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Tej Kantu N, Osswald R, Kandel A, Kang J. Resist-as-Needed ADL Training With SPINDLE for Patients With Tremor. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1735-1748. [PMID: 38652620 DOI: 10.1109/tnsre.2024.3392615] [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: 04/25/2024]
Abstract
Individuals with neurological disorders often exhibit altered manual dexterity and muscle weakness in their upper limbs. These motor impairments with tremor lead to severe difficulties in performing Activities of Daily Living (ADL). There is a critical need for ADL-focused robotic training that improves individual's strength when engaging with dexterous ADL tasks. This research introduces a new approach to training ADLs by employing a novel robotic rehabilitation system, Spherical Parallel INstrument for Daily Living Emulation (SPINDLE), which incorporates Virtual Reality (VR) to simulate ADL tasks. The study results present the feasibility of training individuals with movements similar to ADLs while interacting with the SPINDLE. A new game-based robotic training paradigm is suggested to perform ADL tasks at various intensity levels of resistance as needed. The proposed system can facilitate the training of various ADLs requiring 3-dimensional rotational movements by providing optimal resistance and visual feedback. We envision this system can be utilized as a table-top home device by restoring the impaired motor function of individuals with tremor and muscle weakness, guiding to improved ADL performance and quality of life.
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Feingold-Polak R, Barzel O, Levy-Tzedek S. Socially Assistive Robot for Stroke Rehabilitation: A Long-Term in-the-Wild Pilot Randomized Controlled Trial. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1616-1626. [PMID: 38598401 DOI: 10.1109/tnsre.2024.3387320] [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: 04/12/2024]
Abstract
Socially assistive robots (SARs) have been suggested as a platform for post-stroke training. It is not yet known whether long-term interaction with a SAR can lead to an improvement in the functional ability of individuals post-stroke. The aim of this pilot study was to compare the changes in motor ability and quality of life following a long-term intervention for upper-limb rehabilitation of post-stroke individuals using three approaches: 1) training with a SAR in addition to usual care; 2) training with a computer in addition to usual care; and 3) usual care with no additional intervention. Thirty-three post-stroke patients with moderate-severe to mild impairment were randomly allocated into three groups: two intervention groups - one with a SAR (ROBOT group) and one with a computer (COMPUTER group) - and one control group with no intervention (CONTROL group). The intervention sessions took place three times/week, for a total of 15 sessions/participant; The study was conducted over a period of two years, during which 306 sessions were held. Twenty-six participants completed the study. Participants in the ROBOT group significantly improved in their kinematic and clinical measures which included smoothness of movement, action research arm test (ARAT), and Fugl-Meyer upper-extremity assessment (FMA-UE). No significant improvement in these measures was found in the COMPUTER or the control groups. 100% of the participants in the SAR group gained improvement which reached - or exceeded - the minimal clinically important difference in the ARAT, the gold standard for upper-extremity activity performance post-stroke. This study demonstrates both the feasibility and the clinical benefit of using a SAR for long-term interaction with post-stroke individuals as part of their rehabilitation program. Trial Registration: ClinicalTrials.gov NCT03651063.
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Demers M, Bishop L, Cain A, Saba J, Rowe J, Zondervan DK, Winstein CJ. Wearable Technology to Capture Arm Use of People With Stroke in Home and Community Settings: Feasibility and Early Insights on Motor Performance. Phys Ther 2024; 104:pzad172. [PMID: 38166199 PMCID: PMC10851839 DOI: 10.1093/ptj/pzad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/21/2023] [Accepted: 09/13/2023] [Indexed: 01/04/2024]
Abstract
OBJECTIVE The objectives of this study were to establish the short-term feasibility and usability of wrist-worn wearable sensors for capturing the arm and hand activity of people with stroke and to explore the association between factors related to the use of the paretic arm and hand. METHODS Thirty people with chronic stroke were monitored with wrist-worn wearable sensors for 12 hours per 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. The usability of the wearable sensors was assessed using the adapted System Usability Scale and an exit interview. Associations between motor performance and capacity (arm and hand impairments and activity limitations) were assessed using Spearman 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. The average sensor wear time was 12.6 (standard deviation [SD] = 0.2) hours per day. Three participants experienced discomfort with 1 of the wristbands, and 3 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 correlation coefficients = 0.44-0.71). CONCLUSIONS This work demonstrates the feasibility and usability of a consumer-grade wearable sensor for capturing paretic arm activity outside the laboratory. It provides early insight into the everyday arm use of people with stroke 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. Insight gained from monitoring the arm and hand use of people with stroke in the home and community is the first step toward informing future research with an emphasis on causal mechanisms with clinical relevance.
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Affiliation(s)
- Marika Demers
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - Lauri Bishop
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
- Department of Physical Therapy, University of Miami, Coral Gables, Florida, USA
| | - Amelia Cain
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - Joseph Saba
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - Justin Rowe
- Flint Rehabilitation Devices, Irvine, California, USA
| | | | - Carolee J Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
- Department of Neurology, USC Keck School of Medicine, Los Angeles, California, USA
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Bhattacharjya S, Linares I, Langan J, Xu W, Subryan H, Cavuoto LA. Engaging in a home-based exercise program: a mixed-methods approach to identify motivators and barriers for individuals with stroke. Assist Technol 2023; 35:487-496. [PMID: 36441082 PMCID: PMC10460826 DOI: 10.1080/10400435.2022.2151663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2022] [Indexed: 11/30/2022] Open
Abstract
Community-dwelling individuals with chronic stroke used a novel, portable rehabilitation system, mRehab, that uses a smartphone app coupled with 3D printed objects resembling daily use items. The objectives of this study include evaluating participant's approach and nature of engagement with mRehab and identifying factors that influenced the users' engagement with mRehab. An explanatory mixed-method approach was used. In the first phase, 16 participants used mRehab at home for six weeks; six participants were recruited from the first phase for in-depth interviews. Participants were categorized into High, Moderate, and Low Frequency groups based on their frequency of mRehab use. High frequency of use was not related to improved performance on clinical assessments; instead, High Frequency users more commonly initiated performance of new activities after the mRehab program compared to participants with lower frequency of use. Useful activities that are challenging and meaningful to the participants, and availability of objective feedback for self-monitoring were some of the motivators for mRehab use. Difficulty with time management, lack of caregiver availability, and difficulties with the design of the system posed as barriers to mRehab use. Tailoring home programs to the recipients' needs including perceived meaningfulness of the activities is key for long-term rehabilitation.
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Affiliation(s)
| | - Isabelle Linares
- Biomedical Engineering, University at Buffalo, Buffalo, New York, USA
| | - Jeanne Langan
- Rehabilitation Science, University at Buffalo, Buffalo, New York, USA
| | - Wenyao Xu
- Computer Science and Engineering, University at Buffalo, Buffalo, New York, USA
| | - Heamchand Subryan
- Center for Inclusive Design and Environmental Access, University at Buffalo, Buffalo, New York, USA
| | - Lora Anne Cavuoto
- Industrial and Systems Engineering, University at Buffalo, Buffalo, New York, USA
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Kaneko T, Maeda M, Yokoyama H, Kai S, Obuchi K, Takase S, Horimoto T, Shimada R, Moriya T, Ohmae H, Amanai M, Okita Y, Takebayashi T. Therapeutic effect of adjuvant therapy added to constraint-induced movement therapy in patients with subacute to chronic stroke: a systematic review and meta-analysis. Disabil Rehabil 2023:1-15. [PMID: 37855247 DOI: 10.1080/09638288.2023.2269843] [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: 01/16/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE This review investigated the effectiveness of adjuvant therapy combined with constraint-induced movement therapy (CIMT) in improving the paretic upper limb functionality in adults with stroke sequelae during the subacute to chronic rehabilitation phase. MATERIALS AND METHODS In this systematic review and meta-analysis of randomized controlled trials (RCT), electronic databases, including PubMed, Web of Science, CINAHL, and MEDLINE, were searched. We included RCTs that investigated the outcomes of adjuvant therapy (i.e. other therapies) added to CIMT compared with CIMT alone. Key trial findings were qualitatively synthesized and analyzed. This meta-analysis examined variables, such as mean scores and standard deviations, using the following outcome measures: Fugl-Meyer Assessment (FMA) upper limb items, Action Research Arm Test (ARAT), Amount of Use (AOU) of Motor Activity Log (MAL), and Quality of Movement (QOM) of MAL. RESULTS Eighteen eligible RCTs were included in the analysis. Adding CIMT to adjunctive therapy significantly improved FMA compared with CIMT alone (mean difference [MD] 4.02, 95% confidence interval [CI] 2.60-5.44; I2 = 85%; 15 studies; 330 participants). Similarly, the ARAT and MAL-AOU scores improved significantly. CONCLUSIONS CIMT combined with several adjunctive therapies effectively improved upper limb function.
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Affiliation(s)
- Takao Kaneko
- Department of Rehabilitation, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Masanori Maeda
- Department of Occupational Therapy, JA Nagano Koseiren Kakeyu-Misayama Rehabilitation Center Kakeyu Hospital, Ueda, Japan
| | - Hiroki Yokoyama
- Department of Rehabilitation, Kansai Medical University Kuzuha Hospital, Hirakata, Japan
| | - Shinsuke Kai
- Department of Rehabilitation, Fukuoka Wajiro Hospital, Fukuoka, Japan
| | - Kohei Obuchi
- Department of Rehabilitation, Nagano Matsushiro General Hospital, Nagano, Japan
| | - Shun Takase
- Department of Rehabilitation, Kawasaki Kyodo Hospital, Kawasaki, Japan
| | - Takumi Horimoto
- Department of Rehabilitation, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Ryuichi Shimada
- Department of Occupational Therapy, Faculty of Health Sciences, Iryo Sosei University, Iwaki, Japan
| | - Takashi Moriya
- Department of Rehabilitation, Kosei Hospital, Medical Corporation Rokushinkai, Japan
| | - Hiroshi Ohmae
- Department of Rehabilitation, Tokushima University Hospital, Tokushima, Japan
| | - Masahiro Amanai
- Department of Rehabilitation, Kujira Hospital, Koto City, Japan
| | - Yuho Okita
- Soaring Health Sports, Wellness & Community Centre, Melbourne, Australia
| | - Takashi Takebayashi
- Department of Occupational Therapy, School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Japan
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Altenburger P, Ambike SS, Haddad JM. Integrating Motor Variability Evaluation Into Movement System Assessment. Phys Ther 2023; 103:pzad075. [PMID: 37364059 DOI: 10.1093/ptj/pzad075] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 01/26/2023] [Accepted: 03/19/2023] [Indexed: 06/28/2023]
Abstract
Common assessment tools for determining therapeutic success in rehabilitation typically focus on task-based outcomes. Task-based outcomes provide some understanding of the individual's functional ability and motor recovery; however, these clinical outcomes may have limited translation to a patient's functional ability in the real world. Limitations arise because (1) the focus on task-based outcome assessment often disregards the complexity of motor behavior, including motor variability, and (2) mobility in highly variable real-world environments requires movement adaptability that is made possible by motor variability. This Perspective argues that incorporating motor variability measures that reflect movement adaptability into routine clinical assessment would enable therapists to better evaluate progress toward optimal and safe real-world mobility. The challenges and opportunities associated with incorporating variability-based assessment of pathological movements are also discussed. This Perspective also indicates that the field of rehabilitation needs to leverage technology to advance the understanding of motor variability and its impact on an individual's ability to optimize movement. IMPACT This Perspective contends that traditional therapeutic assessments do not adequately evaluate the ability of individuals to adapt their movements to the challenges faced when negotiating the dynamic environments encountered during daily life. Assessment of motor variability derived during movement execution can address this issue and provide better insight into a patient's movement stability and maneuverability in the real world. Creating such a shift in motor system assessment would advance understanding of rehabilitative approaches to motor system recovery and intervention.
