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Zbytniewska-Mégret M, Salzmann C, Kanzler CM, Hassa T, Gassert R, Lambercy O, Liepert J. The Evolution of Hand Proprioceptive and Motor Impairments in the Sub-Acute Phase After Stroke. Neurorehabil Neural Repair 2023; 37:823-836. [PMID: 37953595 PMCID: PMC10685702 DOI: 10.1177/15459683231207355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND Hand proprioception is essential for fine movements and therefore many activities of daily living. Although frequently impaired after stroke, it is unclear how hand proprioception evolves in the sub-acute phase and whether it follows a similar pattern of changes as motor impairments. OBJECTIVE This work investigates whether there is a corresponding pattern of changes over time in hand proprioception and motor function as comprehensively quantified by a combination of robotic, clinical, and neurophysiological assessments. METHODS Finger proprioception (position sense) and motor function (force, velocity, range of motion) were evaluated using robotic assessments at baseline (<3 months after stroke) and up to 4 weeks later (discharge). Clinical assessments (among others, Box & Block Test [BBT]) as well as Somatosensory/Motor Evoked Potentials (SSEP/MEP) were additionally performed. RESULTS Complete datasets from 45 participants post-stroke were obtained. For 42% of all study participants proprioception and motor function had a dissociated pattern of changes (only 1 function considerably improved). This dissociation was either due to the absence of a measurable impairment in 1 modality at baseline, or due to a severe lesion of central somatosensory or motor tracts (absent SSEP/MEP). Better baseline BBT correlated with proprioceptive gains, while proprioceptive impairment at baseline did not correlate with change in BBT. CONCLUSIONS Proprioception and motor function frequently followed a dissociated pattern of changes in sub-acute stroke. This highlights the importance of monitoring both functions, which could help to further personalize therapies.
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Affiliation(s)
- Monika Zbytniewska-Mégret
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
| | | | - Christoph M. Kanzler
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Thomas Hassa
- Kliniken Schmieder Allensbach, Allensbach, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Joachim Liepert
- Kliniken Schmieder Allensbach, Allensbach, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
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Tulimieri DT, Semrau JA. Aging increases proprioceptive error for a broad range of movement speed and distance estimates in the upper limb. Front Hum Neurosci 2023; 17:1217105. [PMID: 37886690 PMCID: PMC10598783 DOI: 10.3389/fnhum.2023.1217105] [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: 05/04/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
Previous work has identified age-related declines in proprioception within a narrow range of limb movements. It is unclear whether these declines are consistent across a broad range of movement characteristics that more closely represent daily living. Here we aim to characterize upper limb error in younger and older adults across a range of movement speeds and distances. The objective of this study was to determine how proprioceptive matching accuracy changes as a function of movement speed and distance, as well as understand the effects of aging on these accuracies. We used an upper limb robotic test of proprioception to vary the speed and distance of movement in two groups: younger (n = 20, 24.25 ± 3.34 years) and older adults (n = 21, 63 ± 10.74 years). The robot moved one arm and the participant was instructed to mirror-match the movement with their opposite arm. Participants matched seven different movement speeds (0.1-0.4 m/s) and five distances (7.5-17.5 cm) over 350 trials. Spatial (e.g., End Point Error) and temporal (e.g., Peak Speed Ratio) outcomes were used to quantify proprioceptive accuracy. Regardless of the speed or distance of movement, we found that older controls had significantly reduced proprioceptive matching accuracy compared to younger control participants (p ≤ 0.05). When movement speed was varied, we observed that errors in proprioceptive matching estimates of spatial and temporal measures were significantly higher for older adults for all but the slowest tested speed (0.1 m/s) for the majority of parameters. When movement distance was varied, we observed that errors in proprioceptive matching estimates were significantly higher for all distances, except for the longest distance (17.5 cm) for older adults compared to younger adults. We found that the magnitude of proprioceptive matching errors was dependent on the characteristics of the reference movement, and that these errors scaled increasingly with age. Our results suggest that aging significantly negatively impacts proprioceptive matching accuracy and that proprioceptive matching errors made by both groups lies along a continuum that depends on movement characteristics and that these errors are amplified due to the typical aging process.
