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Upper Limb Movement Classification Via Electromyographic Signals and an Enhanced Probabilistic Network. J Med Syst 2020; 44:176. [DOI: 10.1007/s10916-020-01639-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/05/2020] [Indexed: 11/26/2022]
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Signal NEJ, McLaren R, Rashid U, Vandal A, King M, Almesfer F, Henderson J, Taylor D. Haptic Nudges Increase Affected Upper Limb Movement During Inpatient Stroke Rehabilitation: Multiple-Period Randomized Crossover Study. JMIR Mhealth Uhealth 2020; 8:e17036. [PMID: 32723718 PMCID: PMC7424469 DOI: 10.2196/17036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/15/2020] [Accepted: 05/13/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND As many as 80% of stroke survivors experience upper limb (UL) disability. The strong relationships between disability, lost productivity, and ongoing health care costs mean reducing disability after stroke is critical at both individual and society levels. Unfortunately, the amount of UL-focused rehabilitation received by people with stroke is extremely low. Activity monitoring and promotion using wearable devices offer a potential technology-based solution to address this gap. Commonly, wearable devices are used to deliver a haptic nudge to the wearer with the aim of promoting a particular behavior. However, little is known about the effectiveness of haptic nudging in promoting behaviors in patient populations. OBJECTIVE This study aimed to estimate the effect of haptic nudging delivered via a wrist-worn wearable device on UL movement in people with UL disability following stroke undertaking inpatient rehabilitation. METHODS A multiple-period randomized crossover design was used to measure the association of UL movement with the occurrence of haptic nudge reminders to move the affected UL in 20 people with stroke undertaking inpatient rehabilitation. UL movement was observed and classified using movement taxonomy across 72 one-minute observation periods from 7:00 AM to 7:00 PM on a single weekday. On 36 occasions, a haptic nudge to move the affected UL was provided just before the observation period. On the other 36 occasions, no haptic nudge was given. The timing of the haptic nudge was randomized across the observation period for each participant. Statistical analysis was performed using mixed logistic regression. The effect of a haptic nudge was evaluated from the intention-to-treat dataset as the ratio of the odds of affected UL movement during the observation period following a "Planned Nudge" to the odds of affected limb movement during the observation period following "No Nudge." RESULTS The primary intention-to-treat analysis showed the odds ratio (OR) of affected UL movement following a haptic nudge was 1.44 (95% CI 1.28-1.63, P<.001). The secondary analysis revealed an increased odds of affected UL movement following a Planned Nudge was predominantly due to increased odds of spontaneous affected UL movement (OR 2.03, 95% CI 1.65-2.51, P<.001) rather than affected UL movement in conjunction with unaffected UL movement (OR 1.13, 95% CI 0.99-1.29, P=.07). CONCLUSIONS Haptic nudging delivered via a wrist-worn wearable device increases affected UL movement in people with UL disability following stroke undertaking inpatient rehabilitation. The promoted movement appears to be specific to the instructions given. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry 12616000654459; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370687&isReview=true.
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Affiliation(s)
| | - Ruth McLaren
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Usman Rashid
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Alain Vandal
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - Marcus King
- Callaghan Innovation, Christchurch, New Zealand
| | | | - Jeanette Henderson
- Assessment, Treatment and Rehabilitation Department, Waitakere Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Denise Taylor
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
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Levy T, Crotty M, Laver K, Lannin N, Killington M. Does the addition of concurrent visual feedback increase adherence to a home exercise program in people with stroke: a single-case series? BMC Res Notes 2020; 13:361. [PMID: 32727575 PMCID: PMC7391818 DOI: 10.1186/s13104-020-05202-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/22/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Evidence is accumulating for the potential benefits of technology use in stroke rehabilitation. However, few studies have examined ways in which technology can be used to increase adherence to programs after discharge from rehabilitation. The aim of this study was to determine if the addition of concurrent visual feedback, via a tablet computer, increased adherence to an exercise program following stroke. Ten participants were provided with a self-administered exercise program and were asked to perform 60 min of the exercises daily. After a baseline phase (1 week), participants were given a tablet computer (2 weeks) and were asked to video record each exercise session. The tablet computer was removed during the fourth week of the program. RESULTS Exercise duration, measured via wrist-worn accelerometry, was investigated over the 4 weeks using the two-standard deviation (2 SD) band method. A statistically significant effect was observed in four out of ten cases, demonstrated by two successive data points occurring outside the 2 SD band during the intervention phase, suggesting that adherence was increased in response to the tablet computer use. This preliminary study indicates that the use of visual feedback, via a tablet computer, may increase adherence to an exercise program in people with stroke. Trial registration ACTRN: ACTRN12620000252910 (26 February 2020, Retrospectively registered).
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Affiliation(s)
- Tamina Levy
- Flinders Health and Medical Research Institute, Flinders University, Sturt Road, Bedford Park, 5042, Australia. .,Flinders Medical Centre, Rehabilitation and Palliative Services, Bedford Drive, Bedford Park, SA, 5042, Australia. .,Physiotherapy Department, Flinders Medical Centre -RAP Division, Bedford Drive, Bedford Park, SA, 5041, Australia.
| | - Maria Crotty
- Flinders Health and Medical Research Institute, Flinders University, Sturt Road, Bedford Park, 5042, Australia.,Flinders Medical Centre, Rehabilitation and Palliative Services, Bedford Drive, Bedford Park, SA, 5042, Australia
| | - Kate Laver
- Flinders Health and Medical Research Institute, Flinders University, Sturt Road, Bedford Park, 5042, Australia
| | - Natasha Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.,Occupational Therapy Department, Alfred Health, Melbourne, Australia
| | - Maggie Killington
- Flinders Health and Medical Research Institute, Flinders University, Sturt Road, Bedford Park, 5042, Australia.,SA Brain Injury Rehabilitation Services, Royal Adelaide Hospital, Adelaide, SA, Australia
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Oubre B, Daneault JF, Jung HT, Park J, Ryu T, Kim Y, Lee SI. Estimating Quality of Reaching Movement Using a Wrist-Worn Inertial Sensor. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:3719-3722. [PMID: 33018809 DOI: 10.1109/embc44109.2020.9175708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Stroke is a major cause of long-term disability. Because patients recovering from stroke often perform differently in clinical settings than in their naturalistic environments, remote monitoring of motor performance is needed to evaluate the true impact of prescribed therapies. Wearable sensors have been considered as a technical solution to this problem, but most existing systems focus on measuring the amount of movement without considering the quality of movement. We present a novel method to seamlessly and unobtrusively measure the quality of individual reaching movements by leveraging a motor control theory that describes how the central nervous system plans and executes movements. We trained and evaluated our system on 19 stroke survivors to estimate the Functional Ability Scale (FAS) of reaching movements. The analysis showed that we can estimate the FAS scores of reaching movements, with some confusion between adjacent scores. Furthermore, we estimated the average FAS scores of subjects with a normalized root mean square error (NRMSE) of 22.5%. Though our model's high error on two severe subjects influenced our overall estimation performance, we could accurately estimate scores in most of the mild-to-moderate subjects (NRMSE of 13.1% without the outliers). With further development and testing, we believe the proposed technique can be applied to monitor patient recovery in home and community settings.
