Spontaneous arm movement activity assessed by accelerometry is a marker for early recovery after stroke

Abstract

The factors determining recovery from hemiparetic stroke are manifold. We studied spontaneous arm movement activity in the acute phase after stroke as a predictor of recovery. Included in this prospective study were 25 patients (63 ± 10 years; 9 women, 16 men) with acute middle cerebral artery stroke and 7 control patients without neurological disease (61 ± 14 years; 3 women, 4 men). Movement activity was measured continuously for 4 days in both arms using Actiwatches and analysed off-line. Movement activity of the nonaffected arm ranged from <10 to >16 h per day in the stroke patients. Nine stroke patients with an initial decline in arm movement activity showed no increase in movement activity in either arm over 4 days after stroke, and the other 16 patients improved steadily after admission (p < 0.003). C-reactive protein was elevated in the non-recovering patients (4.4 ± 4.9 mg/dl) related to a low number of waking hours (r = -0.512, p < 0.01). Stroke severity, location and treatment, as well as arterial blood pressure (162 ± 21 mmHg) and body temperature (36.9 ± 06 °C) were not different among the groups. The impairment was still different among the two groups 3 months after stroke. Our results support the notion that in the acute stage after middle cerebral artery stroke there are patients with a secondary decline in general motor activity related to an enhanced sleep demand as assessed with accelerometry. This impairment was related to elevated C-reactive protein.

Quantitative Measurement of Physical Activity in Acute Ischemic Stroke and Transient Ischemic Attack

“…One previous study showed an increase in the activity of both the paretic and nonparetic arm in a subgroup of patients with acute stroke during daytime in the course of 4 days. 11 No increase in arm activity with time was found at a later stage in patients with stroke in a rehabilitation center although the study found a significant increase in the number of steps with time, despite low physical activity in the legs. 28 Although our results did show a significant time effect for both the paretic and the nonparetic leg, the relatively few observations calls for caution before concluding that AC from the legs increase with time in the first week after ischemic stroke.…”

“…Others have chosen ways of defining periods of activity or inactivity based on AC from the upper extremities that differ too much to justify comparison with our observations. 9,11 The pattern of physical activity during a 24-hour period measured in our study follows the general daily routines of most hospital wards. It also illustrates that afternoons and early evenings may offer better possibilities for increasing the physical activity of patients with stroke than the morning peak hours.…”

“…In addition, activity in individual extremities can be measured and compared. Few studies have measured physical activity using accelerometers in the acute phase of stroke, [8][9][10][11][12] but simultaneous measurement of physical activity in all 4 extremities has not been investigated previously in patients with acute stroke.…”

Accelerometry for the motion analysis of the lateral plane of the human body during gait

“…Accelerometers have been used to measure a wide range of physiological characteristics [3][4][5][6][7], with emphasis on motor activities [8][9][10][11][12], such as walking and running [5,6,[13][14][15][16][17][18], as well as on some studies of small movements, such as those in the temporomandibular region, mainly related to jaw opening and closing movements [19][20][21], in the characterization of respiratory disorders, such as apneas [3], [22,23], in the study of human body impact and vibration [24,25], its characterization posture [26,27], and movements performed during sleep [28,29].…”

Spontaneous Arm Movement Activity during Sleep in Epileptic and Non-Epileptic Patients

“…For example, it was shown that stroke patients with a focal abnormality of the electroencephalogram (EEG) over the affected hemisphere had a severe reduction of spontaneous movement activity of their contralateral arm [1]. Furthermore, spontaneous arm movements were severely reduced in stroke patients with neglect or with systemic inflammation [2,3]. Similarly, spontaneous movement activity can also be impaired in those with Parkinson's disease and upon se-dating medication.…”