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Affiliation(s)
- Duncan Thibodeau Tulimieri
- Biomechanics and Movement Science (BIOMS), University of Delaware, Newark, DE, United States
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Jennifer A. Semrau
- Biomechanics and Movement Science (BIOMS), University of Delaware, Newark, DE, United States
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
- Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
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3
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Zbytniewska-Mégret M, Kanzler CM, Raats J, Yilmazer C, Feys P, Gassert R, Lambercy O, Lamers I. Reliability, validity and clinical usability of a robotic assessment of finger proprioception in persons with multiple sclerosis. Mult Scler Relat Disord 2023; 70:104521. [PMID: 36701909 DOI: 10.1016/j.msard.2023.104521] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 12/31/2022] [Accepted: 01/13/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Multiple sclerosis often leads to proprioceptive impairments of the hand. However, it is challenging to objectively assess such deficits using clinical methods, thereby also impeding accurate tracking of disease progression and hence the application of personalized rehabilitation approaches. OBJECTIVE We aimed to evaluate test-retest reliability, validity, and clinical usability of a novel robotic assessment of hand proprioceptive impairments in persons with multiple sclerosis (pwMS). METHODS The assessment was implemented in an existing one-degree of freedom end-effector robot (ETH MIKE) acting on the index finger metacarpophalangeal joint. It was performed by 45 pwMS and 59 neurologically intact controls. Additionally, clinical assessments of somatosensation, somatosensory evoked potentials and usability scores were collected in a subset of pwMS. RESULTS The test-retest reliability of robotic task metrics in pwMS was good (ICC=0.69-0.87). The task could identify individuals with impaired proprioception, as indicated by the significant difference between pwMS and controls, as well as a high impairment classification agreement with a clinical measure of proprioception (85.00-86.67%). Proprioceptive impairments were not correlated with other modalities of somatosensation. The usability of the assessment system was satisfactory (System Usability Scale ≥73.10). CONCLUSION The proposed assessment is a promising alternative to commonly used clinical methods and will likely contribute to a better understanding of proprioceptive impairments in pwMS.
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Affiliation(s)
- Monika Zbytniewska-Mégret
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - Christoph M Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland; Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | - Joke Raats
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; Universitair MS Centrum UMSC Hasselt, Pelt, Belgium
| | - Cigdem Yilmazer
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; Universitair MS Centrum UMSC Hasselt, Pelt, Belgium
| | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; Universitair MS Centrum UMSC Hasselt, Pelt, Belgium
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland; Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland; Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | - Ilse Lamers
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; Universitair MS Centrum UMSC Hasselt, Pelt, Belgium; Noorderhart Rehabilitation and MS Centre, Pelt, Belgium
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Zbytniewska-Mégret M, Decraene L, Mailleux L, Kleeren L, Kanzler CM, Gassert R, Ortibus E, Feys H, Lambercy O, Klingels K. Reliable and Valid Robotic Assessments of Hand Active and Passive Position Sense in Children With Unilateral Cerebral Palsy. Front Hum Neurosci 2022; 16:895080. [PMID: 35978982 PMCID: PMC9376476 DOI: 10.3389/fnhum.2022.895080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
Impaired hand proprioception can lead to difficulties in performing fine motor tasks, thereby affecting activities of daily living. The majority of children with unilateral cerebral palsy (uCP) experience proprioceptive deficits, but accurately quantifying these deficits is challenging due to the lack of sensitive measurement methods. Robot-assisted assessments provide a promising alternative, however, there is a need for solutions that specifically target children and their needs. We propose two novel robotics-based assessments to sensitively evaluate active and passive position sense of the index finger metacarpophalangeal joint in children. We then investigate test-retest reliability and discriminant validity of these assessments in uCP and typically developing children (TDC), and further use the robotic platform to gain first insights into fundamentals of hand proprioception. Both robotic assessments were performed in two sessions with 1-h break in between. In the passive position sense assessment, participant's finger is passively moved by the robot to a randomly selected position, and she/he needs to indicate the perceived finger position on a tablet screen located directly above the hand, so that the vision of the hand is blocked. Active position sense is assessed by asking participants to accurately move their finger to a target position shown on the tablet screen, without visual feedback of the finger position. Ten children with uCP and 10 age-matched TDC were recruited in this study. Test-retest reliability in both populations was good (intraclass correlation coefficients (ICC) >0.79). Proprioceptive error was larger for children with uCP than TDC (passive: 11.49° ± 5.57° vs. 7.46° ± 4.43°, p = 0.046; active: 10.17° ± 5.62° vs. 5.34° ± 2.03°, p < 0.001), indicating discriminant validity. The active position sense was more accurate than passive, and the scores were not correlated, underlining the need for targeted assessments to comprehensively evaluate proprioception. There was a significant effect of age on passive position sense in TDC but not uCP, possibly linked to disturbed development of proprioceptive acuity in uCP. Overall, the proposed robot-assisted assessments are reliable, valid and a promising alternative to commonly used clinical methods, which could help gain a better understanding of proprioceptive impairments in uCP, facilitating the design of novel therapies.