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Pan YC(P, Goodwin B, Sabelhaus E, Peters KM, Bjornson KF, Pham KLD, Walker W, Steele KM. Feasibility of using acceleration-derived jerk to quantify bimanual arm use. J Neuroeng Rehabil 2020; 17:44. [PMID: 32178695 PMCID: PMC7076987 DOI: 10.1186/s12984-020-0653-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 01/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accelerometers have become common for evaluating the efficacy of rehabilitation for patients with neurologic disorders. For example, metrics like use ratio (UR) and magnitude ratio (MR) have been shown to differentiate movement patterns of children with cerebral palsy (CP) compared to typically-developing (TD) peers. However, these metrics are calculated from "activity counts" - a measure based on proprietary algorithms that approximate movement duration and intensity from raw accelerometer data. Algorithms used to calculate activity counts vary between devices, limiting comparisons of clinical and research results. The goal of this research was to develop complementary metrics based on raw accelerometer data to analyze arm movement after neurologic injury. METHOD We calculated jerk, the derivative of acceleration, to evaluate arm movement from accelerometer data. To complement current measures, we calculated jerk ratio (JR) as the relative jerk magnitude of the dominant (non-paretic) and non-dominant (paretic) arms. We evaluated the JR distribution between arms and calculated the 50th percentile of the JR distribution (JR50). To evaluate these metrics, we analyzed bimanual accelerometry data for five children with hemiplegic CP who underwent Constraint-Induced Movement Therapy (CIMT) and five typically developing (TD) children. We compared JR between the CP and TD cohorts, and to activity count metrics. RESULTS The JR50 differentiated between the CP and TD cohorts (CP = 0.578 ± 0.041 before CIMT, TD = 0.506 ± 0.026), demonstrating increased reliance on the dominant arm for the CP cohort. Jerk metrics also quantified changes in arm use during and after therapy (e.g., JR50 = 0.378 ± 0.125 during CIMT, 0.591 ± 0.057 after CIMT). The JR was strongly correlated with UR and MR (r = - 0.92, 0.89) for the CP cohort. For the TD cohort, JR50 was repeatable across three data collection periods with an average similarity of 0.945 ± 0.015. CONCLUSIONS Acceleration-derived jerk captured differences in motion between TD and CP cohorts and correlated with activity count metrics. The code for calculating and plotting JR is open-source and available for others to use and build upon. By identifying device-independent metrics that can quantify arm movement in daily life, we hope to facilitate collaboration for rehabilitation research using wearable technologies.
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Affiliation(s)
- Ying-Chun (Preston) Pan
- Department of Bioengineering, University of Washington, Seattle, WA USA
- Seattle Children’s Hospital, Seattle, WA USA
| | - Brianna Goodwin
- Seattle Children’s Hospital, Seattle, WA USA
- Department of Mechanical Engineering, University of Washington, Seattle, WA USA
| | | | - Keshia M. Peters
- Department of Mechanical Engineering, University of Washington, Seattle, WA USA
| | - Kristie F. Bjornson
- Seattle Children’s Hospital, Seattle, WA USA
- Department of Pediatrics, University of Washington, Seattle Children’s Research Institute, Seattle, WA USA
| | - Kelly L. D. Pham
- Seattle Children’s Hospital, Seattle, WA USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA USA
| | | | - Katherine M. Steele
- Department of Mechanical Engineering, University of Washington, Seattle, WA USA
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Oubre B, Daneault JF, Jung HT, Whritenour K, Miranda JGV, Park J, Ryu T, Kim Y, Lee SI. Estimating Upper-Limb Impairment Level in Stroke Survivors Using Wearable Inertial Sensors and a Minimally-Burdensome Motor Task. IEEE Trans Neural Syst Rehabil Eng 2020; 28:601-611. [PMID: 31944983 DOI: 10.1109/tnsre.2020.2966950] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Upper-limb paresis is the most common motor impairment post stroke. Current solutions to automate the assessment of upper-limb impairment impose a number of critical burdens on patients and their caregivers that preclude frequent assessment. In this work, we propose an approach to estimate upper-limb impairment in stroke survivors using two wearable inertial sensors, on the wrist and the sternum, and a minimally-burdensome motor task. Twenty-three stroke survivors with no, mild, or moderate upper-limb impairment performed two repetitions of one-to-two minute-long continuous, random (i.e., patternless), voluntary upper-limb movements spanning the entire range of motion. The three-dimensional time-series of upper-limb movements were segmented into a series of one-dimensional submovements by employing a unique movement decomposition technique. An unsupervised clustering algorithm and a supervised regression model were used to estimate Fugl-Meyer Assessment (FMA) scores based on features extracted from these submovements. Our regression model estimated FMA scores with a normalized root mean square error of 18.2% ( r2=0.70 ) and needed as little as one minute of movement data to yield reasonable estimation performance. These results support the possibility of frequently monitoring stroke survivors' rehabilitation outcomes, ultimately enabling the development of individually-tailored rehabilitation programs.
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Lang CE, Cade WT. A step toward the future of seamless measurement with wearable sensors in pediatric populations with neuromuscular diseases. Muscle Nerve 2019; 61:265-267. [PMID: 31883126 DOI: 10.1002/mus.26795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 12/22/2019] [Accepted: 12/23/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Catherine E Lang
- Program in Physical Therapy, Washington University School of Medicine, St Louis, Missouri
| | - W Todd Cade
- Program in Physical Therapy, Washington University School of Medicine, St Louis, Missouri
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Kim Y, Jung HT, Park J, Kim Y, Ramasarma N, Bonato P, Choe EK, Lee SI. Towards the Design of a Ring Sensor-based mHealth System to Achieve Optimal Motor Function in Stroke Survivors. ACTA ACUST UNITED AC 2019. [DOI: 10.1145/3369817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Maximizing the motor practice in stroke survivors' living environments may significantly improve the functional recovery of their stroke-affected upper-limb. A wearable system that can continuously monitor upper-limb performance has been considered as an effective clinical solution for its potential to provide patient-centered, data-driven feedback to improve the motor dosage. Towards that end, we investigate a system leveraging a pair of finger-worn, ring-type accelerometers capable of monitoring both gross-arm and fine-hand movements that are clinically relevant to the performance of daily activities. In this work, we conduct a mixed-methods study to (1) quantitatively evaluate the efficacy of finger-worn accelerometers in measuring clinically relevant information regarding stroke survivors' upper-limb performance, and (2) qualitatively investigate design requirements for the self-monitoring system, based on data collected from 25 stroke survivors and seven occupational therapists. Our quantitative findings demonstrate strong face and convergent validity of the finger-worn accelerometers, and its responsiveness to changes in motor behavior. Our qualitative findings provide a detailed account of the current rehabilitation process while highlighting several challenges that therapists and stroke survivors face. This study offers promising directions for the design of a self-monitoring system that can encourage the affected limb use during stroke survivors' daily living.
