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

Abstract

Background A common assumption is that changes in upper limb (UL) capacity, or what an individual is capable of doing, translate to improved UL performance in daily life, or what an individual actually does. This assumption should be explicitly tested for individuals with UL paresis post-stroke. Objective To examine changes in UL performance after an intensive, individualized, progressive, task-specific UL intervention for individuals at least 6 months post-stroke. Methods Secondary analysis on 78 individuals with UL paresis who participated in a Phase II, single-blind, randomized parallel dose-response trial. Participants were enrolled in a task-specific intervention for 8 weeks. Participants were randomized into 1 of 4 treatment groups with each group completing different amounts of UL movement practice. UL performance was assessed with bilateral, wrist-worn accelerometers once a week for 24 hours throughout the duration of the study. The six accelerometer variables were tested for change and the influence of potential modifiers using hierarchical linear modeling. Results No changes in UL performance were found on any of the 6 accelerometer variables used to quantify UL performance. Neither changes in UL capacity nor the overall amount of movement practice influenced changes in UL performance. Stroke chronicity, baseline UL capacity, concordance, and ADL status significantly increased the baseline starting points but did not influence the rate of change (slopes) for participants. Conclusions Improved motor capacity resulting from an intensive outpatient UL intervention does not appear to translate to increased UL performance outside the clinic.

Comparison of Self-Report Versus Sensor-Based Methods for Measuring the Amount of Upper Limb Activity Outside the Clinic

“…Participant demographics, and MAL-AOU and use ratio values (Table 1) were not different from the trial cohort. 7,8 Consistent with previous reports 5 , the MAL and use ratio were moderately associated at baseline (r=0.31, 95% CI [0.07, 0.51], p = 0.014) and post-intervention (r = 0.52, 95% CI [0.32, 0.68], p < 0.001).…”

“…Participants wore the accelerometers for 24 hours at baseline and again post-intervention during all daily activities. 8 The variable of interest for this comparison was the use ratio, an established metric of UL performance in daily life. 4,9 The use ratio quantifies the amount of time the paretic UL is active relative to the non-paretic UL and ranges from 0–1.…”

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

“…28 The six metrics are indices of unilateral and bilateral activity, quantifying intensity, magnitude, contributions from each limb, and variability throughout the day. 28 The lack of change in performance occurred in spite of formal bi-weekly and informal, per-session discussions with each participant about how they might incorporate use of the hand and arm into daily activities. Figure 3 shows group data from one metric, the activity (or use) ratio.…”

Therapeutic applications of BCI technologies

“…Repetition is necessary in order to progress to the next highest level of difficulty in the learning of motor control. In recent work [40-41], the number of repetitions was reported, respectively, for 13.6 hrs, 20.0hrs, and 26.3hrs of therapy for mildly/moderately impaired chronic stroke survivors, along with the findings that no increased use of the impaired limb was recorded at home and there was no significant difference in this across the three groups of different dosage (hours of treatment). In contrast, and though no ‘home use measure’ was used, other work [29,42] has shown that even more impaired (moderately/severely) chronic stroke survivors could exhibit recovery of coordinated limb movements and activities of daily living (e.g., pick up the knife and fork and cut the meet).…”