OBJECTIVE. This study explored how upper-extremity (UE) functional capacity and daily performance change during the course of outpatient rehabilitation in people with stroke.METHOD. Fifteen participants receiving outpatient occupational therapy services for UE paresis poststroke were enrolled. UE motor capacity was measured with the Action Research Arm Test (ARAT), and UE performance was measured using bilateral, wrist-worn accelerometers. Measurements were taken at or near the start of therapy, at every 10th visit or every 30 days throughout the duration of services, and at discharge.RESULTS. Three patterns were observed: (1) increase in ARAT scores and more normalized accelerometry profiles, (2) increase in ARAT scores but no change in accelerometry profiles, and (3) no change in ARAT scores or in accelerometry profiles.CONCLUSION. UE performance in daily life was highly variable, with inconsistencies between change in UE capacity and change in UE performance. UE capacity and performance are important constructs to assess separately during rehabilitation.
Surface electromyography (sEMG) can be used as a biofeedback (BFB) parameter to provide information to participants regarding muscle activation in a variety of settings. The objective of our study is to assess whether an sEMG BFB display during physical therapy sessions for acute spinal cord injured inpatients would assist in increasing muscle use and patient engagement during therapy. In addition, we sought to assess whether the therapist and patients would find the sEMG BFB relevant and useful. To achieve this objective, we examined the effect of visual sEMG BFB system in improving muscle activation and therapeutic outcomes during experimental sessions that mimicked conventional slings therapy sessions with a research therapist providing the therapy. We recruited two inpatients with recent spinal cord injuries (SCI) that had been prescribed (clinical) slings therapy as part of their clinical standard of care at our acute rehabilitation hospital. During each experimental session there were two portions. One was the control period which required the participants to repeat elbow flexion 10 times under conventional clinical slings therapy protocols. The other was the BFB period, where the therapist guided the participant in the same movement but both therapist and the participant were provided with visual feedback of realtime sEMG signals recorded from participant's biceps brachii muscles. Our preliminary results show that both participants demonstrated statistically significant improvement of muscle activation level with the sEMG BFB system compared with conventional clinical slings therapy protocols.
Date Presented 4/9/2016 The use of unbiased methods to quantify upper extremity (UE) performance in daily life is critical for stroke rehabilitation. This case series evaluated the relationship between change in UE functional capacity and UE performance using bilateral wrist-worn accelerometers for persons with UE paresis poststroke. Primary Author and Speaker: Caitlin Doman Additional Authors and Speakers: Kimberly Waddell, Contributing Authors: Ryan Bailey, Jennifer Moore, T. George Hornby, Catherine Lang
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