly in laminae III and V, whereas cells with only decreases in activity were concentrated in lamina V. 6. Overall, active arm movements evoke directionally tuned tactile and "deep" activity in areas 3b and 1, in particular in the deeper cortical laminae that are the source of the descending output pathways from SI.

Animals↗
PubMed1995

Two functionally different synergies during arm reaching movements involving the trunk.

1. To address the problem of the coordination of a redundant number of degrees of freedom in motor control, we analyzed the influence of voluntary trunk movements on the arm endpoint trajectory during reaching. 2. Subjects made fast noncorrected planar movements of the right arm from a near to a far target located in the ipsilateral work space at a 45 degrees angle to the sagittal midline of the trunk. These reaching movements were combined with a forward or a backward sagittal motion of the trunk. 3. The direction, positional error, curvature, and velocity profile of the endpoint trajectory remained invariant regardless of trunk movements. Trunk motion preceded endpoint motion by approximately 175 ms, continued during endpoint movement to the target, and outlasted it by 200 ms. This sequence of trunk and arm movements was observed regardless of the direction of the endpoint trajectory (to or from the far target) or trunk movements (forward or backward). 4. Our data imply that reaching movements result from two control synergies: one coordinates trunk and arm movements leaving the position of the endpoint unchanged, and the other produces interjoint coordination shifting the arm endpoint to the target. The use of functionally different synergies may underlie a solution of the redundancy problem.

Arm↗
PubMed1995

Changes in motor cortex activity during reaching movements with similar hand paths but different arm postures.

1. Neuronal activity was recorded in the motor cortex of a monkey that performed reaching movements with the use of two different arm postures. In the first posture (control), the monkey used its natural arm orientation, approximately in the sagittal plane. In the second posture (abducted), the monkey had to adduct its elbow nearly to shoulder level to grasp the handle. The path of the hand between targets was similar in both arm postures, but the joint kinematics and kinetics were different. 2. In both postures, the activity of single cells was often broadly tuned with movement direction and static arm posture over the targets. In a large proportion of cells, either the level of tonic activity, the directional tuning, or both, varied between the two postures during the movement and target hold periods. 3. For most directions of movement, there was a statistically significant difference in the direction of the population vector for the two arm postures. Furthermore, whereas the population vector tended to point in the direction of movement for the control posture, there was a poorer correspondence between the direction of movement and the population vector for the abducted posture. These observed changes are inconsistent with the notion that the motor cortex encodes purely hand trajectory in space.

Animals↗
PubMed1996

Changes in the control of arm position, movement, and thalamic discharge during local inactivation in the globus pallidus of the monkey.

1. To examine the effect of disruption of basal ganglia output on limb stability and movement, muscimol was injected into the internal globus pallidus (GPi) of monkeys trained to make arm movements to visible or remembered targets in a two-dimensional workspace. 2. Injections of as little as 0.25 micrograms muscimol at GPi sites at which pallidal neurons with arm movement activity had been recorded were followed by drift of the contralateral arm within < 10 min. Drift was usually in the flexor direction. Injections at a few sites in or near the external pallidal segment sometimes were followed by extensor drift. 3. Drift was active (accompanied by activation of agonist muscles), but could be overcome by the animal, resulting in an oscillating movement off and on the required position. 4. The pallidal-receiving (PR) area of the thalamus was identified by recording the response of thalamic neurons to stimulation in the globus pallidus. The activity of 15 neurons identified as PR cells (n = 6) or within the PR region was recorded both before and after injection of muscimol into GPi. After the injection, the tonic discharge increased during the hold period in 47% of the cells studied. When postural drift also occurred, there was a close temporal correlation between the postinjection time at which drift occurred and the time at which the tonic discharge rate increased in thalamic neurons that were clearly related to arm movement. 5. The peak velocity of arm movements to visible or remembered visual target locations was decreased after injection of muscimol into GPi, sometimes with an increase in movement time. 6. The firing rate of PR thalamic neurons after injection of muscimol was also increased during the perimovement period. Because of the increase in the tonic discharge rate, however, the phasic movement-related change in activity could stay the same or even decrease. Postinjection changes in this movement-related phasic activity, however, were not necessarily coincident with changes in peak movement velocity. 7. Changes in reaction time were variable after injection of muscimol. In some cases it was increased, and in others decreased. The time of onset of phasic movement-related changes in the activity of PR neurons studied was not altered by the injection. 8. Our data indicate that the tonic inhibitory output of GPi, in particular to the cortical motor areas, is especially important in the maintenance of postural stability. In the absence of normal pallidal output, desired limb position can be achieved on the basis of either current or prior visual cues, but targeted movements are slowed.

