Postural Control and Fine Motor Skills in People With Stroke

Current stroke rehabilitation practice guidelines support an interprofessional approach which integrates discipline-specific goals into a comprehensive plan of care. However, there has been a failure to implement interprofessional guidelines into today's stroke rehabilitation clinical practice. Instead it is common that one discipline focuses on recovery of posture, while another discipline focuses on recovery of fine motor skills. The investigators argue that control of the hand is not independent from postural control. In fact, treating them separately ignores the kinematic and muscular linkages connecting the trunk to the hand via the scapula and proximal arm. It also ignores evidence that postural and hand muscles have overlapping cortical representations thus likely have similar neural control networks. Hence, the overall goal of this project is to demonstrate the relationship of posture and fine motor skills to advance stroke rehabilitation.

The study will include two groups, stroke survivors and neurologically healthy controls, and both will perform a tracing task while seated on a backless bench. The task will be performed twice, at baseline and after giving participants cues to improve their posture. Both task repetitions will be performed in a single session on the same day. Kinetic and kinematic data will be collected to evaluate posture, postural stability and fine motor performance. Data collected at baseline will be used to examine the relationship between postural impairments and fine motor deficits. Additionally, we will evaluate the effects of postural cues on body segment alignment, stability and fine motor performance.

Stroke survivors:

Inclusion criteria

• experienced uni-hemispheric ischemic or hemorrhagic stroke 3 mo - 7 yrs prior
• ability to grasp and hold a stylus for the duration of the experiments
• passive motion throughout the paretic UE within 20° of normal
• dominant side affected

Exclusion criteria

• lesion in brainstem or cerebellum
• presence of other neuro-disease impairing motor skills
• unable to understand 3-step directions
• pain, orthopedic condition or impaired corrected vision that would alter reaching

Healthy Controls:

Inclusion criteria

• no history of stroke or incomplete spinal cord injury
• no medical, orthopedic, neurological, or uncorrected visual condition that would limit the ability to participate in upper extremity testing

Exclusion criteria

• none