| Summary: | 碩士 === 高雄醫學大學 === 行為科學研究所碩士班 === 92 === Bilateral movements are often used to facilitate symmetrical and smoother movements of the hemiparetic arm in stroke patients. Previous research has shown that bilateral movements with loading on unaffected arm may increase interlimb coupling. The present study investigated the quality of movement in the hemiparetic arm following a unilateral and bilateral reaching movement, with and without loading on the unaffected arm in stroke patients.
Recruited were twenty unilateral stroke patients (17 males, 3 females), aged between 37 to 75 years (mean ± standard deviation, 56.00 ±10.54 years). All subjects scored at least 30 on the upper extremity subtest of the Fugl-Meyer Motor Function Assessment (total score: 66). A three-dimensional kinematics analysis equipment (VisualeyezTM Hardware, Canada) was used to collect the movement trajectory data of the hemiparetic arm during performing the experimental tasks. Subjects were asked to perform four movement tasks as quickly as possible: (1) reaching forward with the affected limb only; (2) reaching forward with both limbs simultaneously; (3) reaching forward with both limbs while adding a load of 25% upper limb inertia to the unaffected limb; (4) reaching forward with both limbs while adding a load of 50% upper limb inertia to the unaffected limb.
The results showed that variables, with significant differences among the four movement tasks, were maximal velocity (MA), percentage of reach where maximal velocity occurs (PRMVO), maximal acceleration (MA), movement time (MT), normalized jerk score of movements (NJSM), elbow flexion-extension range (EFER), shoulder flexion-extension range (SFER), and trunk linear line value (TLLV). Post hoc analysis revealed that most of the differences existed between the unilateral reaching task and the others. Subjects showed greater NJSM in bilateral reaching tasks; however, they also performed greater upper extremity range of motion and adaptive trunk movement.
Findings in this study showed that subjects could not demonstrate smoother movements in bilateral tasks either with or without loading. Therefore, these bilateral reaching tasks could be considered as adding costs and challenges during motor control. With the effects of interlimb coupling and visual guiding in bilateral movements, we suggested that bilateral movements with trunk restriction may be considered as a treatment strategy and be incorporated in therapeutic activities to facilitate greater active movement in the affected arm.
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