1
|
Rozaire J, Paquin C, Henry L, Agopyan H, Bard-Pondarré R, Naaim A, Duprey S, Chaleat-Valayer E. A systematic review of instrumented assessments for upper limb function in cerebral palsy: current limitations and future directions. J Neuroeng Rehabil 2024; 21:56. [PMID: 38622731 PMCID: PMC11020208 DOI: 10.1186/s12984-024-01353-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 04/03/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION Recently, interest in quantifying upper limb function in cerebral palsy has grown. However, the lack of reference tasks and protocols, have hindered the development of quantified movement analysis in clinical practice. This study aimed to evaluate existing instrumented assessments of upper limb function in cerebral palsy, with a focus on their clinical applicability, to identify reasons for the lack of adoption and provide recommendations for improving clinical relevance and utility. METHODS A systematic review was conducted by a multidisciplinary team of researchers and clinicians (Prospero CRD42023402382). PubMed and Web of Science databases were searched using relevant keywords and inclusion/exclusion criteria. RESULTS A total of 657 articles were initially identified, and after the selection process, 76 records were included for analysis comprising a total of 1293 patients with cerebral palsy. The quality assessment of the reviewed studies revealed a moderate overall quality, with deficiencies in sample size justification and participant information. Optoelectronic motion capture systems were predominantly used in the studies (N = 57/76). The population mainly consisted of individuals with spastic cerebral palsy (834/1293) with unilateral impairment (N = 1092/1293). Patients with severe functional impairment (MACS IV and V) were underrepresented with 3.4% of the 754 patients for whom the information was provided. Thirty-nine tasks were used across the articles. Most articles focused on unimanual activities (N = 66/76) and reach or reach and grasp (N = 51/76). Bimanual cooperative tasks only represented 3 tasks present in 4 articles. A total of 140 different parameters were identified across articles. Task duration was the most frequently used parameter and 23% of the parameters were used in only one article. CONCLUSION Further research is necessary before incorporating quantified motion analysis into clinical practice. Existing protocols focus on extensively studied populations and rely on costly equipment, limiting their practicality. Standardized unimanual tasks provide limited insights into everyday arm use. Balancing methodological requirements and performance evaluation flexibility is a challenge. Exploring the correlation between outcome parameters and therapeutic guidance could facilitate the integration of quantified movement assessment into treatment pathways.
Collapse
Affiliation(s)
- Julie Rozaire
- Service de Médecine Physique et de Réadaptation, Centre Médico-Chirurgical de Réadaptation des Massues Croix-Rouge française, Hôpital de Jour, Lyon, France
- LBMC UMR_T9406, Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France
| | - Clémence Paquin
- LBMC UMR_T9406, Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France
- Texisense, Torcy, France
| | - Lauren Henry
- LBMC UMR_T9406, Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France
| | - Hovannes Agopyan
- Service de Médecine Physique et de Réadaptation, Centre Médico-Chirurgical de Réadaptation des Massues Croix-Rouge française, Hôpital de Jour, Lyon, France
| | - Rachel Bard-Pondarré
- Service de Médecine Physique et de Réadaptation, Centre Médico-Chirurgical de Réadaptation des Massues Croix-Rouge française, Hôpital de Jour, Lyon, France
| | - Alexandre Naaim
- LBMC UMR_T9406, Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France.
| | - Sonia Duprey
- LBMC UMR_T9406, Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France
| | - Emmanuelle Chaleat-Valayer
- Service de Médecine Physique et de Réadaptation, Centre Médico-Chirurgical de Réadaptation des Massues Croix-Rouge française, Hôpital de Jour, Lyon, France
| |
Collapse
|
2
|
Bagesteiro LB, Tellini TL, Brown LE. Analysis of motor characteristics of reaching movements in children with cerebral palsy. Heliyon 2023; 9:e13455. [PMID: 36846663 PMCID: PMC9947259 DOI: 10.1016/j.heliyon.2023.e13455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/30/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Studies confirm that children with cerebral palsy (CwCP) have difficulty with simple, everyday movements like reaching for objects. Accurate reaching requires that shoulder and elbow joints are coordinated to move the hand along a smooth path to the desired target location. Here we examined multijoint coordination by comparing reaching performance in the affected and unaffected limbs of CwCP (nine children, six girls and three boys, aged 8-10 years) to reaching performance in the non-dominant and dominant limbs of typically-developing age- and gender-matched control (CTR) children. The hypothesis was that CwCP would show the effects of coordination deficits in both their affected and unaffected limbs. All children performed two sessions (one session with each arm) of speeded reaching movements to three targets arranged to manipulate the required pattern of shoulder and elbow coordination. The movements were tracked with a motion tracker allowing us to assess the following measures: movement distance, duration, and speed, hand-path deviation from linearity, final position accuracy and precision, and measures of shoulder and elbow excursion. We found that CwCP made reaches that covered a greater distance and took more time, that their shoulder and elbow rotations were larger, and that their movements showed greater deviation from linearity than the movements performed by CTR children. Children with CP were also more variable than CTR children on every measure except movement duration. The pattern of shoulder and elbow rotation observed in the CwCP group represents a coordination pattern that is significantly different from the pattern used by CTR children and may represent a greater reliance by CwCP on proximal muscular control systems. The discussion section considers the role that the cortical-spinal system may play in multijoint coordination.
