我们感谢布列塔尼·希尔，瑞恩·贝利和迈克·宾他们的加速度计的方法和数据贡献。资金用于此项目来源于美国国立卫生研究院R01 HD068290。

该方案经华盛顿大学人类研究保护办公室。 注:说明写具体的市售加速度计和数据收集及其相关软件（见材料表 ）。 1.准备加速计来收集数据<ol><li>两个加速度计连接到计算机（ 通过对接站），以它们的电池充电;这将确保在整个穿着时间记录。 </li><li>与加速度计连接到电脑上，打开相应的软件进行初始化。 </li><li>在软件上，选择"初始化"同步加速计时钟，彼此到本地计算机，并设置数据采集参数如下。 <ol><li>输入（或从日历和时钟选择）开始和结束的日期和时间。选择数据采集的基础上，当ACC启动elerometers将被放置在所述参与者和至少24个小时后结束时间。 注:一天穿着期间提供了采用非成人日常活动的一个很好的代表。 12周较长时间穿着也更适合于成人或儿童有不同的每天的日程安排。 3，18，26 </li><li>选择"从下拉菜单中选择‘采样率’30赫兹。 </li><li>离开"LED选项"和"无线选项"选中。 </li><li>为了延长电池寿命，使"空闲睡眠模式"。 </li></ol></li><li> 要完成初始化过程中，选择"进入正题信息"。 <ol><li>输入加速度计（手腕）的位置主题的具体信息和机身侧（"右"或"左"）。 </li><li>选择填写其他学科的具体信息如德西红;进入将仅用于识别和数据分析此处描述不会影响。 </li><li>准备就绪后，选择"初始化设备"以完成此过程。一旦初始化确认，加速度计可以安全地与电脑相连。 </li></ol></li></ol> 2.放置和加速度计的佩戴，从参加者收集数据<ol><li>将一个加速度计的参与者的每手腕。 注:加速计应紧贴地配合，但不能太紧密贴合手腕，像一个大腕表。各种条带的可根据尺寸，优先级，并且参与者的舒适度被使用。 </li><li> 指导参与者如下，并回答与会者可能有关于在此期间，穿着周期和活动的任何问题。 <ol><li>请参与者全天做它们经常活动的;加速度计可以在第一次感到陌生，但一个即将被使用到它们。 </li><li>告知他们，加速度计是防水的，可以佩戴在淋浴或做的菜。指导他们在游泳时间过长不穿加速度计。 </li><li>问他们小睡期间和夜间保持加速度计上。 注:该加速度计被标记来识别左右传感器。如果加速度计需要在穿着期间被移除，标签帮助之后再穿上它们时识别正确的一面。指导用户写下对穿着日志的时候被取下并放回again.The加速度计戴在晚上，因为，当我们让人们把他们赶走，他们往往不能放回或放回到上相反四肢。 </li></ol></li><li>发送参与者回家鼓励从事正常的日常活动和什么时候采取两个加速度计关，以及如何指令，以带动或寄回加速度计和weariNG记录。 </li></ol> 3.下载数据的目视检查<ol><li>当加速计24个小时以上的穿着时间后已经返回，加速度计连接到电脑上下载所记录的数据。 </li><li> 选择"下载"适当的软件中，然后选择将数据存储使用"更改位置"按钮在计算机上的位置。 <ol><li>选择"创建AGD文件"的选项。 </li><li>对于那些容易查看文件，从‘时代’下拉框中选择&#39;10秒。在步骤3.3中使用这些文件。 </li><li>选择"下载所有设备"。 </li></ol></li><li> 目视检查数据来确认的加速度计穿着和/或数据穿着日志相匹配的计划时间段。 <ol><li>从顶部的菜单中，单击"文件|打开AGD文件"，然后选择要打开的文件。 </li><li>看着那（这 &#39;;每日图表来查看收集的数据。 </li><li>确认在典型清醒时发生的活动，有没有延长无活动期间，除了在夜间。这些图表可以缩放到聚焦于更小的时间增量，并且如果需要通过滚动。 </li></ol></li></ol> 4.下载的数据进行处理<ol><li>重复下载过程（步骤3.2），但这次从"大纪元"下拉框中选择"1秒"。这将仓中的数据转换成1秒时期，10，11，12，并生成将用于计算文件。 注:加速计和这里使用（见材料表 ）软件使用专有软件（从坐一辆车正在如加速度）滤除高频，非人类活动。过滤可能需要使用，如果要与定制编写的软件完成不同的设备和软件。定制编写的软件还可以用来识别和消除上肢震颤，如帕金森病的人。 </li><li>从保存在步骤4.1中的1秒的文件，计算向量幅度的时间序列的三维数据作为来自每个加速度计数据（x 2 + Y 2 + Z 2）的平方根。然后，这个时间序列可以用来计算一些变量日常生活中量化上肢活动。 注:处理指令采取了为期一天的穿着期。如果穿着期间较长，数据可以在分开的单日的块进行处理，或作为与计算出的变量的单一的时间序列由通过在适当的时候在穿着期间的长度进行调整。 </li></ol> 5.变量和图形表示从加速度计数据的创注:与行走有关的上肢动作都包含在分析的数据。以前的工作<html>建立了步行不影响加速比变量。 15虽然包含行走不改变非比例变量神经系统，完整的成年人，27是可能的行走列入可能导致非比例变量的参与者中风一个小高估。 <ol><li>通过在记录期间的所有秒求和当活动计数非零，然后转换成小时计算使用的每个肢体的小时。 12，17 注意:此计算产生对于每个肢体一个值。 </li><li>计算的使用比例由通过使用显性（或未受影响的）肢体的小时除以使用非优势臂（或受影响的肢体）的小时数（也称为活性比率）。 注意:使用比率量化一节肢的活动的总持续时间相对于另一个。EF"&gt; 12，15该计算产生一个单一的值，典型地在0和1之间的值1表示的两个肢臂被用于相等的持续时间在整个穿着期间。零值意味着非主导或患肢在所有未使用。 </li><li> 计算如下幅度比。 <ol><li>对于在时间序列数据的每个第二，计算由所述主导（或未受影响的）肢体的矢量幅度除以非主导肢（或受影响的肢体）的矢量大小的自然对数。 </li><li>替换值大于7且小于-7更大，7和-7，分别进行分类单肢体运动。 11 注:幅度比量化每个肢体的日常活动上的第二逐第二基础的贡献。 10,11这在概念上类似于使用比，但考虑到INTE每个第二期间每个肢体的运动（加速度幅度）的nsity。该计算产生一个时间序列值，其中的零值表示双肢在那个时间瞬间期间有等于运动强​​度。正值表示从非主导（或受影响）更大的移动强度和肢负值表示从所述主导（或未受影响的）肢更大的移动强度。 </li></ol></li><li>计算双边幅度从两节肢的矢量幅度的总和。 注:双边幅度量化运动的强度上的第二逐第二基础双上肢。 10,11该计算产生一个时间序列的值，其中所述值指示所述运动强度，有指示高强度更高的值。 </li><li> 构造密度图以图形方式从双肢11 FOL代表加速度测量数据低点。 <ol><li>绘制数据的每个第二与在颜色表示的频率的双变量直方图。设置色标，使得冷色调（蓝色），表示不太频繁活动和暖色（黄红通过）表示更频繁的活动。 </li><li>绘出 幅度比，表示贡献一个肢体相对于其他的，在x轴。 </li><li>绘制双边幅度，指示移动的强度，在y轴。 </li><li>绘制单肢值作为最左侧杆（-7）在单独的条，表示刚刚主导（或未受影响的）肢体的活性，并取决于的最右侧（7），表明活性只是非优势（或受影响的）肢体。 注:该地块提供了上下文科学家，临床医生，和与会者解释两个变量一起，幅度比和双边幅度。一个选项，以创建一个使用加速度计数据是在此密度图。 44 &lt;/ SUP&gt; </li></ol></li></ol>

