Dataset Information

Feasibility of a Self-directed Upper Extremity Training Program to Promote Actual Arm Use for Individuals Living in the Community With Chronic Stroke.

ABSTRACT:

Objective

To determine the feasibility of a self-directed training protocol to promote actual arm use in everyday life. The secondary aim was to explore the initial efficacy on upper extremity (UE) outcome measures.

Design

Feasibility study using multiple methods.

Setting

Home and outpatient research lab.

Participants

Fifteen adults (6 women, 9 men, mean age=53.08 years) with chronic stroke living in the community. There was wide range of UE functional levels, ranging from dependent stabilizer (limited function) to functional assist (high function).

Intervention

Use My Arm-Remote protocol. Phase 1 consisted of clinician training on motivational interviewing (MI). Phase 2 consisted of MI sessions with participants to determine participant generated goals, training activities, and training schedules. Phase 3 consisted of UE task-oriented training (60 minutes/day, 5 days/week, for 4 weeks). Participants received daily surveys through an app to monitor arm training behavior and weekly virtual check-ins with clinicians to problem-solve challenges and adjust treatment plans.

Outcome measures

Primary outcome measures were feasibility domains after intervention, measured by quantitative study data and qualitative semi-structured interviews. Secondary outcomes included the Canadian Occupational Performance Measure (COPM), Motor Activity Log (MAL), Fugl-Meyer Assessment (FMA), and accelerometry-based duration of use metric measured at baseline, discharge, and 4-week follow-up.

Results

The UMA-R was feasible in the following domains: recruitment rate, retention rate, intervention acceptance, intervention delivery, adherence frequency, and safety. Adherence to duration of daily practice did not meet our criteria. Improvements in UE outcomes were achieved at discharge and maintained at follow-up as measured by COPM-Performance subscale (F[1.42, 19.83]=17.72, P<.001) and COPM-Satisfaction subscale (F[2, 28]=14.73, P<.001), MAL (F[1.31, 18.30]=12.05, P<.01) and the FMA (F[2, 28]=16.62, P<.001).

Conclusion

The UMA-R was feasible and safe to implement for individuals living in the community with chronic stroke. Adherence duration was identified as area of refinement. Participants demonstrated improvements in standardized UE outcomes to support initial efficacy of the UMA-R. Shared decision-making and behavior change frameworks can support the implementation of UE self-directed rehabilitation. Our results warrant the refinement and further testing of the UMA-R.

SUBMITTER: Kim GJ

PROVIDER: S-EPMC10928291 | biostudies-literature | 2024 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Feasibility of a Self-directed Upper Extremity Training Program to Promote Actual Arm Use for Individuals Living in the Community With Chronic Stroke.

Kim Grace J GJ Gahlot Amanda A Magsombol Camile C Waskiewicz Margaret M Capasso Nettie N Van Lew Stephen S Kim Hayejin H Parnandi Avinash A Dickson Victoria Vaughan VV Goverover Yael Y

Archives of rehabilitation research and clinical translation 20240118 1

<h4>Objective</h4>To determine the feasibility of a self-directed training protocol to promote actual arm use in everyday life. The secondary aim was to explore the initial efficacy on upper extremity (UE) outcome measures.<h4>Design</h4>Feasibility study using multiple methods.<h4>Setting</h4>Home and outpatient research lab.<h4>Participants</h4>Fifteen adults (6 women, 9 men, mean age=53.08 years) with chronic stroke living in the community. There was wide range of UE functional levels, rangin ...[more]

