95
A Kinematic Study of Contextual Effects on Reaching
Performance in Persons With and Without Stroke:
Influences of Object Availability
Ching-yi Wu, ScD, Catherine A. Trombly, ScD, Keh-chung Lin, ScD, Linda Tickle-Degnen, PhD
ABSTRACT. Wu C-Y, Trombly CA, Lin K-C, Tickle-
Degnen L. A kinematic study of contextual effects on reaching
performance in persons with and without stroke: influences of
object availability. Arch Phys Med Rehabil 2000;81:95-101.
Objective: To examine the effects of context on reaching
performance in neurologically impaired and intact populations.
Context was varied by the presence or absence of objects used
to complete a task.
Design: A counterbalanced repeated-measures design.
Setting: A motor control laboratory in a university setting.
Participants: Fourteen persons with stroke and 25 neurologi-
cally intact adults.
Interventions: Each participant was tested under two condi-
tions: the presence of the object, in which the participant reached
forward with the impaired arm (or corresponding arm) to scoop
coins off the table into the other hand; and the absence of the object,
in which the participant reached forward to the place where the
coins would be placed in the condition of object present.
Main Outcome Measures: Kinematic variables of move-
ment time, total displacement, peak velocity, percentage of
reach where peak velocity occurs, and movement units (derived
from acceleration data) for reaching tasks.
Results: The condition of using real objects elicited kinemati-
cally better performance of reaching movements than the
condition of performing movements without relevant objects
present. Better performance was reflected by shorter movement
time, less total displacement, higher peak velocity, greater
percentage of reach where peak velocity occurs, and fewer
movement units.
Conclusion: The results of this study showed that the
condition of object present elicited better performance of move-
ments represented by kinematic variables than the condition of
object absent. The clinical implication is that the use of real and
functional objects might be an effective way of facilitating efficient,
smooth, and coordinated movement with the impaired arm in
persons with stroke. This study, however, should be replicated
and extended to confirm the validity of its findings and to allow
for generalization in various functional activities.
Key Words: Kinematics; Stroke; Movements; Rehabilita-
tion.
r 2000 by the American Congress of Rehabilitation Medi-
From Department of Occupational Therapy, Chang Gung University, Taoyuan (Dr.
Wu), and the School of Occupational Therapy, National Taiwan University, Taipei (Dr.
Lin), Taiwan; and the Department of Occupational Therapy, Boston University,
Boston, MA (Drs. Trombly, Tickle-Degnen).
Submitted for publication January 13, 1999. Accepted in revised form May 6, 1999.
Supported in part by the American Occupational Therapy Foundation.
No commercial party having a direct financial interest in the results of the research
supporting this article has or will confer a benefit upon the authors or upon any
organization with which the authors are associated.
Reprints requests to Dr. Keh-chung Lin, School of Occupational Therapy, College
of Medicine, National Taiwan University, 7 Chung-shan South Road, Taipei 100,
Taiwan.
