Proximal arm non-use in post-stroke individuals

Abstract : The use of compensatory strategies to perform activities of daily living after a stroke can reduce the upper limb recovery. In fact, post-stroke individuals with severe upper limb impairment that limits shoulder-elbow motion, have to use trunk compensation to achieve a reaching task within arms’ length, which is a form of mandatory/adaptive compensation strategy. Whereas, post-stroke individuals having adequately recovered shoulder-elbow motion, continue to use the trunk when they could use the proximal arm to achieve the reach; and this non-mandatory trunk compensation is considered maladaptive because it reflects proximal arm non-use or PANU, which is detrimental to true recovery of the paretic arm.In the first study, 45 post-stroke individuals and 45 age matched healthy controls performed a seated reaching task within arm’s length with the trunk free to move (spontaneous use) and trunk restrained (maximal use) to measure their PANU score. The analysis showed that PANU scores for the post-stroke individuals ranged between 1,9% and 40,7% with a median of 11,7%, and these PANU scores were a reliable and reproducible measure of the functional reserve of the upper limb. The PANU score threshold for clinical significance was set as 6.5% (upper limit in healthy subjects). The PANU score seems pertinent as a complement to usual clinical assessments of upper limb function and impairment (Box and Block test, Fugl-Meyer).The second study explored the applicability of the Kinect system to measure PANU scores in 19 post stroke individuals in comparison to the standard Zebris-CMS20s method. The analysis showed that the PANU score measured by the Kinect was valid and reliable, and therefore should be used as a tool to classify patients in order to propose specific upper limb rehabilitation with arm-forced use by trunk restraint or feedback.Study three was a review of innovative technologies applied to sensorimotor rehabilitation after a stroke suggesting that PANU scores could be implemented in virtual reality rehabilitation and be used as a tool to determine the efficacy of the specialised treatment.In conclusion, this thesis showed that i) objectively quantifying the proximal arm non-use (PANU score) during a reaching task using a 3D motion capture system is feasible and reliable, and ii) PANU scores are accurately determined also using a more widely available and less expensive Kinect-based motion sensor with the future aim of PANU being integrated in a Kinect-based upper limb virtual reality rehabilitation.
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Karima Bakhti. Proximal arm non-use in post-stroke individuals. Human health and pathology. Université Montpellier, 2017. English. ⟨NNT : 2017MONT4006⟩. ⟨tel-01716292⟩

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