Animals↗
PubMed1999

Do arm postures vary with the speed of reaching?

Do arm postures vary with the speed of reaching? For reaching movements in one plane, the hand has been observed to follow a similar path regardless of speed. Recent work on the control of more complex reaching movements raises the question of whether a similar "speed invariance" also holds for the additional degrees of freedom. Therefore we examined human arm movements involving initial and final hand locations distributed throughout the three-dimensional (3D) workspace of the arm. Despite this added complexity, arm kinematics (summarized by the spatial orientation of the "plane of the arm" and the 3D curvature of the hand path) changed very little for movements performed over a wide range of speeds. If the total force (dynamic + quasistatic) had been optimized by the control system (e.g., as in a minimization of the change in joint torques or the change in muscular forces), the optimal solution would change with speed; slow movements would reflect the minimal antigravity torques, whereas fast movements would be more strongly influenced by dynamic factors. The speed-invariant postures observed in this study are instead consistent with a hypothesized optimization of only the dynamic forces.

Arm↗
PubMed2000

Differences in control of limb dynamics during dominant and nondominant arm reaching.

This study compares the coordination patterns employed for the left and right arms during rapid targeted reaching movements. Six right-handed subjects reached to each of three targets, designed to elicit progressively greater amplitude interaction torques at the elbow joint. All targets required the same elbow excursion (20 degrees ), but different shoulder excursions (5, 10, and 15 degrees, respectively). Movements were restricted to the shoulder and elbow and supported on a horizontal plane by a frictionless air-jet system. Subjects received visual feedback only of the final hand position with respect to the start and target locations. For motivation, points were awarded based on final position accuracy for movements completed within an interval of 400-600 ms. For all subjects, the right and left hands showed a similar time course of improvement in final position accuracy over repeated trials. After task adaptation, final position accuracy was similar for both hands; however, the hand trajectories and joint coordination patterns during the movements were systematically different. Right hand paths showed medial to lateral curvatures that were consistent in magnitude for all target directions, whereas the left hand paths had lateral to medial curvatures that increased in magnitude across the three target directions. Inverse dynamic analysis revealed substantial differences in the coordination of muscle and intersegmental torques for the left and right arms. Although left elbow muscle torque contributed largely to elbow acceleration, right arm coordination was characterized by a proximal control strategy, in which movement of both joints was primarily driven by the effects of shoulder muscles. In addition, right hand path direction changes were independent of elbow interaction torque impulse, indicating skillful coordination of muscle actions with intersegmental dynamics. In contrast, left hand path direction changes varied directly with elbow interaction torque impulse. These findings strongly suggest that distinct neural control mechanisms are employed for dominant and non dominant arm movements. However, whether interlimb differences in neural strategies are a consequence of asymmetric use of the two arms, or vice versa, is not yet understood. The implications for neural organization of voluntary movement control are discussed.

Adult↗
PubMed2004

Early and repetitive stimulation of the arm can substantially improve the long-term outcome after stroke: a 5-year follow-up study of a randomized trial.

