Accelerometry and the Capacity–Performance Gap: Case Series Report in Upper-Extremity Motor Impairment Assessment Post-Stroke

This case series investigates whether traditional machine learning (ML) and convolutional neural network (CNN) models trained on wrist-worn accelerometry data collected in a laboratory setting can accurately predict real-world functional hand use in individuals with chronic stroke. Participants (N =...

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Bibliographic Details
Main Authors: Estevan M. Nieto, Edaena Lujan, Crystal A. Mendoza, Yazbel Arriaga, Cecilia Fierro, Tan Tran, Lin-Ching Chang, Alvaro N. Gurovich, Peter S. Lum, Shashwati Geed
Format: Article
Language:English
Published: MDPI AG 2025-06-01
Series:Bioengineering
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Online Access:https://www.mdpi.com/2306-5354/12/6/615
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Summary:This case series investigates whether traditional machine learning (ML) and convolutional neural network (CNN) models trained on wrist-worn accelerometry data collected in a laboratory setting can accurately predict real-world functional hand use in individuals with chronic stroke. Participants (N = 4) with neuroimaging-confirmed chronic stroke completed matched activity scripts—comprising instrumental and basic activities of daily living—in-lab and at-home. Participants wore ActiGraph CenterPoint Insight watches on the impaired and unimpaired wrists; concurrent video recordings were collected in both environments. Frame-by-frame annotations of the video, guided by the FAABOS scale (functional, non-functional, unknown), served as the ground truth. The results revealed a consistent capacity–performance gap: participants used their impaired hand more in-lab than at-home, with the largest discrepancies in patients with moderate to severe impairment. Random forest ML models trained on in-lab accelerometry accurately classified at-home hand use, with the highest performance in mildly and severely impaired limbs (accuracy = 0.80–0.90) and relatively lower performance (accuracy = 0.62) in moderately impaired limbs. CNN models showed comparable accuracy to random forest classifiers. These pilot findings demonstrate the feasibility of using lab-trained ML models to monitor real-world hand use and identify emerging patterns of learned non-use—enabling timely, targeted interventions to promote recovery in outpatient stroke rehabilitation.
ISSN:2306-5354