Validity and reliability of a smartphone inclinometer app for measuring passive upper limb range of motion in a stroke population

Validity of an android device for assessing mobility in people with chronic stroke and hemiparesis: a cross-sectional study

BACKGROUND

Incorporating instrument measurements into clinical assessments can improve the accuracy of results when assessing mobility related to activities of daily living. This can assist clinicians in making evidence-based decisions. In this context, kinematic measures are considered essential for the assessment of sensorimotor recovery after stroke. The aim of this study was to assess the validity of using an Android device to evaluate kinematic data during the performance of a standardized mobility test in people with chronic stroke and hemiparesis.

METHODS

This is a cross-sectional study including 36 individuals with chronic stroke and hemiparesis and 33 age-matched healthy subjects. A simple smartphone attached to the lumbar spine with an elastic band was used to measure participants' kinematics during a standardized mobility test by using the inertial sensor embedded in it. This test includes postural control, walking, turning and sitting down, and standing up. Differences between stroke and non-stroke participants in the kinematic parameters obtained after data sensor processing were studied, as well as in the total execution and reaction times. Also, the relationship between the kinematic parameters and the community ambulation ability, degree of disability and functional mobility of individuals with stroke was studied.

RESULTS

Compared to controls, participants with chronic stroke showed a larger medial-lateral displacement (p = 0.022) in bipedal stance, a higher medial-lateral range (p < 0.001) and a lower cranio-caudal range (p = 0.024) when walking, and lower turn-to-sit power (p = 0.001), turn-to-sit jerk (p = 0.026) and sit-to-stand jerk (p = 0.001) when assessing turn-to-sit-to-stand. Medial-lateral range and total execution time significantly correlated with all the clinical tests (p < 0.005), and resulted significantly different between independent and limited community ambulation patients (p = 0.042 and p = 0.006, respectively) as well as stroke participants with significant disability or slight/moderate disability (p = 0.024 and p = 0.041, respectively).

CONCLUSION

This study reports a valid, single, quick and easy-to-use test for assessing kinematic parameters in chronic stroke survivors by using a standardized mobility test with a smartphone. This measurement could provide valid clinical information on reaction time and kinematic parameters of postural control and gait, which can help in planning better intervention approaches.

Influence of an upper limb exoskeleton on muscle activity during various construction and manufacturing tasks

Musculoskeletal disorders (MSDs) significantly impact workers in the manufacturing and construction sectors. One solution that has gained interest to reduce MSDs incidence is the use of exoskeletons. In this study, the influence of an upper limb exoskeleton on muscle activity was investigated experimentally for three commonly performed tasks in the manufacturing and construction sectors. The tasks tested were overhead assembly, bricklaying, and box moving tasks. Eighteen males participated in the tests. The results showed a reduction in shoulder flexor muscle activation during all three tasks (up to -45.46 ± 4.52% for the anterior deltoid), but increased extensor activation (up to 15.47 ± 8.01% for the latissimus dorsi) was observed when the task was not primarily performed above shoulder level. The results revealed the dependence of the upper-body exoskeleton on tasks and arm posture, which should be considered for both in-field applications and designing new exoskeletons for performance enhancement.

Sustainable effectiveness of kinetic chain stretching on active hip flexion movement and muscle activation for hamstring tightness: A preliminary investigation

BACKGROUND

Conventional hamstring (HAM) stretching therapeutic effects are not substantiable in neuromusculoskeletal conditions with HAM tightness or shortness. We developed a kinetic chain stabilization exercise to provide a more sustainable effectiveness in adults with HAM tightness. However, its therapeutic effects and underlying motor mechanisms remain unknown.

OBJECTIVE

To compare the effects of traditional active HAM stretching (AHS) and kinetic chain stretching (KCS) on electromyographic (EMG) amplitude and hip flexion range of motion (ROM) in participants with HAM tightness.

METHODS

In this randomized controlled trial, 18 participants (mean age: 25.01 ± 2.47 years) with HAM tightness were assigned to the AHS or KCS group. Hip joint movement, EMG amplitude, and onset times were recorded in the bilateral erector spinae, HAM, transverse abdominis/internal oblique (IO), external oblique (EO), and rectus abdominis during a straight leg raise test.

RESULTS

Compared to AHS, KCS led to greater increase in the hip flexion ROM and EMG activation amplitudes in the left and right EO and left IO. Post-test hip flexion ROM data in both the groups were higher than the pre-test data.

CONCLUSION

KCS produced more sustainable effectiveness in hip flexion movement and EMG motor control patterns in participants with HAM tightness than AHS.

Shoulder Range of Motion Measurement Using Inertial Measurement Unit-Concurrent Validity and Reliability

This study aimed to evaluate the reliability of the RSQ Motion sensor and its validity against the Propriometer and electronic goniometer in measuring the active range of motion (ROM) of the shoulder. The study included 15 volunteers (mean age 24.73 ± 3.31) without any clinical symptoms with no history of trauma, disease, or surgery to the upper limb. Four movements were tested: flexion, abduction, external and internal rotation. Validation was assessed in the full range of active shoulder motion. Reliability was revised in full active ROM, a fixed angle of 90 degrees for flexion and abduction, and 45 degrees for internal and external rotation. Each participant was assessed three times: on the first day by both testers and on the second day only by one of the testers. Goniometer and RSQ Motion sensors showed moderate to excellent correlation for all tested movements (ICC 0.61-0.97, LOA < 23 degrees). Analysis of inter-rater reliability showed good to excellent agreement between both testers (ICC 0.74-0.97, LOA 13-35 degrees). Analysis of intra-rater reliability showed moderate to a good agreement (ICC 0.7-0.88, LOA 22-37 degrees). The shoulder internal and external rotation measurement with RSQ Motion sensors is valid and reliable. There is a high level of inter-rater and intra-rater reliability for the RSQ Motion sensors and Propriometer.