r 2000 by the American Congress of Rehabilitation Medicine and the American
Academy of Physical Medicine and Rehabilitation
0003-9993/00/8101-5415$3.00/0
cine and the American Academy of Physical Medicine and
Rehabilitation
A SSESSMENT OF movement performance often involves
recording the end of range of motion or the number of
repetitions. Recently, sophisticated systems have been devel-
oped that quantify or document kinematics in three dimensions
throughout complex movement. Movement kinematics de-
scribe the spatiotemporal characteristics of movement (for
example, displacement and the derivatives of displacement,
acceleration and jerk), which may tap subtle aspects of quality
of performance on motor tasks.1 A complete kinematic descrip-
tion of a movement may indicate the neural commands
responsible for this movement2 and may be used to infer the
organization of the movement.3 Therefore, use of kinematic
analysis is a possible way of providing information on how
movement is organized or can be modified in persons who have
suffered stroke.4,5 One possible way to modify motor perfor-
mance in patients after stroke is to vary the performance
context. The importance of context in determining the perfor-
mance or behavior of any individual6 has been increasingly
addressed in the fields of neurologic rehabilitation7 and move-
ment science.8,9 Despite this emphasis of context, the potential
contribution of contextual features in evaluation and interven-
tion relative to task performance has not been well under-
stood.10 The need for research in this area has been called for.10
Rogoff11 has identified three aspects of context: the task
materials, the meaningfulness of the goal of the activity, and the
social situation in which the task is embedded. The task
materials within the context are the most obvious, and thus the
most likely to be given consideration when contextual effects
on performance are discussed.12,13 There is some evidence that
the presence of objects facilitates better motor performance
than the absence of objects in neurologically intact14 and
impaired15 people. Further knowledge generated from clinical
populations may have direct implications for the evaluation and
therapy of movement disorders. The rationale for studying
neurologically intact subjects is to provide a basis for establish-
ing normal patterns in task performance under the contexts of
object present and absent. This investigation aims at studying
whether object availability would influence movement perfor-
mance in able-bodied adults and persons with cerebral vascular
accident, which is the leading cause of disability among adults,
particularly older adults, in the United States.16
Newell and Valvano9 stressed that action is a result of the
interaction of persons with their everyday environment (ie,
performance context). A person has to perceive useful informa-
tion from the context so that the control of behavior can be
organized and adjusted to the possibilities for action that are
supported by the context.17 Presence of objects allows the actor
to perceive sensory information about the layout of the perfor-
mance context, ones own body, as well as the relation between
the hand and the context,18 and perceptual information such as
the functional usefulness of the object8 and the goal suggested
by the objects. That is, objects existing in a performance context
Arch Phys Med Rehabil Vol 81, January 2000
96 A KINEMATIC STUDY OF CONTEXTUAL EFFECTS, Wu
may facilitate information processing, alluded to above, to
perform a reaching movement.19-21 If the object is absent, the
visual and perceptual information is deprived, the environmen-
tally defined goal is absent, and the movement must be
organized by attending to the process of moving. It is expected
that functional use of an object within a performance context
may facilitate better or more organized performance of move-
ment than movement performed within an objectless context
(eg, movement for exercise).
The notion that using an object during a functional task may
facilitate better performance of movement than a performance
context without objects or objectless exercise has been tested by
cumulative studies. The vast majority of the studies used
traditional measures (eg, the number of movement repetitions,
range of motion, duration of movements) to compare the motor
performance under the conditions of object present versus
object absent in neurologically intact22-26 and neurologically
impaired populations.27,28 Collectively, the results of these
studies showed a positive effect in support of functional use of
an object for enhancing movement performance in neurologi-
cally intact and impaired populations.
Scant studies have utilized computerized measures to com-
pare the kinematic variables of movements performed with the
presence or absence of objects in neurologically intact14,23 and
impaired15 populations. Given the paucity of studies that used
kinematic analysis to investigate movement performance under
various contextual conditions in normal adults, there is need for
further study.
The reaching movement, a complicated multijoint movement
directed to a defined point in space,29 is the major action of the
arm to bring the hand into interaction with the environment.30
Reaching is, thus, an important movement to study in persons
who have suffered stroke. The reaching movement was charac-
terized by kinematic variables, including movement time, total
displacement, the amplitude of peak velocity, percentage of
movement where peak velocity occurs, and the number of
movement units. Movement time refers to the time for the
execution of the reaching movement. The path of the hand in
three-dimensional (3-D) space is described by total displace-
ment in x, y, and z coordinates. Once the movement starts, for
example, reaching for the target, the arm generally accelerates
toward the target and then decelerates at each point of direction
change or correction of trajectory.29 One acceleration and one
deceleration phase comprise a movement unit. The peak
velocity corresponds to the changeover from the acceleration to
the deceleration phase.31,32 If the movement is well controlled,
the motor program may not rely heavily on feedback loops to
correct the ongoing movement. Consequently, the path of the
movement will be more direct (ie, less total displacement),33 the
time for execution of movement will be shorter (ie, shorter
movement time),33,34 the movement will be faster (ie, higher
peak velocity)14 and smoother (ie, fewer movement units),35,36
and the percentage of reach where peak velocity occurs will be
greater.37,38 Greater percentage of reach where peak velocity
occurs indicates less dependence on on-line feedback for
movement correction.
