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Jayaraman C, Mummidisetty CK, Jayaraman A, Pfleeger K, Jacobson M, Ceruolo M, Sen-Gupta E, Caccese J, Chen D. Validity and reliability study of a novel surface electromyography sensor using a well-consolidated electromyography system in individuals with cervical spinal cord injury. Spinal Cord 2024:10.1038/s41393-024-00981-y. [PMID: 38575740 DOI: 10.1038/s41393-024-00981-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/06/2024]
Abstract
STUDY DESIGN Non-interventional, cross-sectional pilot study. OBJECTIVES To establish the validity and reliability of the BioStamp nPoint biosensor (Medidata Solutions, New York, NY, USA [formerly MC10, Inc.]) for measuring electromyography in individuals with cervical spinal cord injury (SCI) by comparing the surface electromyography (sEMG) metrics with the Trigno wireless electromyography system (Delsys, Natick, MA, USA). SETTING Participants were recruited from the Shirley Ryan AbilityLab registry. METHODS Individuals aged 18-70 years with cervical SCI were evaluated with the two biosensors to capture activity on upper-extremity muscles during two study sessions conducted over 2 days (day 1-consent alone; day 2-two data collections in same session). Time and frequency metrics were captured, and signal-to-noise ratio was determined for each muscle group. Test-retest reliability was determined using Pearson's correlation. Validation of the BioStamp nPoint system was based on Bland-Altmann analysis. RESULTS Among the 11 participants, 30.8% had subacute cervical injury at C5-C6; 53.8% were injured within 1 year of the study. Results from the test-retest reliability assessment revealed that most Pearson's correlations between the two sensory measurements were strong (≥0.50). The Bland-Altman analysis found values of the signal-to-noise ratio, frequency, and peak amplitude were within the level of agreement. Signal-to-noise ratios ranged from 7.06 to 22.1. CONCLUSIONS In most instances, the performance of the BioStamp nPoint sensors was moderately to strongly correlated with that of the Trigno sensors in all muscle groups tested. The BioStamp nPoint system is a valid and reliable approach to assess sEMG measures in individuals with cervical SCI. SPONSORSHIP The present study was supported by AbbVie Inc.
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Affiliation(s)
- Chandrasekaran Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | | | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | | | | | - Melissa Ceruolo
- Medidata Solutions, a Dassault Systèmes company, New York, NY, USA
| | - Ellora Sen-Gupta
- Medidata Solutions, a Dassault Systèmes company, New York, NY, USA
| | - James Caccese
- Medidata Solutions, a Dassault Systèmes company, New York, NY, USA
| | - David Chen
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA.
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Moon Y, Yang C, Veit NC, McKenzie KA, Kim J, Aalla S, Yingling L, Buchler K, Hunt J, Jenz S, Shin SY, Kishta A, Edgerton VR, Gerasimenko YP, Roth EJ, Lieber RL, Jayaraman A. Noninvasive spinal stimulation improves walking in chronic stroke survivors: a proof-of-concept case series. Biomed Eng Online 2024; 23:38. [PMID: 38561821 PMCID: PMC10986021 DOI: 10.1186/s12938-024-01231-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND After stroke, restoring safe, independent, and efficient walking is a top rehabilitation priority. However, in nearly 70% of stroke survivors asymmetrical walking patterns and reduced walking speed persist. This case series study aims to investigate the effectiveness of transcutaneous spinal cord stimulation (tSCS) in enhancing walking ability of persons with chronic stroke. METHODS Eight participants with hemiparesis after a single, chronic stroke were enrolled. Each participant was assigned to either the Stim group (N = 4, gait training + tSCS) or Control group (N = 4, gait training alone). Each participant in the Stim group was matched to a participant in the Control group based on age, time since stroke, and self-selected gait speed. For the Stim group, tSCS was delivered during gait training via electrodes placed on the skin between the spinous processes of C5-C6, T11-T12, and L1-L2. Both groups received 24 sessions of gait training over 8 weeks with a physical therapist providing verbal cueing for improved gait symmetry. Gait speed (measured from 10 m walk test), endurance (measured from 6 min walk test), spatiotemporal gait symmetries (step length and swing time), as well as the neurophysiological outcomes (muscle synergy, resting motor thresholds via spinal motor evoked responses) were collected without tSCS at baseline, completion, and 3 month follow-up. RESULTS All four Stim participants sustained spatiotemporal symmetry improvements at the 3 month follow-up (step length: 17.7%, swing time: 10.1%) compared to the Control group (step length: 1.1%, swing time 3.6%). Additionally, 3 of 4 Stim participants showed increased number of muscle synergies and/or lowered resting motor thresholds compared to the Control group. CONCLUSIONS This study provides promising preliminary evidence that using tSCS as a therapeutic catalyst to gait training may increase the efficacy of gait rehabilitation in individuals with chronic stroke. Trial registration NCT03714282 (clinicaltrials.gov), registration date: 2018-10-18.
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Affiliation(s)
- Yaejin Moon
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
- Department of Exercise Science, Syracuse University, Syracuse, NY, 13057, USA
| | - Chen Yang
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Nicole C Veit
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Biomedical Engineering Department, McCormick School of Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Kelly A McKenzie
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Jay Kim
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Shreya Aalla
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Lindsey Yingling
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Kristine Buchler
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Jasmine Hunt
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - Sophia Jenz
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Sung Yul Shin
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Ameen Kishta
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
| | - V Reggie Edgerton
- Rancho Los Amigos National Rehabilitation Center, Broccoli Impossible-to-Possible Lab, Rancho Research Institute, Downy, CA, 90242, USA
- Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Yury P Gerasimenko
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, 40202, USA
- Pavlov Institute of Physiology, St. Petersburg, Russia
| | - Elliot J Roth
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Richard L Lieber
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
- Hines VA Medical Center, Maywood, IL, 60141, USA
| | - Arun Jayaraman
- Shirley Ryan AbilityLab, 355 E. Erie St, Chicago, IL, 60611, USA.
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
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Korutla L, Hoffman JR, Rostami S, Hu R, Korutla V, Markmann C, Mullan C, Sotolongo A, Habertheuer A, Romano C, Acker M, Sen S, Agarwal D, Jayaraman A, Li B, Davis ME, Naji A, Vallabhajosyula P. Circulating T cell specific extracellular vesicle profiles in cardiac allograft acute cellular rejection. Am J Transplant 2024; 24:419-435. [PMID: 38295008 DOI: 10.1016/j.ajt.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 09/30/2023] [Accepted: 10/24/2023] [Indexed: 02/02/2024]
Abstract
There is a critical need for biomarkers of acute cellular rejection (ACR) in organ transplantation. We hypothesized that ACR leads to changes in donor-reactive T cell small extracellular vesicle (sEV) profiles in transplant recipient circulation that match the kinetics of alloreactive T cell activation. In rodent heart transplantation, circulating T cell sEV quantities (P < .0001) and their protein and mRNA cargoes showed time-specific expression of alloreactive and regulatory markers heralding early ACR in allogeneic transplant recipients but not in syngeneic transplant recipients. Next generation sequencing of their microRNA cargoes identified novel candidate biomarkers of ACR, which were validated by stem loop quantitative reverse transcription polymerase chain reaction (n = 10). Circulating T cell sEVs enriched from allogeneic transplant recipients mediated targeted cytotoxicity of donor cardiomyocytes by apoptosis assay (P < .0001). Translation of the concept and EV methodologies to clinical heart transplantation demonstrated similar upregulation of circulating T cell sEV profiles at time points of grade 2 ACR (n = 3 patients). Furthermore, T cell receptor sequencing of T cell sEV mRNA cargo demonstrated expression of T cell clones with intact complementarity determining region 3 signals. These data support the diagnostic potential of T cell sEVs as noninvasive biomarker of ACR and suggest their potential functional roles.
