Skip to main content

Advertisement

SpringerLink
Log in

Spontaneous arm movement activity assessed by accelerometry is a marker for early recovery after stroke

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

The factors determining recovery from hemiparetic stroke are manifold. We studied spontaneous arm movement activity in the acute phase after stroke as a predictor of recovery. Included in this prospective study were 25 patients (63 ± 10 years; 9 women, 16 men) with acute middle cerebral artery stroke and 7 control patients without neurological disease (61 ± 14 years; 3 women, 4 men). Movement activity was measured continuously for 4 days in both arms using Actiwatches and analysed off-line. Movement activity of the nonaffected arm ranged from <10 to >16 h per day in the stroke patients. Nine stroke patients with an initial decline in arm movement activity showed no increase in movement activity in either arm over 4 days after stroke, and the other 16 patients improved steadily after admission (p < 0.003). C-reactive protein was elevated in the non-recovering patients (4.4 ± 4.9 mg/dl) related to a low number of waking hours (r = −0.512, p < 0.01). Stroke severity, location and treatment, as well as arterial blood pressure (162 ± 21 mmHg) and body temperature (36.9 ± 06°C) were not different among the groups. The impairment was still different among the two groups 3 months after stroke. Our results support the notion that in the acute stage after middle cerebral artery stroke there are patients with a secondary decline in general motor activity related to an enhanced sleep demand as assessed with accelerometry. This impairment was related to elevated C-reactive protein.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ancoli-Israel S, Cole R, Alessi C, Chambers M, Moorcroft W, Pollak CP (2003) The role of actigraphy in the study of sleep and circadian rhythms. Sleep 26:342–392

    PubMed  Google Scholar 

  2. Autret A, Lucas B, Mondon K, Hommet C, Corcia P, Saudeau D, de Toffol B (2001) Sleep and brain lesions: a critical review of the literature and additional new cases. Neurophysiol Clin 31:356–375

    Article  PubMed  CAS  Google Scholar 

  3. Bassetti CL, Milanova M, Gugger M (2006) Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome. Stroke 37:967–972

    Article  PubMed  Google Scholar 

  4. Binkofski F, Seitz RJ, Hacklander T, Pawelec D, Mau J, Freund HJ (2001) Recovery of motor functions following hemiparetic stroke: a clinical and magnetic resonance-morphometric study. Cerebrovasc Dis 11:273–281

    Article  PubMed  CAS  Google Scholar 

  5. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J, Holleran R, Eberle R, Hertzberg V et al (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20:864–870

    PubMed  CAS  Google Scholar 

  6. Colebatch JG, Gandevia SC (1989) The distribution of muscular weakness in upper motor neuron lesions affecting the arm. Brain 112:749–763

    Article  PubMed  Google Scholar 

  7. Cramer SC, Seitz RJ (2009) Imaging functional recovery from stroke. In: Aminoff MJ, Boller F, Swaab DF, Fisher M (eds) Handbook of clinical neurology, vol 94, Chap 54. Elsevier, Edinburgh, pp 1097–1117

  8. de Niet M, Bussmann JB, Ribbers GM, Stam HJ (2007) The stroke upper-limb activity monitor: its sensitivity to measure hemiplegic upper-limb activity during daily life. Arch Phys Med Rehabil 88:1121–1126

    Article  PubMed  Google Scholar 

  9. De Vries SI, van Hirtum HW, Bakker I, Hopman-Rock M, Hirasing RA, van Mechelen W (2009) Validity and reproducibility of motion sensors in youth: a systematic update. Med Sci Sports Exerc 41:818–827

    Article  PubMed  Google Scholar 

  10. Feinberg TE, Schindler RJ, Flanagan NG, Haber LD (1992) Two alien hand syndromes. Neurology 42:19–24

    PubMed  CAS  Google Scholar 

  11. Gebruers N, Truijen S, Engelborghs S, Nagels G, Brouns R, De Deyn PP (2008) Actigraphic measurement of motor deficits in acute ischemic stroke. Cerebrovasc Dis 26:533–540

    Article  PubMed  CAS  Google Scholar 

  12. Gibbins J, McCoubrie R, Kendrick AH, Senior-Smith G, Davies AN, Hanks GW (2009) Sleep-wake disturbances in patients with advanced cancer and their family carers. J Pain Symptom Manage 38:860–870

    Article  PubMed  Google Scholar 

  13. Gironda RJ, Lloyd J, Clark ME, Walker RL (2007) Preliminary evaluation of reliability and criterion validity of Actiwatch-Score. J Rehabil Res Dev 44:223–230

    Article  PubMed  Google Scholar 

  14. Giubilei F, Iannilli M, Vitale A, Pierallini A, Sacchetti ML, Antonini G, Fieschi C (1992) Sleep patterns in acute ischemic stroke. Acta Neurol Scand 86:567–571

    Article  PubMed  CAS  Google Scholar 

  15. Haug HJ, Wirz-Justice A, Rossler W (2000) Actigraphy to measure day structure as a therapeutic variable in the treatment of schizophrenic patients. Acta Psychiatr Scand Suppl 407:91–95

