A Novel Approach to Characterizing Patterns of Real-World Upper-Extremity Use During Walking and Activities of Daily Living in People with Subacute Stroke

In accelerometer-based measurement, the inclusion of upper extremity (UE) activity during walking can overestimate real-world functional UE use in people post-stroke. This study introduces a comprehensive, accelerometer-based approach to examining real-world UE use, including the contribution of UE activity during walking, and compares UE use during walking versus ADL-based activities. People with subacute stroke wore bilateral wrist and ankle inertial measurement units (IMU) for one week (24 h/day). Agreement between UE-Total, UE-Continuous Walking and UE-ADL measures were assessed using Bland–Altman analyses. Variables were modeled using linear regression to explore step count, mobility aid use and UE motor impairment as predictors of IMU measures of real-world UE use. Agreement between UE-Total and UE-ADL measures showed minimal bias. Differences between UE-Continuous Walking and UE-ADL varied by mobility aid. UE-Continuous Walking was associated with increased UE activity and relatively greater paretic arm use compared with UE-ADL. Across UE-Continuous Walking and UE-ADL, step count was the strongest predictor of real-world UE use. UE activity during continuous walking exhibits different use patterns as compared to ADL-based activity. Accordingly, separating continuous walking-related UE activity from ADL-based UE use may improve clinical interpretation of IMU measures of real-world UE use in individuals with subacute stroke.