Upper-limb movement smoothness after stroke and its relationship with measures of body function/structure and activity - A cross-sectional study

Acute effect of dry needling on trunk kinematics and balance of patients with non-specific low back pain

BACKGROUND

Limited knowledge exists about the effectiveness of dry needling (DN) concerning the torso kinematics in patients with non-specific low back pain (NS-LBP). Acute effects of DN in NS-LBP patients from a functional perspective were investigated.

METHODS

Sixteen NS-LBP patients and 11 healthy individuals (HG) were examined. NS-LBP patients received a single session of DN at the lumbar region. Baseline and immediate post-treatment measurements during flexion-extension and lateral bending of the trunk were conducted for the NS-LBP patients. HG were measured only at baseline to be used as a reference of NS-LBP patients' initial condition. Algometry was applied in NS-LBP patients. Centre of pressure, range of motion of the trunk and its' derivatives were obtained.

FINDINGS

HG performed significantly faster, smoother and with greater mobility in the performed tasks compared to the pre intervention measurements of the NS-LBP patients. For the NS-LBP patients, significant greater angular velocity in frontal plane and significant lower jerk in the sagittal plane were demonstrated post intervention. DN alleviated pain tolerance significantly at the L5 level. Regarding the effectiveness of the DN upon spine kinematics, their derivatives were more sensitive.

INTERPRETATION

It appeared that the pathological type of torso movement was acutely affected by DN. NS-LBP patients showcased smoother movement immediately after the intervention and better control as imprinted in the higher derivative of motion although range of motion did not improve. This quantitative variable may not be subjected to acute effects of DN but rather need additional time and training to be improved.

Kinematic analysis in post-stroke patients with moderate to severe upper limb paresis and non-disabled controls

BACKGROUND

Kinematic analysis has been recommended to quantify the upper limb motor function after stroke. However, previous studies have rarely reported the kinematic data of the post-stroke patients with moderate to severe upper limb paresis due to the poor accomplishment of the complex tasks.

METHODS

27 post-stroke individuals and 20 non-disabled people participated in the study. The trunk and upper limb movements during the Hand-to-mouth task were captured by the motion capture system and upper extremity kinematic analysis software automatically. The subgroup analysis within stroke group were conducted layering by the Fugl-Meyer Assessment for Upper Extremity scores (severe: 16-31; moderate: 32-50).

FINDINGS

The paretic upper limbs in the stroke group tended to use more trunk and shoulder compensatory strategies to offset the impact of spasticity and weakness compared with non-disabled controls. The less-affected limbs in the stroke group also showed abnormal kinematic data. There were significant differences between the kinematic metrics of severe and moderate subgroups.

INTERPRETATION

The Hand-to-mouth task is a good and feasible option for kinematic analysis of these patients. It is essential to layer the severity of the paresis and put more emphasis on trunk movements in the future kinematic studies.

Validity and Reliability of POM-Checker for Measuring Shoulder Range of Motion in Healthy Participants: A Pilot Single-Center Comparative Study

BACKGROUND

The aim of this study was to compare shoulder movement measurements between a Kinect-based markerless ROM assessment device (POM-Checker) and a 3D motion capture analysis system (BTS SMART DX-400).

METHODS

This was a single-visit clinical trial designed to evaluate the validity and reliability of the POM-Checker. The primary outcome was to assess the equivalence between two measurement devices within the same set of participants, aiming to evaluate the validity of the POM-Checker compared to the gold standard device (3D Motion Analysis System). As this was a pilot study, six participants were included.

RESULTS

The intraclass correlation coefficient (ICC) and the corresponding 95% confidence intervals (CIs) were used to assess the reproducibility of the measurements. Among the 18 movements analyzed, 16 exhibited ICC values of >0.75, indicating excellent reproducibility.

CONCLUSION

The results showed that the POM-checker is reliable and validated to measure the range of motion of the shoulder joint.

