Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-Limb Use in Daily Life

 Research into nonuse is absolutely fucking useless!

I absolutely hate these pontifications on nonuse. Solve the damn problem of dead brain rehab and this nonuse problem goes away. SOLVE THE CORRECT PROBLEM!

Damn it all, it is NOT learned nonuse. It is the actual inability to use it because of dead neurons. If you had dead brain rehab protocols, this fake learned nonuse idea would cease to exist!

Quantifying Nonuse in Chronic Stroke Patients: A Study Into Paretic, Nonparetic, and Bimanual Upper-Limb Use in Daily Life

2012, Archives of Physical Medicine and Rehabilitation

Marian E. Michielsen, MSc†, Ruud W. Selles, PhD, Henk J. Stam, MD, PhD Gerard M. Ribbers, MD, PhD, Johannes B. Bussmann, PhD ABSTRACT. Michielsen ME, Selles RW, Stam HJ, Ribbers GM, Bussmann JB. Quantifying nonuse in chronic stroke pa- tients: a study into paretic, nonparetic, and bimanual upper- limb use in daily life. Arch Phys Med Rehabil 2012;xx:xxx. Objective: To quantify uni- and bimanual upper-limb use in patients with chronic stroke in daily life compared with healthy controls. Design: Cross-sectional observational study. Setting: Outpatient rehabilitation center. Participants: Patients with chronic stroke (n=38) and healthy controls (n=18). Intervention: Not applicable. Main Outcome Measures: Upper-limb use in daily life was measured with an accelerometry-based upper-limb activity monitor, an accelerometer based measurement device. Uni- manual use of the paretic and the nonparetic side and bimanual upper-limb use were measured for a period of 24 hours. Out- comes were expressed in terms of both duration and intensity. Results: Patients used their unaffected limb much more than their affected limb (5.3h vs 2.4h), while controls used both limbs a more equal amount of time (5.4h vs 5.1h). Patients used their paretic side less than controls used their nondominant side and their nonparetic side more than controls their dominant side. The intensity with which patients used their paretic side was lower than that with which controls used their nondomi- nant side, while that of the nonparetic side was higher than that of the dominant side of controls. Finally, patients used their paretic side almost exclusively in bimanual activities. During bimanual activities, the intensity with which they used their affected side was much lower than that of the nonaffected side. Conclusion: Our data show considerable nonuse of the pa- retic side, both in duration and in intensity, and both during unimanual and bimanual activities in patients with chronic stroke. Patients do compensate for this with increased use of the nonparetic side. Key Words: Ambulatory monitoring; Motor activity; Reha- bilitation; Stroke; Upper extremity. © 2012 by the American Congress of Rehabilitation Medicine F IFTY TO 70% OF PATIENTS with stroke suffer from long-term motor deficits of the upper limb, 1 with a de- creased use of the paretic upper extremity in daily life. 2 Be- cause this latter may have a great impact on the manner in which a patient is able to participate in daily life activities, maximizing purposeful use of the upper extremity in daily life is a key factor in motor rehabilitation following stroke. While it is clear that a decreased motor capacity of the paretic arm influences the use of both extremities, the exact changes in upper-limb use following stroke are not yet fully understood. Regarding the paretic upper extremity, many stud- ies have shown that there is no 1-on-1 relation between motor impairment and functional use. 3,4 This may be related to the phenomenon of learned nonuse, 5 which describes how patients will have “learned” not to use the paretic side to its full capacity. 6 Brain injury causes structural damage to motor path- ways as well as depression of neural excitability near the lesion. Decreasing activity of the upper extremity leads to a further reduction in excitability and as such starts a vicious circle of decreasing excitability and decreasing activity. 7 Even less is known about the consequences of stroke on the nonparetic side. Motor performance of the nonparetic side may be impaired compared with that in healthy subjects, showing, for instance, decreased speed and consistency of performance. 8 In addition, it has been shown that patients with acute stroke have a more reduced use of the nonparetic side in daily life than do healthy subjects. 9 On the other hand, it is generally assumed that poststroke the nonparetic side will be used more to com- pensate for the decreased use of the paretic side. However, to our knowledge, this has not been investigated in patients with chronic stroke. Overall many questions on techniques to optimize the func- tion of the paretic extremity after stroke still need to be an- swered. The optimal rehabilitation technique is still not de- fined, and different approaches in reducing upper-extremity paresis are distinguished. 7 Several therapies have been devel- oped to improve the use of the nonparetic arm in daily life. For example, constraint-induced movement therapy (CIMT), 10,11 or forced use, 12 reported as a beneficial treatment option for motor recovery of the arm, 13 prevents the use of the nonparetic upper limb and aims to counterbalance the learned nonuse. CIMT is an augmentative technique, 7 a high-intensity, uni- manual training aiming to counterbalance the vicious circle of decreasing excitability and decreasing activity. Furthermore, CIMT has aspects of task-specific exercising. Bilateral training programs have also been developed, for example, with rhythmic  auditory cueing. 14 To evaluate and understand the effects of upper-extremity training in daily life conditions, detailed insight is needed in unimanual and bimanual function of the arms in daily life conditions. This is the topic of the current article. Several studies have included the measurement of upper- limb use in daily life. For example, Taub, 11 Mark, 15 and Wolf 5 and colleagues used the Motor Activity Log (MAL) in their studies. However, although validated against an objective mea- sure, 16 the MAL still is a subjective instrument that focuses on how well and how much patients use their most impaired arm in a defined category of activities, and the MAL does not include data on the amount of use of the nonimpaired arm and bilateral use. Another method for assessing upper-limb use in a home setting is provided by accelerometers and other portable devices providing the opportunity to assess how much patients with stroke use their upper limbs in daily life for longer periods. 2 However, so far, studies using these devices assessed only the upper-limb use overall and not in detail. For example, many studies express actual upper-limb use only as a ratio between the use of the affected and the use of the unaffected side, 17 thus omitting information about usage times of the paretic side and the nonparetic side separately. Second, current devices do not differentiate between arm movements resulting from general body movements such as walking and arm move- ments during sitting and standing. Third, most measurement devices cannot differentiate between the duration of use and the intensity of use, and finally, most devices cannot or do not differentiate between unilateral and bilateral usage of the arms. The aim of the present study was to quantify uni- and bimanual upper-limb use in patients with chronic stroke in daily life and compare this with healthy controls. By using an accelerometry- based upper-limb activity monitor, 18 we were able to give an insight into both duration and intensity of upper-limb use and to discriminate between upper-limb movements caused by whole- body movements and movements independent of whole-body movements, thus providing an insight into the amount of func- tional and purposeful upper-limb use in daily life conditions.

 

More at link.