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Affiliation(s)
- Peter Altenburger
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, Indiana, USA
| | - Satyajit S Ambike
- Department of Health & Kinesiology, Purdue University, West Lafayette, Indiana, USA
| | - Jeffrey M Haddad
- Department of Health & Kinesiology, Purdue University, West Lafayette, Indiana, USA
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Woodbury M, Grattan ES, Li CY. Development of a Short Form Assessment Combining the Fugl-Meyer Assessment-Upper Extremity and the Wolf Motor Function Test for Evaluating Stroke Recovery. Arch Phys Med Rehabil 2023; 104:1661-1668. [PMID: 37245692 PMCID: PMC10543466 DOI: 10.1016/j.apmr.2023.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/14/2023] [Accepted: 04/26/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To use Rasch methodologies to combine the items of the Fugl-Meyer Assessment-Upper Extremity (FMA-UE, motor skill) and the Wolf Motor Function Test (WMFT, motor function) onto a single measurement metric and create an FMA-UE+WMFT short form. DESIGN Secondary analysis of preintervention data from 2 upper extremity stroke rehabilitation trials. Confirmatory factor analysis and Rasch rating scale analysis were first applied to examine the properties of the pooled item bank and then item response theory methodologies were used to develop the short form. Confirmatory factor analysis and Rasch analysis were then applied to the short form to examine the dimensionality and measurement properties. SETTING Outpatient academic medical research center. PARTICIPANTS Data from 167 participants who completed the FMA-UE and WMFT (rating scale score) were pooled (N=167). Participants were eligible if they had a stroke ≥3 months prior and had upper extremity (UE) hemiparesis and excluded if they had severe UE hemiparesis, severe UE spasticity, or UE pain. INTERVENTION Not applicable. MAIN OUTCOME MEASURES The dimensionality and measurement properties of the pooled 30-item FMA-UE and the 15-item WMFT and short form were examined. RESULTS Five items from the pool of 45 items were misfit and were removed. The 40-item pool demonstrated adequate measurement properties. A 15-item short form was then developed and met rating diagnostic scale criteria. All items on the 15-item short form met the Rasch fit criteria, and the assessment met criteria for reliability (Cronbach alpha=.94), separation (person separation = 3.7), and strata (number of strata = 5). CONCLUSIONS Items from the FMA-UE and WMFT can be pooled to create a psychometrically sound 15-item short form.
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Affiliation(s)
- Michelle Woodbury
- Department of Health Sciences & Research & Division of Occupational Therapy, Medical University of South Carolina, Charleston, SC.
| | - Emily S Grattan
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA; Pittsburgh VA Medical Center, Human Engineering Research Laboratories, Pittsburgh, PA
| | - Chih-Ying Li
- Department of Occupational Therapy, University of Texas Medical Branch, Galveston, TX
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Gardas SS, Lysaght C, McMillan AG, Kantak S, Willson JD, Patterson CG, Surkar SM. Bimanual Movement Characteristics and Real-World Performance Following Hand-Arm Bimanual Intensive Therapy in Children with Unilateral Cerebral Palsy. Behav Sci (Basel) 2023; 13:681. [PMID: 37622821 PMCID: PMC10451828 DOI: 10.3390/bs13080681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
The purpose of this study was to quantify characteristics of bimanual movement intensity during 30 h of hand-arm bimanual intensive therapy (HABIT) and bimanual performance (activities and participation) in real-world settings using accelerometers in children with unilateral cerebral palsy (UCP). Twenty-five children with UCP participated in a 30 h HABIT program. Data were collected from bilateral wrist-worn accelerometers during 30 h of HABIT to quantify the movement intensity and three days pre- and post-HABIT to assess real-world performance gains. Movement intensity and performance gains were measured using six standard accelerometer-derived variables. Bimanual capacity (body function and activities) was assessed using standardized hand function tests. We found that accelerometer variables increased significantly during HABIT, indicating increased bimanual symmetry and intensity. Post-HABIT, children demonstrated significant improvements in all accelerometer metrics, reflecting real-world performance gains. Children also achieved significant and clinically relevant changes in hand capacity following HABIT. Therefore, our findings suggest that accelerometers can objectively quantify bimanual movement intensity during HABIT. Moreover, HABIT enhances hand function as well as activities and participation in real-world situations in children with UCP.
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Affiliation(s)
- Shailesh S. Gardas
- Department of Physical Therapy, East Carolina University, Greenville, NC 27834, USA; (S.S.G.); (C.L.); (A.G.M.); (J.D.W.)
| | - Christine Lysaght
- Department of Physical Therapy, East Carolina University, Greenville, NC 27834, USA; (S.S.G.); (C.L.); (A.G.M.); (J.D.W.)
| | - Amy Gross McMillan
- Department of Physical Therapy, East Carolina University, Greenville, NC 27834, USA; (S.S.G.); (C.L.); (A.G.M.); (J.D.W.)
| | - Shailesh Kantak
- Moss Rehabilitation Research Institute, Elkins Park, PA 19027, USA
- Department of Physical Therapy, Arcadia University, Glenside, PA 19038, USA
| | - John D. Willson
- Department of Physical Therapy, East Carolina University, Greenville, NC 27834, USA; (S.S.G.); (C.L.); (A.G.M.); (J.D.W.)
| | - Charity G. Patterson
- Department of Physical Therapy and School of Health and Rehabilitation Sciences Data Center, University of Pittsburgh, Pittsburgh, PA 15260, USA;
| | - Swati M. Surkar
- Department of Physical Therapy, East Carolina University, Greenville, NC 27834, USA; (S.S.G.); (C.L.); (A.G.M.); (J.D.W.)
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Kretch KS, Koziol NA, Marcinowski EC, Hsu LY, Harbourne RT, Lobo MA, McCoy SW, Willett SL, Dusing SC. Sitting Capacity and Performance in Infants with Typical Development and Infants with Motor Delay. Phys Occup Ther Pediatr 2023; 44:164-179. [PMID: 37550959 DOI: 10.1080/01942638.2023.2241537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/09/2023]
Abstract
AIMS Infants with neuromotor disorders demonstrate delays in sitting skills (decreased capacity) and are less likely to maintain independent sitting during play than their peers with typical development (decreased performance). This study aimed to quantify developmental trajectories of sitting capacity and sitting performance in infants with typical development and infants with significant motor delay and to assess whether the relationship between capacity and performance differs between the groups. METHODS Typically developing infants (n = 35) and infants with significant motor delay (n = 31) were assessed longitudinally over a year following early sitting readiness. The Gross Motor Function Measure (GMFM) Sitting Dimension was used to assess sitting capacity, and a 5-min free play observation was used to assess sitting performance. RESULTS Both capacity and performance increased at a faster rate initially, with more deceleration across time, in infants with typical development compared to infants with motor delay. At lower GMFM scores, changes in GMFM sitting were associated with larger changes in independent sitting for infants with typical development, and the association between GMFM sitting and independent sitting varied more across GMFM scores for typically developing infants. CONCLUSIONS Intervention and assessment for infants with motor delay should target both sitting capacity and sitting performance.
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Affiliation(s)
- Kari S Kretch
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Natalie A Koziol
- Nebraska Center for Research on Children, Youth, Families and Schools, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Emily C Marcinowski
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, United States
| | - Lin-Ya Hsu
- Division of Physical Therapy, University of Washington, Seattle, WA, United States
| | - Regina T Harbourne
- Department of Physical Therapy, Duquesne University, Pittsburgh PA, United States
| | - Michele A Lobo
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Sarah W McCoy
- Division of Physical Therapy, University of Washington, Seattle, WA, United States
| | - Sandra L Willett
- Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Stacey C Dusing
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
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Van de Winckel A, Ottiger B, Veerbeek JM, Nyffeler T, Vanbellingen T. Rasch validation of a new scale to measure dependency in arm use in daily life: the Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale. Front Neurol 2023; 14:1154322. [PMID: 37492854 PMCID: PMC10364475 DOI: 10.3389/fneur.2023.1154322] [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: 03/02/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
Introduction About 77% of adults with stroke have upper limb impairments. Many scales are available to measure the impairment and activity level of the affected limb. However, an observational scale to assess dependency on others in upper limb performance during daily life activities instead of laboratory settings is lacking. Therefore, we developed a new 5-item Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale (UL-LIMOS). As next step in the psychometric analysis, we evaluated the unidimensionality and structural validity of the UL-LIMOS with Rasch Measurement Theory and we calculated a cut-off score for independent arm use in daily life activities at discharge. Methods This is a single-center cross-sectional study in adults with (sub) acute stroke. We applied Rasch Measurement Theory (RMT) to analyze the structural validation and unidimensionality of the UL-LIMOS. The outputs provide evidence of unidimensionality, item and person fit, overall fit, differential item functioning (DIF), principal component analysis of residuals (PCAR), person separation reliability (PSR), and residual item correlations (to identify local item dependence). Person mean location, floor and ceiling effects identify proper targeting. Results We recruited 407 adults with (sub) acute stroke (median age 63 years, 157 women). All items and persons fit the Rasch model. The PSR of 0.90 indicates that clinicians and researchers can reliably use the scale for individual decision-making. There were small floor (2.70%) and ceiling (13.00%) effects. The average person mean location was 1.32 ± 2.99 logits. There was no DIF. PCAR eigenvalue was 2.46 with 49.23% explained variance. Paired t-tests revealed that 0.89% of person locations were significantly different, confirming unidimensionality. One pair of items (arm and hand use and fine hand use) showed residual item correlations. The ROC's AUC was 0.90, CI95% = [0.85-0.96] with cut-off score of ≥14/20, and high sensitivity (87%, CI95% = [81%-91%]), specificity (83%, CI95% = [77%-87%]) for independent arm use in daily living at discharge. Discussion The new Rasch-based UL-LIMOS is a valid ICF-based observation performance scale at the ICF-activity level, to evaluate dependency during upper limb use in daily life in adults with stroke. Additional psychometric analyses are warranted. The UL-LIMOS would be a valuable addition to the core assessments of adults with (sub) acute stroke.