Collapse
Affiliation(s)
- Leia B. Bagesteiro
- Department of Kinesiology, San Francisco State University, San Francisco, CA, 94132, USA
- Corresponding author.
| | | | - Liana E. Brown
- Departments of Psychology and Kinesiology, Trent University, Peterborough, Ontario, Canada
| |
Collapse
|
3
|
Kim H, Kim J, Jo S, Lee K, Kim J, Song C. Video augmented mirror therapy for upper extremity rehabilitation after stroke: a randomized controlled trial. J Neurol 2023; 270:831-842. [PMID: 36210358 DOI: 10.1007/s00415-022-11410-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effects of mirror therapy using a newly developed video augmented wearable reflection device on reach-to-grasp motor control and upper extremity motor function. METHODS Participants were randomly allocated to one of three groups: mirror therapy using a video augmented wearable reflection device group (MTVADG), n = 12; traditional mirror therapy group (TMTG), n = 12; and control group (CG), n = 12. Participants in the MTVADG and TMTG received conventional rehabilitation in addition to mirror therapy. Motor control during the reach-to-grasp movement was assessed using kinematic analysis. Each participant's upper extremity motor function was assessed using the Fugl-Meyer Assessment, Manual Function Test, and Box and Block Test. RESULTS While both the MTVADG and TMTG showed significantly improved reach-to-grasp movement. The MTVADG showed greater efficiency in kinematic performance than the TMTG. Moreover, while both the MTVADG and TMTG showed improved upper extremity motor function, the MTVADG showed significantly greater improvement in proximal upper limb function compared to the TMTG. CONCLUSION Our results suggested that mirror therapy using a video augmented wearable reflection device is more efficient compared to traditional mirror therapy for patients with stroke. CLINICAL TRIAL REGISTRATION UNIQUE IDENTIFIER KCT0003047.
Collapse
Affiliation(s)
- Hyunjin Kim
- Department of Physical Therapy, Graduate School of Sahmyook University, Seoul, 01795, Republic of Korea
| | - Junghyun Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Sungbae Jo
- Department of Physical Therapy, Graduate School of Sahmyook University, Seoul, 01795, Republic of Korea
| | - Kyeongjin Lee
- Department of Physical Therapy, College of Health Science, Kyungdong University, Wonju-si, Gangwon-Do, 26495, Republic of Korea
| | - Junesun Kim
- Department of Physical Therapy, College of Health Science, Korea University, 145, Anam-Ro, Sungbuk-Gu, Seoul, 02841, Republic of Korea.
- Department of Health Science, Rehabilitation Science Program, Korea University Graduate School, Seoul, 02841, Republic of Korea.
- BK21FOUR Program in Learning Health Systems Korea University, Seoul, 02841, Republic of Korea.
| | - Changho Song
- Department of Physical Therapy, College of Health Science, Sahmyook University, 815, Hwarang-ro, Nowon-gu, Seoul, 01795, Republic of Korea.
