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Dixit P, Phalswal U, Kalal N, Srivastava SP. Effectiveness of virtual reality-supported exercise therapy in improving upper extremity function and activities of daily living among patients after stroke: a systematic review of randomized control trials. Osong Public Health Res Perspect 2024; 15:189-200. [PMID: 38988022 PMCID: PMC11237319 DOI: 10.24171/j.phrp.2023.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 01/19/2024] [Accepted: 02/06/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND This systematic review describes the effectiveness of virtual reality (VR)-supported exercise therapy on upper limb motor function and activities of daily living after stroke. METHODS Studies published through January 24, 2022, were identified using CINAHL, Cochrane Library, Embase, Medline, and Web of Science. Randomized control trials comparing VR treatment with conventional therapy (CT) for upper extremity rehabilitation after stroke were included. Methodological quality was assessed using the Cochrane risk-of-bias tool. RESULTS Of 9 included studies, 5 concluded that the VR group outperformed control participants, 1 indicated the superiority of VR-supported exercises alone over CT, and 3 found VR comparable to CT in promoting upper limb motor function. Five studies analyzed independence in daily living, with 4 reporting no significant difference between VR and CT groups. No strong evidence indicated long-term benefits of VR-assisted exercise. All included studies demonstrated low risk of bias concerning random sequence generation, allocation concealment, outcome assessment blinding, incomplete outcome data, and selective reporting bias. However, a high risk of bias was observed regarding participant blinding due to the nature of the intervention. CONCLUSION Most studies suggested that VR, used alongside CT, can improve motor function following stroke. However, the evidence was insufficient to conclude that VR outperforms conventional approaches.
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Affiliation(s)
- Priyanshi Dixit
- Faculty of Nursing, Uttar Pradesh University of Medical Sciences, Uttar Pradesh, India
| | - Uma Phalswal
- Department of Nursing, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Nipin Kalal
- College of Nursing, All India Institute of Medical Sciences, Jodhpur, India
| | - Saumya P. Srivastava
- Faculty of Nursing, Uttar Pradesh University of Medical Sciences, Uttar Pradesh, India
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Li R, Liu S, Li T, Yang K, Wang X, Wang W. The stratified effects of repetitive transcranial magnetic stimulation in upper limb motor impairment recovery after stroke: a meta-analysis. Front Neurol 2024; 15:1369836. [PMID: 38628695 PMCID: PMC11020108 DOI: 10.3389/fneur.2024.1369836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/11/2024] [Indexed: 04/19/2024] Open
Abstract
Background The recovery of upper extremity motor impairment after stroke remains a challenging task. The clinical effectiveness of repetitive transcranial magnetic stimulation (rTMS), which is believed to aid in the recovery process, is still uncertain. Methods A systematic search was conducted in Medline (Ovid), Cochrane and Embase electronic databases from March 28, 2014, to March 28, 2023. The inclusion criteria consisted of randomized controlled trials that assessed the effects of rTMS on the recovery of upper limb motor impairment among stroke patients. Various measurements, including the Fugl Meyer Assessment Upper Extremity Scale (FMA-UE), Brunnstrom recovery stage, Action Research Arm Test (ARAT), and Barthel index, were evaluated both before and after the intervention. Results Nineteen articles with 865 patients were included. When considering only the rTMS parameters, both inhibitory and excitatory rTMS improved FMA-UE (MD = 1.87, 95% CI = [0.88]-[2.86], p < 0.001) and Barthel index (MD = 9.73, 95% CI = [4.57]-[14.89], p < 0.001). When considering only the severity of upper limb hemiplegia, both less severe (MD = 1.56, 95% CI = [0.64]-[2.49], p < 0.001) and severe (MD = 2.05, 95% CI = [1.09]-[3.00], p < 0.001) hemiplegia benefited from rTMS based on FMA-UE. However, when considering the rTMS parameters, severity of hemiplegia and stroke stages simultaneously, inhibitory rTMS was found to be significantly effective for less severe hemiplegia in the acute and subacute phases (MD = 4.55, 95% CI = [2.49]-[6.60], p < 0.001), but not in the chronic phase based on FMA-UE. For severe hemiplegia, inhibitory rTMS was not significantly effective in the acute and subacute phases, but significantly effective in the chronic phase (MD = 2.10, 95% CI = [0.75]-[3.45], p = 0.002) based on FMA-UE. Excitatory rTMS was found to be significantly effective for less severe hemiplegia in the acute and subacute phases (MD = 1.93, 95% CI = [0.58]-[3.28], p = 0.005) based on FMA-UE. The improvements in Brunnstrom recovery stage and ARAT need further research. Conclusion The effectiveness of rTMS depends on its parameters, severity of hemiplegia, and stroke stages. It is important to consider all these factors together, as any single grouping method is incomplete.