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Affiliation(s)
- Ann Van de Winckel
- Brain Body Mind Laboratory, Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | | | | | - Thomas Nyffeler
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tim Vanbellingen
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
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Simpson LA, Hayward KS, Boyd LA, Larssen BC, Mortenson WB, Schneeberg A, Silverberg ND, Eng JJ. Responsiveness and trajectory of changes in the rating of everyday arm-use in the community and home (REACH) scale over the first-year post-stroke. Clin Rehabil 2023; 37:557-568. [PMID: 36310441 PMCID: PMC9989222 DOI: 10.1177/02692155221134413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the trajectory of the Rating of Everyday Arm-use in the Community and Home (REACH) scores over the first-year post-stroke, determine if REACH scores are modified by baseline impairment level and explore the responsiveness of the REACH scale through hypothesis testing. DESIGN Consecutive sample longitudinal study. SETTING Participants were recruited from an acute stroke unit and followed up at three, six, and 12 months post-stroke. PARTICIPANTS Seventy-three participants with upper limb weakness (Shoulder Abduction and Finger Extension score ≤ 8). MAIN MEASURES The REACH scale is a six-level self-report classification scale that captures how the affected upper limb is being used in one's own environment. The Fugl-Meyer Upper Limb Assessment (FMA-UL), Stroke Upper Limb Capacity Scale (SULCS), accelerometer-based activity count ratio and Global Rating of Change Scale (GRCS) were used to capture upper limb impairment, capacity, and use. RESULTS The following proportions of participants improved at least one REACH level: 64% from baseline to three months, 37% from three to six months and 13% from six to 12 months post-stroke. The trajectory of REACH scores over time was associated with baseline impairment. Change in REACH had a moderate correlation to change in SULCS and the GRCS but not FMA-UL or the activity count ratio. CONCLUSIONS Results of hypothesis testing provide preliminary evidence of the responsiveness of the REACH scale. On average, individuals with severe impairment continued to show improvement in use over the first year, while those with mild/moderate impairment plateaued and a small proportion decreased in the early chronic phase.
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Affiliation(s)
- Lisa A Simpson
- Graduate Program in Rehabilitation Sciences, 8166University of British Columbia, Vancouver, Canada
| | - Kathryn S Hayward
- Departments of Physiotherapy, Medicine (RMH) and 56369Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.,Department of Physical Therapy, 8166University of British Columbia, Vancouver, Canada
| | - Lara A Boyd
- Department of Physical Therapy, 8166University of British Columbia, Vancouver, Canada
| | - Beverley C Larssen
- Graduate Program in Rehabilitation Sciences, 8166University of British Columbia, Vancouver, Canada
| | - W Ben Mortenson
- Department of Occupational Science and Occupational Therapy, 8166University of British Columbia, Vancouver, Canada
| | - Amy Schneeberg
- Rehabilitation Research Program, 175184Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Noah D Silverberg
- Department of Psychology, 8166University of British Columbia, Vancouver, Canada
| | - Janice J Eng
- Department of Physical Therapy, 8166University of British Columbia, Vancouver, Canada
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Kim GJ, Gahlot A, Magsombol C, Waskiewicz M, Capasso N, Van Lew S, Goverover Y, Dickson VV. Protocol for a remote home-based upper extremity self-training program for community-dwelling individuals after stroke. Contemp Clin Trials Commun 2023; 33:101112. [PMID: 37113325 PMCID: PMC10126840 DOI: 10.1016/j.conctc.2023.101112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/03/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023] Open
Abstract
Background Half of all stroke survivors experience hemiparesis on the contralateral side, resulting in chronic upper extremity (UE) impairment. Remote rehabilitation is a promising approach to optimize the gains made in the clinic to maximize function and promote UE use at home. This paper describes the study protocol for a remote home-based UE self-training program. Design This was a feasibility study that used a convergent mixed methods approach. Methods We collected data on 15 community-dwelling individuals with UE hemiparesis after stroke. The study used motivational interviewing (MI) and ecological momentary assessments (EMA) to maximize engagement in a 4-week personalized UE self-training program. The study consisted of three phases: 1) training in MI for the interventionists 2) creating customized treatment plans using shared decision making, and 3) four weeks of UE self-training. Measures and analysis To evaluate feasibility, we will summarize recruitment and retention rates, intervention delivery, acceptance, adherence, and safety. Quantitative UE outcomes will measure change in UE status after the intervention (Fugl-Meyer Assessment, Motor Activity Log, Canadian Occupational Performance Measure, and bilateral magnitude ratio). Qualitative data (1:1 semi-structured interviews) will capture participants' perceptions and experience with the intervention. Quantitative and qualitative data will be integrated to gain a deeper understanding of the facilitators and barriers for engagement and adherence to UE self-training. Conclusion The results of this study will advance the scientific knowledge for use of MI and EMA as methods for enhancing adherence and engagement in UE self-training in stroke rehabilitation. The ultimate impact of this research will be to improve UE recovery for individuals with stroke transitioning back into community. Clinical trials registration NCT05032638.
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Affiliation(s)
- Grace J. Kim
- Department of Occupational Therapy, NYU Steinhardt School of Culture, Education, and Human Development, 82 Washington Square E, New York, NY, 10003, USA
- Corresponding author. 82 Washington Sq E, 6th Floor, New York, NY, 10003, USA.
| | - Amanda Gahlot
- Department of Occupational Therapy, NYU Steinhardt School of Culture, Education, and Human Development, 82 Washington Square E, New York, NY, 10003, USA
| | - Camille Magsombol
- Department of Occupational Therapy, NYU Langone Health, Rusk Rehabilitation, 400 E 34th St., New York, NY, 10016, USA
| | - Margaret Waskiewicz
- Department of Occupational Therapy, NYU Langone Health, Rusk Rehabilitation, 400 E 34th St., New York, NY, 10016, USA
| | - Nettie Capasso
- Department of Occupational Therapy, NYU Langone Health, Rusk Rehabilitation, 400 E 34th St., New York, NY, 10016, USA
| | - Steve Van Lew
- Department of Occupational Therapy, NYU Langone Health, Rusk Rehabilitation, 400 E 34th St., New York, NY, 10016, USA
| | - Yael Goverover
- Department of Occupational Therapy, NYU Steinhardt School of Culture, Education, and Human Development, 82 Washington Square E, New York, NY, 10003, USA
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, East Hanover, NJ, USA
| | - Victoria V. Dickson
- NYU Meyers Pless Center for Nursing Research, 433 1st Ave., New York, NY, 10010, USA
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Lang CE, Holleran CL, Strube MJ, Ellis TD, Newman CA, Fahey M, DeAngelis TR, Nordahl TJ, Reisman DS, Earhart GM, Lohse KR, Bland MD. Improvement in the Capacity for Activity Versus Improvement in Performance of Activity in Daily Life During Outpatient Rehabilitation. J Neurol Phys Ther 2023; 47:16-25. [PMID: 35930404 PMCID: PMC9750113 DOI: 10.1097/npt.0000000000000413] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We addressed questions about the potential discrepancy between improvements in activity capacity and improvements in activity performance in daily life. We asked whether this discrepancy is: Common in routine, outpatient care, or an artifact of intervention studies? Unique to upper limb (UL) rehabilitation, or is it seen in walking rehabilitation too? Only seen in persons with stroke, or a broader neurorehabilitation problem?
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Affiliation(s)
- Catherine E. Lang
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Carey L. Holleran
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Michael J Strube
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Terry D. Ellis
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Caitlin A. Newman
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Meghan Fahey
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Tamara R. DeAngelis
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Timothy J. Nordahl
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Darcy S. Reisman
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Gammon M. Earhart
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Keith R. Lohse
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
| | - Marghuretta D. Bland
- Program in Physical Therapy (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Program in Occupational Therapy (C.E.L., M.D.B.), Washington University School of Medicine, St Louis, Missouri; Departments of Neurology (C.E.L., C.L.H., G.M.E., K.R.L., M.D.B.) and Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Brain and Psychological Sciences, Washington University, St Louis, Missouri (M.J.S.); Department of Physical Therapy, Boston University, Boston, Massachusetts (T.D.E., T.R.D., T.J.N.); Shirley Ryan Ability Lab, Chicago, Illinois (C.A.N., M.F.); and Department of Physical Therapy, University of Delaware, Newark (D.S.R.)
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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: 13] [Impact Index Per Article: 6.5] [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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15
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Kim GJ, Lebovich S, Rand D. Perceived Facilitators and Barriers for Actual Arm Use during Everyday Activities in Community Dwelling Individuals with Chronic Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11707. [PMID: 36141980 PMCID: PMC9516989 DOI: 10.3390/ijerph191811707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Our aim was to gain a deeper understanding of perceived predictors for actual arm use during daily functional activities. METHODS Qualitative study. Semi-structured interview data collected from individuals with chronic stroke living in the community. Codebook thematic analysis used for the data analysis. RESULTS Six participants 5-18 years post stroke with moderate to severe UE impairment. Three domains were identified: Person, Context, and Task. Themes for the Person domain included mental (cognitive effort, lack of acceptance), behavioral (routines/habits, self-evaluation), and physical (stiffness/fatigue). Themes for the Context domain included social environment (being in public, presence, and actions of others) and time constraints (being in a hurry). Themes for the task domain included necessity to complete bilateral and unilateral tasks, and safety (increased risk of accidents). CONCLUSION Actual arm use is a complex construct related to the characteristics of the person, contextual environment, and the nature of the task. Facilitators included cognitive effort, routines/habits, self-evaluation, and the perceived necessity. Barriers included in lack of acceptance, stiffness/fatigue, being in public, being in a hurry, and risk of ac-cidents. Social support was both a facilitator and a barrier. Our results support the growing call to adopt a broader biopsychosocial framework into rehabilitation delivery.
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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 10003, USA
| | - Shir Lebovich
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Occupational Therapy Services, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Debbie Rand
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Klinedinst TC, Terhorst L, Rodakowski J. Multimorbidity groups based on numbers of chronic conditions are associated with daily activity. Chronic Illn 2022; 18:634-642. [PMID: 34159840 PMCID: PMC8695626 DOI: 10.1177/17423953211023964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Instrumental activities of daily living (IADL) are important for managing multiple chronic conditions (MCC) and maintaining independence while aging. Using data from the National Health and Aging Trends Study (NHATS), we answered the question: are there differences in ability and performance of IADL among groups of older adults with 0-1 (no MCC), 2-4 (low MCC), and 5+ chronic conditions (multisystem morbidity: MM)? METHODS Cross-sectional study using Poisson regression and incidence rate ratios. Participants were 6,019 community-dwelling older adults who regularly take medications. We derived composite variables for ability and performance of IADL; MCC groups were based on count of 11 chronic conditions. RESULTS Older adults with MM had lower IADL count for ability (IRR = .81) and performance (IRR = .77), and MM group significantly predicted both ability and performance of IADL (p < .001); 'low MCC' group was not significantly different than 'no MCC' regarding disability. DISCUSSION Having MM is statistically and clinically different than having low MCC or no MCC; 5+ chronic conditions may be a meaningful inclusion criterion for interventions to decrease disability and 2-4 chronic conditions may be better for trials to prevent disability. Researchers should measure both ability and performance of daily activity.