Our hypothesis is that the condition of object present could
elicit better performance of movements than that of object
absent in both the able-bodied and the stroke populations.
Enhanced performance of movements would be reflected
kinematically by shorter movement time, less total displace-
ment, higher peak velocity, greater percentage of reach where
peak velocity occurs, and fewer movement units.
Arch Phys Med Rehabil Vol 81, January 2000
METHODS
Participants
Fourteen persons with stroke (9 men, 5 women, aged 39 to 84
years, mean age 61.79 yrs) and 25 age-matched neurologically
intact adults (8 men, 17 women, aged 37 to 81 years, mean age
63.80 yrs) volunteered for this study. All participants signed
informed consent forms approved by the Institutional Review
Board. All participants were right-handed. The able-bodied
adults included in this study had no prior history of cerebral
disease by self-report. The persons with stroke were able to
understand and respond to directions given by the experimenter
and demonstrated movement of the proximal part of the
impaired arm. The stroke group consisted of eight persons with
left hemisphere damage, five persons with right hemisphere
damage, and one person with both hemispheres damaged. The
duration postonset ranged from 5 to 174.5 months. The
information on the date of onset of the stroke and the site of
stroke was obtained from patients self-report. Demographic
and clinical characteristics of persons with stroke are listed in
table 1.
Clinical measures of spasticity, joint sense, and visuospatial
neglect were administered to the stroke patients to enhance
interpretation of results. The modified Ashworth scale39 used to
measure spasticity involves manually moving a limb through
the range of motion to passively stretch specific muscle groups.
Except for subjects 2 and 8, spasticity was negligible in this
sample (table 1).
Leo and Soderberg40 suggested that the sensory awareness of
a stroke patients impaired limb is highly associated with the
ability to combine synergies into normal voluntary movements.
The patient was blindfolded for administration of the Per-
ception of Joint Position Sense Test and asked to move the
index finger of the nonimpaired upper extremity to touch a
small piece of tape affixed to the radial styloid of the impaired
upper extremity, which was moved into each of six combina-
tions of shoulder, elbow, and forearm placements. Three
patients (nos. 5, 7, 13) exhibited severe sensory awareness
impairment (table 1).
The line bisection test was used to test the presence of
visuospatial neglect. This test consisted of three horizontal
black lines of 12, 18, and 24cm in length, each of which was
presented separately on a sheet of legal-size paper.41 Patients 5
and 13 were found to have left neglect (table 1).
Materials and Instrumentation
Coins, including dimes and quarters, were used for the target
objects in the condition of object present.
The OPTOTRAK/3020 3-D active infrared motion analysis
systema was used to track the movement of the infrared
light-emitting diodes (LEDs) attached to the limb as it moved in
3-D. Two infrared LEDs were used in this study: one was
attached over the head of the fifth metacarpal of the hand of the
subject; the other was placed directly in front of the location of
the target object and used as a reference LED. The two LEDs
were tracked simultaneously by three infrared sensors (cam-
eras) permanently mounted in a 5-foot long housing. This
instrument was placed approximately 2m from the subject
during recording.