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Affiliation(s)
- Laxminarayana Korutla
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica R Hoffman
- Department of Biomedical Engineering, Emory School of Medicine, Atlanta, Georgia, USA
| | - Susan Rostami
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert Hu
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Varun Korutla
- Department of Biomedical Engineering, Emory School of Medicine, Atlanta, Georgia, USA
| | - Caroline Markmann
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Clancy Mullan
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alex Sotolongo
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andreas Habertheuer
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Connie Romano
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Acker
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sounok Sen
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Divyansh Agarwal
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Arun Jayaraman
- Department of Biomedical Engineering, Emory School of Medicine, Atlanta, Georgia, USA
| | - Bo Li
- Department of Bioinformatics, University of Texas, Dallas, Texas, USA
| | - Michael E Davis
- Department of Biomedical Engineering, Emory School of Medicine, Atlanta, Georgia, USA
| | - Ali Naji
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Prashanth Vallabhajosyula
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Rigot SK, Maronati R, Lettenberger A, O'Brien MK, Alamdari K, Hoppe-Ludwig S, McGuire M, Looft JM, Wacek A, Cave J, Sauerbrey M, Jayaraman A. Validation of Proprietary and Novel Step-counting Algorithms for Individuals Ambulating With a Lower Limb Prosthesis. Arch Phys Med Rehabil 2024; 105:546-557. [PMID: 37907160 DOI: 10.1016/j.apmr.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To compare the accuracy and reliability of 10 different accelerometer-based step-counting algorithms for individuals with lower limb loss, accounting for different clinical characteristics and real-world activities. DESIGN Cross-sectional study. SETTING General community setting (ie, institutional research laboratory and community free-living). PARTICIPANTS Forty-eight individuals with a lower limb amputation (N=48) wore an ActiGraph (AG) wGT3x-BT accelerometer proximal to the foot of their prosthetic limb during labeled indoor/outdoor activities and community free-living. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Intraclass correlation coefficient (ICC), absolute and root mean square error (RMSE), and Bland Altman plots were used to compare true (manual) step counts to estimated step counts from the proprietary AG Default algorithm and low frequency extension filter, as well as from 8 novel algorithms based on continuous wavelet transforms, fast Fourier transforms (FFTs), and peak detection. RESULTS All algorithms had excellent agreement with manual step counts (ICC>0.9). The AG Default and FFT algorithms had the highest overall error (RMSE=17.81 and 19.91 steps, respectively), widest limits of agreement, and highest error during outdoor and ramp ambulation. The AG Default algorithm also had among the highest error during indoor ambulation and stairs, while a FFT algorithm had the highest error during stationary tasks. Peak detection algorithms, especially those using pre-set parameters with a trial-specific component, had among the lowest error across all activities (RMSE=4.07-8.99 steps). CONCLUSIONS Because of its simplicity and accuracy across activities and clinical characteristics, we recommend the peak detection algorithm with set parameters to count steps using a prosthetic-worn AG among individuals with lower limb loss for clinical and research applications.
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Affiliation(s)
- Stephanie K Rigot
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL; Northwestern University, Department of Physical Medicine & Rehabilitation, Chicago, IL
| | - Rachel Maronati
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL
| | - Ahalya Lettenberger
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL; Rice University, Department of Bioengineering, Houston, TX
| | - Megan K O'Brien
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL; Northwestern University, Department of Physical Medicine & Rehabilitation, Chicago, IL
| | - Kayla Alamdari
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL
| | - Shenan Hoppe-Ludwig
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL
| | - Matthew McGuire
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL
| | - John M Looft
- Motion Analysis Laboratory, Department of Prosthetics, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN; Minneapolis Adaptive Design & Engineering (MADE), Department of Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN; Division of Rehabilitation Science, University of Minnesota Medical School, Minneapolis, MN
| | - Amber Wacek
- Motion Analysis Laboratory, Department of Prosthetics, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN; Minneapolis Adaptive Design & Engineering (MADE), Department of Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN
| | - Juan Cave
- Motion Analysis Laboratory, Department of Prosthetics, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN; Minneapolis Adaptive Design & Engineering (MADE), Department of Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN
| | - Matthew Sauerbrey
- Motion Analysis Laboratory, Department of Prosthetics, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN; Minneapolis Adaptive Design & Engineering (MADE), Department of Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN
| | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL; Northwestern University, Department of Physical Medicine & Rehabilitation, Chicago, IL; Northwestern University, Department of Physical Therapy & Human Movement Sciences, Chicago, IL.
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Awad LN, Jayaraman A, Nolan KJ, Lewek MD, Bonato P, Newman M, Putrino D, Raghavan P, Pohlig RT, Harris BA, Parker DA, Taylor SR. Efficacy and safety of using auditory-motor entrainment to improve walking after stroke: a multi-site randomized controlled trial of InTandem TM. Nat Commun 2024; 15:1081. [PMID: 38332008 PMCID: PMC10853163 DOI: 10.1038/s41467-024-44791-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/03/2024] [Indexed: 02/10/2024] Open
Abstract
Walking slowly after stroke reduces health and quality of life. This multi-site, prospective, interventional, 2-arm randomized controlled trial (NCT04121754) evaluated the safety and efficacy of an autonomous neurorehabilitation system (InTandemTM) designed to use auditory-motor entrainment to improve post-stroke walking. 87 individuals were randomized to 5-week walking interventions with InTandem or Active Control (i.e., walking without InTandem). The primary endpoints were change in walking speed, measured by the 10-meter walk test pre-vs-post each 5-week intervention, and safety, measured as the frequency of adverse events (AEs). Clinical responder rates were also compared. The trial met its primary endpoints. InTandem was associated with a 2x larger increase in speed (Δ: 0.14 ± 0.03 m/s versus Δ: 0.06 ± 0.02 m/s, F(1,49) = 6.58, p = 0.013), 3x more responders (40% versus 13%, χ2(1) ≥ 6.47, p = 0.01), and similar safety (both groups experienced the same number of AEs). The auditory-motor intervention autonomously delivered by InTandem is safe and effective in improving walking in the chronic phase of stroke.
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Affiliation(s)
- Louis N Awad
- Dept. of Physical Therapy, Boston University, Boston, MA, USA.
- Dept. of PM&R, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA.
