Virtual Arm Boot Camp (V-ABC): study protocol for a mixed-methods study to increase upper limb recovery after stroke with an intensive program coupled with a grasp count device.

BACKGROUND: Encouraging upper limb use and increasing intensity of practice in rehabilitation are two important goals for optimizing upper limb recovery post stroke. Feedback from novel wearable sensors may influence practice behaviour to promote achieving these goals. A wearable sensor can potentially be used in conjunction with a virtually monitored home program for greater patient convenience, or due to restrictions that preclude in-person visits, such as COVID-19. This trial aims to (1) determine the efficacy of a virtual behaviour change program that relies on feedback from a custom wearable sensor to increase use and function of the upper limb post stroke; and (2) explore the experiences and perceptions of using a program coupled with wearable sensors to increase arm use from the perspective of people with stroke. METHODS: This mixed-methods study will utilize a prospective controlled trial with random allocation to immediate or 3-week delayed entry to determine the efficacy of a 3-week behaviour change program with a nested qualitative description study. The intervention, the Virtual Arm Boot Camp (V-ABC) features feedback from a wearable device, which is intended to increase upper limb use post stroke, as well as 6 virtual sessions with a therapist. Sixty-four adults within 1-year post stroke onset will be recruited from seven rehabilitation centres. All outcomes will be collected virtually. The primary outcome measure is upper limb use measured by grasp counts over 3 days from the wearable sensor (TENZR) after the 3-week intervention. Secondary outcomes include upper limb function (Arm Capacity and Movement Test) and self-reported function (Hand Function and Strength subscale from the Stroke Impact Scale). Outcome data will be collected at baseline, post-intervention and at 2 months retention. The qualitative component will explore the experiences and acceptability of using a home program with a wearable sensor for increasing arm use from the point of view of individuals with stroke. Semi-structured interviews will be conducted with participants after they have experienced the intervention. Qualitative data will be analysed using content analysis. DISCUSSION: This study will provide novel information regarding the efficacy and acceptability of virtually delivered programs to improve upper extremity recovery, and the use of wearable sensors to assist with behaviour change. TRIAL REGISTRATION: ClinicalTrials.gov NCT04232163 . January 18, 2020.

Exercise-Based Stroke Rehabilitation: Clinical Considerations Following the COVID-19 Pandemic.

Background. The COVID-19 pandemic attributable to the severe acute respiratory syndrome virus (SARS-CoV-2) has had a significant and continuing impact across all areas of healthcare including stroke. Individuals post-stroke are at high risk for infection, disease severity, and mortality after COVID-19 infection. Exercise stroke rehabilitation programs remain critical for individuals recovering from stroke to mitigate risk factors and morbidity associated with the potential long-term consequences of COVID-19. There is currently no exercise rehabilitation guidance for people post-stroke with a history of COVID-19 infection. Purpose. To (1) review the multi-system pathophysiology of COVID-19 related to stroke and exercise; (2) discuss the multi-system benefits of exercise for individuals post-stroke with suspected or confirmed COVID-19 infection; and (3) provide clinical considerations related to COVID-19 for exercise during stroke rehabilitation. This article is intended for healthcare professionals involved in the implementation of exercise rehabilitation for individuals post-stroke who have suspected or confirmed COVID-19 infection and non-infected individuals who want to receive safe exercise rehabilitation. Results. Our clinical considerations integrate pre-COVID-19 stroke (n = 2) and COVID-19 exercise guidelines for non-stroke populations (athletic [n = 6], pulmonary [n = 1], cardiac [n = 2]), COVID-19 pathophysiology literature, considerations of stroke rehabilitation practices, and exercise physiology principles. A clinical decision-making tool for COVID-19 screening and eligibility for stroke exercise rehabilitation is provided, along with key subjective and physiological measures to guide exercise prescription. Conclusion. We propose that this framework promotes safe exercise programming within stroke rehabilitation for COVID-19 and future infectious disease outbreaks.

COVID-19 Pandemic: Clinical Guidance for Aerobic Exercise-Based Stroke Rehabilitation

Objective(s) 1) To discuss the implications of COVID-19 for exercise in the setting of stroke rehabilitation and 2) to guide and inform the clinical implementation of evidence-based aerobic exercise in stroke rehabilitation. Data Sources A literature search was conducted using 4 databases: MEDLINE, EMBASE, PsycINFO, and AMED Allied and Complementary Medicine, from inception to January 27th, 2021. Study Selection We utilized keywords related to COVID-19, exercise, rehabilitation, and included published athletic return to play after COVID-19 infection and clinical practice guidelines on exercise-based recommendations for COVID-19. Out of 391 published articles, none were related to exercise recommendations and stroke rehabilitation in the context of the COVID-19 pandemic. Data Extraction In the absence of stroke-specific guidance, we drew upon pre-COVID clinical practice aerobic exercise guidelines for stroke (n=2) and COVID-19 exercise recommendations for other populations (e.g., athletic [n=6], pulmonary [n=1] and cardiac rehabilitation [n=2]). Data Synthesis Clinical considerations were developed for hospital and out-patient settings to outline safety considerations to reduce the risk of viral transmission and implementation strategies for pre-participation screening, prescription, and progression of aerobic exercise for symptomatic and asymptomatic cases of COVID-19. Based on limited evidence, we suggest that cardiopulmonary exercise stress testing with electrocardiography be conducted following COVID-19 infection and identify subjective and physiological measures to guide decision making regarding the suitability and prescription of aerobic exercise. Finally, we recommend that clinicians and researchers stay abreast with the literature to implement evidence-based practice relating to stroke, aerobic exercise, and COVID-19. Conclusions Using a patient and clinician approach, we have developed COVID-19 specific guidance as a framework for restoring aerobic exercise implementation in stroke rehabilitation settings. Author(s) Disclosures No conflicts of interest.