| |
Collapse
|
4
|
Inacio M, Esser P, Weedon BD, Joshi S, Meaney A, Delextrat A, Springett D, Kemp S, Ward T, Izadi H, Johansen-Berg H, Dawes H. Learning a novel rhythmic stepping task in children with probable developmental coordination disorder. Clin Biomech (Bristol, Avon) 2023; 102:105904. [PMID: 36764101 DOI: 10.1016/j.clinbiomech.2023.105904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Developmental coordination disorder affects approximately 6% of children, interfering with participation in physical activity and can persist through adulthood. However, no studies have investigated the neuromotor mechanisms of learning of a novel task with rhythmic cueing. METHODS Movement Assessment Battery for Children-2nd edition was used to identify 48 children with probable developmental coordination disorder (13.9 ± 0.05 yrs., 27% male) and 37 typically developed (13.9 ± 0.10 yrs., 54% male). While instrumented with an inertial measurement unit, both groups performed a novel rhythmic stepping task and with a concurrent auditory stroop test (dual-task), underwent seven weeks of intervention with step training with rhythmic cuing and were tested for retention five weeks post-intervention. FINDINGS Initially, the group with probable developmental coordination disorder had a higher variability of step timing (coefficient of variation: 0.08 ± 0.003-typically developed - 0.09 ± 0.004-probable developmental coordination disorder, p < 0.05) and a frequency of peak power spectral density further from the target 0.5 Hz (0.50 ± 0.002 Hz-typically developed - 0.51 ± 0.003 Hz-probable developmental coordination disorder, p < 0.05), and were more affected by the dual-task: power spectral density at 0.5 Hz (-7.2 ± 3.3%-typically developed - -13.4 ± 4.6%- prob_DCD, p < 0.05) and stroop test errors (6.4 ± 1.1%-typically developed - -11.1 ± 2.4%- probable developmental coordination disorder, p < 0.05). The intervention led to similar improvements in both groups in coefficient of variation of step timing (0.12 ± 0.01-Pre - 0.07 ± 0.002-Post, p < 0.05), frequency of the peak power spectral density (0.51 ± 0.005 Hz-Pre - 0.50 ± 0.001 Hz-Post, p < 0.05) and relative power spectral density bandpower (3.2 ± 0.2%-Pre - 5.9 ± 0.3%-Post, p < 0.05). All improvements were retained after five weeks post-training. INTERPRETATION Rhythmic cueing shows strong promise for enhancing motor learning in children with probable developmental coordination disorder. TRIAL REGISTRATION Retrospectively registered on ClinicalTrials.gov with reference: NCT03150784.
Collapse
Affiliation(s)
- Mario Inacio
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK; University of Maia, Maia, Portugal; Research Center in Sport Sciences, Health Sciences and Human Development, Vila Real, Portugal.
| | - Patrick Esser
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
| | - Benjamin David Weedon
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
| | - Shawn Joshi
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK; School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, USA
| | - Andy Meaney
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
| | - Anne Delextrat
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
| | - Daniella Springett
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
| | - Steve Kemp
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
| | - Tomas Ward
- Insight Centre for Data Analytics, School of Computing, Dublin City University, Ireland
| | - Hooshang Izadi
- School of Engineering, Computing and Mathematics, Faculty of Technology, Design and Environment, Oxford Brookes University, Oxford, UK
| | - Heidi Johansen-Berg
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Helen Dawes
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK; NIHR Exeter Biomedical Research Centre, University of Exeter, Exeter, UK; Department of Clinical Neurology, University of Oxford, Oxford, UK; Oxford Health Biomedical Research Centre, UK
| |
Collapse
|
5
|
Povedano E, Gallardo-Calero I, Navarrete M, Adillon C, Knorr J, Soldado F. Analysis of dynamic elbow flexion deformity in children with hemiplegic cerebral palsy. Clin Biomech (Bristol, Avon) 2021; 81:105245. [PMID: 33302117 DOI: 10.1016/j.clinbiomech.2020.105245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/28/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cerebral palsy affects 1 per 1.000 children, and in 83% of the cases upper extremity is involved. Dynamic elbow flexion deformity is a movement disorder observed in individuals with hemiparesis secondary to cerebral palsy. We sought to determine whether children with hemiplegic cerebral palsy exhibit dynamic elbow flexion deformity during daily activities and its influence to reaching function. METHODS Sixteen children with upper limb hemiparesis and cerebral palsy (age 11y 7mo (SD 3y 2mo); 11 boys, 5 girls; Gross Motor Function Classification System level I or II) were included in this observational descriptive study. Manual Ability Classification System, Children's Hand-use Experience Questionnaire and Shriners Hospital for Children Upper Extremity Evaluation were used to evaluate affected upper extremity function. Spasticity was assessed with Modified Ashworth scale. Involuntary elbow flexion was recorded in eight daily activities. Elbow motion during reach function was measured. FINDINGS Fifteen out of 16 individuals showed dynamic elbow flexion deformity. There was a significative increase of involved median elbow flexion in all the activities studied, except for "high speed stairs climbing" evaluation. Children's Hand-use Experience Questionnaire showed that children were independent in most of the daily activities (21 out of 29). Correlation between dynamic elbow flexion deformity and Shriners Hospital for Children Upper Extremity Evaluation was observed only in sitting-standing activity (Spearman's ρ 0.549, P = 0.028). INTERPRETATION Dynamic elbow flexion deformity is very common in hemiplegic cerebral palsy and occurs proportionally to the degree of the effort demanded by the activities. Despite of presenting this movement disorder, it does not affect in children participation in daily activities.