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Affiliation(s)
- Ran Li
- Department of Rehabilitation Center, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Sihan Liu
- Capital Medical University Eighth Clinical School, Beijing, China
| | - Tianyuan Li
- Capital Medical University Eighth Clinical School, Beijing, China
| | - Kun Yang
- Department of Evidence-based Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Xue Wang
- Department of Medical Library, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Wenjiao Wang
- Department of Medical Library, Xuan Wu Hospital, Capital Medical University, Beijing, China
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Bayazeed A, Almalki G, Alnuaim A, Klem M, Sethi A. Factors Influencing Real-World Use of the More-Affected Upper Limb After Stroke: A Scoping Review. Am J Occup Ther 2024; 78:7802180250. [PMID: 38634670 DOI: 10.5014/ajot.2024.050512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
IMPORTANCE Current interventions are limited in improving use of the more-affected upper limb in real-world daily occupations and functional independence poststroke. A comprehensive understanding of the factors influencing real-world upper limb use is required to develop interventions to improve functional independence poststroke. OBJECTIVE To systematically review the factors that influence real-world use of the more-affected upper limb poststroke. DATA SOURCES We searched MEDLINE, Embase, PsycINFO, and the Physiotherapy Evidence Database for English-language articles from 2012 to 2023. STUDY SELECTION AND DATA COLLECTION Of 774 studies, we included 33 studies that had participants at least age 18 yr who exhibited upper limb impairments poststroke, objectively measured real-world upper limb use using a movement sensor, and measured factors affecting upper limb use. Two reviewers independently screened the abstracts. FINDINGS The results were categorized by International Classification of Functioning, Disability and Health domains. Prominent factors were upper limb impairment; motor ability; functional independence; task type; hand dominance; stroke-related factors, including time since stroke; and perception of use of the more-affected upper limb. CONCLUSIONS AND RELEVANCE Existing interventions primarily focus on upper limb impairments and motor ability. Our findings suggest that interventions should also incorporate other factors: task type (unilateral vs. bilateral), hand dominance, self-efficacy, and perception of more-affected limb use as active ingredients in improving real-world use of the more-affected upper limb poststroke. We also provide recommendations to use behavioral activation theory in designing an occupation-focused intervention to augment self-efficacy and confidence in use of the more-affected upper limb in daily occupations. Plain-Language Summary: In order to develop interventions to improve functional independence poststroke, occupational therapy practitioners must have a comprehensive understanding of the factors that influence real-world more-affected upper limb use. The study findings provide a set of distinct factors that practitioners can target separately or in combination to improve real-world use of the more-affected upper limb poststroke.
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Affiliation(s)
- Anadil Bayazeed
- Anadil Bayazeed, MSOT, is PhD Candidate, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, and Teaching Assistant, Occupational Therapy Department, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia;
| | - Ghaleb Almalki
- Ghaleb Almalki, MSOT, is PhD Candidate, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, and Teaching Assistant, Occupational Therapy Department, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Amjad Alnuaim
- Amjad Alnuaim, MSc, is Teaching Assistant, Department of Occupational Therapy, King Saud University, Riyadh, Saudi Arabia. At the time of the study, Alnuaim was Master's Student, Occupational Therapy Department, University of Pittsburgh, Pittsburgh, PA
| | - Mary Klem
- Mary Klem, PhD, MLIS, is Assistant Director for Advanced Information Support, Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA
| | - Amit Sethi
- Amit Sethi, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
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Essers B, Veerbeek JM, Luft AR, Verheyden G. The feasibility of the adapted H-GRASP program for perceived and actual daily-life upper limb activity in the chronic phase post-stroke. Disabil Rehabil 2024:1-16. [PMID: 38329448 DOI: 10.1080/09638288.2024.2313121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Abstract
(Purpose: Assessing feasibility and initial impact of the Home-Graded Repetitive Arm Supplementary Program combined with in-home accelerometer-based feedback (AH-GRASP) on perceived and actual daily-life upper limb (UL) activity in stroke survivors during the chronic phase with good UL motor function but low perceived daily-life activity. Material and methods: A 4-week intervention program (4 contact hours, 48 h self-practice) encompassing task-oriented training, behavioral techniques, phone-based support, monitoring, and weekly feedback sessions using wrist-worn accelerometery was implemented using a pre-post double baseline repeated measures design. Feasibility, clinical assessments, patient-reported outcomes, and accelerometer data were investigated. Results: Of the 34 individuals approached, nineteen were included (recruitment rate 56%). Two dropped out, one due to increased UL pain (retention rate 89%). Seven (41%) achieved the prescribed exercise target (120 min/day, six days/week). Positive patient experiences and improvements in UL capacity, self-efficacy, and contribution of the affected UL to overall activity (p < 0.05, small to large effect sizes) were observed. Additionally, seven participants (41%) surpassed the minimal clinically important difference in perceived UL activity.Conclusions: A home-based UL exercise program with accelerometer-based feedback holds promise for enhancing perceived and actual daily-life UL activity for our subgroup of chronic stroke survivors.
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Affiliation(s)
- Bea Essers
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Andreas R Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology and Clinical Neuroscience Center, Neurocenter, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Poitras I, Gagné-Pelletier L, Clouâtre J, Flamand VH, Campeau-Lecours A, Mercier C. Optimizing Epoch Length and Activity Count Threshold Parameters in Accelerometry: Enhancing Upper Extremity Use Quantification in Cerebral Palsy. SENSORS (BASEL, SWITZERLAND) 2024; 24:1100. [PMID: 38400258 PMCID: PMC10892357 DOI: 10.3390/s24041100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
Various accelerometry protocols have been used to quantify upper extremity (UE) activity, encompassing diverse epoch lengths and thresholding methods. However, there is no consensus on the most effective approach. The aim of this study was to delineate the optimal parameters for analyzing accelerometry data to quantify UE use in individuals with unilateral cerebral palsy (CP). METHODS A group of adults with CP (n = 15) participated in six activities of daily living, while a group of children with CP (n = 14) underwent the Assisting Hand Assessment. Both groups performed the activities while wearing ActiGraph GT9X-BT devices on each wrist, with concurrent video recording. Use ratio (UR) derived from accelerometry and video analysis and accelerometer data were compared for different epoch lengths (1, 1.5, and 2 s) and activity count (AC) thresholds (between 2 and 150). RESULTS In adults, results are comparable across epoch lengths, with the best AC thresholds being ≥ 100. In children, results are similar across epoch lengths of 1 and 1.5 (optimal AC threshold = 50), while the optimal threshold is higher with an epoch length of 2 (AC = 75). CONCLUSIONS The combination of epoch length and AC thresholds should be chosen carefully as both influence the validity of the quantification of UE use.