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Affiliation(s)
- Yoojung Kim
- Seoul National University, Seoul, Republic of Korea
| | - Hee-Tae Jung
- University of Massachusetts Amherst, Amherst, Massachusetts, United States
| | - Joonwoo Park
- Smilegreen Child Development Center, Daegu, Republic of Korea
| | - Yangsoo Kim
- Heeyeon Rehabilitation Hospital, Changwon, Republic of Korea
| | | | - Paolo Bonato
- Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, United States
| | - Eun Kyoung Choe
- University of Maryland, College Park, College Park, Maryland, United States
| | - Sunghoon Ivan Lee
- University of Massachusetts Amherst, Amherst, Massachusetts, United States
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Actigraphic measurement of the upper limbs movements in acute stroke patients. J Neuroeng Rehabil 2019; 16:153. [PMID: 31801569 PMCID: PMC6894254 DOI: 10.1186/s12984-019-0603-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/02/2019] [Indexed: 11/21/2022] Open
Abstract
Background Stroke units provide patients with a multiparametric monitoring of vital functions, while no instruments are actually available for a continuous monitoring of patients motor performance. Our aim was to develop an actigraphic index able both to identify the paretic limb and continuously monitor the motor performance of stroke patients in the stroke unit environment. Methods Twenty consecutive acute stroke patients (mean age 69.2 years SD 10.1, 8 males and 12 females) and 17 bed-restrained patients (mean age 70.5 years SD 7.3, 7 males and 10 females) hospitalized for orthopedic diseases of the lower limbs, but not experiencing neurological symptoms, were enrolled. This last group represented our control group. The motor activity of arms was recorded for 24 h using two programmable actigraphic systems showing off as wrist-worn watches. The firmware segmented the acquisition in epochs of 1 minute and for each epoch calculates two motor activity indices: MAe1 (Epoch-related Motor Activity index) and MAe2 (Epoch-related Motor Activity index 2). MAe1 is defined as the standard deviation of the acceleration module and MAe2 as the module of the standard deviation of acceleration components. To describe the 24 h motor performance of each limb, we calculated the mean value of MAe1 and MAe2 (respectively MA1_24h and MA2_24h). Then we obtained two Asymmetry Rate Indices: AR1_24h and AR2_24h to show the motor activity prevalence. AR1_24h refers to the asymmetry index between the values of MAe1 of both arms and AR2_24h to MAe2 values. The stroke patients were clinically evaluated by NIHSS at the beginning (NIHSST0) and at the end (NIHSST1) of the 24 h actigraphic recordings. Results Both MA1_24h and MA2_24h indices were smaller in the paretic than in the unaffected arm (respectively p = 0.004 and p = 0.004). AR2_24h showed a better capability (95% of paretic arms correctly identified, Phi Coefficient: 0.903) to discriminate the laterality of the clinical deficit than AR1_24h (85% of paretic arms correctly identified, Phi Coefficient: 0,698). We also found that AR1_24h did not differ between the two groups of patients while AR2_24h was greater in stroke patients than in controls and positively correlated with NIHSS total scores (r: 0.714, p < 0.001 for NIHSS, IC95%: 0.42–0.90) and with the sub-score relative to the paretic upper limb (r: 0.812, p < 0.001, IC95%: 0.62–0.96). Conclusions Our data show that actigraphic monitoring of upper limbs can detect the laterality of the motor deficit and measure the clinical severity. These findings suggest that the above described actigraphic system could implement the existing multiparametric monitoring in stroke units.
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Chin LF, Hayward KS, Brauer S. Upper limb use differs among people with varied upper limb impairment levels early post-stroke: a single-site, cross-sectional, observational study. Top Stroke Rehabil 2019; 27:224-235. [DOI: 10.1080/10749357.2019.1690796] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Lay Fong Chin
- Rehabilitation Centre, Tan Tock Seng Hospital, Singapore
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- NMRC Singapore, Ministry of Health Singapore, Singapore
| | - Kathryn S. Hayward
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
- Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, Australia
| | - Sandra Brauer
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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Gohlke J, Juul-Kristensen B, Brunner I. Are changes in upper extremity use during sub-acute rehabilitation after stroke associated with physical, cognitive, and social activities? An observational cohort pilot study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1818. [PMID: 31680404 DOI: 10.1002/pri.1818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/24/2019] [Accepted: 10/03/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate how changes in physical, social, and cognitive activity levels are associated with the use of the affected upper extremity at different time points during inpatient rehabilitation after stroke. METHODS In an observational longitudinal cohort pilot study activity of 14 patients with subacute stroke was registered 2-4 times during their inpatient rehabilitation from 2 p.m. to 8 p.m. At the same time, patients wore accelerometers on both wrists to register amount of use and use ratio of the affected to the unaffected upper extremity. Before and after the observation period, patients were assessed with action research arm test, Box and Blocks Test, and Functional Independence Measure. Linear regression models were used to examine the influence of different categories of activities and motor function levels on affected upper extremity use. RESULTS Increasing physical activity levels during rehabilitation and improvement in upper extremity motor function were associated with increased use of the affected upper extremity. Cognitive and social activity levels did not change and were not associated with affected upper extremity use. CONCLUSION Our findings suggest that the use of the affected upper extremity and a general increase in activity are associated. Facilitating both general physical activity and specific upper extremity use at a rehabilitation ward may benefit overall recovery.
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Affiliation(s)
- Jacob Gohlke
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Iris Brunner
- Department of Clinical Medicine, Hammel Neurocenter, Aarhus University, Denmark
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Panwar M, Biswas D, Bajaj H, Jobges M, Turk R, Maharatna K, Acharyya A. Rehab-Net: Deep Learning Framework for Arm Movement Classification Using Wearable Sensors for Stroke Rehabilitation. IEEE Trans Biomed Eng 2019; 66:3026-3037. [DOI: 10.1109/tbme.2019.2899927] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Borschmann KN, Hayward KS. Recovery of upper limb function is greatest early after stroke but does continue to improve during the chronic phase: a two-year, observational study. Physiotherapy 2019; 107:216-223. [PMID: 32026823 DOI: 10.1016/j.physio.2019.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Investigate upper limb (UL) capacity and performance from <14-days to 24-months post stroke. DESIGN Longitudinal study of participants with acute stroke, assessed ≤14-days, 6-weeks, 3-, 6-, 12-, 18-, and 24-months post stroke. SETTING Two acute stroke units. MAIN OUTCOME MEASURES Examination of UL capacity using Chedoke McMaster Stroke Assessment (combined arm and hand scores, 0-14), performance using Motor Activity Log (amount of movement and quality of movement, scored 0-5), and grip strength (kg) using Jamar dynamometer. Random effects regression models were performed to explore the change in outcomes at each time point. Routine clinical imaging was used to describe stroke location as cortical, subcortical or mixed. RESULTS Thirty-four participants were enrolled: median age 67.7 years (IQR 60.7-76.2), NIHSS 11.5 (IQR 8.5-16), female n=10 (36%). The monthly rate of change for all measures was consistently greatest in the 6-weeks post baseline. On average, significant improvements were observed to 12-months in amount of use (median improvement 1.81, 95% CI 1.35 to 2.27) and strength (median improvement 8.29, 95% CI 5.90 to 10.67); while motor capacity (median improvement 4.70, 95% CI 3.8 to 5.6) and quality of movement (median improvement 1.83, 95% CI 1.37 to 2.3) improved to 18-months post stroke. Some individuals were still demonstrating gains at 24-months post stroke within each stroke location group. CONCLUSION This study highlights that the greatest rate of improvement of UL capacity and performance occurs early post stroke. At the group level, improvements were evident at 12- to 18-months post stroke, but at the individual level improvements were observed at 24-months. CLINICAL TRIAL REGISTRATION ACTRN12612000123842.
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Affiliation(s)
- Karen N Borschmann
- School of Allied Health, La Trobe University, Bundoora, Australia; AVERT Early Rehabilitation Research Group, Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia; NHMRC Centre of Research Excellence Stroke Rehabilitation and Brain Repair, Australia; St Vincent's Hospital, Melbourne, Australia.
| | - Kathryn S Hayward
- AVERT Early Rehabilitation Research Group, Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia; NHMRC Centre of Research Excellence Stroke Rehabilitation and Brain Repair, Australia; Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, Australia. https://twitter.com/@karenborschmann
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Waddell KJ, Strube MJ, Tabak RG, Haire-Joshu D, Lang CE. Upper Limb Performance in Daily Life Improves Over the First 12 Weeks Poststroke. Neurorehabil Neural Repair 2019; 33:836-847. [PMID: 31431125 PMCID: PMC7031017 DOI: 10.1177/1545968319868716] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background. Upper limb (UL) performance, or use, in daily life is complex and likely influenced by many factors. While the recovery trajectory of UL impairment poststroke is well documented, little is known about the recovery trajectory of sensor-measured UL performance in daily life early after stroke and the potential moderating role of psychosocial factors. Objective. To examine the recovery trajectory of UL performance within the first 12 weeks poststroke and characterize the potential moderating role of belief, confidence, and motivation on UL performance. Methods. This was a longitudinal, prospective cohort study quantifying UL performance and related psychosocial factors early after stroke. UL performance was quantified via bilateral, wrist-worn accelerometers over 5 assessment sessions for 24 hours. Belief, confidence, and motivation to use the paretic UL, and self-perceived barriers to UL recovery were quantified via survey. Change in 4 accelerometer variables and the moderating role of psychosocial factors was tested using hierarchical linear modeling. The relationship between self-perceived barriers and UL performance was tested via Spearman rank-order correlation analysis. Results. UL performance improved over the first 12 weeks after stroke. Belief, confidence, and motivation did not moderate UL performance over time. There was a negative relationship between UL performance and self-perceived barriers to UL recovery at week 2, which declined over time. Conclusions. Sensor-measured UL performance can improve early after stroke. Early after stroke, rehabilitation interventions may not need to directly target belief, confidence, and motivation but may instead focus on reducing self-perceived barriers to UL recovery.
