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Decraene L, Orban de Xivry JJ, Kleeren L, Crotti M, Verheyden G, Ortibus E, Feys H, Mailleux L, Klingels K. In-depth quantification of bimanual coordination using the Kinarm exoskeleton robot in children with unilateral cerebral palsy. J Neuroeng Rehabil 2023; 20:154. [PMID: 37951867 PMCID: PMC10640737 DOI: 10.1186/s12984-023-01278-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Robots have been proposed as tools to measure bimanual coordination in children with unilateral cerebral palsy (uCP). However, previous research only examined one task and clinical interpretation remains challenging due to the large amount of generated data. This cross-sectional study aims to examine bimanual coordination by using multiple bimanual robotics tasks in children with uCP, and their relation to task execution and unimanual performance. METHODS The Kinarm exoskeleton robot was used in 50 children with uCP (mean age: 11 years 11 months ± 2 years 10 months, Manual Ability Classification system (MACS-levels: l = 27, ll = 16, lll = 7)) and 50 individually matched typically developing children (TDC). All participants performed three tasks: object-hit (hit falling balls), ball-on-bar (balance a ball on a bar while moving to a target) and circuit task (move a cursor along a circuit by making horizontal and vertical motions with their right and left hand, respectively). Bimanual parameters provided information about bimanual coupling and interlimb differences. Differences between groups and MACS-levels were investigated using ANCOVA with age as covariate (α < 0.05, [Formula: see text]). Correlation analysis (r) linked bimanual coordination to task execution and unimanual parameters. RESULTS Children with uCP exhibited worse bimanual coordination compared to TDC in all tasks (p ≤ 0.05, [Formula: see text] = 0.05-0.34). The ball-on-bar task displayed high effect size differences between groups in both bimanual coupling and interlimb differences (p < 0.001, [Formula: see text] = 0.18-0.36), while the object-hit task exhibited variations in interlimb differences (p < 0.001, [Formula: see text] = 0.22-0.34) and the circuit task in bimanual coupling (p < 0.001, [Formula: see text] = 0.31). Mainly the performance of the ball-on-bar task (p < 0.05, [Formula: see text] = 0.18-0.51) was modulated by MACS-levels, showing that children with MACS-level lll had worse bimanual coordination compared to children with MACS-level l and/or II. Ball-on-bar outcomes were highly related to task execution (r = - 0.75-0.70), whereas more interlimb differences of the object-hit task were moderately associated with a worse performance of the non-dominant hand (r = - 0.69-(- 0.53)). CONCLUSION This study gained first insight in important robotic tasks and outcome measures to quantify bimanual coordination deficits in children with uCP. The ball-on-bar task showed the most discriminative ability for both bimanual coupling and interlimb differences, while the object-hit and circuit tasks are unique to interlimb differences and bimanual coupling, respectively.
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Affiliation(s)
- Lisa Decraene
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, KU Leuven, 3000, Leuven, Belgium.
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, 3590, Diepenbeek, Belgium.
- Child and Youth Institute, KU Leuven, 3000, Leuven, Belgium.
| | - Jean-Jacques Orban de Xivry
- Department of Movement Sciences, Research Group of Motor Control and Neuroplasticity, KU Leuven, 3000, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, 3000, Leuven, Belgium
| | - Lize Kleeren
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, KU Leuven, 3000, Leuven, Belgium
- Child and Youth Institute, KU Leuven, 3000, Leuven, Belgium
| | - Monica Crotti
- Child and Youth Institute, KU Leuven, 3000, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, 3000, Leuven, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, KU Leuven, 3000, Leuven, Belgium
| | - Els Ortibus
- Child and Youth Institute, KU Leuven, 3000, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, 3000, Leuven, Belgium
- Department of Pediatric Neurology, University Hospitals Leuven, 3000, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, KU Leuven, 3000, Leuven, Belgium
- Child and Youth Institute, KU Leuven, 3000, Leuven, Belgium
| | - Lisa Mailleux
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, KU Leuven, 3000, Leuven, Belgium
- Child and Youth Institute, KU Leuven, 3000, Leuven, Belgium
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, KU Leuven, 3000, Leuven, Belgium
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, 3590, Diepenbeek, Belgium
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Moeller T, Moehler F, Krell-Roesch J, Dežman M, Marquardt C, Asfour T, Stein T, Woll A. Use of Lower Limb Exoskeletons as an Assessment Tool for Human Motor Performance: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:3032. [PMID: 36991743 PMCID: PMC10057915 DOI: 10.3390/s23063032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 06/19/2023]
Abstract
Exoskeletons are a promising tool to support individuals with a decreased level of motor performance. Due to their built-in sensors, exoskeletons offer the possibility of continuously recording and assessing user data, for example, related to motor performance. The aim of this article is to provide an overview of studies that rely on using exoskeletons to measure motor performance. Therefore, we conducted a systematic literature review, following the PRISMA Statement guidelines. A total of 49 studies using lower limb exoskeletons for the assessment of human motor performance were included. Of these, 19 studies were validity studies, and six were reliability studies. We found 33 different exoskeletons; seven can be considered stationary, and 26 were mobile exoskeletons. The majority of the studies measured parameters such as range of motion, muscle strength, gait parameters, spasticity, and proprioception. We conclude that exoskeletons can be used to measure a wide range of motor performance parameters through built-in sensors, and seem to be more objective and specific than manual test procedures. However, since these parameters are usually estimated from built-in sensor data, the quality and specificity of an exoskeleton to assess certain motor performance parameters must be examined before an exoskeleton can be used, for example, in a research or clinical setting.