The OPTOTRAK is a precalibrated and noncontact system
capable of recording high-velocity motion in three dimensions
with 0.1-mm accuracy at a distance of 2.5m. The LEDs were
fired sequentially at 2,000Hz by the central controller unit via a
strober. As the subject moved, the instantaneous position of
each LED was digitized at a sampling rate of 100Hz. Any
 A KINEMATIC STUDY OF CONTEXTUAL EFFECTS, Wu 97

Table 1: Demographic and Clinical Characteristics of Stroke Subjects

No. of Months Side of Ashworth Sensory Bias Index on
Subject Age Sex Poststroke Lesion Score Awareness Score Line Bisection

1 69 M 27.8 Left 7.5 10 .020

2 39 M 46 Right 19 12 .015
3 64 F 40.3 Right 0 14 .0042
4 51 M 11 Both 0 12 .012
5 66 M NA Right 0 6 .12
6 54 F 69* Left 0 14 .0097
7 51 M 5 Left 3 8 .015
8 45 M 174.5 Right 44.5 18 .0093
9 83 M 5 Right 0 12 .02
10 84 M 50 Left 2 14 .0167
11 61 M 58.3 Left 0 18 .00517
12 80 F 13 Left 0 18 .0583
13 46 F 98 Left 8 6 .0584
14 72 F 15 Left 0 16 .0458
The Ashworth score ranks muscle spasticity of the upper extremity.39 The score can range from 0 (normal tone) to 4 (rigidity) for each motion.
Fourteen upper extremity motions were examined in this test. The Sensory Awareness Score detects the patients awareness of joint position of
the impaired limb. Six combinations of shoulder, elbow, and forearm placement were tested. The score ranges from 6 (difficulty in finding the
tape attached to the impaired hand in each of the six positions) to 18 (direct and accurate movements to touch the tape in the six positions).40
The Bias Index on Line Bisection indicates the degree of bisection bias from center. The index can range from 1 to 1, with 0 representing no
bias toward either side, and with a positive value indicating a rightward bias. A bias index of .055 or more indicates left neglect.41
Abbreviation: NA, not available.
* This patient had three separate strokes; 69mo is the time since the first stroke.
Results are not substantially altered by inclusion of subject 8, who exhibited greater spasticity than other subjects.

occluded points were flagged and the data linearly interpolated
for the occluded points if a total of occluded points was 5% or
less of the data for one trial. One percent of the trials were
excluded because the occluded points were greater than 5%.
The raw data were converted to 3-D coordinates by use of a
direct linear transformation algorithm.
The start and the end of the reach event were determined
through the use of one switch and the reference LED. Before
initiating movement, the participants hand rested on a switch
6.3cm in diameter. The beginning of movement was recorded
when the hand moved off the switch. The end of movement was
determined to be the time when the distance between the
reference LED and the LED attached to the hand of the
participant was minimal.
Design
A counterbalanced repeated-measures design was used. Each
incoming patient was randomly assigned to one of the two
sequences: AB and BA, where A and B represent the conditions
of object present and object absent, respectively.
Procedures
Each person with stroke reached out with the impaired arm,
and the matched neurologically intact adult reached out with the
same arm as that used by the person with stroke. Some persons
with stroke were matched with more than one nonimpaired
adult. The patient with both hemisphere lesions used his left
hand because he reported that his right arm could perform tasks
normally. Consequently, six patients and 14 nonimpaired sub-
jects used their right arms to perform the tasks; eight patients
and 11 controls used their left arms.
Each participant sat on a chair 45.1cm high in front of a table
73.7cm high in the same testing room. Before the start of the
experiment, the participant was asked to place the hand on the
switch located on the table directly in front of the arm. The
target object was placed 16.5cm away from the body in line
with the participants midsagittal plane. The experimenter said
ready to the participant to remind the participant to rest his or
her hand on the switch and then said go to indicate start of a
trial. The timing of the go signal was randomized.
Each participant received two experimental conditions and
performed 10 trials for each condition. The two experimental
conditions are described as follows.
The presence of the object. One quarter and one dime were
placed in front of the participant. The participant was instructed
to reach forward to scoop the coins off the table into the other
hand. After the participant scooped the coins, he or she could
keep the money.
