Wearable sensors and Mobile Health (mHealth) technologies to assess and promote physical activity in stroke: A narrative review

Stroke is a leading cause of disability worldwide, with approximately one third of people left with permanent deficits impacting on their function. This may contribute to a physically inactive lifestyle and further associated health issues. Current research suggests that people after stroke are not meeting the recommended levels of physical activity, and are less active than people with other chronic illnesses. Thus, it is important to understand how to support people after stroke to uptake and maintain physical activity. Wearable sensors and mobile health (mHealth) technologies are a potential platform to measure and promote physical activity. Some of these technologies may incorporate behaviour change techniques such as real-time feedback. Although wearable activity trackers and smartphone technology are widely available, the feasibility and applicability of these technologies for people after stroke is unclear. This article reviews the devices available for assessment of physical activity in stroke and discusses the potential for advances in technology to promote physical activity in this population

Barriers to physical activity of stroke survivors in Singapore: A face-to-face cross-sectional survey

Background Physical activity (PA) levels of stroke survivors are far from recommended levels. To develop specific interventions targeted at improving PA after stroke, there is a need to consider the barriers to PA faced by stroke survivors. Objective To use the comprehensive Barriers to Physical Activity Questionnaire for People with Mobility Impairments (BPAQ-MI) to identify intrapersonal, interpersonal, organizational and community barriers to PA faced by stroke survivors in Singapore. Methods We conducted a face-to-face survey with stroke survivors recruited from Singapore National Stroke Association platforms. Participants were eligible for the study if they were 21 years old and above, had a medical diagnosis of stroke, and had a weak arm or leg. Results 38 stroke survivors participated in the survey. More than half had moderate or moderately severe disability, and needed assistance for activities of daily living or walking. Of the 63 barriers spanning across intrapersonal, interpersonal, organizational and community domains, the top three most commonly reported barriers include lack of accessible classes/programs at fitness centre (21/38; 55%), lack of assistance from fitness centre staff (19/38; 50%) and feelings of tiredness/fatigue (18/38; 47%). Of the top 10 most commonly reported barriers, four were organizational barriers, four were intrapersonal barriers and two were community barriers. Conclusions Stroke survivors in Singapore want to participate in PA, but are often limited by barriers associated with fitness centres, self and the environment in the wider community

Dynamic balance and instrumented gait variables are independent predictors of falls following stroke

Abstract Background Falls are common following stroke and are frequently related to deficits in balance and mobility. This study aimed to investigate the predictive strength of gait and balance variables for evaluating post-stroke falls risk over 12 months following rehabilitation discharge. Methods A prospective cohort study was undertaken in inpatient rehabilitation centres based in Australia and Singapore. A consecutive sample of 81 individuals (mean age 63 years; median 24 days post stroke) were assessed within one week prior to discharge. In addition to comfortable gait speed over six metres (6mWT), a depth-sensing camera (Kinect) was used to obtain fast-paced gait speed, stride length, cadence, step width, step length asymmetry, gait speed variability, and mediolateral and vertical pelvic displacement. Balance variables were the step test, timed up and go (TUG), dual-task TUG, and Wii Balance Board-derived centre of pressure velocity during static standing. Falls data were collected using monthly calendars. Results Over 12 months, 28% of individuals fell at least once. The faller group had increased TUG time and reduced stride length, gait speed variability, mediolateral and vertical pelvic displacement, and step test scores (P < 0.001–0.048). Significant predictors, when adjusted for country, prior falls and assistance (i.e., physical assistance and/or gait aid use) were stride length, step length asymmetry, mediolateral pelvic displacement, step test and TUG scores (P < 0.040; IQR-odds ratio(OR) = 1.37–7.85). With comfortable gait speed as an additional covariate, to determine the additive benefit over standard clinical assessment, only mediolateral pelvic displacement, TUG and step test scores remained significant (P = 0.001–0.018; IQR-OR = 5.28–10.29). Conclusions Reduced displacement of the pelvis in the mediolateral direction during walking was the strongest predictor of post-stroke falls compared with other gait variables. Dynamic balance measures, such as the TUG and step test, may better predict falls than gait speed or static balance measures