    Article  PubMed  Google Scholar 

  16. Hurelbrink CB, Lewis SJ, Barker RA (2005) The use of the Actiwatch-Neurologica system to objectively assess the involuntary movements and sleep-wake activity in patients with mild-moderate Huntington’s disease. J Neurol 252:642–647

    Article  PubMed  Google Scholar 

  17. Krupinski J, Turu MM, Slevin M, Martinez-González J (2008) Carotid plaque, stroke pathogenesis, and CRP: treatment of ischemic stroke. Curr Cardiol Rep 10:25–30

    Article  PubMed  Google Scholar 

  18. Lee MS, Marsden CD (1994) Movement disorders following lesions of the thalamus or subthalamic region. Mov Disord 9:493–507

    Article  PubMed  CAS  Google Scholar 

  19. Lichstein KL, Stone KC, Donaldson J, Nau SD, Soeffing JP, Murray D, Lester KW, Aguillard RN (2006) Actigraphy validation with insomnia. Sleep 29:232–239

    PubMed  Google Scholar 

  20. Lindsberg PJ, Grau AJ (2003) Inflammation and infections as risk factors for ischemic stroke. Stroke 34:2518–2532

    Article  PubMed  Google Scholar 

  21. Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel index. Md State Med J 14:61–65

    PubMed  CAS  Google Scholar 

  22. Prass K, Meisel C, Höflich C, Braun J, Halle E, Wolf T, Ruscher K, Victorov IV, Priller J, Dirnagl U, Volk HD, Meisel A (2003) Stroke-induced immunodeficiency promotes spontaneous bacterial infections and is mediated by sympathetic activation reversal by poststroke T helper cell type 1-like immunostimulation. J Exp Med 198:725–736

    Article  PubMed  CAS  Google Scholar 

  23. Ridker PM, Wilson PW, Grundy SM (2004) Should C-reactive protein be added to metabolic syndrome and to assessment of global cardiovascular risk? Circulation 109:2818–2825

    Article  PubMed  CAS  Google Scholar 

  24. Rossini PM, Calautti C, Pauri F, Baron JC (2003) Post-stroke plastic reorganisation in the adult brain. Lancet Neurol 2:493–502

    Article  PubMed  Google Scholar 

  25. Rowe M, McCrae C, Campbell J, Horne C, Tiegs T, Lehman B, Cheng J (2008) Actigraphy in older adults: comparison of means and variability of three different aggregates of measurement. Behav Sleep Med 6:127–145

    Article  PubMed  Google Scholar 

  26. Seitz RJ, Meisel S, Moll M, Wittsack HJ, Junghans U, Siebler M (2004) The effect of combined thrombolysis with rtPA and tirofiban on ischemic brain lesions. Neurology 62:2110–2112

    PubMed  CAS  Google Scholar 

  27. Siekierka-Kleiser E, Kleiser R, Wohlschläger AM, Freund HJ, Seitz RJ (2006) Quantitative assessment of recovery from motor hemineglect in acute stroke patients. Cerebrovasc Dis 21:307–314

    Article  PubMed  CAS  Google Scholar 

  28. van Swieten JC, Koudstaal PJ, Vissen MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607

    PubMed  Google Scholar 

  29. Taub E, Miller NE, Novack TA, Cook EW III, Fleming WC, Nepomuceno CS et al (1993) Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil 74:347–354

    PubMed  CAS  Google Scholar 

  30. Terzoudi A, Vorvolakos T, Heliopoulos I, Livaditis M, Vadikolias K, Piperidou H (2009) Sleep architecture in stroke and relation to outcome. Eur Neurol 61:16–22

    Article  PubMed  CAS  Google Scholar 

  31. Thorngren KG, Werner CO (1979) Normal grip strength. Acta Orthop Scand 50:255–259

    Article  PubMed  CAS  Google Scholar 

  32. Toni D, Fiorelli M, Bastianello S, Falcou A, Sette G, Ceschin V, Sacchetti ML, Argentino C (1997) Acute ischemic strokes improving during the first 48 hours of onset: predictability, outcome, and possible mechanisms. A comparison with early deteriorating strokes. Stroke 28:10–14

    PubMed  CAS  Google Scholar 

  33. Twitchell T (1951) The restoration of motor function following hemiplegia in man. Brain 74:443–480

    Article  PubMed  CAS  Google Scholar 

  34. Uswatte G, Miltner WH, Foo B, Varma M, Moram S, Taub E (2000) Objective measurement of functional upper-extremity movement using accelerometer recordings transformed with a threshold filter. Stroke 31:662–667

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported from grants to the Brain Imaging Centre West and the Research Project Rehabilitation Gaming System, Federal Ministry for Education and Research (BMBF), Germany.

Conflicts of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Neurology, University Hospital Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany

    Rüdiger J. Seitz, Tim Hildebold & Karin Simeria

  2. Biomedical Research Centre, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany

    Rüdiger J. Seitz

Authors
  1. Rüdiger J. Seitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tim Hildebold
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karin Simeria
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rüdiger J. Seitz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Seitz, R.J., Hildebold, T. & Simeria, K. Spontaneous arm movement activity assessed by accelerometry is a marker for early recovery after stroke. J Neurol 258, 457–463 (2011). https://doi.org/10.1007/s00415-010-5778-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-010-5778-y

Keywords

Search

Navigation