The absence of the object. The participant was instructed
to reach forward to the spot where the coins should be placed in
the condition of object present and then bring his or her arm
back to the starting point. The participant was instructed to
rotate the forearm into midposition while reaching forward,
which was similar to the end position of reaching to the coins in
the condition of object present. The spot was indicated by the
experimenter before the beginning of this condition. There was
no visual cue of the spot. The purpose of reaching forward,
rotating the forearm, and bringing the hand back is to try to keep
the biomechanical constraints the same across the two condi-
tions.
Data Reduction
The 3-D data were filtered using a second order Butterworth
filter, with forward and backward pass, at a frequency of 5Hz.
The displacement data were then processed using a custom
written program to provide information on the velocity and
acceleration reaching performance.
Data Analysis
Two 2 2 mixed (ie, one between-factor and one repeated-
factor) analyses of variance (ANOVA) were used to test the a
priori hypothesis for the able-bodied adult participants and
those with stroke. The between factor was the sequence and the
repeated factor (or the within factor) was the order. The
treatment effect, which was essentially a test of the differences
in the kinematic variables for the two experimental conditions,

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98 A KINEMATIC STUDY OF CONTEXTUAL EFFECTS, Wu

was determined by testing the interaction effect of sequence Table 3: Sequence Order Mixed ANOVA on Kinematic Variables
with order. This practice allowed the use of a more precise error for Persons With Stroke
term by removing the confounding effects of sequence and Sum of Mean
order.42 df Squares Square F p
The data were analyzed using the SAS computer package.b Movement time
The effect size r was calculated for each dependent variable Between 13
using the procedures described by Rosenthal and Rosnow43 to Sequence 1 .0448 .0448 .08 .7854
demonstrate the degree to which performance context exerts an Error 12 6.935 .578
influence on reaching kinematics. The effect size measures are Within 14
free of sample-size influence and can determine the degree to Order 1 .0277 .0277 .32 .5840
which the phenomenon under study is manifested.44 According Order Sequence 1 .996 .996 11.40 .0028
to Cohen, a large effect is represented by an r of at least .50, a Error 12 1.048 .0873
moderate effect by .30, and a small effect by .10.44 Total displacement
Between 13
RESULTS
Sequence 1 28079.26 28079.26 3.16 .1010
Error 12 106782.29 8898.52
Analyses of the Effects of Experimental Conditions
Within 14
Table 2 presents the means of the kinematic variables Order 1 1.108 1.108 0.00 .9802
associated with each testing condition for the stroke patients Order Sequence 1 22056.84 22056.84 12.82 .0019
and the control adults. Except for the variable of peak velocity, Error 12 20643.35 1720.28
patterns of the average performance are consistent with the a Peak velocity
priori hypotheses for both participant groups, that is, the Between 13
condition of object present produced shorter movement time, Sequence 1 44748.81 44748.81 .92 .3568
less total displacement, greater percentage of reach where peak Error 12 584785.12 48732.09
velocity occurs, and fewer movement units than the condition Within 14
of object absent. Order 1 21552.87 21552.87 3.05 .1063
Table 3 displays the sources of variance in the 2 2 mixed Order Sequence 1 2567.82 2567.82 .36 .2791
ANOVA for each kinematic variable for the stroke group. Error 12 84845.27 7070.44
Results of the order by sequence analyses showed significant Percentage of reach where
and large object presence effects for movement time (F(1, peak velocity occurs