作者宣称，他们有没有冲突的财务权益。

该报告详细介绍了测量戴在手腕上的日常使用的生活加速度上肢性能的方法。在康复研究和临床实践该方法的使用得到在现有的方法显著的进步， 即有机会学习如何进行实验或典型的治疗影响日常生活功能的性能，不仅在临床或实验室能力。加速度计可以结合使用，或代替33可以是认知缺陷或无意识的偏见更敏感的日常表现，自我报告的措施，31，32，。 34，35，36，37提前采用这种方法的已取得数据与预期相反，5这可能会迫使吨他场均重新考虑康复服务的内容和交付。 在协议中的关键步骤确保在穿着期间收集准确和实时数据（协议步骤2.2，2.3和3.3）。不遵循这些步骤可能会导致一些没有意义的计算值。这是比较容易确保加速度计是在分配手腕的人离开诊所或实验室。返回加速度计后的数据的目视检查是必要的，因为参与者往往具有不同的行为指导或预期。虽然比较少见，参与者已经知道离开调查队后不久，去除加速度计，把他们再次上的反面，或试图鼓励其他人在他们的家庭穿。这在很大程度上可避免如果加速度计都清楚地标明为每一侧上，该穿着日志完成，并且数据被不久AFTE检查[R返回， 即在情况下，需要后续电话澄清穿着侧和时间。 虽然加速度计的方法量化一般上肢的性能，它不提供有关运动质量或约在穿着期间所执行的具体活动，如明知参与者正在吃的信息;见参考文献3关于这个问题的讨论。作为一种工具，那么，加速度计将是当科学问题或康复干预的重点是在日常生活中不断变化的一般上肢表现，如活动量和双侧肢体的日常活动参与衡量的结果非常有用。当科学问题或康复干预的重点是改变运动的质量或改变日常生活中只有少数特定的运动加速度计将作为衡量的结果不太有用。我们预计，computat有理方法将改善随着时间的推移，该方法的后代也许能够克服这些限制。 总之，加速度计提出了在日常生活上肢性能定量评估的机会。这里描述的方法可以被认为是较常见的流动性的方法，其中每天的步骤或适度的体力活动的分钟数记录在可穿戴式设备的上肢版本。 38，39，40，41，42，43虽然与中风的人开发的，该方法的通用性将允许在各种其他人群的未来应用。另外的方法发展需要比其他中风成人和儿童neurorehabiliation人群，以帮助回答的临床和研究阙有关上肢的双边活动stions。

