Finger strength, individuation, and their interaction: Relationship to hand function and corticospinal tract injury after stroke

Objective: The goal of this study was to determine the relative contributions of finger weakness and reduced finger individuation to reduced hand function after stroke, and their association with corticospinal tract (CST) injury. Methods: We measured individuated and synergistic maximum voluntary contractions (MVCs) of the index and middle fingers, in both flexion and extension, of 26 individuals with a chronic stroke using a robotic exoskeleton. We quantified finger strength and individuation, and defined a novel metric that combines them - "multifinger capacity". We used stepwise linear regression to identify which measure best predicted hand function (Box and Blocks Test, Nine Hole Peg Test) and arm impairment (the Upper Extremity Fugl-Meyer Test). Results: Compared to metrics of strength or individuation, capacity survived the stepwise regression as the strongest predictor of hand function and arm impairment. Capacity was also most strongly related to presence or absence of lesion overlap with the CST. Conclusions: Reduced strength and individuation combine to shrink the space of achievable finger torques, and it is the resulting size of this space - the multifinger capacity - that is of elevated importance for predicting loss of hand function. Significance: Multi-finger capacity may be an important target for rehabilitative hand training. (C) 2018 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.