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Abedi M, Behzadipour S. A novel biomechanical index for quality assessment of the upper-extremity movements in post-stroke patients. Comput Biol Med 2024; 179:108875. [PMID: 39018881 DOI: 10.1016/j.compbiomed.2024.108875] [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: 01/02/2024] [Revised: 06/22/2024] [Accepted: 07/09/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND While motor recovery is preferred to compensatory movements for stroke patients with mild to moderate motion impairment, current movement quality assessments rarely reflect the differences between a patient's pre- and post-stroke movement patterns. Such comparison can help therapists to identify the rate of the restoration of premorbid motion patterns and prescribe the most effective treatment. METHODS This paper attempted to present a new biomechanical metric for the quality of upper-limb movements which uses the subject's optimal movements as a reference to evaluate his/her UL movement quality. To this end, an inverse optimal control algorithm was applied to find an estimation of the patient's premorbid motion patterns. The new biomechanical index was then calculated as a measure of similarity between the optimal and actual movement trajectories. In the next part, various simulation and clinimetric investigations were performed to evaluate the responses of the new index to variations of the movement quality as well as its test-retest reliability and concurrent validity. RESULTS Simulation-based analyses demonstrated that the proposed index, in contrast to the previous popular biomechanical indices, can successfully detect a wide range of abnormalities in motion signals. In addition, it showed good test-retest reliability (ICC = 0.89) and moderate correlation with clinical indices, Fugl-Meyer Assessment (r = 0.66), Action Research Arm Test (r = 0.47), and ABILHAND (r = 0.27). CONCLUSIONS Although the proposed index has the same degree of clinimetric properties as the previous metrics, the ability to identify the level of movement restoration and also various types and severities of motor disabilities may lead to better design and management of motor rehabilitation.
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Affiliation(s)
- Majid Abedi
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran; Djawad Movafaghian Research Center in Rehab Technologies, Sharif University of Technology, Tehran, Iran
| | - Saeed Behzadipour
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran; Djawad Movafaghian Research Center in Rehab Technologies, Sharif University of Technology, Tehran, Iran.
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Güneş Gencer GY, Akkurt L, Aktaş H, Şimşek Erdem N. Investigation of the reliability and validity of the Turkish version of the Comprehensive Coordination Scale in patients with Parkinson's disease. Clin Neurol Neurosurg 2024; 244:108455. [PMID: 39059284 DOI: 10.1016/j.clineuro.2024.108455] [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: 05/15/2024] [Revised: 07/07/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE The Comprehensive Coordination Scale (CCS) is a valid, reliable scale for evaluating motor coordination, described as the ability to produce context-dependent movements of multiple body parts in both spatial and temporal domains in patients with chronic stroke. The aim of this study was to develop a Turkish version of the CCS that can be used to evaluate coordination in Parkinson's disease patients and to test its validity and reliability. METHODS Thirty-four patients with Parkinson's disease (18 females, 16 males) with a mean age of 67.55± 10.93 years were included. The 9-Hole Peg Test (9 HPT), Timed Up and Go Test (TUG), Berg Balance Scale (BBS), Functional Reach Test (FRT), and Modified Hoehn and Yahr (H&Y) were administered to the patients. RESULTS In the correlation analysis for convergent validity, the CCS-TR showed a moderate negative correlation with both the 9 HPT and the TUG test (r=-0.684 and -0.641, respectively). There were also moderate positive correlations observed between the CCS-TR and the FRT and BBS (r=0.607 and 0.657, respectively). The total CCS-TR had excellent intrarater reliability (ICC=0.99; 95 % CI: 0.98-0.99) and interrater reliability (ICC=0.90; 95 % CI: 0.81-0.95). The CCS-TR subscales had excellent intrarater reliability (ICC: range 0.98 from 0.99). For intrarater agreement, the ICC was 0.99, and for interrater agreement, the ICC was 0.90 (excellent agreement). CONCLUSION The results of the present study indicate that the Turkish version of the CCS is a reliable and valid coordination scale that can be used in patients with Parkinson's disease.
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Affiliation(s)
| | - Lütfiye Akkurt
- Kutahya Health Sciences University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kütahya, Turkey.
| | - Hayri Aktaş
- Antalya Bilim University, Health Services Vocational School, Physiotherapy Program, Antalya, Turkey.
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Sakamoto D, Hamaguchi T, Kanemura N, Yasojima T, Kubota K, Suwabe R, Nakayama Y, Abo M. Feature analysis of joint motion in paralyzed and non-paralyzed upper limbs while reaching the occiput: A cross-sectional study in patients with mild hemiplegia. PLoS One 2024; 19:e0295101. [PMID: 38781257 PMCID: PMC11115294 DOI: 10.1371/journal.pone.0295101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
The reaching motion to the back of the head with the hand is an important movement for daily living. The scores of upper limb function tests used in clinical practice alone are difficult to use as a reference when planning exercises for movement improvements. This cross-sectional study aimed to clarify in patients with mild hemiplegia the kinematic characteristics of paralyzed and non-paralyzed upper limbs reaching the occiput. Ten patients with post-stroke hemiplegia who attended the Department of Rehabilitation Medicine of the Jikei University Hospital and met the eligibility criteria were included. Reaching motion to the back of the head by the participants' paralyzed and non-paralyzed upper limbs was measured using three-dimensional motion analysis, and the motor time, joint angles, and angular velocities were calculated. Repeated measures multivariate analysis of covariance was performed on these data. After confirming the fit to the binomial logistic regression model, the cutoff values were calculated using receiver operating characteristic curves. Pattern identification using random forest clustering was performed to analyze the pattern of motor time and joint angles. The cutoff values for the movement until the hand reached the back of the head were 1.6 s for the motor time, 55° for the maximum shoulder joint flexion angle, and 145° for the maximum elbow joint flexion angle. The cutoff values for the movement from the back of the head to the hand being returned to its original position were 1.6 s for the motor time, 145° for the maximum elbow joint flexion angle, 53°/s for the maximum angular velocity of shoulder joint abduction, and 62°/s for the maximum angular velocity of elbow joint flexion. The numbers of clusters were three, four, and four for the outward non-paralyzed side, outward and return paralyzed side, and return non-paralyzed side, respectively. The findings obtained by this study can be used for practice planning in patients with mild hemiplegia who aim to improve the reaching motion to the occiput.
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Affiliation(s)
- Daigo Sakamoto
- Department of Rehabilitation Medicine, The Jikei University School of Medicine Hospital, Tokyo, Japan
- Department of Rehabilitation, Graduate School of Health Science, Saitama Prefectural University, Saitama, Japan
| | - Toyohiro Hamaguchi
- Department of Rehabilitation, Graduate School of Health Science, Saitama Prefectural University, Saitama, Japan
| | - Naohiko Kanemura
- Department of Rehabilitation, Graduate School of Health Science, Saitama Prefectural University, Saitama, Japan
| | - Takashi Yasojima
- Department of Rehabilitation, Graduate School of Health Science, Saitama Prefectural University, Saitama, Japan
| | - Keisuke Kubota
- Research Development Center, Saitama Prefectural University, Saitama, Japan
| | - Ryota Suwabe
- Department of Rehabilitation Medicine, The Jikei University School of Medicine Hospital, Tokyo, Japan
| | - Yasuhide Nakayama
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Tsai HT, Lau HY, Lin KC, Li YC, Lin CJ, Yao G, Lee YY, Chen WS, Chen CL, Chang YJ, Horng YS. Responsiveness and construct validity of two outcome measures of bilateral upper limb function in patients with chronic stroke. Front Neurol 2024; 15:1352365. [PMID: 38846043 PMCID: PMC11153685 DOI: 10.3389/fneur.2024.1352365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
Background Stroke is a leading cause of long-term disability among stroke survivors. Despite the availability of numerous stroke rehabilitative therapies, such as mirror therapy, bilateral arm training, and robot-assisted therapy, the recovery of motor function after stroke remains incomplete. Bilateral arm function is a key component in stroke patients to perform activities of daily living and to reflect their functional autonomy. Objective This clinimetric study investigated and compared the construct validity and responsiveness of 2 bimanual activity outcome measures, the Chedoke Arm and Hand Activity Inventory (CAHAI) and the ABILHAND Questionnaire, in individuals receiving stroke rehabilitation. Methods The present study is a secondary analysis following the framework of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). Individuals with chronic stroke (N = 113) were recruited from outpatient rehabilitation settings. Participants received 18 to 20 sessions of robot-assisted therapy, mirror therapy, combined therapy, or conventional rehabilitation for 4 to 6 weeks. The CAHAI, ABILHAND Questionnaire, and a comparison instrument, the Motor Activity Log (MAL), were administered twice at a 4- to 6-week interval to all participants. ABILHAND scores, in logits, were converted from raw ordinal scores into a linear measure. Results There was medium to large correlation of the CAHAI and the MAL (ρ = 0.60-0.62, p < 0.01) as well as the ABILHAND Questionnaire and the MAL (ρ = 0.44-0.51, p < 0.01). Change scores from the initial measurement to the post-intervention measurement demonstrated small to medium correlation of the CAHAI and the MAL (ρ = 0.27-0.31, p < 0.01) and medium to large correlation of the ABILHAND Questionnaire and the MAL (ρ = 0.37-0.41, p < 0.01). Overall, 7 of 8 hypotheses were supported. The hypothesis testing regarding the construct validity and responsiveness of the CAHAI and ABILHAND Questionnaire was confirmed. Conclusion The CAHAI and ABILHAND Questionnaire are both responsive and suitable to detect changes in bilateral arm functional daily activities in individuals with chronic stroke. Patient-reported outcome measures are recommended to use along with therapist-rated outcome measures for upper limb capacity evaluation in stroke rehabilitation. Further study with a prospective study design to capture specific clinical features of participants and the use of body-worn sensors, such as the arm accelerometer, is suggested.
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Affiliation(s)
- Han-ting Tsai
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hiu-ying Lau
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Keh-chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-chun Li
- Department of Occupational Therapy, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chia-jung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Grace Yao
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Ya-yun Lee
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-shiang Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-ju Chang
- Neuroscience Research Center, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Yi-shiung Horng
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan
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Unger T, de Sousa Ribeiro R, Mokni M, Weikert T, Pohl J, Schwarz A, Held J, Sauerzopf L, Kühnis B, Gavagnin E, Luft A, Gassert R, Lambercy O, Awai Easthope C, Schönhammer J. Upper limb movement quality measures: comparing IMUs and optical motion capture in stroke patients performing a drinking task. Front Digit Health 2024; 6:1359776. [PMID: 38606036 PMCID: PMC11006959 DOI: 10.3389/fdgth.2024.1359776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Clinical assessment of upper limb sensorimotor function post-stroke is often constrained by low sensitivity and limited information on movement quality. To address this gap, recent studies proposed a standardized instrumented drinking task, as a representative daily activity combining different components of functional arm use. Although kinematic movement quality measures for this task are well-established, and optical motion capture (OMC) has proven effective in their measurement, its clinical application remains limited. Inertial Measurement Units (IMUs) emerge as a promising low-cost and user-friendly alternative, yet their validity and clinical relevance compared to the gold standard OMC need investigation. Method In this study, we conducted a measurement system comparison between IMUs and OMC, analyzing 15 established movement quality measures in 15 mild and moderate stroke patients performing the drinking task, using five IMUs placed on each wrist, upper arm, and trunk. Results Our findings revealed strong agreement between the systems, with 12 out of 15 measures demonstrating clinical applicability, evidenced by Limits of Agreement (LoA) below the Minimum Clinically Important Differences (MCID) for each measure. Discussion These results are promising, suggesting the clinical applicability of IMUs in quantifying movement quality for mildly and moderately impaired stroke patients performing the drinking task.
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Affiliation(s)
- T. Unger
- DART Lab, Lake Lucerne Institute, Vitznau, Switzerland
- Rehabilitation Engineering Laboratory, ETH Zurich, Zurich, Switzerland
| | | | - M. Mokni
- DART Lab, Lake Lucerne Institute, Vitznau, Switzerland
| | - T. Weikert
- DART Lab, Lake Lucerne Institute, Vitznau, Switzerland
| | - J. Pohl
- DART Lab, Lake Lucerne Institute, Vitznau, Switzerland
| | - A. Schwarz
- Department of Neurology, UCLA, Los Angeles, CA, United States
- California Rehabilitation Institute, Los Angeles, CA, United States
| | - J.P.O. Held
- Ambulante Reha Triemli Zurich, Zurich, Switzerland
| | - L. Sauerzopf
- ZHAW School of Health Sciences, Institute of Occupational Therapy, Winterthur, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - B. Kühnis
- ZHAW School of Management and Law, Institute of Business Information Technology, Winterthur, Switzerland
| | - E. Gavagnin
- ZHAW School of Management and Law, Institute of Business Information Technology, Winterthur, Switzerland
- ZHAW School of Engineering, Centre for Artificial Intelligence, Winterthur, Switzerland
| | - A.R. Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology and Clinical Neuroscience Center, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - R. Gassert
- Rehabilitation Engineering Laboratory, ETH Zurich, Zurich, Switzerland
| | - O. Lambercy
- Rehabilitation Engineering Laboratory, ETH Zurich, Zurich, Switzerland
| | | | - J.G. Schönhammer
- DART Lab, Lake Lucerne Institute, Vitznau, Switzerland
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology and Clinical Neuroscience Center, University of Zurich and University Hospital Zurich, Zurich, Switzerland
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Proffitt R, Rasmussen KAM, Ma M, Skubic M. An Algorithm for Activity Recognition and Assessment of Adults Poststroke. Am J Occup Ther 2024; 78:7802180090. [PMID: 38346280 PMCID: PMC11017741 DOI: 10.5014/ajot.2024.050407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
IMPORTANCE Stroke is the leading cause of long-term disability in the United States. Providers have no robust tools to objectively and accurately measure the activity of people with stroke living at home. OBJECTIVE To explore the integration of validated upper extremity assessments poststroke within an activity recognition system. DESIGN Exploratory descriptive study using data previously collected over 3 mo to report on algorithm testing and assessment integration. SETTING Data were collected in the homes of community-dwelling participants. PARTICIPANTS Participants were at least 6 mo poststroke, were able to ambulate with or without an assistive device, and self-reported some difficulty using their arm in everyday activities. OUTCOMES AND MEASURES The activity detection algorithm's accuracy was determined by comparing its activity labels with manual labels. The algorithm integrated assessment by describing the quality of upper extremity movement, which was determined by reporting extent of reach, mean and maximum speed during movement, and smoothness of movement. RESULTS Sixteen participants (9 women, 7 men) took part in this study, with an average age of 63.38 yr (SD = 12.84). The algorithm was highly accurate in correctly identifying activities, with 87% to 95% accuracy depending on the movement. The algorithm was also able to detect the quality of movement for upper extremity movements. CONCLUSIONS AND RELEVANCE The algorithm was able to accurately identify in-kitchen activities performed by adults poststroke. Information about the quality of these movements was also successfully calculated. This algorithm has the potential to supplement clinical assessments in treatment planning and outcomes reporting. Plain-Language Summary: This study shows that clinical algorithms have the potential to inform occupational therapy practice by providing clinically relevant data about the in-home activities of adults poststroke. The algorithm accurately identified activities that were performed in the kitchen by adults poststroke. The algorithm also identified the quality of upper extremity movements of people poststroke who were living at home.
