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Many stroke survivors experience persistent upper extremity impairment that limits performance in activities of daily living. Upper limb recovery requires high repetitions of task-specific practice. Stroke survivors are often prescribed task practices at home to supplement rehabilitation therapy. A poor quality of task practices, such as the use of compensatory movement patterns, results in maladaptive neuroplasticity and suboptimal motor recovery. There currently lacks a tool for the remote monitoring of movement quality of stroke survivors' task practices at home. The objective of this study was to evaluate the feasibility of classifying movement quality at home using a wearable IMU. Nineteen stroke survivors wore an IMU sensor on the paretic wrist and performed four functional upper limb tasks in the lab and later at home while videorecording themselves. The lab data served as reference data to classify home movement quality using dynamic time warping. Incorrect and correct movement quality was labeled by a therapist. The home task practice movement quality was classified with an accuracy of 92% and F1 score of 0.95 for all tasks combined. Movement types contributing to misclassification were further investigated. The results support the feasibility of a home movement quality monitoring system to assist with upper limb rehabilitation post stroke.

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Upper extremity hemiplegia is a serious problem affecting the lives of many people post-stroke. Motor recovery requires high repetitions and quality of task-specific practice. Sufficient practice cannot be completed during therapy sessions, requiring patients to perform additional task practices at home on their own. Adherence to and quality of these home task practices are often limited, which is likely a factor reducing rehabilitation effectiveness post-stroke. However, home adherence is typically measured by self-reports that are known to be inconsistent with objective measurement. The objective of this study was to develop algorithms to enable the objective identification of task type and quality. Twenty neurotypical participants wore an IMU sensor on the wrist and performed four representative tasks in prescribed fashions that mimicked correct, compensatory, and incomplete movement qualities typically seen in stroke survivors. LSTM classifiers were trained to identify the task being performed and its movement quality. Our models achieved an accuracy of 90.8% for task identification and 84.9%, 81.1%, 58.4%, and 73.2% for movement quality classification for the four tasks for unseen participants. The results warrant further investigation to determine the classification performance for stroke survivors and if quantity and quality feedback from objective monitoring facilitates effective task practice at home, thereby improving motor recovery.

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Hand impairment is a common consequence of stroke, resulting in long-term disability and reduced quality of life. Recovery may be augmented through self-directed therapy activities at home, complemented by the use of rehabilitation devices such as peripheral sensory stimulation. The objective of this study was to determine the effect of adherence to self-directed therapy and the use of TheraBracelet (subsensory random-frequency vibratory stimulation) on hand function for stroke survivors. In a double-blind, randomized controlled pilot trial, 12 chronic stroke survivors were assigned to a treatment or control group (n = 6/group). All participants were instructed to perform 200 repetitions of therapeutic hand tasks 5 days/week while wearing a wrist-worn device 8 hours/day for 4 weeks. The treatment group received TheraBracelet vibration from the device, while the control group received no vibration. Home task repetition adherence and device wear logs, as well as hand function assessment (Stroke Impact Scale Hand domain), were obtained weekly. Repetition adherence was comparable between groups but varied among participants. Participants wore the device to a greater extent than adhering to completing repetitions. A linear mixed model analysis showed a significant interaction between repetition and group (p = 0.01), with greater adherence resulting in greater hand function change for the treatment group (r = 0.94; R 2 = 0.88), but not for the control group. Secondary analysis revealed that repetition adherence was greater for those with lower motor capacity and greater self-efficacy at baseline. This pilot study suggests that adherence to self-directed therapy at home combined with subsensory stimulation may affect recovery outcomes in stroke survivors. This trial is registered with NCT04026399.

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A peripheral sensory stimulation named TheraBracelet has recently been shown to have a potential to improve gross manual dexterity following stroke. Upper limb function requires both reach and grasp. It is unknown whether TheraBracelet affects one more than other. The objective of this study was to determine whether TheraBracelet improves reaching versus grasping. In a pilot randomized controlled trial, persons with stroke received TheraBracelet (treatment) or no stimulation (control) during task practice therapy (n = 6/group). Effects of TheraBracelet on reaching versus grasping were determined using breakdown of movement times in the Box and Block Test video recordings. Improvements in movement times for the treatment compared with control group were more pronounced for grasping than for reaching at both post and follow-up time points. TheraBracelet may be beneficial for persons with grasping deficits. This knowledge can guide clinicians for targeted use of TheraBracelet, resulting in effective implementation of the new treatment.

