Social Participation and Physical Activity Incentive at Home in Stroke Survivor: Contribution of Technologies.

Increased physical activity has been demonstrated as a relevant treatment after a stroke, with positive effects on impairment recovery, activity limitation, social participation and quality of life. Furthermore, PA is now recommended as part of the stroke recovery pathway, starting during inpatient care and extending through rehabilitation and community integration. The purpose of this presentation is to describe how current technologies may facilitate a continuity of care for stroke survivors. We present a synthesis of 8 studies that we have conducted to date to assess and monitor the activity level of post-stroke patients at home. The results of these studies show that home rehabilitation of post-stroke patients requires the use of individualized monitoring criteria to optimize patient care. To encourage the patient to increase his level of moderate physical activity and reduce his sedentary time, it would be recommended to propose a regularly monitored and structured program.

Impact of a dual task on the energy cost of walking in individuals with subacute phase stroke.

OBJECTIVE: To assess the impact of cognitive Dual Task (DT) during walking on the energy cost of walking (Cw) in individuals with subacute stroke. The secondary objective was to determine whether there is an association between the Cw and cortical activity of the prefrontal area. METHODS: Any individual with stroke localized in the temporal-parietal regions and able to walk without human assistance was included. Cw and prefrontal cortical activity, recorded by fNIRS, were measured during simple task walking activity and cognitive dual task during walking. RESULTS: Nineteen individuals with stroke (age = 67.7 ± 9.6 yrs) were included. The cognitive DT during walking resulted in an increase in Cw of 23.1%; 95%CI [13.1%; 34.5%]. The increase in Cw in cognitive DT was correlated with the Cw for the single task walking activity (r = 0.48, p < 0.01) as well as the predominance of cortical activity of the prefrontal area in the contralesional hemisphere (r = -0.33, p < 0.01). CONCLUSION: There is an increase in Cw during the cognitive DT. This increase is even more significant, as the Cw of the single task walking activity is high, and the cortical activity of the prefrontal areas predominates in the contralesional hemisphere.

The impact of the energy cost of walking on the quality of life of post-stroke individuals: A one-year longitudinal study.

BACKGROUND: The increased energy cost of walking (Cw) for stroke patients affects the walking function and walking independence of stroke patients. However, its impact on quality of life (QoL) has never been studied. OBJECTIVE: Assess the association between Cw and QoL for post-stroke individuals in the year following hospital discharge. METHOD: Thirty-seven individuals with stroke were included. QoL was assessed by the EuroQol-5 Dimensions on the day after hospital discharge (T0), at six months (T1) and at one year after hospital discharge (T2). Concomitant an evaluation of Cw, mood disorders (HADS), fatigue, independence in activities of daily living and the presence of a family caregiver was performed. The association between QoL and the different covariates was analyzed using multiple regression analysis. RESULTS: At T2, data from 29 individuals were analyzable. Multiple regression analyses showed Cw had a significant influence on the QoL at T1 (coeff -0.42 (-0.71 to -0.12), P = .008) and T2 (coeff -0.49 (-0.71 to -0.26), P < .001). HADS score was the only other variable to significantly impact variances of QoL at T0, T1 and T2. Moreover, we showed that Cw at T0 explained 29% of variances of QoL at T1 and 42% at T2. CONCLUSION: Cw appears to be an independent factor in the QoL of individuals with stroke at six months and one year after hospital discharge. In addition, the initial Cw and HADS are predictive of QoL at one year highlighting the importance of early interventions in these two dimensions to improve QoL over the long term.

First Systematic Review and Meta-analysis of the Validity and Test-Retest Reliability of Physical Activity Monitors for Estimating Energy Expenditure During Walking in Individuals With Stroke.

