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

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.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.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.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.Controlled-trials.com ISRCTN82787126

Duration of arm-hand use.

<p>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.</p

Data processing.

<p>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.</p

CONSORT flowchart.

<p>Flowchart representing the number of patients throughout the trial.</p

Intensity of use of the affected arm-hand.

<p>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.</p

Variables used to calculate the actual amount of arm-hand use.

<p>Variables used to calculate the actual amount of arm-hand use.</p

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

<p>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.<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0096414#pone.0096414-LindeVander1" target="_blank">[37]</a>), d) patient wearing actiwatches.</p