Fig 4 - available via license: Creative Commons Attribution 4.0 International
Content may be subject to copyright.
Grasp-types. a: Multi-pulpar, b: Pluri-digital c: Lateral Pinch, d: Palmar, e: Digito-palmar, f: Raking, g: Ulnar, h: Inter-digital. https://doi.org/10.1371/journal.pone.0187608.g004
Source publication
This study aimed to identify and qualify grasp-types used by patients with stroke and determine the clinical parameters that could explain the use of each grasp. Thirty-eight patients with chronic stroke-related hemiparesis and a range of motor and functional capacities (17 females and 21 males, aged 25–78), and 10 healthy subjects were included. F...
Similar publications
Many studies have focused on the plantar pressure characteristics of specific movements and footwork in tennis. However, little research has been conducted for exploring the foot characteristics among tennis professionals’ daily habitual paces. This study aims to examine the pressure profiles associated with foot posture and balance abilities of el...
Citations
... The tangible object was cylindrical in shape and was made using a custom-made 3D printing tool developed specifically for this project. The diameter of the cylinder (5 cm) was chosen to conform with the typical grasping capacity of people with chronic stroke (21). The shape of the tangible object also matched the shape of everyday life objects such as a glass FIGURE 1 Ergotact prototype system. ...
Introduction
Serious games can be used to provide intensive rehabilitation through attractive exercises as part of post-stroke rehabilitation. However, currently available commercial and serious games systems primarily train shoulder and elbow movements. These games lack the grasping and displacement components that are essential to improve upper limb function. For this reason, we developed a tabletop device that encompassed a serious game with a tangible object to rehabilitate combined reaching and displacement movements: the Ergotact system.
Objectives
The aim of this pilot study was to assess the feasibility and the short-term effects of a training program using the Ergotact prototype in individuals with chronic stroke.
Methods
Participants were assigned to one of two groups: a serious game training group (Ergotact) or a control training group (Self).
Results
Twenty-eight individuals were included. Upper limb function increased after the Ergotact training program, although not statistically significantly, and the program did not induce pain or fatigue, demonstrating its safety.
Conclusion
The Ergotact system for upper limb rehabilitation was well accepted and induced participant satisfaction. It complies with current recommendations for people with stroke to autonomously perform intensive active exercises in a fun context, in addition to conventional rehabilitation sessions with therapists.
Clinical trial registration
https://clinicaltrials.gov/ct2/show/NCT03166020?term=NCT03166020&draw=2&rank=1, identifier NCT03166020.
... 26 Previous research demonstrated that the level of hand impairment in hemiplegic individuals reduces the number of viable grasp types, increases intra-and inter-individual variability of grasp movements, and influences the final grasp decision. 36,37 In this study, after annotating different activities from video data, we obtained a significant correlation with current gold-standard clinical assessments, demonstrating that the choice of grasp type, regardless of the environmental constraints, depends heavily on the impairment. Remarkably, the greater the impairment to the hand, the greater the reliance on non-prehensile grasping as a compensatory strategy, as highlighted by the negative correlations between the proportion of non-prehensile grasp use and UEMS, GRASSP, and SCIM subscores. ...
Background:
Following a spinal cord injury, regaining hand function is a top priority. Current hand assessments are conducted in clinics, which may not fully represent real-world hand function. Grasp strategies used in the home environment are an important consideration when examining the impact of rehabilitation interventions.
Objective:
The main objective of this study is to investigate the relationship between grasp use at home and clinical scores.
Method:
We used a previously collected dataset in which 21 individuals with spinal cord injuries (SCI) recorded egocentric video while performing activities of daily living in their homes. We manually annotated 4432 hand-object interactions into power, precision, intermediate, and non-prehensile grasps. We examined the distributions of grasp types used and their relationships with clinical assessments.
Results:
Moderate to strong correlations were obtained between reliance on power grasp and the Spinal Cord Independence Measure III (SCIM; P < .05), the upper extremity motor score (UEMS; P < .01), and the Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP) Prehension (P < .01) and Strength (P < .01). Negative correlations were observed between the proportion of non-prehensile grasping and SCIM (P < .05), UEMS (P < .05), and GRASSP Prehension (P < .01) and Strength (P < .01).
Conclusion:
The types of grasp types used in naturalistic activities at home are related to upper limb impairment after cervical SCI. This study provides the first direct demonstration of the importance of hand grasp analysis in the home environment.