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Affiliation(s)
- Isabelle Poitras
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (L.G.-P.); (J.C.); (V.H.F.); (A.C.-L.)
- School of Rehabilitation Sciences, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Léandre Gagné-Pelletier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (L.G.-P.); (J.C.); (V.H.F.); (A.C.-L.)
- School of Rehabilitation Sciences, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Jade Clouâtre
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (L.G.-P.); (J.C.); (V.H.F.); (A.C.-L.)
- Department of Mechanical Engineering, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Véronique H. Flamand
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (L.G.-P.); (J.C.); (V.H.F.); (A.C.-L.)
- School of Rehabilitation Sciences, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Alexandre Campeau-Lecours
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (L.G.-P.); (J.C.); (V.H.F.); (A.C.-L.)
- Department of Mechanical Engineering, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Catherine Mercier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (L.G.-P.); (J.C.); (V.H.F.); (A.C.-L.)
- School of Rehabilitation Sciences, Laval University, Quebec City, QC G1V 0A6, Canada
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Hirayama K, Matsuda M, Teruya M, Fuchigami T, Morioka S. Trends in amount of use to upper limb function in patients with subacute stroke: a cross-sectional study using segmental regression analysis. BMC Neurol 2023; 23:429. [PMID: 38049736 PMCID: PMC10694878 DOI: 10.1186/s12883-023-03469-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/15/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Hemiparesis affects approximately 33-80% of patients with stroke, and a quarter of these individuals experience difficulty with the voluntary use of their paretic upper limb for performing activities of daily living within five years of stroke onset. Therefore, assessing upper limb functionality and use after a stroke is crucial. The Fugl-Meyer Assessment (FMA) and the Motor Activity Log (MAL) are the two most widely used methods for assessing post-stroke paretic upper limb. While previous research has shown a strong correlation between the FMA of Upper Extremity (FMA-UE) and the MAL scores, to date, no study has investigated the differences in the characteristics and trends of upper extremity usage frequency in the FMA-UE. This study aimed to statistically categorize the FMA-UE scores using segmental regression analysis and identify disparities in the trends of paretic upper extremity utilization frequency in MAL. METHODS Patients with first-episode subacute stroke were chosen for the cohort study. The primary assessments used were FMA-UE and MAL Amount of Use (MAL-A); age, gender, and time since onset served as secondary assessments. Segmental regression analysis was used, with FMA-UE as the independent variable and MAL-A as the dependent variable. R2 values were calculated using linear and polynomial regression on binary values, and the coefficients of determination were compared using segmental regression analysis. RESULTS The study included 203 participants with a mean age of 70.1 ± 13.1 years; 113 were male and 90 female. The mean time since onset was 29.2 ± 14.8 days, the mean FMA-UE score was 43.6 ± 22.3 points, and the mean MAL-A score was 2.3 ± 2.0 points. The segmental regression analysis revealed that the inflection point for FMA-UE was 45.3 points, and the slope of the regression line underwent a transformation before and after the inflection point. CONCLUSIONS This study indicates that the trend in the amount of use of paretic upper limb utilization changes around inflection point 45 in the FMA-UE. These findings could be useful for designing rehabilitation strategies to improve paretic upper limb utilization by increasing exercise duration in patients with subacute stroke.
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Affiliation(s)
- Koichiro Hirayama
- Department of Rehabilitation, Eishinkai Kishiwada Rehabilitation Hospital, 8-10, Kanmatsucho, Kishiwada, 596-0827, Osaka, Japan.
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan.
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Osaka, Japan.
| | - Marina Matsuda
- Department of Rehabilitation, Eishinkai Kishiwada Rehabilitation Hospital, 8-10, Kanmatsucho, Kishiwada, 596-0827, Osaka, Japan
| | - Moe Teruya
- Department of Rehabilitation, Eishinkai Kishiwada Rehabilitation Hospital, 8-10, Kanmatsucho, Kishiwada, 596-0827, Osaka, Japan
| | - Takeshi Fuchigami
- Department of Rehabilitation, Eishinkai Kishiwada Rehabilitation Hospital, 8-10, Kanmatsucho, Kishiwada, 596-0827, Osaka, Japan
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Osaka, Japan
- Neurorehabilitation Research Center, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
| | - Shu Morioka
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Osaka, Japan.
- Neurorehabilitation Research Center, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan.