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Affiliation(s)
- Tara C. Klinedinst
- National Rehabilitation Research and Training Center on Family Support, Health Policy Institute, University of Pittsburgh, 308 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Bridgeside Point I, Suite 350, 100 Technology Drive, Pittsburgh, PA 15219
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA, 15213
- Clinical and Translational Science Institute, University of Pittsburgh, Forbes Tower, Suite 7057, Pittsburgh, PA, 15213
| | - Juleen Rodakowski
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Bridgeside Point I, Suite 350, 100 Technology Drive, Pittsburgh, PA 15219
- Clinical and Translational Science Institute, University of Pittsburgh, Forbes Tower, Suite 7057, Pittsburgh, PA, 15213
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Qin P, Cai C, Chen X, Wei X. Effect of home-based interventions on basic activities of daily living for patients who had a stroke: a systematic review with meta-analysis. BMJ Open 2022; 12:e056045. [PMID: 35902187 PMCID: PMC9341195 DOI: 10.1136/bmjopen-2021-056045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate the effectiveness of home-based interventions in improving the ability to do basic activities of daily living in patients who had a stroke. METHODS Randomised controlled trials were searched through MEDLINE, Embase and CINAHL from their inception to 31 December 2021. We included studies involving home-based intervention prescribed by professionals and implemented at patients' homes. The characteristics of these studies were collected. Risk of bias of individual study was assessed by Physiotherapy Evidence Database scale. Meta-analyses were performed where studies reported comparable interventions and outcomes. RESULTS In total, 49 studies were included in the systematic review and 16 studies had sufficient data for meta-analyses. The short-term effect of home-based intervention showed no significant difference when compared with institution-based intervention (standardised mean difference (SMD)=0.24, 95% CI -0.15 to 0.62, I2=0%). No significant difference was found between home-based intervention and usual care for long-term effect (SMD=0.02; 95% CI -0.17 to 0.22; I2=0%). Home-based rehabilitation combined with usual care showed a significant short-term effect on the ability to do basic daily activities, compared with usual care alone (SMD=0.55; 95% CI 0.22 to 0.87; p=0.001; I2=3%). CONCLUSION Home-based rehabilitation with usual care, which varied from no therapy to inpatient or outpatient therapy, may have a short-term effect on the ability to do basic activities of daily living for patients who had a stroke compared with usual care alone. However, the evidence quality is low because of the limited number of studies and participants included in the meta-analysis and the possible publication bias. Future research is needed to investigate the effectiveness of home-based rehabilitation in groups with stratification by stroke severity and time since stroke onset, with elaboration of details of the home-based and the control interventions. Moreover, more high-quality studies are required to prove the cost-effectiveness of newly developed strategies like caregiver-mediated rehabilitation and telerehabilitation. THE PRIMARY SOURCE OF FUNDING The Medical Research Fund of Guangdong Province (No: A2021041).
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Affiliation(s)
- Ping Qin
- Rehabilitation Lab of Mix Reality, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Canxin Cai
- Rehabilitation Lab of Mix Reality, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Xuan Chen
- Rehabilitation Lab of Mix Reality, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- Department of Rehabilitation Medicine, Shenzhen Hospital, Peking University, Shenzhen, China
| | - Xijun Wei
- Rehabilitation Lab of Mix Reality, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
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Heye AL, Kersting C, Kneer M, Barzel A. Suitability of accelerometry as an objective measure for upper extremity use in stroke patients. BMC Neurol 2022; 22:220. [PMID: 35705906 PMCID: PMC9199226 DOI: 10.1186/s12883-022-02743-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/31/2022] [Indexed: 11/26/2022] Open
Abstract
Background Upper limb (UL) paresis is one of the most common stroke consequences and significantly restricts patients in everyday life. Instruments objectively measuring direct arm use in stroke patients are lacking, but might be helpful to understand patients’ impairment. Aiming to examine whether accelerometry is a suitable objective measure for everyday UL use in stroke patients, we conducted a systematic review on the association between accelerometer-derived measurements and clinical scales. Methods Articles were systematically searched in PubMed, Scopus, Cochrane Library, PeDro and LIVIVO through December 12th, 2021, screened for inclusion by AH, and subsequently independently screened by CK and MK. Disagreements were discussed until consensus. We included English and German peer-reviewed articles dealing with the validity of accelerometers as a measurement of UL use in stroke patients and eligible systematic reviews. Studies exclusively using accelerometry as an outcome parameter, book contributions, conference abstracts and case studies were excluded. Data extraction was conducted by AH and confirmed by CK focussing on study type, objective, accelerometer device, sample size, stroke status, assessments conducted, measurement method, wearing time and key results. We analysed all eligible articles regarding the correlation between accelerometry and other clinical assessments and the validity in accordance with the type of accelerometer. Results Excluding duplicates, the initial search yielded 477 records. In the 34 eligible studies accelerometers was used with a predominance of tri-axial accelerometery (n = 12) and only few with two-axial application (n = 4). Regarding measures to examine association to accelerometer data different clinical scales were applied depending on the setting, the degree of impairment and/or the status of stroke. Cut-off values to determine correlations varied largely; most significant correlations are reported for the MAL [Range 0.31- 0.84] and the ARAT [Range 0.15–0.79]. Conclusions Accelerometers can provide reliable data about daily arm use frequency but do not supply information about the movements´ quality and restrictions on everyday activities of stroke patients. Depending on the context, it is advisable to use both, accelerometry and other clinical measures. According to the literature there is currently no accelerometer device most suitable to measure UL activity. High correlations indicate that multi-dimensional accelerometers should be preferred. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02743-w.
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Affiliation(s)
- Anne-Lisa Heye
- Chair of General Practice I and Interprofessional Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany.
| | - Christine Kersting
- Chair of General Practice II and Patient-Centeredness in Primary Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - Malte Kneer
- Chair of General Practice II and Patient-Centeredness in Primary Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - Anne Barzel
- Institute of General Medicine, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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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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Duff SV, Miller A, Quinn L, Youdan G, Bishop L, Ruthrauff H, Wade E. Quantifying intra- and interlimb use during unimanual and bimanual tasks in persons with hemiparesis post-stroke. J Neuroeng Rehabil 2022; 19:44. [PMID: 35525970 PMCID: PMC9077965 DOI: 10.1186/s12984-022-01020-8] [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: 08/23/2021] [Accepted: 04/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background Individuals with hemiparesis post-stroke often have difficulty with tasks requiring upper extremity (UE) intra- and interlimb use, yet methods to quantify both are limited. Objective To develop a quantitative yet sensitive method to identify distinct features of UE intra- and interlimb use during task performance. Methods Twenty adults post-stroke and 20 controls wore five inertial sensors (wrists, upper arms, sternum) during 12 seated UE tasks. Three sensor modalities (acceleration, angular rate of change, orientation) were examined for three metrics (peak to peak amplitude, time, and frequency). To allow for comparison between sensor data, the resultant values were combined into one motion parameter, per sensor pair, using a novel algorithm. This motion parameter was compared in a group-by-task analysis of variance as a similarity score (0–1) between key sensor pairs: sternum to wrist, wrist to wrist, and wrist to upper arm. A use ratio (paretic/non-paretic arm) was calculated in persons post-stroke from wrist sensor data for each modality and compared to scores from the Adult Assisting Hand Assessment (Ad-AHA Stroke) and UE Fugl-Meyer (UEFM). Results A significant group × task interaction in the similarity score was found for all key sensor pairs. Post-hoc tests between task type revealed significant differences in similarity for sensor pairs in 8/9 comparisons for controls and 3/9 comparisons for persons post stroke. The use ratio was significantly predictive of the Ad-AHA Stroke and UEFM scores for each modality. Conclusions Our algorithm and sensor data analyses distinguished task type within and between groups and were predictive of clinical scores. Future work will assess reliability and validity of this novel metric to allow development of an easy-to-use app for clinicians.
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Affiliation(s)
- Susan V Duff
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University, 9401 Jeronimo Rd, Irvine, CA, 92618, USA.
| | - Aaron Miller
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
| | - Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Gregory Youdan
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Lauri Bishop
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Heather Ruthrauff
- Department of Occupational Therapy, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Eric Wade
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
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21
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Otaki R, Oouchida Y, Aizu N, Sudo T, Sasahara H, Saito Y, Takemura S, Izumi SI. Relationship Between Body-Specific Attention to a Paretic Limb and Real-World Arm Use in Stroke Patients: A Longitudinal Study. Front Syst Neurosci 2022; 15:806257. [PMID: 35273480 PMCID: PMC8902799 DOI: 10.3389/fnsys.2021.806257] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Learned nonuse is a major problem in upper limb (UL) rehabilitation after stroke. Among the various factors that contribute to learned nonuse, recent studies have focused on body representation of the paretic limb in the brain. We previously developed a method to measure body-specific attention, as a marker of body representation of the paretic limb and revealed a decline in body-specific attention to the paretic limb in chronic stroke patients by a cross-sectional study. However, longitudinal changes in body-specific attention and paretic arm use in daily life (real-world arm use) from the onset to the chronic phase, and their relationship, remain unknown. Here, in a longitudinal, prospective, observational study, we sought to elucidate the longitudinal changes in body-specific attention to the paretic limb and real-world arm use, and their relationship, by using accelerometers and psychophysical methods, respectively, in 25 patients with subacute stroke. Measurements were taken at baseline (TBL), 2 weeks (T2w), 1 month (T1M), 2 months (T2M), and 6 months (T6M) after enrollment. UL function was measured using the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT). Real-world arm use was measured using accelerometers on both wrists. Body-specific attention was measured using a visual detection task. The UL function and real-world arm use improved up to T6M. Longitudinal changes in body-specific attention were most remarkable at T1M. Changes in body-specific attention up to T1M correlated positively with changes in real-world arm use up to T6M, and from T1M to T6M, and the latter more strongly correlated with changes in real-world arm use. Changes in real-world arm use up to T2M correlated positively with changes in FMA up to T2M and T6M. No correlation was found between body-specific attention and FMA scores. Thus, these results suggest that improved body-specific attention to the paretic limb during the early phase contributes to increasing long-term real-world arm use and that increased real-world use is associated with the recovery of UL function. Our results may contribute to the development of rehabilitation strategies to enhance adaptive changes in body representation in the brain and increase real-world arm use after stroke.