... The TactArray cylinder was placed on a table surface 15 cm from the hand starting position, directly aligned with the hand, with the wrist in a neutral position [91]. Standardized instructions were given to participants to reach, grasp, and lift the TactArray cylinder to a height of 2-5 cm, then to hold and squeeze as hard as they could for an 8 s period [92] using a 5-digit multifinger prehension grasp [93], then place the object back on the table. The object was picked up with the distal pads of the fingers without involving the palm of the hand [47]. ...
Sensor-based devices can record pressure or force over time during grasping and therefore offer a more comprehensive approach to quantifying grip strength during sustained contractions. The objectives of this study were to investigate the reliability and concurrent validity of measures of maximal tactile pressures and forces during a sustained grasp task using a TactArray device in people with stroke. Participants with stroke (n = 11) performed three trials of sustained maximal grasp over 8 s. Both hands were tested in within- and between-day sessions, with and without vision. Measures of maximal tactile pressures and forces were measured for the complete (8 s) grasp duration and plateau phase (5 s). Tactile measures are reported using the highest value among three trials, the mean of two trials, and the mean of three trials. Reliability was determined using changes in mean, coefficients of variation, and intraclass correlation coefficients (ICCs). Pearson correlation coefficients were used to evaluate concurrent validity. This study found that measures of reliability assessed by changes in means were good, coefficients of variation were good to acceptable, and ICCs were very good for maximal tactile pressures using the average pressure of the mean of three trials over 8 s in the affected hand with and without vision for within-day sessions and without vision for between-day sessions. In the less affected hand, changes in mean were very good, coefficients of variations were acceptable, and ICCs were good to very good for maximal tactile pressures using the average pressure of the mean of three trials over 8 s and 5 s, respectively, in between-day sessions with and without vision. Maximal tactile pressures had moderate correlations with grip strength. The TactArray device demonstrates satisfactory reliability and concurrent validity for measures of maximal tactile pressures in people with stroke.
... Third, stroke patients may adopt different grasping strategies while performing the BBT. 86 This was not assessed in this study. However, longitudinal studies on stroke recovery are required to investigate whether altered grasping strategies could help to explain variance in recovery. ...
Recovery of dexterous hand use is critical for functional outcome after stroke. Grip force recordings can inform on maximal motor output and modulatory and inhibitory cerebral functions, but how these actually contribute to recovery of dexterous hand use is unclear. This cohort study used serially assessed measures of hand kinetics to test the hypothesis that behavioural measures of motor modulation and inhibition explain dexterity recovery beyond that explained by measures of motor output alone. We also investigated the structural and functional connectivity correlates of grip force control recovery. Eighty-nine adults (median age=54 years, 26% females) with first-ever ischemic or hemorrhagic stroke and persistent arm and hand paresis were assessed longitudinally, at 3 by guest on 30 September 2022 2 weeks, and at 3 and 6 months after stroke. Kinetic measures included: maximal grip force, accuracy of precision and power grip force control, and ability to release force abruptly. Dexterous hand use was assessed clinically with the Box and Block Test =and motor impairment with the upper extremity Fugl-Meyer Assessment. Structural and functional MRI was used to assess weighted cortico-spinal tract lesion load, voxel-based lesion symptom mapping and interhemispheric resting-state functional connectivity. Fifty-three percent of patients had severe initial motor impairment and a majority still had residual force control impairments at 6 months. Force release at 3 weeks explained 11% additional variance of Box and Block Test outcome at 6 months, above that explained by initial scores (67%). Other kinetic measures did not explain additional variance of recovery. The predictive value of force release remained significant when controlling for cortico-spinal tract lesion load and clinical measures. Cortico-spinal tract lesion load correlated with recovery in grip force control measures. Lesions involving the parietal operculum, insular cortex, putamen and fronto-striatal tracts were also related to poorer force modulation and release. Lesions to fronto-striatal tracts explained an additional 5% of variance in force release beyond the 43% explained by cortico-spinal injury alone. Interhemispheric functional connectivity did not relate to force control recovery. We conclude that not only voluntary force generation but also force release (reflecting motor inhibition) are important for recovery of dexterous hand use after stroke. Although cortico-spinal injury is a main determinant of recovery, lesions to integrative somatosensory areas and fronto-parietal white matter (involved in motor inhibition) explain additional variance in post-stroke force release recovery. Our findings indicate that post-stroke upper limb motor impairment profiling, which is essential for targeted treatment, should consider both voluntary grasp generation and inhibition. Running title: Motor inhibition and dexterous hand use
... Third, stroke patients may adopt different grasping strategies while performing the BBT. 85 This was not assessed in this study. However, longitudinal studies on stroke recovery are required to investigate whether altered grasping strategies could help to explain variance in recovery. ...