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Affiliation(s)
| | - Michael J Strube
- Psychological and Brain Sciences, Washington University, St. Louis, MO
| | | | | | - Catherine E. Lang
- Program in Physical Therapy, Washington University, St. Louis, MO
- Program in Occupational Therapy, Washington University, St. Louis, MO
- Department of Neurology, Washington University, St. Louis, MO
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Jee H. Feasibility of a set of wrist-worn novice devices for dual motion comparison of the upper limbs during lateral raise motions. J Exerc Rehabil 2019; 15:531-536. [PMID: 31523673 PMCID: PMC6732539 DOI: 10.12965/jer.1938348.174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/15/2019] [Indexed: 11/22/2022] Open
Abstract
Comparison of the upper limbs during natural kinematic motions is necessary for early detection of musculoskeletal imbalance between ipsilateral and contralateral sides in natural settings. Therefore, this study aims to evaluate the feasibility of a novice set of wrist-worn devices designed to assess and compare the dual kinematic motions of the upper limbs during lateral raises. The test-retest and the golden standard and novice device result comparisons were conducted for feasibility assessment of the novice set of devices. Pearson correlation coefficients between 0.65 and 0.88 (P<0.01) and effect sizes between 0.02 and 0.42 indicated feasible application of the novice devices. Considering correlation coefficient of 0.65 between the left and right upper limbs, the results show applicable feasibility of the novice device during lateral raises. In conclusion, the novice set of devices for comparing dual upper limb motions may be applied to assessing and comparing dual upper limb motions for limb motion comparisons and early detection of dysfunctional movements between the limbs.
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Affiliation(s)
- Haemi Jee
- Department of Physical Therapy, Namseoul University, Cheonan, Korea
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66
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Levy T, Killington M, Lannin N, Crotty M. Viability of using a computer tablet to monitor an upper limb home exercise program in stroke. Physiother Theory Pract 2019; 37:331-341. [PMID: 31172867 DOI: 10.1080/09593985.2019.1625092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aims: To evaluate the feasibility of using a tablet computer to monitor the amount of upper limb practice completed by stroke patients prescribed with a home program and to explore factors that influence adherence. Method: Ten consecutive participants randomized to the intervention arm of a randomized controlled trial investigating therapy after spasticity management for stroke patients (ACTRN 12615000616572) were recruited for this sub-study. Participants were asked to perform and record a prescribed 60-min upper limb program, based on the Graded Arm Supplementary Program, on a tablet computer daily. Four randomly selected recorded sessions for each participant were analyzed by the physiotherapist to assess adherence to the amount of exercise and content. Results: Mean score for the System Usability Scale was 85.5 (range 47.5-100) indicating that participants were accepting of the technology. Participants performed exercises on average for 50.32 min (range 26.42-68.37). Self-reported practice time was 59.44 min (range 48-67.5). Conclusion: Monitoring of patient practice using a tablet computer is feasible and may prove more reliable than self-report. There is variability in the amount of upper limb exercise stroke patients do at home.
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Affiliation(s)
- Tamina Levy
- Flinders Medical Centre, Rehabilitation and Palliative Services , Adelaide, Australia.,College of Medicine and Public Health, Flinders University , Adelaide, Australia
| | - Maggie Killington
- Flinders Medical Centre, Rehabilitation and Palliative Services , Adelaide, Australia.,College of Medicine and Public Health, Flinders University , Adelaide, Australia
| | - Natasha Lannin
- School of Allied Health, La Trobe University , Bundoora, Australia.,Occupational Therapy, Alfred Health , Prahran, Australia
| | - Maria Crotty
- Flinders Medical Centre, Rehabilitation and Palliative Services , Adelaide, Australia.,College of Medicine and Public Health, Flinders University , Adelaide, Australia
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Chin LF, Hayward KS, Soh AJA, Tan CM, Wong CJR, Loh JW, Loke GJH, Brauer S. An accelerometry and observational study to quantify upper limb use after stroke during inpatient rehabilitation. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1784. [PMID: 31095833 DOI: 10.1002/pri.1784] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/20/2019] [Accepted: 04/07/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The objectives of the study are to characterize paretic upper limb (UL) use in people with different levels of impairment 4 weeks poststroke and to compare accelerometry and direct observational approaches. METHODS Twelve stroke inpatients (five mild, three moderate, and four severe UL impairment) were recruited from a rehabilitation hospital. UL use was measured using accelerometry (24 hr) and direct observation (12 hr of behavioural mapping). Accelerometry variables included duration of use, use ratio, magnitude ratio, bilateral magnitude, and variation ratio. Direct observation recorded the duration of use and type of UL movement (e.g., functional vs. non-functional). RESULTS From accelerometry data, people with mild, moderate, and severe UL impairments used their paretic UL 59%, 45%, and 22% of a 24 hr-day, respectively. People with severe UL impairment had the lowest paretic UL use duration (median 1.49 hr/day), magnitude ratio, and variation ratio compared with people with mild and moderate UL impairment. From 12 hr of observational data, people with mild impairment were using their UL for 37.8% of the observed time, whereas the people with moderate and severe impairment were using their UL 15.8% and 4.9%, respectively. UL movements for the mild cohort were mainly functional, whereas UL movements of the moderate and severe cohorts were mainly non-functional. UL movements were predominantly active for the mild and moderate cohorts but passive for the severe cohort. Duration of paretic UL use from accelerometry and observation data were highly correlated (ICC > 0.8), but the absolute percentage error between methods ranged from 34.2% to 42.7%. CONCLUSIONS Paretic UL use within the first 4 weeks poststroke differs across levels of impairment in this exploratory study. Accelerometry and observation findings of paretic UL use were correlated and may be needed in different situations as they capture different information.