Smartphone App in Stroke Management: A Narrative Updated Review

The spread of smartphones and mobile-Health (m-health) has progressively changed clinical practice, implementing access to medical knowledge and communication between doctors and patients. Dedicated software called Applications (or Apps), assists the practitioners in the various phases of clinical practice, from diagnosis to follow-up and therapy management. The impact of this technology is even more important in diseases such as stroke, which are characterized by a complex management that includes several moments: primary prevention, acute phase management, rehabilitation, and secondary prevention. This review aims to evaluate and summarize the available literature on Apps for the clinical management of stroke. We described their potential and weaknesses, discussing potential room for improvement. Medline databases were interrogated for studies concerning guideline-based decision support Apps for stroke management and other medical scenarios from 2007 (introduction of the first iPhone) until January 2022. We found 551 studies. Forty-three papers were included because they fitted the scope of the review. Based on their purpose, Apps were classified into three groups: primary prevention Apps, acute stroke management Apps, and post-acute stroke Apps. We described the aim of each App and, when available, the results of clinical studies. For acute stroke, several Apps have been designed with the primary purpose of helping communication and sharing of patients' clinical data among healthcare providers. However, interactive systems Apps aiming to assist clinicians are still lacking, and this field should be developed because it may improve stroke patients' management.

The Telemedicine-Based Pediatric Examination of the Neck and Upper Limbs: A Narrative Review

With the COVID-19 pandemic hastening the adoption of telemedicine into clinical practice, it has also prompted an abundance of new literature highlighting its capabilities and limitations. The purpose of this review is to summarize the current state of the literature on telemedicine applied in the context of a musculoskeletal examination of the neck and upper limbs for children 3 to 18 years old. The PubMed and ScienceDirect databases were searched for relevant articles from January 2015 to August 2021 using a combination of keywords and nested searches. General examination components including inspection, guided self-palpation, range of motion, sensory and motor examination, as well as special testing are described. Although the literature is focused mainly on adult populations, we describe how each component of the exam can be reliably incorporated into a virtual appointment specific to pediatric patients. Caregivers are generally needed for most consultations, but certain maneuvers can be self-performed by older children and adolescents alone. There is general feasibility, validity, and substantial reliability in performing most examination components of the upper limbs remotely, except for the shoulder exam. Compared to those made in person, clinical diagnoses established virtually were found to be either the same or similar in most cases, and management decisions also had high agreement. Despite this, there is evidence that some pediatric providers may not be able to collect all the information needed from a telemedicine visit to make a complete clinical assessment. Lastly, currently available smartphone applications measuring joint range of motion were found to have high reliability and validity. This narrative review not only establishes a foundation for a structured pediatric musculoskeletal examination, but also aims to increase physicians' confidence in incorporating telemedicine into their standard of care.

Assessing the knee flexion range of motion after total knee arthroplasty: Technology versus senses

INTRODUCTION

Following total knee arthroplasty surgery, attention should be paid to post-operative knee range of motion to achieve daily activities. Goniometer assessment is widely used to assess the range of motion in the post-operative period. This study aimed to determine the inter-rater ability of a smartphone application and visual estimation of the knee joint after total knee arthroplasty among different professions that commonly work together and compare whether any method is superior to another.

METHOD

Range of motion measurements was performed by four clinicians as two physiotherapists and two orthopedic fellows. They utilized the Goniometer Reports application for smartphones, universal goniometer, and visual estimation to measure angles of knees which was operated. A two-way mixed model of intra-class correlation coefficient (ICC) with a 95% confidence level was used to assess inter-rater reliability.

RESULTS

Thirteen patients (11 female) and 20 knees (10 right) were assessed. The ICCs were found excellent both for between methods and between raters.

CONCLUSION

Our results show that technology seems a more accurate way to determine the knee range of motion after knee arthroplasty compared to senses. However, in lack of technological resources or time, or to avoid possible infection, visual estimation also could provide useful information.

Measurement of rolling resistance and scrub torque of manual wheelchair drive wheels and casters

The effort needed to maneuver a manual wheelchair is a function of the occupied wheelchair's inertia and energy loss. The primary source of energy loss is due to the resistance of the drive wheels and casters on the ground. Specifically, manual wheelchairs have two major sources of frictional energy loss: rolling resistance and scrub torque. The objective of this study was to develop and validate component-level test methods to evaluate the energy loss properties of drive wheels and casters on different surfaces and with different applied loads. Rolling resistance is measured using a weighted coast-down cart and scrub torque is calculated by measuring the force required to rotate a plate that is loaded onto the tire's surface. Each test method was iterated and then applied to a cohort of drive wheels and casters. Both test methods demonstrated acceptable repeatability and the ability to distinguish energy loss parameters between common wheelchair components. The results show that caster and drive wheel energy losses can vary significantly across surfaces and with increased load on the casters. However, the findings also illuminate complex relationships between rolling resistance and scrub torque performance that embody a tradeoff in performance as applied to mobility during everyday life.