OBJECTIVE: To evaluate the validity and test-retest reliability of physical activity trackers (accelerometer, multisensor, smartphone, pedometer) for estimating energy expenditure during walking in individuals with stroke. DATA SOURCES: Webline, MEDLINE, Scopus, ScienceDirect, Bielefeld Academic Search Engine, and Wiley Online Library databases from 1980 to November 2020. STUDY SELECTION: The inclusion criteria were studies that examined the validity of portable physical activity trackers for estimating energy expenditure in individuals with stroke during walking activities compared to indirect calorimetry. DATA EXTRACTION: This systematic review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the methodological quality of the included studies was determined with the Quality Assessment of Diagnostic Accuracy Studies. The study selection was made by 2 blind observers. DATA SYNTHESIS: We screened 3677 articles; 3647 were excluded after duplicate removal and title and abstract review. Thirty articles were included for full-text analysis. Eight articles met the inclusion criteria (184 individuals with stroke) and were included in the data synthesis and meta-analysis. For all monitors, activities, and placements, the overall level of correlation with indirect calorimetry was 0.34 (95% confidence interval [CI], 0.23-0.44). After subgroups analysis, we showed that type and placement have no effect on the level of validity. Test-retest reliability was high, with intraclass correlation equal to 0.89 (95% CI, 0.76-0.95). CONCLUSIONS: Portable physical activity monitors provided a low correlation with indirect calorimetry during walking in individuals with stroke. It seems essential to pursue studies to improve their validity in this population.

The Best Choice of Oxygen Cost Prediction Equation for Computing Post-Stroke Walking Energy Expenditure Using an Accelerometer.

BACKGROUND: The integration of oxygen cost into the accelerometer's algorithms improves accuracy of total energy expenditure (TEE) values as post-stroke individuals walk. Recent work has shown that oxygen cost can be estimated from specific prediction equations for stroke patients. OBJECTIVE: The objective is to the validity of the different oxygen cost estimation equations available in the literature for calculating TEE using ActigraphGT3x as individuals with stroke sequelae walk. METHOD: Individuals with stroke sequelae who were able to walk without human assistance were included. The TEE was calculated by multiplying the walking distance provided by an ActigraphGT3x worn on the healthy ankle and the patient's oxygen cost estimated from the selected prediction equations. The TEE values from each equation were compared to the TEE values measured by indirect calorimetry. The validity of the prediction methods was evaluated by Bland-Altman analysis (mean bias (MB) and limits of agreement (LoA) values). RESULTS: We included 26 stroke patients (63.5 years). Among the selected equations, those of Compagnat and Polese obtained the best validity parameters for the ActigraphGT3x: MBCompagnat = 1.2 kcal, 95% LoACompagnat = [-12.0; 14.3] kcal and MBPolese = 3.5 kcal, 95% LoAPolese = [-9.2; 16.1] kcal. For comparison, the estimated TEE value according to the manufacturer's algorithm reported MBManufacturer = -15 kcal, 95% LoAManufacturer = [-52.9; 22.8] kcal. CONCLUSION: The Polese and Compagnat equations offer the best validity parameters in comparison with the criterion method. Using oxygen cost prediction equations is a promising approach to improving assessment of TEE by accelerometers in post-stroke individuals.

Which method should be chosen to estimate the oxygen cost of walking in post-stroke individuals?

BACKGROUND: The oxygen cost of walking (Cw) represents the energy expenditure involved in walking, which is a major concern when quantifying physical activity in stroke. Recent studies have reported that Cw may be estimated accurately with a prediction equation using the self-self-selected walking speed (Sfree). RESEARCH QUESTION: To evaluate the validity of Cw estimates according to different modalities of Sfree measurements (10-m walking test, 6-minute walking test, GaitRite system). METHODS: Twenty-one stroke individuals in subacute phase who were able to walk without human aid were included. Cw was estimated from the walking speed measured during a 10-m walking test, a 6-minute walking test and a recording on a GaitRite system. The values of the Cw estimates were compared to those measured by a respiratory gas exchange analyzer (Metamax3b). RESULTS: The findings showed that there is no significant difference between the Cw measured by Metamax3b and the Cw estimates regardless of the modalities used to measure Sfree (Fvalue = 0.02; pvalue = 0.99). The mean bias between Cw measured by the Metamax3b and those estimated using the different Sfree measurement modalities was less than 2.5 % of the mean Cw value. Test retest reliability was excellent with an intraclass correlation coefficient higher than 0.95. SIGNIFICANCE: in stroke survivors who are able to walk independently without human aid, the use of a 10-m walking test, a 6-minute walking test or a GaitRite recording can be considered validated for estimating Cw.