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Affiliation(s)
- Lay Fong Chin
- Rehabilitation Centre, Tan Tock Seng Hospital, Singapore.,Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia.,NMRC Singapore, Ministry of Health Singapore, Singapore
| | - Kathryn S Hayward
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia.,AVERT Lab, Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Victoria, Australia
| | - Aloysius Jun An Soh
- Physiotherapy Department, Singapore Institute of Technology-Nanyang Polytechnics, Singapore
| | - Chin Mei Tan
- Physiotherapy Department, Singapore Institute of Technology-Nanyang Polytechnics, Singapore
| | - Cheryl Jing Ru Wong
- Physiotherapy Department, Singapore Institute of Technology-Nanyang Polytechnics, Singapore
| | - Jia Wei Loh
- Physiotherapy Department, Singapore Institute of Technology-Nanyang Polytechnics, Singapore
| | - Genevieve Jia Hui Loke
- Physiotherapy Department, Singapore Institute of Technology-Nanyang Polytechnics, Singapore
| | - Sandra Brauer
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
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Demartino AM, Rodrigues LC, Gomes RP, Michaelsen SM. Hand function and type of grasp used by chronic stroke individuals in actual environment. Top Stroke Rehabil 2019; 26:247-254. [PMID: 30907287 DOI: 10.1080/10749357.2019.1591037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Knowledge of paretic upper limb (UL) use in the actual environment is crucial for defining treatment strategies that are likely to enhance performance. OBJECTIVE To quantify the hand function and type of grasp performed in the actual environment following stroke and determine if any differences in hand use are dependent on the degree of motor impairment. METHOD This cross-sectional study enrolled 41 participants with chronic hemiparesis classified as having either mild (11), moderate (20), or severe (10) UL impairment. A behavioral map was used while observing hand use over the 4-h experimental period, during which we checked: activity- unimanual, bimanual or non-task-related; hand function- stabilization, manipulation, reach-to-grasp, gesture, support or push; and type of grasp- digital or whole-hand. RESULTS Participants with severe impairment did not use the paretic UL spontaneously; analyzing the moderate and mild subgroup together, the predominant UL hand functions were stabilization and manipulation, the paretic UL performs the stabilization function using the whole-hand more frequently (71.2%) than digital (28.8%) grasp. In the subgroup analysis, the paretic and non-paretic UL in the moderate and the paretic UL in the mild subgroup perform the whole-hand stabilization more frequently than digital. Digital grasp is more accomplished by the non-paretic UL in reach-to-grasp hand function, particularly in the mild subgroup. CONCLUSION The paretic UL is predominantly employed for stabilization function using a whole-hand grasp. The type of grasp in the actual environment is affected by motor impairment, and greater motor impairment leads to the performance of less complex tasks.
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Affiliation(s)
| | - Letícia Cardoso Rodrigues
- a Department of Physical Therapy , Universidade do Estado de Santa Catarina , Florianópolis , Brazil
| | - Raquel Pinheiro Gomes
- a Department of Physical Therapy , Universidade do Estado de Santa Catarina , Florianópolis , Brazil
| | - Stella Maris Michaelsen
- a Department of Physical Therapy , Universidade do Estado de Santa Catarina , Florianópolis , Brazil
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Lee SI, Liu X, Rajan S, Ramasarma N, Choe EK, Bonato P. A novel upper-limb function measure derived from finger-worn sensor data collected in a free-living setting. PLoS One 2019; 14:e0212484. [PMID: 30893308 PMCID: PMC6426183 DOI: 10.1371/journal.pone.0212484] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/03/2019] [Indexed: 12/30/2022] Open
Abstract
The use of wrist-worn accelerometers has recently gained tremendous interest among researchers and clinicians as an objective tool to quantify real-world use of the upper limbs during the performance of activities of daily living (ADLs). However, wrist-worn accelerometers have shown a number of limitations that hinder their adoption in the clinic. Among others, the inability of wrist-worn accelerometers to capture hand and finger movements is particularly relevant to monitoring the performance of ADLs. This study investigates the use of finger-worn accelerometers to capture both gross arm and fine hand movements for the assessment of real-world upper-limb use. A system of finger-worn accelerometers was utilized to monitor eighteen neurologically intact young adults while performing nine motor tasks in a laboratory setting. The system was also used to monitor eighteen subjects during the day time of a day in a free-living setting. A novel measure of real-world upper-limb function—comparing the duration of activities of the two limbs—was derived to identify which upper limb subjects predominantly used to perform ADLs. Two validated handedness self-reports, namely the Waterloo Handedness Questionnaire and the Fazio Laterality Inventory, were collected to assess convergent validity. The analysis of the data recorded in the laboratory showed that the proposed measure of upper-limb function is suitable to accurately detect unilateral vs. bilateral use of the upper limbs, including both gross arm movements and fine hand movements. When applied to recordings collected in a free-living setting, the proposed measure showed high correlation with self-reported handedness indices (i.e., ρ = 0.78 with the Waterloo Handedness Questionnaire scores and ρ = 0.77 with the Fazio Laterality Inventory scores). The results herein presented establish face and convergent validity of the proposed measure of real-world upper-limb function derived using data collected by means of finger-worn accelerometers.
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Affiliation(s)
- Sunghoon Ivan Lee
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, United States of America
- * E-mail:
| | - Xin Liu
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, United States of America
| | - Smita Rajan
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, United States of America
| | | | - Eun Kyoung Choe
- College of Information Studies, University of Maryland, College Park, MD, United States of America
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, United States of America
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Da-Silva RH, Moore SA, Rodgers H, Shaw L, Sutcliffe L, van Wijck F, Price CI. Wristband Accelerometers to motiVate arm Exercises after Stroke (WAVES): a pilot randomized controlled trial. Clin Rehabil 2019; 33:1391-1403. [PMID: 30845829 DOI: 10.1177/0269215519834720] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the feasibility of a multicentre, observer-blind, pilot randomized controlled trial (RCT) of a wristband accelerometer with activity-dependent vibration alerts to prompt impaired arm use after stroke. DESIGN Parallel-group pilot RCT. SETTING Four English stroke services. PARTICIPANTS Patients 0-3 months post stroke with a new arm deficit. INTERVENTION Participants were randomized to wear a prompting or 'sham' wristband during a four-week self-directed therapy programme with twice-weekly therapy review. MAIN OUTCOMES Recruitment, retention and adherence rates, safety and completion of assessments were reported. Arm recovery was measured by Action Research Arm Test (ARAT) and Motor Activity Log (MAL) without statistical comparison. RESULTS In total, 33 patients were recruited (0.6 per month/site; median time post stroke: 26 days (interquartile range (IQR):15.5-45)). Baseline, four-week and eight-week median (IQR) ARAT for the control group (n = 19) were 15 (2-35), 35 (15-26) and 31 (21-55) and those for the intervention group (n = 14) were 37 (16-45), 57 (29-57) and 57 (37-57), respectively; for MAL Amount of Use, the corresponding values in the control group were 0.2 (0.0-1.2), 1.1 (0.3-2.9) and 1.2 (0.7-2.9) and in the intervention group were 1.4 (0.5-2.6), 3.8 (1.9-4.5) and 3.7 (2.1-4.3). Four participants withdrew from the study. Wristbands were worn for 79% of the recommended time. The intervention and control group participants received a median of 6.0 (IQR: 4.3-8.0) and 7.5 (IQR: 6.8-8.0) therapy reviews. A median of 8 (IQR: 6-10) prompts were delivered per intervention participant/day. Research assessments were completed for 28/29 and 25/28 patients at four and eight weeks. Eight serious adverse events were reported, all unrelated to the intervention. CONCLUSION A multicentre RCT of wristband accelerometers to prompt arm activity early after stroke is feasible. A total sample of 108 participants would be required.
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Affiliation(s)
- Ruth H Da-Silva
- 1 Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah A Moore
- 1 Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Helen Rodgers
- 1 Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Lisa Shaw
- 1 Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Sutcliffe
- 1 Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Frederike van Wijck
- 2 School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Christopher I Price
- 1 Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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Sensor Measures of Symmetry Quantify Upper Limb Movement in the Natural Environment Across the Lifespan. Arch Phys Med Rehabil 2019; 100:1176-1183. [PMID: 30703350 DOI: 10.1016/j.apmr.2019.01.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/06/2019] [Accepted: 01/10/2019] [Indexed: 11/20/2022]
Abstract
Knowledge of upper limb activity in the natural environment is critical for evaluating the effectiveness of rehabilitation services. Wearable sensors allow efficient collection of these data and have the potential to be less burdensome than self-report measures of activity. Sensors can capture many different variables of activity and daily performance, many of which could be useful in identifying deviation from typical movement behavior or measuring outcomes from rehabilitation interventions. Although it has potential, sensor measurement is just emerging, and there is a lack of consensus regarding which variables of daily performance are valid, sensitive, specific, and useful. We propose that symmetry of full-day upper limb movement is a key variable. We describe here that symmetry is valid, robustly observed within a narrow range across the lifespan in typical development, and shows evidence of being different in populations with neuromotor impairment. Key next steps include the determination of sensitivity, specificity, minimal detectable change, and minimal clinically important change/difference. This information is needed to determine whether an individual belongs to the typical or atypical group, whether change has occurred, and whether that change is beneficial.
