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Objective: To propose and validate a new method for estimating upper limb orthosis wear time using miniature temperature loggers attached to locations on the upper body. Design: Observational study. Subjects: Fifteen healthy participants. Methods: Four temperature loggers were attached to the arm and chest with straps. Participants were asked to remove and re-attach the straps at specified time-points. The labelled temperature data obtained were used to train a decision tree classification algorithm to estimate wear time. The final performance (mean error and 95% confidence interval) of the trained classifier and the wear time estimation were assessed with a hold-out data-set. Results: The trained algorithm can correctly classify unseen temperature data with a mean classification error between 1.1% and 3.1% for the arm, and between 1.8% and 4.0% for the chest, depending on the sampling time of the temperature logger. This resulted in mean wear time errors between 0.5% and 8.3% for the arm, and 0.13% and 13.0% for the chest. Conclusion: The proposed method based on a classifier can accurately estimate upper limb orthosis wear time. This method could enable healthcare professionals to gain insight into the wear time of any upper limb orthosis. LAY ABSTRACT Upper limb orthoses are wearable devices that support the impaired shoulder, arm or hand. As orthoses can be effective only if they are worn, information about wear time will help physicians and therapists to evaluate the effectiveness of their prescribed treatment. Currently, physicians and therapists rely mainly on subjective data from patients, such as diaries or questionnaires, which may be biased and inaccurate. This study developed a new, objective method to estimate wear time, based on temperature readings from miniature sensors that can be attached easily to any upper limb orthosis. The results show that the wear time of upper limb orthoses can be assessed accurately using this method.

Objective: To determine the diagnostic value of the Duncan-Ely test in predicting abnormal rectus femoris activity during gait in stroke survivors walking with a stiff knee gait. Design: Cross-sectional diagnostic study. Subjects: A total of 95 patients with chronic stroke. Methods: During physical examination, the Duncan-Ely test was performed and scored. Surface electromyography of the rectus femoris was then recorded during dynamic gait. To determine the diagnostic value, the results of the Duncan-Ely test and surface electromyography recordings (gold standard) were compared. Results: The Duncan-Ely test had a sensitivity of 73%, a specificity of 29%, a positive predictive value of 60%, and a negative predictive value of 42%. The area under the curve was 0.488 ([AQ1] CI 0.355–0.621, p = 0.862), showing that the Duncan-Ely test is not better than random guessing. Conclusion: The Duncan-Ely test has no predictive value for determining abnormal activity of the rectus femoris during gait. Using this test can lead to incorrect identification of abnormal rectus femoris activity, which might hamper the selection of optimal treatment options. We recommend stopping use of the Duncan-Ely test to predict rectus femoris overactivity during swing, and instead use surface electromyography.

Objective: To investigate the feasibility of a wear-able, soft-robotic glove system developed to combine assistive support in daily life with performing therapeutic exercises on a computer at home (the HandinMind system). Design: Feasibility study. Patients: Five chronic stroke patients with limitations in activities of daily living due to impaired hand function. Methods: Participants performed a usability test and several functional tasks with the HandinMind system across 2 sessions. Feasibility was measured using the System Usability Scale (SUS), Intrinsic Motivation Inventory (IMI) and performance times of the functional tasks. Results: User acceptance measured by the SUS and IMI was scored high. The median SUS scores of sessions 1 and 2 were 80.0 (interquartile range (IQR) 70.0–88.8) and 77.5 (IQR 75.0–87.5), respectively, and the median IMI score was 6.3 points out of 7 points (IQR 6.2–6.3). Functional task performance was initially slower with the HandinMind glove compared with performance without the glove, but improved up to the level of performance without the glove across no more than 3 repetitions. Conclusion: Chronic stroke patients with impaired hand function were positive about the feasibility of the first prototype of the HandinMind system. How-ever, performance and ease of use of the system should be improved further in future development phases.

Objective: To explore whether functional electrical stimulation of the hamstrings results in improved knee kinematics in chronic stroke survivors walking with a stiff knee gait. Design: Quasi-experimental. Subjects: Sixteen adult chronic stroke survivors. Methods: Survivors received functional electrical stimulation of the hamstrings, 3 times a week for 1 h during a period of 5 weeks. 3D kinematics was calculated before the training period and after 5 weeks of training. Knee kinematics of walking without stimulation before the training period was compared with walking with stimulation after 5 weeks of training. (intervention effect). In addition, knee kinematics of walking without stimulation before the training period was compared with walking without stimulation after the training period (therapeutic effect). Results: The intervention effect showed a significant increase, of mean 8.7° (standard deviation (SD) 8.3, p = 0.001), in peak knee flexion. The therapeutic effect showed a significant increase in peak knee flexion, of mean 3.1° (SD 4.7, p = 0.021) Conclusion: The results of this exploratory study suggest an increase in knee kinematics in swing after functional electrical stimulation of the hamstrings in stroke survivors walking with a stiff knee gait. The largest improvement in peak knee flexion in swing was seen when participants walked with hamstring stimulation. Participants with low neurological impairment responded better to hamstring stimulation, and there are indications that the effect of hamstring stimulation can be predicted during a single session. The effect of functional electrical stimulation is comparable to that of more invasive treatment options, such as botulinum toxin or soft-tissue surgery. This makes functional electrical stimulation a feasible treatment option for daily clinical practice.