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Newton SP, Dalton EJ, Ang JY, Klaic M, Thijs V, Hayward KS. Dose, Content, and Context of Usual Care in Stroke Upper Limb Motor Interventions: A Systematic Review. Clin Rehabil 2023; 37:1437-1450. [PMID: 37151039 PMCID: PMC10492439 DOI: 10.1177/02692155231172295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 04/11/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE The objectives of this systematic review were to describe the current dose and content of usual care upper limb motor intervention for inpatients following stroke and examine if context factors alter dose and content. DATA SOURCES A systematic search (EMBASE, MEDLINE) was completed from January 2015 to February 2023 (PROSPERO CRD42021281986). METHODS Studies were eligible if they reported non-protocolised usual care upper limb motor intervention dose data for stroke inpatients. Studies were rated using the Johanna Briggs Institute critical appraisal tool. Data were descriptively reported for dose dimensions of time (on task or, in therapy) and intensity (repetitions, repetition/minute), content (intervention type/mode), and context (e.g., severity strata). RESULTS Eight studies were included from four countries, largely reflecting inpatient rehabilitation. Time in therapy ranged from 23 to 121 min/day. Time on task ranged from 8 to 44 min/day. Repetitions ranged from 36 to 57/session, and 15 to 282/day. Time on task was lowest in the stratum of people with severe upper limb impairment (8 min/day), the upper limit for this stratum was 41.5 min/day. There was minimal reporting of usual care content across all studies. CONCLUSION Upper limb motor intervention dose appears to be increasing in usual care compared to prior reports (e.g., average 21 min/day and 23 to 32 repetitions/session). Context variability suggests that doses are lowest in the stratum of patients with a severely impaired upper limb. Consistent reporting of the multiple dimensions of dose and content is necessary to better understand usual care offered during inpatient rehabilitation.
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Affiliation(s)
- Sarah P Newton
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
- Department of Occupational Therapy, Austin Health, Melbourne, Australia
| | - Emily J Dalton
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
- Department of Occupational Therapy, Austin Health, Melbourne, Australia
| | - Jia Y Ang
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Marlena Klaic
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Vincent Thijs
- Stroke Theme, Florey Institute of Neurosciences and Mental Health, Melbourne, Australia
- Department of Neurology, Austin Health, Melbourne, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Kathryn S Hayward
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
- Stroke Theme, Florey Institute of Neurosciences and Mental Health, Melbourne, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, Australia
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Demers M, Bishop L, Cain A, Saba J, Rowe J, Zondervan D, Winstein C. Wearable technology to capture arm use of stroke survivors in home and community settings: feasibility and early insights on motor performance. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.25.23284790. [PMID: 36747651 PMCID: PMC9901039 DOI: 10.1101/2023.01.25.23284790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective To establish short-term feasibility and usability of wrist-worn wearable sensors to capture arm/hand activity of stroke survivors and to explore the association between factors related to use of the paretic arm/hand. Methods 30 chronic stroke survivors were monitored with wrist-worn wearable sensors during 12h/day for a 7-day period. Participants also completed standardized assessments to capture stroke severity, arm motor impairments, self-perceived arm use and self-efficacy. Usability of the wearable sensors was assessed using the adapted System Usability Scale and an exit interview. Associations between motor performance and capacity (arm/hand impairments and activity limitations) were assessed using Spearman's correlations. Results Minimal technical issues or lack of adherence to the wearing schedule occurred, with 87.6% of days procuring valid data from both sensors. Average sensor wear time was 12.6 (standard deviation: 0.2) h/day. Three participants experienced discomfort with one of the wristbands and three other participants had unrelated adverse events. There were positive self-reported usability scores (mean: 85.4/100) and high user satisfaction. Significant correlations were observed for measures of motor capacity and self-efficacy with paretic arm use in the home and the community (Spearman's correlation ρs: 0.44-0.71). Conclusions This work demonstrates the feasibility and usability of a consumer-grade wearable sensor to capture paretic arm activity outside the laboratory. It provides early insight into stroke survivors' everyday arm use and related factors such as motor capacity and self-efficacy. Impact The integration of wearable technologies into clinical practice offers new possibilities to complement in-person clinical assessments and to better understand how each person is moving outside of therapy and throughout the recovery and reintegration phase. Insights gained from monitoring stroke survivors arm/hand use in the home and community is the first step towards informing future research with an emphasis on causal mechanisms with clinical relevance.
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Affiliation(s)
- Marika Demers
- School of Rehabilitation, Université de Montréal, Montreal (Qc), Canada
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Lauri Bishop
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Amelia Cain
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Joseph Saba
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Justin Rowe
- Flint Rehabilitation Devices, Irvine (CA), USA
| | | | - Carolee Winstein
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Zhu Y, Wang C, Li J, Zeng L, Zhang P. Effect of different modalities of artificial intelligence rehabilitation techniques on patients with upper limb dysfunction after stroke-A network meta-analysis of randomized controlled trials. Front Neurol 2023; 14:1125172. [PMID: 37139055 PMCID: PMC10150552 DOI: 10.3389/fneur.2023.1125172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/21/2023] [Indexed: 05/05/2023] Open
Abstract
Background This study aimed to observe the effects of six different types of AI rehabilitation techniques (RR, IR, RT, RT + VR, VR and BCI) on upper limb shoulder-elbow and wrist motor function, overall upper limb function (grip, grasp, pinch and gross motor) and daily living ability in subjects with stroke. Direct and indirect comparisons were drawn to conclude which AI rehabilitation techniques were most effective in improving the above functions. Methods From establishment to 5 September 2022, we systematically searched PubMed, EMBASE, the Cochrane Library, Web of Science, CNKI, VIP and Wanfang. Only randomized controlled trials (RCTs) that met the inclusion criteria were included. The risk of bias in studies was evaluated using the Cochrane Collaborative Risk of Bias Assessment Tool. A cumulative ranking analysis by SUCRA was performed to compare the effectiveness of different AI rehabilitation techniques for patients with stroke and upper limb dysfunction. Results We included 101 publications involving 4,702 subjects. According to the results of the SUCRA curves, RT + VR (SUCRA = 84.8%, 74.1%, 99.6%) was most effective in improving FMA-UE-Distal, FMA-UE-Proximal and ARAT function for subjects with upper limb dysfunction and stroke, respectively. IR (SUCRA = 70.5%) ranked highest in improving FMA-UE-Total with upper limb motor function amongst subjects with stroke. The BCI (SUCRA = 73.6%) also had the most significant advantage in improving their MBI daily living ability. Conclusions The network meta-analysis (NMA) results and SUCRA rankings suggest RT + VR appears to have a greater advantage compared with other interventions in improving upper limb motor function amongst subjects with stroke in FMA-UE-Proximal and FMA-UE-Distal and ARAT. Similarly, IR had shown the most significant advantage over other interventions in improving the FMA-UE-Total upper limb motor function score of subjects with stroke. The BCI also had the most significant advantage in improving their MBI daily living ability. Future studies should consider and report on key patient characteristics, such as stroke severity, degree of upper limb impairment, and treatment intensity/frequency and duration. Systematic review registration www.crd.york.ac.uk/prospero/#recordDetail, identifier: CRD42022337776.