Collapse
Affiliation(s)
- Elsa Povedano
- Occupational Therapy Department, Rehabilitation and Physical Medicine, Sant Joan de Dèu Barcelona Children's Hospital, Passeig de Sant Joan de Déu, 2, 08950 Barcelona, Spain.
| | - Irene Gallardo-Calero
- Hand Surgery Unit, Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Passeig Vall Hebron 119-129, 08035, Barcelona 08035, Spain.
| | - Manel Navarrete
- Mechanical engineering department, Volpak. Can Vinyalets 4, 08130, Santa Perpètua de Mogoda, Barcelona, Spain
| | - Cristina Adillon
- Unit of Physiotherapy, Department of Medicina i Cirurgia, Faculty of Medicina i Ciències de la Salut, Rovira i Virgili University, 21 Sant Llorenç St., 43201 Reus, Spain.
| | - Jorge Knorr
- Pediatric upper limb and microsurgery. Barcelona University Children Hospital HM Nens, 437 Consell de Cent St., 08009, Barcelona, Spain. Unidad UCA Mikel Sanchez, Vithas San José, 10 Beato Tomás Zumárraga Av., 01008, Vitoria, Spain
| | - Francisco Soldado
- Pediatric upper limb and microsurgery, Barcelona University Children Hospital HM Nens, Unidad UCA Mikel Sanchez, 437 Consell de Cent St., 08009, Vithas San José, 10 Beato Tomás Zumárraga Av., 01008, Vitoria, Spain
| |
Collapse
|
6
|
Liang P, Kwong WH, Sidarta A, Yap CK, Tan WK, Lim LS, Chan PY, Kuah CWK, Wee SK, Chua K, Quek C, Ang WT. An Asian-centric human movement database capturing activities of daily living. Sci Data 2020; 7:290. [PMID: 32901007 PMCID: PMC7479610 DOI: 10.1038/s41597-020-00627-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/03/2020] [Indexed: 11/14/2022] Open
Abstract
Assessment of human movement performance in activities of daily living (ADL) is a key component in clinical and rehabilitation settings. Motion capture technology is an effective method for objective assessment of human movement. Existing databases capture human movement and ADL performance primarily in the Western population, and there are no Asian databases to date. This is despite the fact that Asian anthropometrics influence movement kinematics and kinetics. This paper details the protocol in the first phase of the largest Asian normative human movement database. Data collection has commenced, and this paper reports 10 healthy participants. Twelve tasks were performed and data was collected using Qualisys motion capture system, force plates and instrumented table and chair. In phase two, human movement of individuals with stroke and knee osteoarthritis will be captured. This can have great potential for benchmarking with the normative human movement captured in phase one and predicting recovery and progression of movement for patients. With individualised progression, it will offer the development of personalised therapy protocols in rehabilitation.
Collapse
Affiliation(s)
- Phyllis Liang
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore.
