A Kinect-based upper limb rehabilitation system to assist people with cerebral palsy

Quantitative assessment of human motion for health and rehabilitation: A novel fuzzy comprehensive evaluation approach

In the pursuit of advancing health and rehabilitation, the quintessence of human motion recognition technology has been underscored through its quantitative contributions to physical performance assessment. This research delineates the inception of a novel fuzzy comprehensive evaluation-based recognition method that stands at the forefront of such innovative endeavours. By synergistically fusing multi-sensor data and advanced classification algorithms, the proposed system offers a granular quantitative analysis with implications for health and fitness monitoring, particularly rehabilitation processes. Our methodological approach, grounded in the modal separation technique and Empirical Mode Decomposition (EMD), effectively distills the motion acceleration component from raw accelerometer data, facilitating the extraction of intricate motion patterns. Quantitative analysis revealed that our integrated framework significantly amplifies the accuracy of motion recognition, achieving an overall recognition rate of 90.03 %, markedly surpassing conventional methods, such as Support Vector Machines (SVM), Decision Trees (DT), and K-Nearest Neighbors (KNN), which hovered around 80 %. Moreover, the system demonstrated an unprecedented accuracy of 97 % in discerning minor left-right swaying motions, showcasing its robustness in evaluating subtle movement nuances-a paramount feature for rehabilitation and patient monitoring. This marked precision in motion recognition heralds a new paradigm in health assessment, enabling objective and scalable analysis pertinent to individualized therapeutic interventions. The experimental evaluation accentuates the system's adeptness at navigating the dichotomy between complex, intense motions and finer, subtler movements with a high fidelity rate. It substantiates the method's utility in delivering sophisticated, data-driven insights for rehabilitation trajectory monitoring.

A Scoping Review of the Serious Game-Based Rehabilitation of People with Cerebral Palsy

In a serious context, individuals with Cerebral Palsy (CP) have limited opportunities to engage in social interaction experiences. Through a review, this study provides an explanation and improved evidence of the methods for rehabilitation in games used in serious contexts for people with CP. Articles published from 2010 to 2022 focusing on serious game-based rehabilitation for people with CP are extracted from MEDILINE, Academic Search Ultimate, CINAHL, and the Web of Science. The articles were assessed based on the McMaster critical review form. This study analyzes the frequencies of goal and assessment tools according to the components using the International Classification of Functioning, Disability and Health (ICF). The evidence of all the studies is presented according to the principles of Population, Intervention, Comparison, Outcome (PICO) to organize the evidence. A total of 19 articles were selected. Five articles involved Randomized Controlled Trials (RCTs), six articles involved non-randomized one-group designs, three articles involved single experimental study designs, and five articles were case report designs. In the selected articles, the average score on the McMaster critical review form was 11.8 points. In the game-based rehabilitation for CP, more articles reported goals and assessment tools focusing on body function than goals and assessment tools focusing on activity and participation, according to the ICF. These findings provide a record of past work and identify the evidence to support the application of game-based rehabilitation for people with CP.

Personalisation of a virtual gaming system for children with motor impairments: performance and usability

PURPOSE

To demonstrate the potential role of virtual game personalisation for use as a therapeutic modality to improve upper extremity function in children with cerebral palsy (CP).

METHODS

The study tested a convenience sample of 60 typically developing children (TD) aged 6-10 years and 20 children with CP aged 7-11 years. Children participated in a single 30-min session when they played the game in accuracy mode (virtual targets are hit as they become progressively larger or smaller) or dwell mode (virtual targets are hit when the users remains on them for progressively shorter or longer durations). These two modes can be played in conventional (non-personalised), personalised and with and without arm weights conditions; weights were used for the TD group in order to ensure that game play would be sufficiently challenging as to require personalisation. We measured performance variables (frequency of changes in game level difficulty and accuracy as measured by percent success of hitting the virtual targets) in each condition and usability variables (self-reported perceived effort and enjoyment).

RESULTS

Comparisons between the usability of the conventional and personalised conditions among typically developing children showed that although children self-reported significantly more effort while playing the personalised game, the level of enjoyment remained high (no significant differences between conventional and personalised game play conditions). In addition, comparisons between playing the personalised game with and without weights by typically developing children, indicated that percent success was significantly higher for the game played without weights, suggesting that the system is sensitive to dynamic changes in performance. Comparisons between the TD and CP groups showed that when the game was played in personalised dwell mode (hovering over the target for several seconds) children with CP progressed significantly less quickly through different difficulty levels compared to typically developing children. In contrast, no significant differences were found in accuracy mode (immediate response on target hit), between the TD and CP groups in any of the experimental conditions.

DISCUSSION

The personalised game approach was shown to be enjoyable for both groups of users and able to change the level of difficulty in real time. The results suggest that this approach to gaming can provide motor challenges while preserving a high level of enjoyment.

CONCLUSION

Personalised virtual therapy shows promise as a tool for upper extremity therapy for children with motor impairment.Implications for RehabiliationIn recent years, there has been an increase in the use of assistive technologies including virtual gaming in the general area of health care and clinical practice.Virtual gaming provides an interactive, real-time experiences that are flexible and ecologically valid ways to improve specific cognitive and motor abilities.Personalisation of virtual games entails dynamic adaptation of the parameters in real time according to the user's functional level).The results have demonstrated that personalised virtual gaming is enjoyable and feasible for typically developing children and children with cerebral palsy.The results suggest that this approach to gaming can provide motor challenges while preserving a high level of enjoyment.

Artificial Intelligence for skeleton-based physical rehabilitation action evaluation: A systematic review

Performing prescribed physical exercises during home-based rehabilitation programs plays an important role in regaining muscle strength and improving balance for people with different physical disabilities. However, patients attending these programs are not able to assess their action performance in the absence of a medical expert. Recently, vision-based sensors have been deployed in the activity monitoring domain. They are capable of capturing accurate skeleton data. Furthermore, there have been significant advancements in Computer Vision (CV) and Deep Learning (DL) methodologies. These factors have promoted the solutions for designing automatic patient's activity monitoring models. Then, improving such systems' performance to assist patients and physiotherapists has attracted wide interest of the research community. This paper provides a comprehensive and up-to-date literature review on different stages of skeleton data acquisition processes for the aim of physio exercise monitoring. Then, the previously reported Artificial Intelligence (AI) - based methodologies for skeleton data analysis will be reviewed. In particular, feature learning from skeleton data, evaluation, and feedback generation for the purpose of rehabilitation monitoring will be studied. Furthermore, the associated challenges to these processes will be reviewed. Finally, the paper puts forward several suggestions for future research directions in this area.

Feasibility of Using Joystick-Operated Ride-on-Toys to Promote Upper Extremity Function in Children With Cerebral Palsy: A Pilot Study

PURPOSE

To evaluate the feasibility of implementation, acceptance, and perceived efficacy of a joystick-operated ride-on-toy intervention to promote upper extremity (UE) function in 3- to 14-year-old children with hemiplegic cerebral palsy.

METHODS

Exit questionnaires were collected from children, caregivers, and clinicians/camp staff following a 3-week ride-on-toy training program incorporated within a summer camp for children with hemiplegic cerebral palsy. Training encouraged children to use their affected UE to maneuver the ride-on-toy. Questionnaires included Likert scale and open-ended questions to assess enjoyment, acceptance, feasibility, and perceived efficacy of the training.

RESULTS

All stakeholder groups indicated that the training was enjoyable. Clinicians/staff and caregivers indicated that the training increased children's motivation to use their affected UE and reported perceived improvements in UE movement control and function following training.

CONCLUSIONS

Our promising preliminary findings call for future research to systematically assess the efficacy of ride-on-toys to promote UE control and function in children with hemiplegic cerebral palsy.Supplemental Digital Content 1 video abstract, available at: http://links.lww.com/PPT/A404.

Healthcare applications of single camera markerless motion capture: a scoping review

Background

Single camera markerless motion capture has the potential to facilitate at home movement assessment due to the ease of setup, portability, and affordable cost of the technology. However, it is not clear what the current healthcare applications of single camera markerless motion capture are and what information is being collected that may be used to inform clinical decision making. This review aims to map the available literature to highlight potential use cases and identify the limitations of the technology for clinicians and researchers interested in the collection of movement data.

