Outside the Laboratory Assessment of Upper Limb Laterality in Patients With Stroke: A Cross-Sectional Study.

BACKGROUND: The rehabilitation of upper limb sensorimotor performance after stroke requires the assessment of daily use, the identification of key levels of impairment, and monitoring the course of recovery. It needs to be answered, how laboratory-based assessments and everyday behavior are connected, which dimension of metrics, that is, volume, intensity, or quality, is most sensitive to reduced function, and what sensor, that is, gyroscope or accelerometer, is best suited to gather such data. METHODS: Performance in laboratory-based sensorimotor tests, as well as smartwatch-derived kinematic data of everyday life relative upper limb activity, during 1 day of inpatient neurorehabilitation (Germany, 2022) of 50 patients with stroke, was cross-sectionally assessed and resulting laterality indices (performance ratios) between the limbs were analyzed using ANCOVAs and principal component analysis. RESULTS: Laboratory-based tests revealed the strongest laterality indices, followed by smartwatch-based (intensity>quality>volume) metrics. Angular velocity-based metrics revealed higher laterality indices than acceleration-based ones. Laterality indices were overall well associated; however, a principal component analysis suggested upper limb impairments to be unidimensional. CONCLUSIONS: Our findings suggest that the use of sensors can deliver valid information of stroke-related laterality. It appeared that commonly used metrics that estimate the volume of use (ie, energy expenditure) are not the most sensitive. Especially reached intensities could be well used for monitoring, because they are more dependent on the performance of the sensorimotor system and less on confounders like age. The unidimensionality of the upper limb laterality suggests that an impaired limb with reduced movement quality and the inability to reach higher intensities will be used less in everyday life, especially when it is the nondominant side.

Changes in thumb tapping rates and central motor conduction times are associated in persons with multiple sclerosis.

INTRODUCTION: In persons with multiple sclerosis, nerve conductivity can be reduced. The assessment is generally performed via motor evoked potentials (MEP). So far, a strongly associated motor performance surrogate for changes in the extracted central motor conduction time (CMCT) is missing. METHODS: CMCT and performance in the nine-hole peg test and maximum thumb tapping frequencies over 10 s of 12 persons with multiple sclerosis were measured prior to and after training over 5 consecutive days. Each training consisted of 10,000 thumb taps at maximum effort with the dominant upper limb. RESULTS: The dominant upper limb improved in maximum tapping frequency over 10 s (d = 0.79) and 10,000 taps (d = 1.04), the nine-hole peg test (d = 0.60), and CMCT (d = 0.52). The nondominant upper limb only improved in the nine-hole peg test (d = 0.38). Models of multiple linear regression predicted 0.78 (model 1, tapping performance as factors) and 0.87 (model 2, patient baseline characteristics as factors) of the variance in CMCT changes. DISCUSSION: Changes in CMCT were well predictable, although the assessment of those surrogates is either not economic (model 1) or rather describing a potential of change (model 2). However, we were able to show moderate changes in CMCT within 5 days.

Circadian rhythm in force tracking and in dual task costs.

The present study determined a circadian rhythm in force control during a visually guided tracking task under single task conditions (i.e., tracking task presented alone) and dual task conditions (i.e., tracking task together with a memory task). Nine healthy young male subjects participated in a Constant Routine protocol involving a week of regular bedtimes, a baseline night of 8 h sleep, and subsequent wakefulness of 40 h. Subjects performed an eye-hand coordination task that required tracking an unpredictable target (presented on a computer screen) by using grip force to adjust a visual feedback to the changing target. Tracking performance (both in precision and delay) were time-of-day-specific with worst performance at around 04:00 h. The dual task costs, as an index of interference of two tasks performed simultaneously, only showed a significant effect of the memory task on tracking precision during the circadian minimum. In contrast, dual task costs were close to zero during midday and absent in tracking delay. Tracking precision descriptively revealed inter-individual differences: half of the subjects maintained fairly stable performance during the 40 h of wakefulness, whereas the other half showed a clear circadian rhythmicity in tracking precision. Thus, tracking precision seems to be a sensitive parameter for conditions of divided attention and inter-individual variability during the circadian minimum, whereas tracking delay revealed neither a dichotomy of task conditions nor inter-individual differences in performance-amplitude over sessions. Nonetheless, both tracking precision and delay showed a comparable circadian rhythmicity.