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Affiliation(s)
- Monika Zbytniewska-Mégret
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- *Correspondence: Monika Zbytniewska-Mégret
| | - Lisa Decraene
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Faculty of Rehabilitation Sciences, Rehabilitation Research Center (REVAL), University of Hasselt, Diepenbeek, Belgium
| | - Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Lize Kleeren
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Christoph M. Kanzler
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Faculty of Rehabilitation Sciences, Rehabilitation Research Center (REVAL), University of Hasselt, Diepenbeek, Belgium
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5
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Zhang L, Wang R, Zhang P, Liu H, Wang G, Fu S. The employment of cynomolgus monkey as proprioceptive deficit model of the anterior cruciate ligament. J Orthop Surg (Hong Kong) 2021; 29:23094990211015519. [PMID: 34036869 DOI: 10.1177/23094990211015519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Clinically, a consensus of the treatment strategies of ACL grade 2 injury is not reached. Therefore, the present study established a proprioceptive deficit model of the ACL via an arthroscope to aid with further studying ACL grade 2 injury and treatment strategies. MATERIALS AND METHODS 12 cynomolgus monkeys were randomly divided into the model group and the blank control group. In the model group, 1/4 of the ACL was cut under an arthroscope, whereas no intervention was performed in the blank control group. Physiological data including the maximum degree of knee flexion, the thigh circumstance and the calf circumference were measured, and the Pivot-shift, Anterior and Lachman tests were also performed. Moreover, electrophysiological data including somatosensory evoked potentials (SEPs) and motor nerve conduction velocity (MNCV) were measured. SEPs and MNCV were assessed for the latent period and amplitude. RESULTS Comparing the data before and after the surgery, in the blank control group, no significant difference was observed. In the model group, significant difference was observed in the Pivot-shift, Anterior drawer and Lachman test (p < 0.05), indicating the instability of the ACL. Moreover, the latent period of SEPs and MNCV were significantly increased (p < 0.009), whereas the amplitude of SEPs and MNCV was significantly decreased (p < 0.009), indicating a degenerated proprioception of the knee joint. CONCLUSIONS Following cutting 1/4 of the ACL, the knee joint became unstable and proprioception was declined. The results indicated that the proprioceptive deficit model of the ACL was successfully established, which could promote further studying ACL injury.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.,Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.,Academician Workstation in Luzhou, Luzhou, Sichuan, People's Republic of China.,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Guangzhou, Guangdong, People's Republic of China
| | - Ruihan Wang
- Clinical Medical College of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Ping Zhang
- Operating Theater, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Huan Liu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.,Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.,Academician Workstation in Luzhou, Luzhou, Sichuan, People's Republic of China.,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Guangzhou, Guangdong, People's Republic of China
| | - Guoyou Wang
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.,Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.,Academician Workstation in Luzhou, Luzhou, Sichuan, People's Republic of China.,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Guangzhou, Guangdong, People's Republic of China
| | - Shijie Fu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.,Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.,Academician Workstation in Luzhou, Luzhou, Sichuan, People's Republic of China.,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Guangzhou, Guangdong, People's Republic of China
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Vieillard S, Msika C. Les modifications du fonctionnement cognitif et émotionnel avec l’avancée en âge au prisme d’une approche incarnée. ANNEE PSYCHOLOGIQUE 2021. [DOI: 10.3917/anpsy1.211.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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7
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Kanzler CM, Rinderknecht MD, Schwarz A, Lamers I, Gagnon C, Held JPO, Feys P, Luft AR, Gassert R, Lambercy O. A data-driven framework for selecting and validating digital health metrics: use-case in neurological sensorimotor impairments. NPJ Digit Med 2020; 3:80. [PMID: 32529042 PMCID: PMC7260375 DOI: 10.1038/s41746-020-0286-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/28/2020] [Indexed: 01/29/2023] Open
Abstract
