Article
Actigraphic Measurement of the Upper Limbs for the Prediction
of Ischemic Stroke Prognosis: An Observational Study
Giuseppe Reale
1,2
, Silvia Giovannini
3,
*, Chiara Iacovelli
3
, Stefano Filippo Castiglia
4
, Pietro Picerno
5
,
Aurelia Zauli
1
, Marco Rabuffetti
6
, Maurizio Ferrarin
6
, Giulio Maccauro
1
and Pietro Caliandro
7
Citation: Reale, G.; Giovannini, S.;
Iacovelli, C.; Castiglia, S.F.; Picerno, P.;
Zauli, A.; Rabuffetti, M.; Ferrarin, M.;
Maccauro, G.; Caliandro, P.
Actigraphic Measurement of the
Upper Limbs for the Prediction of
Ischemic Stroke Prognosis: An
Observational Study. Sensors 2021, 21,
2479. https://doi.org/10.3390/
s21072479
Academic Editor: Angelo
Maria Sabatini
Received: 31 January 2021
Accepted: 30 March 2021
Published: 2 April 2021
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1
Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore, L. Go F. Vito,
1-00168 Rome, Italy; giuseppe.reale@policlinicogemelli.it (G.R.); aureliazauli@gmail.com (A.Z.);
giulio.maccauro@policlinicogemelli.it (G.M.)
2
Unità Operativa Complessa Neuroriabilitazione ad Alta Intensità, Largo A. Gemelli, Fondazione Policlinico
Universitario A. Gemelli IRCCS, 8-00168 Rome, Italy
3
Unità Operativa Complessa Medicina Fisica e Riabilitazione, Largo A. Gemelli, Fondazione Policlinico
Universitario A. Gemelli IRCCS, 8-00168 Rome, Italy; chiara.iacovelli@policlinicogemelli.it
4
Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome,
Polo Pontino, Viale XXIV Maggio, 7-04100 Latina, Italy; stefanofilippo.castiglia@uniroma1.it
5
SMART Engineering Solutions & Technologies Research Center, Università Telematica “e-Campus”,
Via Isimbardi, 10-22060 Novedrate, Italy; pietro.picerno@uniecampus.it
6
Biomedical Technology Department, IRCCS Fondazione Don Carlo Gnocchi, Via Capecelatro,
66-20148 Milan, Italy; mrabuffetti@dongnocchi.it (M.R.); mferrarin@dongnocchi.it (M.F.)
7
Unità Operativa Neurologia, Largo A, Fondazione Policlinico Universitario A. Gemelli IRCCS, Gemelli,
8-00168 Rome, Italy; pietro.caliandro@policlinicogemelli.it
* Correspondence: silvia.giovannini@policlinicogemelli.it; Tel.: +39-0630-155-553
Abstract:
Background: It is often challenging to formulate a reliable prognosis for patients with acute
ischemic stroke. The most accepted prognostic factors may not be sufficient to predict the recovery
process. In this view, describing the evolution of motor deficits over time via sensors might be
useful for strengthening the prognostic model. Our aim was to assess whether an actigraphic-based
parameter (Asymmetry Rate Index for the 24 h period (AR2_24 h)) obtained in the acute stroke phase
could be a predictor of a 90 d prognosis. Methods: In this observational study, we recorded and
analyzed the 24 h upper limb movement asymmetry of 20 consecutive patients with acute ischemic
stroke during their stay in a stroke unit. We recorded the motor activity of both arms using two
programmable actigraphic systems positioned on patients’ wrists. We clinically evaluated the stroke
patients by NIHSS in the acute phase and then assessed them across 90 days using the modified
Rankin Scale (mRS). Results: We found that the AR2_24 h parameter positively correlates with the
90 d mRS (r = 0.69, p < 0.001). Moreover, we found that an AR2_24 h > 32% predicts a poorer outcome
(90 d mRS > 2), with sensitivity = 100% and specificity = 89%. Conclusions: Sensor-based parameters
might provide useful information for predicting ischemic stroke prognosis in the acute phase.
Keywords: cerebrovascular diseases; ischemic stroke; prognosis; actigraphy; inertial sensors
1. Introduction
Stroke is the second-leading cause of death and the third-leading cause of disability
worldwide [
1
]. Although mortality has decreased in past decades, the global burden of
stroke (per year incidence, disability-adjusted life-years) is still great and growing, posing
a significant challenge to national health systems, who will have to face this challenge in
future years [
2
]. Moreover, during the acute and subacute phase, it is often difficult to
formulate a reliable prognosis in terms of 90 d disability. In daily clinical practice, patients
with strokes of a similar clinical severity and risk profile can have very different clinical
outcomes, even when receiving the same acute treatment. This might have a considerable
impact on therapeutic choices and resource allocation, such as rehabilitation programs. We
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