Differences in Circadian Rhythmicity of Activity Levels by Functional Stroke Severity: A Cosinor Analysis

Faculty Mentor

Elena Crooks

Presentation Type

Poster

Start Date

4-14-2026 9:00 AM

End Date

4-14-2026 11:00 AM

Location

PUB NCR

Primary Discipline of Presentation

Physical Therapy

Abstract

BACKGROUND & PURPOSE: Neurobiological mechanisms of sleep-wake regulation hypothesize that greater neurological involvement post-stroke yields greater dysfunction in circadian rhythmicity; however, this has not yet been studied. This study compares circadian rhythmicity of motor activity by stroke severity. METHODS: Seventeen participants (aged 72.09 ± 12.69, 13.73 ± 6.47 days post-stroke) attending inpatient rehabilitation (IR) completed the study. Near IR admission, participants completed the Functional Independence Measure (FIM) and were categorized as having functional impairment of mild severity (MSev; FIM score >61) or severe severity (SSev; FIM score ≤61). Wrist actigraphy continuously measured activity counts (Philips Respironics, Actiware 6.3), averaged into 5-minute bins during baseline (BL; first 48 hours) and discharge (DC; final 48 hours, 6 days later). Nonlinear mixed-effects cosinor regression (SAS 9.4) compared circadian rhythmicity of activity for each stroke severity (MSev vs SSev), study period (BL vs DC) and their interaction. RESULTS: Cosinor analyses confirmed significant 24-hour rhythmicity at BL and DC for both severity groups (p< 0.001). There was a significant interaction of stroke severity by study period (p< 0.001). Amplitude showed no change for MSev (p=0.51), and significantly increased for SSev (p< 0.01) from BL to DC. There were no significant changes in acrophase. CONCLUSIONS: This is the first report to determine circadian rhythmicity in activity by stroke functional severity level. There was a significant 24-hour rhythm in motor activity at BL and DC for both MSev and SSev. Amplitude increased in SSev and not MSev, and there were no changes in peak activity across time.

Comments

Authors:

Elena Crooks, PT, DPT, PhDa, Kirsie R Lundholm, MSb, Amanda A. Higa, SPTa, John K. Zanze SPTa, Brieann C Satterfield, PhDb

aDepartment of Physical Therapy, Eastern Washington University, Spokane, WA
bDepartment of Translational Medicine and Physiology; Sleep and Performance Research Center, Washington State University, Spokane, WA

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Apr 14th, 9:00 AM Apr 14th, 11:00 AM

Differences in Circadian Rhythmicity of Activity Levels by Functional Stroke Severity: A Cosinor Analysis

PUB NCR

BACKGROUND & PURPOSE: Neurobiological mechanisms of sleep-wake regulation hypothesize that greater neurological involvement post-stroke yields greater dysfunction in circadian rhythmicity; however, this has not yet been studied. This study compares circadian rhythmicity of motor activity by stroke severity. METHODS: Seventeen participants (aged 72.09 ± 12.69, 13.73 ± 6.47 days post-stroke) attending inpatient rehabilitation (IR) completed the study. Near IR admission, participants completed the Functional Independence Measure (FIM) and were categorized as having functional impairment of mild severity (MSev; FIM score >61) or severe severity (SSev; FIM score ≤61). Wrist actigraphy continuously measured activity counts (Philips Respironics, Actiware 6.3), averaged into 5-minute bins during baseline (BL; first 48 hours) and discharge (DC; final 48 hours, 6 days later). Nonlinear mixed-effects cosinor regression (SAS 9.4) compared circadian rhythmicity of activity for each stroke severity (MSev vs SSev), study period (BL vs DC) and their interaction. RESULTS: Cosinor analyses confirmed significant 24-hour rhythmicity at BL and DC for both severity groups (p< 0.001). There was a significant interaction of stroke severity by study period (p< 0.001). Amplitude showed no change for MSev (p=0.51), and significantly increased for SSev (p< 0.01) from BL to DC. There were no significant changes in acrophase. CONCLUSIONS: This is the first report to determine circadian rhythmicity in activity by stroke functional severity level. There was a significant 24-hour rhythm in motor activity at BL and DC for both MSev and SSev. Amplitude increased in SSev and not MSev, and there were no changes in peak activity across time.