| | - Arun Jayaraman
- Dept. of PM&R, Northwestern University, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Karen J Nolan
- Center for Mobility and Rehabilitation Engineering, Kessler Foundation, West Orange, NJ, USA
- Dept. of PM&R, Rutgers New Jersey Medical School, Kessler Rehabilitation, Newark, NJ, USA
| | - Michael D Lewek
- Dept. of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paolo Bonato
- Dept. of PM&R, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Mark Newman
- Dept. of PM&R, Carolinas Rehabilitation, Charlotte, NC, USA
| | - David Putrino
- Abilities Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Preeti Raghavan
- Depts. of PM&R & Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ryan T Pohlig
- College of Health Sciences, University of Delaware, Newark, DE, USA
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O’Brien MK, Lanotte F, Khazanchi R, Shin SY, Lieber RL, Ghaffari R, Rogers JA, Jayaraman A. Early Prediction of Poststroke Rehabilitation Outcomes Using Wearable Sensors. Phys Ther 2024; 104:pzad183. [PMID: 38169444 PMCID: PMC10851859 DOI: 10.1093/ptj/pzad183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 11/13/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Inpatient rehabilitation represents a critical setting for stroke treatment, providing intensive, targeted therapy and task-specific practice to minimize a patient's functional deficits and facilitate their reintegration into the community. However, impairment and recovery vary greatly after stroke, making it difficult to predict a patient's future outcomes or response to treatment. In this study, the authors examined the value of early-stage wearable sensor data to predict 3 functional outcomes (ambulation, independence, and risk of falling) at rehabilitation discharge. METHODS Fifty-five individuals undergoing inpatient stroke rehabilitation participated in this study. Supervised machine learning classifiers were retrospectively trained to predict discharge outcomes using data collected at hospital admission, including patient information, functional assessment scores, and inertial sensor data from the lower limbs during gait and/or balance tasks. Model performance was compared across different data combinations and was benchmarked against a traditional model trained without sensor data. RESULTS For patients who were ambulatory at admission, sensor data improved the predictions of ambulation and risk of falling (with weighted F1 scores increasing by 19.6% and 23.4%, respectively) and maintained similar performance for predictions of independence, compared to a benchmark model without sensor data. The best-performing sensor-based models predicted discharge ambulation (community vs household), independence (high vs low), and risk of falling (normal vs high) with accuracies of 84.4%, 68.8%, and 65.9%, respectively. Most misclassifications occurred with admission or discharge scores near the classification boundary. For patients who were nonambulatory at admission, sensor data recorded during simple balance tasks did not offer predictive value over the benchmark models. CONCLUSION These findings support the continued investigation of wearable sensors as an accessible, easy-to-use tool to predict the functional recovery after stroke. IMPACT Accurate, early prediction of poststroke rehabilitation outcomes from wearable sensors would improve our ability to deliver personalized, effective care and discharge planning in the inpatient setting and beyond.
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Affiliation(s)
- Megan K O’Brien
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
| | - Francesco Lanotte
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
| | - Rushmin Khazanchi
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sung Yul Shin
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
| | - Richard L Lieber
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Roozbeh Ghaffari
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, USA
| | - John A Rogers
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, USA
- Departments of Materials Science and Engineering, Chemistry, Mechanical Engineering, Electrical Engineering and Computer Science, Northwestern University, Evanston, Illinois, USA
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
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Lanotte F, O’Brien MK, Jayaraman A. AI in Rehabilitation Medicine: Opportunities and Challenges. Ann Rehabil Med 2023; 47:444-458. [PMID: 38093518 PMCID: PMC10767220 DOI: 10.5535/arm.23131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
Artificial intelligence (AI) tools are increasingly able to learn from larger and more complex data, thus allowing clinicians and scientists to gain new insights from the information they collect about their patients every day. In rehabilitation medicine, AI can be used to find patterns in huge amounts of healthcare data. These patterns can then be leveraged at the individual level, to design personalized care strategies and interventions to optimize each patient's outcomes. However, building effective AI tools requires many careful considerations about how we collect and handle data, how we train the models, and how we interpret results. In this perspective, we discuss some of the current opportunities and challenges for AI in rehabilitation. We first review recent trends in AI for the screening, diagnosis, treatment, and continuous monitoring of disease or injury, with a special focus on the different types of healthcare data used for these applications. We then examine potential barriers to designing and integrating AI into the clinical workflow, and we propose an end-to-end framework to address these barriers and guide the development of effective AI for rehabilitation. Finally, we present ideas for future work to pave the way for AI implementation in real-world rehabilitation practices.
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Affiliation(s)
- Francesco Lanotte
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Megan K. O’Brien
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
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Blanton S, Cotsonis G, Brennan K, Song R, Zajac-Cox L, Caston S, Stewart H, Jayaraman A, Reisman D, Clark PC, Kesar T. Evaluation of a carepartner-integrated telehealth gait rehabilitation program for persons with stroke: study protocol for a feasibility study. Pilot Feasibility Stud 2023; 9:192. [PMID: 38001523 PMCID: PMC10668368 DOI: 10.1186/s40814-023-01411-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Despite family carepartners of individuals post-stroke experiencing high levels of strain and reduced quality of life, stroke rehabilitation interventions rarely address carepartner well-being or offer training to support their engagement in therapeutic activities. Our group has developed creative intervention approaches to support families during stroke recovery, thereby improving physical and psychosocial outcomes for both carepartners and stroke survivors. The purpose of this study is to test the feasibility of an adapted, home-based intervention (Carepartner Collaborative Integrative Therapy for Gait-CARE-CITE-Gait) designed to facilitate positive carepartner involvement during home-based training targeting gait and mobility. METHODS This two-phased design will determine the feasibility of CARE-CITE-Gait, a novel intervention that leverages principles from our previous carepartner-focused upper extremity intervention. During the 4-week CARE-CITE-Gait intervention, carepartners review online video-based modules designed to illustrate strategies for an autonomy-supportive environment during functional mobility task practice, and the study team completes two 2-h home visits for dyad collaborative goal setting. In phase I, content validity, usability, and acceptability of the CARE-CITE-Gait modules will be evaluated by stroke rehabilitation content experts and carepartners. In phase II, feasibility (based on measures of recruitment, retention, intervention adherence, and safety) will be measured. Preliminary effects of the CARE-CITE-Gait will be gathered using a single-group, quasi-experimental design with repeated measures (two baseline visits 1 week apart, posttest, and 1-month follow-up) with 15 carepartner and stroke survivor dyads. Outcome data collectors will be blinded. Outcomes include psychosocial variables (family conflict surrounding stroke recovery, strain, autonomy support, and quality of life) collected from carepartners and measures of functional mobility, gait speed, stepping activity, and health-related quality of life collected from stroke survivors. DISCUSSION The findings of the feasibility testing and preliminary data on the effects of CARE-CITE-Gait will provide justification and information to guide a future definitive randomized clinical trial. The knowledge gained from this study will enhance our understanding of and aid the development of rehabilitation approaches that address both carepartner and stroke survivor needs during the stroke recovery process. TRIAL REGISTRATION ClinicalTrials.gov, NCT05257928. Registered 25 February 2022. TRIAL STATUS This trial was registered on ClinicalTrials.gov (NCT05257928) on March 25, 2022. Recruitment of participants was initiated on May 18, 2022.
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Affiliation(s)
- Sarah Blanton
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road NE, Room 213, Atlanta, GA, 30322, USA.
