Rasch analysis of a new hierarchical scoring system for evaluating hand function on the motor assessment scale for stroke

Characterizing Disease Progression in Parkinson's Disease from Videos of the Finger Tapping Test

INTRODUCTION

Parkinson's disease (PD) is characterized by motor symptoms whose progression is typically assessed using clinical scales, namely the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Despite its reliability, the scale is bounded by a 5-point scale that limits its ability to track subtle changes in disease progression and is prone to subjective interpretations. We aimed to develop an automated system to objectively quantify motor symptoms in PD using Machine Learning (ML) algorithms to analyze videos and capture nuanced features of disease progression.

METHODS

We analyzed videos of the Finger Tapping test, a component of the MDS-UPDRS, from 24 healthy controls and 66 PD patients using ML algorithms for hand pose estimation. We computed multiple movement features related to bradykinesia from videos and employed a novel tiered classification approach to predict disease severity that employed different features according to severity. We compared our video-based disease severity prediction approach against other approaches recently introduced in the literature.

RESULTS

Traditional kinematics features such as amplitude and velocity changed linearly with disease severity, while other non-traditional features displayed non-linear trends. The proposed disease severity prediction approach demonstrated superior accuracy in detecting PD and distinguishing between different levels of disease severity when compared to existing approaches.

Predictors for Upper-Limb Functional Recovery Trajectory in Individuals Receiving Stroke Rehabilitation: A Secondary Analysis of Data from Randomized Controlled Trials

BACKGROUND

The objective of the study was to determine predictors for upper-limb functional recovery trajectory after occupational therapy in a population with chronic stroke.

METHODS

In this retrospective secondary analysis, Fugl-Meyer Assessment-Upper Extremity (FMA-UE) scores before and after intervention and at the 3-month follow-up were used to divide 105 participants with chronic stroke into three groups of recovery trajectories: fast (participants who reached an improvement of 7 after intervention), extended (those who reached an improvement of 7 at follow-up), and limited (those who did not reach an improvement of 7) recovery. Comparisons among the three groups were made in demographics, stroke characteristics, and baseline assessment scores. Logistic regression analyses were performed to determine predictors for group membership.

RESULTS

Time after onset of stroke and the baseline scores of FMA-UE, Stroke Impact Scale-Hand (SIS-Hand), Wolf Motor Function Test (WMFT)-Quality, WMFT-Time scores, Motor Activity Log-Amount of Use (MAL-AOU), and Motor Activity Log-Quality of Movement (MAL-QOM) scores were significantly different among the three groups. Univariate logistic regressions confirmed that SIS-Hand, WMFT-Quality, WMFT-Time, MAL-AOU, and MAL-QOM were significant predictors for both the fast versus limited recovery group membership and the extended versus limited group membership. Time after stroke onset and baseline FMA-UE were additional predictors for the fast versus limited recovery group membership.

CONCLUSION

These findings may assist healthcare professionals in making optimal therapeutic decisions and in informing clients and caregivers about the outcomes of stroke recovery.

ReHabgame: A non-immersive virtual reality rehabilitation system with applications in neuroscience

This paper proposes the use of a non-immersive virtual reality rehabilitation system “ReHabgame” developed using Microsoft Kinect™ and the Thalmic™ Labs Myo gesture control armband. The ReHabgame was developed based on two third-person video games that provide a feasible possibility of assessing postural control and functional reach tests. It accurately quantifies specific postural control mechanisms including timed standing balance, functional reach tests using real-time anatomical landmark orientation, joint velocity, and acceleration while end trajectories were calculated using an inverse kinematics algorithm. The game was designed to help patients with neurological impairment to be subjected to physiotherapy activity and practice postures of daily activities. The subjective experience of the ReHabgame was studied through the development of an Engagement Questionnaire (EQ) for qualitative, quantitative and Rasch model.

The Monte-Carlo Tree Search (MCTS) and Random object (ROG) generator algorithms were used to adapt the physical and gameplay intensity in the ReHabgame based on the Motor Assessment Scale (MAS) and Hierarchical Scoring System (HSS). Rasch analysis was conducted to assess the psychometric characteristics of the ReHabgame and to identify if these are any misfitting items in the game.

