Review
The gap between clinical gaze and systematic assessment of movement disorders after stroke
1 Department of Rehabilitation Medicine, Leiden University Medical Centre, Leiden, Netherlands
2 Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, Netherlands
Journal of NeuroEngineering and Rehabilitation 2012, 9:61 doi:10.1186/1743-0003-9-61
Published: 27 August 2012Abstract
Background
Movement disorders after stroke are still captured by clinical gaze and translated to ordinal scores of low resolution. There is a clear need for objective quantification, with outcome measures related to pathophysiological background. Neural and non-neural contributors to joint behavior should be separated using different measurement conditions (tasks) and standardized input signals (force, position and velocity).
Methods
We reviewed recent literature for the application of biomechanical and/or elektromyographical (EMG) outcome measures under various measurement conditions in clinical research.
Results
Since 2005, 36 articles described the use of biomechanical and/or EMG outcome measures to quantify post-stroke movement disorder. Nineteen of the articles strived to separate neural and non-neural components. Only 6 of the articles measured biomechanical and EMG outcome measures simultaneously, while applying active and passive tasks and multiple velocities.
Conclusion
The distinction between neural and non-neural components to separately assess paresis, stiffness and muscle overactivity is not commonplace yet, while a large gap is to be bridged to attain reproducible and comparable results. Pathophysiologically clear concepts, substantiated with a comprehensive and concise measuring protocol will help professionals to identify and treat limiting factors in movement capabilities of post-stroke patients.