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72
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Levy T, Laver K, Killington M, Lannin N, Crotty M. A systematic review of measures of adherence to physical exercise recommendations in people with stroke. Clin Rehabil 2018; 33:535-545. [PMID: 30458647 PMCID: PMC6416703 DOI: 10.1177/0269215518811903] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE: To review methods for measuring adherence to exercise or physical activity practice recommendations in the stroke population and evaluate measurement properties of identified tools. DATA SOURCES: Two systematic searches were conducted in eight databases (MEDLINE, CINAHL, PsycINFO, Cochrane Library of Systematic Reviews, Sports Discus, PEDro, PubMed and EMBASE). Phase 1 was conducted to identify measures. Phase 2 was conducted to identify studies investigating properties of these measures. REVIEW METHODS: Phase 1 articles were selected if they were published in English, included participants with stroke, quantified adherence to exercise or physical activity recommendations, were patient or clinician reported, were defined and reproducible measures and included patients >18 years old. In phase 2, articles were included if they explored psychometric properties of the identified tools. Included articles were screened based on title/abstract and full-text review by two independent reviewers. RESULTS: In phase 1, seven methods of adherence measurement were identified, including logbooks ( n = 16), diaries ( n = 18), 'record of practice' ( n = 3), journals ( n = 1), surveys ( n = 2) and questionnaires ( n = 4). One measurement tool was identified, the Physical Activity Scale for Individuals with Physical Disabilities ( n = 4). In phase 2, no eligible studies were identified. CONCLUSION: There is not a consistent measure of adherence that is currently utilized. Diaries and logbooks are the most frequently utilized tools.
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Affiliation(s)
- Tamina Levy
- 1 Flinders University, Adelaide, SA, Australia
| | - Kate Laver
- 1 Flinders University, Adelaide, SA, Australia
| | | | - Natasha Lannin
- 2 School of Allied Health, La Trobe University, Melbourne, VIC, Australia.,3 Alfred Health, Melbourne, VIC, Australia
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Liu X, Rajan S, Ramasarma N, Bonato P, Lee SI. Finger-Worn Sensors for Accurate Functional Assessment of the Upper Limbs in Real-World Settings. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:4440-4443. [PMID: 30441336 DOI: 10.1109/embc.2018.8513134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Remote monitoring of stroke survivors' upper limb performance (stroke-affected vs. unaffected limbs) can provide clinicians with information regarding the true impact of rehabilitation in the real-world settings, which allows opportunities to administer individually tailored therapeutic interventions. In this work, we examine the use of finger-worn accelerometers, which are capable of capturing gross-arm as well as fine-hand movements, in order to quantitatively compare the performance of the upper limbs during goal-directed activities of daily living (ADLs). In this proof-of-concept study, data were collected over an eight-hour duration from ten neurologically intact individuals who wore the sensors and continued with their daily living. The sensor-based measure was compared to two clinically validated measures of handedness, i.e., Waterloo Handedness Questionnaire and Fazio Laterality Inventory, that quantity the level of preference of the limbs in performing ADLs. The results yielded statistically significant correlations to the Waterloo and Fazio scores with Pearson correlation coefficients of 0.90 and 0.87 respectively, which was substantially superior compared to the previously studied measure based on wrist-worn accelerometers. We believe this study presents an opportunity to accurately monitor the goal-directed use of the upper limbs in the real-world settings.
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Lawrie S, Dong Y, Steins D, Xia Z, Esser P, Sun S, Li F, Amor JD, James C, Izadi H, Cao Y, Wade D, Mayo N, Dawes H. Evaluation of a smartwatch-based intervention providing feedback of daily activity within a research-naive stroke ward: a pilot randomised controlled trial. Pilot Feasibility Stud 2018; 4:157. [PMID: 30323946 PMCID: PMC6173888 DOI: 10.1186/s40814-018-0345-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/17/2018] [Indexed: 12/11/2022] Open
Abstract
Background The majority of stroke patients are inactive outside formal therapy sessions. Tailored activity feedback via a smartwatch has the potential to increase inpatient activity. The aim of the study was to identify the challenges and support needed by ward staff and researchers and to examine the feasibility of conducting a randomised controlled trial (RCT) using smartwatch activity monitors in research-naive rehabilitation wards. Objectives (Phase 1 and 2) were to report any challenges and support needed and determine the recruitment and retention rate, completion of outcome measures, smartwatch adherence rate, (Phase 2 only) readiness to randomise, adherence to protocol (intervention fidelity) and potential for effect. Methods First admission, stroke patients (onset < 4 months) aged 40-75, able to walk 10 m prior to stroke and follow a two-stage command with sufficient cognition and vision (clinically judged) were recruited within the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine. Phase 1: a non-randomised observation phase (to allow practice of protocol)-patients received no activity feedback. Phase 2: a parallel single-blind pilot RCT. Patients were randomised into one of two groups: to receive daily activity feedback over a 9-h period or to receive no activity feedback. EQ-5D-5L, WHODAS and RMI were conducted at baseline, discharge and 3 months post-discharge. Descriptive statistics were performed on recruitment, retention, completion and activity counts as well as adherence to protocol. Results Out of 470 ward admissions, 11% were recruited across the two phases, over a 30-week period. Retention rate at 3 months post-discharge was 48%. Twenty-two percent of patients dropped out post-baseline assessment, 78% completed baseline and discharge admissions, from which 62% were assessed 3 months post-discharge. Smartwatch data were received from all patients. Patients were correctly randomised into each RCT group. RCT adherence rate to wearing the smartwatch was 80%. Baseline activity was exceeded for 65% of days in the feedback group compared to 55% of days in the no feedback group. Conclusions Delivery of a smartwatch RCT is feasible in a research-naive rehabilitation ward. However, frequent support and guidance of research-naive staff are required to ensure completeness of clinical assessment data and protocol adherence. Trials registration ClinicalTrials.gov Identifier, NCT02587585-30th September 2015.
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Affiliation(s)
- Sophie Lawrie
- 1Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Headington Campus, Headington Road, Gipsy Lane, Oxford, OX3 0BP UK
| | - Yun Dong
- 2Rehabilitation Centre, the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui Province China
| | - Dax Steins
- 1Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Headington Campus, Headington Road, Gipsy Lane, Oxford, OX3 0BP UK
| | - Zhidao Xia
- 1Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Headington Campus, Headington Road, Gipsy Lane, Oxford, OX3 0BP UK
| | - Patrick Esser
- 1Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Headington Campus, Headington Road, Gipsy Lane, Oxford, OX3 0BP UK
| | - Shanbin Sun
- 2Rehabilitation Centre, the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui Province China
| | - Fei Li
- 2Rehabilitation Centre, the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui Province China
| | - James D Amor
- 3School of Engineering, University of Warwick, Coventry, CV4 7AL UK
| | | | - Hooshang Izadi
- 1Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Headington Campus, Headington Road, Gipsy Lane, Oxford, OX3 0BP UK
| | - Yi Cao
- 2Rehabilitation Centre, the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui Province China
| | - Derick Wade
- 1Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Headington Campus, Headington Road, Gipsy Lane, Oxford, OX3 0BP UK
| | - Nancy Mayo
- 4School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, Québec H3G 1Y5 Canada
| | - Helen Dawes
- 1Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Headington Campus, Headington Road, Gipsy Lane, Oxford, OX3 0BP UK
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Lee SI, Jung HT, Park J, Jeong J, Ryu T, Kim Y, Santos VSD, Miranda JGV, Daneault JF. Towards the Ambulatory Assessment of Movement Quality in Stroke Survivors using a Wrist-worn Inertial Sensor. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:2825-2828. [PMID: 30440989 DOI: 10.1109/embc.2018.8512845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Stroke is a leading cause of long-term disability that may lead to significant functional motor impairments in the upper limb (UL). Wrist-worn inertial sensors have emerged as an objective, minimally-obtrusive tool to monitor UL motor function in the real-world setting, such that rehabilitation interventions can be individually tailored to maximize functional performance. However, current wearable solutions focus on capturing the quantity of movement without considering the quality of movement. This paper introduces a novel approach to unobtrusively estimate the quality of UL movements in stroke survivors using a single wrist-worn inertial sensor during any type of voluntary UL movements. The proposed method exploits kinematic characteristics of voluntary limb movements that are optimized by the central nervous system during motor control. This work demonstrates that the proposed method could extract clinically important information during random UL movements in 16 stroke survivors, showing a statistically significant correlation to the Functional Ability Scale - a clinically validated score for movement quality.