Survey Methodology

Studies were collected up to 14 January 2022 using Pubmed, CINAHL and SPORTDiscus using a systematic search. Data recorded included the description of the markerless system, clinical outcome measures, and biomechanical data mapped to the International Classification of Functioning, Disability and Health Framework (ICF). Studies were grouped by patient population.

Results

A total of 50 studies were included for data collection. Use cases for single camera markerless motion capture technology were identified for Neurological Injury in Children and Adults; Hereditary/Genetic Neuromuscular Disorders; Frailty; and Orthopaedic or Musculoskeletal groups. Single camera markerless systems were found to perform well in studies involving single plane measurements, such as in the analysis of infant general movements or spatiotemporal parameters of gait, when evaluated against 3D marker-based systems and a variety of clinical outcome measures. However, they were less capable than marker-based systems in studies requiring the tracking of detailed 3D kinematics or fine movements such as finger tracking.

Conclusions

Single camera markerless motion capture offers great potential for extending the scope of movement analysis outside of laboratory settings in a practical way, but currently suffers from a lack of accuracy where detailed 3D kinematics are required for clinical decision making. Future work should therefore focus on improving tracking accuracy of movements that are out of plane relative to the camera orientation or affected by occlusion, such as supination and pronation of the forearm.

A Telehealth System Incorporating a Serious Game Intervention to Aid Occupational Therapists in Identifying and Treating Children With Difficulty Crossing the Body's Midline: Key Informant Interviews Among Occupational Therapists

Background

The midline is an imaginary line that isolates the left and right parts of the body. Crossing the midline infers that a body part (eg, hand or foot) can spontaneously move over to the opposite side of the body to perform an action. A child who has difficulty crossing the midline can physically perform actions that cross the center of the body; however, they do not intuitively cross the midline when challenged with a task that requires this movement, as their perceptual components prevent them from engaging on the contralateral side. This requires treatment from an occupational therapist. Owing to the recent COVID-19 pandemic, access to therapeutic sessions was not possible or reduced, putting the responsibility for treatment on caretakers at home. Caretakers do not have the knowledge and skills to provide treatment, and occupational therapists do not receive adequate feedback from caretakers on the child’s progress.

Objective

The first objective is to adapt a simple serious game, or applied game, into a telehealth solution. Children will play the game at home under the supervision of a caretaker, and the results will be stored on the web. Occupational therapists can monitor progress via a web-based dashboard, receive additional valuable feedback about the child’s behavior during treatment, and easily adapt the game to target specific needs. The second objective is to evaluate whether the implemented telehealth solution is feasible as a treatment option for midline crossing difficulties and thus fit for purpose.

Methods

To meet the first objective, engineering and game development stakeholders formed a team with an occupational therapist, and through a collaborative design process combined with an agile programming approach, a telehealth solution was designed to assist remote monitoring of the serious gameplay. For the second objective, 6 different occupational therapists were introduced to the game, had the opportunity to play the game, and then provided feedback regarding the feasibility, benefits, and applicability of the system during structured interviews.

Results

A telehealth system was designed aimed to address this problem. All results are saved on the web and accessed by occupational therapists via a dashboard. In addition, observed behavioral information is also saved. During the interviews, occupational therapists indicated that the dashboard would support their treatment plan and was indeed a feasible solution.

Conclusions

The feedback from the occupational therapists for this telehealth solution suggests a feasible method to treat midline crossing problems remotely. The therapists commented on the convenience of integrating both assessment and treatment into the same application, as it assists them when grading a child. The therapists collectively agreed that the quantitative aspect the serious game creates by providing measurable and standardized data proves advantageous when compared with traditional methods of assessment and treatment.

Optimizing the setting of medical interactive rehabilitation assistant platform to improve the performance of the patients: A case study

Tele-rehabilitation is an alternative to the conventional rehabilitation service that helps patients in remote areas to access a service that is practical in terms of logistics and cost, in a controlled environment. It includes the usage of mobile phones or other wireless devices that are applied to rehabilitation exercises. Such applications or software include exercises in the form of virtual games, treatment monitoring based on the rehabilitation progress and data analysis. However, nowadays, physiotherapists use a default profiling setting for patients carrying out rehabilitation, due to lack of information. Medical Interactive Rehabilitation Assistant (MIRA) is a computer-based (virtual reality) rehabilitation platform. The profile setting includes: a level of difficulty, percentage of tolerance and maximum range. To the best of our knowledge, there is a lack of optimization in the parameter values setting of MIRA exergames that could enhance patients' performance. Generally, non-optimal profile setting leads to reduced effectiveness. Therefore, this study aims to develop a method that optimizes the profile setting of each patient according to the estimated (desired) optimal results. The proposed method is developed using unsupervised and supervised machine learning techniques. We use Self-Organizing Map (SOM) to cluster patient records into several distinct clusters. K-fold cross validation is applied to construct the prediction models. Classification And Regression Tree (CART) is utilized to predict the patient's optimal input setting for playing the MIRA games. The combination of these techniques seems to improve the efficiency of the standard (default) way in predicting the optimal settings for exergames. To evaluate the proposed method, we conduct an experiment with data collected from a rehabilitation center. We use three metrics to quantify the quality of the results: R-squared (R²), Mean Absolute Error (MAE) and Root Mean Square Error (RMSE). The results of experimental analysis demonstrate that the proposed method is effective in predicting the adequate parameter setting in MIRA platform. The method has potential to be implemented as an intelligent system for MIRA prediction in healthcare. Moreover, the method could be extended to similar platforms for which data is available to train our method on.

Leap Motion Controller-based training for upper extremity rehabilitation in children and adolescents with physical disabilities: A randomized controlled trial

STUDY DESIGN

Randomized controlled trial.

INTRODUCTION

Juvenile idiopathic arthritis (JIA), cerebral palsy (CP), and brachial plexus birth injury (BPBI) are the most common disorders that cause upper extremity impairments in children and adolescents. Leap Motion Controller-based training (LMCBT) is a novel therapeutic method for upper extremity rehabilitation.

PURPOSE OF THE STUDY

The aim of the present study was to investigate the potential efficacy of an 8-week LMCBT program set as an upper extremity rehabilitation program by comparing conventional rehabilitation program in children and adolescents with physical disabilities such as JIA, CP, and BPBI.

METHODS

A randomized control trial which included children and adolescents of different disabilities (JIA, CP, BPBI) were grouped according to their diagnosis. All patients were randomized into 2 groups namely LMCBT (group I) and conventional treatment (group II) for the treatment (3 days/8 weeks). Duruoz Hand Index and Jebson Taylor Hand Function Test were used as primary outcomes. Secondary outcomes included the nine-hole peg test, Childhood Health Assessment Questionnaire, and assessments of grip and pinch strength using a dynamometer.

RESULTS

One hundred three patients were included in the study, and 92 of them completed the treatment. After treatment, significant differences were found in Childhood Health Assessment Questionnaire, Duruoz Hand Index, Jebson Taylor Hand Function Test, nine-hole peg test, and grip and pinch strength scores in almost all groups (effect size [ES] = 0.10 to -0.77 for group I and 0.09 to -0.70 for group II in CP; ES = 0.31 to 2.65 for the group I and 0.12 to 1.66 for group II in JIA; and ES = 0 to -0.44 for group I and 0.08 to -0.62 for group II in BPBI) (P < .05). Comparisons between LMCBT and conventional treatment groups showed similar results in all parameters in all disease groups (P > .05).

CONCLUSIONS

This study has quantitatively shown that LMCBT should be used as an effective alternative treatment option in children and adolescents with physical disabilities.

Effects of Virtual Reality and Task-Oriented Training on Hand Function and Activity Performance in Pediatric Hand Burns: A Randomized Controlled Trial

OBJECTIVE

To assess the efficacy of a motion-sensing, hands-free gaming device and task-oriented training (TOT) programs on improving hand function, activity performance, and satisfaction in pediatric hand burns.

DESIGN

A randomized controlled trial.

SETTING

Outpatient rehabilitation center.