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Affiliation(s)
- Yu Zhu
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
- Linfen Central Hospital, Linfen, Shanxi, China
| | - Chen Wang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Jin Li
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Liqing Zeng
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Peizhen Zhang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
- *Correspondence: Peizhen Zhang
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Kim GJ, Parnandi A, Eva S, Schambra H. The use of wearable sensors to assess and treat the upper extremity after stroke: a scoping review. Disabil Rehabil 2022; 44:6119-6138. [PMID: 34328803 PMCID: PMC9912423 DOI: 10.1080/09638288.2021.1957027] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/25/2021] [Accepted: 07/13/2021] [Indexed: 01/27/2023]
Abstract
PURPOSE To address the gap in the literature and clarify the expanding role of wearable sensor data in stroke rehabilitation, we summarized the methods for upper extremity (UE) sensor-based assessment and sensor-based treatment. MATERIALS AND METHODS The guideline outlined by the preferred reporting items for systematic reviews and meta-analysis extension for scoping reviews was used to complete this scoping review. Information pertaining to participant demographics, sensory information, data collection, data processing, data analysis, and study results were extracted from the studies for analysis and synthesis. RESULTS We included 43 articles in the final review. We organized the results into assessment and treatment categories. The included articles used wearable sensors to identify UE functional motion, categorize motor impairment/activity limitation, and quantify real-world use. Wearable sensors were also used to augment UE training by triggering sensory cues or providing instructional feedback about the affected UE. CONCLUSIONS Sensors have the potential to greatly expand assessment and treatment beyond traditional clinic-based approaches. This capability could support the quantification of rehabilitation dose, the nuanced assessment of impairment and activity limitation, the characterization of daily UE use patterns in real-world settings, and augment UE training adherence for home-based rehabilitation.IMPLICATIONS FOR REHABILITATIONSensor data have been used to assess UE functional motion, motor impairment/activity limitation, and real-world use.Sensor-assisted treatment approaches are emerging, and may be a promising tool to augment UE adherence in home-based rehabilitation.Wearable sensors may extend our ability to objectively assess UE motion beyond supervised clinical settings, and into home and community settings.
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Affiliation(s)
- Grace J. Kim
- Department of Occupational Therapy, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA
| | - Avinash Parnandi
- Department of Neurology, NYU Langone Grossman School of Medicine, New York, NY, USA
| | - Sharon Eva
- Department of Occupational Therapy, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Heidi Schambra
- Department of Neurology, NYU Langone Grossman School of Medicine, New York, NY, USA
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11
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Lundquist CB, Nguyen BT, Hvidt TB, Stabel HH, Christensen JR, Brunner I. Changes in upper limb capacity and performance in the early and late subacute phase after stroke. J Stroke Cerebrovasc Dis 2022; 31:106590. [PMID: 35716523 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The course of spontaneous biological recovery indicates that no essential improvements in upper limb (UL) capacity should be expected 3 months after stroke. Likewise, UL performance as assessed with accelerometers does not seem to increase. However, this plateau may not apply to all patients with stroke. OBJECTIVES This study aimed to investigate the changes in UL capacity and performance from 3 to 6 months post-stroke, and the association between patients' UL capacity and actual UL performance. METHODS This study was a secondary analysis of a prospective longitudinal cohort study. Patients with UL impairment and first or recurrent stroke were included. Their UL capacity was assessed at 3 and 6 months with the Action Research Arm Test (ARAT) and UL performance was examined with accelerometry and expressed as a use ratio. The association between ARAT and use ratio was examined with multiple regression analyses. RESULTS Data from 67 patients were analyzed. It was shown that UL capacity as assessed with ARAT still improved from 3 to 6 months. A clinically meaningful improvement (≥ 6 points on ARAT) was found in 16 (46%) of the 35 patients whose scores allowed for such an increase. Improvements were mainly observed for patients with ARAT scores in the range of 15-51 at 3 months. Conversely, UL performance did not change. Three and 6 months after stroke respectively 69% and 64% of the variation in use ratio was explained by ARAT. CONCLUSION While a substantial part of patients improved their UL capacity, UL performance did not change from 3 to 6 months post-stroke. Strategies to remind patients of including their affected UL may encourage the transfer from better capacity to increased performance.
