Characteristics and Applications of Technology-Aided Hand Functional Assessment: A Systematic Review

Technology-aided hand functional assessment has received considerable attention in recent years. Its applications are required to obtain objective, reliable, and sensitive methods for clinical decision making. This systematic review aims to investigate and discuss characteristics of technology-aided hand functional assessment and their applications, in terms of the adopted sensing technology, evaluation methods and purposes. Based on the shortcomings of current applications, and opportunities offered by emerging systems, this review aims to support the design and the translation to clinical practice of technology-aided hand functional assessment. To this end, a systematic literature search was led, according to recommended PRISMA guidelines, in PubMed and IEEE Xplore databases. The search yielded 208 records, resulting into 23 articles included in the study. Glove-based systems, instrumented objects and body-networked sensor systems appeared from the search, together with vision-based motion capture systems, end-effector, and exoskeleton systems. Inertial measurement unit (IMU) and force sensing resistor (FSR) resulted the sensing technologies most used for kinematic and kinetic analysis. A lack of standardization in system metrics and assessment methods emerged. Future studies that pertinently discuss the pathophysiological content and clinimetrics properties of new systems are required for leading technologies to clinical acceptance.

Design of a Robotic Coach for Motor, Social and Cognitive Skills Training Toward Applications With ASD Children

Socially assistive robots may help the treatment of autism spectrum disorder(ASD), through games using dyadic interactions to train social skills. Existing systems are mainly based on simplified protocols which qualitatively evaluate subject performance. We propose a robotic coaching platform for training social, motor and cognitive capabilities, with two main contributions: (i) using triadic interactions(adult, robot and child), with robotic mirroring, and (ii) providing quantitative performance indicators. The key system features were accurately designed, including type of protocols, feedback systems and evaluation metrics, contemplating the requirements for applications with ASD children. We implemented two protocols, Robot-Master and Adult-Master, where children performed different gestures guided by the robot or the adult respectively, eventually receiving feedback about movement execution. In both, the robot mirrors the subject during the movement. To assess system functionalities, with a homogeneous group of subjects, tests were carried out with 28 healthy subjects; one preliminary acquisition was done with an ASD child. Data analysis was customized to design protocol-specific parameters for movement characterization. Our tests show that robotic mirroring execution depends on the complexity and standardization of movements, as well as on the robot technical features. The feedback system evaluated movement phases and successfully estimated the completion of the exercises. Future work includes improving platform flexibility and adaptability, and clinical trials with ASD children to test the impact of the robotic coach on reducing symptoms. We trust that the proposed quantitative performance indicators extend the current state-of-the-art towards clinical usage of robotic-based coaching systems.

Analysis of length of finger segments with different hand postures to enhance glove design

It is important to understand how the hand and fingers elongate and contract with hand posture for optimally fitting and comfortable gloves. Nevertheless, the measurement and analysis of the finger segments for glove designs remain largely neglected. Here, the length and proportion of the finger segments when splayed and during gripping, and between the dorsal and palm sides of 30 participants are 3D scanned and analysed. The full digit lengths change by 7.6-11.9% with hand posture, but the finger segment changes are not proportional. The ratios of the fingertip to distal interphalangeal joint/full digit, and fingertip to the proximal interphalangeal joint/full digit, are important variables. The results are validated with 10 more subjects based on ratings of a ready-to-wear sports glove. Inaccurate proportioning of the finger regions causes shifting which results in displacement and discomfort. This research contributes to glove pattern engineering, with a focus on the finger segments.

Estimation of spatial-temporal hand motion parameters in rehabilitation using a low-cost noncontact measurement system

Data collection and analysis are commonly used in a rehabilitation process to measure performances of the treatment. There is a lack of studies on the rehabilitation process monitored by a user-friendly interface. A low-cost system is developed in this research to assist users and therapists to measure hand motions and analyse important data of hand joints. The system consists of modules of data capturing, data analysis, and user interface. A Leap Motion sensor is used to capture joint positions of hand motions. Signal processing and wavelet de-noising methods are developed to improve accuracy of the data analysis. The user interface is designed using the Unity software to show graphical information of joint positions and motion parameters. The system has features of noncontact measurements, interactive environment, analysing and recording temporal data of motion parameters of hands. The system is validated by a gold standard motion capturing system. Case studies show effectiveness of the proposed system.

Design and validation of two embodied mirroring setups for interactive games with autistic children using the NAO humanoid robot

Socially assistive robots have shown potential benefits in therapy of child and elderly patients with social and cognitive deficits. In particular, for autistic children, humanoid robots could enhance engagement and attention, thanks to their simplified toy-like appearance and the reduced set of possible movements and expressions. The recent focus on autism-related motor impairments has increased the interest on developing new robotic tools aimed at improving not only the social capabilities but also the motor skills of autistic children. To this purpose, we have designed two embodied mirroring setups using the NAO humanoid robot. Two different tracking systems were used and compared: Inertial Measurement Units and the Microsoft Kinect, a marker-less vision based system. Both platforms were able to mirror upper limb basic movements of two healthy subjects, an adult and a child. However, despite the lower accuracy, the Kinect-based setup was chosen as the best candidate for embodied mirroring in autism treatment, thanks to the lower intrusiveness and reduced setup time. A prototype of an interactive mirroring game was developed and successfully tested with the Kinect-based platform, paving the way to the development of a versatile and powerful tool for clinical use with autistic children.