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Affiliation(s)
- Rachel Proffitt
- Rachel Proffitt, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, University of Missouri, Columbia;
| | - Kial-Ann M Rasmussen
- Kial-Ann M. Rasmussen, MOT, OTR/L, is Graduate Research Assistant, Department of Occupational Therapy, University of Missouri, Columbia
| | - Mengxuan Ma
- Mengxuan Ma, PhD, is Software Engineer, MathWorks, Boston, MA
| | - Marjorie Skubic
- Marjorie Skubic, PhD, is Curators Distinguished Professor, Department of Computer Science and Electrical Engineering, College of Engineering, University of Missouri, Columbia
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Petrušič T, Novak D. A 16-week school-based intervention improves physical fitness in Slovenian children: a randomized controlled trial. Front Physiol 2024; 15:1311046. [PMID: 38304115 PMCID: PMC10830706 DOI: 10.3389/fphys.2024.1311046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
Introduction: The aim of this study was to evaluate the effects of a 16-week school-based physical activity (PA) intervention on physical fitness (PF) (speed, hand-eye coordination, flexibility) of 8- to 9-year-olds. Methods: A total of seventy-eight boys and girls (boys: n = 45, aged 8.4 ± 4.9 years; girls: n = 42, aged 8.6 ± 0.5 years) from a school in Slovenia were randomly assigned to either a group with an after-school PA program (EXP) or a control group (CON) that participated exclusively in mandatory physical education (PE). The EXP group engaged in the extracurricular PA program for 60 min twice a week for 16 weeks, concurrent with regular PE classes. The program primarily involved elementary PE games that included elements of athletics (e.g., skipping, push- off running, hopping, crossstepping, and jumping) and gymnastics (e.g., handstand, forward roll, backward roll, hand support jumps, squat jump on a vault box, climbing on horizontal bars, incline benches and ropes, crawling, and jumping rope). Standardized tests appropriate for this age group were used to assess PF, including the sit and reach test (SAR), the 30-meter sprint, and the alternate hand wall toss test at distances of 1.0 and 2.0 m (AHWT 1.0 and 2.0). Results: There was a significant group-time interaction for SAR test (EXP group increase: +1.6 cm, +6.3%; CON group decrease: -0.1 cm, -0.4%; p < 0.001, ηp2 = 0.361), and the 30 m sprint (EXP group improvement: -0.4 s, -6.3%; CON group decrease: +0.1 s, +1.6%; p < 0.001, ηp2 = 0.193). Similarly, the EXP group improved by +2.1 points (+25.6%) in the 1.0 m wall throw with the alternating hand, while the CON group showed only minimal changes (-0.2 points, -2.4%; p < 0.001, ηp2 = 0.545). No significant interaction was found for the 2.0 m toss (EXP and CON group both -0.1 points, -2.6%; p = 0.888, ηp2 = 0.001). Post-hoc analyses with paired t-tests revealed that the EXP group showed significant improvements in SAR test (p < 0.001), 30 m sprint (p < 0.001) and AHWT 1.0 test (p < 0.001), while the CON group showed no significant changes in SAR test (p = 0.533), 30 m sprint (p = 0.150), AHWT 1.0 test (p = 0.186) and AHWT 2.0 test (p = 0.430). Discussion: The results of the study showed that the extracurricular program with only two additional weekly sessions significantly improved the components of PF in 8- to 9-year olds. Significant improvements were observed in the areas of flexibility, speed and coordination, as shown in the SAR test, 30-meter sprint and 1.0-meter handwall toss tests. However, no similar improvements were observed in the 2.0-meter handwall toss, which illustrates the specific areas of impact of the program.
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Affiliation(s)
- Tanja Petrušič
- Faculty of Education, University of Ljubljana, Ljubljana, Slovenia
| | - Dario Novak
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
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Alfredo L, David R, Juan‐José B, Sergio L, Raúl F. Combination of different noninvasive brain stimulation treatments for upper limb recovery in stroke patients: A systematic review. Brain Behav 2024; 14:e3370. [PMID: 38376018 PMCID: PMC10823455 DOI: 10.1002/brb3.3370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 02/21/2024] Open
Abstract
We report a review of Pubmed (Medline), CENTRAL, Web of Science, and Scopus to test the effectiveness of the combined application of repetitive transcranial magnetic stimulation and transcranial direct current stimulation in the improvement of different functional variables of the upper limb in people with stroke. Two independent reviewers assessed eligibility and evaluated the quality of the studies. Five articles were included in the final review according to the inclusion criteria: Most show statistically significant differences in motor function improvement in favor of the experimental group, but not in activity. Due to the heterogeneity of the observed studies, the results should be interpreted with caution-more high-quality studies are needed to investigate the effectiveness of these interventions in different stages of stroke patients.
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Affiliation(s)
- Lerín‐Calvo Alfredo
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La SalleUniversidad Autónoma de MadridAravacaMadridSpain
- Clínica Neuron Madrid RíoMadridSpain
- Grupo de Investigación Clínico‐Docente sobre Ciencias de la Rehabilitación (INDOCLIN)CSEU La Salle, UAMAravacaMadridSpain
| | | | | | - Lerma‐Lara Sergio
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La SalleUniversidad Autónoma de MadridAravacaMadridSpain
- Motion in Brains Research GroupAravacaMadridSpain
| | - Ferrer‐Peña Raúl
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La SalleUniversidad Autónoma de MadridAravacaMadridSpain
- Grupo de Investigación Clínico‐Docente sobre Ciencias de la Rehabilitación (INDOCLIN)CSEU La Salle, UAMAravacaMadridSpain
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9
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Levin MF, Berman S, Weiss N, Parmet Y, Baniña MC, Frenkel-Toledo S, Soroker N, Solomon JM, Liebermann DG. ENHANCE proof-of-concept three-arm randomized trial: effects of reaching training of the hemiparetic upper limb restricted to the spasticity-free elbow range. Sci Rep 2023; 13:22934. [PMID: 38129527 PMCID: PMC10739929 DOI: 10.1038/s41598-023-49974-6] [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: 01/28/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Post-stroke motor recovery processes remain unknown. Timescales and patterns of upper-limb (UL) recovery suggest a major impact of biological factors, with modest contributions from rehabilitation. We assessed a novel impairment-based training motivated by motor control theory where reaching occurs within the spasticity-free elbow range. Patients with subacute stroke (≤ 6 month; n = 46) and elbow flexor spasticity were randomly allocated to a 10-day UL training protocol, either personalized by restricting reaching to the spasticity-free elbow range defined by the tonic stretch reflex threshold (TSRT) or non-personalized (non-restricted) and with/without anodal transcranial direct current stimulation. Outcomes assessed before, after, and 1 month post-intervention were elbow flexor TSRT angle and reach-to-grasp arm kinematics (primary) and stretch reflex velocity sensitivity, clinical impairment, and activity (secondary). Results were analyzed for 3 groups as well as those of the effects of impairment-based training. Clinical measures improved in both groups. Spasticity-free range training resulted in faster and smoother reaches, smaller (i.e., better) arm-plane path length, and closer-to-normal shoulder/elbow movement patterns. Non-personalized training improved clinical scores without improving arm kinematics, suggesting that clinical measures do not account for movement quality. Impairment-based training within a spasticity-free elbow range is promising since it may improve clinical scores together with arm movement quality.Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique Identifier: NCT02725853; Initial registration date: 01/04/2016.
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Affiliation(s)
- Mindy F Levin
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada.
- Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada.
| | - Sigal Berman
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- The Zlotowski Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Neta Weiss
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yisrael Parmet
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Melanie C Baniña
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada
- Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada
| | - Silvi Frenkel-Toledo
- Department of Physical Therapy, Ariel University, Ariel, Israel
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Ra'anana, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Ra'anana, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dario G Liebermann
- Department of Physical Therapy, Faculty of Medicine, Stanley Steyer School of Health Professions, Tel Aviv University, POB 39040, 61390, Ramat Aviv, Tel Aviv, Israel.
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Krishnan S, Mandala MA, Wolf SL, Howard A, Kesar TM. Perceptions of stroke survivors regarding factors affecting adoption of technology and exergames for rehabilitation. PM R 2023; 15:1403-1410. [PMID: 36787167 DOI: 10.1002/pmrj.12963] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 11/29/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Task-specific motor training and repetitive practice are essential components of clinical rehabilitation. Emerging evidence suggests that incorporating gaming interfaces (also referred to as "exergames"), including virtual reality and augmented reality (VR/AR)-based interfaces for motor training, can enhance the engagement and efficacy of poststroke rehabilitation. OBJECTIVE To investigate perceptions of individuals with stroke regarding technology and exergames for rehabilitation. DESIGN This qualitative phenomenological study included a convenience sample of 11 individuals with stroke (61.7 ± 12.4 years, 6 women and 5 men, 63.5 ± 41.2 months post stroke). SETTING Community. INTERVENTIONS N/A. OUTCOME MEASURES Semistructured open-ended focus-group interviews to understand their perceptions on technology and exergames to improve recovery were coded using thematic content analysis. RESULTS Individuals with stroke were comfortable using smartphones, computers, and rehabilitation technologies but had limited experiences using exergames and VR/AR devices. Individuals with stroke were motivated to use technologies and exergames to improve their functional recovery. Participants identified facilitators (eg, enhancing functional recovery, feedback, therapist supervision) and barriers (eg, safety, inaccessibility, inadequate knowledge) to adopting exergames in their daily lives. Participants wanted the exergames to be customizable, goal oriented, and enjoyable to maintain their engagement. They were willing to use exergames to improve their functional recovery but indicated that these games could not replace the therapist's supervision. CONCLUSIONS Despite having limited experiences with exergames, people post stroke perceived that exergames could promote functional recovery. The perspectives gained from the present study can inform user-centered game design for neurorehabilitation.
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Affiliation(s)
- Shilpa Krishnan
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mahender A Mandala
- School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Steven L Wolf
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Health Care Center
| | - Ayanna Howard
- School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, Georgia, USA
- The Ohio State University, College of Engineering, Columbus, Ohio, USA
| | - Trisha M Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Subramanian SK, Margolese G, Turolla A, Saposnik G, Levin MF. Responsiveness of the Reaching Performance Scale for Stroke. Arch Phys Med Rehabil 2023; 104:1588-1595. [PMID: 37178950 DOI: 10.1016/j.apmr.2023.04.020] [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: 10/02/2022] [Revised: 04/01/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The objective of the study was to estimate the internal and external responsiveness of the Reaching Performance Scale for Stroke (RPSS) in individuals with stroke. DESIGN Retrospective analysis of data from 4 randomized controlled trials. SETTING Recruitment locations spanning rehabilitation centers and hospitals in Canada, Italy, Argentina, Peru, and Thailand. PARTICIPANTS Data from 567 participants (acute to chronic stroke; N=567) were available. INTERVENTIONS All 4 studies involved training using virtual reality for upper limb rehabilitation. MAIN OUTCOME MEASURES RPSS and upper extremity Fugl-Meyer Assessment (FMA-UE) scores. Responsiveness was quantified for all data and across different stages of stroke. Internal responsiveness of the RPSS was quantified as effect-sizes calculated using post and preintervention change data. External responsiveness was quantified using orthogonal regressions between FMA-UE and RPSS scores. The area under the Receiver Operating Characteristic curve (AUC) was quantified based on the ability of RPSS scores to detect change above FMA-UE minimal clinically important different values across different stages of stroke. RESULTS The RPSS had high internal responsiveness overall and across the acute or subacute and chronic stages of stroke. For external responsiveness, orthogonal regression analyses indicated that change in FMA-UE scores had positive moderate correlations with both RPSS Close and Far Target scores for all data and across the acute or subacute and chronic stages of stroke (0.6 CONCLUSIONS In addition to being reliable and valid, the RPSS is also responsive. Along with the FMA-UE, using RPSS scores can help present a more comprehensive picture of motor compensations to characterize poststroke upper limb motor improvement.
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Affiliation(s)
- Sandeep K Subramanian
- Departments of Physical Therapy, Physician Assistant Studies and Rehabilitation Medicine, University of Texas Health San Antonio, San Antonio, TX
| | - Gita Margolese
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada; Centre for Interdisciplinary Research in Rehabilitation, Montreal, Canada
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Laboratory of Rehabilitation Technologies, Hospital San Camillo IRCCS, Venice, Italy
| | - Gustavo Saposnik
- Stroke Outcomes and Decision Neuroscience Unit, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada; Centre for Interdisciplinary Research in Rehabilitation, Montreal, Canada.
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12
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Scano A, Guanziroli E, Brambilla C, Amendola C, Pirovano I, Gasperini G, Molteni F, Spinelli L, Molinari Tosatti L, Rizzo G, Re R, Mastropietro A. A Narrative Review on Multi-Domain Instrumental Approaches to Evaluate Neuromotor Function in Rehabilitation. Healthcare (Basel) 2023; 11:2282. [PMID: 37628480 PMCID: PMC10454517 DOI: 10.3390/healthcare11162282] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
In clinical scenarios, the use of biomedical sensors, devices and multi-parameter assessments is fundamental to provide a comprehensive portrait of patients' state, in order to adapt and personalize rehabilitation interventions and support clinical decision-making. However, there is a huge gap between the potential of the multidomain techniques available and the limited practical use that is made in the clinical scenario. This paper reviews the current state-of-the-art and provides insights into future directions of multi-domain instrumental approaches in the clinical assessment of patients involved in neuromotor rehabilitation. We also summarize the main achievements and challenges of using multi-domain approaches in the assessment of rehabilitation for various neurological disorders affecting motor functions. Our results showed that multi-domain approaches combine information and measurements from different tools and biological signals, such as kinematics, electromyography (EMG), electroencephalography (EEG), near-infrared spectroscopy (NIRS), and clinical scales, to provide a comprehensive and objective evaluation of patients' state and recovery. This multi-domain approach permits the progress of research in clinical and rehabilitative practice and the understanding of the pathophysiological changes occurring during and after rehabilitation. We discuss the potential benefits and limitations of multi-domain approaches for clinical decision-making, personalized therapy, and prognosis. We conclude by highlighting the need for more standardized methods, validation studies, and the integration of multi-domain approaches in clinical practice and research.
