Utility of a unilateral accelerometer for monitoring upper extremity use in subacute stroke patients after discharge from hospital.

This study was to investigate the utility of a unilateral accelerometer, which is commonly used for monitoring upper extremity performance, in subacute stroke patients by comparing its use with other upper extremity assessments. Twenty-four participants were recruited and required to wear an accelerometer on the affected wrist for 3 hours daily for the first 4 weeks after discharge from hospital. Assessments included Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Box and Block Test (BBT), and self-reporting Motor Activity Log (MAL). Assessments were made at 0, 4, 8, and 12 weeks after hospital discharge. How long the device was worn, movement amount, and movement percentage were extracted from the accelerometer. Throughout the 12-week observation, significant improvements in the participants were shown by the FMA-UE, ARAT, and BBT (p < 0.001, p = 0.026, and p < 0.001, respectively), but no significant change could be found using MAL or the accelerometer parameters across time (p = 0.068 to 0.999). There was moderate-to-good correlation among the assessments; however, no significant correlation was obtained between any of the assessments and the accelerometer data. We suggest that the unilateral accelerometer might not be useful to reflect actual arm functions in daily activities.

"Remind-to-Move" for Promoting Upper Extremity Recovery Using Wearable Devices in Subacute Stroke: A Multi-Center Randomized Controlled Study.

This paper examined the effects of "Remind-to-Move" (RTM) via vibration cueing using wearable devices to increase the use of the affected upper limb and integrate upper limb activities undertaken at home in patients with subacute stroke after inpatient discharge. In a multi-centered randomized controlled trial, 84 eligible patients from four general hospitals, who had a first stroke in the last six months, were randomly allocated to either an experimental, sham, or control group, stratified by arm function levels. Patients in the experimental group were treated by RTM, using wearable devices for three consecutive hours daily, over four weeks. The sham group used sham devices, and the control group received usual care alone. A masked assessor evaluated the patients at 0th, 4th, 8th, and 12th weeks using outcome measures included arm function tests, motor activity log, and movement recorded by the devices. Results showed that there was a significant group by time interaction, and the average movement amount and Action Research Arm Test score in the experimental group were significantly higher than in the sham group. This paper demonstrates that RTM via wearable devices used for the hemiplegic upper extremities could promote more arm recovery than the sham or control and, hence, produce an optimal functional improvement for subacute stroke patients.

Cure SMA and our patient community celebrate the first approved drug for SMA.

Cure SMA is dedicated to the treatment and cure of spinal muscular atrophy (SMA)-a disease affecting motor neurons, that robs patients of their ability to walk, eat and even breathe. Since 1984, we have directed and invested in comprehensive research that has shaped the scientific community's understanding of SMA. On 23 December, 2016, the Food and Drug Administration (FDA) announced approval of Spinraza, a treatment developed by Biogen and Ionis, making it the first-ever approved therapy for SMA. Cure SMA provided early research funding in 2003 leading to the discovery of ISS-N1 sequence, now targeted by Spinraza. We are pleased that our strategy of providing seed funding for research to either identify new therapeutic strategies or de-risk early stage ones, has proven successful with Spinraza's approval. The approval of Spinraza provides great hope to the SMA community and represents decades of hard work and perseverance by families, researchers, pharmaceutical companies and the FDA. Our hope is that Spinraza is the leading edge of a robust drug pipeline, and with our deep expertise in every aspect of SMA, we remain committed to do everything we can to support research and drug development to achieve the greatest possible effect for each and every SMA patient.

Effects of Arm Weight Support Training to Promote Recovery of Upper Limb Function for Subacute Patients after Stroke with Different Levels of Arm Impairments.

