The effects of speed of execution on upper-limb kinematics in activities of daily living with respect to age

Immersive Virtual Reality to Assess Arm Kinematics among Older Adults with and without Major Neurocognitive Disorder - An Exploratory Cross-Sectional Study

Despite the recommendation of improving assessment objectivity and frequency, the use of immersive virtual reality to measure and quantify movement quality remains underexplored. In this study, we aimed to evaluate the reliability, validity and usability of an immersive virtual reality application, KinematicsVR, to assess upper limb kinematics among older adults with and without major neurocognitive disorder. The KinematicsVR involves the drawing of three-dimensional straight lines, circles and squares using a controller in a virtual environment. Twenty-eight older adults with or without major neurocognitive disorder were recruited. Reliability was evaluated through correlations on test-retest and validity through correlations between KinematicsVR variables and other functional tests (TEMPA, BBT-VR and Finger-Nose Test). The usability of the KinematicsVR was assessed with the System Usability Scale questionnaire. Kinematic indexes were compared between eight adults with major neurocognitive disorder and eight matched controls. Results indicated that most variables provided by the KinematicsVR had excellent reliability for tasks involving the drawing of straight lines and circles, but moderate reliability for tasks involving the drawing of squares. Secondary analyses showed that the usability of the application was excellent but few significant and strong correlations were observed between variables of the KinematicsVR and the scores of the TEMPA scale, Finger-Nose Test and BBT-VR. Adults with major neurocognitive disorder, when compared to other older adults, made larger and less linear hand movements. These findings provide perspectives for the use of immersive virtual reality to improve assessment frequency and objectivity through the autonomous measure of upper limb kinematics in older adults.

Going beyond PA: Assessing sensorimotor capacity with wearables in multiple sclerosis-a cross-sectional study

BACKGROUND

Wearable technologies are currently clinically used to assess energy expenditure in a variety of populations, e.g., persons with multiple sclerosis or frail elderly. To date, going beyond physical activity, deriving sensorimotor capacity instead of energy expenditure, is still lacking proof of feasibility.

METHODS

In this study, we read out sensors (accelerometer and gyroscope) of smartwatches in a sample of 90 persons with multiple sclerosis over the course of one day of everyday life in an inpatient setting. We derived a variety of different kinematic parameters, in addition to lab-based tests of sensorimotor performance, to examine their interrelation by principal component, cluster, and regression analyses.

RESULTS

These analyses revealed three components of behavior and sensorimotor capacity, namely clinical characteristics with an emphasis on gait, gait-related physical activity, and upper-limb related physical activity. Further, we were able to derive four clusters with different behavioral/capacity patterns in these dimensions. In a last step, regression analyses revealed that three selected smartwatch derived kinematic parameters were able to partially predict sensorimotor capacity, e.g., grip strength and upper-limb tapping.

CONCLUSIONS

Our analyses revealed that physical activity can significantly differ between persons with comparable clinical characteristics and that assessments of physical activity solely relying on gait can be misleading. Further, we were able to extract parameters that partially go beyond physical activity, with the potential to be used to monitor the course of disease progression and rehabilitation, or to early identify persons at risk or a sub-clinical threshold of disease severity.

Age-related changes in mobility assessments correlate with repetitive goal-directed arm-movement performance

BACKGROUND

There is ample evidence that mobility abilities between healthy young and elderly people differ. However, we do not know whether these differences are based on different lower leg motor capacity or instead reveal a general motor condition that could be detected by monitoring upper-limb motor behavior. We therefore captured body movements during a standard mobility task, namely the Timed Up and Go test (TUG) with subjects following different instructions while performing a rapid, repetitive goal-directed arm-movement test (arm-movement test). We hypothesized that we would be able to predict gait-related parameters from arm motor behavior, even regardless of age.