Digital health metrics promise to advance the understanding of impaired body functions, for example in neurological disorders. However, their clinical integration is challenged by an insufficient validation of the many existing and often abstract metrics. Here, we propose a data-driven framework to select and validate a clinically relevant core set of digital health metrics extracted from a technology-aided assessment. As an exemplary use-case, the framework is applied to the Virtual Peg Insertion Test (VPIT), a technology-aided assessment of upper limb sensorimotor impairments. The framework builds on a use-case-specific pathophysiological motivation of metrics, models demographic confounds, and evaluates the most important clinimetric properties (discriminant validity, structural validity, reliability, measurement error, learning effects). Applied to 77 metrics of the VPIT collected from 120 neurologically intact and 89 affected individuals, the framework allowed selecting 10 clinically relevant core metrics. These assessed the severity of multiple sensorimotor impairments in a valid, reliable, and informative manner. These metrics provided added clinical value by detecting impairments in neurological subjects that did not show any deficits according to conventional scales, and by covering sensorimotor impairments of the arm and hand with a single assessment. The proposed framework provides a transparent, step-by-step selection procedure based on clinically relevant evidence. This creates an interesting alternative to established selection algorithms that optimize mathematical loss functions and are not always intuitive to retrace. This could help addressing the insufficient clinical integration of digital health metrics. For the VPIT, it allowed establishing validated core metrics, paving the way for their integration into neurorehabilitation trials.
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Affiliation(s)
- Christoph M. Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Mike D. Rinderknecht
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Anne Schwarz
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Ilse Lamers
- REVAL, Rehabilitation Research Center, BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Rehabilitation and MS Center, Pelt, Belgium
| | - Cynthia Gagnon
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Jeremia P. O. Held
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Peter Feys
- REVAL, Rehabilitation Research Center, BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Andreas R. Luft
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
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8
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Georgarakis AM, Sonar HA, Rinderknecht MD, Popp WL, Duarte JE, Lambercy O, Paik J, Martin BJ, Riener R, Klamroth-Marganska V. Age-Dependent Asymmetry of Wrist Position Sense Is Not Influenced by Stochastic Tactile Stimulation. Front Hum Neurosci 2020; 14:65. [PMID: 32194386 PMCID: PMC7063068 DOI: 10.3389/fnhum.2020.00065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/12/2020] [Indexed: 12/26/2022] Open
Abstract
Stochastic stimulation has been shown to improve movement, balance, the sense of touch, and may also improve position sense. This stimulation can be non-invasive and may be a simple technology to enhance proprioception. In this study, we investigated whether sub-threshold stochastic tactile stimulation of mechanoreceptors reduces age-related errors in wrist position estimation. Fifteen young (24.5±1.5y) and 23 elderly (71.7±7.3y) unimpaired, right-handed adults completed a wrist position gauge-matching experiment. In each trial, the participant's concealed wrist was moved to a target position between 10 and 30° of wrist flexion or extension by a robotic manipulandum. The participant then estimated the wrist's position on a virtual gauge. During half of the trials, sub-threshold stochastic tactile stimulation was applied to the wrist muscle tendon areas. Stochastic stimulation did not significantly influence wrist position sense. In the elderly group, estimation errors decreased non-significantly when stimulation was applied compared to the trials without stimulation [mean constant error reduction Δμ(θconof)=0.8° in flexion and Δμ(θconoe)=0.7° in extension direction, p = 0.95]. This effect was less pronounced in the young group [Δμ(θcony)=0.2° in flexion and in extension direction, p = 0.99]. These improvements did not yield a relevant effect size (Cohen's d < 0.1). Estimation errors increased with target angle magnitude in both movement directions. In young participants, estimation errors were non-symmetric, with estimations in flexion [μ(θconyf)=1.8°, σ(θconyf)=7.0°] being significantly more accurate than in extension [μ(θconye)=8.3°, σ(θconye)=9.3°, p < 0.01]. This asymmetry was not present in the elderly group, where estimations in flexion [μ(θconof)=7.5°, σ(θconof)=9.8°] were similar to extension [μ(θconoe)=7.7°, σ(θconoe)=9.3°]. Hence, young and elderly participants performed equally in extension direction, whereas wrist position sense in flexion direction deteriorated with age (p < 0.01). Though unimpaired elderly adults did not benefit from stochastic stimulation, it cannot be deduced that individuals with more severe impairments of their sensory system do not profit from this treatment. While the errors in estimating wrist position are symmetric in flexion and extension in elderly adults, young adults are more accurate when estimating wrist flexion, an effect that has not been described before.
