Measuring Reliability of Movement With Accelerometry: Fitbit® Versus ActiGraph®.

OBJECTIVE: We sought to determine the reliability of the Fitbit® Flex™ compared with the ActiGraph® Bluetooth® Smart wGT3X-BT wireless activity monitor and to contribute to the clinical utility of accelerometry measurement of upper extremity (UE) movement. METHOD: Two studies were conducted at different sites with healthy adult participants. In Study 1, participants wore both accelerometers on both wrists during everyday activities for a 24-hr period. In Study 2, participants wore both accelerometers on the dominant wrist for 4 hr during an active period of the day. All participants wore the accelerometers during regular daily activities. RESULTS: Data recorded from the Fitbit and the ActiGraph showed a high positive correlation; however, the Fitbit recorded significantly fewer movements than the ActiGraph. CONCLUSION: Although the Fitbit and the ActiGraph measure UE activity similarly, the Fitbit was not as sensitive as the ActiGraph. This study provides informative data on the clinical utility of the Fitbit compared with the ActiGraph.

Functional Test of the Hemiparetic Upper Extremity: A Rasch Analysis With Theoretical Implications.

OBJECTIVE: To investigate the measurement properties of the Functional Test of the Hemiparetic Upper Extremity (FTHUE) and examine how its score may or may not inform design of a rehabilitation program. DESIGN: The FTHUE was recently used in the Interdisciplinary Comprehensive Arm Rehabilitation Evaluation randomized controlled trial. This circumstance provided the opportunity to examine the psychometric properties of the FTHUE as it pertains to contemporary poststroke rehabilitation and recovery models. SETTING: Outpatient rehabilitation clinic. PARTICIPANTS: Participants (N=109; mean age, 61.2±13.5y; mean days poststroke, 46±20.3) with resultant hemiparesis in the upper extremity. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Dimensionality was examined with confirmatory factor analysis (CFA), and person and item measures were derived with Rasch item response analysis. Therapists' notes were also reviewed. RESULTS: The CFA results support unidimensionality, and 16 of 17 items fit the Rasch model. The Rasch person separation (2.17) and item separation (4.50) indices, ability strata (3.22), person reliability (.82), and item reliability (.95) indicate good measurement properties. Item difficulties ranked from -6.46 to 3.43 logits; however, there was a substantial ceiling effect of person measures. Post hoc examination of therapists' written observations indicated that the scoring criteria are not sensitive to the movement strategy used for task completion. CONCLUSIONS: The FTHUE's item difficulty hierarchy indicated that scores adequately distinguished the ability to perform simple versus complex motor movements of functional tasks. However, the FTHUE scoring method did not allow inclusion of the type of movement strategy used to accomplish task items. Therefore, we suggest modifications to the FTHUE that would allow it to be used for collaborative treatment planning and align well with more contemporary perspectives on treatment theory.

Long-term follow-up after constraint-induced therapy: a case report of a chronic stroke survivor.

OBJECTIVE: Upper-extremity functional improvements after constraint-induced movement therapy have not been documented beyond 2 years. This case report describes the long-term maintenance of the effects of change 4-5 years after an application of constraint-induced therapy. METHOD: A 36-year-old female poststroke patient participated in constraint-induced therapy for 2 weeks. She was evaluated before and after treatment and again 4 and 5 years later. Primary outcome measures included the Wolf Motor Function Test, Stroke Impact Scale, and Motor Activity Log. RESULTS: Improvements were maintained in reported use and ability of the arm and hand, time to complete functional tasks, and physical aspects of health-related quality of life. Fatigue may have had a moderating effect on the extent of these changes. CONCLUSION: Improved upper-extremity function continued over a 5-year period after constraint-induced therapy; however, poststroke fatigue remained an influential limiting factor.

Task Oriented Training and Evaluation at Home.