PARTICIPANTS

Fifty children with deep partial-thickness or full-thickness hand burns. (N=50; mean age, 10.70±1.64y; range, 7-14y) INTERVENTIONS: Children were randomized into 1 of the following 3 groups: the motion-sensing, hands-free gaming device group that used interactive video games plus traditional rehabilitation (TR); the TOT group that used real materials plus TR; and the control group that only received TR, all groups received the interventions 3 days per week for 8 weeks.

MAIN OUTCOME MEASURES

We assessed the children at the baseline and after 8 weeks of intervention. The primary outcome measures were the Jebsen-Taylor Hand Function Test, Duruoz Hand Index (DHI), and Canadian Occupational Performance Measure (COPM). The secondary outcome measures were range of motion (ROM) of the digits, grip strength, and pinch strengths (tip, palmer, and lateral pinch).

RESULTS

There was a significant increase in all measurements of the motion-sensing, hands-free gaming device and TOT groups compared with that of the control group postintervention (P<.05). There was no significant change in Jebsen-Taylor Hand Function Test, COPM performance, ROM, grip strength, and tip and lateral pinch strengths between the motion-sensing, hands-free gaming device group and TOT group (P>.05), whereas there was a significant increase in DHI, COPM satisfaction, and palmer pinch strength (P<.05) in the motion-sensing, hands-free gaming device group compared with the TOT group postintervention.

CONCLUSIONS

The motion-sensing, hands-free gaming device and TOT programs resulted in significant improvement in hand function, activity performance and satisfaction, ROM of the digits, grip strength, and pinch strengths in pediatric hand burns compared with the traditional hand rehabilitation.

Spontaneous movements in the newborns: a tool of quantitative video analysis of preterm babies

BACKGROUND AND OBJECTIVES

The number of preterm babies is steadily growing world-wide and these neonates are at risk of neuro-motor-cognitive deficits. The observation of spontaneous movements in the first three months of age is known to predict such risk. However, the analysis by specifically trained physiotherapists is not suited for the clinical routine, motivating the development of simple computerized video analysis systems, integrated with a well-structured Biobank to make available for preterm babies a growing service with diagnostic, prognostic and epidemiological purposes.

METHODS

MIMAS (Markerless Infant Movement Analysis System) is a simple, low-cost system of video analysis of spontaneous movements of newborns in their natural environment, based on a single standard RGB camera, without markers attached to the body. The original videos are transformed into binarized sequences highlighting the silhouette of the baby, in order to minimize the illumination effects and increase the robustness of the analysis; such sequences are then coded by a large set of parameters (39) related to the spatial and spectral changes of the silhouette. The parameter vectors of each baby were stored in the Biobank together with related clinical information.

RESULTS

The preliminary test of the system was carried out at the Gaslini Pediatric Hospital in Genoa, where 46 preterm (PT) and 21 full-term (FT) babies (as controls) were recorded at birth (T0) and 8-12 weeks thereafter (T1). A simple statistical analysis of the data showed that the coded parameters are sensitive to the degree of maturation of the newborns (comparing T0 with T1, for both PT and FT babies), and to the conditions at birth (PT vs. FT at T0), whereas this difference tends to vanish at T1. Moreover, the coding method seems also able to detect the few 'abnormal' preterm babies in the PT populations that were analyzed as specific case studies.

CONCLUSIONS

Preliminary results motivate the adoption of this tool in clinical practice allowing for a systematic accumulation of cases in the Biobank, thus for improving the accuracy of data analysis performed by MIMAS and ultimately allowing the adoption of data mining techniques.

Using a kinect-based game to teach oral hygiene in four elementary students with intellectual disabilities

BACKGROUND

Individuals with intellectual disabilities (ID) may have difficulties in performing daily living tasks. Among other daily living tasks, independent oral hygiene is an essential life skill for people with ID.

MATERIALS AND METHODS

Four children with intellectual disabilities (two males and two females, ages 7-11) participated in the experiment. We employed the Kinect^TM V2 sensor to gamify oral hygiene skill training. Specifically, a non-concurrent multiple baseline design was adopted to demonstrate the relation between game-based intervention and independent oral hygiene skills.

RESULTS

All students learned how to brush their teeth independently and maintained the skill 4 weeks later with the introduction of the game-based training. Social validity results showed the teachers and parents considered the video game was useful.

CONCLUSIONS

The proposed Kinect-based video game might be used for effective training of elementary students with ID to improve oral hygiene independently.

Rehabilitation Exergames: Use of Motion Sensing and Machine Learning to Quantify Exercise Performance in Healthy Volunteers

Background

Performing physiotherapy exercises in front of a physiotherapist yields qualitative assessment notes and immediate feedback. However, practicing the exercises at home lacks feedback on how well patients are performing the prescribed tasks. The absence of proper feedback might result in patients performing the exercises incorrectly, which could worsen their condition. We present an approach to generate performance scores to enable tracking the progress by both the patient at home and the physiotherapist in the clinic.

Objective

This study aims to propose the use of 2 machine learning algorithms, dynamic time warping (DTW) and hidden Markov model (HMM), to quantitatively assess the patient’s performance with respect to a reference.

Methods

Movement data were recorded using a motion sensor (Kinect V2), capable of detecting 25 joints in the human skeleton model, and were compared with those of a reference. A total of 16 participants were recruited to perform 4 different exercises: shoulder abduction, hip abduction, lunge, and sit-to-stand exercises. Their performance was compared with that of a physiotherapist as a reference.

Results

Both algorithms showed a similar trend in assessing participant performance. However, their sensitivity levels were different. Although DTW was more sensitive to small changes, HMM captured a general view of the performance, being less sensitive to the details.

Conclusions

The chosen algorithms demonstrated their capacity to objectively assess the performance of physical therapy. HMM may be more suitable in the early stages of a physiotherapy program to capture and report general performance, whereas DTW could be used later to focus on the details. The scores enable the patient to monitor their daily performance. They can also be reported back to the physiotherapist to track and assess patient progress, provide feedback, and adjust the exercise program if needed.

A Game-Based Rehabilitation System for Upper-Limb Cerebral Palsy: A Feasibility Study

Game-based rehabilitation systems provide an effective tool to engage cerebral palsy patients in physical exercises within an exciting and entertaining environment. A crucial factor to ensure the effectiveness of game-based rehabilitation systems is to assess the correctness of the movements performed by the patient during the game-playing sessions. In this study, we propose a game-based rehabilitation system for upper-limb cerebral palsy that includes three game-based exercises and a computerized assessment method. The game-based exercises aim to engage the participant in shoulder flexion, shoulder horizontal abduction/adduction, and shoulder adduction physical exercises that target the right arm. Human interaction with the game-based rehabilitation system is achieved using a Kinect sensor that tracks the skeleton joints of the participant. The computerized assessment method aims to assess the correctness of the right arm movements during each game-playing session by analyzing the tracking data acquired by the Kinect sensor. To evaluate the performance of the computerized assessment method, two groups of participants volunteered to participate in the game-based exercises. The first group included six cerebral palsy children and the second group included twenty typically developing subjects. For every participant, the computerized assessment method was employed to assess the correctness of the right arm movements in each game-playing session and these computer-based assessments were compared with matching gold standard evaluations provided by an experienced physiotherapist. The results reported in this study suggest the feasibility of employing the computerized assessment method to evaluate the correctness of the right arm movements during the game-playing sessions.

Assessing the Internal Reliability and Construct Validity of the General Movement Competence Assessment for Children

Validated assessment tools for movement competence typically involve the isolation and reproduction of specific movement forms, which arguably neglects individuals’ ability to combine and adapt movements to overcome constraints within a dynamic environment. A new movement assessment tool, the General Movement Competence Assessment (GMCA), was developed for this study using Microsoft Kinect. Movement competence of 83 children (36 boys and 47 girls), aged 8–10 years (9.06 ± 0.75 years) was measured using the GMCA. An exploratory approach was undertaken to examine the internal consistency reliability (McDonald’s omega coefficient) and factorial structure of the GMCA for the study sample. Factorial structure was determined using exploratory factor analysis by principal component analysis with varimax rotation. For the sample data, reliability for the GMCA games were acceptable (ω = 0.53–0.89) and indicated that combinations of movement attributes were measured by GMCA games. Factorial analysis extracted four movement constructs accounting for 71.31% of variance. Dexterity was tentatively identified as a new independent construct alongside currently accepted movement constructs (i.e., locomotion, object-control, stability). While further development of the GMCA is still required, initial results are encouraging in view of an objective and theoretically informed approach to assess general movement competence in children.