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Affiliation(s)
- Anna-Maria Georgarakis
- Sensory-Motor Systems (SMS) Lab, Department of Health Sciences and Technology (D-HEST), Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Zurich, Switzerland.,Reharobotics Group, Medical Faculty, Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Harshal A Sonar
- Reconfigurable Robotics Laboratory (RRL), Institute of Mechanical Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Mike D Rinderknecht
- Rehabilitation Engineering Laboratory (RELab), Department of Health Sciences and Technology (D-HEST), Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Zurich, Switzerland
| | - Werner L Popp
- Rehabilitation Engineering Laboratory (RELab), Department of Health Sciences and Technology (D-HEST), Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Zurich, Switzerland
| | - Jaime E Duarte
- Sensory-Motor Systems (SMS) Lab, Department of Health Sciences and Technology (D-HEST), Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Zurich, Switzerland.,Reharobotics Group, Medical Faculty, Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory (RELab), Department of Health Sciences and Technology (D-HEST), Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Zurich, Switzerland
| | - Jamie Paik
- Reconfigurable Robotics Laboratory (RRL), Institute of Mechanical Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Bernard J Martin
- Department of Industrial and Operations Engineering (IOE), Center for Ergonomics, University of Michigan, Ann Arbor, MI, United States
| | - Robert Riener
- Sensory-Motor Systems (SMS) Lab, Department of Health Sciences and Technology (D-HEST), Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Zurich, Switzerland
| | - Verena Klamroth-Marganska
- Sensory-Motor Systems (SMS) Lab, Department of Health Sciences and Technology (D-HEST), Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Zurich, Switzerland.,Reharobotics Group, Medical Faculty, Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,School of Health Professions, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
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9
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Odorfer TM, Wind T, Zeller D. Temporal Discrimination Thresholds and Proprioceptive Performance: Impact of Age and Nerve Conduction. Front Neurosci 2019; 13:1241. [PMID: 31803012 PMCID: PMC6877661 DOI: 10.3389/fnins.2019.01241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/04/2019] [Indexed: 11/25/2022] Open
Abstract
Background Increasing attention is payed to the contribution of somatosensory processing in motor control. In particular, temporal somatosensory discrimination has been found to be altered differentially in common movement disorders. To date, there have only been speculations as to how impaired temporal discrimination and clinical motor signs may relate to each other. Prior to disentangling this relationship, potential confounders of temporal discrimination, in particular age and peripheral nerve conduction, should be assessed, and a quantifiable measure of proprioceptive performance should be established. Objective To assess the influence of age and polyneuropathy (PNP) on somatosensory temporal discrimination threshold (STDT), temporal discrimination movement threshold (TDMT), and behavioral measures of proprioception of upper and lower limbs. Methods STDT and TDMT were assessed in 79 subjects (54 healthy, 25 with PNP; age 30–79 years). STDT was tested with surface electrodes over the thenar or dorsal foot region. TDMT was probed with needle electrodes in flexor carpi radialis (FCR) and tibialis anterior (TA) muscle. Goniometer-based devices were used to assess limb proprioception during (i) active pointing to LED markers, (ii) active movements in response to variable visual cues, and (iii) estimation of limb position following passive movements. Pointing (or estimation) error was taken as a measure of proprioceptive performance. Results In healthy subjects, higher age was associated with higher STDT and TDMT at upper and lower extremities, while age did not correlate with proprioceptive performance. Patients with PNP showed higher STDT and TDMT values and decreased proprioceptive performance in active pointing tasks compared to matched healthy subjects. As an additional finding, there was a significant correlation between performance in active pointing tasks and temporal discrimination thresholds. Conclusion Given their notable impact on measures of temporal discrimination, age and peripheral nerve conduction need to be accounted for if STDT and TDMT are applied in patients with movement disorders. As a side observation, the correlation between measures of proprioception and temporal discrimination may prompt further studies on the presumptive link between these two domains.