BACKGROUND AND PURPOSE: Several studies have investigated the effect of therapeutic interventions for the arm in the acute phase after stroke, with follow-ups at a maximum of 12 months. The aim of this study was to examine the effect of repetitive sensorimotor training of the arm at 5 years after stroke. SUBJECTS AND METHODS: One hundred consecutive stroke patients were randomly allocated either to an experimental group that received daily additional sensorimotor stimulation of the arm or to a control group. The intervention period was 6 weeks. Assessments of the patients were made before, midway, and after intervention, and at 6 and 12 months after stroke. In this study, 62 patients were reassessed at 5 years after stroke. The Brunnström-Fugl-Meyer (BFM) test, Action Research Arm (ARA) test, and Barthel index (BI) were used as the primary outcome measures. RESULTS: At the 5-year follow-up, there was a statistically significant difference for both the BFM and ARA tests in favor of the experimental group. The mean differences in improvement between the groups from the initial evaluation to the 5-year assessment corresponded to 17 points on the BFM and 17.4 on the ARA. No effect was found for the BI. The treatment was most effective in patients with a severe initial motor deficit. CONCLUSIONS: Adding a specific intervention for the arm during the acute phase after a stroke resulted in a clinically meaningful and long-lasting effect on motor function. The effect can be attributed to early, repetitive, and targeted stimulation.

Adult↗
PubMed2004

Agreement between ambulance paramedic- and physician-recorded neurological signs with Face Arm Speech Test (FAST) in acute stroke patients.

BACKGROUND AND PURPOSE: Patients with suspected stroke first assessed by ambulance paramedics require early recognition to facilitate appropriate triage and early treatment. We determined paramedic's accuracy in detecting acute stroke signs by comparing agreement between neurological signs recorded in the Face Arm Speech Test (FAST), a stroke recognition instrument, by paramedics on the scene and by stroke physicians after admission. METHODS: Suspected stroke patients admitted by ambulance paramedics directly to an acute stroke unit through a rapid ambulance protocol were examined by a trainee stroke neurologist or admitting stroke physician over a 1-year period. Recorded neurological signs (facial weakness, arm weakness, speech disturbance) in confirmed acute stroke/transient ischemic attack (TIA) cases were compared between paramedics and the stroke neurologist/physician. RESULTS: Ambulance crews referred 278 suspected stroke patients of whom 217 (78%) had confirmed stroke (n=189) or TIA (n=28); 95% were examined by the stroke neurologist (median 18 hours after paramedic assessment). Recorded signs and agreement between paramedics and stroke physicians in confirmed stroke group were: facial weakness, 68% versus 70% (kappa=0.49; 95% CI: 0.36 to 0.62); arm weakness, 96% versus 95% (kappa=0.77; 95% CI: 0.55 to 0.99); and speech disturbance, 79% versus 77% (kappa=0.69; 95% CI: 0.56 to 0.82). Interrater agreement was complete for arm weakness in 98% cases. CONCLUSIONS: Recognition of neurological deficits by ambulance paramedics using FAST shows good agreement with physician assessment, even allowing for temporal evolution of deficits. The high prevalence and good agreement for arm weakness suggest that this sign may have the greatest usefulness for prehospital ambulance triage and paramedic-based neuroprotective trials.

Acute Disease↗
PubMedDate not supplied

Reaching out to see: arm position can attenuate human visual loss.

Electrophysiological recordings in monkeys have now revealed several brain regions that contain bimodal visuotactile neurons capable of responding to either tactile or visual stimuli placed on or near the hands, arms, and face. These cells have now been found in frontal, parietal, and subcortical areas of the monkey brain, suggesting a cortical network of neurons that preferentially represent near peripersonal space. The degree to which the visual responses of such cells rely on input from the primary visual cortex and the extent to which they may contribute to visual perception is not completely understood. Nonetheless, recent neuropsychological studies suggest that a similar representation of near space may be bimodally coded in humans as well. Given the accumulating evidence for specialized processing of visual stimuli placed near the hands and arms, we hypothesized that arm position may be capable of modulating human visual ability. Here we report the case of WM, who lost his ability to see in his left visual hemifield after sustaining damage to his right primary visual cortex. Interestingly, the placement of WM's left arm into his "blind" field resulted in significantly better detection of left visual field stimuli compared to when his hand was placed in his lap at midline. Moreover, we found this attenuation to be confined to stimuli presented within reaching distance (unless a tool that extended WM's reach was held while he performed the test). These findings are highly consistent with the characteristics of the bimodal visuo-tactile neurons that have been described in monkeys. Thus, it seems that arm position can modulate human visual ability, even after damage to the primary visual cortex. This study provides an exciting bridge between monkey neurophysiology and human visual capacity while also offering a novel approach for improving visual defects acquired via cortical injury.

