Accelerometry measuring the outcome of robot-supported upper limb training in chronic stroke: a randomized controlled trial

Abstract

Purpose: This study aims to assess the extent to which accelerometers can be used to determine the effect of robot-supported task-oriented arm-hand training, relative to task-oriented arm-hand training alone, on the actual amount of arm-hand use of chronic stroke patients in their home situation.

Methods: This single-blind randomized controlled trial included 16 chronic stroke patients, randomly allocated using blocked randomization (n = 2) to receive task-oriented robot-supported arm-hand training or task-oriented (unsupported) arm-hand training. Training lasted 8 weeks, 4 times/week, 2 × 30 min/day using the (T-)TOAT ((Technology-supported)-Task-Oriented-Arm-Training) method. The actual amount of arm-hand use, was assessed at baseline, after 8 weeks training and 6 months after training cessation. Duration of use and intensity of use of the affected arm-hand during unimanual and bimanual activities were calculated.

Results: Duration and intensity of use of the affected arm-hand did not change significantly during and after training, with or without robot-support (i.e. duration of use of unimanual use of the affected arm-hand: median difference of -0.17% in the robot-group and -0.08% in the control group between baseline and after training cessation; intensity of the affected arm-hand: median difference of 3.95% in the robot-group and 3.32% in the control group between baseline and after training cessation). No significant between-group differences were found.

Conclusions: Accelerometer data did not show significant changes in actual amount of arm-hand use after task-oriented training, with or without robot-support. Next to the amount of use, discrimination between activities performed and information about quality of use of the affected arm-hand are essential to determine actual arm-hand performance.

Trial registration: Controlled-trials.com ISRCTN82787126.

Figure 1. CONSORT flowchart.

Flowchart representing the number of patients throughout the trial.

Figure 2. Set-up of the training, robotic device Haptic Master and Actiwatch.

a) patient training in the robotic rehabilitation group, b) patient training in the control group, c) workspace of the Haptic Master (reprinted with permission from Van der Linde et al.[37]), d) patient wearing actiwatches.

Figure 3. Data processing.

A) Raw activity count data (solid) and filtered data (dashed) of the left hand; B) Raw activity count data (solid) and filtered data (dashed) of the right hand; C) Filtered data of both hands and summation of filtered data, including start points (+) and endpoints (O) of uptime; D) Raw activity count data of both hands including start points (+) and endpoints (O) of uptime.

Figure 4. Duration of arm-hand use.

Boxplots of the duration of a) unimanual use of the affected arm-hand and b) bimanual use, expressed as a percentage of uptime. The circle represents an outlier and the star represents a far out value.

Figure 5. Intensity of use of the affected arm-hand.

Box plots of the intensity of use of the affected arm-hand during a) both unimanual and bimanual activity, b) unimanual activity of the affected arm-hand and c) bimanual activity. Circles represent outliers.