The Functional Independence of Patients With Stroke Sequelae: How Important Is the Speed, Oxygen Consumption, and Energy Cost of Walking?

OBJECTIVE: To evaluate the association between self-selected walking speed (Sfree), oxygen consumption at Sfree (Vo2free), the oxygen cost of walking (Cw) at Sfree, and mobility independence and independence for activities of daily living in individuals poststroke. DESIGN: Cross-sectional study. SETTING: Hospital. PARTICIPANTS: Individuals with stroke who were able to walk without human assistance were included. We included 90 individuals (N=90; mean age, 63.5±14.0y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Cw was captured during walking from measurements of Sfree and Vo2free. We assessed mobility independence based on the modified Functional Ambulation Classification (mFAC) and independence in activities of daily living by the Barthel Index (BI). Multiple linear regression analyses were performed to evaluate the independence of Cw, Vo2free, and Sfree from the determination of BI and mFAC among the various characteristics of the population (age, stroke delay, body mass index, motor function, spasticity). RESULTS: We reported Cw=0.36 mL/kg/m (interquartile range [IQR]=0.28 mL/kg/m), Sfree=0.60±0.32 m/s, Vo2free=11.2 mL/kg/min (IQR=1.8 mL/kg/min). The multiple linear regression analyses showed that Cw and Sfree were independently associated with the BI (P<.01) and the mFAC (P<.01) scores. Vo2free was not found to be an explanatory variable of functional independence (P>.05). CONCLUSIONS: Cw was independently associated with functional independence. This association appears to be primarily determined by Sfree and not Vo2free, underscoring the importance of evaluating and acting on Sfree to improve the functional independence of individuals with stroke.

Perceived exertion and energy expenditure during physical activities in healthy young people and older adults.

AIM: To test the validity of Borg's 6-20 rating of perceived exertion scale in assessing the exertion intensity over a multi-activity session in young and older adults.Materials and methods: This cross-sectional study included 56 healthy participants. All participants underwent a single session of activities including working on a computer, treadmill walking, biking, and treadmill running. RESULTS: Results showed a non-significant correlation between the overall perceived exertion and energy expenditure in young people (Rho=-0.05, p=0.75) and in older adults (Rho=-0.05, p=0.78) for the whole session. However, results showed that older adults perceived significantly higher exertion compared to young people while working on a computer, walking and running, whereas they presented lower energy expenditure while resting and working on a computer. CONCLUSIONS: Combining the perceived exertion method with other commonly used methods to estimate exercise intensity would be recommended for older adults.

Oxygen Cost During Walking in Individuals With Stroke: Hemiparesis Versus Cerebellar Ataxia.

Background. Understanding the factors that limit mobility in stroke patients is fundamental for proposing appropriate rehabilitation strategies. A high oxygen cost during walking (Cw) has a strong impact on the community ambulation of hemiparetic patients. The Cw in poststroke cerebellar ataxia is poorly evaluated, unlike hemiparetic gait. Objective. To compare the oxygen cost/self-selected walking speed (S) relationship in stroke individuals with cerebellar ataxia or hemiparetic gait. Methods. Thirty-three subjects were included (14 cerebellar stroke, 19 hemispheric stroke), with stroke confirmed by brain imaging and able to walk without human assistance. We measured Cw using the Metamax3B. The relationship between Cw and self-selected walking speed was modelled by logistic regression and then compared between the cerebellar and hemispheric groups. Results. No significant difference was found between the 2 groups for all characteristics of the population, except motor impairments, spasticity, and ataxia (P < .01). We identified 2 separate Cw/S relationships with different logistic regression equations for the 2 groups. Faster than 0.4 m s-1, Cw was 30.6% to 39.9% higher in patients with cerebellar stroke in comparison with hemispheric stroke individuals. The Cw was correlated with ataxia (r = 0.88; P < .001) in the cerebellar group, whereas there was a correlation with motor impairments (r = -0.61; P < .01), spasticity (r = 0.59; P < .01), and ataxia (r = 0.81; P < .01) in hemispheric stroke individuals. Conclusion. The Cw in poststroke cerebellar ataxia is significantly higher compared with hemiparetic patients at an equivalent walking speed. The impact on community walking needs to be explored in stroke survivors with cerebellar stroke.