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Affiliation(s)
- Camilla Biering Lundquist
- Hammel Neurorehabilitation Centre and University Research Clinic, University of Aarhus, Denmark, Voldbyvej 15, 8450 Hammel, Denmark
| | - Binh Tan Nguyen
- User perspectives and Community-based Practice, Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9b, 5000 Odense, Denmark
| | - Thomas Bo Hvidt
- User perspectives and Community-based Practice, Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9b, 5000 Odense, Denmark
| | - Henriette Holm Stabel
- Hammel Neurorehabilitation Centre and University Research Clinic, University of Aarhus, Denmark, Voldbyvej 15, 8450 Hammel, Denmark
| | - Jeanette Reffstrup Christensen
- User perspectives and Community-based Practice, Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9b, 5000 Odense, Denmark; The Research Unit of General Practice, Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9b, 5000 Odense, Denmark; The Research Unit of General Practice, Aarhus University, Bartholins Alle 2, 8000 Aarhus C, Denmark
| | - Iris Brunner
- Hammel Neurorehabilitation Centre and University Research Clinic, University of Aarhus, Denmark, Voldbyvej 15, 8450 Hammel, Denmark.
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12
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Determinants of Different Aspects of Upper-Limb Activity after Stroke. SENSORS 2022; 22:s22062273. [PMID: 35336443 PMCID: PMC8951346 DOI: 10.3390/s22062273] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 12/10/2022]
Abstract
We examined factors associated with different aspects of upper-limb (UL) activity in chronic stroke to better understand and improve UL activity in daily life. Three different aspects of UL activity were represented by four sensor measures: (1) contribution to activity according to activity ratio and magnitude ratio, (2) intensity of activity according to bilateral magnitude, and (3) variability of activity according to variation ratio. We combined data from a Belgian and Danish patient cohort (n = 126) and developed four models to determine associated factors for each sensor measure. Results from standard multiple regression show that motor impairment (Fugl−Meyer assessment) accounted for the largest part of the explained variance in all sensor measures (18−61%), with less motor impairment resulting in higher UL activity values (p < 0.001). Higher activity ratio, magnitude ratio, and variation ratio were further explained by having the dominant hand affected (p < 0.007). Bilateral magnitude had the lowest explained variance (adjusted R2 = 0.376), and higher values were further associated with being young and female. As motor impairment and biological aspects accounted for only one- to two-thirds of the variance in UL activity, rehabilitation including behavioral strategies might be important to increase the different aspects of UL activity.
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13
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Essers B, Van Gils A, Lafosse C, Michielsen M, Beyens H, Schillebeeckx F, Veerbeek JM, Luft AR, Kos D, Verheyden G. Evolution and prediction of mismatch between observed and perceived upper limb function after stroke: a prospective, longitudinal, observational cohort study. BMC Neurol 2021; 21:488. [PMID: 34906100 PMCID: PMC8672498 DOI: 10.1186/s12883-021-02493-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A previously shown 'mismatch' group of patients with good observed upper limb (UL) motor function but low perceived UL activity at six months post stroke tends to use the affected UL less in daily life than would be expected based on clinical tests, and this mismatch may also be present at 12 months. We aimed to confirm this group in another cohort, to investigate the evolution of this group from six to 12 months, and to determine factors on admission to inpatient rehabilitation and at 6 months that can discriminate between mismatch and good match groups at 12 months. METHODS Persons after stroke were recruited on rehabilitation admission and re-assessed at six and 12 months. Observed UL function was measured with the upper extremity subscale of the Fugl-Meyer Assessment (FMA-UE) and perceived UL activity by the hand subscale of the Stroke Impact Scale 3.0 (SIS-Hand). We defined mismatch as good observed UL function (FMA-UE > 50/66) but low perceived activity (SIS-Hand≤75/100). Potential discriminators at admission and 6 months (demographic characteristics, stroke characteristics, UL somatosensory function, cognitive deficits, mental function and activity) were statistically compared for match and mismatch groups at 12 months. RESULTS We included 60 participants (female: 42%) with mean (SD) age of 65 (12) years. We confirmed a mismatch group of 11 (18%) patients at 6 months, which increased to 14 (23%) patients at 12 months. In the mismatch group compared to the good match group at 12 months, patients had a higher stroke severity and more somatosensory impairments on admission and at 6 months. CONCLUSIONS We confirmed a group of patients with good observed UL function but low perceived activity both at six and at 12 months post stroke. Assessment of stroke severity and somatosensory impairments on admission into rehabilitation could determine mismatch at 12 months and might warrant intervention. However, large differences in clinical outcomes between patients in the mismatch group indicate the importance of tailoring training to the individual needs.
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Affiliation(s)
- Bea Essers
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3001, Leuven, Belgium.
