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Simpson LA, Barclay R, Bayley MT, Dukelow SP, MacIntosh BJ, McKay-Lyons M, Menon C, Mortenson WB, Peng TH, Pollock CL, Pooyania S, Teasell R, Yang CL, Yao J, Eng JJ. Virtual Arm Boot Camp (V-ABC): study protocol for a mixed-methods study to increase upper limb recovery after stroke with an intensive program coupled with a grasp count device. Trials 2022; 23:129. [PMID: 35135585 PMCID: PMC8822776 DOI: 10.1186/s13063-022-06047-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background Encouraging upper limb use and increasing intensity of practice in rehabilitation are two important goals for optimizing upper limb recovery post stroke. Feedback from novel wearable sensors may influence practice behaviour to promote achieving these goals. A wearable sensor can potentially be used in conjunction with a virtually monitored home program for greater patient convenience, or due to restrictions that preclude in-person visits, such as COVID-19. This trial aims to (1) determine the efficacy of a virtual behaviour change program that relies on feedback from a custom wearable sensor to increase use and function of the upper limb post stroke; and (2) explore the experiences and perceptions of using a program coupled with wearable sensors to increase arm use from the perspective of people with stroke. Methods This mixed-methods study will utilize a prospective controlled trial with random allocation to immediate or 3-week delayed entry to determine the efficacy of a 3-week behaviour change program with a nested qualitative description study. The intervention, the Virtual Arm Boot Camp (V-ABC) features feedback from a wearable device, which is intended to increase upper limb use post stroke, as well as 6 virtual sessions with a therapist. Sixty-four adults within 1-year post stroke onset will be recruited from seven rehabilitation centres. All outcomes will be collected virtually. The primary outcome measure is upper limb use measured by grasp counts over 3 days from the wearable sensor (TENZR) after the 3-week intervention. Secondary outcomes include upper limb function (Arm Capacity and Movement Test) and self-reported function (Hand Function and Strength subscale from the Stroke Impact Scale). Outcome data will be collected at baseline, post-intervention and at 2 months retention. The qualitative component will explore the experiences and acceptability of using a home program with a wearable sensor for increasing arm use from the point of view of individuals with stroke. Semi-structured interviews will be conducted with participants after they have experienced the intervention. Qualitative data will be analysed using content analysis. Discussion This study will provide novel information regarding the efficacy and acceptability of virtually delivered programs to improve upper extremity recovery, and the use of wearable sensors to assist with behaviour change. Trial registration ClinicalTrials.govNCT04232163. January 18, 2020.
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Affiliation(s)
- Lisa A Simpson
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada
| | - Ruth Barclay
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Mark T Bayley
- Division of Physical Medicine and Rehabilitation, University of Toronto and KITE Research Institute University Health Network, Toronto, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | | | | | - Carlo Menon
- Department of Health Sciences and Technology, ETH, Zurich, Switzerland
| | - W Ben Mortenson
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries, Vancouver, Canada
| | - Tzu-Hsuan Peng
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada
| | - Courtney L Pollock
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Sepideh Pooyania
- Division of Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, Canada
| | - Robert Teasell
- Schulich School of Medicine & Dentistry, Western University and Parkwood Institute Research, Lawson Health Research Institute, London, Canada
| | - Chieh-Ling Yang
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada.,Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Jennifer Yao
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada.,Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
| | - Janice J Eng
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada. .,International Collaboration on Repair Discoveries, Vancouver, Canada. .,Department of Physical Therapy, University of British Columbia, Vancouver, Canada. .,University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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Smith BW, Chang KWC, Saake SJ, Yang LJS, Chung KC, Brown SH. Quantifying Real-World Upper-Limb Activity Via Patient-Initiated Movement After Nerve Reconstruction for Upper Brachial Plexus Injury. Neurosurgery 2020; 85:369-374. [PMID: 30060090 DOI: 10.1093/neuros/nyy335] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/21/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A critical concept in brachial plexus reconstruction is the accurate assessment of functional outcomes. The current standard for motor outcome assessment is clinician-elicited, outpatient clinic-based, serial evaluation of range of motion and muscle power. However, discrepancies exist between such clinical measurements and actual patient-initiated use. We employed emerging technology in the form of accelerometry-based motion detectors to quantify real-world arm use after brachial plexus surgery. OBJECTIVE To evaluate (1) the ability of accelerometry-based motion detectors to assess functional outcome and (2) the real-world arm use of patients after nerve transfer for brachial plexus injury, through a pilot study. METHODS Five male patients who underwent nerve transfer after brachial plexus injury wore bilateral motion detectors for 7 d. The patients also underwent range-of-motion evaluation and completed multiple patient-reported outcome surveys. RESULTS The average age of the recruits was 41 yr (±17 yr), and the average time from operation was 2 yr (±1 yr). The VT (time of use ratio) for the affected side compared to the unaffected side was 0.73 (±0.27), and the VM (magnitude ratio) was 0.63 (±0.59). VT strongly and positively correlated with shoulder flexion and shoulder abduction: 0.97 (P = .008) and 0.99 (P = .002), respectively. CONCLUSION Accelerometry-based activity monitors can successfully assess real-world functional outcomes after brachial plexus reconstruction. This pilot study demonstrates that patients after nerve transfer are utilizing their affected limbs significantly in daily activities and that recovery of shoulder function is critical.
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Affiliation(s)
- Brandon W Smith
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Kate W-C Chang
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Serena J Saake
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Lynda J-S Yang
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Susan H Brown
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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