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Affiliation(s)
| | - Teresa Wind
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Daniel Zeller
- Department of Neurology, University of Würzburg, Würzburg, Germany
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Zbytniewska M, Rinderknecht MD, Lambercy O, Barnobi M, Raats J, Lamers I, Feys P, Liepert J, Gassert R. Design and Characterization of a Robotic Device for the Assessment of Hand Proprioceptive, Motor, and Sensorimotor Impairments. IEEE Int Conf Rehabil Robot 2019; 2019:441-446. [PMID: 31374669 DOI: 10.1109/icorr.2019.8779507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Hand function is often impaired after neurological injuries such as stroke. In order to design patient-specific rehabilitation, it is essential to quantitatively assess those deficits. Current clinical scores cannot provide the required level of detail, and most assessment devices have been developed for the proximal joints of the upper limb. This paper presents a new robotic platform for the assessment of proprioceptive, motor, and sensorimotor hand impairments. A detailed technical evaluation demonstrated the capabilities to render different haptic environments required for a comprehensive assessment battery, and showed that the device is suitable for human interaction due to its ergonomic design. A preliminary study on proprioceptive assessment using a gauge position matching task with one healthy, one stroke, and one multiple sclerosis subject showed that the robotic system is able to rapidly and sensitively quantify proprioceptive deficits, and has the potential to be integrated into the clinical settings.
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Enhancing simulations with intra-subject variability for improved psychophysical assessments. PLoS One 2018; 13:e0209839. [PMID: 30596761 PMCID: PMC6312217 DOI: 10.1371/journal.pone.0209839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 12/12/2018] [Indexed: 11/19/2022] Open
Abstract
Psychometric properties of perceptual assessments, like reliability, depend on stochastic properties of psychophysical sampling procedures resulting in method variability, as well as inter- and intra-subject variability. Method variability is commonly minimized by optimizing sampling procedures through computer simulations. Inter-subject variability is inherent to the population of interest and cannot be influenced. Intra-subject variability introduced by confounds (e.g., inattention or lack of motivation) cannot be simply quantified from experimental data, as these data also include method variability. Therefore, this aspect is generally neglected when developing assessments. Yet, comparing method variability and intra-subject variability could give insights on whether effort should be invested in optimizing the sampling procedure, or in addressing potential confounds instead. We propose a new approach to estimate intra-subject variability of psychometric functions by combining computer simulations and behavioral data, and to account for it when simulating experiments. The approach was illustrated in a real-world scenario of proprioceptive difference threshold assessments. The behavioral study revealed a test-retest reliability of r = 0.212. Computer simulations without considering intra-subject variability predicted a reliability of r = 0.768, whereas the new approach including an intra-subject variability model lead to a realistic estimate of reliability (r = 0.207). Such a model also allows computing the theoretically maximally attainable reliability (r = 0.552) assuming an ideal sampling procedure. Comparing the reliability estimates when exclusively accounting for method variability versus intra-subject variability reveals that intra-subject variability should be reduced by addressing confounds and that only optimizing the sampling procedure may be insufficient to achieve a high reliability. This new approach allows computing the intra-subject variability with only two measurements per subject, and predicting the reliability for a larger number of subjects and retests based on simulations, without requiring additional experiments. Such a tool of predictive value is especially valuable for target populations where time is scarce, e.g., for assessments in clinical settings.
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Rinderknecht MD, Lambercy O, Gassert R. Performance metrics for an application-driven selection and optimization of psychophysical sampling procedures. PLoS One 2018; 13:e0207217. [PMID: 30485350 PMCID: PMC6261547 DOI: 10.1371/journal.pone.0207217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 10/26/2018] [Indexed: 01/08/2023] Open
Abstract
When estimating psychometric functions with sampling procedures, psychophysical assessments should be precise and accurate while being as efficient as possible to reduce assessment duration. The estimation performance of sampling procedures is commonly evaluated in computer simulations for single psychometric functions and reported using metrics as a function of number of trials. However, the estimation performance of a sampling procedure may vary for different psychometric functions. Therefore, the results of these type of evaluations may not be generalizable to a heterogeneous population of interest. In addition, the maximum number of trials is often imposed by time restrictions, especially in clinical applications, making trial-based metrics suboptimal. Hence, the benefit of these simulations to select and tune an ideal sampling procedure for a specific application is limited. We suggest to evaluate the estimation performance of sampling procedures in simulations covering the entire range of psychometric functions found in a population of interest, and propose a comprehensive set of performance metrics for a detailed analysis. To illustrate the information gained from these metrics in an application example, six sampling procedures were evaluated in a computer simulation based on prior knowledge on the population distribution and requirements from proprioceptive assessments. The metrics revealed limitations of the sampling procedures, such as inhomogeneous or systematically decreasing performance depending on the psychometric functions, which can inform the tuning process of a sampling procedure. More advanced metrics allowed directly comparing overall performances of different sampling procedures and select the best-suited sampling procedure for the example application. The proposed analysis metrics can be used for any sampling procedure and the estimation of any parameter of a psychometric function, independent of the shape of the psychometric function and of how such a parameter was estimated. This framework should help to accelerate the development process of psychophysical assessments.