| | - Annick Van Gils
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3001, Leuven, Belgium
| | - Christophe Lafosse
- Department of Allied Health and Department of Research, Rehabilitation Hospital RevArte, Antwerp, Belgium
| | - Marc Michielsen
- Rehabilitation Campus Sint Ursula, Jessa Hospital, Hasselt, Belgium
| | - Hilde Beyens
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Fabienne Schillebeeckx
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | | | - Andreas R Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Daphne Kos
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3001, Leuven, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3001, Leuven, Belgium
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14
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El-Kafy EMA, Alshehri MA, El-Fiky AAR, Guermazi MA. The Effect of Virtual Reality-Based Therapy on Improving Upper Limb Functions in Individuals With Stroke: A Randomized Control Trial. Front Aging Neurosci 2021; 13:731343. [PMID: 34795574 PMCID: PMC8594757 DOI: 10.3389/fnagi.2021.731343] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/11/2021] [Indexed: 01/17/2023] Open
Abstract
Background: Stroke is a common cause of motor disability. The recovery of upper limb after stroke is poor, with few stroke survivors regaining some functional use of the affected upper limb. This is further complicated by the fact that the prolonged rehabilitation is accompanied by multiple challenges in using and identifying meaningful and motivated treatment tasks that may be adapted and graded to facilitate the rehabilitation program. Virtual reality-based therapy is one of the most innovative approaches in rehabilitation technology and virtual reality systems can provide enhanced feedback to promote motor learning in individuals with neurological or musculoskeletal diseases. Purpose: This study investigated the effect of virtual reality-based therapy on improving upper limb functions in individuals with chronic stroke. Methods: Forty Saudi individuals with chronic stroke (6–24 months following stroke incidence) and degree of spasticity ranged between 1, 1 + and 2 according to Modified Ashworth Scale were included in this study. Participants were randomly assigned into two groups, experimental and control, with the experimental group undertaking a conventional 1-h functional training program, followed by another hour of virtual reality-based therapy using Armeo Spring equipment and the control group received 2 h of a conventional functional training program. The treatment program was conducted three times per week for three successive months. The change in the scores of Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), WMFT-Time (time required to complete the test) and Hand Grip Strength (HGS) were recorded at baseline and after completion of the treatment. Parametric (paired and unpaired t-tests) non-parametric (Wilcoxon and Mann–Whitney tests) statistical tests were used to identify the differences within and between groups (experimental group and control group) and evaluation times (pre- and immediately post-treatment). Results: Both groups showed significant differences (all, P < 0.05) in all measured variables after 3 months of the treatment. Individuals with stoke in the experimental group had a better improvement in ARAT (P < 0.01), WMFT (P < 0.01) and WMFT-Time (P < 0.01) scores after completion of the treatment compared to the control group. No significant difference in HGS scores was detected between groups after completion of the treatment (P = 0.252). Conclusion: The use of combined treatment of virtual reality-based therapy and conventional functional training program is more effective for improving upper limb functions in individuals with chronic stroke than the use of the conventional program alone.
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Affiliation(s)
- Ehab Mohamed Abd El-Kafy
- Department of Physiotherapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Mansour Abdullah Alshehri
- Department of Physiotherapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Amir Abdel-Raouf El-Fiky
- Department of Physiotherapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia
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15
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Essers B, Coremans M, Veerbeek J, Luft A, Verheyden G. Daily Life Upper Limb Activity for Patients with Match and Mismatch between Observed Function and Perceived Activity in the Chronic Phase Post Stroke. SENSORS (BASEL, SWITZERLAND) 2021; 21:5917. [PMID: 34502808 PMCID: PMC8434498 DOI: 10.3390/s21175917] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 01/03/2023]
Abstract
We investigated actual daily life upper limb (UL) activity in relation to observed UL motor function and perceived UL activity in chronic stroke in order to better understand and improve UL activity in daily life. In 60 patients, we collected (1) observed UL motor function (Fugl-Meyer Assessment (FMA-UE)), (2) perceived UL activity (hand subscale of the Stroke Impact Scale (SIS-Hand)), and (3) daily life UL activity (bilateral wrist-worn accelerometers for 72 h) data. Data were compared between two groups of interest, namely (1) good observed (FMA-UE >50) function and good perceived (SIS-Hand >75) activity (good match, n = 16) and (2) good observed function but low perceived (SIS-Hand ≤75) activity (mismatch, n = 15) with Mann-Whitney U analysis. The mismatch group only differed from the good match group in perceived UL activity (median (Q1-Q3) = 50 (30-70) versus 93 (85-100); p < 0.001). Despite similar observed UL motor function and other clinical characteristics, the affected UL in the mismatch group was less active in daily life compared to the good match group (p = 0.013), and the contribution of the affected UL compared to the unaffected UL for each second of activity (magnitude ratio) was lower (p = 0.022). We conclude that people with chronic stroke with low perceived UL activity indeed tend to use their affected UL less in daily life despite good observed UL motor function.
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Affiliation(s)
- Bea Essers
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium; (M.C.); (G.V.)
| | - Marjan Coremans
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium; (M.C.); (G.V.)
| | - Janne Veerbeek
- Luzerner Kantonsspital, Neurocenter, 6000 Lucerne, Switzerland;
| | - Andreas Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology and Clinical Neuroscience Center, University of Zurich and University Hospital Zurich, 8091 Zurich, Switzerland;
- Cereneo, Center for Neurology and Rehabilitation, 6354 Vitznau, Switzerland
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium; (M.C.); (G.V.)
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16
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Lundquist CB, Nielsen JF, Brunner IC. Prediction of Upper Limb use Three Months after Stroke: A Prospective Longitudinal Study. J Stroke Cerebrovasc Dis 2021; 30:106025. [PMID: 34464925 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/16/2021] [Accepted: 07/25/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A major goal of upper limb (UL) rehabilitation after stroke is to facilitate the use of the paretic arm in daily life activities. PURPOSE To examine if UL impairment two weeks after stroke can predict real-life UL use at three months. Furthermore, to identify additional factors which contribute to future UL use, and characteristics of patients who do not achieve normal UL use. METHODS This study included patients with stroke ≥ 18 years. UL impairment was assessed by Fugl-Meyer upper extremity motor assessment (FM). Use ratio between affected and unaffected UL was assessed with accelerometers at three months after stroke. The association between FM score and UL use ratio was investigated with linear regression models and adjusted for secondary variables. Non-normal use was examined by a logistic regression. RESULTS Eighty-seven patients were included. FM score two weeks after stroke predicted 38% of the variance in UL use ratio three months after stroke. A multivariate regression model predicted 55%, and the significant predictors were FM, motor-evoked potential (MEP) status, and neglect. Non-normal use could be predicted with a high accuracy based on MEP and/or neglect. In a logistic regression sensitivity for prediction of non-normal use was 0.93 and specificity was 0.75. CONCLUSION Better baseline capacity of the paretic UL predicted increased use of the arm and hand in daily life. Non-normal UL use could be predicted reliably based on the absence of MEPs and/or presence of neglect.