在过去的二十年里，出现了可穿戴的传感器来测量运动的兴趣爆炸。已生成的在神经康复领域的极大兴趣的可佩带式传感器是加速度计。 1，2，3加速度计，顾名思义，测量重力单位加速度（1克= 9.8Hz米/秒2），或在所谓的活动计数任意单位（1个活动计数=制造商指定的引力值）。加速度，像人类的运动，通常是测量和记录在三维中，对应于设备的不同轴。的装置是市售装置和像大手表;他们可以在最小干扰日常活动佩戴。因为合理的成本，它们容易得到的，使用加速度计（加速度计被称为）被集成到neurorehabilitation研究。 加速度计的对神经康复领域的价值在于，它提供了诊所或实验室外的非侵入性，无偏，定量上肢运动活性的量度。 3的康复服务的人中风和其他神经系统疾病的一个主要目标是提高一个人的日常生活中发挥作用的能力，而不是仅仅在临床或实验室。功能的世界卫生组织（WHO）的国际分类的能力的活动区分，在临床试验中，和活动的执行结构化环境中测量，在非结构化环境中测量。 4加速度计能够在非结构化环境上肢性能测量， 即什么样的人时，他们没有在临床或实验室，他们不只是什么实际执行。加速度计的纳入到行程REHA现在bilitation研究是具有挑战性的长期持有的假设，即在结构化临床环境功能改善转化为非结构化，日常生活中的性能改进。 5，6，7，8 我们组9，10，11，12，13，14和其他7，15，16，17，18，19，20，21，22，23，24具有B-EEN花费的时间和精力很大发展加速度测量方法在研究和临床实践中使用。加速度计已成为公认的衡量上肢表现中风后的有效和可靠的工具。 1，2，15，16，17，25中的最近的挑战已经转动原始加速度计数据转换成临床上有意义的信息（参见，这种发展过程的总结参考文献3）。这里描述的方法可用于在健康对照组参与者10，在参加12从谁已经中风6,9遭遇在日常生活中区分上肢表现，11 </s向上&gt;或具有其它病症。从这种方法得到的变量是适应变化，并随着时间的推移量化的改进。 14加速度计的方法是适当的研究调查调查上肢功能障碍和干预措施，旨在提高人们中风和其他神经人群在日常生活中上肢表现。由于其相对简单的，然后将其在临床实践中神经康复也并入它可能不长。

<table border="0" cellpadding="0" cellspacing="0" width="789">
	<colgroup>
		<col />
		<col />
		<col />
		<col />
	</colgroup>
	<tbody>
		<tr height="126">
			<td height="126" style="height:126px;width:216px;">Accelerometers (2)</td>
			<td style="width:204px;">Actigraph LLC</td>
			<td style="width:119px;">wGT3X-BT</td>
			<td style="width:251px;">This is the most common device on the market.&#160; Similar products are available from other vendors.&#160; http://actigraphcorp.com/products-showcase/activity-monitors/actigraph-wgt3x-bt/</td>
		</tr>
		<tr height="147">
			<td height="147" style="height:147px;width:216px;">Hub</td>
			<td style="width:204px;">Actigraph LLC</td>
			<td style="width:119px;">7 Port USB Hub</td>
			<td style="width:251px;">This device connects the accelerometers to the computer allowing for charging and communication. Includes hub, usb cables, power connector. http://actigraphcorp.com/products/7-port-usb-hub-2016/</td>
		</tr>
		<tr height="84">
			<td height="84" style="height:84px;width:216px;">Straps&#160;</td>
			<td style="width:204px;">Actigraph LLC</td>
			<td style="width:119px;">Woven Nylon Wrist Band&#160;</td>
			<td style="width:251px;">Other straps that are velcro or disposable are also available.&#160; http://actigraphcorp.com/product-category/accessories/</td>
		</tr>
		<tr height="126">
			<td height="126" style="height:126px;width:216px;">Actilife Software</td>
			<td style="width:204px;">Actigraph LLC</td>
			<td style="width:119px;"></td>
			<td style="width:251px;">It is best to purchase the software from the same vendor as the accelerometers.&#160; Similar products are available from other vendors. http://actigraphcorp.com/products-showcase/software/actilife/</td>
		</tr>
		<tr height="84">
			<td height="84" style="height:84px;width:216px;">Computational software</td>
			<td style="width:204px;"></td>
			<td style="width:119px;"></td>
			<td style="width:251px;">The most common software is MATLAB, but computation could also be done in Excel or other similar products.&#160;&#160;</td>
		</tr>
	</tbody>
</table>

a method for quantifying upper limb performance in daily life using accelerometers

中风和其他神经系统疾病后转诊至康复服务的一个关键原因是为了提高人的日常生活中发挥作用的能力。它在日常生活中衡量一个人的活动变得非常重要，而不仅仅是衡量一个诊所或实验室的结构化的环境对他们的活动能力。一种可佩戴传感器，其现在能够日常运动的测量值是加速度计。加速计类似，可以全天佩戴大型手表市售的设备。从加速计数据可以量化的肢体是如何参与执行在人民的家庭和社区活动。这份报告介绍了一种方法来收集数据加速度仪，并把它变成临床相关信息。首先，数据被具有参与者佩戴两个加速度计（每手腕）24小时或更长的时间收集。然后，将加速度计数据被下载和处理，以产生四个differen牛逼变量描述日常生活中的上肢活动的关键方面:使用时间，使用比，大小比，和双边幅度。密度图可以被构造在视觉上表示从24小时佩戴期间内的数据。该变量及其产生的密度图是在神经系统，完整的，社区居住的成年人高度一致。这个惊人的一致性使得它们可用于确定是否上肢每日性能与正常不同的有用工具。这种方法适用于调查研究调查上肢功能障碍和干预措施旨在改善人们与中风和其他患者人群在日常生活中上肢表现。由于其相对简单的，然后将其在临床实践中神经康复也并入它可能不长。