PMID: 38482107

Similar Datasets

Project description:BackgroundUpper-extremity hemiparesis is a common and debilitating impairment after stroke, severely restricting stroke survivors' ability to participate in daily activities and function independently. Alarmingly, only a small percentage of stroke patients fully recover upper extremity function. Animal models indicate that high-dose upper extremity training during the early poststroke phase can significantly enhance motor recovery. However, translating such programs for human patients remains challenging due to resource limitations, patient compliance issues, and administrative constraints.ObjectiveThis study aimed to assess the feasibility and potential efficacy of an intensive, video game-based upper-extremity training protocol designed to improve movement quality during inpatient stroke rehabilitation. Additionally, it evaluated the resources required for this intervention. Specifically, the protocol provides high-intensity, high-dose training to facilitate motor recovery by engaging patients in targeted interactive exercises.MethodsTwelve patients with upper-extremity hemiparesis completed a 4-week intensive training program comprising 40 sessions of 60 minutes; the training was conducted for 2 hours per day, 5 days per week. This was delivered in addition to standard care, which included 3 therapeutic sessions daily. Two video game-based platforms were used: one platform (tech 1) targeted proximal movements involving the shoulder and elbow, while the second platform (tech 2) emphasized distal movements of the wrist and fingers. Feasibility was assessed using the measure of time on task and measures of patients' motivation and engagement. Potential effectiveness was assessed using the Fugl-Meyer Assessment of the upper extremity (FMA-UE) scale, Action Research Arm Test (ARAT), and Stroke Impact Scale (SIS).ResultsOf the 12 patients, 8 completed the full protocol, 3 completed 34-38 sessions, and 1 completed 27 sessions. On average, patients actively engaged in exercises for 35 (SD 4) minutes per hour on the proximal platform (tech 1) and 37 (SD 2) minutes on the distal platform (tech 2). Patients reported high motivation and enjoyment throughout the sessions, with an Intrinsic Motivation Inventory enjoyment score of 6.49 (SD 0.66) out of 7. Pain levels were minimal, with a visual analogue scale (VAS) mean score of 2.00 (SD 2.32). Significant improvements were observed in motor function assessments: the mean improvement in FMA-UE score was 16.5 (SD 10.2) points, ARAT scores increased by 22.9 (SD 13.1) points, and the SIS Hand Function and Recovery score showed a mean delta of 1.23 (SD 0.80) points and a 23.33% (SD 21.5%) improvement, respectively.ConclusionsThese findings demonstrate that a high-dose, high-intensity, video game-based training protocol is feasible and can be successfully integrated into subacute stroke rehabilitation. Additionally, preliminary evidence suggests that this supplementary intervention may be effective in enhancing motor recovery. This approach holds promise for future stroke rehabilitation protocols by offering an engaging, high-dose, and high-intensity program during early recovery.

Project description:Mixed reality (MR), which combines virtual reality and tangible objects, can be used for repetitive training by patients with stroke, allowing them to be immersed in a virtual environment while maintaining their perception of the real world. We developed an MR-based rehabilitation board (MR-board) for the upper limb, particularly for hand rehabilitation, and aimed to demonstrate the feasibility of the MR-board as a self-training rehabilitation tool for the upper extremity in stroke patients. The MR-board contains five gamified programs that train upper-extremity movements by using the affected hand and six differently shaped objects. We conducted five 30-min training sessions in stroke patients using the MR-board. The sensor measured hand movement and reflected the objects to the monitor so that the patients could check the process and results during the intervention. The primary outcomes were changes in the Box and Block Test (BBT) score, and the secondary outcomes were changes in the Fugl-Meyer assessment and Wolf Motor Function Test (WMFT) scores. Evaluations were conducted before and after the intervention. In addition, a usability test was performed to assess the patient satisfaction with the device. Ten patients with hemiplegic stroke were included in the analysis. The BBT scores and shoulder strength in the WMFT were significantly improved (p < 0.05), and other outcomes were also improved after the intervention. In addition, the usability test showed high satisfaction (4.58 out of 5 points), and patients were willing to undergo further treatment sessions. No safety issues were observed. The MR-board is a feasible intervention device for improving upper limb function. Moreover, this instrument could be an effective self-training tool that provides training routines for stroke patients without the assistance of a healthcare practitioner.Trial registrationThis study was registered with the Clinical Research Information Service (CRIS: KCT0004167).

