Comparing Home Upper Extremity Activity With Clinical Evaluations of Arm Function in Chronic Stroke

Abstract

Objective: To determine if clinical evaluations of poststroke arm function correspond to everyday motor performance indexed by arm accelerometers. Design: Cross-sectional study analyzing baseline data from a larger trial (NCT02665052). Setting: Outpatient research center. Participants: Community-dwelling adults (N=20) with chronic arm motor deficits (stroke≥6mo). Intervention: A total of 72 hours of home wrist-worn accelerometry during normal routine. Main Outcome Measures: Clinical evaluations included the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), and 2 self-assessments: the Motor Activity Log (MAL) and hand motor subscale of the Stroke Impact Scale (SIS). Accelerometer-derived variables included quantifications of movement intensity (magnitude) and duration of arm use. Results: Participants had moderate arm impairment (FMA, 36.1±9.4). The accelerometer-derived mean magnitude ratio correlated significantly with the FMA (ρ=0.60, P<.01), WMFT functional score (ρ=0.59, P<.01), and ARAT (ρ=0.50, P<.05). The hours of use ratio correlated with the MAL amount of use (ρ=0.58, P<.01) and quality of movement (ρ=0.61, P<.01). Total paretic hours did not correlate with the FMA, WMFT, or ARAT, and intensity variables did not correlate with the MAL or SIS. Conclusions: Participants with higher baseline function had greater intensity of paretic arm movement at home; similarly, those who perceived they had less disability used their paretic arm more relative to their nonparetic arm. However, some participants with higher clinical scores did not exhibit greater arm use in everyday life, possibly because of neglect and learned nonuse. Therefore, individualized home accelerometry profiles could provide valuable insight to better tailor poststroke rehabilitation.

Keywords

• Rehabilitation
• Stroke
• Upper extremity