Effects of Video Games-Based Task-Oriented Activity Training (Xbox 360 Kinect) on Activity Performance and Participation in Patients With Juvenile Idiopathic Arthritis: A Randomized Clinical Trial

OBJECTIVE

The aim of the study was to compare the effects of two different task-oriented activity training programs on activity performance and participation in children/adolescents with juvenile idiopathic arthritis.

DESIGN

Sixty-two patients were randomized into group I and group II for task-oriented activity training. In group I, activities of daily living were practiced using real materials from daily life, and in group II, activities of daily living were practiced using video-based games (Xbox 360 Kinect) for 3 d/wk for 8 wks. Pain by the Numeric Rating Scale, upper limb muscle, grip, and pinch strengths by a dynamometer, activity performance and participation by the Childhood Health Assessment Questionnaire, Canadian Occupational Performance Measure, and Duruoz Hand Index were evaluated.

RESULTS

After treatment in both groups, significant changes were found in the Numeric Rating Scale, muscle strength, grips strength, Childhood Health Assessment Questionnaire, Canadian Occupational Performance Measure, and Duruoz Hand Index (P < 0.05). Group II was statistically superior to group I in changes of almost all upper limb muscle strengths, palmar pinch strength, Canadian Occupational Performance Measure satisfaction, and Duruoz Hand Index scores (P < 0.05).

CONCLUSION

Video games-based task-oriented activity training is an alternative and feasible treatment for children/adolescents with juvenile idiopathic arthritis. This new method may have widespread applicability in future research, given the rapidly growing interest in virtual reality-based therapy in rehabilitation.

TO CLAIM CME CREDITS

Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Understand the rehabilitation benefits of task-oriented activity in patients with neurologic and musculoskeletal conditions; (2) Appreciate the role of video games-based task oriented activity in rehabilitation; and (3) Appropriately incorporate video games-based task oriented activity in the rehabilitation program of individuals with Juvenile Idiopathic Arthritis.

LEVEL

Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Error Augmentation in Immersive Virtual Reality for Bimanual Upper-Limb Rehabilitation in Individuals With and Without Hemiplegic Cerebral Palsy

With more readily available commercial immersive virtual reality (VR) technologies, the potential of new feedback strategies as tools to facilitate motor rehabilitation should be investigated. Augmented feedback or error augmentation (EA) can easily be shown in a virtual environment. Here, visual EA provided via immersive VR was tested for its effectiveness to improve bimanual symmetry in a reaching task. A single-session crossover design was used to test two training cases, with or without EA. With EA, the distance between hands in the forward direction was augmented. Participants were recruited from typically developing (TD) populations (n = 12, ages 13-21) and performed in an adapted environment with an initial asymmetry between limbs. Also, five participants with hemiplegic cerebral palsy (CP) (ages 14-21, MACS I-III) completed the study. Among TD participants, a significantly larger change in symmetry in the adapted environment was shown after EA than training without EA (F (1, 10) = 9.64, p = 0.01). Each participant in the CP group also improved more after EA training (8.8-103.7)%, such that they achieved lower symmetry error after training with EA. As participants in both groups adapted more symmetrically with EA, beneficial changes from this training method could be evaluated in future studies for longer-term functional changes.

Using an augmented reality game to teach three junior high school students with intellectual disabilities to improve ATM use

BACKGROUND

Individuals with intellectual disabilities (ID) may have difficulties in performing daily living tasks. Among other daily living tasks, independent automated teller machine (ATM) skills are an essential life skill for people with intellectual disabilities.

MATERIALS AND METHODS

Three junior high school students in a special education class participated in the experiment. We employed the augmented reality (AR) technology to gamify ATM skill training. Specifically, a multiple baseline design was adopted to demonstrate the relation between game-based intervention and using an ATM independently.

RESULTS

Data showed that the percentage of correct task steps increased among all three participants. Social validity results showed the teachers considered the AR game was very useful and it had helped their students learn the ATM skills effectively.

CONCLUSIONS

The proposed AR game can be used for effective training of students with intellectual disabilities using an ATM independently.

A Framework for Interpretable Full-Body Kinematic Description Using Geometric and Functional Analysis

Rapid advances in cost-effective and non-invasive depth sensors, and the development of reliable and real-time 3D skeletal data estimation algorithms, have opened up a new application area in computer vision - statistical analysis of human kinematic data for fast, automated assessment of body movements. These assessments can play important roles in sports, medical diagnosis, physical therapy, elderly monitoring and related applications. This paper develops a comprehensive geometric framework for quantification and statistical evaluation of kinematic features. The key idea is to avoid analysis of individual joints, as is the current paradigm, and represent movements as temporal evolutions, or trajectories, on shape space of full body skeletons. This allows metrics with appropriate invariance properties to be imposed on these trajectories and leads to definitions of higher-level features, such as spatial symmetry (sS), temporal symmetry (tS), action's velocity (Vl) and body's balance (Bl), during performance of an action. These features exploit skeletal symmetries in space and time, and capture motion cadence to naturally quantify motions of individual subjects. The study of these features as functional data allows us to formulate certain hypothesis tests in feature space. This, in turn, leads to validation of existing assumptions and discoveries of new relationships between kinematics and demographic factors, such as age, gender, and athletic training. We use the clinically validated K3Da kinect dataset to illustrate these ideas, and hope these tools will lead to discovery of new relationships between full-body kinematic features and demographic, health, and wellness factors that are clinically relevant.

Using game technology to teach six elementary school children with autism to take a shower independently

OBJECTIVE

This paper contributes to research investigating the effectiveness of video game intervention in shower training of children with autism spectrum disorders. Previous studies have supported the use of video games in special education.

METHODS

We employed the Kinect sensor to gamify shower training. Specifically, a non-concurrent multiple baseline design was adopted to demonstrate the relation between game-based intervention and taking a shower independently. Six children in a special education class at a regular elementary school participated in the experiment.

RESULTS

Data showed that the percentage of correct task steps significantly increased among all six participants; motivation to engage in training was enhanced as well, thus improving task performance during the intervention and maintenance phases.

CONCLUSIONS

Although the game is a promising and highly accepted training tool for school-use, it currently remains error-prone, and the requested demand exceeds the support that can be provided by special education teachers. A more technically robust system, combined with additional attractive games, will likely result in higher participant motivation and superior task performance.

Personalized Rehabilitation Recognition for Ubiquitous Healthcare Measurements

The physical therapeutic application needs personalized rehabilitation recognition (PRR) for ubiquitous healthcare measurements (UHMs). This study employed the adaptive neuro-fuzzy inference system (ANFIS) to generate a PRR model for a self-development system of UHM. The subjects wore a sensor-enabled wristband during physiotherapy exercises to measure the scheduled motions of their limbs. In the model, the sampling data collected from the scheduled motions are labeled by an arbitrary number within a defined range. The sample datasets are referred as the design of an initial fuzzy inference system (FIS) with data preprocessing, feature visualizing, fuzzification, and fuzzy logic rules. The ANFIS then processes data training to adjust the FIS for optimization. The trained FIS then can infer the motion labels via defuzzification to recognize the features in the test data. The average recognition rate was higher than 90% for the testing motions if the subject followed the sampling schedule. With model implementation, the middle section of motion datasets in each second is recommended for recognition in the UHM system which also includes a mobile App to retrieve the personalized FIS in order to trace the exercise. This approach contributes a PRR model with trackable diagrams for the physicians to explore the rehabilitation motions in details.