Project description:ObjectiveTo develop and clinically evaluate a customizable active upper extremity (UE) assistive system with integrated functional electrical stimulation (FES) that improves function and independence of individuals during activities of daily living (ADLs).DesignSingle-arm, prospective, open-label cohort feasibility trial.SettingAn academic research institution.ParticipantsSubjects were 5 adults with a medical history of stroke resulting in distal UE impairment (N=5). The subjects volunteered from recruitment materials that detailed information about the study.InterventionsA novel, wearable, lightweight, low-profile, and patient-tailored UE assistive system. It comprises a splint component and FES unit that may each be controlled by electromyography (EMG) signals, inertial measurement units (IMUs), manual control source (joystick), and/or voice control.Main outcome measuresSeveral occupational therapy outcome measures were used, including the Canadian Occupational Performance Measure (COPM), Action Research Arm Test (ARAT), The Box and Blocks Test (BBT), the ABILHAND-Manual Ability Measure, and Patient Reported Outcomes Measurement Information System (PROMIS) UE Short Form.ResultsAll participants learned to use our UE assistive system to perform ADLs and were able to use it independently at home. Most participants experienced a clinically meaningful improvement in both performance and satisfaction for the majority of their COPM goals while using the system. All participants experienced improvement in hand grip and release as shown by their baseline and post assessment scores for hand function (BBT, ARAT) and patient-reported outcomes (ABILHAND, PROMIS).ConclusionsThe clinical outcomes suggest that our UE assistive system improves functional performance in patients with UE impairment, allowing them to engage more actively in ADLs. Further innovation including elbow and shoulder components will allow users to have more degrees of freedom during tasks.

Project description:Percutaneous osseointegrated (OI) implants for direct skeletal attachment of upper extremity prosthetics represent an alternative to traditional socket suspension that may yield improved patient function and satisfaction. This is especially true in high-level, transhumeral amputees where prosthetic fitting is challenging and abandonment rates remain high. However, maintaining mechanical integrity of the bone-implant interface is crucial for safe clinical introduction of this technology. The collection of population data on the transhumeral loading environment will aid in the design of compliance and overload protection devices that mitigate the risk of periprosthetic fracture. We collected marker-based upper extremity kinematic data from non-amputee volunteers during advanced activities of daily living (AADLs) that applied dynamic loading to the humerus. Inverse dynamic analysis was applied to calculate the axial force, bending and torsional moments at three virtual amputation levels representing 25, 50, and 75% residual humeral length. The influences of amputation level, elbow flexion constraint, gender and anthropometric scaling were assessed. Results indicate that the proximal (25%) amputation level experienced significantly higher axial forces and bending moments across all subjects when compared to distal amputation levels (p≤0.030). Constraining elbow flexion had a limited influence on peak transhumeral loads. Male subjects experienced higher axial forces during all evaluated activities (p≤0.023). Peak axial force for all activities occurred during jumping jacks (174.5N). Peak bending (57.6Nm) and torsional (57.2Nm) moments occurred during jumping jacks and rapid internal humeral rotation, respectively. Calculated loads fall within the range of implant fixation failure loads reported in cadaveric investigations of humeral stem fixation; indicating that periprosthetic fracture may occur during non-contact AADLs. These kinematic data, collected over a range of AADLs, will aid in the development of overload protection devices and appropriate post-operative rehabilitation protocols that balance return to an active lifestyle with patient safety.

Dataset Information

Feasibility of a Self-directed Upper Extremity Training Program to Promote Actual Arm Use for Individuals Living in the Community With Chronic Stroke.

Objective

Design

Setting

Participants

Intervention

Outcome measures

Results

Conclusion

Publications

Feasibility of a Self-directed Upper Extremity Training Program to Promote Actual Arm Use for Individuals Living in the Community With Chronic Stroke.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets