Stroke is one of the leading causes of long-term disability. Approximately two thirds of stroke survivors require long-term rehabilitation, which suggests the importance of understanding movement quality in real-world settings. To address this need, we have developed an approach that quantifies physical activity and also evaluates performance quality. Accelerometer and gyroscope sensor data are used to measure upper extremity movements and to develop a mathematical framework to relate objective sensor data to clinical performance metrics. In this article we employ two approaches to extract clinically meaningful quality measures from individuals post-stroke; we then compare the resulting predictive ability of the two approaches. Our findings indicate that Bootstrap Aggregating forest approaches may be superior to the computationally simpler decision trees for unstable data sets including those derived from individuals post-stroke.

Purpose: The Rehabilitation Department at the University of Tennessee Medical Center in Knoxville, Tennessee, changed its staffing model in an effort to increase efficiency and reduce hospital length of stay (LOS) without compromising safety for patients undergoing total joint arthroplasty (TJA). This study was designed to reveal effects of extended physical therapy (PT) coverage on TJA patient safety and LOS at our hospital. Methods: Our study is a retrospective chart review including 775 patients. After a staffing change involving the addition of an evening PT shift, we gathered data on patients with TJA in 2 groups: (1) before staffing change and (2) after staffing change. We examined the percentage of patients in each group who received a day of surgery (DOS) PT evaluation and tracked each group's incidence of adverse events and hospital LOS. We then compared outcomes between groups. Results: The percentage of Patients who received a DOS PT evaluation increased from 64.5% prestaffing change to 97.0% poststaffing change. Hospital LOS decreased from 2.30 days (SD = 0.9) in the prestaffing change group to 2.16 days (SD = 0.8) in the poststaffing change group, with no difference in incidence of adverse events between groups. The frequency of adverse events tracked in this study was only 6.6% in each group, indicating that the greater frequency of DOS PT evaluations did not increase the incidence of adverse events or compromise patients' safety. Conclusions: A staffing change involving extended PT evening coverage resulted in a higher percentage of patients with TJA receiving a DOS PT evaluation, no increase of adverse events, and a statistically significant decrease in hospital LOS.

The mechanical assistance provided by exoskeletons could potentially replace, assist, or rehabilitate upper extremity function in patients with mild to moderate shoulder disability to perform activities of daily living. While many exoskeletons are "active" (e.g. motorized), mechanically passive exoskeletons may be a more practical and affordable solution to meet a growing clinical need for continuous, home-based movement assistance. In the current study, we designed, fabricated, and evaluated the performance of a wearable, passive, cable-driven shoulder exoskeleton (WPCSE) prototype. An innovative feature of the WPCSE is a modular spring-cam-wheel system that can be custom designed to compensate for any proportion of the shoulder elevation moment due to gravity over a large range of shoulder motion. The force produced by the spring-cam-wheel system is transmitted over the superior aspect of the shoulder to an arm cuff through a Bowden cable. The results from mechanical evaluation revealed that the modular spring-cam-wheel system could successfully produce an assistive positive shoulder elevation moment that matched the desired, theoretical moment. However, when measured from the physical WPCSE prototype, the moment was lower (up to 30%) during positive shoulder elevation and higher (up to 120%) during negative shoulder elevation due primarily to friction. Even so, our biomechanical evaluation showed that the WPCSE prototype reduced the root mean square (up to 35%) and peak (up to 33%) muscular activity, as measured by electromyography, of several muscles crossing the shoulder during shoulder elevation and horizontal adduction/abduction movements. These preliminary results suggest that our WPCSE may be suitable for providing movement assistance to people with shoulder disability.