Purpose. The goal of this study was to investigate the effects of arm weight support training using the ArmeoSpring for subacute patients after stroke with different levels of hemiplegic arm impairments. Methods. 48 inpatients with subacute stroke, stratified into 3 groups from mild to severe upper extremity impairment, were engaged in ArmeoSpring training for 45 minutes daily, 5 days per week for 3 weeks, in addition to conventional rehabilitation. Evaluations were conducted at three measurement occasions: immediately before training (T1); immediately after training (T2); and at a 3-week follow-up (T3) by a blind rater. Results. Shoulder flexion active range of motion, Upper Extremity Scores in the Fugl-Meyer Assessment (FMA), and Vertical Catch had the greatest differences in gain scores for patients between severe and moderate impairments, whereas FMA Hand Scores had significant differences in gain scores between moderate and mild impairments. There was no significant change in muscle tone or hand-path ratios between T1, T2, and T3 within the groups. Conclusion. Arm weight support training is beneficial for subacute stroke patients with moderate to severe arm impairments, especially to improve vertical control such as shoulder flexion, and there were no adverse effects in muscle tone.

Combined effects of sensory cueing and limb activation on unilateral neglect in subacute left hemiplegic stroke patients: a randomized controlled pilot study.

OBJECTIVE: To compare the effects of contralesional sensory cueing and limb activation with that of sham control in the treatment of unilateral neglect after stroke. DESIGN: A randomized, single-blinded, sham-controlled pilot study. SETTING: Two rehabilitation hospitals. SUBJECTS: Forty subacute left hemiplegic stroke inpatients with unilateral neglect. INTERVENTIONS: Participants were assigned randomly to 1 of 2 groups. The experimental group wore a wristwatch cueing device over the hemiplegic arm for three hours a day, five days per week, for three weeks, and also underwent conventional rehabilitation. Patients were encouraged to move their hemiplegic arm five consecutive times after each prompt. The sham group underwent the same rehabilitation process, except they wore a sham device. MAIN MEASURES: Neglect, arm motor performance, and overall functioning were assessed pre- and posttraining, and at follow-up. RESULTS: There were no significant differences between groups in outcome measures except the neglect drawing tasks (p = 0.034) (the mean gain score from baseline to follow-up assessment was 5.2 (3.7) in the experimental group and 1.9 (3.5) in the sham group), across three time intervals. The experimental group showed greater improvement in arm motor performance than did the sham group. CONCLUSION: The results did not confirm that sensory cueing and limb activation treatment is effective when compared with those receiving placebo to reduce unilateral neglect, but it might be useful for promoting hemiplegic arm performance in stroke patients.

'Remind to move': a pilot study on the effects of sensory cueing treatment on hemiplegic upper limb functions in children with unilateral cerebral palsy.

OBJECTIVE: To investigate the effects of sensory cueing with repetitive practice on hemiplegic arm functions in children with unilateral cerebral palsy. DESIGN: A single-group pre/post comparison. SETTING: A special school for children with physical disabilities. SUBJECTS: Eight children with unilateral cerebral palsy aged 6-18 years. INTERVENTIONS: Participants were required to wear for three weeks a sensory cueing, non-activated wristwatch device and complete 5 hours of conventional therapy per week (treatment A). This was followed by three weeks of continuing conventional therapy and wearing the now activated wristwatch, which prompted the children to do predetermined exercises on the hemiplegic arm for 6 hours daily, 5 days per week, for three weeks (treatment B), and three weeks follow-up. MAIN MEASURES: Assessments of arm efficiency, functional hand use and arm impairments were carried out at baseline (day before treatment A), posttest 1 (day after treatment A), posttest 2 (day after treatment B) and follow-up (three weeks after treatment B). RESULTS: Arm efficiency as revealed by the Jebsen-Taylor Hand Function Test and the Bruininks-Oseretsky Test of Motor Proficiency - but not actual arm use and grip strength - showed significant improvement after treatment B to follow-up (from 286.0 ± 73.9 to 191.9 ± 73.5, P = 0.002, and from 15.5 ± 5.0 to 18.1 ± 7.7, P = 0.021). CONCLUSION: This pilot study provides proof-of-concept data showing that a wearable device might be used to remind children with cerebral palsy to perform a set of predetermined arm exercises in order to promote hemiplegic arm function.

