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Reaching, Swinging, and Punching: Kinematic Change after Video Gaming Intervention in an Individual with Chronic Stroke

Ann Reinthal, Parthasarathy Srinivasan, Jeffrey Swiers and Patrick Kelly

Residual upper extremity impairment can limit function post stroke. The purpose of this study is to examine kinematic changes after participation in the ENGAGE video gaming protocol in order to clarify why and how functional change occurs as a result of this intervention. This case describes a 51 year-old male six years post stroke with right hemiparesis and an initial Fugl-Meyer upper extremity motor score of 20/66. He received twelve hours of individualized video gaming as an adjunct to physical therapyover twelve weeks following the established ENGAGE protocol. Three activities of increasing difficulty were analyzed before and after the intervention: reaching from hand in lap to table top, swinging a Wii golf club, and punching a hanging eight inch ball. Motion capture and analysis were used to calculate hemiparetic shoulderand wrist displacement, time, velocity, and jerk index. After intervention, the Fugl-Meyer score increased five points. Movement time, excursion, and mean/peak velocities decreased in all conditions except for increased shoulder motion in golf and punching where the trunk is an integral part of normal motion. Also, the movement strategy changed completely for punching, from a one-motion circular swing to a posterior set-up followed by a straight plane anterior punch after the intervention. This is the only task in which mean movement velocity and jerkiness increased, suggesting that learning had not consolidated as well for this new movement pattern. Movement smoothness, as measured by the jerk index, decreased for reaching and golf.Trunk and arm motion became better coordinated in the golf swing and punching.