| | - Wai Hang Kwong
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Ananda Sidarta
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Choon Kong Yap
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Wee Kiat Tan
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Lek Syn Lim
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Pui Yee Chan
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | | | | | - Karen Chua
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Colin Quek
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Wei Tech Ang
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
- School of Mechanical & Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| |
Collapse
|
7
|
Chen Y, Garcia-Vergara S, Howard A. Number of trials necessary to achieve performance stability in a reaching kinematics movement analysis game. J Hand Ther 2020; 33:371-377.e1. [PMID: 31519383 PMCID: PMC7062588 DOI: 10.1016/j.jht.2019.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 03/30/2019] [Accepted: 04/01/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A cross-sectional design was used. INTRODUCTION Motion analysis is commonly used to analyze reaching movements of individuals, but how many trials are necessary to provide stable data? PURPOSE OF THE STUDY The purpose of this study was to determine the number of trials necessary to obtain stable kinematic variables during reaching movements in a virtual environment. METHODS Thirty children (10.39 ± 1.68 years) and 20 adults (26.55 ± 3.12 years) participated. All participants interacted with a virtual reality evaluation game called Super Pop VR to collect their reaching kinematics. The players were instructed to pop several sets of virtual bubbles at a self-selected pace and their upper-body coordinates were recorded and reaching kinematics were computed. Two methods (sequential averaging techniques, SAT, and intraclass correlation coefficient, ICC) were carried out to assess performance stability of each kinematic variable. RESULTS For the SAT method, children exhibited 3.11 to 5.96 trial range to achieve stability in the dominant hand and 2.7 to 5.96 trial range in the nondominant hand, whereas adults exhibited 2.65 to 6.16 trial range in the dominant hand and 3.40 to 6.05 range in the nondominant hand. For the ICC method, to reach the "excellent" value of ICC, children's dominant hand required 4.20 trials and their nondominant hand required 2.5 trials, whereas adults' dominant hand required 3.00 trials and their nondominant hand required 2.80 trials. DISCUSSION AND CONCLUSIONS Our findings supported the importance of determining the minimum number of trials required to obtain stable movements regardless of how familiar the movement seems to participants or how sensitive the apparatus is.
Collapse
Affiliation(s)
- Yuping Chen
- Department of Physical Therapy, Georgia State University, Atlanta, GA
| | - Sergio Garcia-Vergara
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Ayanna Howard
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA
| |
Collapse
|
8
|
Bhattacharjya S, Stafford MC, Cavuoto LA, Yang Z, Song C, Subryan H, Xu W, Langan J. Harnessing smartphone technology and three dimensional printing to create a mobile rehabilitation system, mRehab: assessment of usability and consistency in measurement. J Neuroeng Rehabil 2019; 16:127. [PMID: 31665036 PMCID: PMC6820925 DOI: 10.1186/s12984-019-0592-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Residual sensorimotor deficits are common following stroke. While it has been demonstrated that targeted practice can result in improvements in functional mobility years post stroke, there is little to support rehabilitation across the lifespan. The use of technology in home rehabilitation provides an avenue to better support self-management of recovery across the lifespan. We developed a novel mobile technology, capable of quantifying quality of movement with the purpose of providing feedback to augment rehabilitation and improve functional mobility. This mobile rehabilitation system, mRehab, consists of a smartphone embedded in three dimensional printed items representing functional objects found in the home. mRehab allows individuals with motor deficits to practice activities of daily living (ADLs) and receive feedback on their performance. The aim of this study was to assess the usability and consistency of measurement of the mRehab system. METHODS To assess usability of the mRehab system, four older adults and four individuals with stroke were recruited to use the system, and complete surveys to discuss their opinions on the user interface of the smartphone app and the design of the 3D printed items. To assess the consistency of measurement by the mRehab system, 12 young adults were recruited and performed mRehab ADLs in three lab sessions within 1 week. Young adults were chosen for their expected high level of consistency in motor performance. RESULTS Usability ratings from older adults and individuals with stroke led us to modify the design of the 3D printed items and improve the clarity of the mRehab app. The modified mRehab system was assessed for consistency of measurement and six ADLs resulted in coefficient of variation (CV) below 10%. This is a commonly used CV goal for consistency. Two ADLs ranged between 10 and 15% CV. Only two ADLs demonstrated high CV. CONCLUSIONS mRehab is a client-centered technology designed for home rehabilitation that consistently measures performance. Development of the mRehab system provides a support for individuals working on recovering functional upper limb mobility that they can use across their lifespan.
