Original article| Volume 95, ISSUE 2, P338-344, February 2014

Impact of Time on Quality of Motor Control of the Paretic Upper Limb After Stroke

  • Joost van Kordelaar
    Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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  • Erwin van Wegen
    Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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  • Gert Kwakkel
    Corresponding author: Gert Kwakkel, PhD, Chair of Neurorehabilitation, Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
    Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands

    Amsterdam Rehabilitation Research Center, Reade Centre for Rehabilitation and Rheumatology, Amsterdam, The Netherlands
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Published:October 24, 2013DOI:



      To establish the time course of recovery regarding smoothness of upper limb movements in the first 6 months poststroke.


      Cohort study with 3-dimensional kinematic measurements in weeks 1, 2, 3, 4, 5, 8, 12, and 26 poststroke.


      Onsite 3-dimensional kinematic measurements in stroke units, rehabilitation centers, nursing homes, and patients' homes.


      Patients (N=44; 19 women, 25 men; mean age ± SD, 58±12y) with a first-ever unilateral ischemic stroke and incomplete upper limb paresis (27 left sided, 17 right sided) were included.


      Not applicable.

      Main Outcome Measures

      In each measurement, an electromagnetic motion tracker acquired hand and finger trajectories during a reach-to-grasp task. Movement duration was determined, and smoothness of hand transport and grasp aperture was quantified by normalized jerk. With the use of random coefficient analysis, the effect of progress of time on smoothness of hand transport and grasp aperture was investigated.


      During the first 5 weeks poststroke, there was a significant contribution of progress of time to reductions in movement duration and normalized jerk of hand transport and grasp aperture (P<.01).


      The present longitudinal 3-dimensional kinematic study showed that smoothness of paretic upper limb movements improves in the first 8 weeks poststroke. This improvement suggests that motor control normalizes in the first 8 weeks poststroke and can be mostly explained by spontaneous neurologic recovery that occurs typically in the first weeks poststroke. Future 3-dimensional kinematic studies should investigate whether therapies starting early after stroke can improve the quality of motor control beyond spontaneous neurologic recovery.


      List of abbreviations:

