Investigating Measures of Intensity During a Structured Upper Limb Exercise Program in Stroke Rehabilitation: An Exploratory Study

Abstract

Objectives-To use three measures of intensity (i) time, (ii) observed repetitions and (iii) wrist accelerometer activity counts to describe the intensity of exercise carried out when completing a structured upper limb exercise programme. To explore if a relationship exists between wrist accelerometer activity counts and observed repetitions. Design-Observational study design. Setting-Rehabilitation centre research laboratory.Participants-Thirteen community dwelling stroke survivors with upper limb hemiparesis. Intervention-Not applicable.Main Outcome Measures-Time engaged in exercise, total repetitions and accelerometer activity counts for the affected upper limb.Results-Mean session time was 48.5 minutes (SD 7.8 minutes). Participants were observed to be engaged in exercises for 63.8% (SD 7.5%) of the total session time. The median number of observed repetitions per session was 340 of which 251 (IQR 80-309) were purposeful repetitions. Wrist accelerometers showed the stroke survivors' upper limbs to be moving for 75.7% (SD 15.9%) of the total session time. Purposeful repetitions and activity counts were found to be significantly correlated (r s =0.627, p<0.05).Correspondence: Louise Connell, Senior Research Fellow, Brook 426, Clinical Practice Research Unit, School of Health, University of Central, Lancashire, Preston, PR1 2HE, Phone: 01772 893725, laconnell@uclan.ac.uk. Conflicts of interest None declared SUPPLIER'S LIST CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptConclusions-Stroke survivors were not actively engaged in exercises for approximately one third of each exercise session. Overall session time may not be the most accurate measure of intensity. Counting repetitions was feasible when using a structured exercise programme and provides a clinically meaningful way of monitoring intensity and progression. Wrist accelerometers provided an objective measure for how much the arm moves, which correlated with purposeful repetitions. Further research using repetitions and accelerometers as measures of intensity is warranted. KeywordsStroke; rehabilitation; time; repetitions; accelerometer Every year, 15 million people worldwide suffer a stroke 1 . Two thirds of stroke survivors achieve independent ambulation after stroke, but less than half recover upper limb function at six months 2 . Best evidence for improving functional recovery after stroke suggests rehabilitation should consist of high intensity repetitive task-specific practice 3-6 . However despite this, the amount of therapy time dedicated to upper limb rehabilitation remains low 7 and upper limb exercises, when prescribed, are often of low intensity 8 .Therapists working in stroke rehabilitation are being challenged to find new ways of increasing the intensity of practice that stroke survivors engage in each day 7 with suggested strategies including self-administered exercise 9 , group exercise 10 and family assisted exercise 11 . Despite the strength of evidence supporting intensity, objectively quantifying intensity...

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“…Overall session duration may not be an accurate method of measuring intensity, as a one-hour intervention session may not involve one hour of practice. An observational study of 13 adults with stroke found that participants engaged in active practice for only 64% of total session time (Connell, McMahon, Simpson, Watkins, & Eng, 2014).…”

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“…Jedno mówi o 23, drugie o 32 powtórzeniach aktywności ruchowych kończyny górnej [30] w trakcie fizjoterapii i terapii zajęciowej [29]. W ostatnim czasie pojawiły się również dwa niezależne badania pokazujące, że pacjenci w fazie podostrej po udarze są w stanie w ciągu godzinnej fizjoterapii wykonać od 251 do 281 różnych aktywności ruchowych KG z niedowładem [31,32]. Nie odnotowano żadnych polskich badań mówiących o dawce terapeutycznej aktywnych zadaniowych ćwi-czeń KG, w tym ręki w postępowaniu fizjoterapeutycznym i terapii zajęciowej w okresie pierwszych czterech tygodni od udaru mózgu jak i w okresie późniejszym.…”

“…However, new evidence indicates that post-stroke UL physi-na, gdy pacjent jest aktywnie zaangażowany w funkcjonalne zadania ruchowe (ang. Activity -related arm training) [31][32][33]35]. Za najbardziej obiecujące strategie we wczesnej fizjoterapii po udarze mózgu uważa się: zmodyfikowaną terapię ruchem wymuszonym koniecznością -ZTRWK (mCIMT-Modified Constraint-Induced Movement Therapy), terapię z zastosowaniem robotów, specyficzny powtarzalny trening zadaniowy (ang.…”

“…Zatem można wnioskować, że dawki takie są zdecydowanie poniżej poziomu skuteczności. Istnieją dowody na to, że możliwe jest zastosowanie u pacjentów we wczesnym okresie otherapy is particularly effective if the patient is actively engaged in activity-related arm training [31][32][33]35]. The most promising strategies of early post-stroke rehabilitation include mCIMT -modified Constraint-Induced Movement Therapy, therapy with the use of robots, Repetitive/Task-Specific Training Techniques, Mental Practice/Motor Imagery and Transcranial Magnetic Stimulation (TMS) [19,29,35,36].…”

“…Only two meta-analytic studies revealed the number of activity-related arm repetitions in the subacute phase after stroke (23 and 32 repetitions) [30] during physiotherapy and occupational therapy [29]. Recently, two independent investigations have revealed that during a onehour session stroke patients in the subacute phase are capable of performing between 251 and 281 various motor activities related to their paretic UL [31,32]. There are no Polish studies on a therapeutic dose of activity-related UL exercises (including an arm) in physiotherapy and occupational therapy interventions in a period of the first four weeks after stroke and later.…”