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Martino Cinnera A, Ciancarelli I, Marrano S, Palagiano M, Federici E, Bisirri A, Iosa M, Paolucci S, Koch G, Morone G. Sensor-Based Balance Training with Exergaming Feedback in Subjects with Chronic Stroke: A Pilot Randomized Controlled Trial. Brain Sci 2024; 14:917. [PMID: 39335412 PMCID: PMC11429541 DOI: 10.3390/brainsci14090917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 09/06/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND As one of the leading causes of disability in the world, stroke can determine a reduction of balance performance with a negative impact on daily activity and social life. In this study, we aimed to evaluate the effects of sensor-based balance training with exergaming feedback on balance skills in chronic stroke patients. METHODS 21 individuals (11F, 57.14 ± 13.82 years) with a single event of ischemic stroke were randomly assigned to the sensor-based balance training group (SB-group) or the usual care balance training group (UC-group). Both groups received 10 add-on sessions with exergaming feedback (SB-group) or conventional training (UC-group). Clinical and instrumental evaluation was performed before (t0), after (t1), and after one month (t2) from intervention. Participation level was assessed using the Pittsburgh Rehabilitation Participation Scale at the end of each session. RESULTS The SB-group showed an improvement in postural stability (p = 0.02) when compared to the UC-group. In the evaluation of motivational level, the score was statistically higher in the SB-group with respect to the UC-group (p < 0.01). CONCLUSION Except for the improvement in postural stability, no difference was recorded in clinical score, suggesting a comparable gain in both groups. However, patients undergoing sensor-based training exhibited a higher participation score, ultimately indicating the use of this training to improve the adherence to rehabilitation settings, especially in patients with lower compliance.
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Affiliation(s)
- Alex Martino Cinnera
- Scientific Institute for Research, Hospitalization and Health Care IRCCS Santa Lucia Foundation, 00142 Rome, Italy; (S.M.); (M.P.); (S.P.)
| | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (I.C.); (G.M.)
| | - Serena Marrano
- Scientific Institute for Research, Hospitalization and Health Care IRCCS Santa Lucia Foundation, 00142 Rome, Italy; (S.M.); (M.P.); (S.P.)
| | - Massimiliano Palagiano
- Scientific Institute for Research, Hospitalization and Health Care IRCCS Santa Lucia Foundation, 00142 Rome, Italy; (S.M.); (M.P.); (S.P.)
| | - Elisa Federici
- School of Physiotherapy, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Rome, Italy;
| | | | - Marco Iosa
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy;
| | - Stefano Paolucci
- Scientific Institute for Research, Hospitalization and Health Care IRCCS Santa Lucia Foundation, 00142 Rome, Italy; (S.M.); (M.P.); (S.P.)
| | - Giacomo Koch
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy;
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (I.C.); (G.M.)
- San Raffaele Institute of Sulmona, 67039 Sulmona, Italy
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Cornella-Barba G, Okita S, Li Z, Reinkensmeyer DJ. Real-Time Sensing of Upper Extremity Movement Diversity Using Kurtosis Implemented on a Smartwatch. SENSORS (BASEL, SWITZERLAND) 2024; 24:5266. [PMID: 39204961 PMCID: PMC11358890 DOI: 10.3390/s24165266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 07/30/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024]
Abstract
Wearable activity sensors typically count movement quantity, such as the number of steps taken or the number of upper extremity (UE) counts achieved. However, for some applications, such as neurologic rehabilitation, it may be of interest to quantify the quality of the movement experience (QOME), defined, for example, as how diverse or how complex movement epochs are. We previously found that individuals with UE impairment after stroke exhibited differences in their distributions of forearm postures across the day and that these differences could be quantified with kurtosis-an established statistical measure of the peakedness of distributions. In this paper, we describe further progress toward the goal of providing real-time feedback to try to help people learn to modulate their movement diversity. We first asked the following: to what extent do different movement activities induce different values of kurtosis? We recruited seven unimpaired individuals and evaluated a set of 12 therapeutic activities for their forearm postural diversity using kurtosis. We found that the different activities produced a wide range of kurtosis values, with conventional rehabilitation therapy exercises creating the most spread-out distribution and cup stacking the most peaked. Thus, asking people to attempt different activities can vary movement diversity, as measured with kurtosis. Next, since kurtosis is a computationally expensive calculation, we derived a novel recursive algorithm that enables the real-time calculation of kurtosis. We show that the algorithm reduces computation time by a factor of 200 compared to an optimized kurtosis calculation available in SciPy, across window sizes. Finally, we embedded the kurtosis algorithm on a commercial smartwatch and validated its accuracy using a robotic simulator that "wore" the smartwatch, emulating movement activities with known kurtosis. This work verifies that different movement tasks produce different values of kurtosis and provides a validated algorithm for the real-time calculation of kurtosis on a smartwatch. These are needed steps toward testing QOME-focused, wearable rehabilitation.
