Monitoring Step Activity During Task-Oriented Circuit Training in High-Functioning Chronic Stroke Survivors: A Proof-of-Concept Feasibility Study

Abstract

ObjectiveTo explore the amount of practice and progression during task-oriented circuit training (TOCT) in chronic stroke survivors; to test the use of pedometers and observation-based measures in detecting step activity; to verify the possible correlation between step activity and locomotor function improvements.MethodsSix community-dwelling chronic stroke survivors underwent 10 TOCT sessions (2 hours/each) over 2 weeks in which they were trained both on a treadmill and on six task-oriented workstations (W1–W6). During the sessions, they wore a piezoelectric pedometer and step activities were recorded. Outcome measures were as follows: % of activities during which pedometers worked properly; pedometer-based measures (total step counts, treadmill steps, workstation steps—total and W2,W3,W5,W6); observation-based measures (number of repetitions in task W1 and W4); walking speed changes measured by the 10-m walking test (10MWT) and walking endurance changes (6-minute walking test) after TOCT.ResultsDuring TOCT sessions (n=57), activities were recorded through pedometer-based measures in 4 out of the 6 patients. The total amount of step activity was 5,980.05±1,968.39 steps (54.29% in task-oriented workstations, 37.67% on treadmill, and 8.03% during breaks). Exercise progression was highlighted significantly by observational measures (W1, W4). A positive correlation was observed between increased gait speed and observational stair step repetitions progression (W1) (r=0.91, p=0.01) or pedometer-based tandem exercise step progression (W3) (r=0.98, p=0.01).ConclusionTOCT can be considered a high-intensity, progressive intervention to restore locomotor function in chronic stroke survivors. Pedometer-based measures might help in quantifying TOCT's volume of practice; however, further investigations are required.

Cognitive Function is a Predictor of the Daily Step Count in Patients With Subacute Stroke With Independent Walking Ability: A Prospective Cohort Study

“…Ambulatory activity was operationally defined as the daily step count measured using a pedometer. In previous studies, ambulatory activity was assessed using a pedometer in patients with stroke, and this measurement method had an established feasibility, 19 , 20 , 21 validity, 22 , 23 and reliability. 23 We used a pedometer a with a 14-day data storage capacity that had a triaxial acceleration sensor that could measure daily steps.…”

Restoration of motor-evoked cortical activity is a distinguishing feature of the most effective rehabilitation therapy after stroke

“…The use of robotic devices in murine models and human patients gives an unbiased evaluation of recovery of motor performances providing an accurate description of kinetic and kinematic aspects on motor performance during rehabilitation after stroke (Allegra Balasubramanian et al, 2010;Hogan and Krebs, 2011;Spalletti et al, 2014). Importantly, it is increasingly recognized that the combination of stimulation with physical rehabilitation synergistically creates a pro-plasticizing milieu where spared neurons are more susceptible to experience-dependent modifications (Alia et al, 2017;Straudi et al, 2016;Zeiler and Krakauer, 2013). To our knowledge, no investigation has yet described how the combination of optogenetic stimulation and motor training longitudinally molds cortical functional maps in the chronic phase after stroke.…”

“…When combined with motor training, cortical stimulation creates a pro-plasticizing milieu where spared neurons are more susceptible to experience-dependent modifications 4,16,17 . Though several studies investigated the effect of combining neuronal modulation, such as TMS 18–20 and tDCS 21–23 , with robotic training, results are still contradictory.…”

Activity Monitor Placed at the Nonparetic Ankle Is Accurate in Measuring Step Counts During Community Walking in Poststroke Individuals: A Validation Study

“…Previous studies have revealed that consumer‐based activity trackers are inaccurate in monitoring walking activity in slow walkers (<0.8 m/s) . In this context, one activity monitor has received particular attention.…”

“…10 Previous studies have revealed that consumer-based activity trackers are inaccurate in monitoring walking activity in slow walkers (<0.8 m/s). 11,12 In this context, one activity monitor has received particular attention. When the evaluated device is placed at the hip (as recommended by the manufacturer) in older healthy individuals walking slower than 0.8 m/s, its step error rate is higher than 10% 13 (ie, arbitrary threshold used previously and considered acceptable 14 ).…”