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Affiliation(s)
- Ryoji Otaki
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Rehabilitation, Yamagata Saisei Hospital, Yamagata, Japan
| | - Yutaka Oouchida
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Education, Osaka Kyoiku University, Osaka, Japan
| | - Naoki Aizu
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Tamami Sudo
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Computer and Information Sciences, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Hiroshi Sasahara
- Department of Rehabilitation, Yamagata Saisei Hospital, Yamagata, Japan
| | - Yuki Saito
- Department of Neurosurgery, Yamagata Saisei Hospital, Yamagata, Japan
| | - Sunao Takemura
- Department of Neurosurgery, Yamagata Saisei Hospital, Yamagata, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
- *Correspondence: Shin-Ichi Izumi
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22
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Automated Detection of Rehabilitation Exercise by Stroke Patients Using 3-Layer CNN-LSTM Model. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1563707. [PMID: 35154616 PMCID: PMC8837430 DOI: 10.1155/2022/1563707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/12/2022] [Indexed: 11/17/2022]
Abstract
According to statistics, stroke is the second or third leading cause of death and adult disability. Stroke causes losing control of the motor function, paralysis of body parts, and severe back pain for which a physiotherapist employs many therapies to restore the mobility needs of everyday life. This research article presents an automated approach to detect different therapy exercises performed by stroke patients during rehabilitation. The detection of rehabilitation exercise is a complex area of human activity recognition (HAR). Due to numerous achievements and increasing popularity of deep learning (DL) techniques, in this research article a DL model that combines convolutional neural network (CNN) and long short-term memory (LSTM) is proposed and is named as 3-Layer CNN-LSTM model. The dataset is collected through RGB (red, green, and blue) camera under the supervision of a physiotherapist, which is resized in the preprocessing stage. The 3-layer CNN-LSTM model takes preprocessed data at the convolutional layer. The convolutional layer extracts useful features from input data. The extracted features are then processed by adjusting weights through fully connected (FC) layers. The FC layers are followed by the LSTM layer. The LSTM layer further processes this data to learn its spatial and temporal dynamics. For comparison, we trained CNN model over the prescribed dataset and achieved 89.9% accuracy. The conducted experimental examination shows that the 3-Layer CNN-LSTM outperforms CNN and KNN algorithm and achieved 91.3% accuracy.
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23
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Bijalwan V, Semwal VB, Singh G, Mandal TK. HDL-PSR: Modelling Spatio-Temporal Features Using Hybrid Deep Learning Approach for Post-Stroke Rehabilitation. Neural Process Lett 2022. [DOI: 10.1007/s11063-022-10744-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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24
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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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25
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Torriani-Pasin C, Demers M, Polese JC, Bishop L, Wade E, Hempel S, Winstein C. mHealth technologies used to capture walking and arm use behavior in adult stroke survivors: a scoping review beyond measurement properties. Disabil Rehabil 2021; 44:6094-6106. [PMID: 34297652 DOI: 10.1080/09638288.2021.1953623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE We aimed to provide a critical review of measurement properties of mHealth technologies used for stroke survivors to measure the amount and intensity of functional skills, and to identify facilitators and barriers toward adoption in research and clinical practice. MATERIALS AND METHODS Using Arksey and O'Malley's framework, two independent reviewers determined eligibility and performed data extraction. We conducted an online consultation survey exercise with 37 experts. RESULTS Sixty-four out of 1380 studies were included. A majority reported on lower limb behavior (n = 32), primarily step count (n = 21). Seventeen studies reported on arm-hand behaviors. Twenty-two studies reported metrics of intensity, 10 reported on energy expenditure. Reliability and validity were the most frequently reported properties, both for commercial and non-commercial devices. Facilitators and barriers included: resource costs, technical aspects, perceived usability, and ecological legitimacy. Two additional categories emerged from the survey: safety and knowledge, attitude, and clinical skill. CONCLUSIONS This provides an initial foundation for a field experiencing rapid growth, new opportunities and the promise that mHealth technologies affords for envisioning a better future for stroke survivors. We synthesized findings into a set of recommendations for clinicians and clinician-scientists about how best to choose mHealth technologies for one's individual objective.Implications for RehabilitationRehabilitation professionals are encouraged to consider the measurement properties of those technologies that are used to monitor functional locomotor and object-interaction skills in the stroke survivors they serve.Multi-modal knowledge translation strategies (research synthesis, educational courses or videos, mentorship from experts, etc.) are available to rehabilitation professionals to improve knowledge, attitude, and skills pertaining to mHealth technologies.Consider the selection of commercially available devices that are proven to be valid, reliable, accurate, and responsive to the targeted clinical population.Consider usability and privacy, confidentiality and safety when choosing a specific device or smartphone application.
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Affiliation(s)
- Camila Torriani-Pasin
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.,Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Marika Demers
- Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Janaine C Polese
- Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Lauri Bishop
- Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Eric Wade
- Department of Mechanical Engineering, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, CA, USA
| | - Carolee Winstein
- 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, USA
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26
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Whole-Body Movements Increase Arm Use Outcomes of Wrist-Worn Accelerometers in Stroke Patients. SENSORS 2021; 21:s21134353. [PMID: 34202142 PMCID: PMC8271846 DOI: 10.3390/s21134353] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/12/2021] [Accepted: 06/20/2021] [Indexed: 11/17/2022]
Abstract
Wrist-worn accelerometers are often applied to measure arm use after stroke. They measure arm movements during all activities, including whole-body movements, such as walking. Whole-body movements may influence clinimetric properties of arm use measurements—however, this has not yet been examined. This study investigates to what extent arm use measurements with wrist-worn accelerometers are affected by whole-body movements. Assuming that arm movements during whole-body movements are non-functional, we quantify the effect of whole-body movements by comparing two methods: Arm use measured with wrist-worn accelerometers during all whole-body postures and movements (P&M method), and during sitting/standing only (sit/stand method). We have performed a longitudinal observational cohort study with measurements in 33 stroke patients during weeks 3, 12, and 26 poststroke. The P&M method shows higher daily paretic arm use outcomes than the sit/stand method (p < 0.001), the mean difference increased from 31% at week three to 41% at week 26 (p < 0.001). Differences in daily paretic arm use between methods are strongly related to daily walking time (r = 0.83–0.92). Changes in the difference between methods are strongly related to changes in daily walking time (r = 0.89). We show that not correcting arm use measurements for whole-body movements substantially increases arm use outcomes, thereby threatening the validity of arm use outcomes and measured arm use changes.
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27
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Flury D, Massé F, Paraschiv-Ionescu A, Aminian K, Luft AR, Gonzenbach R. Clinical value of assessing motor performance in postacute stroke patients. J Neuroeng Rehabil 2021; 18:102. [PMID: 34167546 PMCID: PMC8223372 DOI: 10.1186/s12984-021-00898-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/14/2021] [Indexed: 01/28/2023] Open
Abstract
Background Rehabilitative treatment plans after stroke are based on clinical examinations of functional capacity and patient-reported outcomes. Objective information about daily life performance is usually not available, but it may improve therapy personalization. Objective To show that sensor-derived information about daily life performance is clinically valuable for counseling and the planning of rehabilitation programs for individual stroke patients who live at home. Performance information is clinically valuable if it can be used as a decision aid for the therapeutic management or counseling of individual patients. Methods This was an observational, cross-sectional case series including 15 ambulatory stroke patients. Motor performance in daily life was assessed with body-worn inertial sensors attached to the wrists, shanks and trunk that estimated basic physical activity and various measures of walking and arm activity in daily life. Stroke severity, motor function and activity, and degree of independence were quantified clinically by standard assessments and patient-reported outcomes. Motor performance was recorded for an average of 5.03 ± 1.1 h on the same day as the clinical assessment. The clinical value of performance information is explored in a narrative style by considering individual patient performance and capacity information. Results The patients were aged 59.9 ± 9.8 years (mean ± SD), were 6.5 ± 7.2 years post stroke, and had a National Institutes of Health Stroke Score of 4.0 ± 2.6. Capacity and performance measures showed high variability. There were substantial discrepancies between performance and capacity measures in some patients. Conclusions This case series shows that information about motor performance in daily life can be valuable for tailoring rehabilitative therapy plans and counseling according to the needs of individual stroke patients. Although the short recording time (average of 5.03 h) limited the scope of the conclusions, this study highlights the usefulness of objective measures of daily life performance for the planning of rehabilitative therapies. Further research is required to investigate whether information about performance in daily life leads to improved rehabilitative therapy results.
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Affiliation(s)
- D Flury
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - F Massé
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - A Paraschiv-Ionescu
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - K Aminian
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - A R Luft
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland.,Center for Neurology and Rehabilitation, Cereneo, Vitznau, Switzerland
| | - R Gonzenbach
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
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28
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He P, Kantu NT, Xu B, Swami CP, Saleem GT, Kang J. A Novel 3-RRR Spherical Parallel Instrument for Daily Living Emulation (SPINDLE) for Functional Rehabilitation of Patients with Stroke. INT J ADV ROBOT SYST 2021. [DOI: 10.1177/17298814211012325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Various robotic rehabilitation devices have been developed for acute stroke patients to ease therapist’s efforts and provide high-intensity training, which resulted in improved strength and functional recovery of patients; however, these improvements did not always transfer to the performance of activities of daily living (ADLs). This is because previous robotic training focuses on the proximal joints or training with exoskeleton-type devices, which do not reflect how humans interact with the environment. To improve the training effect of ADLs, a new robotic training paradigm is suggested with a parallel manipulator that mimics rotational ADL tasks. This study presents training of the proximal and distal joints simultaneously while performing manipulation tasks in a device named spherical parallel instrument for daily living emulation (SPINDLE). Six representative ADLs were chosen to show that both proximal and distal joints are trained when performing tasks with SPINDLE, as compared to the natural ADLs. These results show that SPINDLE can train individuals with movements similar to the ADLs while interacting with the manipulator. We envision using this compact tabletop device as a home-training device to increase the performance of ADLs by restoring the impaired motor function of stroke patients, leading to improved quality of life.