12) 11.40, r .70, p .0028), for total displacement (F(1, Between 13
12) 12.82, r .72, p .0019), for percentage of reach Sequence 1 444.65 444.65 3.27 .0957
where peak velocity occurs (F(1, 12) 15.12, r .75, Error 12 1631.99 136.00
p .0011), and for movement units (F(1, 12) 9.05, r .66, Within 14
p .0055). A nonsignificant and small effect was found in the Order 1 5.49 5.49 .12 .7365
variable of peak velocity (F(1, 12) .36, r .17, p .2791). Order Sequence 1 699.80 699.80 15.12 .0011
Table 4 reveals the sources of variance in the 2 2 mixed Error 12 555.51 46.29
ANOVA in the outcome measures for the neurologically intact Movement units
group. Order by sequence results showed significant and large Between 13
object presence effects for movement time (F(1, 23) 160.16, Sequence 1 1.06 1.06 .14 .7140
r .94, p .00005), for total displacement (F(1, 23) 65.70, Error 12 90.36 7.53
r .86, p .00005), and for percentage of reach where peak Within 14
velocity occurs (F(1, 23) 168.44, r .94, p .00005). A Order 1 .84 .84 .59 .4581
marginally significant and moderate effect was found in the Order Sequence 1 12.93 12.93 9.05 .0055
variable of movement units (F(1, 23) 2.86, r .33, Error 12 17.15 1.43
Order refers to the order of administration of the treatment. For
Table 2: Means (Standard Deviations) for the Kinematic Variables example, in the sequence of AB, A (the condition of object present)
for Each Condition was administered first and took the first order, B (the condition of
object absent) was given next and assumed the second order.
Condition
Kinematic Variables Object Present Object Absent
p .0522) and a nonsignificant and modest effect in the
Stroke
variable of peak velocity (F(1, 23) .21, r .095, p .3249).
Movement time (sec) 1.04 (.44) 1.42 (.65)
As shown in table 4, there were significant sequence effects
Total displacement (mm) 292.39 (74.12) 348.52 (80.42)
in movement time and in total displacement, and a significant
Peak velocity (mm/sec) 544.14 (171.57) 563.30 (164.84)
order effect in movement time. Despite the significant sequence and
Percentage of reach where peak
order effects, significant effects of condition (order by sequence)
velocity occurs (%) 39.50 (10.58) 29.50 (9.54)
were obtained after removing the order and the sequence effects
Movement units 2.63 (1.67) 3.99 (2.37)
and was, therefore, not confounded by these effects.
Able-Bodied
Movement time (sec) .47 (.11) .75 (.15) Further Analyses
Total displacement (mm) 203.89 (41.69) 267.26 (52.25)
To provide better understanding of the nature of participant
Peak velocity (mm/sec) 687.51 (154.52) 700.27 (147.05)
performance, the relationships between kinematic profiles and
Percentage of reach where peak
several factors were examined independent of the testing
velocity occurs (%) 50.54 (5.78) 34.90 (6.84)
conditions. The examinations involved correlation between
Movement units .95 (.57) 1.64 (.39)
kinematic variables and clinical tests (ie, the modified Ashworth

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 A KINEMATIC STUDY OF CONTEXTUAL EFFECTS, Wu 99

Table 4: Sequence Order Mixed ANOVA on Kinematic Variables time, less total displacement, higher peak velocity, greater
for Neurologically Intact Participants percentage of reach where peak velocity occurs, and less
Sum of Mean movement units than the stroke group.
Source df Squares Square F p Effects of laterality of brain damage. The results showed
Movement time moderate, though nonsignificant, effects on total displacement
Between 24 (t(11) 1.32, r .37, p .2130) and percentage of reach
Sequence 1 .2826 .2826 17.11 .0004 where peak velocity occurs (t(11) 1.27, r .36, p .2310).
Error 23 .3798 .0165 Persons with left brain lesions engendered longer total displace-
Within 25 ment and less percentage of reach where peak velocity occurs
Order 1 .0339 .0339 5.41 .0292 than those with right brain lesions.