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Affiliation(s)
- Alessandro Scano
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), Via A. Corti 12, 20133 Milan, Italy; (C.B.); (L.M.T.)
| | - Eleonora Guanziroli
- Villa Beretta Rehabilitation Center, Via N. Sauro 17, 23845 Costa Masnaga, Italy; (E.G.); (G.G.); (F.M.)
| | - Cristina Brambilla
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), Via A. Corti 12, 20133 Milan, Italy; (C.B.); (L.M.T.)
| | - Caterina Amendola
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy; (C.A.); (R.R.)
| | - Ileana Pirovano
- Institute of Biomedical Technologies (ITB), Italian National Research Council (CNR), Via Fratelli Cervi 93, 20054 Segrate, Italy; (I.P.); (G.R.); (A.M.)
| | - Giulio Gasperini
- Villa Beretta Rehabilitation Center, Via N. Sauro 17, 23845 Costa Masnaga, Italy; (E.G.); (G.G.); (F.M.)
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Via N. Sauro 17, 23845 Costa Masnaga, Italy; (E.G.); (G.G.); (F.M.)
| | - Lorenzo Spinelli
- Institute for Photonics and Nanotechnology (IFN), Italian National Research Council (CNR), Piazza Leonardo da Vinci 32, 20133 Milan, Italy;
| | - Lorenzo Molinari Tosatti
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), Via A. Corti 12, 20133 Milan, Italy; (C.B.); (L.M.T.)
| | - Giovanna Rizzo
- Institute of Biomedical Technologies (ITB), Italian National Research Council (CNR), Via Fratelli Cervi 93, 20054 Segrate, Italy; (I.P.); (G.R.); (A.M.)
| | - Rebecca Re
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy; (C.A.); (R.R.)
- Institute for Photonics and Nanotechnology (IFN), Italian National Research Council (CNR), Piazza Leonardo da Vinci 32, 20133 Milan, Italy;
| | - Alfonso Mastropietro
- Institute of Biomedical Technologies (ITB), Italian National Research Council (CNR), Via Fratelli Cervi 93, 20054 Segrate, Italy; (I.P.); (G.R.); (A.M.)
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13
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Barth J, Lohse KR, Bland MD, Lang CE. Predicting later categories of upper limb activity from earlier clinical assessments following stroke: an exploratory analysis. J Neuroeng Rehabil 2023; 20:24. [PMID: 36810072 PMCID: PMC9945671 DOI: 10.1186/s12984-023-01148-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 02/14/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Accelerometers allow for direct measurement of upper limb (UL) activity. Recently, multi-dimensional categories of UL performance have been formed to provide a more complete measure of UL use in daily life. Prediction of motor outcomes after stroke have tremendous clinical utility and a next step is to explore what factors might predict someone's subsequent UL performance category. PURPOSE To explore how different machine learning techniques can be used to understand how clinical measures and participant demographics captured early after stroke are associated with the subsequent UL performance categories. METHODS This study analyzed data from two time points from a previous cohort (n = 54). Data used was participant characteristics and clinical measures from early after stroke and a previously established category of UL performance at a later post stroke time point. Different machine learning techniques (a single decision tree, bagged trees, and random forests) were used to build predictive models with different input variables. Model performance was quantified with the explanatory power (in-sample accuracy), predictive power (out-of-bag estimate of error), and variable importance. RESULTS A total of seven models were built, including one single decision tree, three bagged trees, and three random forests. Measures of UL impairment and capacity were the most important predictors of the subsequent UL performance category, regardless of the machine learning algorithm used. Other non-motor clinical measures emerged as key predictors, while participant demographics predictors (with the exception of age) were generally less important across the models. Models built with the bagging algorithms outperformed the single decision tree for in-sample accuracy (26-30% better classification) but had only modest cross-validation accuracy (48-55% out of bag classification). CONCLUSIONS UL clinical measures were the most important predictors of the subsequent UL performance category in this exploratory analysis regardless of the machine learning algorithm used. Interestingly, cognitive and affective measures emerged as important predictors when the number of input variables was expanded. These results reinforce that UL performance, in vivo, is not a simple product of body functions nor the capacity for movement, instead being a complex phenomenon dependent on many physiological and psychological factors. Utilizing machine learning, this exploratory analysis is a productive step toward the prediction of UL performance. Trial registration NA.
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Affiliation(s)
- Jessica Barth
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Keith R Lohse
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Marghuretta D Bland
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Catherine E Lang
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA.
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
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14
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Cherry-Allen KM, French MA, Stenum J, Xu J, Roemmich RT. Opportunities for Improving Motor Assessment and Rehabilitation After Stroke by Leveraging Video-Based Pose Estimation. Am J Phys Med Rehabil 2023; 102:S68-S74. [PMID: 36634334 DOI: 10.1097/phm.0000000000002131] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ABSTRACT Stroke is a leading cause of long-term disability in adults in the United States. As the healthcare system moves further into an era of digital medicine and remote monitoring, technology continues to play an increasingly important role in post-stroke care. In this Analysis and Perspective article, opportunities for using human pose estimation-an emerging technology that uses artificial intelligence to track human movement kinematics from simple videos recorded using household devices (e.g., smartphones, tablets)-to improve motor assessment and rehabilitation after stroke are discussed. The focus is on the potential of two key applications: (1) improving access to quantitative, objective motor assessment and (2) advancing telerehabilitation for persons post-stroke.
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Affiliation(s)
- Kendra M Cherry-Allen
- From the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland (KMC-A, MAF, JS, RTR); Department of Physical Therapy Education, Western University of Health Sciences, Lebanon, Oregon (KMC-A); Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland (JS, RTR); and Department of Kinesiology, University of Georgia, Athens, Georgia (JX)
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15
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Yamamoto R, Sasaki S, Kuwahara W, Kawakami M, Kaneko F. Effect of exoskeleton-assisted Body Weight-Supported Treadmill Training on gait function for patients with chronic stroke: a scoping review. J Neuroeng Rehabil 2022; 19:143. [PMID: 36544163 PMCID: PMC9768983 DOI: 10.1186/s12984-022-01111-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Therapeutic exercise for gait function using an exoskeleton-assisted Body Weight Supported Treadmill Training (BWSTT) has been identified as a potential intervention that allows for task-based repetitive training with appropriate kinematics while adjusting the amount of body weight support (BWS). Nonetheless, its effect on gait in patients with stroke in the chronic phase are yet to be clarified. The primary aim of this scoping review was to present the status of effectiveness of exoskeleton-assisted BWSTT in patients with chronic stroke. The secondary aims were to summarise intervention protocols, types and functions of BWSTT exoskeletal robotic devices currently used clinically. METHOD AND RESULTS Articles were accessed and collected from PubMed, Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science databases, which were completed in October 2020. Articles were included if the subjects were adults with stroke in the chronic phase (onset ≥ 6 months) and if they utilised a robotic exoskeleton with treadmill and body weight support and investigated the efficacy of gait exercise. A total of 721 studies were identified, of which 11 randomised controlled trials were selected. All included studies were published from 2008 to 2020. Overall, 309 subjects were enrolled; of these, 241 (156 males, 85 females) participated. Walking outcome measures were used more often to evaluate the functional aspects of gait than to evaluate gait independence. In 10 of 11 studies, showed the effectiveness of exoskeleton robot-assisted BWSTT in terms of outcomes contributing to improved gait function. Two studies reported that exoskeleton-assisted BWSTT with combination therapy was significantly more effective in improving than exoskeleton-assisted BWSTT alone. However, no significant difference was identified between the groups; compared with therapist-assisted BWSTT groups, exoskeleton-assisted BWSTT groups did not exhibit significant change. CONCLUSION This review suggests that exoskeleton-assisted BWSTT for patients with chronic stroke may be effective in improving walking function. However, the potential may be "to assist" and not because of using the robot. Further studies are required to verify its efficacy and strengthen evidence on intervention protocols.
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Affiliation(s)
- Rieko Yamamoto
- grid.26091.3c0000 0004 1936 9959Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shjinjuku, Tokyo, Japan ,grid.268446.a0000 0001 2185 8709Department of Artificial Environment, Safety, Environment and System Engineering, Yokohama National University Graduate School of Environment and Information Sciences, 79-7, Tokiwadai, Hodogaya, Yokohama, Japan ,grid.39158.360000 0001 2173 7691Center for Environmental and Health Sciences, Hokkaido University, Kita 12, Nishi 7, Kita-ku, Sapporo, Japan
| | - Shun Sasaki
- grid.26091.3c0000 0004 1936 9959Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shjinjuku, Tokyo, Japan ,Division of Health Promotion, ARCE Inc., Sagamihara, Japan
| | - Wataru Kuwahara
- grid.26091.3c0000 0004 1936 9959Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shjinjuku, Tokyo, Japan ,grid.265074.20000 0001 1090 2030Department of Physical Therapy, Graduate School of Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-Oku, Arakawa-ku, Tokyo, Japan
| | - Michiyuki Kawakami
- grid.26091.3c0000 0004 1936 9959Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shjinjuku, Tokyo, Japan
| | - Fuminari Kaneko
- grid.26091.3c0000 0004 1936 9959Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shjinjuku, Tokyo, Japan ,grid.265074.20000 0001 1090 2030Department of Physical Therapy, Graduate School of Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-Oku, Arakawa-ku, Tokyo, Japan
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16
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Schwartz E, Guidry K, Lee A, Dinh D, Levin MF, Demers M. Clinical Motor Coordination Tests in Adult Neurology: A Scoping Review. Physiother Can 2022; 74:387-395. [PMID: 37324609 PMCID: PMC10262719 DOI: 10.3138/ptc-2021-0025] [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: 02/19/2021] [Revised: 05/07/2021] [Accepted: 05/22/2021] [Indexed: 08/26/2023]
Abstract
Purpose: This scoping review aimed to identify which clinical tests are used to assess upper limb, lower limb, and trunk motor coordination, and their metric and measurement properties for adult neurological populations. Method: MEDLINE (1946-) and EMBASE (1996-) databases were searched using keywords such as movement quality, motor performance, motor coordination, assessment, and psychometrics. Data regarding the body part assessed, neurological condition, psychometric properties, and scored metrics of spatial and/or temporal coordination were independently extracted by two reviewers. Alternate versions of some tests such as the Finger-to-Nose Test were included. Results: Fifty-one included articles yielded 2 tests measuring spatial coordination, 7 tests measuring temporal coordination, and 10 tests measuring both. Scoring metrics and measurement properties differed between tests, with a majority of tests having good-to-excellent measurement properties. Conclusions: The metrics of motor coordination scored by current tests vary. Since tests do not assess functional task performance, the onus falls on clinicians to infer the connection between coordination impairments and functional deficits. Clinical practice would benefit from the development of a battery of tests that assesses the metrics of coordination related to functional performance.
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Affiliation(s)
- Elka Schwartz
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre Intégré de Santé et Services Sociaux de Laval–Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation, Laval, Quebec, Canada
| | - Kathryn Guidry
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre Intégré de Santé et Services Sociaux de Laval–Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation, Laval, Quebec, Canada
| | - Amanda Lee
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre Intégré de Santé et Services Sociaux de Laval–Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation, Laval, Quebec, Canada
| | - Danny Dinh
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre Intégré de Santé et Services Sociaux de Laval–Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation, Laval, Quebec, Canada
| | - Mindy F. Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre Intégré de Santé et Services Sociaux de Laval–Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation, Laval, Quebec, Canada
| | - Marika Demers
- Centre Intégré de Santé et Services Sociaux de Laval–Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation, Laval, Quebec, Canada
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Alhwoaimel N, Warner MB, Hughes AM, Busselli G, Turk R. Validity and reliability of sensor system to measure trunk range of motion during Streamlined Wolf Motor Function Test in chronic stroke and aged-matched healthy participants. Top Stroke Rehabil 2022; 30:410-422. [PMID: 36190018 DOI: 10.1080/10749357.2022.2127665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
OBJECTIVE To investigate the validity and reliability of using the Valedo® system to measure trunk Range of Motion (ROM) during performance of the streamlined Wolf Motor Function Test (SWMFT). METHODS Twenty chronic strokes and 20 age-matched healthy participants performed SWMFT while wearing Valedo® sensors on their trunks to capture trunk movements. A paired sample T-test was used to examine the validity of the system in distinguishing between the healthy and stroke group, and between the affected and unaffected sides in the stroke group. Interclass correlation coefficients were used to assess the inter-rater and intra-rater reliability (between-days) with 95% CI. RESULTS The Valedo® system was able to distinguish between stroke and healthy participants; stroke participants employed greater trunk range of movements than the healthy controls in all tasks (p < .01). Furthermore, the Valedo® system enabled differentiation between affected and unaffected hands of people within the stroke group. The reliability for the stroke group was good to excellent with intrarater reliability (ICC = 0.71-0.92) and interrater reliability (ICC = 0.63-0.95). CONCLUSIONS The Valedo system demonstrates an acceptable level of validity and reliability for measuring trunk ROM during the Streamlined Wolf Motor Function Test (SWMFT). Future studies with a larger sample size, different levels of upper limb impairment are warranted.