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BACKGROUND: Communication partner training (CPT) involves educating conversation partners to implement communication strategies that facilitate improved interactions with people with aphasia (PWA). This study aimed to investigate (1) whether a CPT program increased the knowledge and confidence of students with and without a communication disorders background and (2) the differential effects of this training on students from different allied health disciplines. METHODS: Quasi-experimental design study with 6 adult volunteers with aphasia and 36 students (18 speech-language pathology [SLP] students and 18 physical therapy/occupational therapy [PT/OT] students). The CPT program was provided twice (in 2015 and 2016) as a single seminar at an American university. RESULTS: All students reported increased confidence in communicating with PWA and were able to identify a greater number of appropriate communication strategies after the CPT than they could identify before the training. The SLP students demonstrated greater aphasia knowledge than the PT/OT students prior to training; only the PT/OT students reported increased knowledge about aphasia after training. DISCUSSION: Involvement of PWA in CPT programs may be particularly important in enabling students to develop confidence in communicating with PWA. Practice opportunities with PWA can be provided as early as the beginning of didactic coursework through an interdisciplinary CPT program.

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BACKGROUND: Post-stroke hand impairment is prevalent and persistent even after a full course of rehabilitation. Hand diminishes stroke survivors' abilities for activities of daily living and independence. One way to improve treatment efficacy is to augment therapy with peripheral sensory stimulation. Recently, a novel sensory stimulation, TheraBracelet, has been developed in which imperceptible vibration is applied during task practice through a wrist-worn device. The objective of this trial is to determine if combining TheraBracelet with hand task practice is superior to hand task practice alone. METHODS: A double-blind randomized controlled trial will be used. Chronic stroke survivors will undergo a standardized hand task practice therapy program (3 days/week for 6 weeks) while wearing a device on the paretic wrist. The device will deliver TheraBracelet vibration for the treatment group and no vibration for the control group. The primary outcome is hand function measured by the Wolf Motor Function Test. Other outcomes include the Box and Block Test, Action Research Arm Test, upper extremity use in daily living, biomechanical measure of the sensorimotor grip control, and EEG-based neural communication. DISCUSSION: This research will determine clinical utility of TheraBracelet to guide future translation. The TheraBracelet stimulation is delivered via a wrist-worn device, does not interfere with hand motion, and can be easily integrated into clinical practice. Enhancing hand function should substantially increase stroke survivors' independence and quality of life and reduce caregiver burden. TRIAL REGISTRATION: NCT04569123 . Registered on September 29, 2020.

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BACKGROUND: Functional task performance requires proper control of both movement and force generation in three-dimensional space, especially for the hand. Control of force in three dimensions, however, is not explicitly treated in current physical rehabilitation. To address this gap in treatment, we have developed a tool to provide visual feedback on three-dimensional finger force. Our objective is to examine the effectiveness of training with this tool to restore hand function in stroke survivors. METHODS: Double-blind randomized controlled trial. All participants undergo 18 1-h training sessions to practice generating volitional finger force of various target directions and magnitudes. The experimental group receives feedback on both force direction and magnitude, while the control group receives feedback on force magnitude only. The primary outcome is hand function as measured by the Action Research Arm Test. Other outcomes include the Box and Block Test, Stroke Impact Scale, ability to direct finger force, muscle activation pattern, and qualitative interviews. DISCUSSION: The protocol for this clinical trial is described in detail. The results of this study will reveal whether explicit training of finger force direction in stroke survivors leads to improved motor control of the hand. This study will also improve the understanding of neuromuscular mechanisms underlying the recovery of hand function. TRIAL REGISTRATION: ClinicalTrials.gov NCT03995069 . Registered on June 21, 2019.

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Sensory impairment may impact individual stroke survivors' motor recovery as well as their response to peripheral sensory stimulation treatment. The objective of this study was to determine the effect of sensory impairment level of individual stroke survivors on motor improvement with therapy and peripheral sensory stimulation. A secondary analysis of a pilot triple-blind randomized controlled trial was used. Twelve chronic stroke survivors were randomly assigned to the treatment group receiving peripheral sensory stimulation or the control group receiving no stimulation during 2-week hand task practice therapy. Sensory impairment level was quantified as the pre-intervention sensory threshold. Motor improvement was assessed as change in the Box and Block Test score from pre- to post-intervention. The association between sensory impairment level and motor improvement was examined using a regression analysis, accounting for groups. This study found that participants with better sensation (i.e., with lower sensory threshold) had better motor improvement than patients with worse sensation (i.e., with higher sensory threshold). Sensory impairment level did not alter the effect of peripheral sensory stimulation. These findings suggest that the level of sensory impairment may predict recovery potentials and direct rehabilitation treatment for stroke survivors.

