Daily Life Upper Limb Activity for Patients with Match and Mismatch between Observed Function and Perceived Activity in the Chronic Phase Post Stroke

 It's incredibly simple. To improve mine and lots of other survivors upper limb use, you cure spasticity!

I can do no useful reaching or open my hand until that is cured.

Daily Life Upper Limb Activity for Patients with Match and Mismatch between Observed Function and Perceived Activity in the Chronic Phase Post Stroke

¹,

Janne Veerbeek

²,

Andreas Luft

^3,4 and

Geert Verheyden

¹

¹

Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium

²

Luzerner Kantonsspital, Neurocenter, 6000 Lucerne, Switzerland

³

Division of Vascular Neurology and Neurorehabilitation, Department of Neurology and Clinical Neuroscience Center, University of Zurich and University Hospital Zurich, 8091 Zurich, Switzerland

⁴

Cereneo, Center for Neurology and Rehabilitation, 6354 Vitznau, Switzerland

^*

Author to whom correspondence should be addressed.

Sensors 2021, 21(17), 5917; https://doi.org/10.3390/s21175917

Submission received: 26 July 2021 / Revised: 26 August 2021 / Accepted: 28 August 2021 / Published: 2 September 2021

(This article belongs to the Special Issue Application of Wearable Technology for Neurological Conditions)

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Abstract

We investigated actual daily life upper limb (UL) activity in relation to observed UL motor function and perceived UL activity in chronic stroke in order to better understand and improve UL activity in daily life. In 60 patients, we collected (1) observed UL motor function (Fugl-Meyer Assessment (FMA-UE)), (2) perceived UL activity (hand subscale of the Stroke Impact Scale (SIS-Hand)), and (3) daily life UL activity (bilateral wrist-worn accelerometers for 72 h) data. Data were compared between two groups of interest, namely (1) good observed (FMA-UE >50) function and good perceived (SIS-Hand >75) activity (good match, n = 16) and (2) good observed function but low perceived (SIS-Hand ≤75) activity (mismatch, n = 15) with Mann–Whitney U analysis. The mismatch group only differed from the good match group in perceived UL activity (median (Q1–Q3) = 50 (30–70) versus 93 (85–100); p < 0.001). Despite similar observed UL motor function and other clinical characteristics, the affected UL in the mismatch group was less active in daily life compared to the good match group (p = 0.013), and the contribution of the affected UL compared to the unaffected UL for each second of activity (magnitude ratio) was lower (p = 0.022). We conclude that people with chronic stroke with low perceived UL activity indeed tend to use their affected UL less in daily life despite good observed UL motor function.

Keywords:

stroke; upper limb sensor activity; patient-reported outcome measures

1. Introduction

One of the most important outcomes for stroke survivors, carers, and clinicians is being able to perform everyday tasks, which may be hampered by upper limb (UL) problems [1]. Only a limited number of stroke survivors at six months post stroke are able to fully re-engage the affected UL in daily activities [2]. In order to re-engage the UL in daily life post stroke, a certain level of UL motor function is needed. Cross-sectional studies in the chronic phase post stroke have shown that patients with low to moderate UL motor function use their paretic UL less in daily life than those with good UL function [3,4,5]. A longitudinal study in the first six months post stroke further shows that affected UL use in daily life increases more in patients with excellent UL function recovery than in those with mild or moderate recovery [4]. It thus seems that one’s UL motor function needs to reach a threshold in order to use the UL in daily life [5].

Good UL motor function, however, does not translate into a similar daily life UL use per se. In the subacute phase, a wide variation in daily UL use can be seen in patients with good UL function [6,7], and improved UL function does not directly result in increased daily UL use [8]. These discrepancies seem to persist into the chronic phase post stroke [9,10,11], which suggests that factors in addition to UL motor function influence daily life UL use. Factors such as motivation, health behaviors, environmental supports, comorbidities, psychosocial support, and neglect have been reported, but authors have not further investigated their relationship with UL use in daily life [11,12]. In one cross-sectional study, the authors examined potentially modifying factors of affected UL activity in community-dwelling adults with chronic stroke and found that, next to severity of motor dysfunction, only dependence in activities of daily living was associated with affected UL activity [13].

A factor that is often overlooked but may nevertheless play an important role in the use of one’s UL motor function is the perceived UL activity. How a person perceives his or her ability to use the UL in daily life can be measured with patient-reported outcome measures and is strongly correlated with the patient’s observed UL motor function as assessed by a clinician [14]. However, despite this strong correlation, the observed UL function and perceived UL activity are not always congruent. In a cross-sectional study, patient-reported outcomes revealed deficits in daily life UL activity in a majority of patients with stroke who did not seem to have deficits based on observation-based assessments [15]. Further, we recently investigated the correspondence between perceived UL activity and observed UL function and found that in two third of the patients at 12 months post stroke, observed and perceived assessments correspond well, namely people with a low observed function have a similar low perceived activity (low match group), whereas people with good observed function report good perceived activity (good match group). However, next to these two match groups, one in three patients have good observed function but low perceived UL activity, that is, the mismatch group [16].

A mismatched perception of poor UL motor function despite actually having good UL function might result in reduced UL activity. We thus wanted to investigate if there is a difference in daily life UL activity between patients with good observed UL motor function and low perceived UL activity compared to those with corresponding low or good abilities. Therefore, we cross-sectionally investigated individuals from the low match, good match, and mismatch groups six months post stroke with observation-based assessments, patient-reported outcomes, and assessments of daily life UL activity. We hypothesized that people in the mismatch group will show higher daily life UL activity compared to those in the low match group but reduced daily life UL activity compared to those in the good match group. For this mismatch group to make full use of their capabilities in daily life, a specific therapeutic approach would be required.

 

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