Principles of experience-dependent plasticity, motor learning theory, and the theory of Occupational Adaptation coalesce into a translational model for practice in neurorehabilitation. The objective of this study was to explore the effectiveness of a Task Oriented Training and Evaluation at Home (TOTE Home) program completed by people with subacute stroke, and whether effects persisted 1 month after this training. A single-subject design included a maximum of 30, 1hour sessions of training conducted in participants' homes. Repeated target measures of accelerometry and level of confidence were used to assess movement and confidence in weaker arm use through baseline, intervention, and follow-up phases of TOTE Home. Four participants completed TOTE Home and each demonstrated improvement in movement and confidence in function. The degree of improvement varied between participants, but a detectable change was evident in outcome measures. TOTE Home, using client-centered, salient tasks not only improved motor function but also facilitated an adaptive response demonstrated in continued improvement beyond the intervention.

Client Perceptions of Task-Oriented Training at Home: "I Forgot I Was Sick".

Task-oriented training is a contemporary intervention based on behavioral neuroscience and recent models of motor learning. It can logically be guided by the theory of occupational adaptation. This report presents the perceptions of four participants who underwent task-oriented training at home (TOTE Home) for upper extremity hemiparesis following a stroke. Guided by principles of motor learning and the theory of occupational adaptation, a directed content analysis was used with field notes recorded during the TOTE Home. Three themes emerged: salience of the activity within context, desire for mastery by creating the just right challenge, and adapted self-perception of abilities. While motor learning principles informed the method of task practice and feedback, it was the person's desire to perform meaningful, relevant activities that drove the adaptive process. This study provided insight in the perceptions and experiences of participants undergoing TOTE Home.

Interrater reliability of the Wolf Motor Function Test-Functional Ability Scale: why it matters.

BACKGROUND: One important objective for clinical trialists in rehabilitation is determining efficacy of interventions to enhance motor behavior. In part, limitation in the precision of measurement presents a challenge. The few valid, low-cost observational tools available to assess motor behavior cannot escape the variability inherent in test administration and scoring. This is especially true when there are multiple evaluators and raters, as in the case of multisite randomized controlled trials (RCTs). One way to enhance reliability and reduce variability is to implement rigorous quality control (QC) procedures. OBJECTIVE: This article describes a systematic QC process used to refine the administration and scoring procedures for the Wolf Motor Function Test (WMFT)-Functional Ability Scale (FAS). METHODS: The QC process, a systematic focus-group collaboration, was developed and used for a phase III RCT, which enlisted multiple evaluators and an experienced WMFT-FAS rater panel. RESULTS: After 3 staged refinements to the administration and scoring instructions, we achieved a sufficiently high interrater reliability (weighted κ = 0.8). CONCLUSIONS AND IMPLICATIONS: A systematic focus-group process was shown to be an effective method to improve reliability of observational assessment tools for motor behavior in neurorehabilitation. A reduction in noise-related variability in performance assessments will increase power and potentially lower the number needed to treat. Improved precision of measurement can lead to more cost-effective and efficient clinical trials. Finally, we suggest that improved precision in measures of motor behavior may provide more insight into recovery mechanisms than a single measure of movement time alone.

Functional Test for the Hemiparetic Upper Extremity normative database.

OBJECTIVE: The purpose of this study was to develop a normative database of results of the Functional Test for the Hemiparetic Upper Extremity (FTHUE) from able-bodied participants. METHOD: Ninety healthy adults, aged 20-80, were assessed on the timed tasks of the FTHUE with their nondominant upper extremity serving as the weaker side. RESULTS: A normative table with means and standard deviations for the timed tasks of the FTHUE was created to provide reference values for upper-extremity performance. Significant differences were found among participants by gender and age. CONCLUSION: The FTHUE is an easy-to-administer, inexpensive, quick evaluation. It yields standardized data that allow clinicians to observe their clients performing functional tasks. The table of normative data will further assist clinicians in their assessment of clients with hemiparesis.