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BACKGROUND AND PURPOSE: Despite evidence that falls can be prevented with specific exercise interventions such as the Otago Exercise Program (OEP), translation of these programs into practice is limited in rural and medically underserved areas. The Community Health and Mobility Partnership (CHAMP) addresses this problem through a community-based implementation of the OEP in rural Appalachia where medical resources are scarce. The purpose of this study was to examine the effects of the CHAMP on physical performance and balance confidence in community-dwelling older adults. METHODS: This study was a retrospective analysis of quasi-longitudinal data. Older adults received fall screenings at local senior centers. Those with increased fall risk received individualized OEP home exercises and were advised to return for monthly follow-up visits. Three physical performance measures-Timed Up and Go test (TUG), Four-Stage Balance Test (4SBT), and chair rise test (CRT)-and the Activities-specific Balance Confidence scale (ABC) were assessed at the initial visit (IV) and each follow-up visit. Two groups were created to distinguish participants who returned for their second follow-up (F2) visit within 3 months from those who returned between 3 and 6 months. Within-group change from IV to F2 was calculated using repeated-measures t tests. Repeated-measures 2-way analyses of variance were used to test for main and interaction effects of group and visit. RESULTS AND DISCUSSION: One hundred thirty CHAMP participants aged 76.1 (SD = 8.1) years demonstrated statistically and clinically significant improvements in the 3 physical performance measures (mean 4SBT: IV 29.5 seconds, F2 31.5 second, P = .001), (mean TUG: IV 12.7 seconds, F2 11.9 seconds, P = .021), (mean CRT: IV 0.258 stands/second, F2 0.290 stands/second, P = .002), but not in balance confidence (mean ABC: IV 62.2, F2 64.4, P = .154). A significant interaction of group by visit for the TUG was observed, suggesting that better TUG performance was associated with quicker return for follow-up. CONCLUSIONS: Results indicated that program participants improved from IV to F2 in measures related to fall risk.

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This was a retrospective analysis of quasi-longitudinal data from an ongoing, community-based falls prevention program. The purpose was to identify participant characteristics predicting improvement on physical performance measures associated with falls risk. Community-dwelling older adults ≥60 years old participated in a community-based implementation of the Otago Exercise Program (OEP). Participants with increased falls risk (n = 353) were provided with individualized exercises from OEP and were invited to return for monthly follow-up. One hundred twenty-eight participants returned for at least two follow-up visits within 6 months of their initial visit (mean time to second follow-up = 93 days with standard deviation = 43 days). Outcome measures assessed at initial and all follow-up visits included Four Stage Balance Test (4SBT), Timed Up and Go test (TUG), and Chair Rise Test (CRT). Distributions were examined, and results were categorized to depict improvement from initial visit (IVT) to second follow-up visit (F2). Key predictor variables were included in multivariable linear or logistic regression models. Improved 4SBT performance was predicted by greater balance confidence. Better TUG performance at F2 was predicted by no use of assistive device for walking, higher scores on cognitive screening, and better IVT TUG performance. Improvement on CRT was predicted by younger age and lower scores on cognitive screening. While improvements on each of the three measures were predicted by a unique combination of variables, these variables tended to be associated with less frailty.

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PURPOSE: Decreased social participation is one consequence of aphasia that can lead to poor psychological health and reduced quality of life. Involving people with aphasia in advocacy efforts may be one solution for increasing their social participation. The present study investigated the benefits of a campus program for three people with mild aphasia who were involved in educating allied health students about aphasia and training them to communicate with those who have aphasia. METHODS: Three participants with aphasia shared their stories and interacted with interdisciplinary students in two seminar sessions aimed at educating students about aphasia and helping them learn strategies for supportive communication with people with aphasia. A mixed-method analysis approach was used to assess the effects of the program. Quantitative data were obtained via pre- and post-program survey questionnaires. Qualitative data were acquired through focus group interviews. RESULTS: Scores on questionnaires related to communication confidence or social participation were greater following program participation for all three participants with aphasia and quality of communication life scores were greater for one. Thematic coding of focus group data confirmed that participants with aphasia and their spouses perceived benefits to program participation including increased social access and improved self-concept. CONCLUSIONS: Findings suggest that participation in community education efforts may lead to increased social participation and communication confidence for people with aphasia.

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PURPOSE: Our aim was to examine whether cognitive processing during walking increases the metabolic cost of transport in healthy young adults. METHODS: Twenty healthy, young adults completed five conditions: (1) walking at a self-selected speed (spontaneous single-task), (2) seated resting (baseline), (3) performing cognitive task while seated (cognitive single-task), (4) walking while simultaneously performing the cognitive task (dual-task), and (5) single-task walking at a speed that matched the participant's dual-task gait speed (matched single-task). Rate of oxygen consumption (V̇O2) was recorded during all conditions. Gait speed and cost of walking (Cw; oxygen consumed per distance traveled) were recorded during all walking conditions. Reaction time and accuracy of responses in the cognitive task were recorded during all cognitive task conditions. Data from the fifth minute of each 5-min condition were analyzed. RESULTS: There was no difference in V̇O2 between the dual-task and matched single-task walking conditions. V̇O2 in the seated cognitive condition was significantly smaller than both walking conditions, but was not significantly different than zero. Cw was significantly greater during the matched single-task walking condition than during the dual-task walking condition. However, the difference in Cw was so small that it is unlikely to be clinically significant (0.008 mLO2/kg/m, 95% CI 0.002-0.014). CONCLUSIONS: Cognitive processing while walking may not increase energy demands of walking in healthy young adults. Maintaining non-preferred gait speed (matched speed) overground continuously for 5 min may require attentional resources, and thereby increase metabolic costs relative to walking at habitual speed.

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