Sensor-Acquired Reachable Workspace (RWS) Correlates with Activities of Daily Living (ADL) Function in Stroke as Measured by Functional Independence Measure (FIM) Self-Care

Abstract

Optimal upper extremity motor control and range of motion are necessary to achieve even the basic activities of daily living (ADL) function. Stroke, with resulting hemiparesis, can significantly and negatively impact an individual's ADL function. Functional Independence Measure (FIM) self-care score can provide an assessment of what aspects and to what degree ADL functions are impaired. FIM self-care assessment can also track changes in ADL function during stroke recovery and rehabilitation. Recently, the sensor-acquired 3D motion analysis of stroke patients' upper extremity has shown promise as a potential alternative to assess ADL function. This observational study evaluates whether the sensor-acquired upper extremity reachable workspace (RWS) measure correlates with clinician-evaluated FIM self-care score in stroke patients. Seventeen patients with stroke were enrolled in the study. FIM self-care, NeuroQoL upper extremity, and reachable workspace outcome measures (relative surface area, RSA) were collected upon rehabilitation hospital admission, at discharge, and at the 3-month visit. Pearson and Spearman's rank correlation coefficients as well as multiple linear regression analyses were used to determine the relationships between FIM self-care, NeuroQoL, and reachable workspace RSAs. Moderately strong correlation between total reachable workspace RSA and total FIM self-care score at discharge and at 3 months were noted (r = 0.619, r = 0.661, p < 0.05), and similarly strong correlation was also noted with the upper extremity NeuroQoL total score (r = 0.690, r = 0.815, p < 0.05). Multiple linear regression analyses revealed a change in average bilateral total RSA of 0.1 unit from admission to the 3-month follow-up correlated with a respective change in the FIM self-care score of 2.011 points (95%CI: 0.663-3.360). Longitudinal improvement in ADL function during stroke rehabilitation and recovery process is correlated with improvement in reachable workspace.

Keywords: activities of daily living; function; reachable workspace; stroke; upper extremity.

Figure 4

Correlation between RSA change and FIM self-care (FIMSC) change post stroke. Correlations between ∆RSA (Q1–Q5 and Total) and ∆FIMSC from admission to discharge (A), and from admission to the 3-month follow-up (B).

Figure 1

Reachable workspace with component quadrants. Reachable workspace system set up with a participant undergoing arm movement protocol in front of the video guide and Kinect sensor (A). An individual’s reachable workspace, reconstructed from the collected arm movement tracing illustrated by the dotted lines, and the visual output of relative surface area (RSA) envelope shown with four frontal quadrants Q1–Q4 (B) and one posterior inferior-lateral quadrant Q5 (C): Q1–Q4 are frontal quadrants viewed from the front (B); Q1, medial upper quadrant; Q2, medial lower quadrant; Q3, lateral upper quadrant; Q4, lateral lower quadrant; and Q5 lateral view (right side shown).

Figure 2

Stroke-affected paretic arm and bilateral arm reachable workspace change longitudinally. Changes in reachable workspace post stroke from admission, to discharge, to the 3-month follow-up. Bar graph of the mean RSAs from the stroke-affected arm, showing the individual quadrants’ RSAs (Q1–Q5) and total RSA (A). Bar graph of the mean RSAs of average bilateral arm data, showing the individual quadrants’ RSAs (Q1–Q5) and total RSA (B).

Figure 3

Reachable workspace upon admission, discharge, and 3 months post stroke. Graphical visualization of the bilateral relative surface area (RSA) of an example subject at admission (A), discharge (B), and at the 3-month follow-up (C) are shown. The top panels show the RSAs of the unaffected left arm and the bottom panels show the RSAs of the stroke-affected right side, gradually improving over time.