Interactive Compliance Control of a Wrist Rehabilitation Device (WReD) with Enhanced Training Safety

Interaction control plays an important role in rehabilitation devices to ensure training safety and efficacy. Compliance adaptation of interaction is vital for enabling robot movements to better suit the patient's requirements as human joint characteristics vary. This paper proposes an interactive compliance control scheme on a wrist rehabilitation device (WReD) for enhanced training safety and efficacy. This control system consists of a low-level trajectory tracking loop and a high-level admittance loop. Experiments were conducted with zero load and human interaction, respectively. Satisfactory trajectory tracking responses were obtained, with the normalized root mean square deviation (NRMSD) values being 1.08% with zero load and the NRMSD values no greater than 1.4% with real-time disturbance and interaction from human users. Results demonstrate that such an interactive compliance control method can adaptively adjust the range of training motions and encourage active engagement from human users simultaneously. These findings suggest that the proposed control method of the WReD has great potentials for clinical applications due to enhanced training safety and efficacy. Future work will focus on evaluating its efficacy on a large sample of participants.

Low-Cost Tracking Systems Allow Fine Biomechanical Evaluation of Upper-Limb Daily-Life Gestures in Healthy People and Post-Stroke Patients

Since the release of the first Kinect in 2011, low-cost technologies for upper-limb evaluation has been employed frequently for rehabilitation purposes. However, a limited number of studies have assessed the potential of the Kinect V2 for motor evaluations. In this paper, a simple biomechanical protocol has been developed, in order to assess the performances of healthy people and patients, during daily-life reaching movements, with focus on some of the patients' common compensatory strategies. The assessment considers shoulder range of motion, elbow range of motion, trunk compensatory strategies, and movement smoothness. Seventy-seven healthy people and twenty post-stroke patients participated to test the biomechanical assessment. The testing protocol included four different experimental conditions: (1) dominant limb and (2) non-dominant limb of 77 healthy people, and (3) the more impaired limb of 20 post-stroke hemiparetic patients, and (4) the less-impaired limb of 11 patients (subgroup of the original 20). Biomechanical performances of the four groups were compared. Results showed that the dominant and non-dominant limbs of healthy people had comparable performances (p > 0.05). On the contrary, condition (3) showed statistically significant differences between the healthy dominant/non-dominant limb and the less-affected limb in hemiparetic patients, for all parameters of assessment (p < 0.001). In some cases, the less-affected limb of the patients also showed statistical differences (p < 0.05), with respect to the healthy people. Such results suggest that Kinect V2 has the potential for being employed at home, laboratory or clinical environment, for the evaluation of patients' motor performances.

Comparison of Kinect2Scratch game-based training and therapist-based training for the improvement of upper extremity functions of patients with chronic stroke: a randomized controlled single-blinded trial

BACKGROUND

Virtual reality and interactive video games could decrease the demands on the time of the therapists. However, the cost of a virtual reality system and the requirement for technical support limits the availability of these systems. Commercial exergames are not specifically designed for therapeutic use, most patients with hemiplegic stroke are either too weak to play the games or develop undesirable compensatory movements.

AIM

To develop Kinect2Scratch games and compare the effects of training with therapist-based training on upper extremity (UE) function of patients with chronic stroke.

DESIGN

A randomized controlled single-blinded trial.

SETTING

An outpatient rehabilitation clinic of a tertiary hospital.

POPULATION

Thirty-three patients with chronic hemiplegic stroke.

METHODS

We developed 8 Kinect2Scratch games. The participants were randomly assigned to either a Kinect2Scratch game group or a therapist-based training group. The training comprised 24 sessions of 30 minutes over 12 weeks. The primary outcome measure was the Fugl-Meyer UE scale and the secondary outcome measures were the Wolf Motor Function Test and Motor Activity Log. Patients were assessed at baseline, after intervention, and at the 3-month follow-up. We used the Pittsburgh participation scale (PPS) to assess the participation level of patients at each training session and an accelerometer to assess the activity counts of the affected UE of patients was used at the 12th and 24th training sessions.

RESULTS

Seventeen patients were assigned to the Kinect2Scratch group and 16 were assigned to the therapist-based training group. There were no differences between the two groups for any of the outcome measures postintervention and at the 3-month follow-up (all P>0.05). The level of participation was higher in the Kinect2Scratch group than in the therapist-based training group (PPS 5.25 vs. 5.00, P=0.112). The total activity counts of the affected UE was significantly higher in the Kinect2Scratch group than in the therapist-based training group (P<0.001).

CONCLUSIONS

Kinect2Scratch game training was feasible, with effects similar to those of therapist-based training on UE function of patients with chronic stroke.

CLINICAL REHABILITATION IMPACT

Kinect2Scratch games are low-cost and easily set-up games, which may serve as a complementary strategy to conventional therapy to decrease therapists' work load.

Kinect-based virtual rehabilitation and evaluation system for upper limb disorders: A case study

OBJECTIVE

To help patients with disabilities of the arm and shoulder recover the accuracy and stability of movements, a novel and simple virtual rehabilitation and evaluation system called the Kine-VRES system was developed using Microsoft Kinect.

METHODS

First, several movements and virtual tasks were designed to increase the coordination, control and speed of the arm movements. The movements of the patients were then captured using the Kinect sensor, and kinematics-based interaction and real-time feedback were integrated into the system to enhance the motivation and self-confidence of the patient. Finally, a quantitative evaluation method of upper limb movements was provided using the recorded kinematics during hand-to-hand movement.

RESULTS

A preliminary study of this rehabilitation system indicates that the shoulder movements of two participants with ataxia became smoother after three weeks of training (one hour per day).

CONCLUSION

This case study demonstrated the effectiveness of the designed system, which could be promising for the rehabilitation of patients with upper limb disorders.

Force Resistance Training in Hand Grasp and Arm Therapy: Feasibility of a Low-Cost Videogame Controller

OBJECTIVE

To design and evaluate a low-cost gaming station that supports force resistance training in pediatric arm/hand grasp therapies through mainstream videogame play.

METHODS

The gaming station was developed through an iterative participatory design process and includes a force feedback game controller (Novint Falcon), custom grips, arm/wrist supports, and software to interface with mainstream games and manage difficulty settings in the controller. The station was tested for usability and feasibility with six therapists and six children with cerebral palsy, 7-16 years of age, attending weekly therapy sessions over 12 weeks. Pre- and post-assessments of perceived performance and satisfaction on self-identified goals were measured on the Canadian Occupational Performance Measure (COPM).

RESULTS

The gaming station was considered highly usable by therapists with a score of 76.7 (standard deviation [SD] = 6.1) on the System Usability Scale. Overall, children enjoyed the games, achieved high repetition rates for wrist extensions and arm movements, and all made clinically significant progress on therapy goals. Increases of 3.13 (SD = 1.69) on the performance scale and 2.97 (SD = 0.98) on the satisfaction scale were reported on the COPM. Conclusiion: In-clinic force resistance training for development of upper limb functional capacities is feasible using low-cost video game components adapted to therapy through a participatory design process.

Classification of Therapeutic Hand Poses Using Convolutional Neural Networks

Measurement of finger active range of motion (ARoM) is essential to quantify outcomes accurately after hand surgery and during rehabilitation. Currently, finger ARoM is measured by a hand-held goniometer, which introduces measurement error. Moreover, this method is time-consuming. To speed up and simplify this process, we developed a system to measure the ARoM automatically. However, to assess the ARoM for all joints, different hand poses are required. The goal, then, is to design a classifier that achieves accurate and automatic discovery of the hand pose. According to the detected pose, the system will apply the appropriate algorithm to measure the ARoM for all fingers. Furthermore, this will enable a camera capture control system to provide the best view by moving the camera as required by each algorithm. A critical part of the system is the classifier because it controls the accuracy and compute time of the measurement. In this paper, we describe a study of different classifiers for hand pose and include results. The best classifier achieves 99% accuracy in classifying 400 test samples from five previously unseen human subjects with a compute time of 8ms per sample.

Effects of Exergaming in Cancer Related Fatigue in the Quality of Life and Electromyography of the Middle Deltoid of People with Cancer in Treatment: A Controlled Trial

Objective:

In the present study, we aimed to evaluate the effects an exergaming protocol for cancer patients who undergo or have already undergone cancer treatment. We sought to evaluate changes in cancer-related fatigue, function, and ability to perform daily activities, in addition to changes in the electromyographic pattern of the middle deltoid muscle.

