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

许多中风幸存者习惯性地在日常活动中不使用更复杂的手臂。 尽管保留了足够的运动能力来执行动作。这种“学而不用”的现象是一种 导致残疾的主要原因。我们的项目将评估功能效用和主观患者体验 一种个人运动提示系统，旨在通过激励手臂在白天和 中风后几周。我们的工作是基于这样一个前提，即通过增加 偏瘫患者康复初期的手臂运动量，其中住院患者花费大部分时间 他们的时间空闲而孤独。作为传统疗法的补充，我们开发了低成本的可穿戴技术来 在空闲时间激励和监控偏瘫手臂的无人监督运动。我们预计， 拟议的制度将使患者对自己的治疗有更多的代理，提高他们的参与水平， 并最终增加它们的功能独立性。 该项目采取了关键的第一步，评估旨在激励空闲时间的技术和程序 急性中风恢复期的运动。低成本的系统使用振动触觉提示来鼓励锻炼 被设计成逐渐使用瘫痪的手臂。该系统使用加速度计来监测偏瘫和非轻瘫 偏瘫手臂的使用，并推断是否遵守规定的运动。该系统只需要最少的干预 由一位经验丰富的治疗师。中风幸存者将在住院康复中对该系统进行为期两周的评估 当地一家医院的病房。这项工作需要证明我们的方法可以激励更多的锻炼，而不是 显著的治疗师监督，并确定患者是否认为该系统可用、激励和满意 来使用。因此，我们的目标是： 目的1：建立个人运动提示系统在住院环境中的功能效用 在中风后的几天和几周内。我们将分析加速度计数据以验证系统 在有提示的间歇锻炼期间与没有提示的间歇锻炼相比，可以激发偏瘫患者手臂的更大活动。 目标2：使用个人运动提示系统来描述患者的主观体验 在住院康复室的急性康复期间。在为期两周的住院体验结束时， 参与者将被要求完成问卷，评估他们对系统可用性的看法，内在的 动机，以及他们对在预期环境中使用该系统的满意度。我们希望与会人员 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，这些试验将被设计为优化和 评价早期闲暇运动干预对提高偏瘫患者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，为更大规模的后续项目的设计提供参考 学习。

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.