Rasch rating scale model (RSM) was used to assess the engagement of players in the ReHabgame and evaluate the effectiveness and attractiveness of the game. The results showed that the scales assessing the rehabilitation process met Rasch expectations of reliability, and unidimensionality. Infit and outfit mean squares values are in the range of (0.68–1.52) for all considered 16 items. The Root Mean Square Residual (RMSR) and the person separation reliability were acceptable. The item/person map showed that the persons and items were clustered symmetrically.

Construct validity of the Eating Assessment Tool (EAT-10)

PURPOSE

We aimed to evaluate the construct validity of the Eating Assessment Tool (EAT-10) by determining its dimensionality, rating scale integrity, item-person match, precision and relationship with the degree of airway invasion and functional oral intake.

METHODS

We conducted a retrospective analysis of patients' EAT-10 scores. We used the Rasch rating scale model. We investigated correlations between the EAT-10 and scores on the Penetration-Aspiration Scale (PAS) and Functional Oral Intake Scale (FOIS).

RESULTS

The median score of the EAT-10 from 127 patients was 16 of 40 (range 0-40). Confirmatory factor analysis supported unidimensionality. The 5-point rating scale categories met published criteria. Two items misfit the Rasch model and two other items displayed differential item functioning. Rasch person reliability was 0.79. Our patient cohort was divided into three person-strata. Correlations between the EAT-10 and the PAS and FOIS were weak to moderate in strength (respectively: r = 0.26, p = 0.0036; r = -0.27, p = 0.0027).

CONCLUSIONS

Our analyses identified deficits in the construct validity of the EAT-10 suggestive of a need to improve the EAT-10 to support its frequent use in clinical practice and research. Implications for Rehabilitation Swallowing disorders are associated with severe complications, such as pneumonia and malnutrition, and impose both social and psychological burdens on patients. The Eating Assessment Tool is a self-report instrument developed to estimate initial dysphagia severity and monitor change in patient-reported dysphagia symptoms as a response to treatment. This study shows that the Eating Assessment Tool has deficits in its construct validity and a need to improve the instrument to support its frequent use in clinical practice and research.

Functional Test of the Hemiparetic Upper Extremity: A Rasch Analysis With Theoretical Implications

OBJECTIVE

To investigate the measurement properties of the Functional Test of the Hemiparetic Upper Extremity (FTHUE) and examine how its score may or may not inform design of a rehabilitation program.

DESIGN

The FTHUE was recently used in the Interdisciplinary Comprehensive Arm Rehabilitation Evaluation randomized controlled trial. This circumstance provided the opportunity to examine the psychometric properties of the FTHUE as it pertains to contemporary poststroke rehabilitation and recovery models.

SETTING

Outpatient rehabilitation clinic.

PARTICIPANTS

Participants (N=109; mean age, 61.2±13.5y; mean days poststroke, 46±20.3) with resultant hemiparesis in the upper extremity.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Dimensionality was examined with confirmatory factor analysis (CFA), and person and item measures were derived with Rasch item response analysis. Therapists' notes were also reviewed.

RESULTS

The CFA results support unidimensionality, and 16 of 17 items fit the Rasch model. The Rasch person separation (2.17) and item separation (4.50) indices, ability strata (3.22), person reliability (.82), and item reliability (.95) indicate good measurement properties. Item difficulties ranked from -6.46 to 3.43 logits; however, there was a substantial ceiling effect of person measures. Post hoc examination of therapists' written observations indicated that the scoring criteria are not sensitive to the movement strategy used for task completion.

CONCLUSIONS

The FTHUE's item difficulty hierarchy indicated that scores adequately distinguished the ability to perform simple versus complex motor movements of functional tasks. However, the FTHUE scoring method did not allow inclusion of the type of movement strategy used to accomplish task items. Therefore, we suggest modifications to the FTHUE that would allow it to be used for collaborative treatment planning and align well with more contemporary perspectives on treatment theory.