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Affiliation(s)
- Tobias Moeller
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Felix Moehler
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Janina Krell-Roesch
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Miha Dežman
- Institute for Anthropomatics and Robotics, High Performance Humanoid Technologies (H2T), Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Charlotte Marquardt
- Institute for Anthropomatics and Robotics, High Performance Humanoid Technologies (H2T), Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Tamim Asfour
- Institute for Anthropomatics and Robotics, High Performance Humanoid Technologies (H2T), Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Thorsten Stein
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Alexander Woll
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
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Faheem F, Zafar Z, Razzak A, Kalia JS. Implementing Virtual Care in Neurology - Challenges and Pitfalls. J Cent Nerv Syst Dis 2022; 14:11795735221109745. [PMID: 35795886 PMCID: PMC9252001 DOI: 10.1177/11795735221109745] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Virtual care is here to stay. The explosive expansion of telehealth caused by the SARS-CoV-2 pandemic is more than a necessary measure of protection. The key drivers of this transition in healthcare delivery to a virtual setting are changes in patient behavior and expectations and societal attitudes, and prevailing technologies that are impossible to ignore. The younger population - Generation Z - is increasingly connected and mobile-first. We are heading to a world where we expect to see healthcare in general and neurology, in particular, delivered virtually. The medical community should prepare for this overhaul; proper implementation of virtual care from the ground up is the need of the hour. In an era of virtualization, it is up to the medical community to ensure a well-informed patient population, overcome cultural differences and build digital infrastructure with enhanced access and equity in care delivery, especially for the aging neurological patient population, which is not technologically savvy. Virtual care is a continuum of care that needs deeper integration at systematic levels. The design principles of a patient's journey need to be incorporated while simultaneously placing physician satisfaction with a better user experience at the center of implementation. In this paper, we discuss common challenges and pitfalls of virtual care implementation in neurology - logistical, technical, medicolegal, and those faced in incorporating health and medical education into virtual care - intending to provide solutions and strategies.
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Affiliation(s)
| | | | - Aisha Razzak
- University of Texas at Dallas, Richardson, TX, USA
| | - Junaid Siddiq Kalia
- Founder, NeuroCare.AI.,Editor-in-Chief, neurologypocketbook.com.,Founder, Institute of Health Innovation and Education
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Dobri SCD, Samdup D, Scott SH, Davies TC. Differentiating Motor Coordination in Children with Cerebral Palsy and Typically Developing Populations Through Exploratory Factor Analysis of Robotic Assessments. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:5936-5939. [PMID: 34892470 DOI: 10.1109/embc46164.2021.9630740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
General motor and executive functions are integral for tasks of daily living and are typically assessed when quantifying impairment of an individual. Robotic tasks offer highly repeatable and objective measures of motor and cognitive function. Additionally, robotic tasks and measures have been used successfully to quantify impairment of children with cerebral palsy (CP). Many robotic tasks include multiple performance parameters, so interpretation of results and identification of impairment can be difficult, especially when multiple tasks are completed. This study used exploratory factor analysis to investigate a potential set of quantitative models of motor and cognitive function in children, and compare performance of participants with CP to these models. The three calculated factors achieved strong differentiation between participants with mild CP and the typically developing population. This demonstrates the feasibility of these factors to quantify impairment and track improvements related to therapies.Clinical Relevance- This establishes a method to differentiate atypical motor performance related to CP using a robotic reversed visually guided reaching task.
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