Control of reach extent with the paretic and nonparetic arms after unilateral sensorimotor stroke II: planning and adjustments to control movement distance

Jill Campbell Stewart, James Gordon, Carolee J. Winstein

Nondisabled adults utilize both planning and feedback-based compensatory adjustments to control actual distance moved for skilled reach actions. The purpose of this study was to determine whether individuals post-stroke utilize planning and compensatory adjustments to control movement distance for reaches to targets that vary in distance. Individuals with mild to moderate motor impairment after stroke and nondisabled adults reached with both arms to targets presented at three distances (8, 16, 24 cm). The control of movement distance was compared between arms (control, nonparetic, and paretic) as to the use of planning (correlation of peak acceleration with movement distance), compensatory adjustments prior to peak velocity (correlation of time to peak velocity with movement distance), and compensatory adjustments after peak velocity (variance in movement distance accounted for by deterministic statistical model). The correlation of peak acceleration with movement distance for reaches with the paretic arm was significantly less than controls suggesting a decreased reliance on planning. Feedback-based compensatory adjustments, however, were present prior to and after peak velocity that assisted in achievement of movement distance in a similar manner as controls. Overall reach performance with the paretic arm was impaired, however, as evidenced by greater endpoint error and longer movement times than controls. The decreased use of planning to control movement distance after stroke suggests that the selected motor command was suboptimal in producing the desired movement outcome and may be related to an inability to generate muscle force quickly, lack of knowledge of arm dynamics due to decreased arm use, or lesion characteristics.