<html>从社区居住，神经系统，完整的成年人的指涉样本数据可以用来解释从参与者中风或影响上肢性能的其他条件的数据。 10，11，12 表1示出了用于使用和来自健康指涉样品的使用比例的小时汇总统计。总体而言，大多数人都用自己的优势和非优势手主动约全天同样多的时间。平均近9个小时，但有一个大范围，捕捉更积极和活动较少的人。平均使用比例不到1.0，并且具有一个小的标准偏差。因此，无论是怎样活性之一，显性和非显性四肢用于全天类似持续时间。此外，年龄不身体健康的影响存在上肢性能的措施。小姑娘="外部参照"&gt; 12个计算值基本上外面这些指涉值（±3-4 SDS）值应仔细检查，以确保它们是真实的，由Uswatte和他的同事的建议。 16 <table fo:keep-together.within-page="1"><tbody><tr><td></td><td> 平均 </td><td> 标准偏差 </td><td> 最低限度 </td><td> 最大值 </td></tr><tr><td> 占主导地位的肢体利用小时 </td><td> 9.1 </td><td> 1.9 </td><td> 4.4 </td><td> 14.2 </td></tr><tr><td> 非主导肢体利用小时 </td><td> 8.6 </td><td> 2 </td><td> 4.1 </td><td> 15.5 </td></tr><tr><td> 使用比例 </td><td> 0.95 </td><td> 0.06 </td><td> 0.79 </td><td> 1.1 </td></tr></tbody></table> 表:总结从Neur加速度计统计ologically-完好，社区住宅成年人。值来自所指样品的74名社区居住成年人（平均年龄54±11，53％为女性，84％右手显性），来自参考12。 密度曲线允许一个采取在数据细看。 图1是从一个健康的成年人的代表性密度图，以收集并如上所述处理的数据。像这样的地块提供关于在日常生活中上肢的重要信息。有迹象表明，在所有年龄的成年人高度一致的该地块的三个关键特性。 3，11首先，图像是对称的。这表明上肢同时被激活全天，与类似地使用显性和非显性四肢。运动可能不存在的相似性是在特定的时间实例，每个肢羚牛摹反过来领先或在各种活动滞后，但可以看出在一天的课程。即使是在-7和7任一侧上杆（仅指示显性和单独非主导活性）是相似的颜色。对称是违反有关惯用手共同的看法。第二，情节树形具有宽底部和圆形边缘。在"轮辋"或底部部分的圆形边缘代表其中一个肢体运动，而另一个是相对静止的活性。这方面的一个例子是将对象放置在容器中，用一只手同时保持与其他的容器中。 10中的圆形边缘的对称性表明，双手是活性进行，并在一天的过程中同样稳定。顶部峰代表较不频繁的，强度更高的活动，例如，将大的对象上的高架子用双手。 10第三，没有在中心的温暖的光芒。<html>这表明，最频繁的上肢运动是低强度与来自双肢近似相等的贡献。这方面的例子将被输入或用刀子和叉子切割。 10 <img alt="图1" src="/files/ftp_upload/55673/55673fig1.jpg" /> 图1:从神经学-完整成人代表性的例子。密度曲线图显示了在日常生活上肢使用的24个小时，绘制在第二逐第二基础。 x轴（幅度比）表示各肢体活动的贡献。 y轴（双边幅度）表示运动的强度。颜色表示频率，与该图中，其中较亮的颜色表示更大的频率的右侧的大彩条的规模。在-7和7中的小条分别代表单方面显性和非显性活性。"&gt;请点击此处查看该图的放大版本。 跨该样品的成年人中，密度图的形状和颜色非常相似。 11人谁是相对不活跃往往有短，更宽，与冷色调的图片。人们谁是非常活跃的往往有较温暖的色彩较高的照片。整个成人引人注目的一致性，可以很容易地识别参与者上肢的性能比从这些规范不同。 图2是在与中风的人的密度曲线图的一个例子。此人是右撇子的男性是谁在收集这些数据11之前几个月已经影响到他的右侧大脑缺血性中风。大脑的右侧控制身体的左侧，他的左上肢中度轻瘫和功能障碍，由Motric指示两者均指数28评分60/100和行动研究的ARM测试29分的57分之38。在24小时佩戴期间内，局部麻痹，左侧肢体是1.5小时和非麻痹活性，右肢是活性为5.8小时。他的使用比率为0.47，大约一半的正常值。相比于图1中的密度曲线图，该密度情节决然不对称的，这表明患侧上肢是日常生活中很少活性。相比在-7单条的暗红色的颜色图的中间部分的冷色调表示运动的只用非偏瘫肢体的高频。整体峰低，仅表示低强度活动。总体而言，密度图表明，偏瘫肢体参与只是最低限度的日常活动。 <img alt="图2" src="/files/ftp_upload/55673/55673fig2.jpg" /> 图2:从每代表性实施例儿子中风。密度曲线图显示了在日常生活上肢使用的24个小时，绘制在第二逐第二基础。 x轴（幅度比）表示各肢体活动的贡献。 y轴（双边幅度）表示运动的强度。颜色表示频率，与该图中，其中较亮的颜色表示更大的频率的右侧的大彩条的规模。在-7和7中的小条分别代表单方面显性和非显性活性。比较对称，峰高，和颜色图1. <a href="http://ecsource.jove.com/files/ftp_upload/55673/55673fig2large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> 虽然加速度计方法已经用于与中风的人使用而开发的，这种方法的效用扩展到其他人群。它可以是在VARI评估结果有利患者人群的ETY。 图3是在一个人的密度曲线图用肘部下方的上肢截肢的一个例子。此人是一名75岁的男性，大约8年前在一次事故中受伤。他的右手，先前主导，手在事故发生的时间截肢。他拥有上肢假肢，但穿着它只有每月1-2次举起重物。大多数时候，在这个人物，他不穿它。在24小时佩戴期间内，完好，左侧肢体是为6.9ħ活性和残余，右肢是为4.7ħ活性（加速度计上残肢远侧磨损）。他的使用比率为0.68，表明用于在残肢接合完好肢体的偏好。该密度图是较少对称的，并且具有冷却器的颜色比对照受试者（ 图1）的，但更对称的，并显示比行程在图2中所示的人更活性。因此，这个人˚Favors完整的肢体，但仍从事日常生活中的活动残肢。 <img alt="图3" src="/files/ftp_upload/55673/55673fig3.jpg" /> 图3:从与上肢截肢一个Person代表性的例子。密度曲线图显示了在日常生活上肢活动的24个小时，绘制在第二逐第二基础。 x轴（幅度比）表示各肢的在时间中的时刻的贡献活性。 y轴（双边幅度）表示运动的强度。颜色表示频率，与该图中，其中较亮的颜色表示更大的频率的右侧的大彩条的规模。在-7和7中的小条分别代表单方面显性和非显性活性。比较对称，峰高，和颜色图1和图2。 <a href="http://ecsource.jove.com/files/ftp_upload/55673/55673fig3large.jpg" target="_blank">请点击此处查看大图</a><html>版本这个数字。 这种方法是如何使用的另一个例子是行动不便谁需要增加活动的人。 图4是从一个老年人，右旋个体滞留在专业护理机构的密度曲线图的一个例子。此人的急性疾病衰弱，并接受护理和康复服务，以重新获得独立和回家。占主导地位的是肢活性为2.4小时，并在非优势臂是有活性2.0小时。的使用比率为0.84，这是在规范范围的低端（ 见表1）。这个密度图几乎是对称的，正如从一般医疗状况在意料之中，但峰值是很低的，而且颜色大多是冷静，在穿着期间表示小活动。 OAD / 55673 / 55673fig4.jpg" /&gt; 图4:从一个人在专业护理机构（SNF）从内科疾病中恢复代表性的例子。密度曲线图显示了在日常生活上肢活动的22个小时，绘制在第二逐第二基础。 x轴（幅度比）表示各肢的在时间中的时刻的贡献活性。 y轴（双边幅度）表示运动的强度。颜色表示频率，与该图中，其中较亮的颜色表示更大的频率的右侧的大彩条的规模。在-7和7中的小条分别代表单方面显性和非显性活性。比较对称，峰高，和颜色图1. <a href="http://ecsource.jove.com/files/ftp_upload/55673/55673fig4large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> 最后，这种方法可能不是BË只为成年人。该协议适用于儿童，细微调整，以鼓励穿（ 如多彩肩带，建议该设备的让你看起来像一个超级英雄"）。从正常发育儿童密度曲线显示相同的一般形状，成年人，树形状是窄，峰高得多。孩子们的形状与他们更大的活动水平保持一致;从一个典型的显影儿童和与偏瘫脑瘫子密度图的一个例子可以看出在页码。 25， 图5B和参考文献3 5C。需要为应用程序儿科临床实践进一步的调查。值得注意的是，使用比必须与中风，1成人上肢活动的自我报告一致温和的关系，但是，在脑瘫患儿中，使用比例是不相关的，上LIM的父母报告B的活性。 30无论是传感器测量并报告值之间的关系改变在于记者的看法或在儿童如何运动是未知的一些定量或定性的区别。未来的研究是迫切需要的，以确定标准值正在发育的儿童和调查值的解释残疾儿童。