Collapse
Affiliation(s)
| | | | - Lora Anne Cavuoto
- Industrial and Systems Engineering, University at Buffalo, Buffalo, NY USA
| | - Zhuolin Yang
- Computer Science and Engineering, University at Buffalo, Buffalo, NY USA
| | - Chen Song
- Computer Science and Engineering, University at Buffalo, Buffalo, NY USA
| | - Heamchand Subryan
- Center for Inclusive Design and Environmental Access, University at Buffalo, Buffalo, NY USA
| | - Wenyao Xu
- Computer Science and Engineering, University at Buffalo, Buffalo, NY USA
| | - Jeanne Langan
- Rehabilitation Science, University at Buffalo, Buffalo, NY USA
| |
Collapse
|
9
|
Soares LMDS, Rozane JMSG, Carvalho RDP. Motor performance of children with cerebral palsy in anterior reach. Clin Biomech (Bristol, Avon) 2019; 68:158-162. [PMID: 31212211 DOI: 10.1016/j.clinbiomech.2019.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/30/2019] [Accepted: 06/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Children with cerebral palsy perform small displacements during the anterior reach movement from standing position without loss of balance. There are two possible reasons for their decreased performance: the difficulty to stabilize their lower limbs during forward body inclination to reach greater distances or to control the movement of forward reaching. The objective of this study is to identify and compare the motor performance of children with CP and typically developing children, during anterior reach. METHODS This is a cross-sectional study, composed of 28 children, 14 with spastic cerebral palsy and 14 typical children, who were all evaluated by the Pediatric Reach Test and three-dimensional motion analysis. FINDINGS The decreased performance was shown by the lower movement control by children with cerebral palsy. The bilateral and unilateral cerebral palsy children showed lower range of motion of shoulder and trunk than typical children. INTERPRETATION Children with cerebral palsy show lower anterior displacement and movement control and difficulty bending the trunk and flexing shoulders while reaching forward, suggesting poor postural balance.
Collapse
Affiliation(s)
| | | | - Raquel de Paula Carvalho
- Department of Human Movement Science, Federal University of São Paulo, Rua Silva Jardim, 136 - Vila Mathias, Santos, SP 11015-020, Brazil.
| |
Collapse
|
10
|
Wijeyaratnam DO, Chua R, Cressman EK. Going offline: differences in the contributions of movement control processes when reaching in a typical versus novel environment. Exp Brain Res 2019; 237:1431-1444. [PMID: 30895342 DOI: 10.1007/s00221-019-05515-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 03/09/2019] [Indexed: 12/24/2022]
Abstract
Human movements are remarkably adaptive. We are capable of completing movements in a novel visuomotor environment with similar accuracy to those performed in a typical environment. In the current study, we examined if the control processes underlying movements under typical conditions were different from those underlying novel visuomotor conditions. 16 participants were divided into two groups, one receiving continuous visual feedback during all reaches (CF), and the other receiving terminal feedback regarding movement endpoint (TF). Participants trained in a virtual environment by completing 150 reaches to three targets when (1) a cursor accurately represented their hand motion (i.e., typical environment) and (2) a cursor was rotated 45° clockwise relative to their hand motion (i.e., novel environment). Analyses of within-trial measures across 150 reaching trials revealed that participants were able to demonstrate similar movement outcomes (i.e., movement time and angular errors) regardless of visual feedback or reaching environment by the end of reach training. Furthermore, a reduction in variability across several measures (i.e., reaction time, movement time, time after peak velocity, and jerk score) over time showed that participants improved the consistency of their movements in both reaching environments. However, participants took more time and were less consistent in the timing of initiating their movements when reaching in a novel environment compared to reaching in a typical environment, even at the end of training. As well, angular error variability at different proportions of the movement trajectory was consistently greater when reaching in a novel environment across trials and within a trial. Together, the results suggest a greater contribution of offline control processes and less effective online corrective processes when reaching in a novel environment compared to when reaching in a typical environment.
Collapse
Affiliation(s)
- Darrin O Wijeyaratnam
- School of Human Kinetics, University of Ottawa, 125 University Private, Room 360, Ottawa, ON, K1N 6N5, Canada
| | - Romeo Chua
- School of Kinesiology, University of British Columbia, 6108 Thunderbird Boulevard, Osborne Centre Unit 2, Room 205, Vancouver, BC, V6T 1Z1, Canada
| | - Erin K Cressman
- School of Human Kinetics, University of Ottawa, 125 University Private, Room 360, Ottawa, ON, K1N 6N5, Canada.