METHODS

Sixty healthy individuals were assigned to three groups (young: mean 26 ± 3 years, middle-aged 48 ± 9, old 68 ± 7). They performed the arm-movement and TUG test under three conditions: preferred (at preferred movement speed), dual-task (while counting backwards), and fast (at fast movement speed). We recorded the number of contacts within 20 s and the TUG duration. We also extracted TUG walking sequences to analyze spatiotemporal gait parameters and evaluated the correlation between arm-movement and TUG results.

RESULTS

The TUG condition at preferred speed revealed differences in gait speed and step length only between young and old, while dual-task and fast execution increased performance differences significantly among all 3 groups. Our old group's gait speed decreased the most doing the dual-task, while the young group's gait speed increased the most during the fast condition. As in our TUG results, arm-movements were significant faster in young than in middle-aged and old. We observed significant correlations between arm movements and the fast TUG condition, and that the number of contacts closely predicts TUG timefast and gait speedfast. This prediction is more accurate when including age.

CONCLUSION

We found that the age-related decline in mobility performance that TUG reveals strongly depends on the test instruction: the dual-task and fast condition clearly strengthened group contrasts. Interestingly, a fast TUG performance was predictable by the performance in a fast repetitive goal-directed arm-movements test, even beyond the age effect. We assume that arm movements and the fast TUG condition reflect similarly reduced motor function.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS) number: DRKS00016999, prospectively registered on March, 26, 2019.

Auditory cueing facilitates temporospatial accuracy of sequential movements

Effectively executing goal-directed behaviours requires both temporal and spatial accuracy. Previous work has shown that providing auditory cues enhances the timing of upper-limb movements. Interestingly, alternate work has shown beneficial effects of multisensory cueing (i.e., combined audiovisual) on temporospatial motor control. As a result, it is not clear whether adding visual to auditory cues can enhance the temporospatial control of sequential upper-limb movements specifically. The present study utilized a sequential pointing task to investigate the effects of auditory, visual, and audiovisual cueing on temporospatial errors. Eighteen participants performed pointing movements to five targets representing short, intermediate, and large movement amplitudes. Five isochronous auditory, visual, or audiovisual priming cues were provided to specify an equal movement duration for all amplitudes prior to movement onset. Movement time errors were then computed as the difference between actual and predicted movement times specified by the sensory cues, yielding delta movement time errors (ΔMTE). It was hypothesized that auditory-based (i.e., auditory and audiovisual) cueing would yield lower movement time errors compared to visual cueing. The results showed that providing auditory relative to visual priming cues alone reduced ΔMTE particularly for intermediate amplitude movements. The results further highlighted the beneficial impact of unimodal auditory cueing for improving visuomotor control in the absence of significant effects for the multisensory audiovisual condition.

Systematic Review on the Applicability of Principal Component Analysis for the Study of Movement in the Older Adult Population

Principal component analysis (PCA) is a dimensionality reduction method that has identified significant differences in older adults' motion analysis previously not detected by the discrete exploration of biomechanical variables. This systematic review aims to synthesize the current evidence regarding PCA use in the study of movement in older adults (kinematics and kinetics), summarizing the tasks and biomechanical variables studied. From the search results, 1685 studies were retrieved, and 19 studies were included for review. Most of the included studies evaluated gait or quiet standing. The main variables considered included spatiotemporal parameters, range of motion, and ground reaction forces. A limited number of studies analyzed other tasks. Further research should focus on the PCA application in tasks other than gait to understand older adults' movement characteristics that have not been identified by discrete analysis.

Kinematic analysis of activities of daily living performance in frail elderly

Background

Frailty is accompanied by limitations of activities of daily living (ADL) and frequently associated with reduced quality of life, institutionalization, and higher health care costs. Despite the importance of ADL performance for the consequence of frailty, movement analyses based on kinematic markers during the performance of complex upper extremity-based manual ADL tasks in frail elderly is still pending.

The main objective of this study was to evaluate if ADL task performance of two different tasks in frail elderlies can be assessed by an activity measurement based on an acceleration sensor integrated into a smartwatch, and further to what degree kinematic parameters would be task independent.