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Affiliation(s)
- Peidong He
- Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA
| | - Nikhil Tej Kantu
- Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA
| | - Boxin Xu
- Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA
| | | | | | - Jiyeon Kang
- Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA
- Rehabilitation Science, University at Buffalo, Buffalo, NY, USA
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29
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Day-to-Day Variability of Walking Performance Measures in Individuals Poststroke and Individuals With Parkinson Disease. J Neurol Phys Ther 2021; 44:241-247. [PMID: 32769671 DOI: 10.1097/npt.0000000000000327] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Improvement of walking performance is a primary goal for individuals poststroke or with Parkinson disease (PD) who receive physical therapy. More data about day-to-day variability of walking performance are critical for determining if changes in performance have occurred. METHODS Baseline assessments were utilized from an ongoing, observational, prospective cohort study including 84 individuals poststroke (n = 37) or with PD (n = 47) receiving outpatient physical therapy services to improve mobility. Participants wore step activity monitors for up to 7 days to measure walking performance (steps per day, walking duration, maximum 30-minute output, and peak activity index) in daily life. Correlation analyses evaluated relationships between both capacity and performance measures as well as the relationships between mean performance variables and day-to-day variability. Regression analyses explored factors that contribute to variability in day-to-day performance variables. RESULTS Mean steps per day for participants poststroke (5376 ± 2804) and with PD (8149 ± 4490) were consistent with previously reported cohorts. Greater amounts of walking were related to more day-to-day variability, with moderate correlations found between the mean and day-to-day variability of each performance measure, regardless of medical diagnosis or walking speed. Day-to-day variability is large (upwards of 50% of the mean), with the amount of walking performance serving as the primary predictor of day-to-day variability in walking performance. DISCUSSION AND CONCLUSIONS The results of this study elucidate the factors that are related to and predict day-to-day variability of performance. Walking performance metrics should be evaluated over multiple days and greater variability should be anticipated with greater amounts of performance.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A319).
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Bhattacharjya S, Cavuoto LA, Reilly B, Xu W, Subryan H, Langan J. Usability, Usefulness, and Acceptance of a Novel, Portable Rehabilitation System (mRehab) Using Smartphone and 3D Printing Technology: Mixed Methods Study. JMIR Hum Factors 2021; 8:e21312. [PMID: 33749608 PMCID: PMC8080267 DOI: 10.2196/21312] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/24/2020] [Accepted: 02/19/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Smart technology use in rehabilitation is growing and can be used remotely to assist clients in self-monitoring their performance. With written home exercise programs being the commonly prescribed form of rehabilitation after discharge, mobile health technology coupled with task-oriented programs can enhance self-management of upper extremity training. In the current study, a rehabilitation system, namely mRehab, was designed that included a smartphone app and 3D-printed household items such as mug, bowl, key, and doorknob embedded with a smartphone. The app interface allowed the user to select rehabilitation activities and receive feedback on the number of activity repetitions completed, time to complete each activity, and quality of movement. OBJECTIVE This study aimed to assess the usability, perceived usefulness, and acceptance of the mRehab system by individuals with stroke and identify the challenges experienced by them when using the system remotely in a home-based setting. METHODS A mixed-methods approach was used with 11 individuals with chronic stroke. Following training, individuals with stroke used the mRehab system for 6 weeks at home. Each participant completed surveys and engaged in a semistructured interview. Participants' qualitative reports regarding the usability of mRehab were integrated with their survey reports and quantitative performance data. RESULTS Of the 11 participants, 10 rated the mRehab system between the 67.5th and 97.5th percentile on the System Usability Scale, indicating their satisfaction with the usability of the system. Participants also provided high ratings of perceived usefulness (mean 5.8, SD 0.9) and perceived ease of use (mean 5.3, SD 1.5) on a 7-point scale based on the Technology Acceptance Model. Common themes reported by participants showed a positive response to mRehab with some suggestions for improvements. Participants reported an interest in activities they perceived to be adequately challenging. Some participants indicated a need for customizing the feedback to be more interpretable. Overall, most participants indicated that they would like to continue using the mRehab system at home. CONCLUSIONS Assessing usability in the lived environment over a prolonged duration of time is essential to identify the match between the system and users' needs and preferences. While mRehab was well accepted, further customization is desired for a better fit with the end users. TRIAL REGISTRATION ClinicalTrials.gov NCT04363944; https://clinicaltrials.gov/ct2/show/NCT04363944.
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Affiliation(s)
- Sutanuka Bhattacharjya
- Department of Occupational Therapy, Byrdine F Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, United States
| | - Lora Anne Cavuoto
- Rehabilitation Science, University at Buffalo, Buffalo, NY, United States
| | - Brandon Reilly
- Rehabilitation Science, University at Buffalo, Buffalo, NY, United States
| | - Wenyao Xu
- Rehabilitation Science, University at Buffalo, Buffalo, NY, United States
| | - Heamchand Subryan
- Rehabilitation Science, University at Buffalo, Buffalo, NY, United States
| | - Jeanne Langan
- Rehabilitation Science, University at Buffalo, Buffalo, NY, United States
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Regterschot GRH, Bussmann JBJ, Fanchamps MHJ, Meskers CGM, Ribbers GM, Selles RW. Objectively measured arm use in daily life improves during the first 6 months poststroke: a longitudinal observational cohort study. J Neuroeng Rehabil 2021; 18:51. [PMID: 33741017 PMCID: PMC7980644 DOI: 10.1186/s12984-021-00847-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/10/2021] [Indexed: 12/20/2022] Open
Abstract
Background It is unclear how arm use in daily life changes after stroke since studies investigating the change in arm use poststroke are scarce. The aim of this study was to investigate the change in arm use during the first six months poststroke. Secondary aim was to compare arm use changes between arm recovery clusters. Methods Arm use was measured during week 3, 12, and 26 poststroke with accelerometers on the wrists and the nonaffected leg. Outcomes were the amount of affected and nonaffected arm use during sitting and standing per day and per sit/stand hour, and the daily ratio between arms. Arm function was measured with the Fugl-Meyer Upper Extremity Scale to identify recovery clusters (poor/moderate/excellent). Generalized estimating equations compared arm use outcomes between time points and between recovery clusters. Results Thirty-three stroke patients participated. Affected arm use per day increased between week 3 and 12 (30 %; p = 0.04) and it increased per sit/stand hour between week 3–12 (31 %; p < 0.001) and between week 3 and 26 (48 %; p = 0.02). Nonaffected arm use per day decreased between week 3 and 12 (13 %; p < 0.001) and between week 3 and 26 (22 %; p < 0.001) and it decreased per sit/stand hour between week 3 and 26 (18 %; p = 0.003). The daily ratio increased between week 3 and 12 (43 %; p < 0.001) and between week 3 and 26 (95 %; p < 0.001). Changes in arm use did not differ significantly between recovery clusters (p = 0.11–0.62). Affected arm use was higher in the excellent recovery cluster (p < 0.001). Conclusions Affected arm use and the ratio between arms increase during the first 26 weeks poststroke especially in patients with excellent arm recovery. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00847-x.
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Affiliation(s)
- G R H Regterschot
- Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - J B J Bussmann
- Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Malou H J Fanchamps
- Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan, 1117, 1081 HV, Amsterdam, The Netherlands
| | - Gerard M Ribbers
- Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Westersingel 300, 3015 LJ, Rotterdam, The Netherlands
| | - Ruud W Selles
- Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Lum PS, Shu L, Bochniewicz EM, Tran T, Chang LC, Barth J, Dromerick AW. Improving Accelerometry-Based Measurement of Functional Use of the Upper Extremity After Stroke: Machine Learning Versus Counts Threshold Method. Neurorehabil Neural Repair 2020; 34:1078-1087. [PMID: 33150830 PMCID: PMC7704838 DOI: 10.1177/1545968320962483] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Wrist-worn accelerometry provides objective monitoring of upper-extremity functional use, such as reaching tasks, but also detects nonfunctional movements, leading to ambiguity in monitoring results. OBJECTIVE Compare machine learning algorithms with standard methods (counts ratio) to improve accuracy in detecting functional activity. METHODS Healthy controls and individuals with stroke performed unstructured tasks in a simulated community environment (Test duration = 26 ± 8 minutes) while accelerometry and video were synchronously recorded. Human annotators scored each frame of the video as being functional or nonfunctional activity, providing ground truth. Several machine learning algorithms were developed to separate functional from nonfunctional activity in the accelerometer data. We also calculated the counts ratio, which uses a thresholding scheme to calculate the duration of activity in the paretic limb normalized by the less-affected limb. RESULTS The counts ratio was not significantly correlated with ground truth and had large errors (r = 0.48; P = .16; average error = 52.7%) because of high levels of nonfunctional movement in the paretic limb. Counts did not increase with increased functional movement. The best-performing intrasubject machine learning algorithm had an accuracy of 92.6% in the paretic limb of stroke patients, and the correlation with ground truth was r = 0.99 (P < .001; average error = 3.9%). The best intersubject model had an accuracy of 74.2% and a correlation of r =0.81 (P = .005; average error = 5.2%) with ground truth. CONCLUSIONS In our sample, the counts ratio did not accurately reflect functional activity. Machine learning algorithms were more accurate, and future work should focus on the development of a clinical tool.
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Affiliation(s)
- Peter S Lum
- The Catholic University of America, Washington, DC, USA.,MedStar National Rehabilitation Network, Washington, DC, USA
| | - Liqi Shu
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Tan Tran
- The Catholic University of America, Washington, DC, USA
| | | | - Jessica Barth
- MedStar National Rehabilitation Network, Washington, DC, USA
| | - Alexander W Dromerick
- MedStar National Rehabilitation Network, Washington, DC, USA.,Georgetown University School of Medicine, Washington, DC, USA
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Barth J, Klaesner JW, Lang CE. Relationships between accelerometry and general compensatory movements of the upper limb after stroke. J Neuroeng Rehabil 2020; 17:138. [PMID: 33081783 PMCID: PMC7576735 DOI: 10.1186/s12984-020-00773-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 10/12/2020] [Indexed: 01/08/2023] Open
Abstract
Background Standardized assessments are used in rehabilitation clinics after stroke to measure restoration versus compensatory movements of the upper limb. Accelerometry is an emerging tool that can bridge the gap between in- and out-of-clinic assessments of the upper limb, but is limited in that it currently does not capture the quality of a person’s movement, an important concept to assess compensation versus restoration. The purpose of this analysis was to characterize how accelerometer variables may reflect upper limb compensatory movement patterns after stroke. Methods This study was a secondary analysis of an existing data set from a Phase II, single-blind, randomized, parallel dose–response trial (NCT0114369). Sources of data utilized were: (1) a compensatory movement score derived from video analysis of the Action Research Arm Test (ARAT), and (2) calculated accelerometer variables quantifying time, magnitude and variability of upper limb movement from the same time point during study participation for both in-clinic and out-of-clinic recording periods. Results Participants had chronic upper limb paresis of mild to moderate severity. Compensatory movement scores varied across the sample, with a mean of 73.7 ± 33.6 and range from 11.5 to 188. Moderate correlations were observed between the compensatory movement score and each accelerometer variable. Accelerometer variables measured out-of-clinic had stronger relationships with compensatory movements, compared with accelerometer variables in-clinic. Variables quantifying time, magnitude, and variability of upper limb movement out-of-clinic had relationships to the compensatory movement score. Conclusions Accelerometry is a tool that, while measuring movement quantity, can also reflect the use of general compensatory movement patterns of the upper limb in persons with chronic stroke. Individuals who move their limbs more in daily life with respect to time and variability tend to move with less movement compensations and more typical movement patterns. Likewise, individuals who move their paretic limbs less and their non-paretic limb more in daily life tend to move with more movement compensations at all joints in the paretic limb and less typical movement patterns.