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Affiliation(s)
- Norah Alhwoaimel
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical SciencesKharj, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Martin B Warner
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Ann-Marie Hughes
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Giulia Busselli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Ruth Turk
- School of Health Sciences, University of Southampton, Southampton, UK
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Assunção GSB, Polese JC, Ferreira Pena E, Teixeira-Salmela LF, Faria-Fortini I. Measurement properties of the Brazilian version of the Stroke Upper Limb Capacity Scale (SULCS- Brazil). Top Stroke Rehabil 2022:1-10. [PMID: 35775585 DOI: 10.1080/10749357.2022.2095100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The Stroke Upper Limb Capacity Scale (SULCS) is a clinically useful measure of upper-limb (UL) capacity, which assesses both basic and advanced capacities. OBJECTIVES To examine the reliability, construct validity, and interpretability of the SULCS-Brazil with community-dwelling individuals with stroke. METHODS The SULCS-Brazil and measures of impairment (handgrip strength and motor function of the paretic UL), capacity (manual and digital dexterities), and performance were applied during the first session, to establish construct validity (80 patients). The SULCS-Brazil was applied again during a second session (a sub-set of 30 patients), to investigate test-retest reliability. Test-retest reliability was evaluated using kappa statistics (k) for the individual items, intraclass correlation coefficient (ICC) for the total scores, standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman plot. For the evaluation of construct validity, pre-defined hypotheses were created to estimate the strength of the correlations between the SULCS-Brazil scores and established measures of UL function, using Spearman correlation coefficients. Interpretability was investigated by evaluating both ceiling/ floor effects. RESULTS High level of agreement was found between the SUCLS-Brazil total scores obtained on both applications (ICC = 0.98; 95%CI:0.96-0.99) and 80% of the individual items had almost perfect agreement (k= 0.81-1.0). The SEM (0.46) and the MDC (1.27) showed clinically acceptable values. All pre-defined hypotheses were confirmed, indicating adequate construct validity of the SULCS-Brazil. No significant ceiling/floor effects were observed. CONCLUSIONS The SULCS-Brazil showed to be reliable and valid for the evaluation of upper-limb capacity of individuals with stroke.
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Affiliation(s)
| | - Janaine Cunha Polese
- Department of Physical Therapy, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Elisa Ferreira Pena
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Iza Faria-Fortini
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Tosatto D, Bonacina D, Signori A, Pellicciari L, Cecchi F, Cornaggia CM, Piscitelli D. Spin of information and inconsistency between abstract and full text in RCTs investigating upper limb rehabilitation after stroke: An overview study. Restor Neurol Neurosci 2022; 40:195-207. [PMID: 35723125 DOI: 10.3233/rnn-211247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Researchers may be tempted to favorably distort the interpretation of their findings when reporting the abstract (i.e., spin). Spin bias overemphasizes the beneficial effects of the intervention compared with the results shown in the full text. OBJECTIVE To assess the occurrence of spin bias and incompleteness in reporting abstracts in post-stroke upper limb (UL) rehabilitation randomized clinical trials (RCTs). METHODS A sample of 120 post-stroke UL rehabilitation RCTs (indexed in PEDro database), published in English between 2012 and 2020, was included. The completeness of reporting and spin were assessed using the Consolidated Standards of Reporting Trials for Abstracts (CONSORT-A) and the spin checklist. The relationship between CONSORT-A and spin checklist scores with RCT and journal characteristics was assessed. RESULTS CONSORT-A and spin checklist scored 5.3±2.4 (max 15-points, higher scores indicating better reporting) and 5.5±2.0 (max 7-points, higher scores indicating presence of spin), respectively; Significant differences were detected between abstract and full-text scores in the CONSORT-A checklist (p < 0.01) and the spin checklist (p < 0.01). Items of the CONSORT-A checklist in the abstracts and full text showed a fair agreement (k = 0.31), while a moderate agreement (k = 0.59) for the spin checklist was detected. Completeness of abstract was associated (R2 = 0.46) with journal Impact Factor (p < 0.01), CONSORT Guideline endorsement (p = 0.04), and abstract word number (p = 0.02). A lower spin was associated with a higher journal Impact Factor (p = 0.01) and CONSORT Guideline endorsement (p = 0.01). CONCLUSIONS Post-stroke UL rehabilitation RCTs abstracts were largely incomplete showing spin. Authors, reviewers, publishers, and stakeholders should be aware of this phenomenon. Publishers should consider allowing more words in abstracts to improve the completeness of reporting abstracts. Although we have investigated only stroke rehabilitation, our results suggest that health care professionals of all disciplines should avoid clinical decision-making based solely upon abstracts.
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Affiliation(s)
- Diego Tosatto
- Istituti Clinici Zucchi - Gruppo San Donato, Carate Brianza (MB), Italy
| | - Daniele Bonacina
- Istituti Clinici Zucchi - Gruppo San Donato, Carate Brianza (MB), Italy
| | - Alessio Signori
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milano Bicocca, Milano, Italy.,School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Department of Kinesiology, University of Connecticut, Storrs, CT, USA
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20
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Werner C, Schönhammer JG, Steitz MK, Lambercy O, Luft AR, Demkó L, Easthope CA. Using Wearable Inertial Sensors to Estimate Clinical Scores of Upper Limb Movement Quality in Stroke. Front Physiol 2022; 13:877563. [PMID: 35592035 PMCID: PMC9110656 DOI: 10.3389/fphys.2022.877563] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
Neurorehabilitation is progressively shifting from purely in-clinic treatment to therapy that is provided in both clinical and home-based settings. This transition generates a pressing need for assessments that can be performed across the entire continuum of care, a need that might be accommodated by application of wearable sensors. A first step toward ubiquitous assessments is to augment validated and well-understood standard clinical tests. This route has been pursued for the assessment of motor functioning, which in clinical research and practice is observation-based and requires specially trained personnel. In our study, 21 patients performed movement tasks of the Action Research Arm Test (ARAT), one of the most widely used clinical tests of upper limb motor functioning, while trained evaluators scored each task on pre-defined criteria. We collected data with just two wrist-worn inertial sensors to guarantee applicability across the continuum of care and used machine learning algorithms to estimate the ARAT task scores from sensor-derived features. Tasks scores were classified with approximately 80% accuracy. Linear regression between summed clinical task scores (across all tasks per patient) and estimates of sum task scores yielded a good fit (R 2 = 0.93; range reported in previous studies: 0.61-0.97). Estimates of the sum scores showed a mean absolute error of 2.9 points, 5.1% of the total score, which is smaller than the minimally detectable change and minimally clinically important difference of the ARAT when rated by a trained evaluator. We conclude that it is feasible to obtain accurate estimates of ARAT scores with just two wrist worn sensors. The approach enables administration of the ARAT in an objective, minimally supervised or remote fashion and provides the basis for a widespread use of wearable sensors in neurorehabilitation.
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Affiliation(s)
- Charlotte Werner
- Spinal Cord Injury Research Center, University Hospital Balgrist, Zurich, Switzerland
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Josef G. Schönhammer
- Cereneo Foundation, Center for Interdisciplinary Research (CEFIR), Vitznau, Switzerland
| | - Marianne K. Steitz
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology and Clinical Neuroscience Center, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Zurich, Singapore
| | - Andreas R. Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology and Clinical Neuroscience Center, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - László Demkó
- Spinal Cord Injury Research Center, University Hospital Balgrist, Zurich, Switzerland
| | - Chris Awai Easthope
- Cereneo Foundation, Center for Interdisciplinary Research (CEFIR), Vitznau, Switzerland
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21
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Caimmi M, Giovanzana C, Gasperini G, Molteni F, Molinari Tosatti L. Robot Fully Assisted Upper-Limb Functional Movements Against Gravity to Drive Recovery in Chronic Stroke: A Pilot Study. Front Neurol 2022; 12:782094. [PMID: 35350582 PMCID: PMC8957862 DOI: 10.3389/fneur.2021.782094] [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: 09/23/2021] [Accepted: 12/29/2021] [Indexed: 11/22/2022] Open
Abstract
Background Stroke is becoming more and more a disease of chronically disabled patients, and new approaches are needed for better outcomes. An intervention based on robot fully assisted upper-limb functional movements is presented. Objectives To test the immediate and sustained effects of the intervention in reducing impairment in chronic stroke and to preliminarily verify the effects on activity. Methodology Nineteen patients with mild-to-severe impairment underwent 12 40-min rehabilitation sessions, 3 per week, of robot-assisted reaching and hand-to-mouth movements. The primary outcome measure was the Fugl-Meyer Assessment (FMA) at T1, immediately after treatment (n = 19), and at T2, at a 6-month follow-up (n = 10). A subgroup of 11 patients was also administered the Wolf Motor Function Test Time (WMFT TIME) and Functional Ability Scale (WMFT FAS) and Motor Activity Log (MAL) Amount Of Use (AOU), and Quality Of Movement (QOM). Results All patients were compliant with the treatment. There was improvement on the FMA with a mean difference with respect to the baseline of 6.2 points at T1, after intervention (n = 19, 95% CI = 4.6–7.8, p < 0.0002), and 5.9 points at T2 (n = 10, 95% CI = 3.6–8.2, p < 0.005). Significant improvements were found at T1 on the WMFT FAS (n = 11, +0.3/5 points, 95% CI = 0.2–0.4, p < 0.004), on the MAL AOU (n = 11, +0.18/5, 95% CI = 0.07–0.29, p < 0.02), and the MAL QOM (n = 11, +0.14/5, 95% CI = 0.08–0.20, p < 0.02). Conclusions Motor benefits were observed immediately after intervention and at a 6-month follow-up. Reduced impairment would appear to translate to increased activity. Although preliminary, the results are encouraging and lay the foundation for future studies to confirm the findings and define the optimal dose-response curve. Clinical Trial Registration www.ClinicalTrials.gov, identifier: NCT03208634.
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Affiliation(s)
- Marco Caimmi
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing, National Research Council of Italy, Milan, Italy
| | - Chiara Giovanzana
- Villa Beretta Rehabilitation Centre, Valduce Hospital, Costa Masnaga, Italy
| | - Giulio Gasperini
- Villa Beretta Rehabilitation Centre, Valduce Hospital, Costa Masnaga, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Centre, Valduce Hospital, Costa Masnaga, Italy
| | - Lorenzo Molinari Tosatti
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing, National Research Council of Italy, Milan, Italy
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22
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Tomita Y, Hasegawa S, Chida D, Asakura T, Usuda S. Association between self-perceived activity performance and upper limb functioning in subacute stroke. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1946. [PMID: 35254717 DOI: 10.1002/pri.1946] [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: 09/14/2021] [Revised: 02/02/2022] [Accepted: 02/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to investigate to what extent upper limb (UL) motor impairment, trunk compensation, and activity performance are related to self-perception of UL activity performance in subacute stroke. METHODS This was a prospective observational study. Twenty-four adults with subacute stroke (age: 65.4 ± 10.8 years) underwent clinical and kinematic assessments at baseline (33.9 ± 5.2 days after stroke onset) and 4 weeks after the baseline. The clinical assessment included the UL Fugl-Meyer motor assessment (FMA), Simple Test for Evaluating hand Function (STEF), and the performance and satisfaction scores of the Canadian Occupational Performance Measure (COPM). The kinematic measurement was performed using a motion capture system during a standardized reach-to-grasp task. Endpoint performance variables and trunk displacement were calculated as kinematic outcomes. An inpatient rehabilitation program of 3 h/day was provided every day for 4 weeks between the two measurement points. The relationships between COPM scores and clinical/kinematic outcomes were examined by multiple regression analysis. Significance levels of p < 0.05 were used. RESULTS The results of the multiple regression analysis showed that the changes in STEF (β = 0.520, p = 0.005) and trunk compensation (β = -0.398, p = 0.024) were moderately related to the change in the COPM satisfaction (R2 adj = 0.426, p = 0.001), while the change in UL FMA was not. DISCUSSION The changes in activity performance and trunk compensation were related to improved self-perception of UL activity performance. Therapeutic management for activity performance and trunk compensation may be important for improving self-perception of UL activity performance after stroke.
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Affiliation(s)
- Yosuke Tomita
- Department of Physical Therapy, Takasaki University of Health and Welfare, Takasaki, Japan
| | - Satoshi Hasegawa
- Department of Rehabilitation, Public Nanokaichi Hospital, Tomioka, Japan
| | - Daiki Chida
- Department of Rehabilitation, Gunma Rehabilitation Hospital, Maebashi, Japan
| | - Tomoyuki Asakura
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Shigeru Usuda
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
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23
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Poitras I, Clouâtre J, Campeau-Lecours A, Mercier C. Accelerometry-Based Metrics to Evaluate the Relative Use of the More Affected Arm during Daily Activities in Adults Living with Cerebral Palsy. SENSORS 2022; 22:s22031022. [PMID: 35161767 PMCID: PMC8839842 DOI: 10.3390/s22031022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 01/27/2023]
Abstract
Adults living with cerebral palsy (CP) report bimanual and unimanual difficulties that interfere with their participation in activities of daily living (ADL). There is a lack of quantitative methods to assess the impact of these motor dysfunctions on the relative use of each arm. The objective of this study was to evaluate the concurrent and discriminative validity of accelerometry-based metrics when used to assess bimanual and unimanual functions. METHODS A group of control subjects and hemiplegic adults living with CP performed six ADL tasks, during which they were wearing an Actigraph GT9X on each wrist and being filmed. Four bimanual and unimanual metrics were calculated from both accelerometry-based and video-based data; these metrics were then compared to one other with an intraclass correlation coefficient (ICC). Some of these metrics were previously validated in other clinical population, while others were novel. The discriminative validity was assessed through comparisons between groups and between tasks. RESULTS The concurrent validity was considered as good to excellent (ICC = 0.61-0.97) depending on the experience of the raters. The tasks made it possible to discriminate between groups. CONCLUSION The proposed accelerometry-based metrics are a promising tool to evaluate bimanual and unimanual functions in adults living with CP.
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Affiliation(s)
- Isabelle Poitras
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (J.C.); (A.C.-L.)
- Department of Rehabilitation, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Jade Clouâtre
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (J.C.); (A.C.-L.)
- Department of Mechanical Engineering, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Alexandre Campeau-Lecours
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (J.C.); (A.C.-L.)
- Department of Mechanical Engineering, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Catherine Mercier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (J.C.); (A.C.-L.)
