Application of the Coupling Angle to Investigate Upper Limb Interjoint Coordination After Stroke

Objective: Interjoint coordination after stroke is affected, which limits the use of the upper limb. Current methods to determine interjoint coordination lack the ability to visualize and quantify the movement. Therefore we investigated if the coupling angle can be used to visualize and interpret upper limb interjoint coordination following a stroke. Methods: Seven chronic stroke patients trained six weeks with an assistive home-training system (MERLIN). Kinematic outcomes, i.e. elbow and shoulder range of motion, movement duration, and angle-angle plots were determined in a retrieving task. Interjoint coordination between elbow flexion and shoulder abduction angles was expressed as the coupling angle phases and the number of phase transitions: proximal/distal joint leading phase, in-phase and anti-phase. Comparisons were made within sides: pre-test versus post-test, and between sides: most-affected (MA) versus least-affected (LA). Results: Smaller elbow flexion angles were found PreMA versus PreLA, and smaller shoulder abduction angles in PostMA versus PostLA. A general coordination pattern was revealed on the LA side, but not on the MA side. A trend showed less phase transitions at the MA side after training, suggesting a smoother movement. Quantification of the movement phases indicated more involvement of the shoulder joint involvement in the MA side during pre-test. After training, these differences were not apparent, which might reveal an increased independent control of the elbow joint. Conclusions: The coupling angle and the movement phases provide a promising tool to investigate post-stroke interjoint coordination patterns. Significance: A new visualisation of the interjoint coordination may benefit rehabilitation of stroke survivors. Registration: This trial was registered at the Netherlands Trial Register (NL7535) https://www.trialregister.nl/trial/7535.