Reaching-lifting-placing task during standing after stroke: Coordination among ground forces, ankle muscle activity, and hand movement  Ann Kusoffsky, MSc, PT, Ingmarie Apel, Helga Hirschfeld, PhD, PT  Archives of Physical Medicine and Rehabilitation  Volume 82, Issue 5, Pages 650-660 (May 2001) DOI: 10.1053/apmr.2001.22611 Copyright © 2001 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 1 (A) Schematic drawing of the experimental setup. Note the different 3-dimensional reference coordinates for kinematicsb and forceplates.a (B) Time traces (1 trial) of object, wrist, and GRF show the 5 events providing temporal reference points: (1) loading onset, (2) hand movement onset, (3) object lift onset, (4) time of object peak height, and (5) object placing end. Movement time (100%) was defined as between event 1 and 5. Abbreviation: AP, anterior-posterior. Archives of Physical Medicine and Rehabilitation 2001 82, 650-660DOI: (10.1053/apmr.2001.22611) Copyright © 2001 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 2 Bar graph shows weight distribution expressed as %BW (A) during 5-second quiet stance without following task instruction; (B) during 0.5-second stance before onset of audio signal for task performance. *p =.04, †p =.001. Abbreviations: LL, left leg; RL, right leg; RH, right hand; LH, left hand. □, Control; ▨, NP; ■, P. Archives of Physical Medicine and Rehabilitation 2001 82, 650-660DOI: (10.1053/apmr.2001.22611) Copyright © 2001 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 3 Single time traces of hand path, vertical GRF beneath both feet and ankle muscle electromyograms are shown for a right-hand task in (A) 1 control, (B) 1 stroke subject with right hemiparesis, and (C) for nonparetic left-hand task. Scale bars are on the right. Positive going traces follow the 3-dimensional coordinates in figure 1A. Numbers 1-5 indicate the temporal events (fig 1B). Abbreviations: AP, anterior-posterior; ML, mediolateral; R, right; L, left. Archives of Physical Medicine and Rehabilitation 2001 82, 650-660DOI: (10.1053/apmr.2001.22611) Copyright © 2001 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 4 Distribution of subphases loading, reaching, lifting, and placing in the different groups. Group mean ± SD of task subphases are expressed as percentage of movement time. Archives of Physical Medicine and Rehabilitation 2001 82, 650-660DOI: (10.1053/apmr.2001.22611) Copyright © 2001 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 5 (A) Peak amplitude of loading expressed as change %BW. Bar graphs (group mean ± SD) are shown for initial loading (ipsilateral leg) and during task performance (contralateral leg). □, Control; ▩,NP; ■, P. (B) Temporal sequence of peak time for ipsilateral and contralateral loading and instant of object lift-off are plotted as percentage of movement time. *p =.001, †p =.002. ○, Control; ● NP; ●, P. Archives of Physical Medicine and Rehabilitation 2001 82, 650-660DOI: (10.1053/apmr.2001.22611) Copyright © 2001 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 6 (A) Reaching and object velocity are shown for a single trial of 1 control and 1 stroke patient (NP and P hand). Object traces are aligned to onset of object velocity and the hand velocity traces are aligned to hand movement onset. Scale base indicates percentage of movement time. (B) Velocity peak time in anterior, medial, and lateral direction shown as percentage of movement time. Group mean ± SD is shown. ○, Control; ●, NP; ●, P. Archives of Physical Medicine and Rehabilitation 2001 82, 650-660DOI: (10.1053/apmr.2001.22611) Copyright © 2001 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 7 (A) Bar graphs of mean velocity (group mean ± SD) for the different subject groups. (B) Peak amplitude of forward medial and lateral hand path velocity are expressed as relative unit (=1) to mean reaching velocity for the different subject groups (group mean ± SD). (C) Object peak height is shown in absolute values for the different subject groups (group mean ± SD). The dotted horizontal line indicates the shelf height (65mm). *p =.004, †p =.001, ‡p =.003, §p =.01, ∥p.05. □, Control; ▩, NP; ■, P. Abbreviation: rel, relative. Archives of Physical Medicine and Rehabilitation 2001 82, 650-660DOI: (10.1053/apmr.2001.22611) Copyright © 2001 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 8 LG onset shown relative to movement time in ipsilateral or contralateral leg. Abbreviations: Contral, contralateral; Ipsil, ipsilateral. Archives of Physical Medicine and Rehabilitation 2001 82, 650-660DOI: (10.1053/apmr.2001.22611) Copyright © 2001 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions