Agreement between physiotherapists on quality of movement rated via videotape

Analysis of Fluency of Movement in Parkour Using a Video and Inertial Measurement Unit Technology

Fluency is a movement parameter combining smoothness and hesitation, and its objective measurement may be used to determine the effects of practice on sports performance. This study aimed to measure fluency in parkour, an acrobatic discipline comprising complex non-cyclical movements, which involves fluency as a critical aspect of performance. Inter-individual fluidity differences between advanced and novice athletes as well as intra-individual variations of fluency between different parts and subsequent repetitions of a path were addressed. Seventeen parkour participants were enrolled and divided into two groups based on their experience. We analysed signals captured from an inertial measurement unit fixed on the back of the pelvis of each participant during three consecutive repetitions of a specifically designed parkour routine under the guidance of video analysis. Two fluency parameters, namely smoothness and hesitation, were measured. Smoothness was calculated as the number of inflexions on the so-called jerk graph; hesitation was the percentage of the drop in the centre of mass velocity. Smoothness resulted in significantly lower values in advanced athletes (mean: 126.4; range: 36-192) than in beginners (mean: 179.37; range: 98-272) during one of the three motor activities (p = 0.02). A qualitative analysis of hesitation showed that beginner athletes tended to experience more prominent velocity drops and negative deflection than more advanced athletes. In conclusion, a system based on a video and an inertial measurement unit is a promising approach for quantification and the assessment of variability of fluency, and it is potentially beneficial to guide and evaluate the training process.

Exploring the perspectives of outpatient rehabilitation clinicians on the challenges with monitoring patient health, function and activity in the community

PURPOSE

Rehabilitation clinicians need information about patient activities in the home/community to inform care. Despite active efforts to develop technologies that can meet this need, clinicians' perspectives regarding how information is collected and used in outpatient rehabilitation have not been comprehensively described. Therefore, we aimed to describe: (1) what data pertaining to a patient's health, function and activity in their home/community are currently collected in outpatient rehabilitation, (2) how these data can impact clinical decisions, and (3) what challenges clinicians encounter when they manage the care of outpatients based on this information.

MATERIALS AND METHODS

Eight clinicians working in outpatient rehabilitation programs completed qualitative interviews that were analyzed using an inductive thematic analysis.

RESULTS

Four themes were identified: "Nature of data about a patient's health, function and activity in the home/community and how it is collected by clinicians," "Value of data from the home/community," "Perceived drawbacks of current data collection methods," and "Improving data collection to understand patient trajectory."

CONCLUSIONS

Clinicians described the importance of understanding patient activities in the home/community, but perspectives varied regarding the suitability of current methods. These perceptions may inform the design of solutions to bridge the gap between the clinic and the community in outpatient rehabilitation.Implications for rehabilitationClinical decision-making in outpatient rehabilitation is guided by verbal and written reports about a patient's health and function in the community and adherence to treatment plans.Differing perceptions on the suitability of current data collection methods indicate that the development of new solutions, such as rehabilitation technologies, needs to carefully consider clinician workflows and what data are perceived as meaningful.Potentially impactful directions for new solutions include providing well validated data on adherence, movement quality, or longitudinal progression, presented in formats that match clinical decision criteria.

Validity and Reliability of the New Basic Functional Assessment Protocol (BFA)

The global evaluation of motion patterns can examine the synchrony of neuromuscular control, range of motion, strength, resistance, balance and coordination needed to complete the movement. Visual assessments are commonly used to detect risk factors. However, it is essential to define standardized field-based tests that can evaluate with accuracy. The aims of the study were to design a protocol to evaluate fundamental motor patterns (FMP), and to analyze the validity and reliability of an instrument created to provide information about the quality of movement in FMP. Five tasks were selected: Overhead Squat (OHS); Hurdle Step (HS); Forward Step Down (FSD); Shoulder Mobility (SM); Active Stretching Leg Raise (ASLR). A list of variables was created for the evaluation of each task. Ten qualified judges assessed the validity of the instrument, while six external observers performed inter-intra reliability. The results show that the instrument is valid according to the experts' opinion; however, the reliability shows values below those established. Thus, the instrument was considered unreliable, so it is recommended to repeat the reliability process by performing more training sessions for the external observers. The present study creates the basic functional assessment (BFA), a new protocol which comprises five tasks and an instrument to evaluate FMP.

Implementation of interactive games to a shoulder rehabilitation and evaluation system

BACKGROUND

After an operation, the shoulder and wrist might not be able to lift and swing freely, and must be assisted with rehabilitation training.

OBJECTIVE

In this paper, Kinect combined with multiple sensors of a Bluetooth ball is proposed to improve the measurement function of the arm's micro-motion trajectory, rotation amount, and acceleration, which cannot be detected by Kinect alone.

METHODS

We designed two virtual scene rehabilitation games for clinical trials. We performed validity analysis with a paired sample t-test.

RESULTS

A significance value of P*< 1 was obtained, and the arm lift angle shows an improvement from 30∘ to 60∘, indicating that the range of motion of the hand and shoulder is gradually improving.

CONCLUSION

Experiments show that virtual games combined with multiple sensors can better understand the patient's rehabilitation situation.

Cellphone-Based Automated Fugl-Meyer Assessment to Evaluate Upper Extremity Motor Function After Stroke

The Fugl-Meyer Assessment (FMA) is a widely used evaluation tool for assessing upper extremity motor function during stroke rehabilitation. However, the FMA is a repetitive, time-consuming task that currently must be performed by therapists in a hospital or clinic. We thus propose an alternative automated approach in which patients perform FMA movements while holding a cellphone at the hand and receive automated FMA scores. In the proposed system, features are extracted from cellphone movement data and decision trees are used to automatically score FMA test items. Ten stroke patients with upper extremity dysfunction participated in a validation experiment to compare automated FMA scores with traditional FMA scores from a trained therapist. Results showed that FMA scores from the cellphone-based automated system were highly correlated with FMA scores from the trained therapist (r² = 0.97), and that the average accuracy for individual FMA test items was 85%. These results demonstrate that such a portable, automated FMA system could potentially be used to assess upper extremity function during stroke rehabilitation to remove the repetitive, time-consuming burden from therapists and could potentially be performed in clinic or home-based settings.

Viability of using a computer tablet to monitor an upper limb home exercise program in stroke

Aims: To evaluate the feasibility of using a tablet computer to monitor the amount of upper limb practice completed by stroke patients prescribed with a home program and to explore factors that influence adherence. Method: Ten consecutive participants randomized to the intervention arm of a randomized controlled trial investigating therapy after spasticity management for stroke patients (ACTRN 12615000616572) were recruited for this sub-study. Participants were asked to perform and record a prescribed 60-min upper limb program, based on the Graded Arm Supplementary Program, on a tablet computer daily. Four randomly selected recorded sessions for each participant were analyzed by the physiotherapist to assess adherence to the amount of exercise and content. Results: Mean score for the System Usability Scale was 85.5 (range 47.5-100) indicating that participants were accepting of the technology. Participants performed exercises on average for 50.32 min (range 26.42-68.37). Self-reported practice time was 59.44 min (range 48-67.5). Conclusion: Monitoring of patient practice using a tablet computer is feasible and may prove more reliable than self-report. There is variability in the amount of upper limb exercise stroke patients do at home.

Inter- and intra-tester reliability of the acute brain injury physiotherapy assessment (ABIPA) in patients with acquired brain injury

BACKGROUND

The Acute Brain Injury Physiotherapy Assessment (ABIPA) is a new outcome measure with face validity and sensitivity to change in the early stages of neuromotor recovery after acquired brain injury (ABI). Reliability of physiotherapists using the tool has not been established.

OBJECTIVE

Determine inter- and intra-tester reliability of physiotherapists using the ABIPA.

METHODS

An observational study using video-recorded assessments of patient performance (n = 7) was undertaken with two cohorts of physiotherapists: those receiving training (n = 23) and those provided with guidelines only (n = 7) to administer the ABIPA.

RESULTS

Across all physiotherapists (n = 30), inter-tester reliability was excellent (α ≥ 0.9) for total ABIPA score. All individual items, except trunk alignment in supine (α = 0.5), showed excellent or good internal consistency (α ≥ 0.7). For intra-tester reliability, substantial or perfect agreement was achieved for eight items (weighted Kappa K_w ≥ 0.6), moderate agreement for four items (K_w = 0.4-0.6) and three items achieved fair agreement (alignment head supine: K_w = 0.289; alignment trunk supine: Kw = 0.387 and tone left upper limb: K_w = 0.366).

CONCLUSION

Physiotherapists are highly consistent using the ABIPA but several items may need revision to improve intra-tester reliability.

Quality assessment of shoulder plyometric exercises: Examining the relationship to scapular muscle activity

OBJECTIVES

The purpose of the study was to evaluate performance quality of shoulder plyometric exercises, and examine the relationship to scapular muscle activation during an intense exercise bout.

DESIGN

Observational study.

SETTING

University laboratory.

PARTICIPANTS

32 healthy university students (male/female: 14/18) volunteers.

MAIN OUTCOME MEASURES

Subjects performed 10 plyometric exercises. Surface EMG of upper (UT), middle (MT) and lower (LT) trapezius and serratus anterior (SA) was registered. A quality assessment questionnaire was administered at the beginning and end of the exercise bout. Muscle activation at the beginning and end was evaluated by t-test. Mixed repeated measures ANOVA was conducted to test the effects of criterion-quality, time, muscles, exercises, and their interactions.

RESULTS

Increased EMG activation was noted in 34/40 cases, (21/40 significant (p < 0.05) changes). Quality assessment revealed a decline in the ability to maintain initial position (43% of subjects), failure to keep a consistent and symmetrical arc of motion (62% of subjects), and performance with trick movements (48% of subjects). Inability to keep a consistent arc of motion was significant in 4 exercises.

CONCLUSIONS

The novel questionnaire may aid quality assessment during plyometric exercises. Ability to keep a consistent arc of motion was the most sensitive marker of decline of performance quality.

A smartphone-centric system for the range of motion assessment in stroke patients

The range of motion (ROM) in stroke patients is often severely affected. Poststroke rehabilitation is guided through the use of clinical assessment scales for the rROM. Unfortunately, these scales are not widely utilized in clinical practice as they are excessively time-consuming. Although commercial motion-capture systems are capable of providing the information required for the assessments, most systems are either too costly or lack the convenience required for assessments to be conducted on a daily basis. This paper presents the design and implementation of a smartphone-based system for automated motor assessment using low-cost off-the-shelf inertial sensors. The system was used to automate a portion of the upper-extremity Fugl-Meyer assessment (FMA), which is widely used to quantify motor deficits in stroke survivors. Twelve out of 33 items were selected, focusing mainly on joint angle measurements of the upper body. The system has the ability to automatically identify the assessment item being conducted, and calculate the maximum respective joint angle achieved. Preliminary results show the ability of this system to achieve comparable results to goniometer measurements, while significantly reducing the time required to conduct the assessments. The portability and ease-of-use of the system would simplify the task of conducting range-of-motion assessments.

The Quality Function Measure: reliability and discriminant validity of a new measure of quality of gross motor movement in ambulatory children with cerebral palsy

AIM

Optimizing movement quality is a common rehabilitation goal for children with cerebral palsy (CP). The new Quality Function Measure (QFM)--a revision of the Gross Motor Performance Measure (GMPM)--evaluates five attributes: Alignment, Co-ordination, Dissociated movement, Stability, and Weight-shift, for the Gross Motor Function Measure (GMFM) Stand and Walk/Run/Jump items. This study evaluated the reliability and discriminant validity of the QFM.

METHOD

Thirty-three children with CP (17 females, 16 males; mean age 8y 11mo, SD 3y 1mo; Gross Motor Function Classification System [GMFCS] levels I [n=17], II [n=7], III [n=9]) participated in reliability testing. Each did a GMFM Stand/Walk assessment, repeated 2 weeks later. Both GMFM assessments were videotaped. A physiotherapist assessor pair independently scored the QFM from an assigned child's GMFM video. GMFM data from 112 children. That is, (GMFCS I [n=38], II [n=27], III [n=47]) were used for discriminant validity evaluation.

RESULTS

QFM mean scores varied from 45.0% (SD 27.2; Stability) to 56.2% (SD 27.5; Alignment). Reliability was excellent across all attributes: intraclass correlation coefficients (ICCs) ≥0.97 (95% confidence intervals [CI] 0.95-0.99), interrater ICCs ≥0.89 (95% CI 0.80-0.98), and test-retest ICCs ≥0.90 (95% CI 0.79-0.99). QFM discriminated qualitative attributes of motor function among GMFCS levels (maximum p<0.05).

INTERPRETATION

The QFM is reliable and valid, making it possible to assess how well young people with CP move and what areas of function to target to enhance quality of motor control.

Quality and Quantity of Rehabilitation Exercises Delivered By A 3-D Motion Controlled Camera: A Pilot Study

INTRODUCTION

Tele-rehabiliation technologies that track human motion could enable physical therapy in the home. To be effective, these systems need to collect critical metrics without PT supervision both in real time and in a store and forward capacity. The first step of this process is to determine if PTs (PTs) are able to accurately assess the quality and quantity of an exercise repetition captured by a tele-rehabilitation platform. The purpose of this pilot project was to determine the level of agreement of quality and quantity of an exercise delivered and assessed by the Virtual Exercise Rehabilitation Assistant (VERA), and seven PTs.

METHODS

Ten healthy subjects were instructed by a PT in how to perform four lower extremity exercises. Subjects then performed each exercises delivered by VERA which counted repetitions and quality. Seven PTs independently reviewed video of each subject's session and assessed repetitions quality. The percent difference in total repetitions and analysis of the distribution of rating repetition quality was assessed between the VERA and PTs.

RESULTS

The VERA counted 426 repetitions across 10 subjects performing the four different exercises while the mean repetition count from the PT panel was 426.7 (SD = 0.8). The VERA underestimated the total repetitions performed by 0.16% (SD = 0.03%, 95% CI 0.12 - 0. 22). Chi square analysis across raters was χ² = 63.17 (df = 6, p<.001), suggesting significant variance in at least one rater.

CONCLUSION

The VERA count of repetitions was accurate in comparison to a seven member panel of PTs. For exercise quality the VERA was able to rate 426 exercise repetitions across 10 patients and four different exercises in a manner consistent with five out of seven experienced PTs.

Measuring movement fluency during the sit-to-walk task

BACKGROUND

Restoring movement fluency is a key focus for physical rehabilitation; it's measurement, however, lacks objectivity. The purpose of this study was to find whether measurable movement fluency variables differed between groups of adults with different movement abilities whilst performing the sit-to-walk (STW) movement. The movement fluency variables were: (1) hesitation during movement (reduction in forward velocity of the centre of mass; CoM), (2) coordination (percentage of temporal overlap of joint rotations) and (3) smoothness (number of inflections in the CoM jerk signal).

METHODS

Kinematic data previously collected for another study were extracted for three groups: older adults (n=18), older adults at risk of falling (OARF, n=18), and younger adults (n=20). Each subject performed the STW movement freely while a motion analysis system tracked 11 body segments. The fluency variables were derived from the processed kinematic data and tested for group variation using analysis of variance.

FINDINGS

All three variables showed statistically significant differences among the groups. Hesitation (F=15.11, p<0.001) was greatest in the OARF 47.5% (SD 18.0), compared to older adults 30.3% (SD 15.9) and younger adults 20.8% (SD 11.4). Co-ordination (F=44.88, p<0.001) was lowest for the OARF (6.93%, SD 10.99) compared to both the young (31.21%, SD 5.48) and old (26.24%, SD 5.84). Smoothness (F=35.96, p<0.001) was best in the younger adults, 18.3 (SD 5.2) inflections, compared to the old, 42.5 (SD 11.5) and OARF, 44.25 (SD 7.29).

INTERPRETATION

Hesitation, co-ordination and smoothness may be valid indicators of movement fluency in adults, with important consequences for research and clinical practice.

Estimating Fugl-Meyer clinical scores in stroke survivors using wearable sensors

Clinical assessment scales to evaluate motor abilities in stroke survivors could be used to individualize rehabilitation interventions thus maximizing motor gains. Unfortunately, these scales are not widely utilized in clinical practice because their administration is excessively time-consuming. Wearable sensors could be relied upon to address this issue. Sensor data could be unobtrusively gathered during the performance of motor tasks. Features extracted from the sensor data could provide the input to models designed to estimate the severity of motor impairments and functional limitations. In previous work, we showed that wearable sensor data collected during the performance of items of the Wolf Motor Function Test (a clinical scale designed to assess functional capability) can be used to estimate scores derived using the Functional Ability Scale, a clinical scale focused on quality of movement. The purpose of the study herein presented was to investigate whether the same dataset could be used to estimate clinical scores derived using the Fugl-Meyer Assessment scale (a clinical scale designed to assess motor impairments). Our results showed that Fugl-Meyer Assessment Test scores can be estimated by feeding a Random Forest with features derived from wearable sensor data recorded during the performance of as few as a single item of the Wolf Motor Function Test. Estimates achieved using the proposed method were marked by a root mean squared error as low as 4.7 points of the Fugl-Meyer Assessment Test scale.

Measurement properties of the Motor Evaluation Scale for Upper Extremity in Stroke patients (MESUPES)

PURPOSE

To investigate inter-rater reliability of the Motor Evaluation Scale for Upper Extremity in Stroke patients (MESUPES), to provide estimates of the minimal detectable change (MDC) of the MESUPES and to investigate concurrent validity in relation to the arm scores of the Modified Motor Assessment Scale (M MAS).

METHODS

Forty-two stroke patients (mean age 56 ± 12 years) were independently assessed within a 48-hours window by two raters in different pairs (total available raters = 4).

RESULTS

Weighted κ analysis indicated good to very good agreement at item level (range 0.63-0.96). The relative and absolute reliability of the total score of MESUPES (maximum 58) was high according to the intraclass correlation coefficients (ICC = 0.98) and the standard error of measurement (SEM = 2.68). The MDC for three levels of confidence was calculated: A score change of 8, 7 and 5 is necessary for a MDC to have confidence of 95%, 90% and 80%, respectively, of a genuine change. Correlation between the MESUPES and M MAS was high (r(s) = 0.87).

CONCLUSIONS

The MESUPES shows high inter-rater reliability, and our study provides useful estimates of MDC for different levels of certainty. Additional research to confirm concurrent validity and to examine other psychometric properties of the MESUPES such as sensitivity is needed.

Higher-intensity treadmill walking during rehabilitation after stroke in feasible and not detrimental to walking pattern or quality: a pilot randomized trial

Objective: To determine whether higher-intensity treadmill walking during rehabilitation in those newly able to walk after stroke is feasible, is detrimental to walking or is beneficial.

Design: A single-blind, randomized trial.

Setting: Two rehabilitation units.

Participants: Thirty people with first stroke.

Interventions: Experimental group received 30 minutes of higher-intensity treadmill walking, three times per week for six weeks, in addition to usual physiotherapy. Control group received usual physiotherapy only.

Main outcome measures: Feasibility was measured by examining compliance and adverse events. Detriment to walking was measured by examining pattern and quality. Benefit to walking was measured as capacity using six-minute walk test and speed, at baseline (Week 0), immediately after (Week 6) and at three months (Week 18).

Results: Overall compliance was 89%, with no adverse events reported. There was no between-group difference in walking pattern and quality. By Week 6, the experimental group improved walking capacity by 62 m (95% confidence interval (CI) 10 to 114), comfortable walking speed by 0.18 m/s (95% CI 0.07 to 0.29) and fast walking speed by 0.18 m/s (95% CI 0.03 to 0.35) more than the control group. By Week 18, the experimental group was still walking 0.26 m/s (95% CI 0.12 to 0.41) faster than the control group.

Conclusions: Higher-intensity treadmill walking during rehabilitation after stroke is feasible and not detrimental to walking pattern and quality in those newly able to walk. 94 participants are required to detect a between-group difference of 75 m on six-minute walk test (α 0.05, β 0.90) in future trials.

