Target-dependent differences between free and constrained arm movements in chronic hemiparesis

This study compares the kinematic and kinetic characteristics of constrained and free upper limb movements in eight subjects with chronic hemiparesis. Movements of the dominant and nondominant limbs were also examined in five control subjects. Rapid movements were performed in the horizontal plane from a central starting point to five targets located to require various combinations of flexion/extension rotations at the elbow and shoulder. Support of the upper limb against gravity loading was provided either by a low-friction air-bearing apparatus (constrained condition) or by voluntary generation of abduction and external rotation torques at the shoulder (free condition). Data analysis focused on the peak joint torques generated during the acceleratory phase of movement, and on the net change in joint angles at the elbow and shoulder. We found that movement parameters were broadly invariant with support condition for either limb of control subjects, as well as for the nonparetic limb of hemiparetic subjects. In contrast, support condition had a target-dependent effect on movements of the paretic limb. Relative to the constrained condition, peak torques for free arm movements were significantly reduced for distal targets requiring elbow extension and/or shoulder flexion torques. However, peak elbow flexion and shoulder extension joint torques for proximal targets were relatively unaffected by support condition. Of perhaps more functional importance, free movements were characterized by a target-dependent restriction in the hand's work area that reflected a reduced range of active elbow extension, relative to constrained movements. The target-dependent effects of support condition on movements of the paretic limb are consistent with the existence of abnormal constraints on muscle activation patterns in subjects with chronic hemiparesis, namely an abnormal linkage between activation of the elbow flexors and shoulder extensors, abductors, and external rotators.