Prompting arm activity after stroke: A clinical proof of concept study of wrist-worn accelerometers with a vibrating alert function

Abstract

Background Frequent practice of functional movements after stroke may optimise motor recovery; however, it is challenging for patients to remember to integrate an impaired limb into daily activities. We report the activity responses of stroke patients receiving a vibrating alert delivered by a tri-axial accelerometer wristband to prompt movement of the impaired arm if hourly activity levels fell. Methods Adults with upper limb impairment ≤28 days post-stroke wore the device for four weeks. Therapists and patients reviewed movement activity data twice weekly to agree ongoing rehabilitation activities and programme the wristband with a personalised prompt threshold (median baseline activity + 5%, 25% or 50%). Results: S even patients completed the programme (five males; mean ± standard deviation (age) 64 ± 5 years; days post-stroke 13 ± 7; baseline/four-week Action Research Arm Test median (Interquartile range (IQR)) 39 (8, 44)/56 (11, 57)). Wristbands were worn for 89% of programme duration. A total of 1,288 prompts were delivered, with a median of four (IQR 3,7) prompts per patient per day. Mean activity increases following a prompt ranged from 11% to 29%. Conclusions Feedback delivered by a programmable accelerometer increased impaired arm activity. Improvements are required in device reliability before conducting a pragmatic clinical trial to examine the impact upon recovery.

Wristband Accelerometers to motiVate arm Exercises after Stroke (WAVES): a pilot randomized controlled trial

“…The median ARAT scores for both groups showed an improvement during the four-week study intervention phase with the intervention group continuing to improve up to the eight-week follow-up outcome. The amount of use of the impaired arm as measured by the MAL and the accelerometers also indicated an increase for both groups, which continued up to the week eight out- 15 (10)(11)(12)(13)(14)(15)(16)(17)(18) 19 (16)(17)(18)(19) 19 (17)(18)(19)(20) 12 (10)(11)(12)(13)(14)(15)(16) 17 (12)(13)(14)(15)(16)(17)(18)(19) 15 (15)(16)(17)(18) ARAT: Action Research Arm Test; IQR: interquartile range; NIHSS: National Institutes of Health Stroke Scale. come for the intervention group but not for the control group.…”

Haptic Nudges Increase Affected Upper Limb Movement During Inpatient Stroke Rehabilitation: Multiple-Period Randomized Crossover Study

“…The greater odds of moving the affected UL in the minute following a planned nudge resulted in a 32.2% increase in the average amount of movement. Another small-scale proof-of-concept study involving people with stroke (n=7) [ 30 ] indicated an increase of 19.7% in the average amount of affected UL movement in the hour following a haptic nudge reminder to undertake exercises. In that study, participants were instructed to perform up to 80 repetitions of task-specific training in response to a haptic nudge, but only received a median of 4 nudges across the rehabilitation day.…”

“…Preliminary indications suggest that wearable devices may increase the amount and intensity of physical activity undertaken during rehabilitation [ 26 - 28 ] and potentially contribute to improved functional outcomes [ 29 ]. However, the effect of wearable devices on UL rehabilitation and outcomes has been less well studied [ 30 , 31 ], with much of the research to date focusing on the accuracy and validity of accelerometry measurement of real-world UL movement [ 32 - 34 ].…”

“…Haptic nudges have been used to effectively promote behaviors in people with autism spectrum disorder [ 40 ] and traumatic brain injury engaged in a rehabilitation task [ 41 ]. Research also suggests that wearable devices are feasible and well tolerated in people with stroke [ 30 , 42 , 43 ], with preliminary data indicating haptic nudging via wearable devices may promote affected UL movement [ 31 ]. The aim of this study was to estimate the effect of haptic nudging delivered via a wrist-worn wearable device on UL movement in people with UL disability following stroke undertaking inpatient rehabilitation.…”

2nd Workshop on upper-extremity assistive technology for people with Duchenne: Effectiveness and usability of arm supports Irvine, USA, 22nd–23rd January 2018

“…Unfortunately, none of these products are tailored to people with movement impairments and thus have limited usefulness for them. Recently, few studies have been initiated to evaluate the effectiveness of providing feedback on arm activity [22,23] .…”