Methods:

We conducted a controlled trial. Nineteen volunteers in the cancer group (aged 61 ± 9 years; body mass index28 ± 5) and 19 in the control group (aged 58 ± 8 years); body mass index 28 ± 4) participated in the study. They were evaluated by means of a sociodemographic and clinical questionnaire, the Functional Assessment of Chronic Therapy-Fatigue (FACIT-F) questionnaire, and surface electromyography in the deltoid muscle at three moments: before the beginning of the exergaming protocol, after 10 training sessions, and after 20 sessions. The protocol consisted of practicing exergaming using Xbox 360^® (Microsoft, Redmond, USA) with Kinect^®. The game “Your Shape Fitness Evolved” (Ubisoft, Rennes, France) was used.

Results:

Total FACIT-F scores, fatigue subscale scores, and median frequency values observed in the cancer group were lower than those in the control group. These values improved in relation to the initial evaluation in the cancer group after the practice of the exergaming protocol.

Conclusion:

The exergaming protocol used in this study was effective for reducing reported symptoms of fatigue, increasing perceived quality of life, and improving the pattern of deltoid muscle contraction in cancer patients.

Developing a Suite of Motion-Controlled Games for Upper Extremity Training in Children with Cerebral Palsy: A Proof-of-Concept Study

Aim: The Scratch programming language allows learner developers to write games. The Kinect2Scratch extension makes Scratch games with bodily motion control possible by connecting to Microsoft's Kinect sensor. This study examined the feasibility and possible efficacy of a suite of motion-controlled games designed for upper extremity (UE) training in children with cerebral palsy (CP) using Kinect2Scratch.

Materials and Methods: This is a proof-of-concept study. We developed three games, requiring three UE movement patterns (shoulder holding, reaching, and handclap), for use in children with CP. The primary outcome was feasibility, addressed by adherence, engagement, satisfaction, and safety. The secondary outcome was efficacy, which was evaluated by Quality of Upper Extremities Skills Test (QUEST), Box and Block Test (BBT), Melbourne Assessment 2 (MA2) test, and ABILHAND-kids score.

Results: Thirteen children with CP (mean age 6.9 years) received 24 sessions of training (30 minutes per session). The adherence rate was 100%. During the first 2 weeks of training, children had a significantly higher level of participation in Kinect2Scratch training than in conventional rehabilitation [Pittsburgh Participation Scale, median (interquartile range [IQR]), 6 (3–6) vs. 4 (3–6) P = 0.04]. However, during the last 2 weeks of training, there was no significant difference in participation between the Kinect2Scratch and conventional training [Pittsburgh Rehabilitation Participation Scale, median (IQR), 4 (3–5) vs. 4 (3–6) P = 0.55]. Most children enjoyed playing the games. The mean score of enjoyment was 4.54 ± 0.66. There were no adverse events during the training periods. The children had significant improvement in total score of QUEST and MA2. There were no significant improvements in BBT and ABILHAND-kids score.

Conclusion: Using Kinect2Scratch games for UE training is a feasible adjunctive program for children with CP.

Stability of Kinect for range of motion analysis in static stretching exercises

Physical rehabilitation aims people with physical impairments to enhance and restore their functional ability. The Microsoft Kinect v1 and v2 technologies apply depth information and machine vision techniques to generate 3D coordinates of a set of anatomical landmarks on the human body regarded as Kinect joints. Trigonometry relationship between Kinect joints can be used to extract body Range of Motion (ROM). The purpose of this study was to evaluate stability of Kinect for ROM measurement during static stretching exercises. According to the literature, the stability of Kinect in static exercises has been reported to a limited extent. 13 healthy men participated in this study and performed 5 exercises in 2 different distances from the cameras. Exercises were recorded by Kinect v1 and Kinect v2, concurrently. The stability of Kinect was also evaluated for 5 ROMs including: elbow flexion, shoulder abduction, wrist pronation, wrist flexion, and wrist ulnar deviation. Maximum and average joint displacement errors were used for stability analysis. Results showed that Kinect v2 is more stable compared to Kinect v1. Kinect v2 joints showed displacement error of more than 15 mm for wrist. For the other joints, Kinect showed an average displacement error of less than 10 mm.

A Telerehabilitation System for the Selection, Evaluation and Remote Management of Therapies

Telerehabilitation systems that support physical therapy sessions anywhere can help save healthcare costs while also improving the quality of life of the users that need rehabilitation. The main contribution of this paper is to present, as a whole, all the features supported by the innovative Kinect-based Telerehabilitation System (KiReS). In addition to the functionalities provided by current systems, it handles two new ones that could be incorporated into them, in order to give a step forward towards a new generation of telerehabilitation systems. The knowledge extraction functionality handles knowledge about the physical therapy record of patients and treatment protocols described in an ontology, named TrhOnt, to select the adequate exercises for the rehabilitation of patients. The teleimmersion functionality provides a convenient, effective and user-friendly experience when performing the telerehabilitation, through a two-way real-time multimedia communication. The ontology contains about 2300 classes and 100 properties, and the system allows a reliable transmission of Kinect video depth, audio and skeleton data, being able to adapt to various network conditions. Moreover, the system has been tested with patients who suffered from shoulder disorders or total hip replacement.

Kinect V2 implementation and testing of the reaching performance scale for motor evaluation of patients with neurological impairment

Automated procedures for neurological patients' motor evaluation may take advantage of the coupling between clinical scales and motion tracking devices to provide affordable, quantified and reliable assessment to be used in clinics, in surgeries and domestic environment. In this study, 20 post-stroke patients performed frontal reaching movements with their more affected limb, and a physician administered the Reaching Performance Scale (RPS) to assess motor functionality. At the same time, patients' kinematics were recorded with the Kinect V2 sensor. An automated algorithm was developed to compute the RPS based on Kinect V2 tracking data, and visual and Kinect V2 RPS scores were compared. Results showed very high statistical correlation between the automated procedure and the visual administration (Pearson Correlation Coefficient: R = 0.90, p < 0.001). While the number of patients is limited, the automated RPS seems to be successfully applicable to different levels of impairment, from mild to severe.

Reliability and validity of the Microsoft Kinect for assessment of manual wheelchair propulsion

Concurrent validity and test-retest reliability of the Microsoft Kinect in quantification of manual wheelchair propulsion were examined. Data were collected from five manual wheelchair users on a roller system. Three Kinect sensors were used to assess test-retest reliability with a still pose. Three systems were used to assess concurrent validity of the Kinect to measure propulsion kinematics (joint angles, push loop characteristics): Kinect, Motion Analysis, and Dartfish ProSuite (Dartfish joint angles were limited to shoulder and elbow flexion). Intraclass correlation coefficients revealed good reliability (0.87-0.99) between five of the six joint angles (neck flexion, shoulder flexion, shoulder abduction, elbow flexion, wrist flexion). ICCs suggested good concurrent validity for elbow flexion between the Kinect and Dartfish and between the Kinect and Motion Analysis. Good concurrent validity was revealed for maximum height, hand-axle relationship, and maximum area (0.92-0.95) between the Kinect and Dartfish and maximum height and hand-axle relationship (0.89-0.96) between the Kinect and Motion Analysis. Analysis of variance revealed significant differences (p < 0.05) in maximum length between Dartfish (mean 58.76 cm) and the Kinect (40.16 cm). Results pose promising research and clinical implications for propulsion assessment and overuse injury prevention with the application of current findings to future technology.

A tool for home-based rehabilitation allowing for clinical evaluation in a visual markerless scenario

This work deals with the design of an interactive monitoring tool for home-based physical rehabilitation. The software platform includes a video processing stage and the exercise performance evaluation. Image features are extracted by a Kinect v2 sensor and elaborated to return the exercises score. Furthermore the tool provides to physiotherapists a quantitative exercise evaluation of subject's performances. The proposed tool for home rehabilitation has been tested on 5 subjects and 5 different exercises and results are presented. In particular both exercises and relative evaluation indexes were selected by specialists in neurorehabilitation.

