Dataset Information

Comparing Home Upper Extremity Activity with Clinical Evaluations of Arm Function in Chronic Stroke.

ABSTRACT:

Objective

To determine if clinical evaluations of post-stroke arm function correspond to everyday motor performance indexed by arm accelerometers.

Design

Cross-sectional study analyzing baseline data from a larger trial (NCT02665052).

Setting

Outpatient research center.

Participants

Twenty community-dwelling adults with chronic arm motor deficits (stroke?6mo).

Intervention

72-hours of home wrist-worn accelerometry during normal routine.

Main outcome measures

Clinical evaluations included the Fugl-Meyer (FM), Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), and two self-assessments: the Motor Activity Log (MAL) and hand motor subscale of the Stroke Impact Scale (SIS). Accelerometer-derived variables included quantifications of movement intensity (magnitude) and duration of arm use.

Results

Participants had moderate arm impairment (FM 36.1 ± 9.4). The accelerometer-derived mean magnitude ratio correlated significantly with the FM (? = 0.60, p < 0.01), WMFT functional score (? = 0.59, p < 0.01), and ARAT (? = 0.50, p < 0.05). The hours of use ratio correlated with the MAL amount of use (? = 0.58, p < 0.01) and quality of movement (? = 0.61, p < 0.01). Total paretic hours did not correlate with the FM, WMFT or ARAT, and intensity variables did not correlate with the MAL or SIS.

Conclusions

Participants with higher baseline function had greater intensity of paretic arm movement at home; similarly, those who perceived they had less disability used their paretic arm more relative to their non-paretic arm. However, some participants with higher clinical scores did not exhibit greater arm use in everyday life, possibly due to neglect and learned non-use. Therefore, individualized home accelerometry profiles could provide valuable insight to better tailor post-stroke rehabilitation.

SUBMITTER: Bhatnagar K

PROVIDER: S-EPMC7739859 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Comparing Home Upper Extremity Activity with Clinical Evaluations of Arm Function in Chronic Stroke.

Bhatnagar Kavita K Bever Christopher T CT Tian Jing J Zhan Min M Conroy Susan S SS

Archives of rehabilitation research and clinical translation 20200601 2

<h4>Objective</h4>To determine if clinical evaluations of post-stroke arm function correspond to everyday motor performance indexed by arm accelerometers.<h4>Design</h4>Cross-sectional study analyzing baseline data from a larger trial (NCT02665052).<h4>Setting</h4>Outpatient research center.<h4>Participants</h4>Twenty community-dwelling adults with chronic arm motor deficits (stroke≥6mo).<h4>Intervention</h4>72-hours of home wrist-worn accelerometry during normal routine.<h4>Main outcome measure ...[more]

PMID: 33336184

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Project description:ObjectiveTo 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.DesignFeasibility study using multiple methods.SettingHome and outpatient research lab.ParticipantsFifteen 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).InterventionUse 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 measuresPrimary 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.ResultsThe 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).ConclusionThe 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.

Project description:The ipsilesional arm of stroke patients often has functionally limiting deficits in motor control and dexterity that depend on the side of the brain that is lesioned and that increase with the severity of paretic arm impairment. However, remediation of the ipsilesional arm has yet to be integrated into the usual standard of care for upper limb rehabilitation in stroke, largely due to a lack of translational research examining the effects of ipsilesional-arm intervention. We now ask whether ipsilesional-arm training, tailored to the hemisphere-specific nature of ipsilesional-arm motor deficits in participants with moderate to severe contralesional paresis, improves ipsilesional arm performance and generalizes to improve functional independence. We assessed the effects of this intervention on ipsilesional arm unilateral performance [Jebsen-Taylor Hand Function Test (JHFT)], ipsilesional grip strength, contralesional arm impairment level [Fugl-Meyer Assessment (FM)], and functional independence [Functional independence measure (FIM)] (N = 13). Intervention occurred over a 3 week period for 1.5 h/session, three times each week. All sessions included virtual reality tasks that targeted the specific motor control deficits associated with either left or right hemisphere damage, followed by graded dexterity training in real-world tasks. We also exposed participants to 3 weeks of sham training to control for the non-specific effects of therapy visits and interactions. We conducted five test-sessions: two pre-tests and three post-tests. Our results indicate substantial improvements in the less-impaired arm performance, without detriment to the paretic arm that transferred to improved functional independence in all three posttests, indicating durability of training effects for at least 3 weeks. We provide evidence for establishing the basis of a rehabilitation approach that includes evaluation and remediation of the ipsilesional arm in moderately to severely impaired stroke survivors. This study was originally a crossover design; however, we were unable to complete the second arm of the study due to the COVID-19 pandemic. We report the results from the first arm of the planned design as a longitudinal study.

Dataset Information

Comparing Home Upper Extremity Activity with Clinical Evaluations of Arm Function in Chronic Stroke.

Objective

Design

Setting

Participants

Intervention

Main outcome measures

Results

Conclusions

Publications

Comparing Home Upper Extremity Activity with Clinical Evaluations of Arm Function in Chronic Stroke.

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