Abstract
Upper-limb impairments in stroke patients are usually measured in clinical setting using standard clinical assessment. In addition, kinematic analysis using opto-electronic systems has been used in the laboratory setting to map arm recovery. Such kinematic measurements cannot capture the actual function of the upper extremity in daily life. The aim of this study is to longitudinally explore the complementarity of post-stroke upper-limb recovery measured by standard clinical assessments and daily-life recorded kinematics. The study was designed as an observational, single-group study to evaluate rehabilitation progress in a clinical and home environment, with a full-body sensor system in stroke patients. Kinematic data were recorded with a full-body motion capture suit during clinical assessment and self-directed activities of daily living. The measurements were performed at three time points for 3 h: (1) 2 weeks before discharge of the rehabilitation clinic, (2) right after discharge, and (3) 4 weeks after discharge. The kinematic analysis of reaching movements uses the position and orientation of each body segment to derive the joint angles. Newly developed metrics for classifying activity and quality of upper extremity movement were applied. The data of four stroke patients (three mildly impaired, one sever impaired) were included in this study. The arm motor function assessment improved during the inpatient rehabilitation, but declined in the first 4 weeks after discharge. A change in the data (kinematics and new metrics) from the daily-life recording was seen in in all patients. Despite this worsening patients increased the number of reaches they performed during daily life in their home environment. It is feasible to measure arm kinematics using Inertial Measurement Unit sensors during daily life in stroke patients at the different stages of rehabilitation. Our results from the daily-life recordings complemented the data from the clinical assessments and illustrate the potential to identify stroke patient characteristics, based on kinematics, reaching counts, and work area. https://clinicaltrials.gov, identifier NCT02118363.
Highlights
Stroke is the second most common cause of disability worldwide (Murray et al, 2012)
Our results from the daily-life recordings complemented the data from the clinical assessments and illustrate the potential to identify stroke patient characteristics, based on kinematics, reaching counts, and work area
The impaired hand is neglecting the non-impaired side (Figure 4). These results demonstrate the feasibility of the method to measure upper-limb kinematics, with an inertial measurement unit (IMU)-based motion capture system at different stages of stroke rehabilitation and during self-directed activities of daily living (sADL) and the concordance to standard clinical assessment
Summary
Stroke is the second most common cause of disability worldwide (Murray et al, 2012). After stroke, approximately 50% of all patients have long-term impairments of upper-limb motor function (Kwakkel et al, 2003). Kinematic analysis of the upper extremity using optoelectronic systems in a clinical setting (Levin, 1996; Cirstea and Levin, 2000; Alt Murphy et al, 2011, 2013; Subramanian and Levin, 2011), has been applied as well to evaluate upper-limb motor recovery after stroke (de los Reyes-Guzman et al, 2014). These clinical assessments reflect the patients’ best abilities as they are encouraged by an assessor. The aim of this study is to longitudinally explore the complementarity of poststroke upper-limb recovery measured by standard clinical assessments and daily-life recorded kinematics
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