Addressing arm non-use by encouraging idle-time activity during early recovery from stroke

通过鼓励中风早期恢复期间的闲暇活动来解决手臂不使用的问题

• 批准号: 10453128
• 负责人: JOHN R MCGUIRE
• 金额: $ 23.94万
• 依托单位: MARQUETTE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10453128
• 关键词: Accelerometer; Acute; Address; Chronic; Clinic; Clinical; Clinical Trials; Cues; Custom; Data; Environment; Exercise; Feasibility Studies; Future; Goals; Hand; Health Promotion; Hospitals; Hour; In Situ; Individual; Inpatients; Intervention; Lead; Limb structure; Long-Term Effects; Monitor; Motivation; Motor; Movement; National Institute of Child Health and Human Development; Occupational Therapy; Paresis; Participant; Patients; Perception; Phase; Physical Rehabilitation; Physical therapy; Procedures; Public Health; Quality of life; Questionnaires; Recovery; Regimen; Rehabilitation therapy; Research; Resources; Speech Therapy; Stroke; System; Technology; Testing; Therapeutic exercise; Time; Training; Upper Extremity; Work; Workload; acute stroke; arm; arm movement; arm paresis; base; chronic stroke; constraint induced movement therapy; conventional therapy; cost; design; disability; efficacy clinical trial; efficacy evaluation; exercise intervention; expectation; experience; follow-up; functional independence; hemiparesis; improved; intrinsic motivation; mHealth; mobile sensor; motor recovery; participant retention; patient engagement; personalized care; post stroke; primary outcome; retention rate; satisfaction; secondary analysis; secondary outcome; stroke recovery; stroke survivor; success; usability; wearable device

Many survivors of stroke habitually refrain from using their more-involved arm during common daily activities despite retaining sufficient motor capability to perform movements. This phenomenon of "learned non-use" is a leading cause of disability. Our project will assess the functional utility and subjective patient experience using a personal exercise cueing system designed to increase arm use by motivating arm activity in the days and weeks following stroke. Our work is based on the premise that motor recovery may be enhanced by increasing the amount of hemiparetic arm exercise in the earliest stages of recovery, wherein inpatients spend most of their time idle and alone. As an adjunct to conventional therapy, we developed low-cost wearable technology to motivate and monitor unsupervised exercise of the hemiparetic arm during idle-time. We expect that the proposed system will give patients more agency over their own therapy, increase their level of participation, and ultimately increase their functional independence. This project takes critical first steps evaluating technology and procedures designed to motivate idle-time exercise during acute stroke recovery. The low-cost system uses vibrotactile cues to encourage exercises designed to progressively engage paretic arm use. The system uses accelerometry to monitor paretic and non- paretic arm use, and to infer compliance with prescribed exercises. The system requires minimal intervention by a skilled therapist. Survivors of stroke will evaluate the system for two weeks in the inpatient rehabilitation unit of a local hospital. The work is needed to show that our approach can motivate increased exercise without significant therapist oversight, and to determine if patients find the system usable, motivating, and satisfactory to use. Thus, our Aims are: Aim 1: To establish the functional utility of a personal exercise cueing system in an inpatient setting during the days and weeks following stroke. We will analyze accelerometry data to verify that the system can motivate greater hemiparetic arm activity during cued exercise intervals vs. intervals without cues. Aim 2: To characterize the subjective patient experience using a personal exercise cueing system during acute recovery on the inpatient rehabilitation unit. At the end of the 2-week inpatient experience, participants will be asked to complete questionnaires assessing their perceptions of system usability, intrinsic motivation, and their satisfaction in using the system in its intended environment. We expect that participants will have positive subjective experiences using the system as inpatients. Project success will provide critical support for future clinical trials that will be designed to optimize and evaluate the efficacy of early idle-time exercise interventions to increase hemiparetic arm use and quality of life after stroke. This R21 project will also provide pilot data that will inform the design of those larger follow-on studies.

许多中风幸存者在日常活动中习惯性地避免使用受影响较大的手臂 尽管保留了足够的运动能力来执行动作。这种“习得不使用”现象是 造成残疾的主要原因。我们的项目将使用以下方法评估功能效用和主观患者体验 个人锻炼提示系统，旨在通过激励当天的手臂活动来增加手臂的使用， 中风后几周。我们的工作基于这样的前提：运动恢复可以通过增加 偏瘫手臂运动量在恢复的最初阶段，其中住院患者花费了大部分时间 他们的时间闲散而孤独。作为传统疗法的辅助手段，我们开发了低成本可穿戴技术 在空闲时间激励和监测偏瘫手臂的无人监督运动。我们期望 拟议的系统将使患者对自己的治疗有更多的代理权，提高他们的参与程度， 并最终提高其功能独立性。 该项目迈出了关键的第一步，评估旨在激励空闲时间的技术和程序 急性中风恢复期间的锻炼。低成本系统使用振动触觉提示来鼓励锻炼 旨在逐步参与麻痹手臂的使用。该系统使用加速度计来监测麻痹和非 麻痹手臂的使用，并推断对规定练习的遵守情况。该系统需要最少的干预 由熟练的治疗师进行。中风幸存者将在住院康复中评估该系统两周 当地一家医院的单位。需要开展工作来证明我们的方法可以激励人们增加锻炼，而无需 重要的治疗师监督，并确定患者是否认为该系统可用、激励和满意 使用。因此，我们的目标是： 目标 1：建立个人运动提示系统在住院环境中的功能实用性 中风后的几天和几周内。我们将分析加速度数据以验证系统 与无提示的运动间隔相比，在有提示的运动间隔期间可以激发更大的偏瘫手臂活动。 目标 2：使用个人运动提示系统描述患者的主观体验 在住院康复科的急性恢复期间。两周的住院体验结束后， 参与者将被要求完成调查问卷，评估他们对系统可用性、内在 动机以及他们在预期环境中使用系统的满意度。我们期望参与者 作为住院患者使用该系统会有积极的主观体验。 项目的成功将为未来的临床试验提供关键支持，这些试验将旨在优化和 评估早期空闲时间运动干预对增加偏瘫手臂使用和生活质量的效果 中风后。该 R21 项目还将提供试点数据，为那些更大的后续项目的设计提供信息 研究。