Order Sequence 1 1.004 1.004 160.16 .00005
Error 23 .144 .00627 DISCUSSION
Total displacement
The findings of this study agree with those of previous
Between 24
research14,15 showing that movements performed under the
Sequence 1 28347.33 28347.33 10.87 .0032
condition of object present were more efficient (shorter move-
Error 23 59970.86 2607.43
ment time), straighter (less total displacement), more pro-
Within 25
grammed (greater percentage of reach where peak velocity
Order 1 1162.74 1162.74 1.51 .2322
occurs), and smoother (fewer movement units) than those
Order Sequence 1 50734.29 50734.29 65.70 .00005
performed under the context without object present. These
Error 23 17760.07 772.18
findings are in accord with the view that providing concrete
Peak velocity
sensory (eg, the presence of the object) and functional informa-
Between 24
tion on object use would enhance performance of functional
Sequence 1 259.457 259.457 .01 .9356
movements. When the object was presented as the end goal of
Error 23 894675.394 38898.93
reaching, the person could scale the spatial relationships
Within 25
between the person and the object without making an extra
Order 1 6236.71 6236.71 .75 .3948
effort to imagine the target location. The scaling of this spatial
Order Sequence 1 1755.61 1755.61 .21 .3249
Error 23 190780.51 8294.80
relationships without the need to imagine the target location
Percentage of reach
may lead to better integrity of the planning of the executive
where peak
neuromuscular system to perform the object-related task,
velocity occurs
compared with the condition of object absent. Therefore, the
Between 24
movement performed was more efficient (ie, less movement
Sequence 1 2.34 2.34 .04 .8494
time) and straighter (ie, less total displacement).45 A complemen-
Error 23 1461.52 63.54
tary explanation for the more efficient and straighter movement
Within 25
under the condition of object present pertains to monetary
Order 1 47.61 47.61 2.65 .1170
rewards. When the objects (ie, coins) were present, the subject
Order Sequence 1 3022.46 3022.46 168.44 .00005
reached for, scooped, and then kept the coins. Rewarding the
Error 23 412.72 17.94
subject with objects of sociocultural value may have motivated
Movement units
the person to perform the task in a more efficient way. This
Between 24
rewarding effect warrants further scrutiny in future research.
Sequence 1 10.75 10.75 3.07 .0930
There are two possible explanations for the results that the
Error 23 80.47 3.50
person performed more programmed and smoother (or more
Within 25
continuous) reaching movements when the target object existed
Order 1 3.33 3.33 1.52 .2302
within the context than when no object was present. The first
Order Sequence 1 6.27 6.27 2.86 .0522
was described earlier, that is, when the target position of a
Error 23 50.46 2.19
reaching movement was decided by presence of a real object,
the participant acquired clear visual information on the object
before performing the task, which facilitated the scaling of the
spatial and temporal characteristics of movements in advance.
scale and the Perception of Joint Position Sense Test) in stroke Therefore, the degree of reliance on external feedback decreased
patients, the differences in movement kinematics between the during task performance; the deceleration phase is shorter (ie,
control and the stroke groups, and the differences in perfor- greater percentage of reach where peak velocity occurs) when the
mance by persons with left and right hemisphere lesions. object is present versus absent. Second, the condition of object
Correlation with clinical tests. A moderate correlation present involved a functional and familiar task that might have been
between movement time and the score of the Perception of the performed numerous times during the participants daily life. The
Joint Position Sense test (r .40, p .1570) was found. As movement of forward reach to scoop coins might thus be more
the awareness of joint position sense decreased, the time for the centrally preprogrammed than the movement involving only
execution of movement increased. reaching forward to a particular location.
Differences between the control and the stroke groups. The beneficial effects of the presence of the object on
The group effects are significant and moderate to large for movement kinematics have practical implications for rehabilita-
movement time (t(13.8) 4.41, r .76, p .0006), total tive treatment of the persons with stroke. Tasks with the use of
displacement (t(18.3) 4.03, r .69, p .0008), peak ve- real objects may improve movement performance of persons
locity (t(37) 2.93, r .43, p .0058), percentage of reach with stroke by enhancing the quality of their movements; that
where peak velocity occurs (t(18.7) 3.13, r .59, p .0056), is, movements may be performed more efficiently, smoothly,
and movement units (t(37) 3.84, r .53, p .0005). The and directly. In addition, use of activities that involve objects of
control group performed movements with shorter movement rewarding values may motivate the patient to accomplish the

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100 A KINEMATIC STUDY OF CONTEXTUAL EFFECTS, Wu
task goal in a more efficient manner. Further efficacy studies are
needed to corroborate the effects observed in this study.