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Affiliation(s)
- Guillem Cornella-Barba
- Department of Mechanical and Aerospace Engineering, University of California Irvine, Irvine, CA 92697, USA;
| | - Shusuke Okita
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL 60611, USA;
| | - Zheng Li
- School of Electronics, Electrical Engineering and Computer Science, Queen’s University Belfast, Belfast BT7 1NN, UK;
| | - David J. Reinkensmeyer
- Department of Mechanical and Aerospace Engineering, University of California Irvine, Irvine, CA 92697, USA;
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Cereatti A, Gurchiek R, Mündermann A, Fantozzi S, Horak F, Delp S, Aminian K. ISB recommendations on the definition, estimation, and reporting of joint kinematics in human motion analysis applications using wearable inertial measurement technology. J Biomech 2024; 173:112225. [PMID: 39032224 DOI: 10.1016/j.jbiomech.2024.112225] [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: 03/11/2024] [Revised: 06/07/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024]
Abstract
There is widespread and growing use of inertial measurement technology for human motion analysis in biomechanics and clinical research. Due to advancements in sensor miniaturization, inertial measurement units can be used to obtain a description of human body and joint kinematics both inside and outside the laboratory. While algorithms for data processing continue to improve, a lack of standard reporting guidelines compromises the interpretation and reproducibility of results, which hinders advances in research and development of measurement and intervention tools. To address this need, the International Society of Biomechanics approved our proposal to develop recommendations on the use of inertial measurement units for joint kinematics analysis. A collaborative effort that incorporated feedback from the biomechanics community has produced recommendations in five categories: sensor characteristics and calibration, experimental protocol, definition of a kinematic model and subject-specific calibration, analysis of joint kinematics, and quality assessment. We have avoided an overly prescriptive set of recommendations for algorithms and protocols, and instead offer reporting guidelines to facilitate reproducibility and comparability across studies. In addition to a conceptual framework and reporting guidelines, we provide a checklist to guide the design and review of research using inertial measurement units for joint kinematics.
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Affiliation(s)
- Andrea Cereatti
- Department of Electronics and Telecommunications, Polytechnic University of Torino, Torino, Italy.
| | - Reed Gurchiek
- Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Silvia Fantozzi
- Department of Electric, Electronic and Information Engineering "Guglielmo Marconi" - DEI, University of Bologna, Italy
| | - Fay Horak
- APDM Precision Motion of Clario, Portland, Oregon, USA; Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Scott Delp
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Martino Cinnera A, Bonanno M, Calabrò RS, Bisirri A, D'Arienzo M, D'Acunto A, Ciancarelli I, Morone G, Koch G. Paired associative stimulation to enhance motor outcome in spinal cord injury: a systematic review of first evidence. Expert Rev Med Devices 2024:1-12. [PMID: 38768088 DOI: 10.1080/17434440.2024.2358048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/17/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Spinal cord injuries (SCI) often result in motor impairment and lifelong disability. METHODS This systematic review, conducted in agreement with PRISMA guidelines, aimed to evaluate the effects of cortico-spinal paired associative stimulation (PAS) on motor outcomes in individuals with SCI. PubMed, Scopus/EMBASE, Pedro, and Cochrane databases were consulted from inception to 2023/01/12. RESULTS In 1021 articles, 10 studies involving 84 patients meet the inclusion criteria, 7 case series/study, and 3 clinical trials. Despite light differences, the included studies performed a cortico-peripheral PAS using a single transcranial magnetic stimulation and high frequency electrical peripheral nerve stimulation for a consistent number of sessions (>20). All included studies reported improvement in motor outcomes recorded via clinical and/or neurophysiological assessment. CONCLUSION Available evidence showed an increase in motor outcomes after PAS stimulation. Indeed, both clinical and neurophysiological outcomes suggest the effectiveness of a high number of PAS sessions in chronic individuals with SCI. Due to a limited number of studies and an unsatisfactory study design, well-designed RCTs are needed to confirm the potentiality of these approaches and clarify the adequate dose-response of PAS in the SCI population. REGISTRATION ID The protocol was registered on the PROSPERO database (CRD42023485703).