Watch this Scientific Journal Video about A Method for Quantifying Upper Limb Performance in Daily Life Using Accelerometers at JoVE.com

A Method for Quantifying Upper Limb Performance in Daily Life Using Accelerometers

这个协议描述了使用腕戴式加速度计来量化在日常生活上肢性能的方法。

一种使用加速度计量化上肢表现在日常生活的方法

A key reason for referral to rehabilitation services after stroke and other neurological conditions is to improve one's ability to function in daily life. ...

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Research

JoVE Journal

Medicine

12.3K 次观看.  Washington University School of Medicine. 这个协议描述了使用腕戴式加速度计来量化在日常生活上肢性能的方法。 

视频: A Method for Quantifying Upper Limb Performance in Daily Life Using Accelerometers

Driving Simulation in the Clinic: Testing Visual Exploratory Behavior in Daily Life Activities in Patients with Visual Field Defects

Patients suffering from homonymous hemianopia after infarction of the posterior cerebral artery (PCA) report different degrees of constraint in daily life, despite similar visual deficits. We assume this could be due to variable development of compensatory strategies such as altered visual scanning behavior. Scanning compensatory therapy (SCT) is studied as part of the visual training after infarction next to vision restoration therapy. SCT consists of learning to make larger eye movements into the blind field enlarging the visual field of search, which has been proven to be the most useful strategy1, not only in natural search tasks but also in mastering daily life activities2. Nevertheless, in clinical routine it is difficult to identify individual levels and training effects of compensatory behavior, since it requires measurement of eye movements in a head unrestrained condition. Studies demonstrated that unrestrained head movements alter the visual exploratory behavior compared to a head-restrained laboratory condition3. Martin et al.4 and Hayhoe et al.5 showed that behavior demonstrated in a laboratory setting cannot be assigned easily to a natural condition. Hence, our goal was to develop a study set-up which uncovers different compensatory oculomotor strategies quickly in a realistic testing situation: Patients are tested in the clinical environment in a driving simulator. SILAB software (Wuerzburg Institute for Traffic Sciences GmbH (WIVW)) was used to program driving scenarios of varying complexity and recording the driver's performance. The software was combined with a head mounted infrared video pupil tracker, recording head- and eye-movements (EyeSeeCam, University of Munich Hospital, Clinical Neurosciences).
The positioning of the patient in the driving simulator and the positioning, adjustment and calibration of the camera is demonstrated. Typical performances of a patient with and without compensatory strategy and a healthy control are illustrated in this pilot study. Different oculomotor behaviors (frequency and amplitude of eye- and head-movements) are evaluated very quickly during the drive itself by dynamic overlay pictures indicating where the subjects gaze is located on the screen, and by analyzing the data. Compensatory gaze behavior in a patient leads to a driving performance comparable to a healthy control, while the performance of a patient without compensatory behavior is significantly worse. The data of eye- and head-movement-behavior as well as driving performance are discussed with respect to different oculomotor strategies and in a broader context with respect to possible training effects throughout the testing session and implications on rehabilitation potential.

