Acceleration Metrics Are Responsive to Change in Upper Extremity Function of Stroke Survivors

Abstract

Objectives The primary purpose of this study was to determine if acceleration metrics derived from monitoring outside of treatment are responsive to change in upper extremity (UE) function. The secondary purposes were two-fold: The first was to compare metric values during task-specific training and while in the free-living environment. The second was to establish metric associations with an in-clinic measure of movement capabilities. Design Before-After Observational Study Setting Inpatient Hospital (primary purpose); Outpatient Hospital (secondary purpose) Participants Individuals (n=8) with UE hemiparesis < 30 days post stroke (primary purpose); Individuals (n=27) with UE hemiparesis ≥ 6 months post stroke (secondary purpose). Methods The inpatient sample was evaluated for UE movement capabilities and monitored with wrist-worn accelerometers for 22 hours outside of treatment before and after multiple sessions of task-specific training. The outpatient sample was evaluated for UE movement capabilities and monitored during a single session of task-specific training and the subsequent 22 hours outside of clinical settings. Main Outcome Measures Action Research Arm Test and acceleration metrics quantified from accelerometer recordings. Results Five metrics improved in the inpatient sample, along with UE function as measured on the ARAT: use ratio, magnitude ratio, variation ratio, median paretic UE acceleration magnitude, and paretic UE acceleration variability. Metric values were greater during task-specific training than in the free-living environment, and each metric was strongly associated with ARAT score. Conclusions Multiple metrics that characterize different aspects of UE movement are responsive to change in function. Metric values are different during training than in the free-living environment, providing further evidence that what the paretic UE does in the clinic may not generalize to what it does in everyday life.

Wearable sensors for clinical applications in epilepsy, Parkinson’s disease, and stroke: a mixed-methods systematic review

“…Wearables were also used to quantify sleep disturbances [30], gait measures [31, 32], freezing of gait [33, 34], missteps and fall [35, 36], and physical activity levels [37–39]. In stroke, upper extremity activity [40–51], walking, and physical activity levels were investigated in several studies using step and activity counts [52–62]. …”

Does Task-Specific Training Improve Upper Limb Performance in Daily Life Poststroke?

“…The median paretic acceleration magnitude captures the individual’s median acceleration value over the entire recording period. 45 The acceleration variability is the variance of the mean acceleration value over the recording period and explains the average distance of the paretic accelerations from the mean acceleration. 45 A higher value for both the median acceleration magnitude and acceleration variability indicates more overall UL movement and greater variability of movement, respectively.…”

“…45 While not responsive to change in UL function, the bilateral magnitude may be a valuable variable for quantifying the intensity of bilateral movement, which is of interest to rehabilitation professionals.…”

Consideration of Dose and Timing When Applying Interventions After Stroke and Spinal Cord Injury

“…what a person is capable of doing in the structured environment of a clinic or laboratory. 26 Accelerometry metrics are responsive to change 27 and provide critical information about what a person actually does in daily life. One of the striking features from our neurologically-intact adults sample (n = 74) was the strong consistency across individuals in their daily upper limb performance as revealed from accelerometry profiles (see Figure 2 for representative examples).…”