Recovery of dexterous hand use is critical for functional outcome after stroke. Grip force recordings can inform on maximal motor output and modulatory and inhibitory cerebral functions, but how these actually contribute to recovery of dexterous hand use is unclear. This cohort study used serially assessed measures of hand kinetics to test the hypothesis that behavioural measures of motor modulation and inhibition explain dexterity recovery beyond that explained by measures of motor output alone. We also investigated the structural and functional connectivity correlates of grip force control recovery.
Eighty-nine adults (median age = 54 years, 26% females) with first-ever ischemic or hemorrhagic stroke and persistent arm and hand paresis were assessed longitudinally, at 3 weeks, and at 3 and 6 months after stroke. Kinetic measures included: maximal grip force, accuracy of precision and power grip force control, and ability to release force abruptly. Dexterous hand use was assessed clinically with the Box and Block Test = and motor impairment with the upper extremity Fugl-Meyer Assessment. Structural and functional MRI was used to assess weighted cortico-spinal tract lesion load, voxel-based lesion symptom mapping and interhemispheric resting-state functional connectivity.
Fifty-three percent of patients had severe initial motor impairment and a majority still had residual force control impairments at 6 months. Force release at 3 weeks explained 11% additional variance of Box and Block Test outcome at 6 months, above that explained by initial scores (67%). Other kinetic measures did not explain additional variance of recovery. The predictive value of force release remained significant when controlling for cortico-spinal tract lesion load and clinical measures. Cortico-spinal tract lesion load correlated with recovery in grip force control measures. Lesions involving the parietal operculum, insular cortex, putamen and fronto-striatal tracts were also related to poorer force modulation and release. Lesions to fronto-striatal tracts explained an additional 5% of variance in force release beyond the 43% explained by cortico-spinal injury alone. Interhemispheric functional connectivity did not relate to force control recovery.
We conclude that not only voluntary force generation but also force release (reflecting motor inhibition) are important for recovery of dexterous hand use after stroke. Although cortico-spinal injury is a main determinant of recovery, lesions to integrative somatosensory areas and fronto-parietal white matter (involved in motor inhibition) explain additional variance in post-stroke force release recovery. Our findings indicate that post-stroke upper limb motor impairment profiling, which is essential for targeted treatment, should consider both voluntary grasp generation and inhibition.
... 6 Poor force control during manipulation and grasping of objects is also present alongside spasticity. 7,8 The ability of the individuals with spasticity to quickly adapt arm movements during altering environmental conditions is impaired. The adaptation of movements significantly relies on the joint range of motion in which the motion is performed. ...
Objective: Stroke is a common reason for motor disability and is often associated with spasticity and poor motor function of the upper limbs involved. Spasticity management is important to accelerate motor recovery. The objective of this study was to investigate the effects of training with robot-mediated virtual reality gaming on upper limb spasticity and motor functions in individuals with chronic stroke.
Materials and Methods: A total of 40 Saudi individuals with chronic stroke were involved in this study. Participants were randomly assigned to two groups. The experimental group received conventional physiotherapy and training with robot-mediated virtual reality gaming, and the control group received only conventional physiotherapy. Outcomes were measured by the Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), WMFT-Time, Modified Ashworth Scale (MAS), Active Range of Motion (AROM) of multiple joints of the upper limb , and Hand Grip Strength (HGS). The scores of all the outcome measures were recorded at baseline and after the completion of the treatment.
Results: Individuals with stroke in the experimental group had a better improvement in most measured variables (AROM of shoulder abduction, elbow supination and wrist extension, WMFT-Time, HGS, ARAT, WMFT , and MAS) compared to the control group after the completion of the treatment. Both groups showed significant improvement in all the measured variables after completion of the treatment, except in MAS for wrist flexors in the control group.
Conclusion: Training with robot-mediated virtual reality gaming was effective in modulating spasticity and improving the motor functions of the affected upper limbs in individuals with chronic stroke.