- Department of Rehabilitation, Laval University, Quebec City, QC G1V 0A6, Canada
- Correspondence:
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24
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Sardesai S, Solomon M J, Arumugam A, Guddattu V, Gorthi SP, Pai A, Kumaran D S. Predicting post-stroke motor recovery of upper extremity using clinical variables and performance assays: A prospective cohort study protocol. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1937. [PMID: 35037341 DOI: 10.1002/pri.1937] [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: 08/16/2021] [Revised: 12/19/2021] [Accepted: 12/30/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND PURPOSE Measurement of movement quality is essential to distinguish motor recovery patterns and optimize rehabilitation strategies post-stroke. Recently, the Stroke Recovery and Rehabilitation Roundtable Taskforce (SRRR) recommended four kinetic and kinematic performance assays to measure upper extremity (UE) movements and distinguish behavioral restitution and compensation mechanisms early post-stroke. The purpose of this study is to develop and validate a prediction model to analyze the added prognostic value of performance assays over clinical variables assessed up to 1-month post stroke for predicting recovery of UE motor impairment, capacity and quality of movement (QoM) measured at 3 months post-stroke onset. METHODS In this prospective cohort study, 120 stroke survivors will be recruited within seven days post-stroke. Candidate predictors such as baseline characteristics, demographics and performance assays as per SRRR recommendations along with tonic stretch reflex threshold will be measured up to 1-month post-stroke. Upper extremity motor recovery will be evaluated in terms of motor impairment (Fugl-Meyer assessment for UE), UE capacity measured with Action Research Arm Test (ARAT) and QoM (movement smoothness in the form of peak metrics [PM]) assessed with a reach-to-grasp-to-mouth task (mimicking a drinking task) at 3 months post-stroke. Three multivariable linear regression models will be developed to predict factors responsible for the outcomes of Fugl-Meyer assessment for upper extremity (FM-UE), ARAT and movement quality. The developed models will be internally validated using a split-sample method. DISCUSSION This study will provide a validated prediction model inclusive of clinical and performance assays that may assist in prediction of UE motor recovery. Predicting the amount of recovery and differentiating between behavioral restitution and compensation (as reflected by the FM-UE, QoM and ARAT) would enable us in realistic goal formation and planning rehabilitation. It would also help in encouraging patients to partake in early post-stroke rehabilitation thus improving the recovery potential.
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Affiliation(s)
- Sanjukta Sardesai
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - John Solomon M
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Ashokan Arumugam
- Department of Physiotherapy, University of Sharjah College of Health Sciences, Sharjah, United Arab Emirates
| | - Vasudeva Guddattu
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | | | - Aparna Pai
- Department of Neurology, Kasturba Hospital, Manipal Academy of Higher Education, Manipal, India
| | - Senthil Kumaran D
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
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25
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Camacho-Zavala JK, Perez-Medina AL, Mercado-Gutierrez JA, Gutierrez MI, Gutierrez-Martinez J, Aguirre-Güemez AV, Quinzaños-Fresnedo J, Perez-Orive J. Personalized protocol and scoring scale for functional electrical stimulation of the hand: A pilot feasibility study. Technol Health Care 2022; 30:51-63. [PMID: 34397438 DOI: 10.3233/thc-213016] [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] [Indexed: 10/20/2022]
Abstract
BACKGROUND Complex personalized Functional Electrical Stimulation (FES) protocols for calibrating parameters and electrode positioning have been proposed, most being time-consuming or technically cumbersome for clinical settings. Therefore, there is a need for new personalized FES protocols that generate comfortable, functional hand movements, while being feasible for clinical translation. OBJECTIVE To develop a personalized FES protocol, comprising electrode placement and parameter selection, to generate hand opening (HO), power grasp (PW) and precision grip (PG) movements, and compare in a pilot feasibility study its performance to a non-personalized protocol based on standard FES guidelines. METHODS Two FES protocols, one personalized (P1) and one non-personalized (P2), were used to produce hand movements in twenty-three healthy participants. FES-induced movements were assessed with a new scoring scale which comprises items for selectivity, functionality, and comfort. RESULTS Higher FES-HSS scores were obtained with P1 for all movements: HO (p= 0.00013), PW (p= 0.00007), PG (p= 0.00460). Electrode placement time was significantly shorter for P2 (p= 0.00003). Comfort scores were similar for both protocols. CONCLUSIONS The personalized protocol for electrode placement and parameter selection enabled functional FES-induced hand movements and presented advantages over a non-personalized protocol. This protocol warrants further investigation to confirm its suitability for developing upper-limb rehabilitation interventions with clinical translational potential.
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Affiliation(s)
- Jessica K Camacho-Zavala
- Facultad de Ingeniería, Universidad Nacional Autónoma de México, Cd. de México, México
- Facultad de Ingeniería, Universidad Nacional Autónoma de México, Cd. de México, México
| | - Ana L Perez-Medina
- Facultad de Ingeniería, Universidad Nacional Autónoma de México, Cd. de México, México
- Facultad de Ingeniería, Universidad Nacional Autónoma de México, Cd. de México, México
| | - Jorge A Mercado-Gutierrez
- División de Investigación en Ingeniería Médica, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Cd. de México, México
| | - Mario I Gutierrez
- CONACYT-Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Cd. de México, México
| | - Josefina Gutierrez-Martinez
- División de Investigación en Ingeniería Médica, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Cd. de México, México
| | - A Valeria Aguirre-Güemez
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Cd. de México, México
| | - Jimena Quinzaños-Fresnedo
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Cd. de México, México
| | - Javier Perez-Orive
- Facultad de Ingeniería, Universidad Nacional Autónoma de México, Cd. de México, México
- División de Neurociencias, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Cd. de México, México
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26
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Prange-Lasonder GB, Alt Murphy M, Lamers I, Hughes AM, Buurke JH, Feys P, Keller T, Klamroth-Marganska V, Tarkka IM, Timmermans A, Burridge JH. European evidence-based recommendations for clinical assessment of upper limb in neurorehabilitation (CAULIN): data synthesis from systematic reviews, clinical practice guidelines and expert consensus. J Neuroeng Rehabil 2021; 18:162. [PMID: 34749752 PMCID: PMC8573909 DOI: 10.1186/s12984-021-00951-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/18/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Technology-supported rehabilitation can help alleviate the increasing need for cost-effective rehabilitation of neurological conditions, but use in clinical practice remains limited. Agreement on a core set of reliable, valid and accessible outcome measures to assess rehabilitation outcomes is needed to generate strong evidence about effectiveness of rehabilitation approaches, including technologies. This paper collates and synthesizes a core set from multiple sources; combining existing evidence, clinical practice guidelines and expert consensus into European recommendations for Clinical Assessment of Upper Limb In Neurorehabilitation (CAULIN). METHODS Data from systematic reviews, clinical practice guidelines and expert consensus (Delphi methodology) were systematically extracted and synthesized using strength of evidence rating criteria, in addition to recommendations on assessment procedures. Three sets were defined: a core set: strong evidence for validity, reliability, responsiveness and clinical utility AND recommended by at least two sources; an extended set: strong evidence OR recommended by at least two sources and a supplementary set: some evidence OR recommended by at least one of the sources. RESULTS In total, 12 measures (with primary focus on stroke) were included, encompassing body function and activity level of the International Classification of Functioning and Health. The core set recommended for clinical practice and research: Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT); the extended set recommended for clinical practice and/or clinical research: kinematic measures, Box and Block Test (BBT), Chedoke Arm Hand Activity Inventory (CAHAI), Wolf Motor Function Test (WMFT), Nine Hole Peg Test (NHPT) and ABILHAND; the supplementary set recommended for research or specific occasions: Motricity Index (MI); Chedoke-McMaster Stroke Assessment (CMSA), Stroke Rehabilitation Assessment Movement (STREAM), Frenchay Arm Test (FAT), Motor Assessment Scale (MAS) and body-worn movement sensors. Assessments should be conducted at pre-defined regular intervals by trained personnel. Global measures should be applied within 24 h of hospital admission and upper limb specific measures within 1 week. CONCLUSIONS The CAULIN recommendations for outcome measures and assessment procedures provide a clear, simple, evidence-based three-level structure for upper limb assessment in neurological rehabilitation. Widespread adoption and sustained use will improve quality of clinical practice and facilitate meta-analysis, critical for the advancement of technology-supported neurorehabilitation.
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Affiliation(s)
- Gerdienke B Prange-Lasonder
- Roessingh Research and Development, Enschede, The Netherlands.
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands.
| | - Margit Alt Murphy
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Ilse Lamers
- Rehabilitation Research Center (REVAL), UHasselt, Diepenbeek, Belgium
- Rehabilitation and MS Center, Pelt, Belgium
| | - Ann-Marie Hughes
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jaap H Buurke
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Biosignals and Systems, University of Twente, Enschede, The Netherlands
| | - Peter Feys
- Rehabilitation Research Center (REVAL), UHasselt, Diepenbeek, Belgium
| | - Thierry Keller
- Neurorehabilitation Area at the Health Division of TECNALIA, Basque Research and Technology Alliance (BRTA), Donostia - San Sebastian, Spain
| | | | - Ina M Tarkka
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Annick Timmermans
- Rehabilitation Research Center (REVAL), UHasselt, Diepenbeek, Belgium
| | - Jane H Burridge
- School of Health Sciences, University of Southampton, Southampton, UK
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27
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Molad R, Levin MF. Construct Validity of the Upper-Limb Interlimb Coordination Test in Stroke. Neurorehabil Neural Repair 2021; 36:49-60. [PMID: 34715755 PMCID: PMC8721533 DOI: 10.1177/15459683211058092] [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] [Indexed: 11/15/2022]
Abstract
Background Coordination impairments are under-evaluated in patients with stroke due to the lack of validated assessments resulting in an unclear relationship between coordination deficits and functional limitations. Objective Determine the construct validity of the new clinical upper-limb (UL) Interlimb Coordination test (ILC2) in individuals with chronic stroke. Methods Thirteen individuals with stroke, ≥40 years, with ≥30° isolated supination of the more-affected (MAff) arm, who could understand instructions and 13 healthy controls of similar age participated in a cross-sectional study. Participants performed synchronous bilateral anti-phase forearm rotations for 10 seconds in 4 conditions: self-paced internally-paced (IP1), fast internally-paced (IP2), slow externally-paced (EP1), and fast externally-paced (EP2). Primary (continuous relative phase-CRP, cross-correlation, lag) and secondary outcome measures (UL and trunk kinematics) were compared between groups. Results Participants with stroke made slower UL movements than controls in all conditions, except EP1. Cross-correlation coefficients were lower (i.e., closer to 0) in stroke in IP1, but CRP and lag were similar between groups. In IP1 and matched-speed conditions (IP1 for healthy and IP2 for stroke), stroke participants used compensatory trunk and shoulder movements. The synchronicity sub-scale and total scores of ILC2 were related to temporal coordination in IP2. Interlimb Coordination test total score was related to greater shoulder rotation of the MAff arm. Interlimb Coordination test scores were not related to clinical scores. Conclusion Interlimb Coordination test is a valid clinical measure that may be used to objectively assess UL interlimb coordination in individuals with chronic stroke. Further reliability testing is needed to determine the clinical utility of the scale.
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Affiliation(s)
- Roni Molad
- School of Physical and Occupational Therapy, 5620McGill University, Montreal, QC, Canada.,Feil and Oberfeld Research Centre, 60387Jewish Rehabilitation Hospital Site of Centre for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, 5620McGill University, Montreal, QC, Canada.,Feil and Oberfeld Research Centre, 60387Jewish Rehabilitation Hospital Site of Centre for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
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28
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Lackritz H, Parmet Y, Frenkel-Toledo S, Baniña MC, Soroker N, Solomon JM, Liebermann DG, Levin MF, Berman S. Effect of post-stroke spasticity on voluntary movement of the upper limb. J Neuroeng Rehabil 2021; 18:81. [PMID: 33985543 PMCID: PMC8117272 DOI: 10.1186/s12984-021-00876-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/03/2021] [Indexed: 11/17/2022] Open
Abstract
Background Hemiparesis following stroke is often accompanied by spasticity. Spasticity is one factor among the multiple components of the upper motor neuron syndrome that contributes to movement impairment. However, the specific contribution of spasticity is difficult to isolate and quantify. We propose a new method of quantification and evaluation of the impact of spasticity on the quality of movement following stroke. Methods Spasticity was assessed using the Tonic Stretch Reflex Threshold (TSRT). TSRT was analyzed in relation to stochastic models of motion to quantify the deviation of the hemiparetic upper limb motion from the normal motion patterns during a reaching task. Specifically, we assessed the impact of spasticity in the elbow flexors on reaching motion patterns using two distinct measures of the ‘distance’ between pathological and normal movement, (a) the bidirectional Kullback–Liebler divergence (BKLD) and (b) Hellinger’s distance (HD). These measures differ in their sensitivity to different confounding variables. Motor impairment was assessed clinically by the Fugl-Meyer assessment scale for the upper extremity (FMA-UE). Forty-two first-event stroke patients in the subacute phase and 13 healthy controls of similar age participated in the study. Elbow motion was analyzed in the context of repeated reach-to-grasp movements towards four differently located targets. Log-BKLD and HD along with movement time, final elbow extension angle, mean elbow velocity, peak elbow velocity, and the number of velocity peaks of the elbow motion were computed. Results Upper limb kinematics in patients with lower FMA-UE scores (greater impairment) showed greater deviation from normality when the distance between impaired and normal elbow motion was analyzed either with the BKLD or HD measures. The severity of spasticity, reflected by the TSRT, was related to the distance between impaired and normal elbow motion analyzed with either distance measure. Mean elbow velocity differed between targets, however HD was not sensitive to target location. This may point at effects of spasticity on motion quality that go beyond effects on velocity. Conclusions The two methods for analyzing pathological movement post-stroke provide new options for studying the relationship between spasticity and movement quality under different spatiotemporal constraints.
