Circle Drawing Task as a Novel Evaluation Method for Upper Limb functions in Patients with Cervical Spinal Cord Injury.

Upper limb function is essential for performing activities of daily living (ADLs). Specifically for individuals with cervical spinal cord injury (CSCI), impairment of upper limb functions largely affect to reduce their ADLs. Conventional assessments for upper limb functions, for example, Simple Test for Evaluating Hand Function (STEF), is scored by the total time requirement of various types of upper limb movement and hand manipulation, and additional subjective evaluation would be complemented. While coordination of shoulder and elbow movements is a key function for ADLs in patients with CSCI, this point is totally disregarded as the clinical evaluation. We propose a novel assessment method, Circle Drawing Task (CDT) for the evaluation of shoulder-elbow coordination in individuals with CSCI. In this study, 15 individuals with incomplete CSCI (age: 46.47 ± 10.43) and 12 individuals with complete CSCI (age: 31.00 ± 10.32) were recruited and asked to perform CDT under the quantitative recording of kinematic and electromyographic (EMG). Trunk and upper limb motions were captured using 3D motion analysis (MAC3D, 200 Hz), and muscle activity was recorded using a surface EMG system (Delsys, 1000 Hz). Four key muscles, biceps brachii, triceps brachii, anterior deltoid, and posterior deltoid, were analyzed to observe coordination patterns. Our results indicated that the CDT effectively revealed joint coordination and muscle recruitment patterns, for example, difference between complete and incomplete CSCI and relevance with the level of injury.Clinical Relevance- Our findings suggest that CDT provides additional and quantitative information for the evaluation of upper limb functions which might complement the conventional clinical assessment. Since shoulder-elbow coordination is a key function for individuals with CSCI, our proposed method might be useful not only as an evaluation method, but also as information for the prescription of the rehabilitation interventions.