Concerning peak velocity, the two experimental conditions
produced similar amplitudes of peak velocity. This suggests that
the variable of peak velocity is not a sensitive outcome variable
for detecting the effects of certain contextual features.
In comparison with neurologically intact controls, the per-
sons with stroke generated movements that were less efficient
(longer movement time), less direct (greater total displace-
ment), less smooth (more movement units), and slower (lower
peak velocity), and used more feedback for correcting the
ongoing movements (lower percentage of reach where peak
velocity occurs). This poorer performance might result from the
disturbance of proprioceptive sensation.4 The data from this
study showed that increased impairment of joint position
sensation moderately correlated with decreased level of move-
ment performance. This evidence suggests that persons with
impaired proprioceptive sensation may not be able to efficiently
use past experience about the relationships of sensory input to
motor outcomes and, thus, have difficulty in directly and
efficiently reaching for the end target. The poorer performance
by the persons with stroke also might be explained by the lack
of appropriate force generation and control.5 According to Wing
and colleagues,46 increased peak velocity is associated with
greater force generation. The persons with stroke generated
lower peak velocity than the controls, suggesting the patients
might have the problem of force generation. Mattingley and
associates47 suggested that the high proportion of movement
time spent in the deceleration phase by the persons with stroke
implied poor force control that required more submovements.
In this study, when compared to normal performance, the
persons with stroke revealed a lower percentage of reach where
peak velocity occurs, that is, prolonged deceleration time,
which might stem from loss of force control. Moreover, poor
force control may lead to more distinct changes in movement
direction, which resulted in more movement units.
Persons with left hemisphere damage demonstrated less
direct and less programmed movement than those with right
hemisphere damage. These findings suggested that persons with
left hemisphere lesions were less able to make use of visual and
proprioceptive information to update and modify the trajectory
of the reach than persons with right hemisphere damage
possibly because the left hemisphere is responsible for motor
programming and for translating external information into
internal coordinates.48,49 Once the left hemisphere is damaged,
the ability to translate external information into internal coordi-
nates is diminished. Therefore, movement performance of the
persons with left-hemisphere damage is worse than that of right
hemisphere damage. The results also suggest that damage to the
left hemisphere is more detrimental to the performance of
functional tasks with the right arm than right hemisphere
damage is to the performance of tasks with the left arm.
CONCLUSION
One of the unique contributions of this study was the use of
both nonimpaired controls and persons with stroke to study
contextual effects on kinematic characteristics. The results we
obtained corroborate the findings of previous research14 that the
presence of an object for functional use enhances the perfor-
mance of functional reach, relative to the absence of an object.
The clinical implication is that the use of real objects might be
an effective way of facilitating efficient, smooth, and coordi-
nated movement with the impaired arm in persons with stroke.
This study, however, should be replicated and extended to
confirm the validity of its findings, and to allow for generaliza-
tion. For example, would the beneficial effects of the use of real
Arch Phys Med Rehabil Vol 81, January 2000
objects still hold for other functional tasks? Would the effects
found in this study be obtained when samples of other stroke
patients or different clinical populations are employed?
Finally, this study discussed the kinematic nature of move-
ment disorders following cerebral vascular accident. Descrip-
tions of the abnormal kinematics observed in persons with
stroke and the different kinematics in left versus right hemi-
sphere damage provides us with a better understanding of the
characteristics of reaching movements.
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Arch Phys Med Rehabil Vol 81, January 2000