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA
| | | | - Robert Song
- Emory Rehabilitation Hospital, Atlanta, GA, USA
| | - Laura Zajac-Cox
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road NE, Room 213, Atlanta, GA, 30322, USA
| | - Sarah Caston
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road NE, Room 213, Atlanta, GA, 30322, USA
| | | | - Arun Jayaraman
- Technology & Innovation Hub (tiHUB), Department of Physical Medicine and Rehabilitation, Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Max Näder Center for Rehabilitation Technologies & Outcomes Research, Northwestern University, Chicago, IL, 60611, USA
| | - Darcy Reisman
- Department of Physical Therapy and Graduate Program in Biomechanics and Movement Science, Neurologic and Older Adult Clinic, University of Delaware, Newark, DE, USA
| | - Patricia C Clark
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA, USA
| | - Trisha Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road NE, Room 213, Atlanta, GA, 30322, USA
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Muter WM, Mansson L, Tuthill C, Aalla S, Barth S, Evans E, McKenzie K, Prokup S, Yang C, Sandhu M, Rymer WZ, Edgerton VR, Gad P, Mitchell GS, Wu SS, Shan G, Jayaraman A, Trumbower RD. A Research Protocol to Study the Priming Effects of Breathing Low Oxygen on Enhancing Training-Related Gains in Walking Function for Persons With Spinal Cord Injury: The BO 2ST Trial. Neurotrauma Rep 2023; 4:736-750. [PMID: 38028272 PMCID: PMC10659019 DOI: 10.1089/neur.2023.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Brief episodes of low oxygen breathing (therapeutic acute intermittent hypoxia; tAIH) may serve as an effective plasticity-promoting primer to enhance the effects of transcutaneous spinal stimulation-enhanced walking therapy (WALKtSTIM) in persons with chronic (>1 year) spinal cord injury (SCI). Pre-clinical studies in rodents with SCI show that tAIH and WALKtSTIM therapies harness complementary mechanisms of plasticity to maximize walking recovery. Here, we present a multi-site clinical trial protocol designed to examine the influence of tAIH + WALKtSTIM on walking recovery in persons with chronic SCI. We hypothesize that daily (eight sessions, 2 weeks) tAIH + WALKtSTIM will elicit faster, more persistent improvements in walking recovery than either treatment alone. To test our hypothesis, we are conducting a placebo-controlled clinical trial on 60 SCI participants who randomly receive one of three interventions: tAIH + WALKtSTIM; Placebo + WALKtSTIM; and tAIH + WALKtSHAM. Participants receive daily tAIH (fifteen 90-sec episodes at 10% O2 with 60-sec intervals at 21% O2) or daily placebo (fifteen 90-sec episodes at 21% O2 with 60-sec intervals at 21% O2) before a 45-min session of WALKtSTIM or WALKtSHAM. Our primary outcome measures assess walking speed (10-Meter Walk Test), endurance (6-Minute Walk Test), and balance (Timed Up and Go Test). For safety, we also measure pain levels, spasticity, sleep behavior, cognition, and rates of systemic hypertension and autonomic dysreflexia. Assessments occur before, during, and after sessions, as well as at 1, 4, and 8 weeks post-intervention. Results from this study extend our understanding of the functional benefits of tAIH priming by investigating its capacity to boost the neuromodulatory effects of transcutaneous spinal stimulation on restoring walking after SCI. Given that there is no known cure for SCI and no single treatment is sufficient to overcome walking deficits, there is a critical need for combinatorial treatments that accelerate and anchor walking gains in persons with lifelong SCI. Trial Registration ClinicalTrials.gov, NCT05563103.
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Affiliation(s)
- William M. Muter
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Linda Mansson
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher Tuthill
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Shreya Aalla
- Shirley Ryan AbilityLab, Max Nader Center for Rehabilitation Technologies and Outcomes Research, Chicago, Illinois, USA
| | - Stella Barth
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- UMass Chan Medical School, University of Massachusetts, Worcester, Massachusetts, USA
| | - Emily Evans
- Department of Physical Therapy, Boston University, Boston, Massachusetts, USA
| | - Kelly McKenzie
- Shirley Ryan AbilityLab, Max Nader Center for Rehabilitation Technologies and Outcomes Research, Chicago, Illinois, USA
| | - Sara Prokup
- Shirley Ryan AbilityLab, Max Nader Center for Rehabilitation Technologies and Outcomes Research, Chicago, Illinois, USA
| | - Chen Yang
- Shirley Ryan AbilityLab, Max Nader Center for Rehabilitation Technologies and Outcomes Research, Chicago, Illinois, USA
| | - Milap Sandhu
- Shirley Ryan AbilityLab, Max Nader Center for Rehabilitation Technologies and Outcomes Research, Chicago, Illinois, USA
| | - W. Zev Rymer
- Shirley Ryan AbilityLab, Max Nader Center for Rehabilitation Technologies and Outcomes Research, Chicago, Illinois, USA
| | - Victor R. Edgerton
- Department of Integrative Biology and Physiology, University of California–Los Angeles, Los Angeles, California, USA
- SpineX Inc., Northridge, California, USA
| | - Parag Gad
- Department of Integrative Biology and Physiology, University of California–Los Angeles, Los Angeles, California, USA
- SpineX Inc., Northridge, California, USA
| | - Gordon S. Mitchell
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| | - Samuel S. Wu
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Guogen Shan
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Arun Jayaraman
- Shirley Ryan AbilityLab, Max Nader Center for Rehabilitation Technologies and Outcomes Research, Chicago, Illinois, USA
| | - Randy D. Trumbower
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
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10
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Knight AD, Jayaraman C, Elrod JM, Schnall BL, McGuire MS, Sleeman TJ, Hoppe-Ludwig S, Dearth CL, Hendershot BD, Jayaraman A. Functional Performance Outcomes of a Powered Knee-Ankle Prosthesis in Service Members With Unilateral Transfemoral Limb Loss. Mil Med 2023; 188:3432-3438. [PMID: 35895305 DOI: 10.1093/milmed/usac231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/29/2022] [Accepted: 07/23/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Clinical knowledge surrounding functional outcomes of a powered knee-ankle (PKA) device is limited, particularly among younger and active populations with limb loss. Here, three service members (SM) with unilateral transfemoral limb loss received an optimally tuned PKA prosthesis and device-specific training. MATERIALS AND METHODS Once proficiency with the PKA device was demonstrated on benchmark activities, and outcomes with the PKA and standard-of-care (SoC) prostheses were obtained via a modified graded treadmill test, 6-minute walk test, and overground gait assessment. RESULTS All SM demonstrated proficiency with the PKA prosthesis within the minimum three training sessions. With the PKA versus SoC prosthesis, cost of transport during the modified graded treadmill test was 4.0% ± 5.2% lower at slower speeds (i.e., 0.6-1.2 m/s), but 7.0% ± 5.1% greater at the faster walking speeds (i.e., ≥1.4 m/s). For the 6-minute walk test, SM walked 83.9 ± 13.2 m shorter with the PKA versus SoC prosthesis. From the overground gait assessment, SM walked with 20.6% ± 10.5% greater trunk lateral flexion and 31.8% ± 12.8% greater trunk axial rotation ranges of motion, with the PKA versus SoC prosthesis. CONCLUSIONS Compared to prior work with the PKA in a civilian cohort, although SM demonstrated faster device proficiency (3 versus 12 sessions), SM walked with greater compensatory motions compared to their SoC prostheses (contrary to the civilian cohort). As such, it is important to understand patient-specific factors among various populations with limb loss for optimizing device-specific training and setting functional goals for occupational and/or community reintegration, as well as reducing the risk for secondary complications over the long term.
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Affiliation(s)
- Ashley D Knight
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20889, USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Department of Rehabilitation Medicine, Uniformed Services of the Health Sciences, Bethesda, MD 20814, USA
| | - Chandrasekaran Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL 60611, USA
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL 60611, USA
| | - Jonathan M Elrod
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Barri L Schnall
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Matt S McGuire
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL 60611, USA
| | - Todd J Sleeman
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Shenan Hoppe-Ludwig
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL 60611, USA
| | - Christopher L Dearth
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20889, USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Department of Surgery, Walter Reed National Military Medical Center-Uniformed Services of the Health Sciences, Bethesda, MD 20814, USA
| | - Brad D Hendershot
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20889, USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Department of Rehabilitation Medicine, Uniformed Services of the Health Sciences, Bethesda, MD 20814, USA
| | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL 60611, USA
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL 60611, USA
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11
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Fowler King B, MacDonald J, Stoff L, Nettnin E, Jayaraman A, Goldman JG, Rafferty M. Activity Monitoring in Parkinson Disease: A Qualitative Study of Implementation Determinants. J Neurol Phys Ther 2023; 47:189-199. [PMID: 37306418 DOI: 10.1097/npt.0000000000000451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND PURPOSE There is interest in incorporating digital health technology in routine practice. We integrate multiple stakeholder perspectives to describe implementation determinants (barriers and facilitators) regarding digital health technology use to facilitate exercise behavior change for people with Parkinson disease in outpatient physical therapy. METHODS The purposeful sample included people with Parkinson disease (n = 13), outpatient physical therapists (n = 12), and advanced technology stakeholders including researchers and reimbursement specialists (n = 13). Semistructured interviews were used to elicit implementation determinants related to using digital health technology for activity monitoring and exercise behavior change. Deductive codes based on the Consolidated Framework for Implementation Research were used to describe implementation determinants. RESULTS Key implementation determinants were similar across stakeholder groups. Essential characteristics of digital health technology included design quality and packaging, adaptability, complexity, and cost. Implementation of digital health technology by physical therapists and people with Parkinson disease was influenced by their knowledge, attitudes, and varied confidence levels in using digital health technology. Inner setting organizational determinants included available resources and access to knowledge/information. Process determinants included device interoperability with medical record systems and workflow integration. Outer setting barriers included lack of external policies, regulations, and collaboration with device companies. DISCUSSION AND CONCLUSIONS Future implementation interventions should address key determinants, including required processes for how and when physical therapists instruct people with Parkinson disease on digital health technology, organizational readiness, workflow integration, and characteristics of physical therapists and people with Parkinson disease who may have ingrained beliefs regarding their ability and willingness to use digital health technology. Although site-specific barriers should be addressed, digital health technology knowledge translation tools tailored to individuals with varied confidence levels may be generalizable across clinics.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content available at: http://links.lww.com/JNPT/A436 ).