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Affiliation(s)
- Mike D. Rinderknecht
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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Reliability, validity, and clinical feasibility of a rapid and objective assessment of post-stroke deficits in hand proprioception. J Neuroeng Rehabil 2018; 15:47. [PMID: 29880003 PMCID: PMC5991441 DOI: 10.1186/s12984-018-0387-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 05/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Proprioceptive function can be affected after neurological injuries such as stroke. Severe and persistent proprioceptive impairments may be associated with a poor functional recovery after stroke. To better understand their role in the recovery process, and to improve diagnostics, prognostics, and the design of therapeutic interventions, it is essential to quantify proprioceptive deficits accurately and sensitively. However, current clinical assessments lack sensitivity due to ordinal scales and suffer from poor reliability and ceiling effects. Robotic technology offers new possibilities to address some of these limitations. Nevertheless, it is important to investigate the psychometric and clinimetric properties of technology-assisted assessments. METHODS We present an automated robot-assisted assessment of proprioception at the level of the metacarpophalangeal joint, and evaluate its reliability, validity, and clinical feasibility in a study with 23 participants with stroke and an age-matched group of 29 neurologically intact controls. The assessment uses a two-alternative forced choice paradigm and an adaptive sampling procedure to identify objectively the difference threshold of angular joint position. RESULTS Results revealed a good reliability (ICC(2,1) = 0.73) for assessing proprioception of the impaired hand of participants with stroke. Assessments showed similar task execution characteristics (e.g., number of trials and duration per trial) between participants with stroke and controls and a short administration time of approximately 12 min. A difference in proprioceptive function could be found between participants with a right hemisphere stroke and control subjects (p<0.001). Furthermore, we observed larger proprioceptive deficits in participants with a right hemisphere stroke compared to a left hemisphere stroke (p=0.028), despite the exclusion of participants with neglect. No meaningful correlation could be established with clinical scales for different modalities of somatosensation. We hypothesize that this is due to their low resolution and ceiling effects. CONCLUSIONS This study has demonstrated the assessment's applicability in the impaired population and promising integration into clinical routine. In conclusion, the proposed assessment has the potential to become a powerful tool to investigate proprioceptive deficits in longitudinal studies as well as to inform and adjust sensorimotor rehabilitation to the patient's deficits.
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Algorithm for improving psychophysical threshold estimates by detecting sustained inattention in experiments using PEST. Atten Percept Psychophys 2018; 80:1629-1645. [PMID: 29748784 DOI: 10.3758/s13414-018-1521-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Psychophysical procedures are applied in various fields to assess sensory thresholds. During experiments, sampled psychometric functions are usually assumed to be stationary. However, perception can be altered, for example by loss of attention to the presentation of stimuli, leading to biased data, which results in poor threshold estimates. The few existing approaches attempting to identify non-stationarities either detect only whether there was a change in perception, or are not suitable for experiments with a relatively small number of trials (e.g., [Formula: see text] 300). We present a method to detect inattention periods on a trial-by-trial basis with the aim of improving threshold estimates in psychophysical experiments using the adaptive sampling procedure Parameter Estimation by Sequential Testing (PEST). The performance of the algorithm was evaluated in computer simulations modeling inattention, and tested in a behavioral experiment on proprioceptive difference threshold assessment in 20 stroke patients, a population where attention deficits are likely to be present. Simulations showed that estimation errors could be reduced by up to 77% for inattentive subjects, even in sequences with less than 100 trials. In the behavioral data, inattention was detected in 14% of assessments, and applying the proposed algorithm resulted in reduced test-retest variability in 73% of these corrected assessments pairs. The novel algorithm complements existing approaches and, besides being applicable post hoc, could also be used online to prevent collection of biased data. This could have important implications in assessment practice by shortening experiments and improving estimates, especially for clinical settings.