Patients with visual deficits after stroke report about different constraints in daily life most likely due to variable compensatory strategies, which are difficult to differentiate in clinical routine. We present a clinical set-up which allows measurement of different compensatory head- and eye-movement-strategies and evaluating their effects on driving performance.

驾驶模拟诊所:测试视觉与视野缺损的患者在日常活动中的探索行为

Patients suffering from homonymous hemianopia after infarction of the posterior cerebral artery (PCA) report different degrees of constraint in daily ...

科研

医学

Quantifying Glomerular Permeability of Fluorescent Macromolecules Using 2-Photon Microscopy in Munich Wistar Rats

Kidney diseases involving urinary loss of large essential macromolecules, such as serum albumin, have long been thought to be caused by alterations in the permeability barrier comprised of podocytes, vascular endothelial cells, and a basement membrane working in unison. Data from our laboratory using intravital 2-photon microscopy revealed a more permeable glomerular filtration barrier (GFB) than previously thought under physiologic conditions, with retrieval of filtered albumin occurring in an early subset of cells called proximal tubule cells (PTC)1,2,3.
Previous techniques used to study renal filtration and establishing the characteristic of the filtration barrier involved micropuncture of the lumen of these early tubular segments with sampling of the fluid content and analysis4. These studies determined albumin concentration in the luminal fluid to be virtually non-existent; corresponding closely to what is normally detected in the urine. However, characterization of dextran polymers with defined sizes by this technique revealed those of a size similar to serum albumin had higher levels in the tubular lumen and urine; suggesting increased permeability5.
Herein is a detailed outline of the technique used to directly visualize and quantify glomerular fluorescent albumin permeability in vivo. This method allows for detection of filtered albumin across the filtration barrier into Bowman's space (the initial chamber of urinary filtration); and also allows quantification of albumin reabsorption by proximal tubules and visualization of subsequent albumin transcytosis6. The absence of fluorescent albumin along later tubular segments en route to the bladder highlights the efficiency of the retrieval pathway in the earlier proximal tubule segments. Moreover, when this technique was applied to determine permeability of dextrans having a similar size to albumin virtually identical permeability values were reported2. These observations directly support the need to expand the focus of many proteinuric renal diseases to included alterations in proximal tubule cell reclamation.

A technique utilizing high resolution intavital 2-photon microscopy to directly visualize and quantify gloemrular filtration in surface glomeruli. This method allows for direct determination of permeability characteristics of macromolecules in both normal and diseased states.

利用双光子显微镜在慕尼黑Wistar大鼠量化肾小球通透性荧光大分子

Kidney  diseases involving urinary loss of large essential macromolecules, such as  serum albumin, have long been thought to be caused by alterations in ...

Human Skeletal Muscle Biopsy Procedures Using the Modified Bergstr&#246;m Technique

The percutaneous biopsy technique enables researchers and clinicians to collect skeletal muscle tissue samples. The technique is safe and highly effective. This video describes the percutaneous biopsy technique using a modified Bergstr&#246;m needle to obtain skeletal muscle tissue samples from the vastus lateralis of human subjects. The Bergstr&#246;m needle consists of an outer cannula with a small opening (&#8216;window&#8217;) at the side of the tip and an inner trocar with a cutting blade at the distal end. Under local anesthesia and aseptic conditions, the needle is advanced into the skeletal muscle through an incision in the skin, subcutaneous tissue, and fascia. Next, suction is applied to the inner trocar, the outer trocar is pulled back, skeletal muscle tissue is drawn into the window of the outer cannula by the suction, and the inner trocar is rapidly closed, thus cutting or clipping the skeletal muscle tissue sample. The needle is rotated 90&#176;&#160;and another cut is made. This process may be repeated three more times. This multiple cutting technique typically produces a sample of 100-200 mg or more in healthy subjects and can be done immediately before, during, and after a bout of exercise or other intervention. Following post-biopsy dressing of the incision site, subjects typically resume their activities of daily living right away and can fully participate in vigorous physical activity within 48-72 hr. Subjects should avoid heavy resistance exercise for 48 hr to reduce the risk of herniation of the muscle through the incision in the fascia.

The purpose of this video is to present the modified Bergstr&#246;m skeletal muscle biopsy technique on human subjects.

人骨骼肌活检手术使用修改伯格斯坦技术

The percutaneous biopsy technique enables researchers and clinicians to collect skeletal muscle tissue samples. The technique is safe and highly ...

Remote Limb Ischemic Preconditioning:  A Neuroprotective Technique in Rodents

Sublethal ischemia protects tissues against subsequent, more severe ischemia through the upregulation of endogenous mechanisms in the affected tissue. Sublethal ischemia has also been shown to upregulate protective mechanisms in remote tissues. A brief period of ischemia (5-10 min) in the hind limb of mammals induces self-protective responses in the brain, lung, heart and retina. The effect is known as remote ischemic preconditioning (RIP). It is a therapeutically promising way of protecting vital organs, and is already under clinical trials for heart and brain injuries. This publication demonstrates a controlled, minimally invasive method of making a limb &#8211; specifically the hind limb of a rat &#8211; ischemic. A blood pressure cuff developed for use in human neonates is connected to a manual sphygmomanometer and used to apply 160 mmHg pressure around the upper part of the hind limb. A probe designed to detect skin temperature is used to verify the ischemia, by recording the drop in skin temperature caused by pressure-induced occlusion of the leg arteries, and the rise in temperature which follows release of the cuff. This method of RIP affords protection to the rat retina against bright light-induced damage and degeneration.

