Skip to main content

Advertisement

Log in

The nature of hand motor impairment after stroke and its treatment

  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Hand motor impairments may be viewed as 1) a deficit in motor execution, resulting from weakness, spasticity, and abnormal muscle synergies, and/or 2) a deficit in higher-order processes, such as motor planning and motor learning, which lead to poorly formed sensorimotor associations that lead to impaired motor control. Although weakness and spasticity impede motor execution, strengthening and tone reduction represent simplistic solutions to the deficit in motor control after stroke. Deficits in hand motor control are better appreciated by examining the coordination of fingertip forces and movements during natural movements, and suggest that impairments in motor learning and planning are fundamental impediments to motor recovery following stroke. However, despite an explosion in the number of therapeutic protocols based on the principles of motor learning, little is known about the types of motor learning impairment that occur after stroke and how lesion location may influence motor relearning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Twitchell TE: The restoration of motor function following hemiplegia in man. Brain 1951, 74:443–480.

    Article  PubMed  CAS  Google Scholar 

  2. Brunnstrom S, ed: Movement Therapy in Hemiplegia. A Neurophysiological Approach. New York: Harper & Row; 1970.

    Google Scholar 

  3. Fugl-Meyer AR, Jaasko L, Leyman I, et al.: The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med 1975, 7:13–31.

    PubMed  CAS  Google Scholar 

  4. Raghavan P, Krakauer JW, Gordon AM: Impaired anticipatory control of fingertip forces in patients with a pure motor or sensorimotor lacunar syndrome. Brain 2006, 129(Pt 6):1415–1425.

    Article  PubMed  Google Scholar 

  5. Lang CE, Schieber MH: Differential impairment of individuated finger movements in humans after damage to the motor cortex or the corticospinal tract. J Neurophysiol 2003, 90:1160–1170.

    Article  PubMed  Google Scholar 

  6. Lang CE, Schieber MH: Reduced muscle selectivity during individuated finger movements in humans after damage to the motor cortex or corticospinal tract. J Neurophysiol 2004, 91:1722–1733.

    Article  PubMed  Google Scholar 

  7. Raghavan P, Petra E, Krakauer JW, Gordon AM: Patterns of impairment in digit independence after subcortical stroke. J Neurophysiol 2006, 95:369–378.

    Article  PubMed  Google Scholar 

  8. Cauraugh J, Light K, Kim S, et al.: Chronic motor dysfunction after stroke: recovering wrist and finger extension by electromyography-triggered neuromuscular stimulation. Stroke 2000, 31:1360–1364.

    PubMed  CAS  Google Scholar 

  9. Kamper DG, Harvey RL, Suresh S, Rymer WZ: Relative contributions of neural mechanisms versus muscle mechanics in promoting finger extension deficits following stroke. Muscle Nerve 2003, 28:309–318.

    Article  PubMed  CAS  Google Scholar 

  10. Trombly CA, Thayer-Nason L, Bliss G, et al.: The effectiveness of therapy in improving finger extension in stroke patients. Am J Occup Ther 1986, 40:612–617.

    PubMed  CAS  Google Scholar 

  11. Kamper DG, Rymer WZ: Impairment of voluntary control of finger motion following stroke: role of inappropriate muscle coactivation. Muscle Nerve 2001, 24:673–681.

    Article  PubMed  CAS  Google Scholar 

  12. Kamper DG, Fischer HC, Cruz EG, Rymer WZ: Weakness is the primary contributor to finger impairment in chronic stroke. Arch Phys Med Rehabil 2006, 87:1262–1269.

    Article  PubMed  Google Scholar 

  13. Li S, Kamper DG, Rymer WZ: Effects of changing wrist positions on finger flexor hypertonia in stroke survivors. Muscle Nerve 2006, 33:183–190.

    Article  PubMed  Google Scholar 

  14. Chae J, Hart R: Intramuscular hand neuroprosthesis for chronic stroke survivors. Neurorehabil Neural Repair 2003, 17:109–117.

    Article  PubMed  Google Scholar 

  15. Brashear A, Gordon MF, Elovic E, et al.: Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after a stroke. N Engl J Med 2002, 347:395–400.

    Article  PubMed  CAS  Google Scholar 

  16. Slawek J, Bogucki A, Reclawowicz D: Botulinum toxin type A for upper limb spasticity following stroke: an open-label study with individualised, flexible injection regimens. Neurol Sci 2005, 26:32–39.

    Article  PubMed  CAS  Google Scholar 

  17. Gracies JM: Pathophysiology of spastic paresis. II: Emergence of muscle overactivity. Muscle Nerve 2005, 31:552–571.

    Article  PubMed  Google Scholar 

  18. Butler A, Blanton S, Rowe V, Wolf S: Attempting to improve function and quality of life using the FTM Protocol: case report. J Neurol Phys Ther 2006, 30:148–156.