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Affiliation(s)
- Hadar Lackritz
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yisrael Parmet
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Silvi Frenkel-Toledo
- Faculty of Health Sciences, Department of Physical Therapy, Ariel University, Ariel, Israel.,Department of Neurological Rehabilitation, Loewenstein Hospital, Ra'anana, Israel
| | - Melanie C Baniña
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Hospital, Ra'anana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dario G Liebermann
- Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mindy F Levin
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada
| | - Sigal Berman
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel. .,The Zlotowski Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Subramanian SK, Baniña MC, Turolla A, Levin MF. Reaching performance scale for stroke - Test-retest reliability, measurement error, concurrent and discriminant validity. PM R 2021; 14:337-347. [PMID: 33675151 DOI: 10.1002/pmrj.12584] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Post-stroke upper limb motor improvement can be better quantified by describing movement patterns characterizing movement quality and use of compensations. Movement patterns can be described using both kinematic and clinical outcomes. One clinical outcome that assesses movement quality and compensations used for reaching a Close (18 points) and Far target (18 points) is the Reaching Performance Scale for Stroke (RPSS). OBJECTIVE To estimate the pilot test-retest reliability and validity (concurrent, discriminant) of the RPSS in individuals with chronic stroke. DESIGN Retrospective data analysis. SETTING Research laboratory. PARTICIPANTS Seventy-two individuals with upper limb hemiparesis ≥6 months prior to participation. INTERVENTION Not applicable. MAIN OUTCOME MEASURE RPSS Close and Far Target scores. Intraclass correlation coefficients (ICCs) helped assess pilot test-retest reliability on a subset of 14 participants. Concurrent validity was assessed for individual RPSS items with corresponding kinematic outcomes (trunk displacement, shoulder flexion, shoulder horizontal adduction, elbow extension, trajectory straightness) using Pearson correlations. We also ran multiple regression analyses with the RPSS total scores and used kinematic outcomes as the criterion standard. Logistic regression analyses estimated discriminant validity. We divided participants into two groups based on the Fugl-Meyer Assessment (FMA) scores (mild: ≥50/66; moderate-to-severe: ≤49/66). RESULTS Test-retest reliability was excellent for Close (ICC = 0.98, 95% confidence interval [CI] 0.94-0.99) and Far targets (ICC = 0.98, 95% CI 0.95-0.99). Individual RPSS items for both targets were mildly to moderately correlated with corresponding kinematic values. A combination of trajectory straightness, elbow extension, and trunk displacement explained the majority of the variance in RPSS scores (47%) for both targets. The RPSS scores discriminated between individuals with mild and moderate-to-severe motor impairment for both Close (ExpB = 3.33, P < .001; 95% CI 1.70-6.52) and Far targets (ExpB = 2.59, P < .001, 95% CI 1.65-4.07). Cutoff points for transition between groups were 15.5 (Close target) and 14 (Far target). CONCLUSION The RPSS is a valid clinical measure with excellent pilot results of test-retest reliability for assessing movement patterns and compensations used for reaching.
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Affiliation(s)
- Sandeep K Subramanian
- Department of Neurosciences, University of Montreal, Montreal, Quebec, Canada.,Feil-Oberfeld JRH CRIR Research Centre, Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada
| | - Melanie C Baniña
- Feil-Oberfeld JRH CRIR Research Centre, Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Andrea Turolla
- Laboratory of Rehabilitation Technologies, Ospedale San Camillo IRCCS, Venice, Italy
| | - Mindy F Levin
- Feil-Oberfeld JRH CRIR Research Centre, Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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Molad R, Alouche SR, Demers M, Levin MF. Development of a Comprehensive Outcome Measure for Motor Coordination, Step 2: Reliability and Construct Validity in Chronic Stroke Patients. Neurorehabil Neural Repair 2021; 35:194-203. [PMID: 33410389 DOI: 10.1177/1545968320981943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A comprehensive scale assessing motor coordination of multiple body segments was developed using a 3-phase content validation process. The Comprehensive Coordination Scale (CCS) evaluates motor coordination defined as the ability to produce context-dependent movements of multiple effectors in both spatial and temporal domains. The scale assesses motor coordination in individuals with neurological injuries at 2 levels of movement description: the motor performance level describes end point movements (ie, hand, foot), and the movement quality level describes limb joints/trunk movements contributing to end point movement. OBJECTIVE To determine measurement properties of the scale in people with chronic stroke. METHODS Standardized approaches determined the internal consistency (factor loadings), intrarater and interrater reliability (interclass correlation coefficient), measurement error (SEM; minimal detectable change [MDC]), construct validity, and interpretability (ie, ceiling and floor effects) of the CCS. RESULTS Data from 30 patients with chronic stroke were used for the analysis. The internal consistency of the scale was high (0.94), and the scale consisted of separate factors characterizing end point motor performance and movement quality. Intrarater (intraclass correlation coefficient [ICC] = 0.97-0.97) and interrater (ICC=0.76-0.98) reliability of the whole scale and subscales were good to excellent. The CCS had an SEM of 1.80 points (total score = 69 points) and an MDC95 of 4.98 points. The CCS total score was related to Fugl-Meyer Assessment total and motor scores and had no ceiling or floor effects. CONCLUSIONS The CCS scale has strong measurement properties and may be a useful measure of spatial and temporal coordination deficits in chronic stroke survivors.
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Affiliation(s)
- Roni Molad
- McGill University, Montréal, QC, Canada.,Jewish Rehabilitation Hospital Site of Centre for Interdisciplinary Research in Rehabilitation, Laval, Canada
| | - Sandra R Alouche
- McGill University, Montréal, QC, Canada.,Jewish Rehabilitation Hospital Site of Centre for Interdisciplinary Research in Rehabilitation, Laval, Canada.,Universidade Cidade de São Paulo, Brazil
| | - Marika Demers
- McGill University, Montréal, QC, Canada.,Jewish Rehabilitation Hospital Site of Centre for Interdisciplinary Research in Rehabilitation, Laval, Canada.,University of Southern California, Los Angeles, CA, USA
| | - Mindy F Levin
- McGill University, Montréal, QC, Canada.,Jewish Rehabilitation Hospital Site of Centre for Interdisciplinary Research in Rehabilitation, Laval, Canada
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Kapadia N, Myers M, Musselman K, Wang RH, Yurkewich A, Popovic MR. 3-Dimensional printing in rehabilitation: feasibility of printing an upper extremity gross motor function assessment tool. Biomed Eng Online 2021; 20:2. [PMID: 33402170 PMCID: PMC7786477 DOI: 10.1186/s12938-020-00839-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/11/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Use of standardized and scientifically sound outcome measures is encouraged in clinical practice and research. With the development of newer rehabilitation therapies, we need technology-supported upper extremity outcome measures that are easily accessible, reliable and valid. 3-Dimensional printing (3D-printing) has recently seen a meteoric rise in interest within medicine including the field of Physical Medicine and Rehabilitation. The primary objective of this study was to evaluate the feasibility of designing and constructing a 3D printed version of the Toronto Rehabilitation Institute-Hand Function Test (TRI-HFT). The TRI-HFT is an upper extremity gross motor function assessment tool that measures function at the intersection of the International Classification of Function's body structure and function, and activity domain. The secondary objective was to assess the preliminary psychometrics of this test in individuals with stroke. RESULTS 3D design files were created using the measurements of the original TRI-HFT objects. The 3D printed objects were then compared to the original test objects to ensure that the original dimensions were preserved. All objects were successfully printed except the sponge and paper which required some modification. The error margin for weight of the objects was within 10% of the original TRI-HFT for the rest of the objects. Nine participants underwent the following assessments: the Chedoke Arm and Hand Activity Inventory (CAHAI), Fugl Meyer Assessment-Hand (FMA-Hand), Chedoke McMaster stages of recovery of the arm (CMSA-Arm) and Chedoke McMaster stages of recovery of the hand (CMSA-Hand) and the 3D TRI-HFT for assessment of psychometric properties of the test. The video recorded assessment of the 3D TRI-HFT was used for reliability testing. Construct validity was assessed by comparing the scores on 3D TRI-HFT with the scores on CAHAI, CMSA-Arm, CMSA-Hand and FMA-Hand. The 3D TRI-HFT had high inter-rater reliability (Intra-Class Correlation Co-efficient (ICC) of 0.99; P < 0.000), high intra-rater reliability (ICC of 0.99; P < 0.000) and moderate-to-strong correlation with the CMSA-Arm, CMSA-Hand and FMA-Hand scores. CONCLUSIONS The TRI-HFT could be successfully 3D printed and initial testing indicates that the test is a reliable and valid measure of upper extremity motor function in individuals with stroke.
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Affiliation(s)
- Naaz Kapadia
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON Canada
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada
- Rocket Family Upper Extremity Clinic, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada
| | - Mathew Myers
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON Canada
| | - Kristin Musselman
- Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON Canada
- SCI Mobility Laboratory, Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada
| | - Rosalie H. Wang
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON Canada
- Intelligent Assistive Technology and Systems Laboratory, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada
| | | | - Milos R. Popovic
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON Canada
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Alouche SR, Molad R, Demers M, Levin MF. Development of a Comprehensive Outcome Measure for Motor Coordination; Step 1: Three-Phase Content Validity Process. Neurorehabil Neural Repair 2020; 35:185-193. [PMID: 33349134 DOI: 10.1177/1545968320981955] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Motor coordination, the ability to produce context-dependent organized movements in spatial and temporal domains, is impaired after neurological injuries. Outcome measures assessing coordination mostly quantify endpoint performance variables (ie, temporal qualities of whole arm movement) but not movement quality (ie, trunk and arm joint displacements). OBJECTIVE To develop an outcome measure to assess coordination of multiple body segments at both endpoint trajectory and movement quality levels, based on observational kinematics, in adults with neurological injuries. METHODS A 3-phase study was used to develop the Comprehensive Coordination Scale (CCS): instrument development, Delphi process, and focus group meeting. The CCS was constructed from common tests used in clinical practice and research. Rating scales for different behavioral elements were developed to guide analysis. For content validation, 8 experts (ie, neurological clinicians/researchers) answered questionnaires about relevance, comprehension, and feasibility of each test and rating scale. A focus group conducted with 6 of 8 experts obtained consensus on rating scale and instruction wording, and identified gaps. Three additional experts reviewed the revised CCS content to obtain a final version. RESULTS Experts identified a gap regarding assessment of hand/finger coordination. The CCS final version is composed of 6 complementary tests of coordination: finger-to-nose, arm-trunk, finger, lower extremity, and 2- and 4-limb interlimb coordination. Constructs include spatial and temporal variables totaling 69 points. Higher scores indicate better performance. CONCLUSIONS The CCS may be an important, understandable and feasible outcome measure to assess spatial and temporal coordination. CCS measurement properties are presented in the companion article.
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Affiliation(s)
- Sandra R Alouche
- Universidade Cidade de São Paulo, Sao Paulo, Brazil.,McGill University, Montreal, Quebec, Canada.,Jewish Rehabilitation Hospital Site of Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
| | - Roni Molad
- McGill University, Montreal, Quebec, Canada.,Jewish Rehabilitation Hospital Site of Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
| | - Marika Demers
- McGill University, Montreal, Quebec, Canada.,Jewish Rehabilitation Hospital Site of Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada.,University of Southern California, Los Angeles, CA, USA
| | - Mindy F Levin
- McGill University, Montreal, Quebec, Canada.,Jewish Rehabilitation Hospital Site of Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
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Solnik S, Furmanek MP, Piscitelli D. Movement Quality: A Novel Biomarker Based on Principles of Neuroscience. Neurorehabil Neural Repair 2020; 34:1067-1077. [PMID: 33185150 DOI: 10.1177/1545968320969936] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A major problem in neurorehabilitation is the lack of objective outcomes to measure movement quality. Movement quality features, such as coordination and stability, are essential for everyday motor actions. These features allow reacting to continuously changing environment or to resist external perturbations. Neurological disorders affect movement quality, leading to functionally impaired movements. Recent findings suggest that the central nervous system organizes motor elements (eg, muscles, joints, fingers) into task-specific ensembles to stabilize motor tasks performance. A method to quantify this feature has been previously developed based on the uncontrolled manifold (UCM) hypothesis. UCM quantifies movement quality in a spatial-temporal domain using intertrial analysis of covariation between motor elements. In this point-of-view article, we first describe major obstacles (eg, the need for group analysis) that interfere with UCM application in clinical settings. Then, we propose a process of quantifying movement quality for a single individual with a novel use of bootstrapping simulations and UCM analysis. Finally, we reanalyze previously published data from individuals with neurological disorders performing a wide range of motor tasks, that is, multi-digit pressing and postural balance tasks. Our method allows one to assess motor quality impairments in a single individual and to detect clinically important motor behavior changes. Our solution may be incorporated into a clinical setting to assess sensorimotor impairments, evaluate the effects of specific neurological treatments, or track movement quality recovery over time. We also recommended the proposed solution to be used jointly with a typical statistical analysis of UCM parameters in cohort studies.
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Affiliation(s)
- Stanislaw Solnik
- University of North Georgia, Dahlonega, GA, USA.,University School of Physical Education in Wroclaw, Wroclaw, Poland
| | - Mariusz P Furmanek
- Northeastern University, Boston, MA, USA.,The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Daniele Piscitelli
- McGill University, Montreal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada
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Matthew RP, Seko S, Kurillo G, Bajcsy R, Cheng L, Han JJ, Lotz J. Reachable Workspace and Proximal Function Measures for Quantifying Upper Limb Motion. IEEE J Biomed Health Inform 2020; 24:3285-3294. [PMID: 32340969 DOI: 10.1109/jbhi.2020.2989722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There are a lack of quantitative measures for clinically assessing upper limb function. Conventional biomechanical performance measures are restricted to specialist labs due to hardware cost and complexity, while the resulting measurements require specialists for analysis. Depth cameras are low cost and portable systems that can track surrogate joint positions. However, these motions may not be biologically consistent, which can result in noisy, inaccurate movements. This paper introduces a rigid body modelling method to enforce biological feasibility of the recovered motions. This method is evaluated on an existing depth camera assessment: the reachable workspace (RW) measure for assessing gross shoulder function. As a rigid body model is used, position estimates of new proximal targets can be added, resulting in a proximal function (PF) measure for assessing a subject's ability to touch specific body landmarks. The accuracy, and repeatability of these measures is assessed on ten asymptomatic subjects, with and without rigid body constraints. This analysis is performed both on a low-cost depth camera system and a gold-standard active motion capture system. The addition of rigid body constraints was found to improve accuracy and concordance of the depth camera system, particularly in lateral reaching movements. Both RW and PF measures were found to be feasible candidates for clinical assessment, with future analysis needed to determine their ability to detect changes within specific patient populations.
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Abstract
PURPOSE OF REVIEW Recent advances in the machine learning field, especially in deep learning, provide the opportunity for automated, detailed, and unbiased analysis of motor behavior. Although there has not yet been wide use of these techniques in the motor rehabilitation field, they have great potential. In this review, I describe how the current state of machine learning can be applied to 3D kinematic analysis, and how this will have an impact on neurorehabilitation. RECENT FINDINGS Applications of deep learning methods, in the form of convolutional neural networks, have been revolutionary for image analysis such as face recognition and object detection in images, exceeding human level performance. Recent studies have shown applicability of these deep learning approaches to human posture and movement classification. It is to be expected that portable stereo-camera systems will bring 3D pose estimation into the clinical setting and allow the assessment of movement quality in response to interventions. Advances in machine learning can help automate the process of obtaining 3D kinematics of human movements and to identify/classify patterns of movement.