Quantification of energy expenditure during daily living activities after stroke by multi-sensor.

Objective: To explore the validity of energy expenditure estimates using the SenseWear Armband during a sequence of four daily living activities in patients post-stroke. Method: Patients with stroke who were able to walk during 6 min without human assistance were asked to wear the SenseWear Armband on the non-paretic arm while performing transfers, a manual task, walking, and walking up and down stairs. The energy expenditure estimated using the SenseWear Armband was compared to the energy expenditure calculated from oxygen consumption, measured by a portable indirect calorimeter (Metamax 3B). The mean of energy expenditure was pooled for each task. Accuracy was explored by mean bias (MB) of Bland-Altman analysis and root mean square error (RMSE), agreement by 95% of limits of agreement (95%LoA) and coefficient of correlation (r). Results: Thirty-eight participants (65.7 ± 13.5 years) were included. The SenseWear Armband globally underestimated energy expenditure, MB = 9.77 kcal for the whole sequence. RMSE were large, accounting for 15% to 41% of the measured energy expenditure. Agreement was low with r < 0.70 and 95%LoA from 42% to 93% of the measured energy expenditure. Conclusions: This study reported a global underestimation and a low level of agreement of the energy expenditure estimated by SenseWear Armband in four daily living activities in patients after stroke. Abbreviations: EE: Energy Expenditure; NIHSS: National Institute of Health Stroke Score.

Effort Assessment of Stroke Patients in Physiotherapy Session by Accelerometry and Perceived Exertion Score: Preliminary Study.

OBJECTIVE: To determine whether post-stroke patient's perceived exertion correlates with effort intensity score as measured by a wearable sensor and to assess whether estimates of perceived exertion are correlated to the cerebral hemisphere involved in the stroke. METHODS: We evaluated the effort intensity score during physiotherapy sessions using a wearable sensor and subjects assessed their perceived exertion using the modified Borg CR10 Scale. RESULTS: Fifty-seven subacute stroke patients participated in the study. The correlation between perceived exertion rating and measured effort intensity was insignificant-mean (r=-0.04, p=0.78) and peak (r=-0.05, p=0.70). However, there was a significant difference (p<0.02) in the perceived exertion ratings depending on the cerebral hemisphere where the stroke occurred. Patients with left-hand side lesions rated their perceived exertion as 4.5 (min-max, 0.5-8), whereas patients with right-hand side lesions rated their perceived exertion as 5.0 (2-8). CONCLUSION: While there was an insignificant correlation between perceived exertion and effort intensity measured by a wearable sensor, a consistent variations in perceived exertion estimates according to the side of the cerebral lesion was identified and established.

Compendium of Physical Activities Strongly Underestimates the Oxygen Cost During Activities of Daily Living in Stroke Patients.