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Affiliation(s)
- Alex Martino Cinnera
- Scientific Institute for Research, Hospitalisation and Health Care IRCCS Santa Lucia Foundation, Rome, Italy
| | | | | | | | - Martina D'Arienzo
- Scientific Institute for Research, Hospitalisation and Health Care IRCCS Santa Lucia Foundation, Rome, Italy
| | - Alessia D'Acunto
- Department of Neurosciences, Paediatric neurology, University of Rome Tor Vergata, Rome, Italy
| | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- San Raffaele Institute of Sulmona, Sulmona, Italy
| | - Giacomo Koch
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
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Cinnera AM, Bonnì S, D'Acunto A, Maiella M, Ferraresi M, Casula EP, Pezzopane V, Tramontano M, Iosa M, Paolucci S, Morone G, Vannozzi G, Koch G. Cortico-cortical stimulation and robot-assisted therapy (CCS and RAT) for upper limb recovery after stroke: study protocol for a randomised controlled trial. Trials 2023; 24:823. [PMID: 38129910 PMCID: PMC10740274 DOI: 10.1186/s13063-023-07849-1] [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: 01/18/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Since birth, during the exploration of the environment to interact with objects, we exploit both the motor and sensory components of the upper limb (UL). This ability to integrate sensory and motor information is often compromised following a stroke. However, to date, rehabilitation protocols are focused primarily on recovery of motor function through physical therapies. Therefore, we have planned a clinical trial to investigate the effect on functionality of UL after a sensorimotor transcranial stimulation (real vs sham) in add-on to robot-assisted therapy in the stroke population. METHODS A randomised double-blind controlled trial design involving 32 patients with a single chronic stroke (onset > 180 days) was planned. Each patient will undergo 15 consecutive sessions (5 days for 3 weeks) of paired associative stimulation (PAS) coupled with UL robot-assisted therapy. PAS stimulation will be administered using a bifocal transcranial magnetic stimulator (TMS) on the posterior-parietal cortex and the primary motor area (real or sham) of the lesioned hemisphere. Clinical, kinematics and neurophysiological changes will be evaluated at the end of protocol and at 1-month follow-up and compared with baseline. The Fugl-Meyer assessment scale will be the primary outcome. Secondly, kinematic variables will be recorded during the box-and-block test and reaching tasks using video analysis and inertial sensors. Single pulse TMS and electroencephalography will be used to investigate the changes in local cortical reactivity and in the interconnected areas. DISCUSSION The presented trial shall evaluate with a multimodal approach the effects of sensorimotor network stimulation applied before a robot-assisted therapy training on functional recovery of the upper extremity after stroke. The combination of neuromodulation and robot-assisted therapy can promote an increase of cortical plasticity of sensorimotor areas followed by a clinical benefit in the motor function of the upper limb. TRIAL REGISTRATION ClinicalTrials.gov NCT05478434. Registered on 28 Jul 2022.
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Affiliation(s)
- Alex Martino Cinnera
- Scientific Institute for Research, Hospitalization and Health Care IRCCS Santa Lucia Foundation, Rome, Italy.
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.
