AMUSE: Activity Monitoring of Upper extremity use in Stroke patients during and after rEhabilitation: a new step towards a solution of an old problem

Approximately 80% of acute stroke patients suffer from acute hemiparesis,
leading in about 40% of stroke patients to chronic upper extremity impairment,
limiting functional use as well as engagement in community life. Six months
after the stroke event, arm-hand function (AHF) has recovered completely in
only 5-20 % of patients and only 33% of patients could be classified as being
independent. From clinical experience it is known that performance in general
and arm-hand performance specifically may deteriorate once a stroke patient has
left the training program. However, it is neither well understood at what rate
such deterioration (or improvement) occurs, nor in which patient categories
this is most prominent. Answers to these problems are essential in the
development more adequate, personalised and cost-effective interventions that
may augment and/or maintain arm-hand skill performance (AHSP) levels in chronic
stroke patients living in a home environment.

The aim of the present study is:
a) to monitor the development of arm-hand use in a broad range of stroke
patients over time both during and after clinical rehabilitation;
b) to assess the rate of improvement (or decline) in arm-hand use during and
after specific training interventions in each of three subgroups, i.e. low AHF
subgroup (UAT=0-1), intermediate AHF subgroup (UAT=2-3) and higher AHF subgroup
(UAT=4-7);
c) to assess which patient characteristics are associated with either
improvement or decline in arm-hand use during and after training;
d) to correlate actual arm-hand use to measures of AHF, AHSP, functional health
status, and quality of life.
Results will also serve as input for a) studies aimed at further developing
client-centred (technology-assisted) training modules for AHSP training in
chronic stroke patients; and b) a large-scale multi-centre RCT into the effects
of such new (modular) training possibilities improving AHSP in chronic stroke
patients who live in a home environment.

Prospective cohort study.

The research involves only measurements. The therapy is NO part of the research.
The measurements involve questionnaires and very low risk arm function tests.
Also participants are asked to wear two watch-like devices around their wrist
for several days. These devices do not pose any harm to the participant.
Results from the study
may reveal how arm-hand function and skill performance in stroke patients
evolves during and after rehabilitation. This knowledge may lead to further
improvement of existing treatment. Also possible predictors of (poor) arm-hand
function and skill performance outcome in stroke may be identified. They in
turn may be used to better predict outcome and guide training of arm and hand
in rehabilitation.