Remote ischemic preconditioning (RIP) is a method of conditioning tissues against damaging stress. We have established a method of remote ischemia at the hind limb, by inflating a sphygmomanometer cuff for 5-10 min. The neuroprotective capabilities of RIP have been demonstrated in a model of retinal degeneration in rodents.

远程肢体缺血预适应:在啮齿动物的保护技术

Sublethal ischemia protects tissues against subsequent, more severe ischemia through the upregulation of endogenous mechanisms in the affected tissue. ...

Orthotopic Hind Limb Transplantation in the Mouse

In vivo animal model systems, and in particular mouse models, have evolved into powerful and versatile scientific tools indispensable to basic and translational research in the field of transplantation medicine. A vast array of reagents is available exclusively in this setting, including mono- and polyclonal antibodies for both diagnostic and interventional applications. In addition, a vast number of genotyped, inbred, transgenic, and knock out strains allow detailed investigation of the individual contributions of humoral and cellular components to the complex interplay of an immune response and make the mouse the gold standard for immunological research. 
Vascularized Composite Allotransplantation (VCA) delineates a novel field of transplantation using allografts to replace "like with like" in patients suffering traumatic or congenital tissue loss. This surgical methodological protocol shows the use of a non-suture cuff technique for super-microvascular anastomosis in an orthotopic mouse hind limb transplantation model. The model specifically allows for comparison between established paradigms in solid organ transplantation with a novel form of transplants consisting of various different tissue components. Uniquely, this model allows for the transplantation of a viable vascularized bone marrow compartment and niche that have the potential to exert a beneficial effect on the balance of immune acceptance and rejection. This technique provides a tool to investigate alloantigen recognition and allograft rejection and acceptance, as well as enables the pursuit of functional nerve regeneration studies to further advance this novel field of transplantation.

This novel model for orthotopic hind limb transplantation in the mouse, applying a non-suture cuff technique for super-microvascular anastomosis, provides a powerful tool for in&#160;vivo mechanistic immunological research related to vascularized composite allotransplantation (VCA).

原位后肢移植中的鼠标

In vivo animal model systems, and in particular mouse models, have evolved into powerful and versatile scientific tools indispensable to basic and ...

Exergaming in Older People Living with HIV Improves Balance, Mobility and Ameliorates Some Aspects of Frailty

Approximately 1.2 million people in the United States live with HIV infection. Medical advancements have increased the life expectancy and this cohort is aging. HIV-positive individuals have a high incidence of frailty (~20%) characterized by depression and sedentary behavior. Exercise would be healthy, but due to the frail status of many HIV-positive individuals, conventional exercise is too taxing. The aim of this study was to evaluate the effectiveness and acceptability of a novel game-based training program (exergame) in ameliorating some aspects of frailty in HIV-infected individuals. Ten older people living with HIV were enrolled in an exergame intervention. Patients performed balance exercises such as weight shifting, ankle reaching, and obstacle crossing. Real-time visual/audio lower-extremity joint motion feedback was provided using wearable sensors to assist feedback and encourage subjects to accurately execute each exercise task. Patients trained twice a week for 45 min for 6 weeks. Changes in balance, gait, psychosocial parameters and quality of life parameters were assessed at the beginning, midterm and at conclusion of the training program. Ten patients completed the study and their results analyzed. The mean age was 57.2 &#177; 9.2 years. The participants showed a significant reduction in center of mass sway (78.2%, p = .045) during the semi-tandem balance stance with eyes closed and showed a significant increase in gait speed during a dual task motor-cognitive assessment (9.3%, p = .048) with an increase in stride velocity of over 0.1 m/sec. A significant reduction in reported pain occurred (43.5%, p = .041). Preliminary results of this exergame intervention show promise in improving balance and mobility while requiring older people living with HIV to be more active. The exergame can be continued at home and may have long term as well as short-term benefits for ameliorating frailty associated with HIV infection.

Persons infected with HIV are often frail, depressed and live a sedentary lifestyle for which conventional exercise is too taxing. Here, we present an exercise protocol that ameliorates aspects of frailty in HIV-infected persons. An exergame integrating cognitive control was developed using biosensors that measured balance, weight-shifting and obstacle crossing.

老年人艾滋病感染者健身游戏平衡改善，流动性和可改善虚弱的几个问题

Approximately 1.2 million people in the United States live with HIV infection. Medical advancements have increased the life expectancy and this cohort is ...

Corneal Epithelial Abrasion with Ocular Burr As a Model for Cornea Wound Healing

The murine cornea provides an excellent model to study wound healing. The cornea is the outermost layer of the eye, and thus is the first defense to injury. In fact, the most common type of eye injury found in clinic is a corneal abrasion. Here, we utilize an ocular burr to induce an abrasion resulting in removal of the corneal epithelium in vivo on anesthetized mice. This method allows for targeted and reproducible epithelial disruption, leaving other areas intact. In addition, we describe the visualization of the abraded epithelium with fluorescein staining and provide concrete advice on how to visualize the abraded cornea. Then, we follow the timeline of wound healing 0, 18, and 72 h after abrasion, until the wound is re-epithelialized. The epithelial abrasion model of corneal injury is ideal for studies on epithelial cell proliferation, migration and re-epithelialization of the corneal layers. However, this method is not optimal to study stromal activation during wound healing, because the ocular burr does not penetrate to the stromal cell layers. This method is also suitable for clinical applications, for example, pre-clinical test of drug effectiveness.

