Measuring Real-World Upper-Extremity Activity of Stroke Survivors in the Outpatient Setting

Introduction Homework-based rehabilitation programs can help stroke survivors restore upper extremity function. However, compensatory motions can develop without therapist supervision, leading to sub-optimal recovery. We developed a visual feedback system using a live video feed or an avatar reflecting users' movements so users are aware of compensations. This pilot study aimed to evaluate validity (how well the avatar characterizes different types of compensations) and acceptability of the system. Methods Ten participants with chronic stroke performed upper-extremity exercises under three feedback conditions: none, video, and avatar. Validity was evaluated by comparing agreement on compensations annotated using video and avatar images. A usability survey was administered to participants after the experiment to obtain information on acceptability. Results There was substantial agreement between video and avatar images for shoulder elevation and hip extension (Cohen's κ: 0.6–0.8) and almost perfect agreement for trunk rotation and flexion (κ: 0.80–1). Acceptability was low due to lack of corrective prompts and occasional noise with the avatar display. Most participants suggested that an automatic compensation detection feature with visual and auditory cuing would improve the system. Conclusion The avatar characterized four types of compensations well. Future work will involve increasing sensitivity for shoulder elevation and implementing a method to detect compensations.

Download Full-text

Relation of Accelerometer and EMG Recordings for the Measurement of Upper Extremity Movement

Journal of Psychophysiology ◽

10.1027//0269-8803.13.2.77 ◽

1999 ◽

Vol 13 (2) ◽

pp. 77-82 ◽

Cited By ~ 12

Author(s):

Andreas Keil ◽

Thomas Elbert ◽

Edward Taub

Keyword(s):

Upper Extremity ◽

Real World ◽

Daily Life ◽

Upper Arm ◽

Activities Of Daily Life ◽

Strong Relation ◽

Integrated Emg ◽

Male Subjects ◽

Upper Extremity Movement

Abstract In order to determine the value of accelerometry as a measure of real world outcome when a subject is outside the laboratory, accelerometer recordings from the wrist were compared with simultaneous electromyogram (EMG) recordings from the lower and upper arm. Accelerometer and EMG signals were recorded simultaneously by the “Kölner Vitaport System,” an ambulatory device. Six male subjects performed standardized tasks as well as activities of daily life (ADL). Low correlations between accelerometer counts and integrated EMG were found in the standardized tasks, whereas there were considerably higher correlations for ADL. However, there was a strong relation between several parameters derived from EMG and accelerometer recordings. The two techniques appear to measure different aspects of movement and may be complementary.

Download Full-text

A comparison of the effects and usability of two exoskeletal robots with and without robotic actuation for upper extremity rehabilitation among patients with stroke: a single-blinded randomised controlled pilot study

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-020-00763-6 ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Jin Ho Park ◽

Gyulee Park ◽

Ha Yeon Kim ◽

Ji-Yeong Lee ◽

Yeajin Ham ◽

...

Keyword(s):

Upper Extremity ◽

Pilot Trial ◽

Stroke Survivors ◽

Robotic Rehabilitation ◽

Time Interaction ◽

Stroke Impact Scale ◽

Impact Scale ◽

Wolf Motor Function Test ◽

Upper Extremity Rehabilitation ◽

Randomised Controlled

Abstract Background Robotic rehabilitation of stroke survivors with upper extremity dysfunction may yield different outcomes depending on the robot type. Considering that excessive dependence on assistive force by robotic actuators may interfere with the patient’s active learning and participation, we hypothesised that the use of an active-assistive robot with robotic actuators does not lead to a more meaningful difference with respect to upper extremity rehabilitation than the use of a passive robot without robotic actuators. Accordingly, we aimed to evaluate the differences in the clinical and kinematic outcomes between active-assistive and passive robotic rehabilitation among stroke survivors. Methods In this single-blinded randomised controlled pilot trial, we assigned 20 stroke survivors with upper extremity dysfunction (Medical Research Council scale score, 3 or 4) to the active-assistive robotic intervention (ACT) and passive robotic intervention (PSV) groups in a 1:1 ratio and administered 20 sessions of 30-min robotic intervention (5 days/week, 4 weeks). The primary (Wolf Motor Function Test [WMFT]-score and -time: measures activity), and secondary (Fugl-Meyer Assessment [FMA] and Stroke Impact Scale [SIS] scores: measure impairment and participation, respectively; kinematic outcomes) outcome measures were determined at baseline, after 2 and 4 weeks of the intervention, and 4 weeks after the end of the intervention. Furthermore, we evaluated the usability of the robots through interviews with patients, therapists, and physiatrists. Results In both the groups, the WMFT-score and -time improved over the course of the intervention. Time had a significant effect on the WMFT-score and -time, FMA-UE, FMA-prox, and SIS-strength; group × time interaction had a significant effect on SIS-function and SIS-social participation (all, p < 0.05). The PSV group showed better improvement in participation and smoothness than the ACT group. In contrast, the ACT group exhibited better improvement in mean speed. Conclusions There were no differences between the two groups regarding the impairment and activity domains. However, the PSV robots were more beneficial than ACT robots regarding participation and smoothness. Considering the high cost and complexity of ACT robots, PSV robots might be more suitable for rehabilitation in stroke survivors capable of voluntary movement. Trial registration The trial was registered retrospectively on 14 March 2018 at ClinicalTrials.gov (NCT03465267).

