Real-time auditory feedback may reduce abnormal movements in patients with chronic stroke

Figures & data

Figure 1. Flow diagram of patient progress through the pilot study.

A flow chart shows that 25 patients were screened with 4 excluded. 21 patients took part in the study. Due to a data collection failure with one patient 20 patients were included in the final analysis.

Table 1. Demographic and clinical characteristics of patients.

Patient ID (n = 20)	Gender (M = 75%)	Age* (years)	AL (R = 85%)	DH (R = 75%)	TSS* (months)	mRS* Max = 5	BI* Max = 20	NFI* Max = 62	HADS* Max = 34	MoCA* Max = 30	FMS* Max = 12	FM-UL* Max = 54	ARAT* Max = 57	CAHAI* Max = 91	Arm-A* Max = 28	Arm-B* Max = 52	Apraxia* (Yes = 15%)
1	M	62	R	L	32	3	18	52	12	na	12	13	16	20	9	31	Yes
2	M	63	R	L	23	3	20	39	17	25	12	28	25	36	16	47	No
3	M	64	R	R	62	3	17	46	9	23	12	15	23	27	7	41	No
4	F	47	R	R	13	2	18	39	9	28	12	14	20	29	6	38	No
5	M	55	R	R	137	2	19	34	8	25	12	18	17	44	2	48	No
6	M	61	R	R	8	3	16	38	23	29	11	40	35	55	3	33	No
7	F	51	L	R	18	3	17	41	22	30	7	24	52	64	4	14	No
8	M	49	R	L	23	3	17	39	12	19	11	38	28	37	0	19	No
9	M	36	R	R	30	2	20	na	12	26	12	20	18	32	11	36	No
10	M	64	R	L	23	3	20	23	1	na	10	32	14	28	5	25	Yes
11	M	50	R	R	14	3	19	46	18	30	10	29	29	52	3	46	No
12	F	27	L	R	108	3	20	59	27	25	11	13	14	26	15	45	No
13	F	39	R	L	23	3	18	43	12	26	10	33	40	64	1	21	No
14	F	19	R	R	17	3	16	na	na	na	10	17	22	46	1	43	Yes
15	M	58	R	R	28	3	18	38	5	16	10	33	35	60	6	26	No
16	M	54	R	R	43	3	19	39	13	30	6	23	20	53	8	43	No
17	M	51	R	R	23	2	18	42	12	na	8	44	37	43	2	39	No
18	M	72	R	R	26	2	19	41	2	29	12	22	20	35	8	42	No
19	M	68	R	R	18	3	17	26	1	14	12	28	42	57	0	19	No
20	M	63	L	R	16	3	16	27	17	28	8	14	10	32	9	30	No
Mean (SD)		53 (14)			34 (33)	3 (0)	18 (1)	40 (9)	6 (4)	25 (5)	10 (2)	25 (10)	26 (11)	42 (14)	6 (5)	34 (11)

AL: affected limb; DH: dominant hand; TSS: time since stroke; mRS: modified Rankin Scale; BI: Barthel Index; NFI: Neurological Fatigue Index; HADS: Hospital Anxiety and Depression Scale; MoCA: Montreal Cognitive Assessment; FMS: Fugl-Meyer Sensory; FM-UL: modified upper limb Fugl-Meyer; ARAT: Action Research Arm Test; CAHAI: Chedoke Arm and Hand Activity Inventory; ArmA: Arm Activity Measure, na: data not available.

*Included in Spearman’s rank tests and Mann-Whitney U tests.

Figure 2. The patient seated upright with their wrist on the edge of a height adjusted table. They move their hand forward to reach a target button (marked with X) before returning to the original start position. A 2D webcam positioned at 2 o’clock/60 degrees relative to the patient collects video footage of their movement and sends kinematic data into a machine learning system.

A picture shows a patient sitting on a chair at a height adjusted table with a webcam positioned to collect data from their arm movements. Patients move their hand forward to reach a target button while the webcam tracks their movements and sends the kinematic movement information into a machine learning system for processing.

Figure 3. The duration of abnormal movement for 20 patients undertaking 50 repetitions with auditory feedback compared to 50 repetitions with no feedback. Error bars are adjusted 95% CI removing between-subject variability.

A bar chart showing the duration of abnormal movement for 20 patients undertaking 50 repetitions with auditory feedback compared to 50 repetitions with no feedback. There is a significant reduction in the duration of abnormal movement with feedback.

Figure 4. The duration of abnormal movement for 20 patients who provided full datasets (with and without auditory feedback). Median (dashed line), upper and lower quartiles (dotted lines) are shown.

A line chart plotting the duration of abnormal movement for each patient individually both with and without feedback. A median line shows the duration of abnormal movement is around 20% less with feedback comparted to without feedback with upper and lower quartiles showing a similar slope. However, there is variability in the data with some patients not benefitting from the feedback and some patients who show floor effects.