Bilateral actigraphic quantification of upper extremity movement in hemiparetic children with perinatal stroke: a case control study

Background Hemiparetic cerebral palsy impacts millions of people worldwide. Assessment of bilateral motor function in real life remains a major challenge. We evaluated quantification of upper extremity movement in hemiparetic children using bilateral actigraphy. We hypothesized that movement asymmetry correlates with standard motor outcome measures. Methods Hemiparetic and control participants wore bilateral wrist Actiwatch2 (Philips) for 48 h with movement counts recorded in 15-s intervals. The primary outcome was a novel statistic of movement asymmetry, the Actigraphic Movement Asymmetry Index (AMAI). Relationships between AMAI and standard motor outcomes (Assisting Hand Assessment, Melbourne Assessment, and Box and Block Test [BB]) were explored with Pearson or Spearman correlation. Results 30 stroke (mean 11 years 2 months (3 years 10 months); 13 female, 17 male) and 23 control (mean 11 years 1 month (4 years 5 months); 8 female, 15 male) were enrolled. Stroke participants demonstrated higher asymmetry. Correlations between AMAI and standard tests were moderate and strongest during sleep (BB: r = 0.68, p < 0.01). Conclusions Standard tests may not reflect the extent of movement asymmetry during daily life in hemiparetic children. Bilateral actigraphy may be a valuable complementary tool for measuring arm movement, potentially enabling improved evaluation of therapies with a focus on child participation.

Virtual Rehabilitation of the Paretic Hand and Arm in Persons With Stroke: Translation From Laboratory to Rehabilitation Centers and the Patient's Home

The anatomical and physiological heterogeneity of strokes and persons with stroke, along with the complexity of normal upper extremity movement make the possibility that any single treatment approach will become the definitive solution for all persons with upper extremity hemiparesis due to stroke unlikely. This situation and the non-inferiority level outcomes identified by many studies of virtual rehabilitation are considered by some to indicate that it is time to consider other treatment modalities. Our group, among others, has endeavored to build on the initial positive outcomes in studies of virtual rehabilitation by identifying patient populations, treatment settings and training schedules that will best leverage virtual rehabilitation's strengths. We feel that data generated by our lab and others suggest that (1) persons with stroke may adapt to virtual rehabilitation of hand function differently based on their level of impairment and stage of recovery and (2) that less expensive, more accessible home based equipment seems to be an effective alternative to clinic based treatment that justifies continued optimism and study.

Single limb cable driven wearable robotic device for upper extremity movement support after traumatic brain injury

Introduction Recently, soft exosuits have been proposed for upper limb movement assistance, most supporting single joint movements. We describe the design of a portable wearable robotic device (WRD), “Armstrong,” able to support three degrees-of-freedom of arm movements, and report on its feasibility for movement support of individuals with hemiparesis after traumatic brain injury (TBI). Methods We introduce Armstrong and report on a pilot evaluation with two male individuals post-TBI (T1 and T2) and two healthy individuals. Testing involved elbow flexion/extension with and without robotic-assisted shoulder stabilization; shoulder abduction with and without robotic-assisted elbow stabilization; and assisted shoulder abduction and flexion. Outcome measures included range of motion and root mean square trajectory and velocity errors. Results TBI subjects performed active, passive, hybrid and active assistive movements with Armstrong. Subjects showed improvements in movement trajectory and velocity. T1 benefited from hybrid, active, and assistive modes due to upper extremity weakness and muscle tone. T2 benefited from hybrid and assistive modes due to impaired coordination. Healthy subjects performed isolated movements of shoulder and elbow with minimal trajectory and velocity errors. Conclusions This study demonstrates the safety and feasibility of Armstrong for upper extremity movement assistance for individuals with TBI, with therapist supervision.