Reliability and concurrent validity of the Microsoft Xbox One Kinect for assessment of standing balance and postural control

The Microsoft Kinect V2 for Windows™, also known as the Xbox One Kinect, includes new and potentially far improved depth and image sensors which may increase its accuracy for assessing postural control and balance. The aim of this study was to assess the concurrent validity and reliability of kinematic data recorded using a marker-based three dimensional motion analysis (3DMA) system and the Kinect V2 during a variety of static and dynamic balance assessments. Thirty healthy adults performed two sessions, separated by one week, consisting of static standing balance tests under different visual (eyes open vs. closed) and supportive (single limb vs. double limb) conditions, and dynamic balance tests consisting of forward and lateral reach and an assessment of limits of stability. Marker coordinate and joint angle data were concurrently recorded using the Kinect V2 skeletal tracking algorithm and the 3DMA system. Task-specific outcome measures from each system on Day 1 and 2 were compared. Concurrent validity of trunk angle data during the dynamic tasks and anterior–posterior range and path length in the static balance tasks was excellent (Pearson's r > 0.75). In contrast, concurrent validity for medial–lateral range and path length was poor to modest for all trials except single leg eyes closed balance. Within device test–retest reliability was variable; however, the results were generally comparable between devices. In conclusion, the Kinect V2 has the potential to be used as a reliable and valid tool for the assessment of some aspects of balance performance

Wearable sensors and Mobile Health (mHealth) technologies to assess and promote physical activity in stroke: a narrative review

Stroke is a leading cause of disability worldwide, with approximately one third of people left with permanent deficits impacting on their function. This may contribute to a physically inactive lifestyle and further associated health issues. Current research suggests that people after stroke are not meeting the recommended levels of physical activity, and are less active than people with other chronic illnesses. Thus, it is important to understand how to support people after stroke to uptake and maintain physical activity. Wearable sensors and mobile health (mHealth) technologies are a potential platform to measure and promote physical activity. Some of these technologies may incorporate behaviour change techniques such as real-time feedback. Although wearable activity trackers and smartphone technology are widely available, the feasibility and applicability of these technologies for people after stroke is unclear. This article reviews the devices available for assessment of physical activity in stroke and discusses the potential for advances in technology to promote physical activity in this population. © Copyright Australasian Society for the Study of Brain Impairment 2016

Establishing Organized Stroke Care in Low- and Middle-Income Countries: From Training of Non-specialist to Implementation

Low- and middle-income countries (LMICs) suffer from a higher stroke burden compared to high-income countries with higher mortality and disability due to stroke. However, the availability of resources, both infrastructural and personnel, is widely discrepant. The lack of specialist neurologists or stroke physicians in LMICs makes it imperative to rely on alternative models of stroke care. Task-sharing models such as the physician-led model or the non-specialist model have been evaluated previously with evidence for feasibility and cost-effectiveness. We propose to implement and assess the effectiveness of a non-specialist model of stroke care across 3 LMICs through a structured capacity building program, augmented by a tailored mobile application to guide the non-specialists in delivering optimal stroke care. This study will provide essential information on the effectiveness of a non-specialist driven delivery of stroke care on a larger scale across different regional contexts

Improving life after stroke needs global efforts to implement evidence-based physical activity pathways

There is an urgent need to improve life after stroke across the world-especially in low-income countries-through methods that are effective, equitable and sustainable. This paper highlights physical activity (PA) as a prime candidate for implementation. PA reduces modifiable risk factors for first and recurrent stroke and improves function and activity during rehabilitation and following discharge. Preliminary evidence also indicates PA is cost-effective. This compelling evidence urgently needs to be translated into seamless pathways to enable stroke survivors across the world to engage in a more active lifestyle. Although more quality research is needed-particularly on how to optimize uptake and maintenance of PA-this should not delay implementation of high-quality evidence already available. This paper shares examples of best practice service models from low-, middle-, and high-income countries around the world. The authors call for a concerted effort to implement high-quality PA services to improve life after stroke for all