This protocol describes a method to inflict an abrasion to the ocular surface of the mouse, and to follow the wound healing process thereafter. The protocol takes advantage of an ocular burr to partially remove the surface epithelium of the eye in anaesthetized mice.

眼毛刺角膜上皮磨损与角膜创面愈合的模型研究

The murine cornea provides an excellent model to study wound healing. The cornea is the outermost layer of the eye, and thus is the first defense to ...

Preclinical Model of Hind Limb Ischemia in Diabetic Rabbits

Peripheral vascular disease is a widespread clinical problem that affects millions of patients worldwide. A major consequence of peripheral vascular disease is the development of ischemia. In severe cases, patients can develop critical limb ischemia in which they experience constant pain and an increased risk of limb amputation. Current therapies for peripheral ischemia include bypass surgery or percutaneous interventions such as angioplasty with stenting or atherectomy to restore blood flow. However, these treatments often fail to the continued progression of vascular disease or restenosis or are contraindicated due to the overall poor health of the patient. A promising potential approach to treat peripheral ischemia involves the induction of therapeutic neovascularization to allow the patient to develop collateral vasculature. This newly formed network alleviates peripheral ischemia by restoring perfusion to the affected area. The most frequently employed preclinical model for peripheral ischemia utilizes the creation of hind limb ischemia in healthy rabbits through femoral artery ligation. In the past, however, there has been a strong disconnect between the success of preclinical studies and the failure of clinical trials regarding treatments for peripheral ischemia. Healthy animals typically have robust vascular regeneration in response to surgically induced ischemia, in contrast to the reduced vascularity and regeneration in patients with chronic peripheral ischemia. Here, we describe an optimized animal model for peripheral ischemia in rabbits that includes hyperlipidemia and diabetes. This model has reduced collateral formation and blood pressure recovery in comparison to a model with a higher cholesterol diet. Thus, the model may provide better correlation with human patients with compromised angiogenesis from the common co-morbidities that accompany peripheral vascular disease.

We describe a surgical procedure used to induce peripheral ischemia in rabbits with hyperlipidemia and diabetes. This surgery acts as a preclinical model for conditions experienced in peripheral artery disease in patients. Angiography is also described as a means to measure the extent of introduced ischemia and recovery of perfusion.

糖尿病家兔欣德肢体缺血的临床前模型

Peripheral vascular disease is a widespread clinical problem that affects millions of patients worldwide. A major consequence of peripheral vascular ...

Using a Chemical Biopsy for Graft Quality Assessment

Kidney transplantation is a life-saving treatment for a large number of people with end-stage renal dysfunction worldwide. The procedure is associated with an increased survival rate and greater quality of patient&#8217;s life when compared to conventional dialysis. Regrettably, transplantology suffers from a lack of reliable methods for organ quality assessment. Standard diagnostic techniques are limited to macroscopic appearance inspection or invasive tissue biopsy, which do not provide comprehensive information about the graft. The proposed protocol aims to introduce solid phase microextraction (SPME) as an ideal analytical method for comprehensive metabolomics and lipidomic analysis of all low molecular compounds present in kidneys allocated for transplantation. The small size of the SPME probe enables performance of a chemical biopsy, which enables extraction of metabolites directly from the organ without any tissue collection. The minimum invasiveness of the method permits execution of multiple analyses over time: directly after organ harvesting, during its preservation, and immediately after revascularization at the recipient&#8217;s body. It is hypothesized that the combination of this novel sampling method with a high-resolution mass spectrometer will allow for discrimination of a set of characteristic compounds that could serve as biological markers of graft quality and indicators of possible development of organ dysfunction.

The protocol presents utilization of the chemical biopsy approach followed by comprehensive metabolomic and lipidomic analysis for quality assessment of kidney grafts allocated for transplantation.

使用化学活检进行移植质量评估

Kidney transplantation is a life-saving treatment for a large number of people with end-stage renal dysfunction worldwide. The procedure is associated ...

Therapy Interventions for Upper Limb Amputees Undergoing Selective Nerve Transfers

Targeted Muscle Reinnervation (TMR) improves the biological control interface for myoelectric prostheses after above-elbow amputation. Selective activation of muscle units is made possible by surgically re-routing nerves, yielding a high number of independent myoelectric control signals. However, this intervention requires careful patient selection and specific rehabilitation therapy. Here a rehabilitation protocol is presented for high-level upper limb amputees undergoing TMR, based on an expert Delphi study. Interventions before surgery include detailed patient assessment and general measures for pain control, muscle endurance and strength, balance, and range of motion of the remaining joints. After surgery, additional therapeutic interventions focus on edema control and scar treatment and the selective activation of cortical areas responsible for upper limb control. Following successful&#160;reinnervation of target muscles, surface electromyographic (sEMG) biofeedback is used to train the activation of the novel muscular units. Later on, a table-top prosthesis may provide the first experience of prosthetic control. After fitting the actual prosthesis, training includes repetitive drills without objects, object manipulation, and finally, activities of daily living. Ultimately, regular patient appointments and functional assessments allow tracking prosthetic function and enabling early interventions if malfunctioning.

This work presents a protocol to enhance prosthetic function after selective nerve transfer surgery. Rehabilitation interventions include patient information and selection, support of wound healing, cortical re-activation of sensory-motor areas of the upper limb, training of selective muscle activation, prosthetic handling in daily life, and regular follow-up assessments.