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Deblock-Bellamy A, Batcho CS, Mercier C, Blanchette AK. Quantification of upper limb position sense using an exoskeleton and a virtual reality display. J Neuroeng Rehabil 2018; 15:24. [PMID: 29548326 PMCID: PMC5857112 DOI: 10.1186/s12984-018-0367-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 03/06/2018] [Indexed: 11/21/2022] Open
Abstract
Background Proprioceptive sense plays a significant role in the generation and correction of skilled movements and, consequently, in most activities of daily living. We developed a new proprioception assessment protocol that enables the quantification of elbow position sense without using the opposite arm, involving active movement of the evaluated limb or relying on working memory. The aims of this descriptive study were to validate this assessment protocol by quantifying the elbow position sense of healthy adults, before using it in individuals who sustained a stroke, and to investigate its test-retest reliability. Methods Elbow joint position sense was quantified using a robotic device and a virtual reality system. Two assessments were performed, by the same evaluator, with a one-week interval. While the participant’s arms and hands were occluded from vision, the exoskeleton passively moved the dominant arm from an initial to a target position. Then, a virtual arm representation was projected on a screen placed over the participant’s arm. This virtual representation and the real arm were not perfectly superimposed, however. Participants had to indicate verbally the relative position of their arm (more flexed or more extended; two-alternative forced choice paradigm) compared to the virtual representation. Each participant completed a total of 136 trials, distributed in three phases. The angular differences between the participant’s arm and the virtual representation ranged from 1° to 27° and changed pseudo-randomly across trials. No feedback about results was provided to the participants during the task. A discrimination threshold was statistically extracted from a sigmoid curve fit representing the relationship between the angular difference and the percentage of successful trials. Test-retest reliability was evaluated with 3 different complementary approaches, i.e. a Bland-Altman analysis, an intraclass correlation coefficient (ICC) and a standard error of measurement (SEm). Results Thirty participants (24.6 years old; 17 males, 25 right-handed) completed both assessments. The mean discrimination thresholds were 7.0 ± 2.4 (mean ± standard deviation) and 5.9 ± 2.1 degrees for the first and the second assessment session, respectively. This small difference between assessments was significant (− 1.1 ± 2.2 degrees), however. The assessment protocol was characterized by a fair to good test-retest reliability (ICC = 0.47). Conclusion This study demonstrated the potential of this assessment protocol to objectively quantify elbow position sense in healthy individuals. Futures studies will validate this protocol in older adults and in individuals who sustained a stroke.
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Affiliation(s)
- Anne Deblock-Bellamy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525 Boulevard Wilfrid-Hamel, Quebec City (QC), G1M 2S8, Canada.,Faculty of Medicine, Universite Laval, 1050 Avenue de la Medecine, Quebec City (QC), G1V 0A6, Canada
| | - Charles Sebiyo Batcho
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525 Boulevard Wilfrid-Hamel, Quebec City (QC), G1M 2S8, Canada.,Faculty of Medicine, Universite Laval, 1050 Avenue de la Medecine, Quebec City (QC), G1V 0A6, Canada.,Department of Rehabilitation, Universite Laval, 1050 Avenue de la Medecine, Quebec City (QC), G1V 0A6, Canada
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525 Boulevard Wilfrid-Hamel, Quebec City (QC), G1M 2S8, Canada.,Faculty of Medicine, Universite Laval, 1050 Avenue de la Medecine, Quebec City (QC), G1V 0A6, Canada.,Department of Rehabilitation, Universite Laval, 1050 Avenue de la Medecine, Quebec City (QC), G1V 0A6, Canada
| | - Andreanne K Blanchette
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525 Boulevard Wilfrid-Hamel, Quebec City (QC), G1M 2S8, Canada. .,Faculty of Medicine, Universite Laval, 1050 Avenue de la Medecine, Quebec City (QC), G1V 0A6, Canada. .,Department of Rehabilitation, Universite Laval, 1050 Avenue de la Medecine, Quebec City (QC), G1V 0A6, Canada.
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