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Affiliation(s)
- Camilla Biering Lundquist
- Research Department, Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.
| | - Jørgen Feldbæk Nielsen
- Research Department, Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.
| | - Iris Charlotte Brunner
- Research Department, Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark; Aarhus University, Department of Clinical Medicine, Denmark.
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17
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Chin LF, Hayward KS, Chai ALM, Brauer SG. A Self-Empowered Upper Limb Repetitive Engagement Program to Improve Upper Limb Recovery Early Post-Stroke: Phase II Pilot Randomized Controlled Trial. Neurorehabil Neural Repair 2021; 35:836-848. [PMID: 34281405 DOI: 10.1177/15459683211032967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Time outside therapy provides an opportunity to increase upper limb (UL) use during post-stroke hospitalization. Objective. To determine if a self-directed UL program outside therapy (Self-Empowered UL Repetitive Engagement, SURE) was feasible and to explore the potential effect of the SURE program on UL use and recovery. Methods. Twenty-three patients from an inpatient rehabilitation center who were ≤21 days post-stroke and had a Fugl Meyer UL (FMUL) score ≤50 and a positive motor evoked potential (MEP+) response were randomized (stratified by impairment) to either experimental group (SURE: individualized, UL self-exercise and use outside therapy for 6 hours/week for 4 weeks) or control group (education booklet). Feasibility was evaluated by program adherence, dropout rate, adverse events, and satisfaction. Potential effect was measured by paretic UL use via accelerometry weekly during the intervention, FMUL and Action Research Arm Test (ARAT) at baseline (Week 0), post-intervention (Week 4), and follow-up (Week 8 and Week 16). Results. Adherence to SURE was high: 87% program completion (mean 313±75 repetitions/day). There were no dropouts, no adverse events related to SURE, and patient satisfaction averaged 7.8/10. Experimental participants achieved an additional hour of UL use daily (range: .3-1.2 hours/day) compared to control. Significant improvements in FMUL and ARAT were observed in both groups from Week 0 to Week 4 and to Week 8 (P ≤ .002), which were maintained to Week 16. There were no differences between groups (P ≥ .119). Conclusions. SURE was a feasible self-directed program that increased UL use in MEP+ individuals with moderate-severe impairment early post-stroke. Further studies with larger sample sizes and potentially higher dose are required to determine efficacy.
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Affiliation(s)
- Lay Fong Chin
- Rehabilitation Centre, Tan Tock Seng Hospital, Singapore, Singapore.,Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Kathryn S Hayward
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia.,Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, VIC, 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, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - Sandra G Brauer
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
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18
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David A, ReethaJanetSureka S, Gayathri S, Annamalai SJ, Samuelkamleshkumar S, Kuruvilla A, Magimairaj HP, Varadhan S, Balasubramanian S. Quantification of the relative arm use in patients with hemiparesis using inertial measurement units. J Rehabil Assist Technol Eng 2021; 8:20556683211019694. [PMID: 34290880 PMCID: PMC8273871 DOI: 10.1177/20556683211019694] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 05/05/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Accelerometry-based activity counting for measuring arm use is prone to overestimation due to non-functional movements. In this paper, we used an inertial measurement unit (IMU)-based gross movement (GM) score to quantify arm use. Methods In this two-part study, we first characterized the GM by comparing it to annotated video recordings of 5 hemiparetic patients and 10 control subjects performing a set of activities. In the second part, we tracked the arm use of 5 patients and 5 controls using two wrist-worn IMUs for 7 and 3 days, respectively. The IMU data was used to develop quantitative measures (total and relative arm use) and a visualization method for arm use. Results From the characterization study, we found that GM detects functional activities with 50–60% accuracy and eliminates non-functional activities with >90% accuracy. Continuous monitoring of arm use showed that the arm use was biased towards the dominant limb and less paretic limb for controls and patients, respectively. Conclusions The gross movement score has good specificity but low sensitivity in identifying functional activity. The at-home study showed that it is feasible to use two IMU-watches to monitor relative arm use and provided design considerations for improving the assessment method. Clinical trial registry number: CTRI/2018/09/015648
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Affiliation(s)
- Ann David
- Department of Applied Mechanics, Indian Institute of Technology, Madras, Tamil Nadu, India.,Department of Bioengineering, Christian Medical College (CMC) Vellore, Tamil Nadu, India
| | | | - Sankaralingam Gayathri
- Department of Physical Medicine and Rehabilitation, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | | | - Selvaraj Samuelkamleshkumar
- Department of Physical Medicine and Rehabilitation, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Anju Kuruvilla
- Department of Psychiatry, Christian Medical College (CMC) Vellore, Tamil Nadu, India
| | - Henry Prakash Magimairaj
- Department of Physical Medicine and Rehabilitation, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Skm Varadhan
- Department of Applied Mechanics, Indian Institute of Technology, Madras, Tamil Nadu, India
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19
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Factors Influencing Paretic Upper Limb Use During First 4 Weeks After Stroke. Am J Phys Med Rehabil 2020; 100:153-160. [DOI: 10.1097/phm.0000000000001539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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