Abstract
Acquired brain injuries place a significant burden on sub-Saharan African rehabilitation clinicians and health care facilities. While wearable sensors have the potential to alleviate these issues, many are beyond the financial capabilities of the majority of African persons and clinics. To bridge this gap, we have developed a low-cost wrist-worn sensor (the outREACH sensor) capable of accurately measuring upper limb movement kinematics. In this study we evaluated the extent to which the outREACH sensor is sensitive to the hand performing the task (unimpaired, impaired) and level of impairment (mild, moderate) in 14 Ethiopian persons with acquired brain injury (mean age = 51.6 ± 12.2 years, 1 female, 13 male). Participants performed an object manipulation task with both the impaired and the unimpaired limb, and reaching performance was measured using standard kinematic measures (i.e., movement time, spectral arc length, peak velocity, peak acceleration, mean velocity, mean acceleration). Overall, movements were smoother and faster when performed by the patient's unimpaired limb. In contrast, maximum velocity did not differ between the two limbs. Moreover, the outREACH sensor was sensitive to differences in performance-based upper limb impairment. Fugl-Meyer assessment for upper extremity scores were significantly correlated with movement time, spectral arc length, and peak velocity. Upper limb movement kinematics can be accurately measured using the outREACH sensor. The outREACH sensor can be a valuable addition to standardized clinical measures that provides rehabilitation clinicians with information regarding initial upper limb impairment level and changes in function across the rehabilitation lifespan.
Highlights
Each year, acquired brain injuries as stroke and traumatic brain injury, affect millions of persons worldwide [1]
We found that uFMA scores were significantly correlated with the majority of kinematic variables, with moderately impaired brain injured patients taking longer to perform the task, and in a less smooth fashion, than mildly impaired patients
Traditional out-patient post-acquired brain injury evaluation and rehabilitation therapy in sub-Saharan Africa is delivered in hospitals located in an urban area, impacting the ability for patients with limited access to rehabilitation clinics to receive adequate rehabilitation care
Summary
Each year, acquired brain injuries as stroke and traumatic brain injury, affect millions of persons worldwide [1]. Approximately one-third of all sub-Saharan African patients with traumatic brain injury suffer poor outcomes [4, 5], with severe head injury patients exhibiting twice the risk of dying compared to counterparts from developed countries [4]. Motor Assessment With a Wearable Sensor sub-Saharan Africa exhibit poorer prognoses [6] and more severe long-term physical disabilities (e.g., weakness or paralysis, sensory loss, immobility, spasticity, and pain) than individuals from developed countries [7, 8]. Patients who survive severe traumatic brain injury or stroke often exhibit upper limb sensorimotor disabilities that negatively influence their ability to perform activities of daily living and have a detrimental effect on patients’ capacity for independent living and economic self-sufficiency [9,10,11]. While there is strong evidence that high-intensity task-specific rehabilitation facilitates neural reorganization and motor recovery [12], conventional physical therapy places a significant burden on sub-Saharan health systems, due to the shortage of healthcare professionals and technical resources crucial to the delivery of physical rehabilitation services [13, 14]
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