Azure Kinect performance evaluation for human motion and upper limb biomechanical analysis

Human motion tracking is a valuable task for many medical applications. Marker-based optoelectronic systems are considered the gold standard in human motion tracking. However, their use is not always feasible in clinics and industrial environments. On the other hand, marker-less sensors became valuable tools, as they are inexpensive, noninvasive and easy to use. However, their accuracy can depend on many factors including sensor positioning, light conditions and body occlusions. In this study, following previous works on the feasibility of marker-less systems for human motion monitoring, we investigate the performance of the Microsoft Azure Kinect sensor in computing kinematic and dynamic measurements of static postures and dynamic movements. According to our knowledge, it is the first time that this sensor is compared with a Vicon marker-based system to assess the best camera positioning while observing the upper body part movements of people performing several tasks. Twenty-five healthy volunteers were monitored to evaluate the effects of the several testing conditions, including the Azure Kinect positions, the light conditions, and lower limbs occlusions, on the tracking accuracy of kinematic, dynamic, and motor control parameters. From the statistical analysis of the performed measurements, the camera in the frontal position was the most reliable, the lighting conditions had almost no effects on the tracking accuracy, while the lower limbs occlusion worsened the accuracy of the upper limbs. The assessment of human static postures and dynamic movements based on experimental data proves the feasibility of applying the Azure Kinect to the biomechanical monitoring of human motion in several fields.

A biomedical decision support system for meta-analysis of bilateral upper-limb training in stroke patients with hemiplegia

The purpose of this study is to investigate the efficacy of bilateral upper-limb training (BULT) in helping people with upper-limb impairments due to stroke or brain illness regain their previous level of function. Patients recuperating from a stroke or cerebral disease were given the option of undergoing BULT or conventional training to enhance their upper-limb function. Participants were randomly allocated to one of the several different fitness programs. Results from the action research arm test, Box and block test, Wolf motor function test, Fugal-Meyer evaluation, and any other tests administered were taken into account. Some researchers have found that exercising with BULT for just 30 min per day for 6 weeks yields significant results. There were a total of 1,411 individuals from 10 randomized controlled trials included in this meta-analysis. Meta-analysis findings revealed that biofeedback treatment outperformed conventional rehabilitation therapy in reducing lower leg muscular strain, complete spasm scale score, electromyography score, and inactive ankle joint range of motion. An analysis of the literature found that BULT improved limb use in people who had suffered a stroke and hemiplegia but it did not provide any additional benefit over unilateral training.

Effects of Upper Limb Robot-Assisted Rehabilitation Compared with Conventional Therapy in Patients with Stroke: Preliminary Results on a Daily Task Assessed Using Motion Analysis

Robotic rehabilitation of the upper limb has demonstrated promising results in terms of the improvement of arm function in post-stroke patients. The current literature suggests that robot-assisted therapy (RAT) is comparable to traditional approaches when clinical scales are used as outcome measures. Instead, the effects of RAT on the capacity to execute a daily life task with the affected upper limb are unknown, as measured using kinematic indices. Through kinematic analysis of a drinking task, we examined the improvement in upper limb performance between patients following a robotic or conventional 30-session rehabilitation intervention. In particular, we analyzed data from nineteen patients with subacute stroke (less than six months following stroke), nine of whom treated with a set of four robotic and sensor-based devices and ten with a traditional approach. According to our findings, the patients increased their movement efficiency and smoothness regardless of the rehabilitative approach. After the treatment (either robotic or conventional), no differences were found in terms of movement accuracy, planning, speed, or spatial posture. This research seems to demonstrate that the two investigated approaches have a comparable impact and may give insight into the design of rehabilitation therapy.

Do Higher Transcranial Direct Current Stimulation Doses Lead to Greater Gains in Upper Limb Motor Function in Post-Stroke Patients?