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Affiliation(s)
- Bridget Fowler King
- Shirley Ryan AbilityLab, Chicago, Illinois (B.F.K., J.M., L.S., E.N., A.J., J.G.G., M.R.); and Departments of Physical Medicine and Rehabilitation (A.J., J.G.G., M.R.), Physical Therapy & Human Movement Sciences (A.J.), Medical Social Sciences (A.J.), Neurology (J.G.G), and Psychiatry and Behavioral Science (M.R.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
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12
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Cleland BT, Giffhorn M, Jayaraman A, Madhavan S. Understanding corticomotor mechanisms for activation of non-target muscles during unilateral isometric contractions of leg muscles after stroke. Int J Neurosci 2023:1-10. [PMID: 37750212 PMCID: PMC10963339 DOI: 10.1080/00207454.2023.2263817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE Muscle activation often occurs in muscles ipsilateral to a voluntarily activated muscle and to a greater extent after stroke. In this study, we measured muscle activation in non-target, ipsilateral leg muscles and used transcranial magnetic stimulation (TMS) to provide insight into whether corticomotor pathways contribute to involuntary activation. MATERIALS AND METHODS Individuals with stroke performed unilateral isometric ankle dorsiflexion, ankle plantarflexion, knee extension, and knee flexion. To quantify involuntary muscle activation in non-target muscles, muscle activation was measured during contractions from the ipsilateral tibialis anterior (TA), medial gastrocnemius (MG), rectus femoris (RF), and biceps femoris (BF) and normalized to resting muscle activity. To provide insight into mechanisms of involuntary non-target muscle activation, TMS was applied to the contralateral hemisphere, and motor evoked potentials (MEPs) were recorded. RESULTS We found significant muscle activation in nearly every non-target muscle during isometric unilateral contractions. MEPs were frequently observed in non-target muscles, but greater non-target MEP amplitude was not associated with greater non-target muscle activation. CONCLUSIONS Our results suggest that non-target muscle activation occurs frequently in individuals with chronic stroke. The lack of association between non-target TMS responses and non-target muscle activation suggests that non-target muscle activation may have a subcortical or spinal origin. Non-target muscle activation has important clinical implications because it may impair torque production, out-of-synergy movement, and muscle activation timing.
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Affiliation(s)
- Brice T Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences University of Illinois Chicago, Chicago, IL, USA
| | - Matt Giffhorn
- Max Nader Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Arun Jayaraman
- Max Nader Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences University of Illinois Chicago, Chicago, IL, USA
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13
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Deng W, Anastasopoulos S, deRegnier RA, Pouppirt N, Barlow AK, Patrick C, O’Brien MK, Babula S, Sukal-Moulton T, Peyton C, Morgan C, Rogers JA, Lieber RL, Jayaraman A. Protocol for a randomized controlled trial to evaluate a year-long (NICU-to-home) evidence-based, high dose physical therapy intervention in infants at risk of neuromotor delay. PLoS One 2023; 18:e0291408. [PMID: 37725613 PMCID: PMC10508609 DOI: 10.1371/journal.pone.0291408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Developmental disabilities and neuromotor delay adversely affect long-term neuromuscular function and quality of life. Current evidence suggests that early therapeutic intervention reduces the severity of motor delay by harnessing neuroplastic potential during infancy. To date, most early therapeutic intervention trials are of limited duration and do not begin soon after birth and thus do not take full advantage of early neuroplasticity. The Corbett Ryan-Northwestern-Shirley Ryan AbilityLab-Lurie Children's Infant Early Detection, Intervention and Prevention Project (Project Corbett Ryan) is a multi-site longitudinal randomized controlled trial to evaluate the efficacy of an evidence-based physical therapy intervention initiated in the neonatal intensive care unit (NICU) and continuing to 12 months of age (corrected when applicable). The study integrates five key principles: active learning, environmental enrichment, caregiver engagement, a strengths-based approach, and high dosage (ClinicalTrials.gov identifier NCT05568264). METHODS We will recruit 192 infants at risk for neuromotor delay who were admitted to the NICU. Infants will be randomized to either a standard-of-care group or an intervention group; infants in both groups will have access to standard-of-care services. The intervention is initiated in the NICU and continues in the infant's home until 12 months of age. Participants will receive twice-weekly physical therapy sessions and caregiver-guided daily activities, assigned by the therapist, targeting collaboratively identified goals. We will use various standardized clinical assessments (General Movement Assessment; Bayley Scales of Infant and Toddler Development, 4th Edition (Bayley-4); Test of Infant Motor Performance; Pediatric Quality of Life Inventory Family Impact Module; Alberta Infant Motor Scale; Neurological, Sensory, Motor, Developmental Assessment; Hammersmith Infant Neurological Examination) as well as novel technology-based tools (wearable sensors, video-based pose estimation) to evaluate neuromotor status and development throughout the course of the study. The primary outcome is the Bayley-4 motor score at 12 months; we will compare scores in infants receiving the intervention vs. standard-of-care therapy.
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Affiliation(s)
- Weiyang Deng
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | | | - Raye-Ann deRegnier
- Division of Neonatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics (Neonatology), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Nicole Pouppirt
- Division of Neonatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics (Neonatology), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Ann K. Barlow
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | - Cheryl Patrick
- Division of Rehabilitative Services, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
| | - Megan K. O’Brien
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern Medicine, Chicago, IL, United States of America
| | - Sarah Babula
- Pathways.org, Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | - Theresa Sukal-Moulton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John A. Rogers
- Department of Biomedical Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, United States of America
- Departments of Materials Science and Engineering, Chemistry, Mechanical Engineering, Electrical Engineering and Computer Science, Northwestern University, Evanston, Illinois, United States of America
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Richard L. Lieber
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Biomedical Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, United States of America
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Jessie Brown Jr., Hines V.A. Medical Center, Hines, Illinois, United States of America
| | - Arun Jayaraman
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern Medicine, Chicago, IL, United States of America
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
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Lanotte F, Shin SY, O'Brien MK, Jayaraman A. Validity and reliability of a commercial wearable sensor system for measuring spatiotemporal gait parameters in a post-stroke population: the effects of walking speed and asymmetry. Physiol Meas 2023; 44:085005. [PMID: 37557187 DOI: 10.1088/1361-6579/aceecf] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/09/2023] [Indexed: 08/11/2023]
Abstract
Objective.Commercial wearable sensor systems are a promising alternative to costly laboratory equipment for clinical gait evaluation, but their accuracy for individuals with gait impairments is not well established. Therefore, we investigated the validity and reliability of the APDM Opal wearable sensor system to measure spatiotemporal gait parameters for healthy controls and individuals with chronic stroke.Approach.Participants completed the 10 m walk test over an instrumented mat three times in different speed conditions. We compared performance of Opal sensors to the mat across different walking speeds and levels of step length asymmetry in the two populations.Main results. Gait speed and stride length measures achieved excellent reliability, though they were systematically underestimated by 0.11 m s-1and 0.12 m, respectively. The stride and step time measures also achieved excellent reliability, with no significant errors (median absolute percentage error <6.00%,p> 0.05). Gait phase duration measures achieved moderate-to-excellent reliability, with relative errors ranging from 4.13%-21.59%. Across gait parameters, the relative error decreased by 0.57%-9.66% when walking faster than 1.30 m s-1; similar reductions occurred for step length symmetry indices lower than 0.10.Significance. This study supports the general use of Opal wearable sensors to obtain quantitative measures of post-stroke gait impairment. These measures should be interpreted cautiously for individuals with moderate-severe asymmetry or walking speeds slower than 0.80 m s-1.