Aged↗
PubMed1996

Arm span-height relationships in patients referred for spirometry.

Arm span has been proposed as a surrogate for standing height in the prediction of lung volumes in patients with thoracic deformities or who are unable to stand. The relationship between arm span and height has previously been reported as either a fixed ratio unaffected by age or as a regression equation in which the ratio varies as a function of age. We studied the relationship between standing height, arm span, race, sex, and age in 202 patients (ages 20 to 88 yrs) referred for screening spirometry. Multiple linear regression analysis found arm span, race, sex, and age to be predictive of standing height (r2 = 0.8659, p < 0.0001). Subgroup analysis revealed that age was a significant factor among males of either race, but not among females of either race. Fixed arm span to height ratios were also calculated for each group and may be used to estimate standing height with reasonable accuracy except at extremes of stature.

Adult↗
PubMed2000

Low TENS treatment on post-stroke paretic arm: a three-year follow-up.

OBJECTIVE: To determine whether stroke patients with initial increases in arm motor recovery following low-frequency transcutaneous electrical nerve stimulation (low TENS) treatment go on to show long-term benefits. Also whether the same therapy results in long-term improvements in motor function, spasticity or activities of daily living (ADL). DESIGN: A three-year follow-up study. SUBJECTS: Twenty-eight stroke patients, who had participated in a randomized trial of daily treatment with low-frequency (1.7 Hz) transcutaneous electrical nerve stimulation (low TENS) on the paretic arm for three months starting 6-12 months after stroke. OUTCOMES: Fugl-Meyer Motor Performance Scale for evaluation of changes in arm motor function. A 6-point Ashworth Scale to measure spasticity. Barthel Index to evaluate performance in ADL. RESULTS: Motor function of the paretic arm had deteriorated in both treatment and control groups. Increased spasticity was seen in both groups. ADL score remained at a similar level in the low TENS group, whereas the control group had deteriorated during the same time period. CONCLUSIONS: Low TENS stimulation started 6-12 months after stroke may not have a specific effect on arm motor function years after completion of treatment.

Activities of Daily Living↗
PubMed2003

Is the repetitive training of complex hand and arm movements beneficial for motor recovery in stroke patients?

OBJECTIVE: To determine whether a repetitive training of complex movements of arm and hand contributes to functional recovery in stroke patients. DESIGN: Prospective, longitudinal, multiple baseline design across individuals. SETTING: Neurological rehabilitation centre. SUBJECTS: Twenty-one patients with stroke in the middle cerebral artery territory. INTERVENTIONS: Baseline phase: 'house-typical' occupational and physiotherapy; training phase: 'house-typical' therapy supplemented by repetitive training of (1) grasping and transport movements and (2) sawing movements of the affected arm over 10 minutes each, twice daily, five days per week. MAIN OUTCOME MEASURES: Rivermead Motor Assessment (RMA, arm section), grip strength, rapid isotonic hand extension, three-dimensional motion analysis. RESULTS: Patients experienced a continuous functional improvement of the affected arm (RMA score from initial 4.9 +/- 2.1 to 8.0 +/- 4.6, p < 0.001) and an increase of grip strength during the baseline and the training phase (from initial 102.4 +/- 43.3 N to 150.6 +/- 118.9 N, p < 0.05). Movement analysis revealed a trend to a more precise movement execution. The repetitive training of complex movements did not result in an additional benefit. CONCLUSION: The repetitive training of complex movements does not further enhance the functional recovery of the affected arm and hand in stroke patients compared with functionally based occupational and physiotherapy.

Adult↗