      MD (movement duration), NJ (normalized jerk)
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        • Kwakkel G.
        • Kollen B.J.
        • Twisk J.
        Impact of time on improvement of outcome after stroke.
        Stroke. 2006; 37: 2348-2353
        • Kwakkel G.
        • Kollen B.J.
        • Lindeman E.
        Understanding the pattern of functional recovery after stroke: facts and theories.
        Restor Neurol Neurosci. 2004; 22: 281-299
        • Twitchell T.E.
        The restoration of motor function following hemiplegia in man.
        Brain. 1951; 74: 443-480
        • Duncan P.W.
        • Goldstein L.
        • Matchar D.
        • Divine G.
        • Feussner J.
        Measurement of motor recovery after stroke. Outcome assessment and sample size requirements.
        Stroke. 1992; 23: 1084-1089
        • Phan T.G.
        • Wright P.M.
        • Markus R.
        • Howells D.W.
        • Davis S.M.
        • Donnan G.A.
        Salvaging the ischaemic penumbra: more than just reperfusion?.
        Clin Exp Pharmacol Physiol. 2002; 29: 1-10
        • Andrews R.J.
        Transhemispheric diaschisis. A review and comment.
        Stroke. 1991; 22: 943-949
        • Krakauer J.W.
        • Carmichael S.T.
        • Corbett D.
        • Wittenberg G.F.
        Getting neurorehabilitation right: what can be learned from animal models?.
        Neurorehabil Neural Repair. 2012; 26: 923-931
        • Van Kordelaar J.
        • van Wegen E.E.H.
        • Nijland R.H.M.
        • et al.
        Assessing longitudinal change in coordination of the paretic upper limb using on-site 3-dimensional kinematic measurements.
        Phys Ther. 2012; 92: 142-151
        • Alt Murphy M.
        • Willén C.
        • Sunnerhagen K.S.
        Kinematic variables quantifying upper-extremity performance after stroke during reaching and drinking from a glass.
        Neurorehabil Neural Repair. 2011; 25: 71-80
        • Caimmi M.
        • Carda S.
        • Giovanzana C.
        • et al.
        Using kinematic analysis to evaluate constraint-induced movement therapy in chronic stroke patients.
        Neurorehabil Neural Repair. 2008; 22: 31-39
        • Rohrer B.
        • Fasoli S.E.
        • Krebs H.I.
        • et al.
        Movement smoothness changes during stroke recovery.
        J Neurosci. 2002; 22: 8297-8304
        • Levin M.F.
        Interjoint coordination during pointing movements is disrupted in spastic hemiparesis.
        Brain. 1996; 119: 281-293
        • Van Kordelaar J.
        • van Wegen E.E.H.
        • Kwakkel G.
        Unraveling the interaction between pathological upper limb synergies and compensatory trunk movements during reach-to-grasp after stroke: a cross-sectional study.
        Exp Brain Res. 2012; 221: 251-262
        • Kwakkel G.
        • Meskers C.G.M.
        • van Wegen E.E.H.
        • et al.
        Impact of early applied upper limb stimulation: the EXPLICIT-stroke programme design.
        BMC Neurol. 2008; 8: 49
        • Bamford J.
        • Sandercock P.
        • Dennis M.
        • Burn J.
        • Warlow C.
        Classification and natural history of clinically identifiable subtypes of cerebral infarction.
        Lancet. 1991; 337: 1521-1526
        • Goldstein L.
        • Bertels C.
        • Davis J.
        Interrater reliability of the NIH Stroke Scale.
        Arch Neurol. 1989; 46: 660-662
        • Fugl-Meyer A.R.
        • Jääskö L.
        • Leyman I.
        • Olsson S.
        • Steglind S.
        The post-stroke hemiplegic patient 1. A method for evaluation of physical performance.
        Scand J Rehabil Med. 1975; 7: 13-31
        • Lyle R.C.
        A performance test for assessment of upper limb function in physical rehabilitation treatment and research.
        Int J Rehabil Res. 1981; 4: 483-492
        • Collin C.
        • Wade D.T.
        • Davies S.
        • Horne V.
        The Barthel ADL Index: a reliability study.
        Int Disabil Stud. 1988; 10: 61-63
        • Hogan N.
        • Sternad D.
        Sensitivity of smoothness to movement duration, amplitude, and arrests.
        J Mot Behav. 2009; 41: 529-534
        • Prabhakaran S.
        • Zarahn E.
        • Riley C.
        • et al.
        Inter-individual variability in the capacity for motor recovery after ischemic stroke.
        Neurorehabil Neural Repair. 2008; 22: 64-71
        • Langhorne P.
        • Bernhardt J.
        • Kwakkel G.
        Stroke rehabilitation.
        Lancet. 2011; 377: 1693-1702
        • Alt Murphy M.
        • Willén C.
        • Sunnerhagen K.S.
        Responsiveness of upper extremity kinematic measures and clinical improvement during the first three months after stroke.
        Neurorehabil Neural Repair. 2013; 27: 844-853
        • Schmidt R.A.
        A schema theory of discrete motor skill learning.
        Psychol Rev. 1975; 82: 250-260
        • Todorov E.
        Optimality principles in sensorimotor control [review].
        Nat Neurosci. 2004; 7: 907-915
        • Van Kordelaar J.
        • van Wegen E.E.H.
        • Nijland R.H.M.
        • Daffertshofer A.
        • Kwakkel G.
        Understanding adaptive motor control of the paretic upper limb early poststroke: the EXPLICIT-stroke program.
        Neurorehabil Neural Repair. 2013; 27: 854-863
        • Tang A.
        • Rymer W.Z.
        Abnormal force—EMG relations in paretic limbs of hemiparetic human subjects.
        J Neurol Neurosurg Psychiatry. 1981; 44: 690-698
        • Gemperline J.J.
        • Allen S.
        • Walk D.
        • Rymer W.Z.
        Characteristics of motor unit discharge in subjects with hemiparesis.
        Muscle Nerve. 1995; 18: 1101-1114
        • Mottram C.J.
        • Wallace C.L.
        • Chikando C.N.
        • Rymer W.Z.
        Origins of spontaneous firing of motor units in the spastic-paretic biceps brachii muscle of stroke survivors.
        J Neurophysiol. 2010; 104: 3168-3179
        • Van Vliet P.M.
        • Sheridan M.R.
        Coordination between reaching and grasping in patients with hemiparesis and healthy subjects.
        Arch Phys Med Rehabil. 2007; 88: 1325-1331
        • McCrea P.H.
        • Eng J.J.
        Consequences of increased neuromotor noise for reaching movements in persons with stroke.
        Exp Brain Res. 2005; 162: 70-77
        • Nijland R.H.M.
        • van Wegen E.E.H.
        • Harmeling-van der Wel B.C.
        • Kwakkel G.
        Presence of finger extension and shoulder abduction within 72 hours after stroke predicts functional recovery: early prediction of functional outcome after stroke: the EPOS cohort study.
        Stroke. 2010; 41: 745-750
        • Stinear C.
        Prediction of recovery of motor function after stroke.
        Lancet Neurol. 2010; 9: 1228-1232
        • Van Vliet P.
        • Pelton T.A.
        • Hollands K.L.
        • Carey L.
        • Wing A.M.
        Neuroscience findings on coordination of reaching to grasp an object: implications for research.
        Neurorehabil Neural Repair. 2013; 27: 622-635