OBJECTIVE: The aim of the study was to measure the metabolic equivalent task when performing physical activities of daily living in poststroke individuals. DESIGN: Poststroke individuals who were able to walk without human assistance were recruited and asked to perform the following activities of daily living: washing dishes (activity code: 05041 in Ainsworth's compendium), walking at a slow pace of less than 2 mph (activity code: 17151), climbing stairs (activity code: 17133), and walking down stairs (activity code: 17070). The metabolic equivalent task was measured along these activities using a portable breath gas exchange analyzer. The measured values were then compared with Ainsworth's compendium. RESULTS: Thirty-five participants were included (mean [SD] age = 64.3 [14.3] yrs). The mean (SD) resting metabolic rate was 3.08 (0.79) ml O2 kg(-1) min(-1). The metabolic equivalent task values were significantly higher than the compendium values: metabolic equivalent task washing dishes = 2.57 (0.96) versus 1.80 for compendium; metabolic equivalent task walking = 4.16 (0.93) versus 2.00 for compendium; metabolic equivalent task climbing stairs = 5.90 (1.43) versus 4.00 for compendium; metabolic equivalent task walking down stairs = 3.29 (0.48) versus 3.50 for compendium. CONCLUSIONS: The metabolic equivalent tasks during activities were higher than Ainsworth's compendium. Stroke individuals are thus exposed to high oxygen requirements when performing activities of daily living, which could have a strong impact on their ability to perform these activities in real life.

Validity of the Actigraph GT3x and influence of the sensor positioning for the assessment of active energy expenditure during four activities of daily living in stroke subjects.

OBJECTIVE:: To explore the validity of the Actigraph and the influence of the placement of the sensor when estimating the active energy expenditure in four common daily activities (transfers, manual task, walking in overground and walking up and down stairs) in stroke survivors. DESIGN:: Cross-sectional study. SETTING:: Department of Physical Medicine and Rehabilitation. SUBJECTS:: A total of 46 subjects affected with stroke sequelae were wearing the Actigraph on three different locations-ankle, hip and wrist on the non-affected side-and performed four tasks: transfers, manual task, walking on flat ground and walking up and down stairs. MAIN MEASURES:: The values of active energy expenditure estimated by the Actigraph were compared to those measured by a portable breathing gas exchange analyzer Metamax3B. The accuracy and agreement between Actigraph and Metamax values were analyzed with mean bias, root mean square error, correlation coefficient and Bland-Altman plots for each task and each sensor location. RESULTS:: The mean bias between the Metamax and Actigraph placed on wrist, hip and ankle were, respectively, MD = 1.16 kcal (%MD = 3%), MD =-20.44 kcal (%MD =-58%) and MD = 17.64 kcal (%MD = 50%). The agreement with the Metamax was poor in general regardless of the sensor location and type of task ( r = 0.12-0.58). CONCLUSION:: This study found large differences and a poor agreement between the active energy expenditure as measured by the Actigraph and the Metamax according to the location of the sensor and the type of task performed by the subject.

Can energy expenditure be accurately assessed using accelerometry-based wearable motion detectors for physical activity monitoring in post-stroke patients in the subacute phase?

Background In the subacute stroke phase, the monitoring of ambulatory activity and activities of daily life with wearable sensors may have relevant clinical applications. Do current commercially available wearable activity trackers allow us to objectively assess the energy expenditure of these activities? The objective of the present study was to compare the energy expenditure evaluated by indirect calorimetry during the course of a scenario consisting of everyday activities while estimating the energy expenditure using several commercialised wearable sensors in post-stroke patients (less than six months since stroke). Method Twenty-four patients (age 68.2 ± 13.9; post-stroke delay 34 ± 25 days) voluntarily participated in this study. Each patient underwent a scenario of various everyday tasks (transfer, walking, etc.). During the implementation, patients wore 14 wearable sensors (Armband, Actigraph GT3X, Actical, pedometer) to obtain an estimate of the energy expenditure. The actual energy expenditure was concurrently determined by indirect calorimetry. Results Except for the Armband worn on the non-plegic side, the results of our study show a significant difference between the energy expenditure values estimated by the various sensors and the actual energy expenditure when the scenario is considered as a whole. Conclusion The present results suggest that, for a series of everyday tasks, the wearable sensors underestimate the actual energy expenditure values in post-stroke patients in the subacute phase and are therefore not accurate. Several factors are likely to confound the results: types of activity, prediction equations, the position of the sensor and the hemiplegia side.