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: 10655426
• 负责人: JOHN R MCGUIRE
• 金额: $ 18.84万
• 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/10655426
• 关键词: Accelerometer; Acute; Address; Chronic; Clinic; Clinical; Clinical Trials; Cues; Custom; Data; Environment; Exercise; Feasibility Studies; Friends; Future; Goals; Hand; Health Promotion; Hospitals; Hour; In Situ; Individual; Inpatients; Intervention; Learning; Life; Limb structure; Long-Term Effects; Monitor; Motivation; Motor; Movement; National Institute of Child Health and Human Development; Occupational Therapy; Outcome Assessment; Paresis; Participant; Patients; Perception; Performance; 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; chronic stroke; constraint induced movement therapy; conventional therapy; cost; design; disability; efficacy clinical trial; efficacy evaluation; exercise intervention; exercise prescription; 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; skills; 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.

许多中风的幸存者习惯性地避免在常见的日常活动中使用其涉及更多的手臂 尽管保留了足够的运动能力来执行运动。这种“学到的不使用”的现象是 残疾的主要原因。我们的项目将评估使用功能效用和主观的患者经验 一个个人锻炼提示系统，旨在通过激励手臂活动来增加手臂的使用，并且 中风后几周。我们的工作是基于以下前提，即通过增加可能会增强电动机的回收率 在最早的恢复阶段，偏瘫手臂运动的数量，住院患者大部分时间 他们的时间闲着和一个人。作为常规疗法的辅助手段，我们开发了低成本可穿戴技术 在闲置时间内，激励和监视无监督的肢体臂运动。我们期望 拟议的系统将使患者在自己的疗法上提供更多代理，提高他们的参与水平， 并最终提高其功能独立性。 该项目采取关键的第一步，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运动。低成本系统使用颤振提示来鼓励练习 旨在逐步参与偏臂的使用。该系统使用加速度计监测偏度和非 - 掌控手臂的使用，并推断出规定的练习。该系统需要最少的干预 由熟练的治疗师。中风的幸存者将在住院康复中评估系统两周 当地医院的单位。需要工作以表明我们的方法可以激发不用的锻炼而无需 重要的治疗师监督，并确定患者是否发现该系统是否可用，激励和令人满意 使用。因此，我们的目标是： 目标1：在住院环境中建立个人锻炼系统的功能实用性 在中风后的几天和几周。我们将分析加速度计数据以验证系统 在提示运动间隔内与没有提示的间隔，可以激励更大的偏瘫臂活动。 目标2：使用个人运动提示系统来表征主观的患者体验 在住院康复单元的急性恢复期间。在2周的住院体验结束时， 将要求参与者完成评估他们对系统可用性的看法的问卷 动机及其对在其预期环境中使用系统的满意度。我们希望参与者 将使用系统作为住院患者具有积极的主观经验。 项目成功将为未来的临床试验提供关键的支持，该试验旨在优化和 评估早期闲置运动干预措施的功效以增加偏瘫手臂的使用和生活质量 中风后。这个R21项目还将提供试点数据，以告知那些更大的跟进的设计 研究。