title: Monitoring Upper Limb Recovery after Cervical Spinal Cord Injury: Insights beyond Assessment Scores.
abstract: BACKGROUND
  Preclinical investigations in animal models demonstrate that enhanced upper limb (UL) activity during rehabilitation promotes motor recovery following spinal cord injury (SCI). Despite this, following SCI in humans, no commonly applied training protocols exist, and therefore, activity-based rehabilitative therapies (ABRT) vary in frequency, duration, and intensity. Quantification of UL recovery is limited to subjective questionnaires or scattered measures of muscle function and movement tasks.
  
  
  OBJECTIVE
  To objectively measure changes in UL activity during acute SCI rehabilitation and to assess the value of wearable sensors as novel measurement tools that are complimentary to standard clinical assessments tools.
  
  
  METHODS
  The overall amount of UL activity and kinematics of wheeling were measured longitudinally with wearable sensors in 12 thoracic and 19 cervical acute SCI patients (complete and incomplete). The measurements were performed for up to seven consecutive days, and simultaneously, SCI-specific assessments were made during rehabilitation sessions 1, 3, and 6 months after injury. Changes in UL activity and function over time were analyzed using linear mixed models.
  
  
  RESULTS
  During acute rehabilitation, the overall amount of UL activity and the active distance wheeled significantly increased in tetraplegic patients, but remained constant in paraplegic patients. The same tendency was shown in clinical scores with the exception of those for independence, which showed improvements at the beginning of the rehabilitation period, even in paraplegic subjects. In the later stages of acute rehabilitation, the quantity of UL activity in tetraplegic individuals matched that of their paraplegic counterparts, despite their greater motor impairments. Both subject groups showed higher UL activity during therapy time compared to the time outside of therapy time.
  
  
  CONCLUSIONS
  Tracking day-to-day UL activity is necessary to gain insights into the real impact of a patient's impairments on their UL movements during therapy and during their leisure time. In the future, this novel methodology may be used to reliably control and adjust ABRT and to evaluate the progress of UL rehabilitation in clinical trials.
authors.affiliation: Spinal Cord Injury Center, Balgrist University Hospital , Zurich , Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Brogioli
authors.affiliation: Spinal Cord Injury Center, Balgrist University Hospital , Zurich , Switzerland.
authors.forename: Sophie
authors.initials: S
authors.lastname: Schneider
authors.affiliation: Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland; Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
authors.forename: Werner L
authors.initials: WL
authors.lastname: Popp
authors.affiliation: Spinal Cord Injury Center, Balgrist University Hospital , Zurich , Switzerland.
authors.forename: Urs
authors.initials: U
authors.lastname: Albisser
authors.affiliation: Clinical Trial Unit, Swiss Paraplegic Centre , Nottwil , Switzerland.
authors.forename: Anne K
authors.initials: AK
authors.lastname: Brust
authors.affiliation: Clinical Trial Unit, Swiss Paraplegic Centre , Nottwil , Switzerland.
authors.forename: Inge-Marie
authors.initials: IM
authors.lastname: Velstra
authors.affiliation: Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich , Zurich , Switzerland.
authors.forename: Roger
authors.initials: R
authors.lastname: Gassert
authors.affiliation: Spinal Cord Injury Center, Balgrist University Hospital , Zurich , Switzerland.
authors.forename: Armin
authors.initials: A
authors.lastname: Curt
authors.affiliation: Spinal Cord Injury Center, Balgrist University Hospital , Zurich , Switzerland.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Starkey
keywords: long-term monitoring; rehabilitation; spinal cord injury; upper limb; wearable sensors