ABSTRACT
Provide a critical analysis of measurement properties of mHealth technologies (wearable sensors and smartphone applications) currently used to capture the amount and intensity of functional skills (locomotion and object-interaction) in stroke survivors. The search was performed in four databases from inception to January 8, 2020 using key words and variations of 'stroke,' 'mHealth technology,' and 'functional movement behaviors' [1-2]. Publication language was restricted to English, Portuguese, and French. Inclusion criteria: original research assessing step count, arm/hand activity and/or intensity, and measurement properties of mHealth technologies in adults post-stroke. Titles, abstracts and full texts were screened for eligibility by two reviewers using COVIDENCE software [3]. Of 1,380 publications, 64 met inclusion criteria. We extracted reliability, validity, responsiveness, and interpretability [4-5]. Measurement properties were reported in 32 studies of locomotor behaviors, 17 of arm/hand behaviors, and 22 studies reported intensity metrics. Remarkably, no studies reported simultaneous measurement of arm/hand and locomotor behaviors. Reliability and validity were the most frequently reported measurement properties, with large variability between devices and smartphone applications. Most studies were conducted in laboratory settings with chronic stroke. Few to none were longitudinal in design across stroke chronicity. Findings underscore the need for further development and use of mHealth technologies to better understand activity of stroke survivors in the natural environment and throughout recovery and reintegration. This review provides a foundation for a field experiencing rapid growth and new opportunities within research and clinical practice to help shape a more active and healthier future for stroke survivors. The authors do not have any conflict of interest.
ABSTRACT
The ipsilesional arm of stroke patients often has functionally limiting deficits in motor control and dexterity that depend on the side of the brain that is lesioned and that increase with the severity of paretic arm impairment. However, remediation of the ipsilesional arm has yet to be integrated into the usual standard of care for upper limb rehabilitation in stroke, largely due to a lack of translational research examining the effects of ipsilesional-arm intervention. We now ask whether ipsilesional-arm training, tailored to the hemisphere-specific nature of ipsilesional-arm motor deficits in participants with moderate to severe contralesional paresis, improves ipsilesional arm performance and generalizes to improve functional independence. We assessed the effects of this intervention on ipsilesional arm unilateral performance [Jebsen-Taylor Hand Function Test (JHFT)], ipsilesional grip strength, contralesional arm impairment level [Fugl-Meyer Assessment (FM)], and functional independence [Functional independence measure (FIM)] (N = 13). Intervention occurred over a 3 week period for 1.5 h/session, three times each week. All sessions included virtual reality tasks that targeted the specific motor control deficits associated with either left or right hemisphere damage, followed by graded dexterity training in real-world tasks. We also exposed participants to 3 weeks of sham training to control for the non-specific effects of therapy visits and interactions. We conducted five test-sessions: two pre-tests and three post-tests. Our results indicate substantial improvements in the less-impaired arm performance, without detriment to the paretic arm that transferred to improved functional independence in all three posttests, indicating durability of training effects for at least 3 weeks. We provide evidence for establishing the basis of a rehabilitation approach that includes evaluation and remediation of the ipsilesional arm in moderately to severely impaired stroke survivors. This study was originally a crossover design; however, we were unable to complete the second arm of the study due to the COVID-19 pandemic. We report the results from the first arm of the planned design as a longitudinal study.
ABSTRACT
Current guidelines against spread of coronavirus (COVID-19) interrupt non-essential rehabilitation services. Thus, individuals with physical disabilities such as children with cerebral palsy can no longer benefit from physical rehabilitation during this undetermined period. Using either a synchronous or asynchronous format, in collaboration with a therapist via telerehabilitation, we suggest that active video games and low-cost virtual reality are a promising delivery mode for at-home rehabilitation in the context of a global pandemic. This therapeutic modality, incorporated into an at-home individualized treatment plan, provides a means to lessen the impact of an interruption in rehabilitation services while not loosing the pre-pandemic, in-person physical activity gains. Growing evidence supports active video games and low-cost virtual reality as viable therapeutic interventions for children with physical disabilities. These technologies are especially well-accepted by pediatric populations for the ludic and motivating features that lend themselves to nearly seamless incorporation into telerehabilitation. Advantages for rehabilitation of active video games and low-cost virtual reality include a rich, challenging, multi-modal training environment in which high numbers of movement repetitions can be accomplished, and a unique opportunity to foster engaged practice actions that go beyond household activities. We offer suggestions for the clinician about how to adopt active video games and low-cost virtual reality into your practice during a global pandemic.