    PubMed  Google Scholar 

  19. Cauraugh JH, Kim S: Two coupled motor recovery protocols are better than one: electromyogram-triggered neuromuscular stimulation and bilateral movements. Stroke 2002, 33:1589–1594.

    Article  PubMed  Google Scholar 

  20. Sunderland A, Tinson D, Bradley L, Hewer RL: Arm function after stroke. An evaluation of grip strength as a measure of recovery and a prognostic indicator. J Neurol Neurosurg Psychiatry 1989, 52:1267–1272.

    Article  PubMed  CAS  Google Scholar 

  21. Thickbroom GW, Byrnes ML, Archer SA, Mastaglia FL: Motor outcome after subcortical stroke: MEPs correlate with hand strength but not dexterity. Clin Neurophysiol 2002, 113:2025–2029.

    Article  PubMed  Google Scholar 

  22. Raghavan P, Santello M, Krakauer JW, Gordon AM: Shaping the hand to object contours after stroke [abstract 655.14]. Paper presented at Neuroscience 2006. Atlanta, GA; October 14–18, 2006.

  23. Wenzelburger R, Kopper F, Frenzel A, et al.: Hand coordination following capsular stroke. Brain 2005, 128(Pt 1):64–74.

    PubMed  Google Scholar 

  24. McDonnell MN, Hillier SL, Ridding MC, Miles TS: Impairments in precision grip correlate with functional measures in adult hemiplegia. Clin Neurophysiol 2006, 117:1474–1480.

    Article  PubMed  Google Scholar 

  25. Blennerhassett JM, Carey LM, Matyas TA: Grip force regulation during pinch grip lifts under somatosensory guidance: comparison between people with stroke and healthy controls. Arch Phys Med Rehabil 2006, 87:418–429.

    Article  PubMed  Google Scholar 

  26. Nowak DA, Hermsdorfer J: Predictive and reactive control of grasping forces: on the role of the basal ganglia and sensory feedback. Exp Brain Res 2006, 173:650–660.

    Article  PubMed  Google Scholar 

  27. Porter R, Lemon RN, eds: Corticospinal Function and Voluntary Movement. Oxford: Oxford University Press; 1993.

    Google Scholar 

  28. Colebatch JG, Gandevia SC: The distribution of muscular weakness in upper motor neuron lesions affecting the arm. Brain 1989, 112(Pt 3):749–763.

    Article  PubMed  Google Scholar 

  29. Lang CE, Wagner JM, Bastian AJ, et al.: Deficits in grasp versus reach during acute hemiparesis. Exp Brain Res 2005, 166:126–136.

    Article  PubMed  Google Scholar 

  30. Santello M, Soechting JF: Gradual molding of the hand to object controus. J Neurophysiol 1998, 79:1307–1320.

    PubMed  CAS  Google Scholar 

  31. Johansson RS, Westling G: Coordinated isometric muscle commands adequately and erroneously programmed for the weight during lifting task with precision grip. Exp Brain Res 1988, 71:59–71.

    PubMed  CAS  Google Scholar 

  32. Beer R, Dewald J, Rymer Z: Disturbances of voluntary movement coordination in stroke: problems of planning or execution? Prog Brain Res 1999, 123:455–460.

    Article  PubMed  CAS  Google Scholar 

  33. Levin MF: Interjoint coordination during pointing movements is disrupted in spastic hemiparesis. Brain 1996, 119(Pt 1):281–293.

    Article  PubMed  Google Scholar 

  34. Takahashi CD, Reinkensmeyer DJ: Hemiparetic stroke impairs anticipatory control of arm movement. Exp Brain Res 2003, 149:131–140.

    PubMed  Google Scholar 

  35. Shadmehr R, Wise SP, eds: The Computational Neurobiology of Reaching and Pointing: A Foundation for Motor Learning. Cambridge, MA: MIT Press; 2005.

    Google Scholar 

  36. Grichting B, Hediger V, Kaluzny P, Wiesendanger M: Impaired proactive and reactive grip force control in chronic hemiparetic patients. Clin Neurophysiol 2000, 111:1661–1671.

    Article  PubMed  CAS  Google Scholar 

  37. Chouinard PA, Leonard G, Paus T: Role of the primary motor and dorsal premotor cortices in the anticipation of forces during object lifting. J Neurosci 2005, 25:2277–2284.

    Article  PubMed  CAS  Google Scholar 

  38. Wise SP, Murray EA: Arbitrary associations between antecedents and actions. Trends Neurosci 2000, 23:271–276.

    Article  PubMed  CAS  Google Scholar 

  39. Dum RP, Strick PL: The origin of corticospinal projections from the premotor areas in the frontal lobe. J Neurosci 1991, 11:667–689.

    PubMed  CAS  Google Scholar 

  40. Fries W, Danek A, Scheidtmann K, Hamburger C.: Motor recovery following capsular stroke. Role of descending pathways from multiple motor areas. Brain 1993, 116(Pt 2):369–382.