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Affiliation(s)
- Francesco Lanotte
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research Shirley Ryan Ability Lab 355 E Erie St., Chicago, IL, 60611, United States of America
- Department of Physical Medicine and Rehabilitation Northwestern University, 710 N Lake Shore Dr, Chicago, IL, 60611, United States of America
| | - Sung Yul Shin
- NOV, Inc., Houston, TX 77064, United States of America
| | - Megan K O'Brien
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research Shirley Ryan Ability Lab 355 E Erie St., Chicago, IL, 60611, United States of America
- Department of Physical Medicine and Rehabilitation Northwestern University, 710 N Lake Shore Dr, Chicago, IL, 60611, United States of America
| | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research Shirley Ryan Ability Lab 355 E Erie St., Chicago, IL, 60611, United States of America
- Department of Physical Medicine and Rehabilitation Northwestern University, 710 N Lake Shore Dr, Chicago, IL, 60611, United States of America
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15
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Ghomrawi HMK, O'Brien MK, Carter M, Macaluso R, Khazanchi R, Fanton M, DeBoer C, Linton SC, Zeineddin S, Pitt JB, Bouchard M, Figueroa A, Kwon S, Holl JL, Jayaraman A, Abdullah F. Applying machine learning to consumer wearable data for the early detection of complications after pediatric appendectomy. NPJ Digit Med 2023; 6:148. [PMID: 37587211 PMCID: PMC10432429 DOI: 10.1038/s41746-023-00890-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/01/2023] [Indexed: 08/18/2023] Open
Abstract
When children are discharged from the hospital after surgery, their caregivers often rely on subjective assessments (e.g., appetite, fatigue) to monitor postoperative recovery as objective assessment tools are scarce at home. Such imprecise and one-dimensional evaluations can result in unwarranted emergency department visits or delayed care. To address this gap in postoperative monitoring, we evaluated the ability of a consumer-grade wearable device, Fitbit, which records multimodal data about daily physical activity, heart rate, and sleep, in detecting abnormal recovery early in children recovering after appendectomy. One hundred and sixty-two children, ages 3-17 years old, who underwent an appendectomy (86 complicated and 76 simple cases of appendicitis) wore a Fitbit device on their wrist for 21 days postoperatively. Abnormal recovery events (i.e., abnormal symptoms or confirmed postoperative complications) that arose during this period were gathered from medical records and patient reports. Fitbit-derived measures, as well as demographic and clinical characteristics, were used to train machine learning models to retrospectively detect abnormal recovery in the two days leading up to the event for patients with complicated and simple appendicitis. A balanced random forest classifier accurately detected 83% of these abnormal recovery days in complicated appendicitis and 70% of abnormal recovery days in simple appendicitis prior to the true report of a symptom/complication. These results support the development of machine learning algorithms to predict onset of abnormal symptoms and complications in children undergoing surgery, and the use of consumer wearables as monitoring tools for early detection of postoperative events.
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Affiliation(s)
- Hassan M K Ghomrawi
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Global Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medicine (Rheumatology), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Michela Carter
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Rushmin Khazanchi
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Christopher DeBoer
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Samuel C Linton
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Suhail Zeineddin
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - J Benjamin Pitt
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Megan Bouchard
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Angie Figueroa
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Soyang Kwon
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jane L Holl
- Department of Neurology and Center for Healthcare Delivery Science and Innovation, Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - Arun Jayaraman
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Fizan Abdullah
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Center for Global Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 63, Chicago, IL, 60611, USA.
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16
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Lucas M, Danilov AV, Levitin LV, Jayaraman A, Casey AJ, Faoro L, Tzalenchuk AY, Kubatkin SE, Saunders J, de Graaf SE. Quantum bath suppression in a superconducting circuit by immersion cooling. Nat Commun 2023; 14:3522. [PMID: 37316500 DOI: 10.1038/s41467-023-39249-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/02/2023] [Indexed: 06/16/2023] Open
Abstract
Quantum circuits interact with the environment via several temperature-dependent degrees of freedom. Multiple experiments to-date have shown that most properties of superconducting devices appear to plateau out at T ≈ 50 mK - far above the refrigerator base temperature. This is for example reflected in the thermal state population of qubits, in excess numbers of quasiparticles, and polarisation of surface spins - factors contributing to reduced coherence. We demonstrate how to remove this thermal constraint by operating a circuit immersed in liquid 3He. This allows to efficiently cool the decohering environment of a superconducting resonator, and we see a continuous change in measured physical quantities down to previously unexplored sub-mK temperatures. The 3He acts as a heat sink which increases the energy relaxation rate of the quantum bath coupled to the circuit a thousand times, yet the suppressed bath does not introduce additional circuit losses or noise. Such quantum bath suppression can reduce decoherence in quantum circuits and opens a route for both thermal and coherence management in quantum processors.
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Affiliation(s)
- M Lucas
- Physics Department, Royal Holloway University of London, Egham, UK
| | - A V Danilov
- Department of Microtechnology and Nanoscience MC2, Chalmers University of Technology, SE-412 96, Göteborg, Sweden
| | - L V Levitin
- Physics Department, Royal Holloway University of London, Egham, UK
| | - A Jayaraman
- Department of Microtechnology and Nanoscience MC2, Chalmers University of Technology, SE-412 96, Göteborg, Sweden
| | - A J Casey
- Physics Department, Royal Holloway University of London, Egham, UK
| | - L Faoro
- Google Quantum AI, Google Research, Mountain View, CA, USA
| | - A Ya Tzalenchuk
- Physics Department, Royal Holloway University of London, Egham, UK
- National Physical Laboratory, Teddington, TW11 0LW, UK
| | - S E Kubatkin
- Department of Microtechnology and Nanoscience MC2, Chalmers University of Technology, SE-412 96, Göteborg, Sweden
| | - J Saunders
- Physics Department, Royal Holloway University of London, Egham, UK
| | - S E de Graaf
- National Physical Laboratory, Teddington, TW11 0LW, UK.
