Higher-dose, higher-repetition upper limb motor rehabilitation program after stroke is not superior to dose-matched or usual-dose customary occupational therapy [commentary]

Preliminary Examination of the Ability of a New Wearable Device to Capture Functional Hand Activity After Stroke

Background and Purpose- A reliable measure of movement repetitions is required to assist in determining the optimal dose for maximizing upper limb recovery after stroke. This study investigated the ability of a new wearable device to capture reach-to-grasp repetitions in individuals with stroke. Methods- Eight individuals with stroke wore an instrumented wrist bracelet while completing 12 upper limb activities. Participants completed 5 and 10 repetitions of each activity on 2 separate sessions (time 1 and time 2) and completed clinical assessments (Fugl-Meyer Upper Extremity Assessment and Action Research Arm Test). Mean reach-to-grasp counts (ie, hand counts) were compared across activities. Scaling properties were assessed by the ratio of 10 repetitions to 5 repetitions for the activities (ie, expected value of 2). Bland-Altman diagrams were used to examine agreement between time 1 and time 2 counts. Results- The wrist bracelet averaged 0 to 0.6 hand counts per repetition for the arm-only and hand-only activities and averaged 1 to 2 counts per repetition of the reach-to-grasp activities. The mean ratio of 10 repetition to 5 repetition counts was ≈2 for all of the reach-to-grasp activities. Mean differences from time 1 to time 2 were <0.3 counts/repetition for all activities except one. Conclusions- These preliminary results provide evidence that the wrist bracelet is able to capture hand counts over a variety of tasks in a consistent manner. This wrist bracelet could be further developed as a tool to record dose of upper limb practice for research or clinical practice, as well as providing motivation and accountability to patients participating in treatments requiring upper limb movement repetitions. Currently, there are limitations in interpreting the impact of impairment and common compensatory movements on hand counts, and it would be valuable for future studies to explore these effects.