Use of Accelerometers to Assess Upper-Extremity Motor Performance Following Stroke: A Pilot Study

This session will discuss the preliminary results of a pilot study (N = 40) addressing the use of accelerometers (i.e., motion monitors) to assess hemiplegic arm use in the home setting after stroke. Accelerometry is a common research technique used to objectively measure the frequency of limb use in the home environment. The goal of this study was to understand the relationship between clinical measures of arm motor performance and actual arm use in the home.

Clinical assessment of motor performance can provide valuable information related to motor recovery after stroke, yet it only provides a glimpse into an individual’s abilities at a particular moment. In contrast, measurement of motor performance captured by accelerometers can provide rich data related to performance in the natural context.

The study was also interested in using accelerometry data to identify salient movement characteristics (i.e., joint range of motion, speed, coordination) that most closely predict functional hemiplegic arm use. For instance, a certain level of supination may prove to have a significant impact on home use, and addressing smoothness of a particular motion may prove to have little impact on function.

The study occurred within the outpatient rehabilitation clinic of a free-standing rehabilitation hospital. Forty stroke survivors were successfully recruited and completed all study-related activities. Study procedures involved participants completing an assessment battery of clinical measures focused on motor performance of the hemiplegic arm. Assessments included the Fugl-Meyer Test of Motor Function, the Action Research Arm Test (ARAT), and the Motor Activity Log. After administration of the clinical assessments, participants were provided with two wireless wrist Accelerometers (ActiGraph, GT1M, Pensacola, FL) to objectively evaluate the extent of arm use at home. Participants were asked to wear the accelerometers outside the clinic during all waking hours for 4 consecutive days.

We hypothesized that the amount of arm use in the home (as measured by the accelerometers) would be weakly correlated to clinical measurement of impairment and function; however, preliminary results have suggested the contrary. Specifically, results indicated a strong correlation between ARAT scores and data captured by the wrist accelerometers. This session will further explore this relationship between clinical measurement of hemiplegic arm use and data captured by the accelerometers. In addition, further discussion will be dedicated to analyzing the use of accelerometers to identify relevant movement characteristics associated with successful arm use after stroke.

References

Dromerick, A. W., Lang, C. E., Birkenmeier, R., Hahn, M. G., Sahrmann, S. A., & Edwards, D. F. (2006). Relationships between upper-limb functional limitations and self-reported disability 3 months after stroke. Journal of Rehabilitation Research and Development, 43, 401–408.

Lang, C. E., Wagner, J. M., Edwards, D. F., & Dromerick, A. W. (2007). Upper extremity use in people with hemiparesis in the first few weeks after stroke. Journal of Neurological Physical Therapy, 31, 56–63. http://dx.doi.org/10.1097/NPT.0b013e31806748bd

Patten, C., Candliffe, E. G., Dairaghi, C. A., & Lum, P. S. (2013). Concurrent neuromechanical and functional gains following upper-extremity power training post-stroke. Journal of Neuroengineering and Rehabilitation, 21, 1. http://dx.doi.org/10.1186/1743-0003-10-1

Rand, D., & Eng, J. J. (2015). Predicting daily use of the affected upper extremity 1 year after stroke. Journal of Stroke and Cerebrovascular Diseases, 24, 274–283. http://dx.doi.org/10.1016/j.jstrokecerebrovasdid.2014.07.039