| |
Collapse
|
11
|
Kuczynski AM, Kirton A, Semrau JA, Dukelow SP. Bilateral reaching deficits after unilateral perinatal ischemic stroke: a population-based case-control study. J Neuroeng Rehabil 2018; 15:77. [PMID: 30115093 PMCID: PMC6097295 DOI: 10.1186/s12984-018-0420-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Detailed kinematics of motor impairment of the contralesional ("affected") and ipsilesional ("unaffected") limbs in children with hemiparetic cerebral palsy are not well understood. We aimed to 1) quantify the kinematics of reaching in both arms of hemiparetic children with perinatal stroke using a robotic exoskeleton, and 2) assess the correlation of kinematic reaching parameters with clinical motor assessments. METHODS This prospective, case-control study involved the Alberta Perinatal Stroke Project, a population-based research cohort, and the Foothills Medical Center Stroke Robotics Laboratory in Calgary, Alberta over a four year period. Prospective cases were collected through the Calgary Stroke Program and included term-born children with magnetic resonance imaging confirmed perinatal ischemic stroke and upper extremity deficits. Control participants were recruited from the community. Participants completed a visually guided reaching task in the KINARM robot with each arm separately, with 10 parameters quantifying motor function. Kinematic measures were compared to clinical assessments and stroke type. RESULTS Fifty children with perinatal ischemic stroke (28 arterial, mean age: 12.5 ± 3.9 years; 22 venous, mean age: 11.5 ± 3.8 years) and upper extremity deficits were compared to healthy controls (n = 147, mean age: 12.7 ± 3.9 years). Perinatal stroke groups demonstrated contralesional motor impairments compared to controls when reaching out (arterial = 10/10, venous = 8/10), and back (arterial = 10/10, venous = 6/10) with largest errors in reaction time, initial direction error, movement length and time. Ipsilesional impairments were also found when reaching out (arterial = 7/10, venous = 1/10) and back (arterial = 6/10). The arterial group performed worse than venous on both contralesional and ipsilesional parameters. Contralesional reaching parameters showed modest correlations with clinical measures in the arterial group. CONCLUSIONS Robotic assessment of reaching behavior can quantify complex, upper limb dysfunction in children with perinatal ischemic stroke. The ipsilesional, "unaffected" limb is often abnormal and may be a target for therapeutic interventions in stroke-induced hemiparetic cerebral palsy.
Collapse
Affiliation(s)
- Andrea M Kuczynski
- University of Calgary, Calgary, AB, T2N 2T9, Canada.,Section of Neurology, Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Adam Kirton
- University of Calgary, Calgary, AB, T2N 2T9, Canada.,Section of Neurology, Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.,Department of Clinical Neurosciences, Foothills Medical Centre, Hotchkiss Brain Institute, 1403 - 29th St. NW, Calgary, AB, Canada
| | - Jennifer A Semrau
- University of Calgary, Calgary, AB, T2N 2T9, Canada.,Department of Clinical Neurosciences, Foothills Medical Centre, Hotchkiss Brain Institute, 1403 - 29th St. NW, Calgary, AB, Canada
| | - Sean P Dukelow
- University of Calgary, Calgary, AB, T2N 2T9, Canada. .,Department of Clinical Neurosciences, Foothills Medical Centre, Hotchkiss Brain Institute, 1403 - 29th St. NW, Calgary, AB, Canada.
| |
Collapse
|
12
|
Kim DH, An DH, Yoo WG. Measurement of upper limb movement acceleration and functions in children with cerebral palsy. Technol Health Care 2018; 26:429-435. [DOI: 10.3233/thc-171148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Do Hyun Kim
- HIP&MAL Laboratory, Department of Rehabilitation Science, Inje University, Gimhae, Korea
| | - Duk-Hyun An
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Gimhae, Korea
| | - Won-Gyu Yoo
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Gimhae, Korea
| |
Collapse
|
13
|
Kuczynski AM, Dukelow SP, Hodge JA, Carlson HL, Lebel C, Semrau JA, Kirton A. Corticospinal tract diffusion properties and robotic visually guided reaching in children with hemiparetic cerebral palsy. Hum Brain Mapp 2017; 39:1130-1144. [PMID: 29193460 DOI: 10.1002/hbm.23904] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/01/2017] [Accepted: 11/22/2017] [Indexed: 12/20/2022] Open
Abstract
Perinatal stroke is the leading cause of hemiparetic cerebral palsy (CP), resulting in life-long disability. In this study, we examined the relationship between robotic upper extremity motor impairment and corticospinal tract (CST) diffusion properties. Thirty-three children with unilateral perinatal ischemic stroke (17 arterial, 16 venous) and hemiparesis were recruited from a population-based research cohort. Bilateral CSTs were defined using diffusion tensor imaging (DTI) and four diffusion metrics were quantified: fractional anisotropy (FA), mean (MD), radial (RD), and axial (AD) diffusivities. Participants completed a visually guided reaching task using the KINARM robot to define 10 movement parameters including movement time and maximum speed. Twenty-six typically developing children underwent the same evaluations. Partial correlations assessed the relationship between robotic reaching and CST diffusion parameters. All diffusion properties of the lesioned CST differed from controls in the arterial group, whereas only FA was reduced in the venous group. Non-lesioned CST diffusion measures were similar between stroke groups and controls. Both stroke groups demonstrated impaired reaching performance. Multiple reaching parameters of the affected limb correlated with lesioned CST diffusion properties. Lower FA and higher MD were associated with greater movement time. Few correlations were observed between non-lesioned CST diffusion and unaffected limb function though FA was associated with reaction time (R = -0.39, p < .01). Diffusion properties of the lesioned CST are altered after perinatal stroke, the degree of which correlates with specific elements of visually guided reaching performance, suggesting specific relevance of CST structural connectivity to clinical motor function in hemiparetic children.