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17
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Blanton S, Cotsonis G, Brenan K, Song R, Zajac-Cox L, Caston S, Stewart H, Jayaraman A, Reisman D, Clark PC, Kesar T. Evaluation of a Carepartner-Integrated Telehealth Gait Rehabilitation Program for Persons with Stroke : Study Protocol for a Feasibility Study. Res Sq 2023:rs.3.rs-2689016. [PMID: 37090566 PMCID: PMC10120785 DOI: 10.21203/rs.3.rs-2689016/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Background Despite family carepartners of individuals post-stroke experiencing high levels of strain and reduced quality of life, stroke rehabilitation interventions rarely address carepartner well-being or offer training to support their engagement in therapeutic activities. Our group has developed creative intervention approaches to support families during stroke recovery, thereby improving physical and psychosocial outcomes for both carepartners and stroke survivors. The purpose of this preliminary clinical trial is to test the feasibility of an adapted, home-based intervention (Carepartner Collaborative Integrative Therapy for Gait-CARE-CITE-Gait) designed to facilitate positive carepartner involvement during home-based training targeting gait and mobility. Methods This two-phased study will determine the feasibility of CARE-CITE-Gait, a novel intervention developed by our team that leverages principles from our previous carepartner-focused upper extremity intervention. During the 4-week CARE-CITE-Gait intervention, carepartners review online video-based modules designed to illustrate strategies for an autonomy-supportive environment during functional mobility task practice, and the study team completes two 2-hour (home-based) visits for dyad collaborative goal setting. In Phase I, the usability and acceptability of the CARE-CITE-Gait modules will be evaluated by stroke rehabilitation content experts and carepartners. In Phase II, feasibility (based on measures of recruitment, retention, and intervention adherence) will be measured. Preliminary effects of the CARE-CITE-Gait will be gathered using a single-group, evaluator blinded, quasi-experimental design with repeated measures (two baseline visits one week apart, post-test, and one-month follow-up) with 15 carepartner and stroke survivor dyads. Outcomes include psychosocial variables (strain, family conflict surrounding stroke recovery, autonomy support and life changes) collected from carepartners, and measures of functional mobility, gait speed, stepping activity, and health-related quality of life collected from stroke survivors. Discussion The findings of the feasibility testing and preliminary data on the effects of CARE-CITE-Gait will provide justification and information to guide a future definitive randomized clinical trial. The knowledge gained from this study will enhance our understanding of and aid the development of rehabilitation approaches that address both carepartner and stroke survivor needs during the stroke recovery process. Trial Registration ClinicalTrials.gov, NCT05257928. Registered 25 February 2022, https://clinicaltrials.gov/ct2/show/NCT05257928.
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Affiliation(s)
| | | | | | | | | | | | | | - Arun Jayaraman
- Northwestern University Department of Physical Medicine and Rehabilitation
| | - Darcy Reisman
- University of Delaware Department of Physical Therapy
| | - Patricia C Clark
- Georgia State University Byrdine F Lewis School of Nursing and Health Professions
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18
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Sieberts SK, Borzymowski H, Guan Y, Huang Y, Matzner A, Page A, Bar-Gad I, Beaulieu-Jones B, El-Hanani Y, Goschenhofer J, Javidnia M, Keller MS, Li YC, Saqib M, Smith G, Stanescu A, Venuto CS, Zielinski R, Jayaraman A, Evers LJW, Foschini L, Mariakakis A, Pandey G, Shawen N, Synder P, Omberg L. Developing better digital health measures of Parkinson's disease using free living data and a crowdsourced data analysis challenge. PLOS Digit Health 2023; 2:e0000208. [PMID: 36976789 PMCID: PMC10047543 DOI: 10.1371/journal.pdig.0000208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/07/2023] [Indexed: 03/29/2023]
Abstract
One of the promising opportunities of digital health is its potential to lead to more holistic understandings of diseases by interacting with the daily life of patients and through the collection of large amounts of real-world data. Validating and benchmarking indicators of disease severity in the home setting is difficult, however, given the large number of confounders present in the real world and the challenges in collecting ground truth data in the home. Here we leverage two datasets collected from patients with Parkinson's disease, which couples continuous wrist-worn accelerometer data with frequent symptom reports in the home setting, to develop digital biomarkers of symptom severity. Using these data, we performed a public benchmarking challenge in which participants were asked to build measures of severity across 3 symptoms (on/off medication, dyskinesia, and tremor). 42 teams participated and performance was improved over baseline models for each subchallenge. Additional ensemble modeling across submissions further improved performance, and the top models validated in a subset of patients whose symptoms were observed and rated by trained clinicians.
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Affiliation(s)
| | | | - Yuanfang Guan
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Yidi Huang
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ayala Matzner
- Gonda Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | - Alex Page
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, United States of America
- Cardiology Division, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Izhar Bar-Gad
- Gonda Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | - Brett Beaulieu-Jones
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Yuval El-Hanani
- Gonda Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | | | - Monica Javidnia
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, United States of America
- Department of Neurology, University of Rochester, Rochester, New York, United States of America
| | - Mark S. Keller
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Yan-chak Li
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Mohammed Saqib
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Greta Smith
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, United States of America
- Department of Neurology, University of Rochester, Rochester, New York, United States of America
| | - Ana Stanescu
- Department of Computing and Mathematics, University of West Georgia, Carrollton, Georgia, United States of America
| | - Charles S. Venuto
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, United States of America
- Department of Neurology, University of Rochester, Rochester, New York, United States of America
| | - Robert Zielinski
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, United States of America
- Department of Neurology, University of Rochester, Rochester, New York, United States of America
| | | | - Arun Jayaraman
- Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | - Luc J. W. Evers
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, the Netherlands
| | - Luca Foschini
- Evidation Health, Santa Barbara, California, United States of America
| | - Alex Mariakakis
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Gaurav Pandey
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Nicholas Shawen
- Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Phil Synder
- Sage Bionetworks, Seattle, Washington, United States of America
| | - Larsson Omberg
- Sage Bionetworks, Seattle, Washington, United States of America
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19
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Khazanchi R, Lanotte F, O'Brien M, Jayaraman A. Abstract WMP27: Augmenting Early Prediction Of Post-Rehabilitation Ambulation Ability And Risk Of Falling Status For Recovering Stroke Patients Using Wearable Sensors And Machine Learning. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wmp27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
Inertial measurement units (IMU) can capture objective biomarkers of recovery during everyday activity paving the way to early prognosis and personalized therapy in post-stroke rehabilitation. In this study, we evaluated the performance of IMU data incorporated into machine learning models to predict discharge abilities compared to models based on traditional clinical variables.
Methods:
32 subacute stroke patients admitted to inpatient rehabilitation performed clinical tests while wearing IMU sensors placed on the pelvis and both unaffected and affected-side shanks (US, AS). Variables collected were patient information (PI), clinician-scored functional assessments (FA), signal-processed IMU data during the 10-Meter Walk Test (IMU
10MWT
) and the Berg-Balance Scale (IMU
BBS
). Patients were identified as
household
or
community
ambulators (Amb), and with
high
or
normal
risk of fall (RoF) based on discharge functional scores. A class-weighted L1-penalized logistic regression model was trained using nested leave-one-out cross-validation on admission data to predict discharge Amb and RoF statuses. The impact of sensor data on model performance was assessed on three feature sets: PI+FA, PI+IMU
10MWT/BBS
, PI+FA+IMU
10MWT/BBS
. Evaluation metrics included: weighted F1 score (WF1), accuracy, log-loss, and feature importance.
Results:
The PI+FA+IMU
BBS
, and both the PI+IMU
10MWT
and PI+FA+IMU
10MWT
models, outperformed the PI + FA benchmark model for RoF and Amb prediction, respectively, across all metrics (Figure 1). US gyroscopic and AS/US acceleration were relevant for Amb prediction, while the admission BBS score and pelvic acceleration were important to RoF prediction.
Conclusions:
Incorporation of simple IMU data from admission can improve discharge functional predictions over a model using PI and FA. Early, accurate predictions of post-stroke recovery could facilitate more personalized and efficient rehabilitation strategies.