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76
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Lee SI, Adans-Dester CP, Grimaldi M, Dowling AV, Horak PC, Black-Schaffer RM, Bonato P, Gwin JT. Enabling Stroke Rehabilitation in Home and Community Settings: A Wearable Sensor-Based Approach for Upper-Limb Motor Training. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2018; 6:2100411. [PMID: 29795772 PMCID: PMC5951609 DOI: 10.1109/jtehm.2018.2829208] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 01/16/2018] [Accepted: 03/28/2018] [Indexed: 11/06/2022]
Abstract
High-dosage motor practice can significantly contribute to achieving functional recovery after a stroke. Performing rehabilitation exercises at home and using, or attempting to use, the stroke-affected upper limb during Activities of Daily Living (ADL) are effective ways to achieve high-dosage motor practice in stroke survivors. This paper presents a novel technological approach that enables 1) detecting goal-directed upper limb movements during the performance of ADL, so that timely feedback can be provided to encourage the use of the affected limb, and 2) assessing the quality of motor performance during in-home rehabilitation exercises so that appropriate feedback can be generated to promote high-quality exercise. The results herein presented show that it is possible to detect 1) goal-directed movements during the performance of ADL with a \documentclass[12pt]{minimal}
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\end{document}-score of 84.3%, thus enabling the generation of appropriate feedback. In a survey to gather preliminary data concerning the clinical adequacy of the proposed approach, 91.7% of occupational therapists demonstrated willingness to use it in their practice, and 88.2% of stroke survivors indicated that they would use it if recommended by their therapist.
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Affiliation(s)
- Sunghoon I Lee
- College of Information and Computer SciencesUniversity of MassachusettsAmherstMA01003USA
| | - Catherine P Adans-Dester
- Department of Physical Medicine and RehabilitationHarvard Medical SchoolSpaulding Rehabilitation HospitalCharlestownMA02129USA.,School of Health and Rehabilitation SciencesMGH Institute of Health ProfessionsCharlestownMA02129USA
| | - Matteo Grimaldi
- Department of Physical Medicine and RehabilitationHarvard Medical SchoolSpaulding Rehabilitation HospitalCharlestownMA02129USA
| | | | | | - Randie M Black-Schaffer
- Department of Physical Medicine and RehabilitationHarvard Medical SchoolSpaulding Rehabilitation HospitalCharlestownMA02129USA
| | - Paolo Bonato
- Department of Physical Medicine and RehabilitationHarvard Medical SchoolSpaulding Rehabilitation HospitalCharlestownMA02129USA
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Liu X, Rajan S, Ramasarma N, Bonato P, Lee SI. The Use of a Finger-Worn Accelerometer for Monitoring of Hand Use in Ambulatory Settings. IEEE J Biomed Health Inform 2018; 23:599-606. [PMID: 29994103 DOI: 10.1109/jbhi.2018.2821136] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objective assessment of stroke survivors' upper limb movements in ambulatory settings can provide clinicians with important information regarding the real impact of rehabilitation outside the clinic and help to establish individually-tailored therapeutic programs. This paper explores a novel approach to monitor the amount of hand use, which is relevant to the purposeful, goal-directed use of the limbs, based on a body networked sensor system composed of miniaturized finger- and wrist-worn accelerometers. The main contributions of this paper are twofold. First, this paper introduces and validates a new benchmark measurement of the amount of hand use based on data recorded by a motion capture system, the gold standard for human movement analysis. Second, this paper introduces a machine learning-based analytic pipeline that estimates the amount of hand use using data obtained from the wearable sensors and validates its estimation performance against the aforementioned benchmark measurement. Based on data collected from 18 neurologically intact individuals performing 11 motor tasks resembling various activities of daily living, the analytic results presented herein show that our new benchmark measure is reliable and responsive, and that the proposed wearable system can yield an accurate estimation of the amount of hand use (normalized root mean square error of 0.11 and average Pearson correlation of 0.78). This study has the potential to open up new research and clinical opportunities for monitoring hand function in ambulatory settings, ultimately enabling evidence-based, patient-centered rehabilitation and healthcare.
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78
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Da-Silva RH, van Wijck F, Shaw L, Rodgers H, Balaam M, Brkic L, Ploetz T, Jackson D, Ladha K, Price CI. Prompting arm activity after stroke: A clinical proof of concept study of wrist-worn accelerometers with a vibrating alert function. J Rehabil Assist Technol Eng 2018; 5:2055668318761524. [PMID: 31191927 PMCID: PMC6453063 DOI: 10.1177/2055668318761524] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 01/11/2018] [Indexed: 11/20/2022] Open
Abstract
Background Frequent practice of functional movements after stroke may optimise motor
recovery; however, it is challenging for patients to remember to integrate
an impaired limb into daily activities. We report the activity responses of
stroke patients receiving a vibrating alert delivered by a tri-axial
accelerometer wristband to prompt movement of the impaired arm if hourly
activity levels fell. Methods Adults with upper limb impairment ≤28 days post-stroke wore the device for
four weeks. Therapists and patients reviewed movement activity data twice
weekly to agree ongoing rehabilitation activities and programme the
wristband with a personalised prompt threshold (median baseline
activity + 5%, 25% or 50%). Results: Seven patients completed the programme (five males;
mean ± standard deviation (age) 64 ± 5 years; days post-stroke 13 ± 7;
baseline/four-week Action Research Arm Test median (Interquartile range
(IQR)) 39 (8, 44)/56 (11, 57)). Wristbands were worn for 89% of programme
duration. A total of 1,288 prompts were delivered, with a median of four
(IQR 3,7) prompts per patient per day. Mean activity increases following a
prompt ranged from 11% to 29%. Conclusions Feedback delivered by a programmable accelerometer increased impaired arm
activity. Improvements are required in device reliability before conducting
a pragmatic clinical trial to examine the impact upon recovery.