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Affiliation(s)
- Ahmet Arac
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, 710 Westwood Plaza, Rm 3-232, Los Angeles, CA, 90095, USA.
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36
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Subramanian SK, Cross MK, Hirschhauser CS. Virtual reality interventions to enhance upper limb motor improvement after a stroke: commonly used types of platform and outcomes. Disabil Rehabil Assist Technol 2020; 17:107-115. [PMID: 32448005 DOI: 10.1080/17483107.2020.1765422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Virtual Reality (VR) based platforms are useful in enhancing post-stroke sub-optimal upper limb (UL) motor improvement. A variety of options are available from expensive highly customizable platforms to low cost turnkey solutions. Clinical outcomes primarily help assess the effects of VR-based platforms. These outcomes mainly quantify how much improvement has occurred. Very few outcomes characterize the type (i.e. how) of recovery. We categorized the types of VR-based platforms and outcome measures commonly used for post-stroke UL motor improvement.Methods: We reviewed the published literature in English from 2000-2019. Different types of VR-based platforms were grouped into those available commercially and those developed by the various research groups. We initially classified outcomes from the retrieved studies under the appropriate International Classification of Functioning categories. Then, we divided the outcomes as those quantifying the type or extent of improvement.Results: We found a total of 125 studies. Majority of the studies used commercially available platforms. A total of 42 different outcome measures were used. Seventeen different outcomes were used to assess body structure and functions as well as in activity limitations. Eight outcomes assessed the effects of contextual factors and participation restrictions. The Fugl Meyer Assessment, Wolf Motor Function Test and Stroke Impact Scale were most often used across the three categories. Of the 125 studies, 52 used outcomes characterizing the type of recovery. Although a smaller proportion, 24 studies included movement patterns outcomes.Conclusion: A standardized set of outcomes can promote better comparisons between studies using different VR-based platforms for post-stroke UL motor improvement.Implications for RehabilitationA wide variety of commercially available systems are present from expensive customizable systems to low-cost turnkey systems.The Fugl-Meyer Assessment and Wolf Motor Function Test along with the Stroke Impact Scale-Social Participation subscale were used most often across all studies as assessments of body structure and function, activity limitations and participation restriction.It is essential to include movement pattern outcomes addressing whether recovery of compensation occurs with the use of VR-based platforms.
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Affiliation(s)
- Sandeep K Subramanian
- Department of Physical Therapy, School of Health Professions, UT Health San Antonio, San Antonio, TX, USA.,Rehabilitation Services, University Hospital, University Health System, San Antonio, TX, USA
| | - MacKenzie K Cross
- Department of Physical Therapy, School of Health Professions, UT Health San Antonio, San Antonio, TX, USA
| | - Cole S Hirschhauser
- Department of Physical Therapy, School of Health Professions, UT Health San Antonio, San Antonio, TX, USA
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Abstract
OBJECTIVE To adapt the Reaching Performance Scale for Stroke (RPSS) for the Wolf Motor Function Test (WMFT) "Lift Can" (Can) and "Hand to Box" (Box) items. DESIGN Retrospective analysis of video-recorded WMFT assessment performed by 3 raters on 2 occasions. SETTING Not applicable. PARTICIPANTS Participants (N=29) with mild to moderate upper extremity impairment less than 3 months after stroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Inter- and intra-rater agreement, concurrent validity of WMFT-RPSS. RESULTS Mean ± SD inter-rater Gwet's agreement coefficient (AC2) was 0.61±0.05 for Can WMFT-RPSS and 0.56 (0.03) for Box. Mean ± SD intra-rater AC2 for Can was 0.63±0.05 and 0.70±0.04 for Box. WMFT-RPSS Can and Box scores correlated with log mean WMFT time (C, -0.73; B, -0.48), Functional Ability Scale (C, 0.87; B, 0.62), Upper Extremity Fugl-Meyer Motor Score (C, 0.69; B, 0.51), and item movement rate (C, 0.74; B, 0.71) (P<.05 for all). Mean ± SD WMFT-RPSS score across the 29 participants was 12.7±3.5 for Can (max score, 19) and 11.4±3.0 for Box (max score, 16). CONCLUSIONS WMFT-RPSS demonstrated moderate intra-rater and weak-to-moderate inter-rater agreement for individuals with mild-moderate impairment. For construct validity, Can and Box WMFT-RPSS were significantly correlated with 4 standardized measures. Average WMFT-RPSS scores revealed that some participants may have relied on compensatory movements to complete the task, a revelation not discernable from movement rate alone. The WMFT-RPSS is potentially useful as a valid and reliable tool to examine longitudinal changes in movement quality after stroke.
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Villepinte C, Verma A, Dimeglio C, De Boissezon X, Gasq D. Responsiveness of kinematic and clinical measures of upper-limb motor function after stroke: A systematic review and meta-analysis. Ann Phys Rehabil Med 2020; 64:101366. [PMID: 32156646 DOI: 10.1016/j.rehab.2020.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 02/11/2020] [Accepted: 02/15/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Kinematic analysis and clinical outcome measures with established responsiveness contribute to the quantified assessment of upper-limb function post-stroke, the selection of interventions and the differentiation of motor recovery patterns. OBJECTIVE This systematic review and meta-analysis aimed to report trends in use and compare the responsiveness of kinematic and clinical measures in studies measuring the effectiveness of constraint-induced movement, trunk restraint and bilateral arm therapies for upper-limb function after stroke. METHODS In this systematic review, randomised controlled trials implementing kinematic analysis and clinical outcome measures to evaluate the effects of therapies in post-stroke adults were eligible. We searched 8 electronic databases (MEDLINE, EMBASE, Web of Science, Scopus, CINAHL, CENTRAL, OTseeker and Pedro). Risk of bias was assessed according to the Cochrane Risk of Bias domains. A meta-analysis was conducted for repeated design measures of pre- and post-test data providing estimated standardised mean differences (SMDs). RESULTS We included reports of 12 studies (191 participants) reporting kinematic smoothness, movement duration and efficiency, trunk and shoulder range of motion, control strategy and velocity variables in conjunction with assessment by Motor Activity Log, Fugl-Meyer Assessment and Wolf Motor Function Test. Responsiveness was higher (i.e., non-overlap of 95% confidence intervals [CIs]) for Motor Activity Log score (SMD for amount of use 1.0, 95% CI 0.75-1.25, P<0.001; SMD for quality of movement 0.96, 95% CI 0.72-1.20, P<0.001) than movement efficiency, trunk and shoulder range of motion, control strategy and peak velocity. CONCLUSION These results are consistent with current literature supporting the use of combined kinematic and clinical measures for comprehensive and accurate evaluation of upper-limb function post-stroke. Future research should include other design trials and rehabilitation types to confirm these findings, focusing on subgroup analysis of type of rehabilitation intervention and functional levels.
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Affiliation(s)
- Claire Villepinte
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France; Toulouse University Hospital, School of Occupational Therapy, PREFMS, Toulouse, France; Department of Physiological Explorations, University Hospital of Toulouse, Toulouse, France.
| | - Arpana Verma
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, United Kingdom
| | - Chloe Dimeglio
- LEASP - UMR 1027 Inserm - University of Toulouse III Paul Sabatier, Toulouse, France; Department of Epidemiology, University Hospital of Toulouse, Toulouse, France
| | - Xavier De Boissezon
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France; Department of Physical Medicine and Rehabilitation, University Hospital of Toulouse, Toulouse, France
| | - David Gasq
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France; Department of Physiological Explorations, University Hospital of Toulouse, Toulouse, France
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Hancock NJ, Shepstone L, Rowe P, Pomeroy VM. Identification of neuromuscular targets for restoration of walking ability after stroke: Precursor to precision rehabilitation. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1816. [PMID: 31758747 DOI: 10.1002/pri.1816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/19/2019] [Accepted: 10/03/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Restoration of walking is a priority for stroke survivors and key target for physical therapies. Upright pedalling (UP) can provide functional walking-like activity using a variety of muscle synergies; it is unclear which synergies might be most useful for recovery of walking. Objectives here were as follows: to examine whether neuromuscular measures derived during UP might identify targets for walking rehabilitation after stroke and to determine test-retest repeatability and concurrent validity of the measures. DESIGN This was a prospective correlational study. SETTING The study was carried out in a movement science laboratory. PARTICIPANTS The participants were 18 adults with stroke (StrS) and 10 healthy older adults (HOA). INTERVENTION/MEASUREMENT StrS and HOA took part in two identical measurement sessions. During UP, surface electromyography and kinematic data were recorded and then processed to derive three measures: reciprocal activity of quadriceps and hamstrings; percentage muscle activity "on" according to crank angle; and smoothness of movement. RESULTS HOA and StrS demonstrated differences in reciprocal muscle activity (p = .044) and quadriceps activity according to crank angle (p = .034) but pedalled similarly smoothly (p = .367). For muscle activation according to crank angle in StrS, intraclass correlation coefficients (95% confidence interval) showing acceptable repeatability were 0.46 [0.32, 0.58] affected quadriceps; 0.43 [0.28, 0.56] affected hamstrings; and 0.67 [0.56, 0.75] unaffected quadriceps. CONCLUSION Muscle activation according to crank angle is a promising measure of lower limb impairment during functional activity after stroke; subsequent investigation should determine magnitude of variance between testing sessions. Reciprocal activity of quadriceps and hamstrings muscles and quadriceps activity according to crank angle are both potential targets for physical therapies to improve motor recovery. Further investigations are warranted.
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Affiliation(s)
- Nicola J Hancock
- Acquired Brain Injury Rehabilitation Alliance, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Philip Rowe
- Biomedical Engineering Department, University of Strathclyde, Glasgow, UK
| | - Valerie M Pomeroy
- Acquired Brain Injury Rehabilitation Alliance, School of Health Sciences, University of East Anglia, Norwich, UK
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Kwakkel G, van Wegen EEH, Burridge JH, Winstein CJ, van Dokkum LEH, Alt Murphy M, Levin MF, Krakauer JW. Standardized Measurement of Quality of Upper Limb Movement After Stroke: Consensus-Based Core Recommendations From the Second Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2019; 33:951-958. [PMID: 31660781 DOI: 10.1177/1545968319886477] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The second Stroke Recovery and Rehabilitation Roundtable "metrics" task force developed consensus around the recognized need to add kinematic and kinetic movement quantification to its core recommendations for standardized measurements of sensorimotor recovery in stroke trials. Specifically, we focused on measurement of the quality of upper limb movement. We agreed that the recommended protocols for measurement should be conceptually rigorous, reliable, valid and responsive to change. The recommended measurement protocols include four performance assays (i.e. 2D planar reaching, finger individuation, grip strength, and precision grip at body function level) and one functional task (3D drinking task at activity level) that address body function and activity respectively. This document describes the criteria for assessment and makes recommendations about the type of technology that should be used for reliable and valid movement capture. Standardization of kinematic measurement protocols will allow pooling of participant data across sites, thereby increasing sample size aiding meta-analyses of published trials, more detailed exploration of recovery profiles, the generation of new research questions with testable hypotheses, and development of new treatment approaches focused on impairment. We urge the clinical and research community to consider adopting these recommendations.
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Affiliation(s)
- G Kwakkel
- Amsterdam UMC, VU Medical Centre, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - E E H van Wegen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - J H Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - C J Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - L E H van Dokkum
- I2FH, Institue d'imagerie Fonctionelle Humaine, Montpellier University Hospital Guide, Chauliac, France
| | - M Alt Murphy
- Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - M F Levin
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - J W Krakauer
- Departments of Neurology, Neuroscience, Physical Medicine & Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kwakkel G, Van Wegen EEH, Burridge JH, Winstein CJ, van Dokkum LEH, Alt Murphy M, Levin MF, Krakauer JW. Standardized measurement of quality of upper limb movement after stroke: Consensus-based core recommendations from the Second Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2019; 14:783-791. [DOI: 10.1177/1747493019873519] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The second Stroke Recovery and Rehabilitation Roundtable “metrics” task force developed consensus around the recognized need to add kinematic and kinetic movement quantification to its core recommendations for standardized measurements of sensorimotor recovery in stroke trials. Specifically, we focused on measurement of the quality of upper limb movement. We agreed that the recommended protocols for measurement should be conceptually rigorous, reliable, valid and responsive to change. The recommended measurement protocols include four performance assays (i.e. 2D planar reaching, finger individuation, grip strength, and precision grip at body function level) and one functional task (3D drinking task at activity level) that address body function and activity respectively. This document describes the criteria for assessment and makes recommendations about the type of technology that should be used for reliable and valid movement capture. Standardization of kinematic measurement protocols will allow pooling of participant data across sites, thereby increasing sample size aiding meta-analyses of published trials, more detailed exploration of recovery profiles, the generation of new research questions with testable hypotheses, and development of new treatment approaches focused on impairment. We urge the clinical and research community to consider adopting these recommendations.
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Affiliation(s)
- G Kwakkel
- Amsterdam UMC, VU Medical Centre, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - EEH Van Wegen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - JH Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - CJ Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - LEH van Dokkum
- I2FH, Institue d'imagerie Fonctionelle Humaine, Montpellier University Hospital Guide, Chauliac, France
| | - M Alt Murphy
- Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - MF Levin
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - JW Krakauer
- Departments of Neurology, Neuroscience, Physical Medicine & Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Vianna de Andrade FPP, Padula RS, Binda AC, da Silva ML, Alouche SR. Measurement properties of the Reaching Performance Scale for Stroke. Disabil Rehabil 2019; 43:1171-1175. [PMID: 31429325 DOI: 10.1080/09638288.2019.1650963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIM Reaching Performance Scale for Stroke (RPSS) evaluates the upper limb reach-to-grasp movement quality and compensatory movements. The objective of the study was to test the reliability, construct validity, and interpretability of the Brazilian-Portuguese RPSS. METHODS Fifty-one individuals (mean age 62 ± 10.8 years), with acute-to-chronic stroke (range: 1-300 months) were video recorded while performing a reach-to-grasp task of a cone placed both close and far from the individual. Their degree of motor impairment ranged from 4 to 59 points in the Fugl-Meyer scale. RESULTS Reaching Performance Scale for Stroke showed excellent intra- (ICC2,1 = 1.00) and interrater (ICC2,1 = 0.98-0.99) reliability, and redundant internal consistency (Cronbach's α = 0.98). The construct validity between RPSS and Fugl-Meyer scale was strong (Spearman rho = 0.88-0.89; p < 0.0001). The scale was able to discriminate individuals with mild or moderate upper limb impairment from those with severe impairment. We found ceiling and floor effects. CONCLUSIONS Reaching Performance Scale for Stroke showed excellent reliability and redundant internal consistency. The construct validity with the Fugl-Meyer scale was strong. Reaching Performance Scale for Stroke was able to discriminate individuals with different levels of upper limb impairment.IMPLICATIONS FOR REHABILITATIONPost-stroke individuals develop compensatory strategies to perform reaching movements with the paretic upper limb.The Reaching Performance Scale for Stroke provides a quantitative and qualitative evaluation of the reach-to-grasp movement.The Reaching Performance Scale for Stroke is suitable for use with Brazilian-Portuguese speakers and has adequate reliability and validity.
