We studied the effects of fatigue of the index finger on indices of force variability in discrete and rhythmic accurate force production tasks performed by the index finger and by all four fingers pressing in parallel. An increase in the variance of the force produced by the fatigued index finger was expected. We hypothesized that the other fingers would also show increased variance of their forces, which would be accompanied by co-variation among the finger forces resulting in relatively preserved accuracy of performance. The subjects performed isometric tasks including maximal voluntary contraction (MVC) and accurate force production before and after a 1-min MVC fatiguing exercise by the index finger. During fatigue, there was a significant increase in the root mean square index of force variability during accurate force production by the index finger. In the four-finger tasks, the variance of the individual finger force increased for all four fingers, while the total force variance showed only a modest change. We quantified two components of variance in the space of hypothetical commands to fingers, finger modes. There was a large increase in the variance component that did not affect total force and a much smaller increase in the component that did. The results suggest an adaptive increase in force variance by nonfatigued elements as a strategy to attenuate effects of fatigue on accuracy of multi-element performance. These effects were unlikely to originate at the level of synchronization of motor units across muscle compartments but rather involved higher control levels.

In a multifinger cyclic force production task, the finger force variance measured across trials can be decomposed into two components, one that affects the combined force output (“bad variance”), and one that does not (“good variance”). Previous studies have found similar time patterns of “bad variance” and force rate leading to an approximately linear relationship between them. Based on this finding and a recently developed model of multifinger force production, we expected the “bad variance” during cyclic force production to increase monotonically with the rate of force change, both within-a-cycle, and across trials at different frequencies. Alternatively, “bad variance” could show a dependence on task frequency, not on actual force derivative values. Healthy subjects were required to produce cyclic force patterns to prescribed targets by pressing on unidimensional force sensors, at a frequency set by a metronome. The task was performed with only the index finger, and with all four fingers. In the task with all four fingers, the “good variance” increased approximately linearly with an increase in the force magnitude. The “bad variance” showed within-a-cycle modulation similar to that of the force rate. However, an increase in the frequency did not lead to an increase in the “bad variance” that could be expected based on the natural relationships between action frequency and the rate of force change modulation. The results have been interpreted in the framework of an earlier model of multifinger force production where “bad variance” is a result of variance of the timing parameter. The unexpected lack of modulation of the “bad variance” with frequency suggests a drop in variance of the timing parameter with increased frequency. This mechanism may serve to maintain a constant acceptable level of variance under different conditions.

Introduction Accelerometry-based activity counting for measuring arm use is prone to overestimation due to non-functional movements. In this paper, we used an inertial measurement unit (IMU)-based gross movement (GM) score to quantify arm use. Methods In this two-part study, we first characterized the GM by comparing it to annotated video recordings of 5 hemiparetic patients and 10 control subjects performing a set of activities. In the second part, we tracked the arm use of 5 patients and 5 controls using two wrist-worn IMUs for 7 and 3 days, respectively. The IMU data was used to develop quantitative measures (total and relative arm use) and a visualization method for arm use. Results From the characterization study, we found that GM detects functional activities with 50–60% accuracy and eliminates non-functional activities with >90% accuracy. Continuous monitoring of arm use showed that the arm use was biased towards the dominant limb and less paretic limb for controls and patients, respectively. Conclusions The gross movement score has good specificity but low sensitivity in identifying functional activity. The at-home study showed that it is feasible to use two IMU-watches to monitor relative arm use and provided design considerations for improving the assessment method. Clinical trial registry number: CTRI/2018/09/015648

The ultimate goal of any upper-limb neurorehabilitation procedure is to improve upper-limb functioning in daily life. While clinic-based assessments provide an assessment of what a patient can do, they do not completely reflect what a patient does in his/her daily life. The use of compensatory strategies such as the use of the less affected upper-limb or excessive use of trunk in daily life is a common behavioral pattern seen in patients with hemiparesis. To this end, there has been an increasing interest in the use of wearable sensors to objectively assess upper-limb functioning. This paper presents a framework for assessing upper-limb functioning using sensors by providing: (a) a set of definitions of important constructs associated with upper-limb functioning; (b) different visualization methods for evaluating upper-limb functioning; and (c) two new measures for quantifying how much an upper-limb is used and the relative bias in their use. The demonstration of some of these components is presented using data collected from inertial measurement units from a previous study. The proposed framework can help guide the future technical and clinical work in this area to realize valid, objective, and robust tools for assessing upper-limb functioning. This will in turn drive the refinement and standardization of the assessment of upper-limb functioning.

Background: The most popular method for measuring upper limb activity is based on accelerometry. However, this method is prone to overestimation and is agnostic to the functional utility of a movement. In this study, we used an inertial measurement unit(IMU)-based gross movement score to quantify arm-use in hemiparetic patients at home. Objectives: (i) Validate the gross movement score detected by wrist-worn IMUs against functional movements identified by human assessors. (ii) Test the feasibility of using wrist-worn IMUs to measure arm-use in patients' natural settings. Methods: To validate the gross movement score two independent assessors analyzed and annotated the video recordings of 5 hemiparetic patients and 10 healthy controls performing a set of activities while wearing IMUs. The second study tracked arm-use of 5 hemiparetic patients and 5 healthy controls using two wrist-worn IMUs for 7 days and 3 days, respectively. The IMU data obtained from this study was used to develop quantitative measures (total and relative arm-use (RAU)) and a visualization method for arm-use. Results: The gross movement score detects functional movement with 50-60% accuracy in hemiparetic patients, and is robust to non-functional movements. Healthy controls showed a slight bias towards the dominant arm (RAU: 40.52)°. Patients' RAU varied between 15-47° depending upon their impairment level and pre-stroke hand dominance. Conclusions: The gross movement score performs moderately well in detecting functional movements while rejecting non-functional movements. The patients' total arm-use is less than healthy controls, and their relative arm-use is skewed towards the less-impaired arm.