Collapse
Affiliation(s)
- Andrea M Kuczynski
- University of Calgary, Calgary, Alberta, Canada.,Section of Neurology, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Sean P Dukelow
- University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Jacquie A Hodge
- Section of Neurology, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Helen L Carlson
- Section of Neurology, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Catherine Lebel
- University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Jennifer A Semrau
- University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Adam Kirton
- University of Calgary, Calgary, Alberta, Canada.,Section of Neurology, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| |
Collapse
|
14
|
Simon-Martinez C, Jaspers E, Mailleux L, Desloovere K, Vanrenterghem J, Ortibus E, Molenaers G, Feys H, Klingels K. Negative Influence of Motor Impairments on Upper Limb Movement Patterns in Children with Unilateral Cerebral Palsy. A Statistical Parametric Mapping Study. Front Hum Neurosci 2017; 11:482. [PMID: 29051729 PMCID: PMC5633911 DOI: 10.3389/fnhum.2017.00482] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/19/2017] [Indexed: 11/13/2022] Open
Abstract
Upper limb three-dimensional movement analysis (UL-3DMA) offers a reliable and valid tool to evaluate movement patterns in children with unilateral cerebral palsy (uCP). However, it remains unknown to what extent the underlying motor impairments explain deviant movement patterns. Such understanding is key to develop efficient rehabilitation programs. Although UL-3DMA has been shown to be a useful tool to assess movement patterns, it results in a multitude of data, challenging the clinical interpretation and consequently its implementation. UL-3DMA reports are often reduced to summary metrics, such as average or peak values per joint. However, these metrics do not take into account the continuous nature of the data or the interdependency between UL joints, and do not provide phase-specific information of the movement pattern. Moreover, summary metrics may not be sensitive enough to estimate the impact of motor impairments. Recently, Statistical Parametric Mapping (SPM) was proposed to overcome these problems. We collected UL-3DMA of 60 children with uCP and 60 typically developing children during eight functional tasks and evaluated the impact of spasticity and muscle weakness on UL movement patterns. SPM vector field analysis was used to analyze movement patterns at the level of five joints (wrist, elbow, shoulder, scapula, and trunk). Children with uCP showed deviant movement patterns in all joints during a large percentage of the movement cycle. Spasticity and muscle weakness negatively impacted on UL movement patterns during all tasks, which resulted in increased wrist flexion, elbow pronation and flexion, increased shoulder external rotation, decreased shoulder elevation with a preference for movement in the frontal plane and increased trunk internal rotation. Scapular position was altered during movement initiation, although scapular movements were not affected by muscle weakness or spasticity. In conclusion, we identified pathological movement patterns in children with uCP and additionally mapped the negative impact of spasticity and muscle weakness on these movement patterns, providing useful insights that will contribute to treatment planning. Last, we also identified a subset of the most relevant tasks for studying UL movements in children with uCP, which will facilitate the interpretation of UL-3DMA data and undoubtedly contribute to its clinical implementation.
Collapse
Affiliation(s)
| | - Ellen Jaspers
- Neural Control of Movement Lab, ETH Zurich, Zurich, Switzerland
| | - Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | | | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Guy Molenaers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Orthopedic Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Rehabilitation Research Center (REVAL), BIOMED, University of Hasselt, Diepenbeek, Belgium
| |
Collapse
|