Methods

ADL data was obtained from twenty-seven elderly participants (mean age 81.6 ± 7.0 years) who performed two ADL tasks. Acceleration data of the dominant hand was collected using a smartwatch. Participants were split up in three groups, F (frail, n = 6), P (pre-frail, n = 13) and R (robust, n = 8) according to a frailty screening. A variety of kinematic measures were calculated from the vector product reflecting activity, agility, smoothness, energy, and intensity.

Results

Measures of agility, smoothness, and intensity revealed significant differences between the groups (effect sizes combined over tasks η²_p = 0.18 – 0.26). Smoothness was particularly affected by frailty in the tea making task, while activity, agility, a different smoothness parameter and two intensity measures were related to frailty in the gardening task. Four of nine parameters revealed good reliability over both tasks (r = 0.44 – 0.69). Multiple linear regression for the data combined across tasks showed that only the variability of the magnitude of acceleration peaks (agility) contributed to the prediction of the frailty score (R² = 0.25).

Conclusion

The results demonstrate that ADL task performance can be assessed by smartwatch-based measures and further shows task-independent differences between the three levels of frailty. From the pattern of impaired and preserved performance parameters across the tested tasks, we concluded that in persons with frailty ADL performance was more impaired by physiological deficiencies, i.e., physical power and endurance, than by cognitive functioning or sensorimotor control.

State and trait of finger tapping performance in multiple sclerosis

Finger tapping tests have been shown feasible to assess motor performance in multiple sclerosis (MS) and were observed to be strongly associated with the estimated clinical severity of the disease. Therefore, tapping tests could be an adequate tool to assess disease status in MS. In this study we examined potential influencing factors on a maximum tapping task with the whole upper-limb for 10 s in 40 MS patients using linear mixed effects modelling. Patients were tested in three sessions with two trials per body-side per session over the course of 4–27 days of inpatient rehabilitation. Tested factors were the expanded disability scale (EDSS) score, laterality of MS, age, sex, hand dominance, time of day, session, trial (first or second), time between sessions, and the reported day form. A second model used these factors to examine the self-reported day form of patients. Linear mixed effects modelling indicated the tapping test to have a good inter-trial (proportional variance < 0.01) and inter-session reliability (non-significant; when controlling for time between sessions), an influence of hand-dominance (proportional variance 0.08), to be strongly associated with the EDSS (eta² = 0.22, interaction with laterality of MS eta² = 0.12) and to be not associated with the reported day form. The model explained 87% (p < 0.01) of variance in tapping performance. Lastly, we were able to observe a positive effect of neurologic inpatient rehabilitation on task performance obvious from a significant effect of the time between sessions (eta² = 0.007; longer time spans between sessions were associated with higher increments in performance). Day form was only impacted by EDSS and the time of the day (p < 0.01, R² = 0.57, eta²_TIME = 0.017, eta²_EDSS = 01.19). We conclude that the tapping test is a reliable and valid assessment tool for MS.

Impairment and Compensation in Dexterous Upper-Limb Function After Stroke. From the Direct Consequences of Pyramidal Tract Lesions to Behavioral Involvement of Both Upper-Limbs in Daily Activities

