A novel taxonomy to assess dressing activity in chronic stroke

Upper-body dressing (UBD) is a key aspect of motor rehabilitation after stroke, but most individuals with stroke require long-term dressing assistance. Having a measurement approach that captures the quantity and quality of dressing movements during training could support more targeted strategies. As the basis of an approach, we modified our previously developed motion taxonomy, which categorizes elemental motions into classes of functional primitives (e.g. reaches, transports, stabilizations). Three expert coders examined videos of two healthy subjects performing dressing tasks, and expanded the taxonomy to account for the unique arm and trunk motions of UBD. An expert and a trained coder then applied the expanded taxonomy to dressing videos of five chronic stroke subjects. We examined the interrater reliability (IRR) for classifying primitives. Using the expanded taxonomy, IRR for identifying primitives in UBD was overall low (k = 0.52) but varied by primitive class: IRR was moderate for reach (k = 0.75), transport (k = 0.63), and idle (k = 0.68), lower for reposition (k = 0.58), and negligible for stabilization (k = -0.02). IRR increased with increasing UE-FMA score ({rho}=1, p<0.0001), indicating that the reliability of primitive classification improved with less impaired movement. With additional modification, the expanded taxonomy could support the measurement of training doses and impaired motion during dressing activities.