By not writing this up as a protocol this is totally fucking useless for any survivor's recovery. God, I absolutely hate the fact that mentors and senior researchers are not telling their underlings that the only goal in stroke is 100% recovery and ALL
RESEARCH should lead to that. And that won't occur until survivors are in charge.
Relationships between accelerometry and general compensatory movements of the upper limb after stroke
Journal of NeuroEngineering and Rehabilitation volume 17, Article number: 138 (2020)
Abstract
Background
Standardized assessments are used in rehabilitation clinics after stroke to measure restoration versus compensatory movements of the upper limb. Accelerometry is an emerging tool that can bridge the gap between in- and out-of-clinic assessments of the upper limb, but is limited in that it currently does not capture the quality of a person’s movement, an important concept to assess compensation versus restoration. The purpose of this analysis was to characterize how accelerometer variables may reflect upper limb compensatory movement patterns after stroke.
Methods
This study was a secondary analysis of an existing data set from a Phase II, single-blind, randomized, parallel dose–response trial (NCT0114369). Sources of data utilized were: (1) a compensatory movement score derived from video analysis of the Action Research Arm Test (ARAT), and (2) calculated accelerometer variables quantifying time, magnitude and variability of upper limb movement from the same time point during study participation for both in-clinic and out-of-clinic recording periods.
Results
Participants had chronic upper limb paresis of mild to moderate severity. Compensatory movement scores varied across the sample, with a mean of 73.7 ± 33.6 and range from 11.5 to 188. Moderate correlations were observed between the compensatory movement score and each accelerometer variable. Accelerometer variables measured out-of-clinic had stronger relationships with compensatory movements, compared with accelerometer variables in-clinic. Variables quantifying time, magnitude, and variability of upper limb movement out-of-clinic had relationships to the compensatory movement score.
Conclusions
Accelerometry is a tool that, while measuring movement quantity, can also reflect the use of general compensatory movement patterns of the upper limb in persons with chronic stroke. Individuals who move their limbs more in daily life with respect to time and variability tend to move with less movement compensations and more typical movement patterns. Likewise, individuals who move their paretic limbs less and their non-paretic limb more in daily life tend to move with more movement compensations at all joints in the paretic limb and less typical movement patterns.
Introduction
As advances in medicine persist, more people are surviving a stroke. Over 80% of those affected will have persistent hemiparesis of their upper limb [1]. These people will be left with chronic disability when trying to complete their activities of daily living (ADL), and an even larger number will not resume their normal daily activities completed prior to stroke [2]. At this time, physical and occupational therapy is the only option available to improve upper limb use after stroke. The ultimate goal of these therapies is to restore the use of the upper limb to the same level it was used before the stroke. Most individuals, however, only partially regain function of their upper limb requiring compensations of the upper limb to complete daily tasks. The differentiation between restoration of upper limb movement and compensation is an area of high interest in stroke rehabilitation [3]. Compensation can occur on multiple levels, such as using an alternative movement pattern, using an alternative tool or support (e.g. built up spoon for self-feeding), and/or using an alternate means to achieve the task (e.g. completion of an activity by a spouse rather than the individual). For the purposes of this paper, compensatory movements will refer to completion of the same movement but with an alternative movement pattern. Specifically, this level of compensatory movements typically describe accessory movements of the head, trunk and upper limb that an individual incorporates in order to accomplish tasks. A simple example is that if an individual lacks shoulder flexion, or the ability to raise their arm in front of them, the individual lifts their arm by raising it more to the side and bending forward with the trunk [4, 5]. Many in the neurorehabilitation field view compensation and restoration as a dichotomy, where individuals will either be classified as using compensatory movement patterns or restored movement patterns. Return of upper limb function may be better conceptualized as a gradient, with individuals having degrees of compensatory movement patterns [6].
Currently, many in-clinic standardized assessments have some aspects that measure use of compensatory movement patterns. For example, the Reaching Performance Scale specifically assesses compensatory movements of the upper limb during reaching in people with hemiparesis [7]. The Wolf Motor Function Test’s Functional Ability Scale reduces scores if movement compensations were observed during item completion [8]. The Fugl-Meyer arm motor scale, an impairment scale, focused on movement patterns, takes points off where specific compensatory movements are observed on each item [9]. Additionally the Action Research Arm Test (ARAT) scores individuals completing functional reach to grasp tasks with consideration of the quality of the reach and grasp pattern along with the fluidity or precision of the task [10, 11]. Standardized assessments have the ability to measure upper limb functional capacity and compensatory movements of the upper limb after stroke, however these assessments only capture one piece of upper limb recovery after stroke.
The current gold standard in the field to measure quality of movement or compensatory movements is through the use of 3D kinematics [12]. Kinematics provides the most detailed assessment of how an individual moves after stroke. It is not realistic, however, to use kinematics in the clinic for all patients due to cost of equipment, time required to test, and training of personnel. This leaves standardized assessments to be the alternative and most accessible measure of compensatory movement patterns. This gap in measurement has lead our lab to question how we might utilize our existing accelerometry methodology to capture some of these changes in compensatory movement.
In-clinic assessments are limited in that they measure the individual’s ability to use the limb in a standardized, structured setting, leaving the individuals actual activity of the limb during daily life unaccounted for. Over the past 5 years, methodology has been developed to measure upper limb activity in daily life using wearable sensors (accelerometers) [13, 14]. Accelerometry can quantify how much and how often a person uses their affected limb during their daily life, bridging the gap between in and out-of-clinic assessment. Current accelerometer metrics quantify time, magnitude and variability of movement of the upper limb [15,16,17,18,19]. A limitation of current accelerometry methods is that they quantify the amount of movement, but do not capture the quality of a person’s movement, an important concept to assess compensation versus restoration.
The purpose of this secondary analysis was to characterize how accelerometer variables reflect upper limb compensatory movement patterns after stroke. Relationships between compensatory movement patterns and accelerometer variables were calculated for both in-clinic and out-of-clinic time points. Both time points were included as the in-clinic time includes completion of standardized assessments and participation in an intensive upper limb therapy protocol. Due to the nature of the therapy protocol, we anticipated there may be different relationships because during the in-clinic time participants are intentionally training their affected limb. The out-of-clinic recordings captures the individual in their free-living environment, providing a more realistic picture of how the individual uses their upper limb in daily life. It is hypothesized that quantitative metrics from accelerometers both in and out-of-clinic will have moderate associations with compensatory movement patterns of the upper limb.
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