Dimensionality and clinical importance of pain and disability in hand osteoarthritis: Development of the Australian/Canadian (AUSCAN) Osteoarthritis Hand Index.

OBJECTIVE: To develop a reliable, valid, and responsive self-administered questionnaire to probe pain, stiffness and physical disability in patients with osteoarthritis (OA) of the hand. DESIGN: In order to assess the dimensionality of the symptomatology of hand OA, a self-administered questionnaire was developed to probe various aspects of pain (10 items), stiffness (two items), and physical function (83 items). The question inventory was generated from eight existing health status measures and an interactive process involving four rheumatologists, two physiotherapists, and an orthopaedic surgeon. RESULTS: Face-to-face interviews were conducted with 50 OA hand patients; 39 females and 11 males with mean age 62.8 years and mean disease duration 9.4 years. Items retained were those which fulfilled specified selection criteria: prevalence > or =60% and mean importance score approximating or exceeding 2.0 Item exclusion criteria included low prevalence, gender-based, ambiguous, duplicates or similarities, alternatives, composite items, and items that were too restrictive. This process resulted in five pain, one stiffness and nine function items which have been proposed for incorporation in the AUSCAN Index. CONCLUSIONS: Using a traditional development strategy, we have constructed a self-administered multi-dimensional outcome measure for assessing hand OA. The next stage includes reliability, validity and responsiveness testing of the 15-item questionnaire.

Clinimetric properties of the AUSCAN Osteoarthritis Hand Index: an evaluation of reliability, validity and responsiveness.

OBJECTIVE: To assess the reliability, validity and responsiveness of the Australian/Canadian (AUSCAN) Osteoarthritis Hand Index in both Likert (LK) and Visual Analogue (VA)-scaled formats. METHODS: Two separate studies were conducted; the first addressing reliability and validity issues and the second addressing index responsiveness. In a group of 50 patients with osteoarthritis (OA) of the hand, test-retest reliability was assessed at a 1-week interval and internal consistency from single administrations of the Index. Construct validity was evaluated against several other outcome measures including the Functional Index for Hand Osteoarthritis (FIHOA), separate patient and physician global assessments, Doyle Index, grip strength, pinch grip, and Health Assessment Questionnaire. A 6-week washout retreatment design was used in a group of 44 OA hand patients to assess index responsiveness and comparative responsiveness against the FIHOA. RESULTS: Reliability and construct validity coefficients confirm the reliability and construct validity of both the AUSCAN LK3.0 and AUSCAN VA3.0 Indices. The washout retreatment study establishes index responsiveness and suggests that the AUSCAN LK3.0 and AUSCAN VA3.0 Indices may be more responsive than the FIHOA. CONCLUSIONS: The patient self-completed AUSCAN LK3.0 and AUSCAN VA3.0 Indices are reliable, valid and responsive and can be recommended as primary outcome measures for future hand OA clinical trials.

Evaluation of quadrupole time-of-flight tandem mass spectrometry and ion-trap multiple-stage mass spectrometry for the differentiation of C-glycosidic flavonoid isomers.

LC-MS-MS is becoming a very important tool for the on-line identification of natural products in crude plant extracts. For an efficient use of this technique in the dereplication of natural products, a careful study of the parameters used to generate informative MS-MS spectra is needed. In this paper, the collision-induced dissociation (CID) MS-MS spectra of ubiquitous C-glycosidic flavonoids have been systematically studied using hybrid quadrupole time-of-flight and ion-trap (IT) mass analysers under various CID energy conditions. Efficient differentiation of flavonoid C-glycoside isomers was possible, based on the comparison of CID-MS-MS spectra of particular C-glycoside unit fragments. Striking differences between 6-C and 8-C flavonoid glycosides were especially observed in the product ion spectra of their 0.2X+ fragments ([M+H-120]+). Some guidelines for the on-line characterisation of C-glycosidic flavonoids by LC-MS-MS or LC-multiple-stage MS are given.