... That each task provides at least one non-redundant measure indicates that the five tasks are complimentary for quantifying dexterity at this fine-grained, multicomponent level. Nonetheless, we do not claim that they capture necessarily all aspects of dexterous control: extracting elements of force control [32] would likely lead to an even more comprehensive description, with potentially higher sensibility, while kinematic approaches can provide information on grasp strategies [60,61] not captured by the tablet. ...
Background
We developed five tablet-based tasks (applications) to measure multiple components of manual dexterity. Aim: to test reliability and validity of tablet-based dexterity measures in healthy participants.
Methods
Tasks included: (1) Finger recognition to assess mental rotation capacity. The subject taps with the finger indicated on a virtual hand in three orientations (reaction time, correct trials). (2) Rhythm tapping to evaluate timing of finger movements performed with, and subsequently without, an auditory cue (inter-stimulus interval). (3) Multi-finger tapping to assess independent finger movements (reaction time, correct trials, unwanted finger movements). (4) Sequence tapping to assess production and memorization of visually cued finger sequences (successful taps). (5) Line-tracking to assess movement speed and accuracy while tracking an unpredictably moving line on the screen with the fingertip (duration, error). To study inter-rater reliability, 34 healthy subjects (mean age 35 years) performed the tablet tasks twice with two raters. Relative reliability (Intra-class correlation, ICC) and absolute reliability (Standard error of measurement, SEM) were established. Task validity was evaluated in 54 healthy subjects (mean age 49 years, range: 20–78 years) by correlating tablet measures with age, clinical dexterity assessments (time taken to pick-up objects in Box and Block Test, BBT and Moberg Pick Up Test, MPUT) and with measures obtained using a finger force-sensor device.
Results
Most timing measures showed excellent reliability. Poor to excellent reliability was found for correct trials across tasks, and reliability was poor for unwanted movements. Inter-session learning occurred in some measures. Age correlated with slower and more variable reaction times in finger recognition, less correct trials in multi-finger tapping, and slower line-tracking. Reaction times correlated with those obtained using a finger force-sensor device. No significant correlations between tablet measures and BBT or MPUT were found. Inter-task correlation among tablet-derived measures was weak.
Conclusions
Most tablet-based dexterity measures showed good-to-excellent reliability (ICC ≥ 0.60) except for unwanted movements during multi-finger tapping. Age-related decline in performance and association with finger force-sensor measures support validity of tablet measures. Tablet-based components of dexterity complement conventional clinical dexterity assessments. Future work is required to establish measurement properties in patients with neurological and psychiatric disorders.
... Of the numerous functional grasp patterns afforded by hand anatomy, most healthy human subjects rely on pinch and power grasps that use the thumb extensively; stroke survivors lacking thumb function instead often rake the four fingers against an object to drag it along a surface, or tuck the thumb away against the backs of the fingers in order to squeeze an object between fingers and palm [17]. Our orthosis, like any exoskeleton with rigid elements spanning the hand, limits the ability to perform compensatory grasps that avoid thumb involvement. ...
We present a tendon-driven, active-extension thumb exoskeleton adding opposition/reposition capabilities to a robotic hand orthosis designed for individuals with chronic upper-limb hemiparesis after stroke. The orthosis uses two actuators to assist hand-opening, with one tendon network controlling simultaneous four-finger extension and one separately driving thumb extension. When combined with a passive palmar abduction constraint, the thumb network can counteract spasticity and provide stable thumb opposition for manipulating objects in a range of sizes. We performed a preliminary assessment with five chronic stroke survivors presenting with arm-hand motor deficits and increased muscle tone (spasticity). Experiments consisted of unimanual resistive-pull tasks and bimanual twisting tasks with simulated real-world objects; these explored the effects of thumb assistance on grasp stability and functional range of motion. We specifically compare functional performance of actuation against static thumb-splinting and against no device. The addition of active-extension to the thumb improves positioning ability when reaching for objects, and improves consistency and duration of maintaining stable grasps.
... When displacing handheld objects, healthy subjects generally use a precision grip or multipulpar grasp including the thumb and a number of fingers according to the size of the object (Cesari and Newell, 1999). Stroke patients, however, appear to use these particular grasp configurations much less frequently when employing objects regularly used in daily life activities (Roby-Brami et al., 1997;Bensmail et al., 2010;Garcia Alvarez et al., 2017). For example, while the majority of healthy subjects used multipulpar grasps to take a spoon, water bottle or ball, the different stroke patients used various combinations of palmar and digito-palmar grasp configurations (Garcia Alvarez et al., 2017). ...