| | - Sonia Bonnì
- Scientific Institute for Research, Hospitalization and Health Care IRCCS Santa Lucia Foundation, Rome, Italy
| | - Alessia D'Acunto
- Scientific Institute for Research, Hospitalization and Health Care IRCCS Santa Lucia Foundation, Rome, Italy
| | - Michele Maiella
- Scientific Institute for Research, Hospitalization and Health Care IRCCS Santa Lucia Foundation, Rome, Italy
| | - Matteo Ferraresi
- Scientific Institute for Research, Hospitalization and Health Care IRCCS Santa Lucia Foundation, Rome, Italy
| | - Elias Paolo Casula
- Scientific Institute for Research, Hospitalization and Health Care IRCCS Santa Lucia Foundation, Rome, Italy
- Department of System Medicine, University of Tor Vergata, Rome, Italy
| | - Valentina Pezzopane
- Scientific Institute for Research, Hospitalization and Health Care IRCCS Santa Lucia Foundation, Rome, Italy
| | - Marco Tramontano
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Iosa
- Scientific Institute for Research, Hospitalization and Health Care IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Psychology, Sapienza University of Rome, 00185, Rome, Italy
| | - Stefano Paolucci
- Scientific Institute for Research, Hospitalization and Health Care IRCCS Santa Lucia Foundation, Rome, Italy
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Giuseppe Vannozzi
- Scientific Institute for Research, Hospitalization and Health Care IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Giacomo Koch
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
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Li S. Stroke Recovery Is a Journey: Prediction and Potentials of Motor Recovery after a Stroke from a Practical Perspective. Life (Basel) 2023; 13:2061. [PMID: 37895442 PMCID: PMC10608684 DOI: 10.3390/life13102061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/01/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Stroke recovery is a journey. Stroke survivors can face many consequences that may last the rest of their lives. Assessment of initial impairments allows reasonable prediction of biological spontaneous recovery at 3 to 6 months for a majority of survivors. In real-world clinical practice, stroke survivors continue to improve their motor function beyond the spontaneous recovery period, but management plans for maximal recovery are not well understood. A model within the international classification of functioning (ICF) theoretical framework is proposed to systematically identify opportunities and potential barriers to maximize and realize the potentials of functional recovery from the acute to chronic stages and to maintain their function in the chronic stages. Health conditions of individuals, medical and neurological complications can be optimized under the care of specialized physicians. This permits stroke survivors to participate in various therapeutic interventions. Sufficient doses of appropriate interventions at the right time is critical for stroke motor rehabilitation. It is important to highlight that combining interventions is likely to yield better clinical outcomes. Caregivers, including family members, can assist and facilitate targeted therapeutic exercises for these individuals and can help stroke survivors comply with medical plans (medications, visits), and provide emotional support. With health optimization, comprehensive rehabilitation, support from family and caregivers and a commitment to a healthy lifestyle, many stroke survivors can overcome barriers and achieve potentials of maximum recovery and maintain their motor function in chronic stages. This ICF recovery model is likely to provide a guidance through the journey to best achieve stroke recovery potentials.
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Affiliation(s)
- Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center—Houston, Houston, TX 77025, USA;
- TIRR Memorial Hermann Hospital, Houston, TX 77030, USA
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Li M, Scronce G, Finetto C, Coupland K, Zhong M, Lambert ME, Baker A, Luo F, Seo NJ. Application of Deep Learning Algorithm to Monitor Upper Extremity Task Practice. SENSORS (BASEL, SWITZERLAND) 2023; 23:6110. [PMID: 37447958 DOI: 10.3390/s23136110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/25/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
Upper extremity hemiplegia is a serious problem affecting the lives of many people post-stroke. Motor recovery requires high repetitions and quality of task-specific practice. Sufficient practice cannot be completed during therapy sessions, requiring patients to perform additional task practices at home on their own. Adherence to and quality of these home task practices are often limited, which is likely a factor reducing rehabilitation effectiveness post-stroke. However, home adherence is typically measured by self-reports that are known to be inconsistent with objective measurement. The objective of this study was to develop algorithms to enable the objective identification of task type and quality. Twenty neurotypical participants wore an IMU sensor on the wrist and performed four representative tasks in prescribed fashions that mimicked correct, compensatory, and incomplete movement qualities typically seen in stroke survivors. LSTM classifiers were trained to identify the task being performed and its movement quality. Our models achieved an accuracy of 90.8% for task identification and 84.9%, 81.1%, 58.4%, and 73.2% for movement quality classification for the four tasks for unseen participants. The results warrant further investigation to determine the classification performance for stroke survivors and if quantity and quality feedback from objective monitoring facilitates effective task practice at home, thereby improving motor recovery.
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Affiliation(s)
- Mingqi Li
- Department of Computer Science, School of Computing, Clemson University, Clemson, SC 29634, USA
| | - Gabrielle Scronce
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA
- Ralph H. Johnson VA Health Care System, Charleston, SC 29401, USA
| | - Christian Finetto
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Kristen Coupland
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA
- Ralph H. Johnson VA Health Care System, Charleston, SC 29401, USA
| | - Matthew Zhong
- Department of Computer Science, School of Computing, Clemson University, Clemson, SC 29634, USA
- Summer Intern, Research Experience for Undergraduates, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Melanie E Lambert
- Department of Computer Science, School of Computing, Clemson University, Clemson, SC 29634, USA
| | - Adam Baker
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA
- Ralph H. Johnson VA Health Care System, Charleston, SC 29401, USA
| | - Feng Luo
- Department of Computer Science, School of Computing, Clemson University, Clemson, SC 29634, USA
| | - Na Jin Seo
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA
- Ralph H. Johnson VA Health Care System, Charleston, SC 29401, USA
- Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA
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