Altered Anticipatory Postural Adjustments During Whole-Body Reaching in Subjects With Stroke.

Neurorehabilitation and neural repair Pub Date : 2024-03-01 Epub Date: 2024-02-12 DOI:10.1177/15459683241231528
Yosuke Tomita, Aditi A Mullick, Anatol G Feldman, Mindy F Levin
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Abstract

Background: Coordination between arm movements and postural adjustments is crucial for reaching-while-stepping tasks involving both anticipatory postural adjustments (APAs) and compensatory movements to effectively propel the whole-body forward so that the hand can reach the target. Stroke impairs the ability to coordinate the action of multiple body segments but the underlying mechanisms are unclear. Objective. To determine the effects of stroke on reaching performance and APAs during whole-body reaching.

Methods: We tested arm reaching in standing (stand-reach) and reaching-while-stepping (step-reach; 15 trials/condition) in individuals with chronic stroke (n = 18) and age-matched healthy subjects (n = 13). Whole-body kinematics and kinetic data were collected during the tasks. The primary outcome measure for step-reach was "gain" (g), defined as the extent to which the hip displacement contributing to hand motion was neutralized by appropriate changes in upper limb movements (g = 1 indicates complete compensation) and APAs measured as spatio-temporal profiles of the center-of-pressure shifts preceding stepping.

Results: Individuals with stroke had lower gains and altered APAs compared to healthy controls. In addition, step onset was delayed, and the timing of endpoint, trunk, and foot movement offset was prolonged during step-reach compared to healthy controls. Those with milder sensorimotor impairment and better balance function had higher gains. Altered APAs were also related to reduced balance function.

Conclusions: Altered APAs and prolonged movement offset in stroke may lead to a greater reliance on compensatory arm movements. Altered APAs in individuals with stroke may be associated with a reduced shift of referent body configuration during the movement.

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脑卒中患者在全身伸展过程中的预期姿势调整发生了改变。
背景:手臂运动和姿势调整之间的协调对于边迈步边伸手的任务至关重要,这涉及到预期姿势调整(APA)和补偿运动,以有效地推动整个身体向前,从而使手能够触及目标。中风损害了协调多个身体节段动作的能力,但其潜在机制尚不清楚。研究目的确定中风对全身伸手时的伸手表现和 APA 的影响:方法:我们对慢性中风患者(18 人)和年龄匹配的健康受试者(13 人)进行了站立伸臂(站立伸臂)和迈步伸臂(迈步伸臂;15 次试验/条件)的测试。任务期间收集全身运动学和动力学数据。步进的主要结果测量指标是 "增益"(g),即通过上肢运动的适当变化(g = 1 表示完全补偿)和步进前压力中心移动的时空剖面测量的 APA 来中和手部运动的髋关节位移的程度:结果:与健康对照组相比,中风患者的增益较低,APA 也发生了改变。此外,与健康对照组相比,迈步开始时间延迟,迈步过程中终点、躯干和足部运动偏移的时间延长。那些感知运动障碍程度较轻、平衡功能较好的人获得的收益更高。APA的改变也与平衡功能的降低有关:结论:中风患者 APAs 的改变和运动偏移的延长可能会导致他们更加依赖手臂的代偿运动。中风患者 APAs 的改变可能与运动过程中参考体配置的转移减少有关。
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