... Stroke patients, however, appear to use these particular grasp configurations much less frequently when employing objects regularly used in daily life activities (Roby-Brami et al., 1997;Bensmail et al., 2010;Garcia Alvarez et al., 2017). For example, while the majority of healthy subjects used multipulpar grasps to take a spoon, water bottle or ball, the different stroke patients used various combinations of palmar and digito-palmar grasp configurations (Garcia Alvarez et al., 2017). Others still were seen to use a particular "raking" strategy, either with the four fingers and the palm parallel to the table, or with the ulnar aspect of the hand, the palm perpendicular to the table. ...
Impairments in dexterous upper limb function are a significant cause of disability following stroke. While the physiological basis of movement deficits consequent to a lesion in the pyramidal tract is well demonstrated, specific mechanisms contributing to optimal recovery are less apparent. Various upper limb interventions (motor learning methods, neurostimulation techniques, robotics, virtual reality, and serious games) are associated with improvements in motor performance, but many patients continue to experience significant limitations with object handling in everyday activities. Exactly how we go about consolidating adaptive motor behaviors through the rehabilitation process thus remains a considerable challenge. An important part of this problem is the ability to successfully distinguish the extent to which a given gesture is determined by the neuromotor impairment and that which is determined by a compensatory mechanism. This question is particularly complicated in tasks involving manual dexterity where prehensile movements are contingent upon the task (individual digit movement, grasping, and manipulation…) and its objective (placing, two step actions…), as well as personal factors (motivation, acquired skills, and life habits…) and contextual cues related to the environment (presence of tools or assistive devices…). Presently, there remains a lack of integrative studies which differentiate processes related to structural changes associated with the neurological lesion and those related to behavioral change in response to situational constraints. In this text, we shall question the link between impairments, motor strategies and individual performance in object handling tasks. This scoping review will be based on clinical studies, and discussed in relation to more general findings about hand and upper limb function (manipulation of objects, tool use in daily life activity). We shall discuss how further quantitative studies on human manipulation in ecological contexts may provide greater insight into compensatory motor behavior in patients with a neurological impairment of dexterous upper-limb function.
... The involvement of the pencil grasp during coordination exercises may have acted as an additional source of noise for the performance, as evidenced by the reduced reliability exhibited by these exercises compared with the non-use of a pen. The heterogeneity of the individual strategies used to compensate for motor limitations [57] and the difficulty adapting grip strength after stroke could also support these results [58]. Altered grip strength could also explain the worse results for participants with worse motor conditions during the test, as grip strength is not only strongly associated with sensorimotor function [59] but also can be a predictor of hand motor performance [60]. ...
Background:
The assessment of upper-limb motor impairments after stroke is usually performed using clinical scales and tests, which may lack accuracy and specificity and be biased. Although some instruments exist that are capable of evaluating hand functions and grasping during functional tasks, hand mobility and dexterity are generally either not specifically considered during clinical assessments or these examinations lack accuracy. This study aimed to determine the convergent validity, reliability, and sensitivity to impairment severity after a stroke of a dedicated, multi-touch app, named the Hand Assessment Test.
Methods:
The hand mobility, coordination, and function of 88 individuals with stroke were assessed using the app, and their upper-limb functions were assessed using the Fugl-Meyer Assessment for Upper Extremity, the Jebsen-Taylor Hand Function Test, the Box and Block Test, and the Nine Hole Peg Test. Twenty-three participants were further considered to investigate inter- and intra-rater reliability, standard error of measurement, and the minimal detectable change threshold of the app. Finally, participants were categorized according to motor impairment severity and the sensitivity of the app relative to these classifications was investigated.
Results:
Significant correlations, of variable strengths, were found between the measurements performed by the app and the clinical scales and tests. Variable reliability, ranging from moderate to excellent, was found for all app measurements. Exercises that involved tapping and maximum finger-pincer grasp were sensitive to motor impairment severity.
Conclusions:
The convergent validity, reliability, and sensitivity to motor impairment severity of the app, especially of those exercises that involved tapping and the maximum extension of the fingers, together with the widespread availability of the app, could support the use of this and similar apps to complement conventional clinical assessments of hand function after stroke.
