Roni Molad
Published: 2021
Total Pages:
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"Background: Bimanual coordination is a major component of normal movement. Coordination impairments are common following stroke and may lead to limitations in performance of activities of daily living, participation and quality of life. Coordination deficits are under evaluated in patients with stroke due to the lack of validated assessments. Therefore, the clinical relationship between bimanual coordination deficits and limitations in functional recovery is unclear. Objective: The Interlimb Coordination test (ILC2) is one element of a comprehensive outcome measure (Comprehensive Coordination Scale) developed by our group, to assess coordination at two levels of movement description based on observational kinematics. This study aims to describe the construct validity of the ILC2, according to the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) panel definition, assessing upper limb (UL) bimanual coordination in healthy individuals and in individuals with chronic stroke. Methodology: A cross-sectional study was conducted. Thirteen healthy individuals and 13 individuals who have had a stroke performed synchronous anti-phase forearm rotations for 10 seconds under 4 conditions: internally-paced self-paced (IP1), fast internally-paced (IP2), slow externally-paced (EP1), and fast externally-paced (EP2). Trunk, shoulder and elbow kinematics were recorded with an electromagnetic 9 sensor Polhemus system. Primary outcome measures (continuous relative phase, cross-correlation and lag) and secondary outcome measures (trunk and UL displacements and rotations) were compared to detect differences between groups using one-way analysis of variance (ANOVA) or repeated measure ANOVA. Between-group data were compared in a matched-speed condition in which frequency of arm rotation was similar. Based on the analysis, IP1 in the healthy group was compared to IP2 in the stroke group. To test the construct validity of the clinical ILC2, scores were correlated with primary and secondary outcome measures, scores on a similar test (Finger-To-Nose test); sensorimotor impairment scores at the Body function/structure level (Fugl-Meyer Assessment for the Upper Limb) and the Activity level (Chedoke Arm and Hand Activity Inventory) using Spearman correlation or Chi-square correlations. Results: Participants in both groups had similar sociodemographic characteristics. In the stroke group, participants had mild to moderate UL sensorimotor impairment and activity limitations, with no marked cognitive, sensory or proprioceptive deficits. Participants with stroke moved slower than healthy participants in all conditions, except EP1. Cross-correlation coefficient was lower (i.e. closer to 0) in the stroke group in the IP1 condition, but continuous relative phase and lag were similar between groups. In the IP1 condition, participants with stroke used more trunk rotation and shoulder abduction of the more-affected arm. In the matched-speed condition, participants with stroke used more trunk rotation and side-flexion and shoulder abduction of both arms, but less shoulder rotation of the more-affected arm compared to controls. In the stroke group, in the IP fast condition, ILC2 synchronicity and total scores were related to temporal coordination measure. ILC2 total score was also related to greater shoulder rotation of the more-affected arm. ILC2 score were not related to scores of clinical assessments.Conclusion: The ILC2, one of six tests in the CCS, is a valid measure of bimanual coordination in people with chronic stroke. Significance: The ILC2 may be used by clinicians to objectively assess UL bilateral coordination in individuals who have had a stroke, to help establish functional treatment goals and to monitor the effects of treatment interventions"--