Trial registration: ACTRN12607000412437

Continuous monitoring of upper-limb activity in a free-living environment: a validation study

Monitoring upper-limb activity in a free-living environment is important for the evaluation of rehabilitation. This study is a validation of the Strathclyde Upper-Limb Activity Monitor (SULAM) which records the vertical movement and position of each wrist, and assesses bimanual movement. Agreement between the SULAM and two independent video observers was assessed using interclass correlation coefficients (ICC) and the Bland and Altman method. Concurrent validity was very good for movement of each upper-limb (ICC > 0.9), and good for the vertical position of the wrist (ICC > 0.8 for wrist positions below the shoulder, ICC > 0.6 otherwise). The ICC was good (>0.8) for bimanual movement, however the SULAM systematically underreported this by approximately 15%. The SULAM could be a useful tool to assess upper-limb activity of clinical populations in their usual environment.

The effects of observational feedback and verbal cues on the motor learning of an aimed reach-and-point task

PURPOSE

Current technology allows the recording of movement for both motion analysis and providing observational feedback. The most effective type of observational feedback is under debate. We compared a child's reach-and-point performance after viewing a videotaped playback of a model's performance and after viewing a split-screen comparison of the model's and child's performances while simultaneously receiving verbal cues.

METHODS

A PTVision system provided observational feedback and recorded spatial trajectory, target accuracy, movement time, and joint angles while a 13 year-old boy with cerebral palsy reached for three targets.

RESULTS

The split-screen comparison had the largest effect on reach performance, including slower-yet-more-accurate movements and a more extended wrist, curved spatial trajectories, and an ulnar-deviated wrist.

CONCLUSIONS

Feedback using split-screen comparison between a model's and the child's performance with verbal cues appears to promote motor learning. When using technology to augment therapy, the intervention should be designed considering current motor learning principles.

Sensory motor learning in patients with chronic low back pain: a prospective pilot study using optoelectronic movement analysis

STUDY DESIGN

The effect of sensory motor learning (SML) on chronic low back pain (CLBP) patients' movement capacity was evaluated with the optoelectronic Posturo-Locomotion-Manual (PLM) test.

OBJECTIVE

To study SML changes of an intentional dynamic behavior of daily life in a group of CLBP patients and compare the performance with an age- and sex-matched group of back-healthy individuals.

SUMMARY OF BACKGROUND DATA

In a previous study, the PLM test was found reliable when used in CLBP patients. SML addresses dynamic movement capacity. There is little scientific evidence of the effectiveness of educational interventions in improving motor behavior.

METHODS

Twelve patients with treatment-resistant CLBP were selected by two orthopedic spine surgeons. Twelve back-healthy age- and sex-matched individuals were included as controls. The patients participated in weekly SML lessons during a maximum of 12 months. All study participants were investigated with the PLM test, before intervention, directly after intervention, and 10 to 12 months after completion of the intervention, and patients were compared with controls.

RESULTS

Before intervention significant differences in performance were found between the group of patients and the healthy control group. After the intervention, the CLBP patients had improved their performance so there were no longer any significant differences between the groups. The results were retained 12 months after intervention.

CONCLUSIONS

The study shows that the CLBP patients had learned and retained a more efficient behavior. The results suggest that SML is an effective intervention for nonspecific CLBP patients.

A comparison of knee kinematic characteristics of stroke patients and age-matched healthy volunteers

OBJECTIVE

To investigate which knee kinematic characteristics show the greatest differences between stroke patients with minimal residual disability and age-matched healthy volunteers as a first step towards the development of a sensitive, objective measure of performance of movement for use in the clinical setting.

DESIGN

A comparative study.

SETTING

A movement analysis laboratory.

SUBJECTS

Ten patients between 6 and 12 months post stroke aged between 65 and 74 years and 10 age-matched healthy volunteers. All patients had made a good recovery and were able to complete all of the functional tasks.

INTERVENTIONS

Each subject had reflective markers placed on anatomical landmarks and was filmed performing three movement tasks: sit-to-stand, walking, and step on block.

MAIN OUTCOME MEASURES

Knee kinematic characteristics involving timing, joint angle and angular velocity at key points during each task.

RESULTS

Significant differences were found between patients and volunteers for only some of the timing and joint angle characteristics but for all angular velocity characteristics for which the mean differences ranged from 31.85 degrees/s for sit-to-stand (p = 0.013) to 82.5 degrees/s (p = 0.014) for the swing phase of gait.

CONCLUSIONS

These preliminary findings suggest that angular velocity of the knee during functional tasks might have potential as a sensitive, objective measure of performance of movement after stroke for patients with minimal residual disability.