Potential contributing factors to upper limb associated reactions in people with acquired brain injury: an exploratory study

Abstract

Purpose

To determine which potential contributing factors are associated with upper limb associated reaction (AR) expression in individuals with acquired brain injury (ABI).

Methods

Forty-two participants underwent three-dimensional motion analysis at self-selected walking speed to generate the AR outcome measure, quantifying their upper limb kinematic deviation compared to healthy controls. Clinical assessment included: upper and lower limb hypertonicity, spasticity and strength, balance, dynamic walking stability, arm and leg function, anxiety, arm pain/discomfort, and fear of falling.

Results

Significant, moderate-to-strong correlations (r = 0.42–0.74, p < 0.05) existed between upper limb ARs and both hypertonicity and spasticity of the upper limb muscles and the knee extensors. Significant, moderate correlations to ARs (r = 0.42–0.59, p < 0.05) existed for balance, dynamic stability, upper limb strength, and arm function. The severity of AR was significantly different between those with and without hypertonicity of the four tested upper limb muscles, elbow and long finger flexor spasticity, knee extensor spasticity, and reduced dynamic stability (p < 0.05; effect sizes ≥0.80). However, these contributing factors were not present in all participants.

Conclusions

Associated reactions are complex and multi-factorial. There were several significant correlations indicating that factors may influence AR severity. While positive upper motor neuron syndrome features should be prioritised for clinical assessment, these factors are not prerequisites for ARs.

IMPLICATIONS FOR REHABILITATION

• Upper limb associated reactions are a complex and multi-factorial phenomenon.

• Upper limb muscle hypertonicity and spasticity should be prioritised for assessment; however, they are not prerequisites for associated reactions.

• Hypertonicity and spasticity should be differentiated as they may have differing relationships to associated reactions.

• Knee extensor hypertonicity and spasticity, postural stability, upper limb strength, and arm function may also be contributing factors to consider.

Keywords:

• Stroke
• acquired brain injury
• upper limb
• associated reactions
• spasticity
• hypertonicity
• contributing factors

Author contributions

Primary Author MBK performed study design, all data collection, cleaning, analysis, processing and interpretation, and drafting the manuscript; GW and RC contributed to study design, data analysis and interpretation, and critical revision of the manuscript; BFM assisted in data collection of the clinical cohort, developed the upper limb model and analysis program for the three-dimensional motion analysis, assisted in data processing and critical review of the manuscript. KJB and JO contributed to the study design and critical revision of the manuscript.

Ethics approval and consent to participate

This research is approved by the Human Research Ethics Committees of Epworth Healthcare (HREC 648-14) and the University of the Sunshine Coast (S/17/1006). All subjects that were invited, consented to do so and provided written informed consent prior to assessment.

Disclosure statement

Each of the authors has read and concurs with the content in the final manuscript. The material within has not been and will not be submitted for publication elsewhere except as an abstract.

Additional information

Funding

This work was supported by a part-time Australian Government Research Training Program Scholarship. This funder played no role in the design, conduct, or reporting of this study.