Arm reaching movements in tetraplegic patients

Enio W A Cacho
Faculdade de Ci?ncias M?dicas - Universidade Estadual de Cam

Roberta Oliveira
Faculdade de Ci?ncias M?dicas - Universidade Estadual de Campinas

Rodrigo L?cio Ortolan
Escola de Engenharia de S?o Carlos ? USP

Alberto Cliquet Jr
Faculdade de Ci?ncias M?dicas - Universidade Estadual de Campinas

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     Last modified: March 1, 2007

Abstract
The impairment of the upper limb in tetraplegic subjects results in a great lack of functionality. The reaching movements performed by these subjects are characterized by compensatory strategies that clinically might not be evaluated. In order to comprehend these movements, the present study aims to evaluate the tetraplegic arm reaching movement using the kinematic analysis. Five C7 (ASIA) tetraplegic subjects (TS) in a chronic phase (more than one year post-ictus), with a mean score of 46.0 (+/- 15.7) in the motor sub-section of the Functional Independent Measure (FIM) and a mean age of 29.9 (+/- 9.95) years old were selected from the Biomechanics and Rehabilitation Laboratory Unit of the University Hospital ? UNICAMP. Ten healthy subjects (HS) (mean age of 27.7 +/- 7.17) were recruited into the control group. For the kinematic capture was used the infrared analysis system (Qualisys AB - 2.57) with a frequency of 240 Hz filtered with a 6 Hz low pass filter FIR (MATLAB program). The record was made for the dominant upper limb using five reflexive markers placed on the wrist ulnar styloid process, the lateral humeral epicondyle, bilateral acromial processes and the vertical axis of the sternum. Time of maximum peak velocity (percentage ratio of total time - %), number of velocity peaks (n), maximum velocity (m/s), trunk and shoulder girdle displacement (m), index of curvature and length of wrist trajectory were computed. Mann-Whitney?s test was used to compare the two groups and the significance level adopted for the statistical tests was 5% (p< 0.05). A significant statistical difference was found for both groups in the shoulder girdle displacement (TS - 0.058 +/- 0.052; HS - 0.115 +/- 0.038; p = 0.037), index of curvature (TS - 1.12 +/- 0.024; HS - 1.08 +/- 0.03; p = 0.027), maximum velocity (TS - 0.627 +/- 0.0118; HS - 0.849 +/- 0.142; p = 0.014) and number of velocity peaks (TS - 4.06 +/- 1.75; HS - 1.76 +/- 0.73; p = 0.014). In the variables trunk displacement (TS - 0.019 +/- 0.012; HS - 0.034 +/- 0.021; p = 0.111), length of wrist trajectory (TS - 0.419 +/- 0.026; HS - 0.430 +/- 0.44; p = 0.806) and percentage ratio (TS - 50 +/- 7.1; HS - 56 +/- 12.0; p = 0.141) no statistical significance was present. The present study concludes that the tetraplegic subjects demonstrate a slower and less smoothness reaching movements than the healthy subjects, but they are able to practice these tasks.
This research was supported by FAPESP grants 06/58891-4.