Evaluation of velocity-dependent performance of the spastic elbow during voluntary movements

Characterization of the Stroke-Induced Changes in the Variability and Complexity of Handgrip Force

Introduction: The variability and complexity of handgrip forces in various modulations were investigated to identify post-stroke changes in force modulation, and extend our understanding of stroke-induced deficits. Methods: Eleven post-stroke subjects and ten age-matched controls performed voluntary grip force control tasks (power-grip tasks) at three contraction levels, and stationary dynamometer holding tasks (stationary holding tasks). Variability and complexity were described with root mean square jerk (RMS-jerk) and fuzzy approximate entropy (fApEn), respectively. Force magnitude, Fugl-Meyer upper extremity assessment and Wolf motor function test were also evaluated. Results: Comparing the affected side with the controls, fApEn was significantly decreased and RMS-jerk increased across the three levels in power-grip tasks, and fApEn was significantly decreased in stationary holding tasks. There were significant strong correlations between RMS-jerk and clinical scales in power-grip tasks. Discussion: Abnormal neuromuscular control, altered mechanical properties, and atrophic motoneurons could be the main causes of the differences in complexity and variability in post-stroke subjects.

Objective Evaluation of the Quality of Movement in Daily Life after Stroke

Background

Stroke survivors are commonly left with disabilities that impair activities of daily living. The main objective of their rehabilitation program is to maximize the functional performance at home. However, the actual performance of patients in their home environment is unknown. Therefore, objective evaluation of daily life activities of stroke survivors in their physical interaction with the environment is essential for optimal guidance of rehabilitation therapy. Monitoring daily life movements could be very challenging, as it may result in large amounts of data, without any context. Therefore, suitable metrics are necessary to quantify relevant aspects of movement performance during daily life. The objective of this study is to develop data processing methods, which can be used to process movement data into relevant metrics for the evaluation of intra-patient differences in quality of movements in a daily life setting.

Methods

Based on an iterative requirement process, functional and technical requirements were formulated. These were prioritized resulting in a coherent set of metrics. An activity monitor was developed to give context to captured movement data at home. Finally, the metrics will be demonstrated in two stroke participants during and after their rehabilitation phases.

Results

By using the final set of metrics, quality of movement can be evaluated in a daily life setting. As example to demonstrate potential of presented methods, data of two stroke patients were successfully analyzed. Differences between in-clinic measurements and measurements during daily life are observed by applying the presented metrics and visualization methods. Heel height profiles show intra-patient differences in height, distance, stride profile, and variability between strides during a 10-m walk test in the clinic and walking at home. Differences in distance and stride profile between both feet were larger at home, than in clinic. For the upper extremities, the participant was able to reach further away from the pelvis and cover a larger area.

Discussion

Presented methods can be used for the objective evaluation of intra-patient differences in movement quality between in-clinic and daily life measurements. Any observed progression or deterioration of movement quality could be used to decide on continuing, stopping, or adjusting rehabilitation programs.

Sensorimotor control of tracking movements at various speeds for stroke patients as well as age-matched and young healthy subjects

There are aging- and stroke-induced changes on sensorimotor control in daily activities, but their mechanisms have not been well investigated. This study explored speed-, aging-, and stroke-induced changes on sensorimotor control. Eleven stroke patients (affected sides and unaffected sides) and 20 control subjects (10 young and 10 age-matched individuals) were enrolled to perform elbow tracking tasks using sinusoidal trajectories, which included 6 target speeds (15.7, 31.4, 47.1, 62.8, 78.5, and 94.2 deg/s). The actual elbow angle was recorded and displayed on a screen as visual feedback, and three indicators, the root mean square error (RMSE), normalized integrated jerk (NIJ) and integral of the power spectrum density of normalized speed (IPNS), were used to investigate the strategy of sensorimotor control. Both NIJ and IPNS had significant differences among the four groups (P<0.01), and the values were ranked in the following order: young controls < age-matched controls Collapse

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MESH Headings

• Adult
• Case-Control Studies
• Elbow/physiopathology
• Female
• Humans
• Male
• Middle Aged
• Movement/physiology
• Psychomotor Performance/physiology
• Stroke/physiopathology
• Young Adult

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Grants Collapse

Affiliation(s)

Di Ao School of Engineering, Sun Yat-sen University, Guangzhou, Guang Dong, P. R. China Key Laboratory of Sensing Technology and Biomedical Instrument of GuangDong province, Guangzhou, Guang Dong, P. R. China
Rong Song School of Engineering, Sun Yat-sen University, Guangzhou, Guang Dong, P. R. China Key Laboratory of Sensing Technology and Biomedical Instrument of GuangDong province, Guangzhou, Guang Dong, P. R. China
Kai-yu Tong Division of Biomedical Engineering, Department of Electronic Engineering, the Chinese University of Hong Kong, Hong Kong, China

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Excellent test-retest and inter-rater reliability for Tardieu Scale measurements with inertial sensors in elbow flexors of stroke patients

BACKGROUND

Spasticity is often clinically assessed with the Tardieu Scale, using goniometry to measure the range of motion and angle of catch. However, the test-retest and inter-rater reliability of these measurements have been questioned. Inertial sensors (IS) have been developed to measure orientation in space and are suggested to be a more appropriate tool than goniometry to measure angles in Tardieu Scale measurements.

OBJECTIVE

To compare the test-retest and inter-rater reliability of Tardieu Scale scores measured with IS and goniometry.

METHODS

Two physiotherapists performed Tardieu Scale measurements in two sessions, using both goniometry and IS, to quantify spasticity in elbow flexors of 13 stroke patients.

RESULTS

For goniometry, test-retest and inter-rater reliability proved to be excellent (ICC 0.86) and fair to good (ICC 0.66), respectively. For IS, both test-retest (ICC 0.76) and inter-rater reliability (ICC 0.84) were excellent.

CONCLUSIONS

Inertial sensors are reliable and accurate to use in Tardieu Scale measurements to quantify spasticity in the elbow flexors of hemiplegic stroke patients.