Download Full-text

Influence of Chronic Stroke on Functional Arm Reaching: Quantifying Deficits in the Ipsilesional Upper Extremity

Rehabilitation Research and Practice ◽

10.1155/2019/5182310 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10

Author(s):

Savitha Subramaniam ◽

Rini Varghese ◽

Tanvi Bhatt

Keyword(s):

Reaction Time ◽

Upper Extremity ◽

Movement Time ◽

Chronic Stroke ◽

Community Dwelling ◽

Stroke Survivors ◽

Initiation Time ◽

Peak Acceleration ◽

Movement Initiation ◽

And Performance

Purpose. The purpose of this study was to quantify ipsilesional upper extremity (UE) stand-reaching performance (kinematics and kinetics) among chronic stroke survivors.Method. Community-dwelling chronic stroke survivors (n=13) and age-similar healthy adults (n=13) performed flexion- and abduction-reaching tasks. Surface EMG and acceleration were sampled using wireless sensors from the prime movers (anterior and middle deltoid) and provided performance-outcome (reaction time, burst duration, movement time, and movement initiation time) and performance-production (peak acceleration) measures and were then evaluated.Results. Individuals with chronic stroke demonstrated significantly reduced performance outcomes (i.e., longer reaction time, burst duration, movement time, and movement initiation time) and performance production ability (i.e., smaller peak acceleration) compared to their healthy counterparts (p< 0.05) for both flexion- and abduction-reaching movements.Conclusion. Our results are suggestive of post-stroke deficits in ipsilesional motor execution during a stand-reaching task. Based on these findings, it is essential to integrate ipsilesional UE training into rehabilitation interventions as this might aid functional reaching activities of daily living and could ultimately help community-dwelling chronic stroke survivors maintain their independent living.

Download Full-text

Evaluation of negative viscosity as upper extremity training for stroke survivors

2011 IEEE International Conference on Rehabilitation Robotics ◽

10.1109/icorr.2011.5975514 ◽

2011 ◽

Cited By ~ 8

Author(s):

Felix C. Huang ◽

J. L. Patton

Keyword(s):

Upper Extremity ◽

Stroke Survivors ◽

Negative Viscosity

Download Full-text

Systematic review of mirror therapy compared with conventional rehabilitation in upper extremity function in stroke survivors

Australian Occupational Therapy Journal ◽

10.1111/1440-1630.12342 ◽

2016 ◽

Vol 64 (2) ◽

pp. 91-112 ◽

Cited By ~ 14

Author(s):

David Pérez-Cruzado ◽

Jose Antonio Merchán-Baeza ◽

Manuel González-Sánchez ◽

Antonio I. Cuesta-Vargas

Keyword(s):

Systematic Review ◽

Upper Extremity ◽

Stroke Survivors ◽

Mirror Therapy ◽

Extremity Function ◽

Upper Extremity Function

Download Full-text

Safety and Tolerability of Sacubitril/Valsartan Initiation in Inpatient Versus Outpatient Setting: A Retrospective Real World Study

Heart Lung and Circulation ◽

10.1016/j.hlc.2020.08.014 ◽

2020 ◽

Author(s):

Bee Ling Kelly Chng ◽

Jin Shing Hon ◽

Hong Chan ◽

Yiliang Zheng ◽

Fei Gao ◽

...

Keyword(s):

Real World ◽

Outpatient Setting

Download Full-text

Feasibility, Safety and Efficacy of a Virtual Reality Exergame System to Supplement Upper Extremity Rehabilitation Post-Stroke: A Pilot Randomized Clinical Trial and Proof of Principle

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17010113 ◽

2019 ◽

Vol 17 (1) ◽

pp. 113 ◽

Cited By ~ 2

Author(s):

Nahid Norouzi-Gheidari ◽

Alejandro Hernandez ◽

Philippe S. Archambault ◽

Johanne Higgins ◽

Lise Poissant ◽

...

Keyword(s):

Virtual Reality ◽

Upper Extremity ◽

Intervention Group ◽

Outpatient Rehabilitation ◽

Control Group ◽

Stroke Survivors ◽

Post Intervention ◽

Serious Adverse Events ◽

Traditional Therapy ◽

Post Stroke

(1) Background: Increasing the amount of therapy time has been shown to improve motor function in stroke survivors. However, it is often not possible to increase the amount of therapy time provided in the current one-on-one therapy models. Rehabilitation-based virtual reality exergame systems, such as Jintronix, can be offered to stroke survivors as an adjunct to traditional therapy. The goal of this study was to examine the safety and feasibility of providing additional therapy using an exergame system and assess its preliminary clinical efficacy. (2) Methods: Stroke survivors receiving outpatient rehabilitation services participated in this pilot randomized control trial in which the intervention group received 4 weeks of exergaming sessions in addition to traditional therapy sessions. (3) Results: Nine subjects in the intervention and nine subjects in the control group completed the study. The intervention group had at least two extra sessions per week, with an average duration of 44 min per session and no serious adverse events (falls, dizziness, or pain). The efficacy measures showed statistically meaningful improvements in the activities of daily living measures (i.e., MAL-QOM (motor activity log-quality of movement) and both mobility and physical domains of the SIS (stroke impact scale) with mean difference of 1.0%, 5.5%, and 6.7% between the intervention and control group, respectively) at post-intervention. (4) Conclusion: Using virtual reality exergaming technology as an adjunct to traditional therapy is feasible and safe in post-stroke rehabilitation and may be beneficial to upper extremity functional recovery.

Download Full-text