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Affiliation(s)
- Jessica Barth
- Washington University School of Medicine, Program in Physical Therapy, St. Louis, MO, USA
| | - Joeseph W Klaesner
- Washington University School of Medicine, Program in Physical Therapy, St. Louis, MO, USA.,Department in Biomedical Engineering, Washington University, St. Louis, MO, USA
| | - Catherine E Lang
- Washington University School of Medicine, Program in Physical Therapy, St. Louis, MO, USA. .,Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, USA. .,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
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Lang CE, Barth J, Holleran CL, Konrad JD, Bland MD. Implementation of Wearable Sensing Technology for Movement: Pushing Forward into the Routine Physical Rehabilitation Care Field. SENSORS 2020; 20:s20205744. [PMID: 33050368 PMCID: PMC7601835 DOI: 10.3390/s20205744] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 01/01/2023]
Abstract
While the promise of wearable sensor technology to transform physical rehabilitation has been around for a number of years, the reality is that wearable sensor technology for the measurement of human movement has remained largely confined to rehabilitation research labs with limited ventures into clinical practice. The purposes of this paper are to: (1) discuss the major barriers in clinical practice and available wearable sensing technology; (2) propose benchmarks for wearable device systems that would make it feasible to implement them in clinical practice across the world and (3) evaluate a current wearable device system against the benchmarks as an example. If we can overcome the barriers and achieve the benchmarks collectively, the field of rehabilitation will move forward towards better movement interventions that produce improved function not just in the clinic or lab, but out in peoples' homes and communities.
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Affiliation(s)
- Catherine E. Lang
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63122, USA
- Correspondence:
| | - Jessica Barth
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
| | - Carey L. Holleran
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63122, USA
| | - Jeff D. Konrad
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
| | - Marghuretta D. Bland
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63122, USA
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Improving Spatiotemporal Gait Asymmetry Has Limited Functional Benefit for Individuals Poststroke. J Neurol Phys Ther 2020; 44:197-204. [DOI: 10.1097/npt.0000000000000321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jones M, DeRuyter F, Morris J. The Digital Health Revolution and People with Disabilities: Perspective from the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020381. [PMID: 31936006 PMCID: PMC7013503 DOI: 10.3390/ijerph17020381] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/24/2019] [Accepted: 01/03/2020] [Indexed: 12/23/2022]
Abstract
This article serves as the introduction to this special issue on Mobile Health and Mobile Rehabilitation for People with Disabilities. Social, technological and policy trends are reviewed. Needs, opportunities and challenges for the emerging fields of mobile health (mHealth, aka eHealth) and mobile rehabilitation (mRehab) are discussed. Healthcare in the United States (U.S.) is at a critical juncture characterized by: (1) a growing need for healthcare and rehabilitation services; (2) maturing technological capabilities to support more effective and efficient health services; (3) evolving public policies designed, by turns, to contain cost and support new models of care; and (4) a growing need to ensure acceptance and usability of new health technologies by people with disabilities and chronic conditions, clinicians and health delivery systems. Discussion of demographic and population health data, healthcare service delivery and a public policy primarily focuses on the U.S. However, trends identified (aging populations, growing prevalence of chronic conditions and disability, labor shortages in healthcare) apply to most countries with advanced economies and others. Furthermore, technologies that enable mRehab (wearable sensors, in-home environmental monitors, cloud computing, artificial intelligence) transcend national boundaries. Remote and mobile healthcare delivery is needed and inevitable. Proactive engagement is critical to ensure acceptance and effectiveness for all stakeholders.
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Affiliation(s)
- Mike Jones
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA 30309, USA;
| | - Frank DeRuyter
- Department of Surgery, Duke University, Durham, NC 27708, USA;
| | - John Morris
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA 30309, USA;
- Correspondence: ; Tel.: +1-404-367-1348
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37
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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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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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Abstract
Simultaneous tracking of muscle activity and joint rotation is of significant interest in rehabilitation, but gold-standard methods with optical motion tracking and wireless electromyography recording typically restricts this to the laboratory setting. There has been significant progress using wear-able inertial measurement units (IMUs) for motion tracking, but there are no systems that can easily be deployed to home and provide simultaneous electromyography. We addressed this gap by developing a flexible, wearable, Bluetooth-connected sensor that records both IMU and EMG activity. The sensor runs an efficient quaternion-based complementary filter that estimates the sensor orientation while correcting for estimate drift and constraining magnetometer estimates to only influence heading. The difference in two sensor orientations is used to estimate the joint angle, which can be further improved with joint axis estimation. We demonstrate successful tracking of joint angle and muscle activity in a home environment with just the sensors and a smartphone.
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Rowe VT, Neville M. Measuring Reliability of Movement With Accelerometry: Fitbit ® Versus ActiGraph ®. Am J Occup Ther 2019; 73:7302205150p1-7302205150p6. [PMID: 30915976 DOI: 10.5014/ajot.2019.030692] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We sought to determine the reliability of the Fitbit® Flex™ compared with the ActiGraph® Bluetooth® Smart wGT3X-BT wireless activity monitor and to contribute to the clinical utility of accelerometry measurement of upper extremity (UE) movement. METHOD Two studies were conducted at different sites with healthy adult participants. In Study 1, participants wore both accelerometers on both wrists during everyday activities for a 24-hr period. In Study 2, participants wore both accelerometers on the dominant wrist for 4 hr during an active period of the day. All participants wore the accelerometers during regular daily activities. RESULTS Data recorded from the Fitbit and the ActiGraph showed a high positive correlation; however, the Fitbit recorded significantly fewer movements than the ActiGraph. CONCLUSION Although the Fitbit and the ActiGraph measure UE activity similarly, the Fitbit was not as sensitive as the ActiGraph. This study provides informative data on the clinical utility of the Fitbit compared with the ActiGraph.
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Affiliation(s)
- Veronica T Rowe
- Veronica T. Rowe, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, University of Central Arkansas, Conway;
| | - Marsha Neville
- Marsha Neville, PhD, OT, is Associate Professor, School of Occupational Therapy, Texas Woman's University, Dallas
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McLaren R, Signal N, Lord S, Taylor S, Henderson J, Taylor D. The volume and timing of upper limb movement in acute stroke rehabilitation: still room for improvement. Disabil Rehabil 2019; 42:3237-3242. [PMID: 30951402 DOI: 10.1080/09638288.2019.1590471] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To observe upper limb activity patterns of people with stroke during sub-acute rehabilitation to inform the development of treatment strategies for upper limb rehabilitation. Design: Observational study of upper limb activity. Methods: Twenty participants admitted for sub-acute rehabilitation following stroke were observed during a week day for 1 minute every 10 min between 7 am and 7 pm. Upper limb activity was recorded and categorized into five types of movement. Results: Participants used either one or both upper limbs for 45.8% of the observation time. The affected arm moved 26.4% of the time, with most movement occurring in conjunction with the unaffected arm (18.9% of the time) and only 7.5% of the time being movement of the affected arm by itself. The largest proportion of upper limb activity was observed during mealtimes. Conclusions: Recognition of the need to improve upper limb outcomes after stroke has not yet translated into changes in the amount of upper limb activity undertaken during sub-acute rehabilitation. Opportunities to rehabilitate the hemiplegic upper limb are not fully realized. The dominance of bilateral movement in the early stages after stroke may provide scope for interventions that maximize this aspect of motor control.IMPLICATIONS FOR REHABILITATIONDespite advances in rehabilitation, time spent in upper limb activity following stroke is very low, particularly in the affected arm.Most movement of the affected arm occurs in conjunction with the unaffected arm.There is an urgent need to redress this low level of movement, given the importance of upper limb recovery to quality of life for people following stroke.
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Affiliation(s)
- Ruth McLaren
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Nada Signal
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Sue Lord
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Steve Taylor
- Department of Biostatistics and Epidemiology, Auckland University of Technology, Auckland, New Zealand
| | - Jeanette Henderson
- Assessment, Treatment and Rehabilitation Department, Waitakere Hospital, Auckland, New Zealand
| | - Denise Taylor
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
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Franck JA, Smeets RJEM, Seelen HAM. Changes in actual arm-hand use in stroke patients during and after clinical rehabilitation involving a well-defined arm-hand rehabilitation program: A prospective cohort study. PLoS One 2019; 14:e0214651. [PMID: 30934015 PMCID: PMC6443150 DOI: 10.1371/journal.pone.0214651] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/18/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Improvement of arm-hand function and arm-hand skill performance in stroke patients is reported by many authors. However, therapy content often is poorly described, data on actual arm-hand use are scarce, and, as follow-up time often is very short, little information on patients’ mid- and long-term progression is available. Also, outcome data mainly stem from either a general patient group, unstratified for the severity of arm-hand impairment, or a very specific patient group. Objectives To investigate to what extent the rate of improvement or deterioration of actual arm-hand use differs between stroke patients with either a severely, moderately or mildly affected arm-hand, during and after rehabilitation involving a well-defined rehabilitation program. Methods Design: single–armed prospective cohort study. Outcome measure: affected arm-hand use during daily tasks (accelerometry), expressed as ‘Intensity-of arm-hand-use’ and ‘Duration-of-arm-hand-use’ during waking hours. Measurement dates: at admission, clinical discharge and 3, 6, 9, and 12 months post-discharge. Statistics: Two-way repeated measures ANOVAs. Results Seventy-six patients (63 males); mean age: 57.6 years (sd:10.6); post-stroke time: 29.8 days (sd:20.1) participated. Between baseline and 1-year follow-up, Intensity-of-arm-hand-use on the affected side increased by 51%, 114% and 14% (p < .000) in the mildly, moderately and severely affected patients, respectively. Similarly, Duration-of-arm-hand-use increased by 26%, 220% and 161% (p < .000). Regarding bimanual arm-hand use: Intensity-of-arm-hand-use increased by 44%, 74% and 30% (p < .000), whereas Duration-of-arm-hand-use increased by 10%, 22% and 16% (p < .000). Conclusion Stroke survivors with a severely, moderately or mildly affected arm-hand showed different, though (clinically) important, improvements in actual arm-hand use during the rehabilitation phase. Intensity-of-arm-hand-use and Duration-of-arm-hand-use significantly improved in both unimanual and bimanual tasks/skills. These improvements were maintained until at least 1 year post-discharge.