Statistical Validation for Clinical Measures: Repeatability and Agreement of Kinect™-Based Software

Background

The rehabilitation process is a fundamental stage for recovery of people's capabilities. However, the evaluation of the process is performed by physiatrists and medical doctors, mostly based on their observations, that is, a subjective appreciation of the patient's evolution. This paper proposes a tracking platform of the movement made by an individual's upper limb using Kinect sensor(s) to be applied for the patient during the rehabilitation process. The main contribution is the development of quantifying software and the statistical validation of its performance, repeatability, and clinical use in the rehabilitation process.

Methods

The software determines joint angles and upper limb trajectories for the construction of a specific rehabilitation protocol and quantifies the treatment evolution. In turn, the information is presented via a graphical interface that allows the recording, storage, and report of the patient's data. For clinical purposes, the software information is statistically validated with three different methodologies, comparing the measures with a goniometer in terms of agreement and repeatability.

Results

The agreement of joint angles measured with the proposed software and goniometer is evaluated with Bland-Altman plots; all measurements fell well within the limits of agreement, meaning interchangeability of both techniques. Additionally, the results of Bland-Altman analysis of repeatability show 95% confidence. Finally, the physiotherapists' qualitative assessment shows encouraging results for the clinical use.

Conclusion

The main conclusion is that the software is capable of offering a clinical history of the patient and is useful for quantification of the rehabilitation success. The simplicity, low cost, and visualization possibilities enhance the use of the software Kinect for rehabilitation and other applications, and the expert's opinion endorses the choice of our approach for clinical practice. Comparison of the new measurement technique with established goniometric methods determines that the proposed software agrees sufficiently to be used interchangeably.

Combined Vision and Wearable Sensors-based System for Movement Analysis in Rehabilitation

Background: Traditional rehabilitation sessions are often a slow, tedious, disempowering and non-motivational process, supported by clinical assessment tools, i.e. evaluation scales that are prone to subjective rating and imprecise interpretation of patient’s performance. Poor patient motivation and insufficient accuracy are thus critical factors that can be improved by new sensing/processing technologies.

Objectives: We aim to develop a portable and affordable system, suitable for home rehabilitation, which combines vision-based and wearable sensors. We introduce a novel approach for examining and characterizing the rehabilitation movements, using quantitative descriptors. We propose new Movement Performance Indicators (MPIs) that are extracted directly from sensor data and quantify the symmetry, velocity, and acceleration of the movement of different body/hand parts, and that can potentially be used by therapists for diagnosis and progress assessment.

Methods: First, a set of rehabilitation exercises is defined, with the supervision of neurologists and therapists for the specific case of Parkinson’s disease. It comprises full-body movements measured with a Kinect device and fine hand movements, acquired with a data glove. Then, the sensor data is used to compute 25 Movement Performance Indicators, to assist the diagnosis and progress monitoring (assessing the disease stage) in Parkinson’s disease. A kinematic hand model is developed for data verification and as an additional resource for extracting supplementary movement information.

Results: Our results show that the proposed Movement Performance Indicators are relevant for the Parkinson’s disease assessment. This is further confirmed by correlation of the proposed indicators with clinical tapping test and UPDRS clinical scale. Classification results showed the potential of these indicators to discriminate between the patients and controls, as well as between the stages that characterize the evolution of the disease.

Conclusions: The proposed sensor system, along with the developed approach for rehabilitation movement analysis have a significant potential to support and advance traditional rehabilitation therapy. The main impact of our work is two-fold: (i) the proposition of an approach for supporting the therapists during the diagnosis and monitoring evaluations by reducing subjectivity and imprecision, and (ii) offering the possibility of the system to be used at home for rehabilitation exercises in between sessions with doctors and therapists.

[Application of movement recognition technology in assessing spontaneous general movements in preterm infants]

Preterm birth is a major factor which induces neurological and motor impairments, particularly cerebral palsy, in high-risk infants. Early identification of potential neurodevelopmental impairments provides the opportunity to improve neurodevelopmental outcomes in preterm infants through early rehabilitation interventions. Clinically, the general movement assessment is a pivotal tool to predict neurodevelopmental outcomes, especially motor developmental outcomes, in high-risk infants. Movement recognition can continuously capture relevant limb movements and perform objective and quantitative assessment using computerized approaches. Various methods of recording and analyzing spontaneous general movements for infants at a risk of cerebral palsy have been extensively explored. This article summarizes the general movement assessment method and reviews the translational research on using movement recognition technology for the assessment of spontaneous general movements of preterm infants.

Kinect V2 Performance Assessment in Daily-Life Gestures: Cohort Study on Healthy Subjects for a Reference Database for Automated Instrumental Evaluations on Neurological Patients

Background

The increase of sanitary costs related to poststroke rehabilitation requires new sustainable and cost-effective strategies for promoting autonomous and dehospitalized motor training. In the Riprendo@Home and Future Home for Future Communities research projects, the promising approach of introducing low-cost technologies that promote home rehabilitation is exploited. In order to provide reliable evaluation of patients, a reference database of healthy people's performances is required and should consider variability related to healthy people performances.

Methods

78 healthy subjects performed several repetitions of daily-life gestures, the reaching movement (RM) and hand-to-mouth (HtMM) movement with both the dominant and nondominant upper limbs. Movements were recorded with a Kinect V2. A synthetic biomechanical protocol based on kinematical, dynamical, and motor control parameters was used to assess motor performance of the healthy people. The investigation was conducted by clustering participants depending on their limb dominancy (right/left), gender (male/female), and age (young/middle/senior) as sources of variability.

Results

Results showed that limb dominancy has minor relevance in affecting RM and HtMM; gender has relevance in affecting the HtMM; age has major effect in affecting RM and HtMM.

Conclusions

An investigation of healthy subjects' upper limb performances during daily-life gestures was performed with the Kinect V2 sensor. Findings will be the basis for a database of normative data for neurological patients' motor evaluation.

Design and Interaction Control of a New Bilateral Upper-Limb Rehabilitation Device

This paper proposed a bilateral upper-limb rehabilitation device (BULReD) with two degrees of freedom (DOFs). The BULReD is portable for both hospital and home environment, easy to use for therapists and patients, and safer with respect to upper-limb robotic exoskeletons. It was implemented to be able to conduct both passive and interactive training, based on system kinematics and dynamics, as well as the identification of real-time movement intention of human users. Preliminary results demonstrate the potential of the BULReD for clinical applications, with satisfactory position and interaction force tracking performance. Future work will focus on the clinical evaluation of the BULReD on a large sample of poststroke patients.

Virtual Reality and Serious Games in Neurorehabilitation of Children and Adults: Prevention, Plasticity, and Participation

Use of virtual reality (VR) and serious games (SGs) interventions within rehabilitation as motivating tools for task specific training for individuals with neurological conditions are fast-developing. Within this perspective paper we use the framework of the IV STEP conference to summarize the literature on VR and SG for children and adults by three topics: Prevention; Outcomes: Body-Function-Structure, Activity and Participation; and Plasticity. Overall the literature in this area offers support for use of VR and SGs to improve body functions and to some extent activity domain outcomes. Critical analysis of clients' goals and selective evaluation of VR and SGs are necessary to appropriately take advantage of these tools within intervention. Further research on prevention, participation, and plasticity is warranted. We offer suggestions for bridging the gap between research and practice integrating VR and SGs into physical therapist education and practice.

Exercise interventions for cerebral palsy

BACKGROUND

Cerebral palsy (CP) is a neurodevelopmental disorder resulting from an injury to the developing brain. It is the most common form of childhood disability with prevalence rates of between 1.5 and 3.8 per 1000 births reported worldwide. The primary impairments associated with CP include reduced muscle strength and reduced cardiorespiratory fitness, resulting in difficulties performing activities such as dressing, walking and negotiating stairs.Exercise is defined as a planned, structured and repetitive activity that aims to improve fitness, and it is a commonly used intervention for people with CP. Aerobic and resistance training may improve activity (i.e. the ability to execute a task) and participation (i.e. involvement in a life situation) through their impact on the primary impairments of CP. However, to date, there has been no comprehensive review of exercise interventions for people with CP.

OBJECTIVES

To assess the effects of exercise interventions in people with CP, primarily in terms of activity, participation and quality of life. Secondary outcomes assessed body functions and body structures. Comparators of interest were no treatment, usual care or an alternative type of exercise intervention.