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Affiliation(s)
- Flávia P P Vianna de Andrade
- Master and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.,School of Physical Therapy, Universidade do Vale do Sapucaí, Pouso Alegre, Brazil
| | - Rosimeire S Padula
- Master and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Aline C Binda
- Master and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.,School of Physical Therapy, Universidade Estadual do Centro-Oeste, Guarapuava, Brazil
| | - Maria Liliane da Silva
- Master and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Sandra R Alouche
- Master and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
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Gómez-Blasco A, Hernández-Fernández A, Roche-Albero A, Martín-Hernández C. Results measured by means of a motion capture system in proximal humerus fractures treated by osteosynthesis with locking plate. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Bernhardt J, Borschmann KN, Kwakkel G, Burridge JH, Eng JJ, Walker MF, Bird ML, Cramer SC, Hayward KS, O’Sullivan MJ, Clarkson AN, Corbett D. Setting the scene for the Second Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2019; 14:450-456. [DOI: 10.1177/1747493019851287] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The Stroke Recovery and Rehabilitation Roundtable (SRRR) meetings bring together an international group of preclinical and clinical researchers along with statisticians, methodologists, funders and consumers, working to accelerate the development of effective treatments for stroke recovery and to support best-evidence uptake in rehabilitation practice. The first meeting (2016) focused on four recommendation areas: translation of preclinical evidence into human discovery trials; recovery biomarkers to provide knowledge of therapeutic targets and prognosis in human stroke; intervention development, monitoring, and reporting standards; and standardized measurement in motor recovery trials. The impact of SRRR is growing, with uptake of recommendations emerging, and funders exploring ways to incorporate research targets and recommendations. At our second meeting (SRRR2, 2018), we worked on new priority areas: (1) cognitive impairment, (2) standardizing metrics for measuring quality of movement, (3) improving development of recovery trials, and (4) moving evidence-based treatments into practice. To accelerate progress towards breakthrough treatments, formation of an International Stroke Recovery and Rehabilitation Alliance is our next step, where working groups will take recommendations and build partnerships needed to achieve our goals.
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Affiliation(s)
- Julie Bernhardt
- Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Australia
| | - Karen N Borschmann
- Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Australia
| | - Gert Kwakkel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Neurosciences and Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre, Reade, The Netherlands
| | - Jane H Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Janice J Eng
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
- GF Strong Rehabilitation Research Laboratory, The University of British Columbia, Vancouver, Canada
| | - Marion F Walker
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Marie-Louise Bird
- GF Strong Rehabilitation Research Laboratory, The University of British Columbia, Vancouver, Canada
| | - Steven C Cramer
- Departments of Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, University of California, Irvine, USA
| | - Kathryn S Hayward
- Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Australia
| | - Michael J O’Sullivan
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Andrew N Clarkson
- Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Dale Corbett
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
- Canadian Partnership for Stroke Recovery, University of Ottawa, Ottawa, Canada
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Levin MF, Hiengkaew V, Nilanont Y, Cheung D, Dai D, Shaw J, Bayley M, Saposnik G. Relationship Between Clinical Measures of Upper Limb Movement Quality and Activity Poststroke. Neurorehabil Neural Repair 2019; 33:432-441. [PMID: 31072222 DOI: 10.1177/1545968319847969] [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] [Indexed: 11/17/2022]
Abstract
Background. Understanding the relationship between movement quality (impairment) and performance (activity) in poststroke patients is important for rehabilitation intervention studies. This has led to an interest in kinematic characterization of upper limb motor impairment. Since instrumented motion analysis is not readily clinically available, observational kinematics may be a viable alternative. Objective. To determine if upper limb movement quality during a reach-to-grasp task identified by observation could be used to describe the relationship between motor impairments and the time to perform functional tasks. Methods. Cross-sectional, secondary analysis of baseline data from 141 participants with stroke, age 18 to 85 years, who participated in a multicenter randomized controlled trial. Clinical assessment of movement quality using the Reaching Performance Scale for Stroke (RPSS-Close and Far targets) and of performance (activity) from the Wolf Motor Function Test (WMFT-7 items) was assessed. The degree to which RPSS component scores explained scores on WMFT items was determined by multivariable regression. Results. Clinically significant decreases (>2 seconds) in performance time for some of the more complex WMFT tasks involving prehension were predicted from RPSS-Close and Far target components. Trunk compensatory movements did not predict either increases or decreases in performance time for the WMFT tasks evaluated. Overall, the strength of the regression models was low. Conclusions. In lieu of kinematic analysis, observational clinical movement analysis may be a valid and accessible method to determine relationships between motor impairment, compensations and upper limb function in poststroke patients. Specific relationships are unlikely to generalize to all tasks due to kinematic redundancy and task specificity.
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Affiliation(s)
- Mindy F Levin
- 1 McGill University and Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
| | | | | | - Donna Cheung
- 4 St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David Dai
- 4 St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Shaw
- 4 St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mark Bayley
- 5 Toronto Rehabilitation Institute and University of Toronto, Toronto, ON, Canada
| | - Gustavo Saposnik
- 4 St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Gómez-Blasco AM, Hernández-Fernández A, Roche-Albero A, Martín-Hernández C. Results measured by means of a motion capture system in proximal humerus fractures treated by osteosynthesis with locking plate. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:268-274. [PMID: 31014932 DOI: 10.1016/j.recot.2019.03.002] [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: 06/06/2018] [Revised: 12/16/2018] [Accepted: 03/10/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To evaluate the results after locking plate internal fixation of proximal humerus fractures by means of a motion capture system, and functional scales. MATERIAL AND METHOD Retrospective study of a cohort of 47 elderly patients undergoing surgery from January 2010 to December 2014. After a minimum follow-up of two years, two functional scales (Constant-Murley and Quick DASH), and a quality of life scale (EQ-5D) were used for clinical evaluation. For objective evaluation of the range of motion a kinematic marker-free analysis with cameras was performed. RESULTS The average age was 74.85 years. Average functional scores were: Constant-Murley 70.06 points, Quick DASH 35.74 points and EQ-5D 6.79 points. The average range of motion was: flexion, 111.49°; extension: 24.13°; abduction: 109.40°; adduction: 15.13°; external rotation: 38.96°, and internal rotation: 49.28°. Correlation was found between the two functional scales, between them and the EQ-5D, and between range of motion and functional scales (except for external rotation) as well as between range of motion and EQ-5D (except for flexion and external rotation). CONCLUSION Locking plate osteosynthesis in proximal humerus fragility fractures achieved good functional and quality of life scores. Motion capture systems can be a useful tool for the functional assessment of shoulder pathology allowing an objective evaluation of range of motion.
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Affiliation(s)
- A M Gómez-Blasco
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón, Zaragoza, España.
| | - A Hernández-Fernández
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón, Zaragoza, España
| | - A Roche-Albero
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón, Zaragoza, España; Universidad de Zaragoza, Zaragoza, España
| | - C Martín-Hernández
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón, Zaragoza, España; Universidad de Zaragoza, Zaragoza, España
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Perez-Marcos D. Virtual reality experiences, embodiment, videogames and their dimensions in neurorehabilitation. J Neuroeng Rehabil 2018; 15:113. [PMID: 30477527 PMCID: PMC6258149 DOI: 10.1186/s12984-018-0461-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/12/2018] [Indexed: 12/22/2022] Open
Abstract
Background In the context of stroke rehabilitation, new training approaches mediated by virtual reality and videogames are usually discussed and evaluated together in reviews and meta-analyses. This represents a serious confounding factor that is leading to misleading, inconclusive outcomes in the interest of validating these new solutions. Main body Extending existing definitions of virtual reality, in this paper I put forward the concept of virtual reality experience (VRE), generated by virtual reality systems (VRS; i.e. a group of variable technologies employed to create a VRE). Then, I review the main components composing a VRE, and how they may purposely affect the mind and body of participants in the context of neurorehabilitation. In turn, VRS are not anymore exclusive from VREs but are currently used in videogames and other human-computer interaction applications in different domains. Often, these other applications receive the name of virtual reality applications as they use VRS. However, they do not necessarily create a VRE. I put emphasis on exposing fundamental similarities and differences between VREs and videogames for neurorehabilitation. I also recommend describing and evaluating the specific features encompassing the intervention rather than evaluating virtual reality or videogames as a whole. Conclusion This disambiguation between VREs, VRS and videogames should help reduce confusion in the field. This is important for databases searches when looking for specific studies or building metareviews that aim at evaluating the efficacy of technology-mediated interventions.
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Alt Murphy M, Murphy S, Persson HC, Bergström UB, Sunnerhagen KS. Kinematic Analysis Using 3D Motion Capture of Drinking Task in People With and Without Upper-extremity Impairments. J Vis Exp 2018. [PMID: 29658937 DOI: 10.3791/57228] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Kinematic analysis is a powerful method for objective assessment of upper extremity movements in a three-dimensional (3D) space. Three-dimensional motion capture with an optoelectronic camera system is considered as golden standard for kinematic movement analysis and is increasingly used as outcome measure to evaluate the movement performance and quality after an injury or disease involving upper extremity movements. This article describes a standardized protocol for kinematic analysis of drinking task applied in individuals with upper extremity impairments after stroke. The drinking task incorporates reaching, grasping and lifting a cup from a table to take a drink, placing the cup back, and moving the hand back to the edge of the table. The sitting position is standardized to the individual's body size and the task is performed in a comfortable self-paced speed and compensatory movements are not constrained. The intention is to keep the task natural and close to a real-life situation to improve the ecological validity of the protocol. A 5-camera motion capture system is used to gather 3D coordinate positions from 9 retroreflective markers positioned on anatomical landmarks of the arm, trunk, and face. A simple single marker placement is used to ensure the feasibility of the protocol in clinical settings. Custom-made Matlab software provides automated and fast analyses of movement data. Temporal kinematics of movement time, velocity, peak velocity, time of peak velocity, and smoothness (number of movement units) along with spatial angular kinematics of shoulder and elbow joint as well as trunk movements are calculated. The drinking task is a valid assessment for individuals with moderate and mild upper extremity impairment. The construct, discriminative and concurrent validity along with responsiveness (sensitivity to change) of the kinematic variables obtained from the drinking task have been established.
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Affiliation(s)
- Margit Alt Murphy
- Institution of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg; Departement of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital;
| | | | - Hanna C Persson
- Institution of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg; Departement of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital
| | - Ulla-Britt Bergström
- Departement of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital
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Perez-Marcos D, Chevalley O, Schmidlin T, Garipelli G, Serino A, Vuadens P, Tadi T, Blanke O, Millán JDR. Increasing upper limb training intensity in chronic stroke using embodied virtual reality: a pilot study. J Neuroeng Rehabil 2017; 14:119. [PMID: 29149855 PMCID: PMC5693522 DOI: 10.1186/s12984-017-0328-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 10/31/2017] [Indexed: 01/05/2023] Open
Abstract
Background Technology-mediated neurorehabilitation is suggested to enhance training intensity and therefore functional gains. Here, we used a novel virtual reality (VR) system for task-specific upper extremity training after stroke. The system offers interactive exercises integrating motor priming techniques and embodied visuomotor feedback. In this pilot study, we examined (i) rehabilitation dose and training intensity, (ii) functional improvements, and (iii) safety and tolerance when exposed to intensive VR rehabilitation. Methods Ten outpatient stroke survivors with chronic (>6 months) upper extremity paresis participated in a ten-session VR-based upper limb rehabilitation program (2 sessions/week). Results All participants completed all sessions of the treatment. In total, they received a median of 403 min of upper limb therapy, with 290 min of effective training. Within that time, participants performed a median of 4713 goal-directed movements. Importantly, training intensity increased progressively across sessions from 13.2 to 17.3 movements per minute. Clinical measures show that despite being in the chronic phase, where recovery potential is thought to be limited, participants showed a median improvement rate of 5.3% in motor function (Fugl-Meyer Assessment for Upper Extremity; FMA-UE) post intervention compared to baseline, and of 15.4% at one-month follow-up. For three of them, this improvement was clinically significant. A significant improvement in shoulder active range of motion (AROM) was also observed at follow-up. Participants reported very low levels of pain, stress and fatigue following each session of training, indicating that the intensive VR intervention was well tolerated. No severe adverse events were reported. All participants expressed their interest in continuing the intervention at the hospital or even at home, suggesting high levels of adherence and motivation for the provided intervention. Conclusions This pilot study showed how a dedicated VR system could deliver high rehabilitation doses and, importantly, intensive training in chronic stroke survivors. FMA-UE and AROM results suggest that task-specific VR training may be beneficial for further functional recovery both in the chronic stage of stroke. Longitudinal studies with higher doses and sample sizes are required to confirm the therapy effectiveness. Trial registration This trial was retrospectively registered at ClinicalTrials.gov database (registration number NCT03094650) on 14 March 2017.
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Affiliation(s)
| | - Odile Chevalley
- MindMaze SA, Lausanne, Switzerland.,Laboratory of Cognitive Neuroscience, Brain-Mind Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Thomas Schmidlin
- Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | | | - Andrea Serino
- MindMaze SA, Lausanne, Switzerland.,Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Tej Tadi
- MindMaze SA, Lausanne, Switzerland
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Brain-Mind Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - José D R Millán
- Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Chair in Brain-Machine Interface, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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