Kinetic and kinematic workspaces of the index finger following stroke

The objective of this study was to explore motor impairment of the index finger following stroke. More specifically, the kinetics and kinematics of the index finger were analysed throughout its workspace. Twenty-four stroke survivors with chronic hemiparesis of the hand participated in the trials, along with six age-matched controls. Hand impairment was classified according to the clinical Chedoke-McMaster Stage of Hand scale. Subjects were instructed to generate fingertip force in six orthogonal directions at five different positions within the workspace. Split-plot analysis of variance revealed that clinical impairment level had a significant effect on measured force (P < 0.001), with the weakness in stroke survivors being directionally dependent (P < 0.01). Electromyographic recordings revealed altered muscle activation patterns in the more impaired subjects. Unlike the control subjects, these subjects exhibited peak muscle excitation of flexor digitorum superficialis, extensor digitorum communis and first dorsal interosseous during the generation of fingertip flexion forces. Subjects also attempted to reach locations scattered throughout the theoretical workspace of the index finger. Quantification of the active kinematic workspace demonstrated a relationship between impairment level and the percentage of the theoretical workspace that could be attained (P < 0.001). The stroke survivors exhibited a high correlation between mean force production and active workspace (R = 0.90). Thus, our data suggest that altered muscle activation patterns contribute to directionally dependent weakness following stroke. Both the modulation of muscle excitation with force direction and the independence of muscle activation seem to be reduced. These alterations translate into a significantly reduced active range of motion for the fingers.