Quantifying dosage of physical therapy using lower body kinematics: a longitudinal pilot study on early post-stroke individuals

BACKGROUND: While therapy is an important part of the recovery process, there is a lack of quantitative data detailing the “dosage” of therapy received due to the limitations on in/outpatient accessibility and mobility. Advances in wearable sensor technology have allowed us to obtain an unprecedented glimpse into joint-level kinematics in an unobtrusive manner. The objective of this observational longitudinal pilot study was to evaluate the relations between lower body joint kinematics during therapy and functional gait recovery over the first three months after stroke. METHODS: Six individuals with subacute stroke (< 1 month) were monitored for a total of 59 one-hour physical therapy sessions including gait and non-gait activities. Participants donned a heart rate monitor and an inertial motion capture system to measure full lower body joint kinematics during each therapy session. Linear mixed regression models were used to examine relations between functional gait recovery (speed) and activity features including total joint displacements, defined as amount of motion (AoM), step number, change in heart rate (∆HR), and types of tasks performed. RESULTS: All activity features including AoM, step number, types of tasks performed (all p < 0.01), and ∆HR (p < 0.05) showed strong associations with gait speed. However, AoM (R(2) = 32.1%) revealed the greatest explained variance followed by step number (R(2) = 14.1%), types of tasks performed (R(2) = 8.0%) and ∆HR (R(2) = 5.8%). These relations included both gait and non-gait tasks. Contrary to our expectations, we did not observe a greater relation of functional recovery to motion in the impaired limb (R(2) = 27.8%) compared to the unimpaired limb (R(2) = 32.9%). CONCLUSIONS: This proof-of-concept study shows that recording joint kinematics during gait therapy longitudinally after stroke is feasible and yields important information for the recovery process. These initial results suggest that compared to step number, more holistic outcome measures such as joint motions may be more informative and help elucidate the dosage of therapy.