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

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.

Magnetically Counting Hand Movements: Validation of a Calibration-Free Algorithm and Application to Testing the Threshold Hypothesis of Real-World Hand Use after Stroke

“…This result should be compared to a recent result by Franck et al [ 30 ] that acquired bilateral wrist accelerometry readings in 76 subacute stroke patients at home. They measured hours of active use of the impaired arm relative to the hours of active use of the non-dominant arms of unimpaired persons and plotted it against the UEFM, an impairment-based rather than functionally oriented scale.…”

Quantification of the relative arm use in patients with hemiparesis using inertial measurement units

“…Accelerometery-based activity counts are currently the most popular method for measuring arm use. [21][22][23][24][25] Activity counts detect all types of movements failing to isolate functional movements from non-functional ones due to their high sensitivity and low specificity. 26,27 Activity counts assume that the effect of ambulation is negligible because most patients with upper limb impairments due to neurological conditions have accompanying lower limb, posture, and balance impairments.…”

Assessment of Hand Function in Post Stroke Patients Using ‘Jebsen Taylor Hand Function Test’

“…Yet there is substantial evidence that recovery continues at a slower rate over a much longer, unspecified period (months or years). 4 Thus the study aims to assess the hand function using Jebsen Taylor Hand function test among patients post stroke.…”