Objective: To investigate whether a higher number of transcranial direct current stimulation (tDCS) sessions results in a greater improvement in upper limb function in chronic post-stroke patients. Materials and methods: A randomized, sham-controlled, double-blind clinical trial was conducted in 57 chronic post-stroke patients (≥ 3 months after their injuries). The patients were allocated to receive sessions of tDCS combined with physiotherapy and divided into three groups (anodal, cathodal, and sham). The Fugl-Meyer Assessment of Upper Extremity (FMA-UE) was used to assess the sensorimotor impairment of the patients’ upper limbs before (baseline) and after five and ten sessions. The percentage of patients who achieved a clinically significant improvement (> five points on the FMA-UE) was also analyzed. Results: The FMA-UE score increased after five and ten sessions in both the anodal and cathodal tDCS groups, respectively, compared to the baseline. However, in the sham group, the FMA-UE score increased only after ten sessions. When compared to the sham group, the mean difference from the baseline after five sessions was higher in the anodal tDCS group. The percentage of individuals who achieved greater clinical improvement was higher in the stimulation groups than in the sham group and after ten sessions when compared to five sessions. Conclusions: Our results suggest that five tDCS sessions are sufficient to augment the effect of standard physiotherapy on upper limb function recovery in chronic post-stroke patients, and ten sessions resulted in greater gains.

Evaluation of Gait Smoothness in Patients with Stroke Undergoing Rehabilitation: Comparison between Two Metrics

The use of quantitative methods to analyze the loss in gait smoothness, an increase in movement intermittency which is a distinguishing hallmark of motor deficits in stroke patients, has gained considerable attention in recent years. In the literature, the spectral arc length (SPARC), as well as metrics based on the measurement of the jerk, such as the log dimensionless jerk (LDLJ), are currently employed to assess smoothness. However, the optimal measure for evaluating the smoothness of walking in stroke patients remains unknown. Here, we investigated the smoothness of the body's center of mass (BCoM) trajectory during gait, using an optoelectronic system, in twenty-two subacute and eight chronic patients before and after a two-month rehabilitation program. The two measures were evaluated for their discriminant validity (ability to differentiate the smoothness of the BCoM trajectory calculated on the cycle of the affected and unaffected limb, and between subacute and chronic patients), validity (correlation with clinical scales), and responsiveness to the intervention. According to our findings, the LDLJ outperformed the SPARC in terms of the examined qualities. Based on data gathered using an optoelectronic system, we recommend using the LDLJ rather than the SPARC to investigate the gait smoothness of stroke patients.

Updated Integrated Framework for Making Clinical Decisions Across the Lifespan and Health Conditions

The updated Integrated Framework for Clinical Decision Making responds to changes in evidence, policy, and practice since the publication of the first version in 2008. The original framework was proposed for persons with neurological health conditions, whereas the revised framework applies to persons with any health condition across the lifespan. In addition, the revised framework (1) updates patient-centered concepts with shared clinical decision-making; (2) frames the episode of care around the patient's goals for participation; (3) explicitly describes the role of movement science; (4) reconciles movement science and International Classification of Function language, illustrating the importance of each perspective to patient care; (5) provides a process for movement analysis of tasks; and (6) integrates the movement system into patient management. Two cases are used to illustrate the application of the framework: (1) a 45-year-old male bus driver with low back pain whose goals for the episode of care are to return to work and recreational basketball; and (2) a 65-year-old female librarian with a fall history whose goals for the episode of care are to return to work and reduce future falls. The framework is proposed as a tool for physical therapist education and to guide clinical practice for all health conditions across the lifespan.

Kinematic Evaluation via Inertial Measurement Unit Associated with Upper Extremity Motor Function in Subacute Stroke: A Cross-Sectional Study

Kinematic evaluation via portable sensor system has been increasingly applied in neurological sciences and clinical practice. However, conventional kinematic evaluation rarely extends the context beyond the motor impairment level. In addition, kinematic tasks with numerous items could be complex and time consuming that pose a burden to test applications and data processing. The study aimed to explore the correlation of finger-to-nose task (FNT) kinematics via Inertial Measurement Unit with upper limb motor function in subacute stroke. In this study, six FNT kinematic variables were used to measure movement time, smoothness, and velocity in 37 participants with subacute stroke. Upper limb motor function was evaluated with the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), and modified Barthel Index (MBI). As a result, mean velocity, peak velocity, and the number of movement units were associated with the clinical assessments. The multivariable linear regression models could estimate 55%, 51%, and 32% of variance in FMA-UE, ARAT, and MBI, respectively. In addition, age, gender, type of stroke, and paretic side had no significant effects on these associations. Results show that FNT kinematic variables measured via Inertial Measurement Unit are associated with upper extremity motor function in individuals with subacute stroke. The objective kinematic evaluation may be suitable for predicting clinical measures of motor impairment and capacity to understand upper extremity motor recovery and clinical decision making after stroke. This trial is registered with ChiCTR1900026656.

