Authors

  1. Simone, Lisa K. PhD
  2. Rigg, John MD
  3. John, Sylvia MD
  4. Nolan, Karen J. PhD
  5. Sundarrajan, Nappinnai MS
  6. Elovic, Elie P. MD

Article Content

Objective: To develop and validate objective functional assessment tools that will accurately mirror real-life functional improvements following spasticity interventions, as well as provide new information over traditional outcome measures. Hypotheses: New assessment devices can quantify functional performance. We are currently evaluating the StepWatch activity monitor (ambulation), Shadow Glove (hand function), and the Pedar-X System (foot pressure). StepWatch pilot studies were performed prereversible and postreversible nerve blockade and with chemoneurolytic intervention. Improvements in ambulation parameters were assessed. Subjects: Individuals at least 18 years of age with acquired brain injury-related spasticity were recruited for participation in multiple pilot studies in quantitative outcome assessment. Methods: In 2 StepWatch studies, subjects undergoing open label clinical intervention with chemoneurolysis or reversible nerve block with marcaine were evaluated prior to and after intervention. Data included a 6-minute walk, stride length, total strides, and distance traveled over 1 week. Other pilot studies included subjects with acquired brain injury who received no intervention. Results: StepWatch studies produced objective measures of ambulation with step count error measured at 2.4%. Following marcaine nerve block, subjects walked 43% further in the 6MTW test. Following botulinum toxin injection, subjects improved distanced walked in the 6MTW test by an average 61.3%. All 4 subjects increased stride length (39%), while 75% increased distance walked per day (47%). Discussion: Advances in technology (eg, miniaturization, wireless) make it possible to objectively measure functional performance outside the clinic before and after spasticity interventions. Pre-stepWatch and post-StepWatch evaluations effectively capture improvements in function as a result of intervention. Use of wearable technology can provide more relevant functional information than traditional methods.

 

REFERENCES

 

1. Cyma Inc. Studies using StepWatch(TM). 2004. Available at: http://www.nichd.nih.gov/about/ncmrr/innovations/publications.htm. Accessed May 5, 2005.

 

2. Elovic EP, Simone LK, Zafonte R. Outcome assessment for spasticity management in the patient with TBI: the state of the art. J Head Trauma Rehabil. 2004;19(2):155-177.

 

3. Simone LK, Kamper DG. Design considerations for a wearable monitor to measure finger posture. J NeuroEng Rehabil. 2005;2(1):5.