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Affiliation(s)
- Johan Anton Franck
- Adelante Rehabilitation Centre, dept. of Brain Injury Rehabilitation, Hoensbroek, the Netherlands
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
- * E-mail:
| | | | - Henk Alexander Maria Seelen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
- Maastricht University, Research School CAPHRI, dept. of Rehabilitation Medicine, Maastricht, the Netherlands
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Stewart JC, Lewthwaite R, Rocktashel J, Winstein CJ. Self-efficacy and Reach Performance in Individuals With Mild Motor Impairment Due to Stroke. Neurorehabil Neural Repair 2019; 33:319-328. [PMID: 30880592 DOI: 10.1177/1545968319836231] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Persistent deficits in arm function are common after stroke. An improved understanding of the factors that contribute to the performance of skilled arm movements is needed. One such factor may be self-efficacy (SE). OBJECTIVE To determine the level of SE for skilled, goal-directed reach actions in individuals with mild motor impairment after stroke and whether SE for reach performance correlated with actual reach performance. METHODS A total of 20 individuals with chronic stroke (months poststroke: mean 58.1 ± 38.8) and mild motor impairment (upper-extremity Fugl-Meyer [FM] motor score: mean 53.2, range 39 to 66) and 6 age-matched controls reached to targets presented in 2 directions (ipsilateral, contralateral). Prior to each block (24 reach trials), individuals rated their confidence on reaching to targets accurately and quickly on a scale that ranged from 0 ( not very confident) to 10 ( very confident). RESULTS Overall reach performance was slower and less accurate in the more-affected arm compared with both the less-affected arm and controls. SE for both reach speed and reach accuracy was lower for the more-affected arm compared with the less-affected arm. For reaches with the more-affected arm, SE for reach speed and age significantly predicted movement time to ipsilateral targets ( R2 = 0.352), whereas SE for reach accuracy and FM motor score significantly predicted end point error to contralateral targets ( R2 = 0.291). CONCLUSIONS SE relates to measures of reach control and may serve as a target for interventions to improve proximal arm control after stroke.
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Affiliation(s)
| | - Rebecca Lewthwaite
- 2 Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA.,3 University of Southern California, Los Angeles, CA, USA
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Doron N, Rand D. Is Unilateral Spatial Neglect Associated With Motor Recovery of the Affected Upper Extremity Poststroke? A Systematic Review. Neurorehabil Neural Repair 2019; 33:179-187. [PMID: 30784364 DOI: 10.1177/1545968319832606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Individuals with stroke often present symptoms of multiple domains, such as weakness of the affected upper extremity (UE) and unilateral spatial neglect (USN), which are both associated with poor functional outcome. The aims of this systematic review were to search and review studies that investigated (1) the relationship between USN and affected UE sensorimotor recovery poststroke and (2) the effectiveness of sensorimotor interventions to improve the affected UE in patients with USN. METHODS An electronic search of databases (MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL) was conducted using a combination of the following terms: stroke, USN, and affected UE. Studies meeting the inclusion criteria were rated using a modified version of the Quality Index, and relevant data were extracted. RESULTS A total of 850 studies were identified, and 14 were included; 13 studies assessed correlations between USN and the affected UE capacity/recovery, and 1 study assessed an intervention to improve the UE of individuals with USN. An association between presence of USN and UE capacity/recovery was found in most studies and USN did not interfere with recovery of the affected UE in the single experimental study. CONCLUSIONS USN is associated with poor UE motor capacity and less UE recovery poststroke. Therefore, these impairments should be considered when planning rehabilitation and discharge. Because USN is a well-researched phenomenon, the lack of studies and insufficient evidence related to UE interventions in individuals with USN was unexpected. These interventions should be developed and researched to improve UE and overall functional outcome poststroke.
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Affiliation(s)
- Noa Doron
- 1 Beit Rivka Geriatric Rehabilitation Center, Petach Tiqva, Israel.,2 School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Debbie Rand
- 2 School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel
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Branco JP, Oliveira S, Sargento-Freitas J, Galego O, Cordeiro G, Cunha L, Freire Gonçalves A, Pinheiro J. Neuroimaging, serum biomarkers, and patient characteristics as predictors of upper limb functioning 12 weeks after acute stroke: an observational, prospective study. Top Stroke Rehabil 2018; 25:1-7. [PMID: 30213243 DOI: 10.1080/10749357.2018.1517491] [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] [Received: 06/07/2018] [Accepted: 08/25/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the potential of neuroimaging, serum biomarkers, stroke etiology, and clinical characteristics as predictors of upper limb functioning 12 weeks after stroke. METHODS This was a prospective, observational study of patients (18-85 years-old) hospitalized due to acute ischemic stroke in the territory of the middle cerebral artery. Patients were hospitalized at a stroke rehabilitation center, where they underwent a standardized rehabilitation program. Clinical, imagiology, laboratory (biomarkers: C-reactive protein, D-dimer, and fibrinogen, and S100 calcium binding protein β [S100β]), and functionality assessments were conducted four different times: within 24 hours, and at 48 hours, 3 weeks, and 12 weeks after acute stroke. RESULTS Upper limb functioning at 12 weeks was significantly associated with Alberta Stroke Program Early CT Score (ASPECTS) score (OR:2.012 [CI:1.349-3.000]; P = 0.001) and S100β protein levels (OR:0.997 [CI:0.994-0.999]; P = 0.007). Advanced age was associated with poor upper limb functioning. S100β protein levels < 140.5 ng/L at 48 hours and ASPECTS scores ≥ 7.5 within 24 hours of admission predicted good hand functioning at 12 weeks. Upper limb functioning and general functioning were significantly correlated (P < 0.001), with strong negative correlations (all correlation coefficients ≤-0.586) for all comparisons. CONCLUSION ASPECTS score ≥ 8 within 24 hours and S100β protein < 140.5 ng/L at 48 hours predict better upper limb functioning, while advanced age predicts worse upper limb functioning 12 weeks after stroke.
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Affiliation(s)
- João Paulo Branco
- a Faculty of Medicine , University of Coimbra , Coimbra , Portugal
- b Physical and Rehabilitation Medicine Department , Centro Hospitalar Universitário de Coimbra , Coimbra , Portugal
- c Physical and Rehabilitation Medicine Department , Centro de Medicina de Reabilitação da Região Centro - Rovisco Pais , Tocha , Portugal
| | - Sandra Oliveira
- c Physical and Rehabilitation Medicine Department , Centro de Medicina de Reabilitação da Região Centro - Rovisco Pais , Tocha , Portugal
| | - João Sargento-Freitas
- a Faculty of Medicine , University of Coimbra , Coimbra , Portugal
- d Neurology Department , Centro Hospitalar Universitário de Coimbra , Coimbra , Portugal
| | - Orlando Galego
- d Neurology Department , Centro Hospitalar Universitário de Coimbra , Coimbra , Portugal
| | - Gustavo Cordeiro
- d Neurology Department , Centro Hospitalar Universitário de Coimbra , Coimbra , Portugal
| | - Luís Cunha
- a Faculty of Medicine , University of Coimbra , Coimbra , Portugal
- d Neurology Department , Centro Hospitalar Universitário de Coimbra , Coimbra , Portugal
| | - António Freire Gonçalves
- a Faculty of Medicine , University of Coimbra , Coimbra , Portugal
- d Neurology Department , Centro Hospitalar Universitário de Coimbra , Coimbra , Portugal
| | - João Pinheiro
- a Faculty of Medicine , University of Coimbra , Coimbra , Portugal
- b Physical and Rehabilitation Medicine Department , Centro Hospitalar Universitário de Coimbra , Coimbra , Portugal
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Proffitt RM, Henderson W, Scholl S, Nettleton M. Lee Silverman Voice Treatment BIG ® for a Person With Stroke. Am J Occup Ther 2018; 72:7205210010p1-7205210010p6. [PMID: 30157019 DOI: 10.5014/ajot.2018.028217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The extant literature suggests the Lee Silverman Voice Treatment BIG® (LSVT BIG) program is an effective intervention for persons with Parkinson's disease; however, no literature or research on the use of this program as an intervention for persons with stroke exists. We examined the effects of the LSVT BIG program for a 52-yr-old community-dwelling woman with mild to moderate upper extremity hemiparesis 2 yr after a stroke and the feasibility of delivering the home exercise component of the program in a game-based format. We made measurements at pretest, posttest, and 6-wk follow-up. The participant demonstrated self-reported improvements in occupational performance and satisfaction and large improvements in upper extremity motor function. The next step in this research is to deliver LSVT BIG and a home game-based program with a larger, more diverse population of persons with chronic stroke to further determine the effectiveness and appropriateness of this intervention.
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Affiliation(s)
- Rachel M Proffitt
- Rachel M. Proffitt, OTD, OTR/L, is Assistant Professor, Department of Occupational Therapy, University of Missouri, Columbia;
| | - Whitney Henderson
- Whitney Henderson, OTD, MOT, OTR/L, is Assistant Clinical Professor, Department of Occupational Therapy, University of Missouri, Columbia
| | - Shea Scholl
- Shea Scholl, MOT, is Student, Department of Occupational Therapy, University of Missouri, Columbia
| | - Micaela Nettleton
- Micaela Nettleton, MOT, is Student, Department of Occupational Therapy, University of Missouri, Columbia
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Abstract
BACKGROUND AND PURPOSE The IV STEP conference challenged presenters and participants to consider the state of science in rehabilitation, highlighting key area of progress since the previous STEP conference related to prediction, prevention, plasticity, and participation in rehabilitation. KEY POINTS Emerging from the thought-provoking discussions was recognition of the progress we have made as a profession and a call for future growth. In this summary article, we present a recap of the key points and call for action. We review the information presented and the field at large as it relates to the 4 Ps: prediction, prevention, plasticity, and participation. RECOMMENDATIONS FOR PRACTICE Given that personalized medicine is an increasingly important approach that was clearly woven throughout the IV STEP presentations, we took the liberty of adding a fifth "P," Personalized, in our discussion of the future direction of the profession.
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Hreha K, Gillen G, Noce N, Nilsen D. The feasibility and effectiveness of using prism adaptation to treat motor and spatial dysfunction in stroke survivors with multiple incidents of stroke. Top Stroke Rehabil 2018; 25:305-311. [DOI: 10.1080/10749357.2018.1437937] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kimberly Hreha
- Rehabilitation Medicine, University of Washington, Seattle, WA, USA
- Movement Science, Teachers College, Columbia University, New York City, USA
- Occupational Therapy, Kessler Institute for Rehabilitation, West Orange, USA
| | - Glen Gillen
- Occupational Therapy, Columbia University, New York City, USA
- Movement Science, Teachers College, Columbia University, New York City, USA
| | - Natalia Noce
- Occupational Therapy, Kessler Institute for Rehabilitation, West Orange, USA
| | - Dawn Nilsen
- Occupational Therapy, Columbia University, New York City, USA
- Movement Science, Teachers College, Columbia University, New York City, USA
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Mettler JA, Bennett SM, Doucet BM, Magee DM. Neuromuscular Electrical Stimulation and Anabolic Signaling in Patients with Stroke. J Stroke Cerebrovasc Dis 2017; 26:2954-2963. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/17/2017] [Accepted: 07/21/2017] [Indexed: 01/09/2023] Open
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