Association Between Finger-to-Nose Kinematics and Upper Extremity Motor Function in Subacute Stroke: A Principal Component Analysis

Background

Kinematic analysis facilitates interpreting the extent and mechanisms of motor restoration after stroke. This study was aimed to explore the kinematic components of finger-to-nose test obtained from principal component analysis (PCA) and the associations with upper extremity (UE) motor function in subacute stroke survivors.

Methods

Thirty-seven individuals with subacute stroke and twenty healthy adults participated in the study. Six kinematic metrics during finger-to-nose task (FNT) were utilized to perform PCA. Clinical assessments for stroke participants included the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), and Modified Barthel Index (MBI).

Results

Three principal components (PC) accounting for 91.3% variance were included in multivariable regression models. PC1 (48.8%) was dominated by mean velocity, peak velocity, number of movement units (NMU) and normalized integrated jerk (NIJ). PC2 (31.1%) described percentage of time to peak velocity and movement time. PC3 (11.4%) profiled percentage of time to peak velocity. The variance explained by principal component regression in FMA-UE (R² = 0.71) were higher than ARAT (R² = 0.59) and MBI (R² = 0.29) for stroke individuals.

Conclusion

Kinematic components during finger-to-nose test identified by PCA are associated with UE motor function in subacute stroke. PCA reveals the intrinsic association among kinematic metrics, which may add value to UE assessment and future intervention targeted for kinematic components for stroke individuals.

Clinical Trial Registration

Chinese Clinical Trial Registry (http://www.chictr.org.cn/) on 17 October 2019, identifier: ChiCTR1900026656.

Evaluating Rehabilitation Progress Using Motion Features Identified by Machine Learning

Evaluating progress throughout a patient's rehabilitation episode is critical for determining the effectiveness of the selected treatments and is an essential ingredient in personalised and evidence-based rehabilitation practice. The evaluation process is complex due to the inherently large human variations in motor recovery and the limitations of commonly used clinical measurement tools. Information recorded during a robot-assisted rehabilitation process can provide an effective means to continuously quantitatively assess movement performance and rehabilitation progress. However, selecting appropriate motion features for rehabilitation evaluation has always been challenging. This paper exploits unsupervised feature learning techniques to reduce the complexity of building the evaluation model of patients' progress. A new feature learning technique is developed to select the most significant features from a large amount of kinematic features measured from robotics, providing clinically useful information to health practitioners with reduction of modeling complexity. A novel indicator that uses monotonicity and trendability is proposed to evaluate kinematic features. The data used to develop the feature selection technique consist of kinematic data from robot-aided rehabilitation for a population of stroke patients. The selected kinematic features allow for human variations across a population of patients as well as over the sequence of rehabilitation sessions. The study is based on data records pertaining to 41 stroke patients using three different robot assisted exercises for upper limb rehabilitation. Consistent with the literature, the results indicate that features based on movement smoothness are the best measures among 17 kinematic features suitable to evaluate rehabilitation progress.

Validation of Yonsei-Bilateral Activity Test (Y-BAT)-Bilateral Upper Extremity Inventory Using Rasch Analysis

There is little assessment to provide specific information about quality of bilateral upper extremity movement specifically. This study examined the psychometric properties of the Yonsei-Bilateral Activity Test (Y-BAT). An observational cross-sectional design was used with 100 stroke survivors. Unidimensionality was examined using factor analyses, and Rasch analysis was used to test rating scale structure, fit statistics, and precision of the Y-BAT. The Y-BAT demonstrated a unidimensional measurement construct, and 19 of the 27 items fit the Rasch model. The instrument demonstrated good precision, including person reliability and person strata. The Y-BAT estimated person measures within a wide range of theta values with a reliability of .9 with good precision. Our results indicate that a revised, 19-item version of the Y-BAT demonstrates sound internal validity and may be a useful instrument for clinicians to measure upper extremity function with good precision following stroke.