Quantifying the reach-and-grasp practice using novel wearable technology: Application in a stroke rehabilitation setting

 Measuring something DOES ABSOLUTELY NOTHING FOR RECOVERY!  Are you that blitheringly stupid? I'd have you all fired! What the fuck does it take for you idiots to create protocols that deliver recovery?

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'.

Quantifying the reach-and-grasp practice using novel wearable technology: Application in a stroke rehabilitation setting

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https://doi.org/10.1016/j.jht.2025.02.017

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Highlights

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  The TENZR is an alternative to direct observation for quantifying the intensity of UE practice.
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  The device allows for objective monitoring and tracking of UE practice for each hand.
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  The application of the TENZR could expand to home-based rehabilitation and telehealth services.

ABSTRACT

Background

Wrist-worn accelerometers have been used to measure the intensity of upper extremity (UE) practice, but their primary focus is on general arm usage, lacking the ability to capture reaching and grasping of the hand that are relevant for rehabilitation.

Purpose

We aimed to explore the potential of a novel wrist-worn sensor as a meaningful measure for quantifying the amount of reaching and grasping practice during a structured UE exercise session for stroke.

Study Design

A cross-sectional study.

Methods

Fourteen individuals with stroke wore sensor devices (TENZR) on both wrists while performing a structured UE exercise program comprising of 35 exercises. Counts recorded from observation (observed repetitions) and counts from the sensor device (sensor counts) were used to describe the amount of UE practice. The level of agreement between the observed repetitions and sensor counts were examined to determine if the TENZR is a meaningful measure. We also explore if the sensor counts were affected by the level of UE impairment.

Results

The participants performed 792 observed reach and grasp repetitions, with corresponding 711 and 465 sensor counts for the paretic hand and nonparetic hand, respectively, over the hour practice session. The TENZR and the observational method might measure UE movement differently, as evidenced by a lack of agreement between observed repetitions and sensor counts in the paretic hand. No significant relationship between the sensor counts in the paretic hand and the level of impairment was found.

Conclusions

This study used the TENZR to quantify reaching and grasping practice and characterize individual participation pattern for both paretic and nonparetic hands in stroke rehabilitation. The device is an alternative to direct observation for quantifying the intensity of reach-and-grasp practice. In the future, this device could expand to home-based rehabilitation and telehealth services, enabling objective monitoring and tracking of UE training progress.

Introduction

Wearable sensor technology can track physiological and body motion signals to facilitate diagnostics and monitoring of people recovering from an injury or living with a chronic disease. There is strong evidence that greater upper extremity (UE) practice leads to better motor recovery after neurological insults, including stroke,¹ head injury,² incomplete spinal cord injury,³ and cerebral palsy.⁴ In addition, there are musculoskeletal injuries and postsurgical treatments where UE activity can reduce secondary complications such as contracture and pain.⁵

Engaging in repeated practice of functional tasks facilitates neural plasticity and induces brain reorganization after a brain injury, leading to the reacquisition of motor skills.⁶ However, quantifying the precise amount of task-specific practice is challenging, and determining the optimal dose for achieving the maximum treatment outcome remains uncertain.

Counting records from observation is a common method to quantify the intensity of structured task-specific practice sessions but is resource-intensive and is subjective and reliant on the observer's judgment, which may introduce potential bias and inaccuracy.⁷

In addition, counting the repetitions from observation usually reflects the number of successful completions of a task (e.g., picking up the clothing peg and pegging it onto the side of the cup), not the actual number of functional reach-and-grasp movements. Wrist-worn accelerometry has emerged as a reliable alternative for objectively quantifying the duration and intensity of UE motor practice.⁸ Findings from a study that used both approaches to quantify UE practice in a structured rehabilitation program have supported the validity of the wrist accelerometer data.⁹ Unlike the observational method, wrist accelerometry allows for the quantification of general UE performance in real-world natural settings, providing insights into individual arm usage by detecting arm acceleration during activities. However, the accelerometer does not provide the data in a measurement unit that is easily interpretable for clinicians or patients, nor does it capture the use of the hand which is critical for the person to participate in activities of daily living. Moreover, accelerometers may be less useful in quantifying the amount of practice in individuals with more severe UE impairment who may conduct more passive movements and have limited active movements in the paretic hands.⁹ Therefore, clinically meaningful ways to quantify the functional use of the hand are required.

A step counter (e.g., pedometer) has long been recognized as an effective tool for tracking walking activity, which is functional for improving mobility and overall health; it is easy for patients to set targets for their walking steps and interpret the data. We aimed to develop a comparable measurement for UE movements; input from clinicians, stroke survivors, and their caregivers highlighted the need to capture functional grasping movements.¹⁰ To better achieve the quantification of functional grasping movements, a novel wrist sensor, the TENZR Neuro Tracker, was purposefully developed. We demonstrated its reliability and consistency in quantifying the number of functional reach-grasp movements across various UE tasks (e.g., pouring water and opening a jar) among individuals with stroke.¹¹ Our previous study also characterized functional hand opening and grasping activities over multiple days in real-world environments in community-dwelling individuals with stroke and healthy controls.¹² However, the clinical utility of using TENZR to measure the amount of practice during a structured UE exercise program has yet to be examined.

In this study, we use the TENZR device to describe the amount of UE practice carried out during a structured UE exercise program. The second objective of this study is to determine if the TENZR is a meaningful measure in clinical practice by examining the level of agreement between the amount of practice recorded by the TENZR device (sensor counts in the paretic hands) and repetitions observed by a therapist. Third, we explored whether the sensor counts were influenced by the level of UE impairment (the Fugl-Meyer Upper Extremity Assessment [FM-UE] score).

This is the first study to objectively quantify the amount of UE practice by using a novel wrist-worn device during a structured UE exercise program. The findings of this study have the potential to impact clinical practice, providing clinicians and researchers with a feasible and objective measurement to monitor and assess the intensity of UE practice as well as provide patients with motivation and accountability.

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