Successful performance of basic gestures in tablet technology in post stroke patients: A feasibility study

Correlation between the Ability to Manipulate a Touchscreen Device and Hand Strength and Manual Dexterity among Community-Living Older Individuals

Information regarding the relationship between the degree of hand function among the elderly as measured by traditional assessments and the ability to manipulate touchscreens is lacking. This study aimed to examine the correlation between the ability to manipulate a touchscreen device, as assessed using the touchscreen assessment tool (TATOO) (University of Haifa, Israel & Universetiy of Bologna, Italy), and hand strength and manual dexterity among independent community-living older individuals. Thirty-four community-living older adults (average age 79.4 ± 6.7 years) participated in single-session assessments lasting 45 min each. The assessment included hand strength measurement using the manual hand dynamometry and hydraulic pinch gauge, a functional dexterity test (FDT), and TATOO. No significant correlations were observed between most of the TATOO items (22 out of 26) and handgrip strength, pinch strength, and FDT results. Moderately significant correlations were demonstrated between the number of drag attempts in the “Drag to different directions” task and handgrip strength and manual dexterity (r value: −0.39, p value: 0.02; r value: 0.36, p value: 0.04, respectively). In addition, a moderately significant correlation was noted between the number of double taps and manual dexterity (r value: 0.32, p value: 0.07). These results indicate that more complex gestures that require greater accuracy (dragging task) or rapid movements (double tapping) are related to hand strength and manual dexterity. These results suggest that the manual gestures necessary for touchscreen operation entail unique and specific capabilities that are generally not captured by traditional tools. The clinical implication is that the hand function assessment toolbox should be expanded. Tools such as the TATOO should be used to capture skills required for touchscreen manipulation in the context of the modern digital milieu.

Validity, reliability, and sensitivity to motor impairment severity of a multi-touch app designed to assess hand mobility, coordination, and function after stroke

BACKGROUND

The assessment of upper-limb motor impairments after stroke is usually performed using clinical scales and tests, which may lack accuracy and specificity and be biased. Although some instruments exist that are capable of evaluating hand functions and grasping during functional tasks, hand mobility and dexterity are generally either not specifically considered during clinical assessments or these examinations lack accuracy. This study aimed to determine the convergent validity, reliability, and sensitivity to impairment severity after a stroke of a dedicated, multi-touch app, named the Hand Assessment Test.

METHODS

The hand mobility, coordination, and function of 88 individuals with stroke were assessed using the app, and their upper-limb functions were assessed using the Fugl-Meyer Assessment for Upper Extremity, the Jebsen-Taylor Hand Function Test, the Box and Block Test, and the Nine Hole Peg Test. Twenty-three participants were further considered to investigate inter- and intra-rater reliability, standard error of measurement, and the minimal detectable change threshold of the app. Finally, participants were categorized according to motor impairment severity and the sensitivity of the app relative to these classifications was investigated.

RESULTS

Significant correlations, of variable strengths, were found between the measurements performed by the app and the clinical scales and tests. Variable reliability, ranging from moderate to excellent, was found for all app measurements. Exercises that involved tapping and maximum finger-pincer grasp were sensitive to motor impairment severity.

CONCLUSIONS

The convergent validity, reliability, and sensitivity to motor impairment severity of the app, especially of those exercises that involved tapping and the maximum extension of the fingers, together with the widespread availability of the app, could support the use of this and similar apps to complement conventional clinical assessments of hand function after stroke.

Physiotherapists' and occupational therapists' perspectives on information and communication technology in stroke rehabilitation

Aim

The aim of this study was to explore the current and potential use of information and communication technology (ICT) to enhance coherent person-centred rehabilitation after stroke, from the perspectives of physiotherapists and occupational therapists.

Method

Five occupational therapists and four physiotherapists from different phases of the Danish stroke rehabilitation process were included and two focus group interviews were carried out. A grounded theory approach was used throughout the study and a constant comparative method was used in the analysis.

Results

Three subcategories were identified from the analysis of interviews with participants: 1) ICT and apps as meaningful and supportive in the rehabilitation process, 2) ICT as a tool in communication and documentation and 3) Barriers to the integration of ICT and apps in the rehabilitation process. From these categories one core category emerged: The potential of a personalized app solution to facilitate coherent person-centred rehabilitation.

Conclusion

ICT was perceived as important to integrate in stroke rehabilitation both for assessment, training and to compensate for remaining deficits. The development of a personalized app solution could accommodate stroke survivors’ and significant others’ need for insight into and overview over the rehabilitation process as well as access to relevant information, which would thereby empower them. Furthermore, a personalized app solution could also facilitate follow-up after discharge and was perceived to ease the communication and documentation within and between sectors, as well as communication with both stroke survivors and significant others.