Impairments in dexterous upper limb function are a significant cause of disability following stroke. While the physiological basis of movement deficits consequent to a lesion in the pyramidal tract is well demonstrated, specific mechanisms contributing to optimal recovery are less apparent. Various upper limb interventions (motor learning methods, neurostimulation techniques, robotics, virtual reality, and serious games) are associated with improvements in motor performance, but many patients continue to experience significant limitations with object handling in everyday activities. Exactly how we go about consolidating adaptive motor behaviors through the rehabilitation process thus remains a considerable challenge. An important part of this problem is the ability to successfully distinguish the extent to which a given gesture is determined by the neuromotor impairment and that which is determined by a compensatory mechanism. This question is particularly complicated in tasks involving manual dexterity where prehensile movements are contingent upon the task (individual digit movement, grasping, and manipulation…) and its objective (placing, two step actions…), as well as personal factors (motivation, acquired skills, and life habits…) and contextual cues related to the environment (presence of tools or assistive devices…). Presently, there remains a lack of integrative studies which differentiate processes related to structural changes associated with the neurological lesion and those related to behavioral change in response to situational constraints. In this text, we shall question the link between impairments, motor strategies and individual performance in object handling tasks. This scoping review will be based on clinical studies, and discussed in relation to more general findings about hand and upper limb function (manipulation of objects, tool use in daily life activity). We shall discuss how further quantitative studies on human manipulation in ecological contexts may provide greater insight into compensatory motor behavior in patients with a neurological impairment of dexterous upper-limb function.

Effect of Age on the Touchscreen Manipulation Ability of Community-Dwelling Adults

Assessment of touchscreen manipulation skills is essential for determining the abilities of older individuals and the extent to which they may benefit from this technology as a means to enhance participation, self-esteem, and quality of life. The aim of this study was to compare the touchscreen manipulation ability between community-dwelling older adults and middle-aged adults using a newly developed Touchscreen Assessment Tool (TATOO) and to determine the usability of this instrument. Convenience samples of two age groups were considered, one including 28 independent community-living older adults aged 81.9 ± 4.2 years with intact or corrected vision and with the abilities to walk independently with or without a walking aid and to understand and follow simple commands, and the other including 25 healthy middle-age adults aged 53.4 ± 5.9 years. The usability assessment was conducted during a single session using the System Usability Scale (SUS). Older adults demonstrated poorer touchscreen skills compared to middle-aged adults. Previous experience in manipulating a smartphone by the older adults did not affect their performance. The SUS results indicated good usability of the TATOO by both age groups. The TATOO shows promise as a user-friendly tool for assessing the specific skills needed to operate touchscreens. The outcomes of this study support the suitability of touchscreen devices and applications as well as the need for adapted accessibility for older adults. Researchers and clinicians will benefit from the availability of a rapid, low-cost, and objective tool to assess the skills required for touchscreen use.

Assessment of cognitive instrumental activities of daily living: a systematic review

PURPOSE

Cognitive instrumental activities of daily living are particularly related to executive functions, such as scheduling appointments, monthly payments, managing the household economy, shopping or taking the bus. The aim of this systematic review was to determine the available tests for the assessment of executive functions with ecological validity to predict individuals' functioning.

MATERIALS AND METHODS

An electronic search was conducted in MEDLINE, Cochrane Central, PsyCInfo and IEEE Xplore until May 2019, in addition to a manual search. The PRISMA criteria and the Covidence platform were used to select articles and extract data.

RESULTS

After applying the search selection criteria, 76 studies were identified. They referred to 110 tools to assess instrumental activities of daily living. Those that have received most attention are related to menu preparation and shopping. Performance-based measures are the most widely used traditional methods. Most tests were aimed at the adult population with acquired brain damage, cognitive impairment or dementia. There was a predominance of tests based on the Multiple Errands Test paradigm.

CONCLUSIONS

In recent years, it has increased the number of tools that assess the instrumental activities of daily living based on technologies such as personal or environmental sensors and serious games.IMPLICATIONS FOR REHABILITATIONAssessment of Instrumental Activities of Daily Living through performance-based measures is especially useful for the early detection of dysfunctions or preclinical disability.Difficulties in performing instrumental activities of daily living are closely associated with deficits in executive functions and prospective memory.Activities of Daily Living can be understood as multitasks.The use of virtual reality-based tests was shown to be sensitive to the detection of cognitive deficits in Activities of Daily Living.An advantage of using virtual reality in assessments is that it can help to predict the level of personal autonomy in patients who are in an institutional environment and could be a first approximation to the real environment.