Recent advances in rehabilitation for Parkinson's Disease with Exergames: A Systematic Review

OBJECTIVE

The goal of this contribution is to gather and to critically analyze recent evidence regarding the potential of exergaming for Parkinson's disease (PD) rehabilitation and to provide an up-to-date analysis of the current state of studies on exergame-based therapy in PD patients.

METHODS

We performed our search based on the conclusions of a previous systematic review published in 2014. Inclusion criteria were articles published in the indexed databases Pubmed, Scopus, Sciencedirect, IEEE and Cochrane published since January 1, 2014. Exclusion criteria were papers with a target group other than PD patients exclusively, or contributions not based on exergames. Sixty-four publications out of 525 matches were selected.

RESULTS

The analysis of the 64 selected publications confirmed the putative improvement in motor skills suggested by the results of the previous review. The reliability and safety of both Microsoft Kinect and Wii Balance Board in the proposed scenarios was further confirmed by several recent studies. Clinical trials present better (n = 5) or similar (n = 3) results than control groups (traditional rehabilitation or regular exercise) in motor (TUG, BBS) and cognitive (attention, alertness, working memory, executive function), thus emphasizing the potential of exergames in PD. Pilot studies (n = 11) stated the safety and feasibility of both Microsoft Kinect and Wii Balance Board, potentially in home scenarios as well. Technical papers (n = 30) stated the reliability of balance and gait data captured by both devices. Related meta-analyses and systematic reviews (n = 15) further support these statements, generally citing the need for adaptation to patient's skills and new input devices and sensors as identified gaps.

CONCLUSION

Recent evidence indicates exergame-based therapy has been widely proven to be feasible, safe, and at least as effective as traditional PD rehabilitation. Further insight into new sensors, best practices and different cognitive stadiums of PD (such as PD with Mild Cognitive Impairment), as well as task specificity, are required. Also, studies linking game parameters and results with traditional assessment methods, such as UPDRS scores, are required. Outcomes for randomized controlled trials (RCTs) should be standardized, and follow-up studies are required, particularly for motor outcomes.

Quantitative Assessment of the Arm/Hand Movements in Parkinson's Disease Using a Wireless Armband Device

We present an approach for quantitative assessment of the arm/hand movements in patients with Parkinson’s disease (PD), from sensor data acquired with a wearable, wireless armband device (Myo sensor). We propose new Movement Performance Indicators that can be adopted by practitioners for the quantitative evaluation of motor performance and support their clinical evaluations. In addition, specific Movement Performance Indicators can indicate the presence of the bradykinesia symptom. The study includes seventeen PD patients and sixteen age-matched controls. A set of representative arm/hand movements is defined under the supervision of movement disorder specialist. In order to assist the evaluations, and for progress monitoring purposes, as well as for assessing the amount of bradykinesia in PD, a total set of 84 Movement Performance Indicators are computed from the sensor readings. Subsequently, we investigate whether wireless armband device, with the use of the proposed Movement Performance Indicators can be utilized: (1) for objective and precise quantitative evaluation of the arm/hand movements of Parkinson’s patients, (2) for assessment of the bradykinesia motor symptom, and (3) as an adequate low-cost alternative for the sensor glove. We conducted extensive analysis of proposed Movement Performance Indicators and results are indicating following clinically relevant characteristics: (i) adequate reliability as measured by ICC; (ii) high accuracy in discrimination between the patients and controls, and between the disease stages (support to disease diagnosis and progress monitoring, respectively); (iii) substantial difference in comparison between the left-hand and the right-hand movements across controls and patients, as well as between disease stage groups; (iv) statistically significant correlation with clinical scales (tapping test and UPDRS-III Motor Score); and (v) quantitative evaluation of bradykinesia symptom. Results suggest that the proposed approach has a potential to be adopted by physicians, to afford them with quantitative, objective and precise methods and data during clinical evaluations and support the assessment of bradykinesia.

Technologies Solutions Schemes for Patients' Rehabilitation. Methodologies, Models and Algorithms

OBJECTIVE

The present editorial is part of the focus theme of Methods of Information in Medicine entitled "Technologies solutions schemes for Patients' Rehabilitation: Methodologies, Models and Algorithms". The focus theme aims to present nowadays most innovative solutions to improve patients' rehabilitation by applying and using sophisticated and pioneering Information and Communication Technologies (ICT) and human factors.

METHODS

The focus theme explores the different existent research works and tools used, applied and developed for incapable people in terms of rehabilitation and health care, as to look into the extent methodologies, models and algorithms by means of ICT in this process.

RESULTS

The focus theme lists a group of research works, which are presenting various solutions using ICT systems to improve the rehabilitation process of people with physical incapacities and to help them in carrying out their daily life.