Relationship of diminished interjoint coordination after stroke to hand path consistency

Differences between 12 left-brain (LCVA, 65.4 ± 11.7 years old) and 10 right-brain (RCVA, 61 ± 12.1 years old) chronic stroke survivors and 10 age-matched control adults in coordinating specific joint motions of the arm to stabilize hand path when reaching to a central target were investigated in this study. The importance of coordinating joints to stabilize hand path was tested by comparing results from uncontrolled manifold (UCM) analysis performed on experimental data versus simulated data where the covariation (coordination) between particular joint motions was removed from the original data set. UCM analysis allowed estimation of the joint configuration variance magnitude that led to hand path variability (V ORT), where the extent of increase in V ORT after removing a joint's covariation indicated how well coordinated its motion actually was with those of the other joints. The more strongly coordinated a joint was with other joints, the greater effect removal of its covariance should have on indices of hand path stability. For the paretic arm of stroke survivors, simulated removal of a joint's covariation, mainly that of shoulder with elbow and wrist, led to less change in the magnitude of V ORT compared to the same arm of control subjects. These findings confirm a reduced ability of the motion of proximal joint from paretic arm to combine flexibly with motions of the distal joints to stabilize hand path.