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Affiliation(s)
- Ruth H Da-Silva
- 1Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Frederike van Wijck
- 2School of Health and Life Science, Glasgow Caledonian University, Glasgow, UK
| | - Lisa Shaw
- 1Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Helen Rodgers
- 1Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Madeline Balaam
- 3School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - Lianne Brkic
- 1Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Thomas Ploetz
- 3School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - Dan Jackson
- 3School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - Karim Ladha
- 3School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
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Chadwell A, Kenney L, Granat M, Thies S, Head JS, Galpin A. Visualisation of upper limb activity using spirals: A new approach to the assessment of daily prosthesis usage. Prosthet Orthot Int 2018; 42. [PMID: 28650213 PMCID: PMC5808815 DOI: 10.1177/0309364617706751] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Current outcome measures used in upper limb myoelectric prosthesis studies include clinical tests of function and self-report questionnaires on real-world prosthesis use. Research in other cohorts has questioned both the validity of self-report as an activity assessment tool and the relationship between clinical functionality and real-world upper limb activity. Previously,1 we reported the first results of monitoring upper limb prosthesis use. However, the data visualisation technique used was limited in scope. STUDY DESIGN Methodology development. OBJECTIVES To introduce two new methods for the analysis and display of upper limb activity monitoring data and to demonstrate the potential value of the approach with example real-world data. METHODS Upper limb activity monitors, worn on each wrist, recorded data on two anatomically intact participants and two prosthesis users over 1 week. Participants also filled in a diary to record upper limb activity. Data visualisation was carried out using histograms, and Archimedean spirals to illustrate temporal patterns of upper limb activity. RESULTS Anatomically intact participants' activity was largely bilateral in nature, interspersed with frequent bursts of unilateral activity of each arm. At times when the prosthesis was worn prosthesis users showed very little unilateral use of the prosthesis (≈20-40 min/week compared to ≈350 min/week unilateral activity on each arm for anatomically intact participants), with consistent bias towards the intact arm throughout. The Archimedean spiral plots illustrated participant-specific patterns of non-use in prosthesis users. CONCLUSION The data visualisation techniques allow detailed and objective assessment of temporal patterns in the upper limb activity of prosthesis users. Clinical relevance Activity monitoring offers an objective method for the assessment of upper limb prosthesis users' (PUs) activity outside of the clinic. By plotting data using Archimedean spirals, it is possible to visualise, in detail, the temporal patterns of upper limb activity. Further work is needed to explore the relationship between traditional functional outcome measures and real-world prosthesis activity.
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Affiliation(s)
- Alix Chadwell
- Centre for Health Sciences Research, University of Salford, Salford, UK
| | - Laurence Kenney
- Centre for Health Sciences Research, University of Salford, Salford, UK,Laurence Kenney, Centre for Health Sciences Research, Brian Blatchford Building, University of Salford, Salford, M6 6PU, UK.
| | - Malcolm Granat
- Centre for Health Sciences Research, University of Salford, Salford, UK
| | - Sibylle Thies
- Centre for Health Sciences Research, University of Salford, Salford, UK
| | - John S Head
- Centre for Health Sciences Research, University of Salford, Salford, UK
| | - Adam Galpin
- Centre for Health Sciences Research, University of Salford, Salford, UK
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80
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Stewart C, McCluskey A, Ada L, Kuys S. Structure and feasibility of extra practice during stroke rehabilitation: A systematic scoping review. Aust Occup Ther J 2017; 64:204-217. [DOI: 10.1111/1440-1630.12351] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Claire Stewart
- Faculty of Health Sciences; The University of Sydney; Lidcombe New South Wales Australia
| | - Annie McCluskey
- Faculty of Health Sciences; The University of Sydney; Lidcombe New South Wales Australia
| | - Louise Ada
- Faculty of Health Sciences; The University of Sydney; Lidcombe New South Wales Australia
| | - Suzanne Kuys
- School of Physiotherapy; Australian Catholic University; Brisbane Queensland Australia
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Waddell KJ, Strube MJ, Bailey RR, Klaesner JW, Birkenmeier RL, Dromerick AW, Lang CE. Does Task-Specific Training Improve Upper Limb Performance in Daily Life Poststroke? Neurorehabil Neural Repair 2016; 31:290-300. [PMID: 27909071 DOI: 10.1177/1545968316680493] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A common assumption is that changes in upper limb (UL) capacity, or what an individual is capable of doing, translates to improved UL performance in daily life, or what an individual actually does. This assumption should be explicitly tested for individuals with UL paresis poststroke. OBJECTIVE To examine changes in UL performance after an intensive, individualized, progressive, task-specific UL intervention for individuals at least 6 months poststroke. METHODS Secondary analysis on 78 individuals with UL paresis who participated in a phase II, single-blind, randomized parallel dose-response trial. Participants were enrolled in a task-specific intervention for 8 weeks. Participants were randomized into 1 of 4 treatment groups with each group completing different amounts of UL movement practice. UL performance was assessed with bilateral, wrist-worn accelerometers once a week for 24 hours throughout the duration of the study. The 6 accelerometer variables were tested for change and the influence of potential modifiers using hierarchical linear modeling. RESULTS No changes in UL performance were found on any of the 6 accelerometer variables used to quantify UL performance. Neither changes in UL capacity nor the overall amount of movement practice influenced changes in UL performance. Stroke chronicity, baseline UL capacity, concordance, and ADL status significantly increased the baseline starting points but did not influence the rate of change (slopes) for participants. CONCLUSIONS Improved motor capacity resulting from an intensive outpatient UL intervention does not appear to translate to increased UL performance outside the clinic.
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Affiliation(s)
| | | | | | | | | | - Alexander W Dromerick
- 2 Georgetown University, Washington, DC, USA.,3 MedStar National Rehabilitation Hospital, Washington DC, USA
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Turton AJ, Cunningham P, van Wijck F, Smartt HJM, Rogers CA, Sackley CM, Jowett S, Wolf SL, Wheatley K, van Vliet P. Home-based Reach-to-Grasp training for people after stroke is feasible: a pilot randomised controlled trial. Clin Rehabil 2016; 31:891-903. [DOI: 10.1177/0269215516661751] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: To determine feasibility of a randomised controlled trial (RCT) of home-based Reach-to-Grasp training after stroke. Design: single-blind parallel group RCT. Participants: Residual arm deficit less than 12 months post-stroke. Interventions: Reach-to-Grasp training in 14 one-hour therapist’s visits over 6 weeks, plus one hour self-practice per day (total 56 hours). Control: Usual care. Main Measures: Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), pre-randomisation, 7, 12, 24 weeks post-randomisation. Results: Forty-seven participants (Reach-to-Grasp=24, usual care=23) were randomised over 17 months. Reach-to-Grasp participants received a median (IQR) 14 (13,14) visits, and performed 157 (96,211) repetitions per visit; plus 30 minutes (22,45) self-practice per day. Usual care participants received 10.5 (5,14) therapist visits, comprising 38.6 (30,45) minutes of arm therapy with 16 (6,24) repetitions of functional tasks per visit. Median ARAT scores in the reach-to-grasp group were 8.5 (3.0,24.0) at baseline and 14.5 (3.5,26.0) at 24 weeks compared to median of 4 at both time points (IQR: baseline (3.0,14.0), 24 weeks (3.0,30.0)) in the usual-care group. Median WMFT tasks completed at baseline and 24 weeks were 6 (3.0,11.5) and 8.5 (4.5,13.5) respectively in the reach-to-grasp group and 4 (3.0,10.0), 6 (3.0,14.0) in the usual care group. Incidence of arm pain was similar between groups. The study was stopped before 11 patients reached the 24 weeks assessment. Conclusions: An RCT of home-based Reach-to-Grasp training after stroke is feasible and safe. With ARAT being our preferred measure it is estimated that 240 participants will be needed for a future two armed trial.
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Affiliation(s)
- AJ Turton
- Department of Allied Health Professions, University of the West of England, UK
| | - P Cunningham
- Department of Allied Health Professions, University of the West of England, UK
| | - F van Wijck
- Institute for Applied Health Research and School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - HJM Smartt
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, UK
| | - CA Rogers
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, UK
| | - CM Sackley
- Institute of Health and Social Care Research, King’s College London, UK
| | - S Jowett
- School of Health and Population Sciences, University of Birmingham, UK
| | - SL Wolf
- Emory Rehabilitation Hospital, Emory University, Atlanta, USA
| | - K Wheatley
- Institute of Cancer and Genomic Sciences, University of Birmingham, UK
| | - P van Vliet
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Australia, and Hunter Medical Research Institute, UK
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