    Article  PubMed  Google Scholar 

  41. Johansen-Berg H, Rushworth MF, Bogdanovic MD, et al.: The role of ipsilateral premotor cortex in hand movement after stroke. Proc Natl Acad Sci U S A 2002, 99:14518–14523.

    Article  PubMed  CAS  Google Scholar 

  42. Davare M, Andres M, Cosnard G, et al.: Dissociating the role of ventral and dorsal premotor cortex in precision grasping. J Neurosci 2006, 26:2260–2268.

    Article  PubMed  Google Scholar 

  43. Whitall J, McCombe Waller S, Silver KH, Macko RF: Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke. Stroke 2000, 31:2390–2395.

    PubMed  CAS  Google Scholar 

  44. Ehrsson HH, Fagergren A, Jonsson T, et al.: Cortical activity in precision-versus power-grip tasks: an fMRI study. J Neurophysiol 2000, 83:528–536.

    PubMed  CAS  Google Scholar 

  45. Decety J, Perani D, Jeannerod M, et al.: Mapping motor representations with positron emission tomography. Nature 1994, 371:600–602.

    Article  PubMed  CAS  Google Scholar 

  46. Lotze M, Cohen LG: Volition and imagery in neurorehabilitation. Cogn Behav Neurol 2006, 19:135–140.

    Article  PubMed  Google Scholar 

  47. Ustinova KI, Chernikova LA, Ioffe ME, Sliva SS: Impairment of learning the voluntary control of posture in patients with cortical lesions of different locations: the cortical mechanisms of pose regulation. Neurosci Behav Physiol 2001, 31:259–267.

    Article  PubMed  CAS  Google Scholar 

  48. Kunesch E, Binkofski F, Steinmetz H, Freund HJ: The pattern of motor deficits in relation to the site of stroke lesions. Eur Neurol 1995, 35:20–26.

    PubMed  CAS  Google Scholar 

  49. Ghez C, Gordon J, Ghilardi MF: Impairments of reaching movements in patients without proprioception. II. Effects of visual information on accuracy. J Neurophysiol 1995, 73:361–372.

    PubMed  CAS  Google Scholar 

  50. Krakauer JW, Ghilardi MF, Ghez C: Independent learning of internal models for kinematic and dynamic control of reaching. Nat Neurosci 1999, 2:1026–1031.

    Article  PubMed  CAS  Google Scholar 

  51. Doyon J, Penhune V, Ungerleider LG: Distinct contribution of the cortico-striatal and cortico-cerebellar systems to motor skill learning. Neuropsychologia 2003, 41:252–262.

    Article  PubMed  Google Scholar 

  52. Krakauer JW: Motor learning: its relevance to stroke recovery and neurorehabilitation. Curr Opin Neurol 2006, 19:84–90.

    Article  PubMed  Google Scholar 

  53. Chouinard PA, Leonard G, Paus T: Changes in effective connectivity of the primary motor cortex in stroke patients after rehabilitative therapy. Exp Neurol 2006, 201:375–387.

    Article  PubMed  Google Scholar 

  54. Sunderland A, Tuke A: Neuroplasticity, learning and recovery after stroke: a critical evaluation of constraint-induced therapy. Neuropsychol Rehabil 2005, 15:81–96.

    PubMed  Google Scholar 

  55. Fasoli SE, Krebs HI, Stein J, et al.: Effects of robotic therapy on motor impairment and recovery in chronic stroke. Arch Phys Med Rehabil 2003, 84:477–482.

    Article  PubMed  Google Scholar 

  56. Platz T: Impairment-oriented training (IOT)—scientific concept and evidence-based treatment strategies. Restor Neurol Neurosci 2004, 22:301–315.

    PubMed  CAS  Google Scholar 

  57. Gharbawie OA, Whishaw IQ: Parallel stages of learning and recovery of skilled reaching after motor cortex stroke: “oppositions” organize normal and compensatory movements. Behav Brain Res 2006, 175:249–262.

    Article  PubMed  Google Scholar 

  58. Hallett M: Plasticity of the human motor cortex and recovery from stroke. Brain Res Brain Res Rev 2001, 36:169–174.

    Article  PubMed  CAS  Google Scholar 

  59. Hummel F, Celnik P, Giraux P, et al.: Effects of non-invasive cortical stimulation on skilled motor function in chronic stroke. Brain 2005, 128(Pt 3):490–499.

    Article  PubMed  Google Scholar 

  60. Krishnan RV: Botulinum toxin: from spasticity reliever to a neuromotor re-learning tool. Int J Neurosci 2005, 115:1451–1467.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Pretti Raghavan MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Raghavan, P. The nature of hand motor impairment after stroke and its treatment. Curr Treat Options Cardio Med 9, 221–228 (2007). https://doi.org/10.1007/s11936-007-0016-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11936-007-0016-3

Keywords

Navigation