SEARCH METHODS

In June 2016 we searched CENTRAL, MEDLINE, Embase, nine other databases and four trials registers.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and quasi-RCTs of children, adolescents and adults with CP. We included studies of aerobic exercise, resistance training, and 'mixed training' (a combination of at least two of aerobic exercise, resistance training and anaerobic training).

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles, abstracts and potentially relevant full-text reports for eligibility; extracted all relevant data and conducted 'Risk of bias' and GRADE assessments.

MAIN RESULTS

We included 29 trials (926 participants); 27 included children and adolescents up to the age of 19 years, three included adolescents and young adults (10 to 22 years), and one included adults over 20 years. Males constituted 53% of the sample. Five trials were conducted in the USA; four in Australia; two in Egypt, Korea, Saudi Arabia, Taiwan, the Netherlands, and the UK; three in Greece; and one apiece in India, Italy, Norway, and South Africa.Twenty-six trials included people with spastic CP only; three trials included children and adolescents with spastic and other types of CP. Twenty-one trials included people who were able to walk with or without assistive devices, four trials also included people who used wheeled mobility devices in most settings, and one trial included people who used wheeled mobility devices only. Three trials did not report the functional ability of participants. Only two trials reported participants' manual ability. Eight studies compared aerobic exercise to usual care, while 15 compared resistance training and 4 compared mixed training to usual care or no treatment. Two trials compared aerobic exercise to resistance training. We judged all trials to be at high risk of bias overall.We found low-quality evidence that aerobic exercise improves gross motor function in the short term (standardised mean difference (SMD) 0.53, 95% confidence interval (CI) 0.02 to 1.04, N = 65, 3 studies) and intermediate term (mean difference (MD) 12.96%, 95% CI 0.52% to 25.40%, N = 12, 1 study). Aerobic exercise does not improve gait speed in the short term (MD 0.09 m/s, 95% CI -0.11 m/s to 0.28 m/s, N = 82, 4 studies, very low-quality evidence) or intermediate term (MD -0.17 m/s, 95% CI -0.59 m/s to 0.24 m/s, N = 12, 1 study, low-quality evidence). No trial assessed participation or quality of life following aerobic exercise.We found low-quality evidence that resistance training does not improve gross motor function (SMD 0.12, 95% CI -0.19 to 0.43, N = 164, 7 studies), gait speed (MD 0.03 m/s, 95% CI -0.02 m/s to 0.07 m/s, N = 185, 8 studies), participation (SMD 0.34, 95% CI -0.01 to 0.70, N = 127, 2 studies) or parent-reported quality of life (MD 12.70, 95% CI -5.63 to 31.03, n = 12, 1 study) in the short term. There is also low-quality evidence that resistance training does not improve gait speed (MD -0.03 m/s, 95% CI -0.17 m/s to 0.11 m/s, N = 84, 3 studies), gross motor function (SMD 0.13, 95% CI -0.30 to 0.55, N = 85, 3 studies) or participation (MD 0.37, 95% CI -6.61 to 7.35, N = 36, 1 study) in the intermediate term.We found low-quality evidence that mixed training does not improve gross motor function (SMD 0.02, 95% CI -0.29 to 0.33, N = 163, 4 studies) or gait speed (MD 0.10 m/s, -0.07 m/s to 0.27 m/s, N = 58, 1 study) but does improve participation (MD 0.40, 95% CI 0.13 to 0.67, N = 65, 1 study) in the short-term.There is no difference between resistance training and aerobic exercise in terms of the effect on gross motor function in the short term (SMD 0.02, 95% CI -0.50 to 0.55, N = 56, 2 studies, low-quality evidence).Thirteen trials did not report adverse events, seven reported no adverse events, and nine reported non-serious adverse events.

AUTHORS' CONCLUSIONS

The quality of evidence for all conclusions is low to very low. As included trials have small sample sizes, heterogeneity may be underestimated, resulting in considerable uncertainty relating to effect estimates. For children with CP, there is evidence that aerobic exercise may result in a small improvement in gross motor function, though it does not improve gait speed. There is evidence that resistance training does not improve gait speed, gross motor function, participation or quality of life among children with CP.Based on the evidence available, exercise appears to be safe for people with CP; only 55% of trials, however, reported adverse events or stated that they monitored adverse events. There is a need for large, high-quality, well-reported RCTs that assess the effectiveness of exercise in terms of activity and participation, before drawing any firm conclusions on the effectiveness of exercise for people with CP. Research is also required to determine if current exercise guidelines for the general population are effective and feasible for people with CP.

Mother and Child Ratings of Child Anxiety: Associations With Behavioral Avoidance and the Role of Family Accommodation

OBJECTIVE

This study compared mother and child ratings of child anxiety to each other and to an objective measure of the child's avoidant behavior, using a novel motion-tracking paradigm. The study also examined the moderating role of family accommodation for the link between mother ratings of child anxiety and child behavioral avoidance.

DESIGN

Participants were 98 children (7- to 14-years-old) and their mothers. Children met criteria for a primary anxiety disorder. Measures included parent and child versions of the Multi-Dimensional Anxiety Scale for Children and the Screen for Child Anxiety Related Emotional Disorders. Children also completed the Spider Phobia Questionnaire for children and the Family Accommodation Scale for Anxiety-Child Report. The Yale Interactive Kinect Environment Software platform was used to measure children's behavioral avoidance of spider images.

RESULTS

Mother and child ratings of child anxiety were moderately correlated. Only child ratings of child anxiety were associated with child behavioral avoidance. Child-rated family accommodation moderated the association between parent ratings and child avoidance. When accommodation was low parent ratings correlated with child avoidance, but not when accommodation was high.

CONCLUSIONS

The findings contribute to understanding commonly reported discrepancies between mother and child ratings of child anxiety symptoms.

Generation of a Movement Scheme for Positive Training

Rehabilitation robots have been demonstrated to be an efficient tool in the field of rehabilitation training. Meanwhile, there are varieties of tasks designed for motion training. These tasks need to be transmitted to motion data for rehabilitation robots. In this paper, we designed a drinking task and captured the motion data as the ground truth, through sensors of an exoskeleton device named Neo-Arm. To verify the effectiveness of Neo-Arm, we used a Vicon system to capture the same motion task without Neo-Arm for comparison. Eight subjects participated in the experiment. The motion data of the drinking task, including the range of motion (ROM) and the velocity of each joint, are obtained. The result shows that the Neo-Arm can achieve the suitable precision and be fit for other kinds of upper limb motion tasks.

Using data from the Microsoft Kinect 2 to determine postural stability in healthy subjects: A feasibility trial

The objective of this study was to determine whether kinematic data collected by the Microsoft Kinect 2 (MK2) could be used to quantify postural stability in healthy subjects. Twelve subjects were recruited for the project, and were instructed to perform a sequence of simple postural stability tasks. The movement sequence was performed as subjects were seated on top of a force platform, and the MK2 was positioned in front of them. This sequence of tasks was performed by each subject under three different postural conditions: "both feet on the ground" (1), "One foot off the ground" (2), and "both feet off the ground" (3). We compared force platform and MK2 data to quantify the degree to which the MK2 was returning reliable data across subjects. We then applied a novel machine-learning paradigm to the MK2 data in order to determine the extent to which data from the MK2 could be used to reliably classify different postural conditions. Our initial comparison of force plate and MK2 data showed a strong agreement between the two devices, with strong Pearson correlations between the trunk centroids "Spine_Mid" (0.85 ± 0.06), "Neck" (0.86 ± 0.07) and "Head" (0.87 ± 0.07), and the center of pressure centroid inferred by the force platform. Mean accuracy for the machine learning classifier from MK2 was 97.0%, with a specific classification accuracy breakdown of 90.9%, 100%, and 100% for conditions 1 through 3, respectively. Mean accuracy for the machine learning classifier derived from the force platform data was lower at 84.4%. We conclude that data from the MK2 has sufficient information content to allow us to classify sequences of tasks being performed under different levels of postural stability. Future studies will focus on validating this protocol on large populations of individuals with actual balance impairments in order to create a toolkit that is clinically validated and available to the medical community.