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20
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Pinto D, Heinemann AW, Chang SH, Charlifue S, Field-Fote EC, Furbish CL, Jayaraman A, Tefertiller C, Taylor HB, French DD. Cost-effectiveness analysis of overground robotic training versus conventional locomotor training in people with spinal cord injury. J Neuroeng Rehabil 2023; 20:10. [PMID: 36681852 PMCID: PMC9867867 DOI: 10.1186/s12984-023-01134-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Few, if any estimates of cost-effectiveness for locomotor training strategies following spinal cord injury (SCI) are available. The purpose of this study was to estimate the cost-effectiveness of locomotor training strategies following spinal cord injury (overground robotic locomotor training versus conventional locomotor training) by injury status (complete versus incomplete) using a practice-based cohort. METHODS A probabilistic cost-effectiveness analysis was conducted using a prospective, practice-based cohort from four participating Spinal Cord Injury Model System sites. Conventional locomotor training strategies (conventional training) were compared to overground robotic locomotor training (overground robotic training). Conventional locomotor training included treadmill-based training with body weight support, overground training, and stationary robotic systems. The outcome measures included the calculation of quality adjusted life years (QALYs) using the EQ-5D and therapy costs. We estimate cost-effectiveness using the incremental cost utility ratio and present results on the cost-effectiveness plane and on cost-effectiveness acceptability curves. RESULTS Participants in the prospective, practice-based cohort with complete EQ-5D data (n = 99) qualified for the analysis. Both conventional training and overground robotic training experienced an improvement in QALYs. Only people with incomplete SCI improved with conventional locomotor training, 0.045 (SD 0.28), and only people with complete SCI improved with overground robotic training, 0.097 (SD 0.20). Costs were lower for conventional training, $1758 (SD $1697) versus overground robotic training $3952 (SD $3989), and lower for those with incomplete versus complete injury. Conventional overground training was more effective and cost less than robotic therapy for people with incomplete SCI. Overground robotic training was more effective and cost more than conventional training for people with complete SCI. The incremental cost utility ratio for overground robotic training for people with complete spinal cord injury was $12,353/QALY. CONCLUSIONS The most cost-effective locomotor training strategy for people with SCI differed based on injury completeness. Conventional training was more cost-effective than overground robotic training for people with incomplete SCI. Overground robotic training was more cost-effective than conventional training for people with complete SCI. The effect estimates may be subject to limitations associated with small sample sizes and practice-based evidence methodology. These estimates provide a baseline for future research.
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Affiliation(s)
- Daniel Pinto
- Department of Physical Therapy, College of Health Sciences, Marquette University, Milwaukee, USA.
- World Health Organization Collaborating Center for the Epidemiology of Musculoskeletal Health and Aging, University of Liege, Liege, Belgium.
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Shuo-Hsiu Chang
- Neurorecovery Research Center, TIRR Memorial Hermann, Houston, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, USA
| | | | - Edelle C Field-Fote
- Spinal Cord Injury, Shepherd Center, Atlanta, Georgia
- Division of Physical Therapy, Emory University, Atlanta, USA
| | | | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research and Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | | | - Heather B Taylor
- Spinal Cord Injury and Disability Research, TIRR Memorial Hermann, Houston, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, USA
| | - Dustin D French
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Health Services Research and Development Service, US Department of Veterans Affairs, Chicago, USA
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21
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Jayaraman C, Embry KR, Mummidisetty CK, Moon Y, Giffhorn M, Prokup S, Lim B, Lee J, Lee Y, Lee M, Jayaraman A. Modular hip exoskeleton improves walking function and reduces sedentary time in community-dwelling older adults. J Neuroeng Rehabil 2022; 19:144. [PMID: 36585676 PMCID: PMC9801566 DOI: 10.1186/s12984-022-01121-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite the benefits of physical activity for healthy physical and cognitive aging, 35% of adults over the age of 75 in the United States are inactive. Robotic exoskeleton-based exercise studies have shown benefits in improving walking function, but most are conducted in clinical settings with a neurologically impaired population. Emerging technology is starting to enable easy-to-use, lightweight, wearable robots, but their impact in the otherwise healthy older adult population remains mostly unknown. For the first time, this study investigates the feasibility and efficacy of using a lightweight, modular hip exoskeleton for in-community gait training in the older adult population to improve walking function. METHODS Twelve adults over the age of 65 were enrolled in a gait training intervention involving twelve 30-min sessions using the Gait Enhancing and Motivating System for Hip in their own senior living community. RESULTS Performance-based outcome measures suggest clinically significant improvements in balance, gait speed, and endurance following the exoskeleton training, and the device was safe and well tolerated. Gait speed below 1.0 m/s is an indicator of fall risk, and two out of the four participants below this threshold increased their self-selected gait speed over 1.0 m/s after intervention. Time spent in sedentary behavior also decreased significantly. CONCLUSIONS This intervention resulted in greater improvements in speed and endurance than traditional exercise programs, in significantly less time. Together, our results demonstrated that exoskeleton-based gait training is an effective intervention and novel approach to encouraging older adults to exercise and reduce sedentary time, while improving walking function. Future work will focus on whether the device can be used independently long-term by older adults as an everyday exercise and community-use personal mobility device. Trial registration This study was retrospectively registered with ClinicalTrials.gov (ID: NCT05197127).
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Affiliation(s)
- Chandrasekaran Jayaraman
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA
| | - Kyle R. Embry
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Departments of Physical Medicine and Rehabilitation, Medical Social Sciences and Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL USA
| | - Chaithanya K. Mummidisetty
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA
| | - Yaejin Moon
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA
| | - Matt Giffhorn
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA
| | - Sara Prokup
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA
| | | | - Jusuk Lee
- grid.266102.10000 0001 2297 6811Department of Radiology, University of California, San Francisco, USA
| | | | - Minhyung Lee
- grid.419666.a0000 0001 1945 5898Samsung Electronics Co, Suwon, South Korea
| | - Arun Jayaraman
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Departments of Physical Medicine and Rehabilitation, Medical Social Sciences and Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL USA
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22
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Hohl K, Giffhorn M, Jackson S, Jayaraman A. A framework for clinical utilization of robotic exoskeletons in rehabilitation. J Neuroeng Rehabil 2022; 19:115. [PMID: 36309686 PMCID: PMC9618174 DOI: 10.1186/s12984-022-01083-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/08/2022] [Indexed: 11/25/2022] Open
Abstract
Exoskeletons are externally worn motorized devices that assist with sit-to-stand and walking in individuals with motor and functional impairments. The Food & Drug Administration (FDA) has approved several of these technologies for clinical use however, there is limited evidence to guide optimal utilization in every day clinical practice. With the diversity of technologies & equipment available, it presents a challenge for clinicians to decide which device to use, when to initiate, how to implement these technologies with different patient presentations, and when to wean off the devices. Thus, we present a clinical utilization framework specific to exoskeletons with four aims. These aims are to assist with clinical decision making of when exoskeleton use is clinically indicated, identification of which device is most appropriate based on patient deficits and device characteristics, providing guidance on dosage parameters within a plan of care and guidance for reflection following utilization. This framework streamlines how clinicians can approach implementation through the synthesis of published evidence with appropriate clinical assessment & device selection to reflection for success and understanding of these innovative & complex technologies.
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23
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Tabashum T, Xiao T, Jayaraman C, Mummidisetty CK, Jayaraman A, Albert MV. Autoencoder Composite Scoring to Evaluate Prosthetic Performance in Individuals with Lower Limb Amputation. Bioengineering (Basel) 2022; 9:bioengineering9100572. [PMID: 36290540 PMCID: PMC9598529 DOI: 10.3390/bioengineering9100572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/02/2022] [Accepted: 10/11/2022] [Indexed: 11/21/2022] Open
Abstract
We created an overall assessment metric using a deep learning autoencoder to directly compare clinical outcomes in a comparison of lower limb amputees using two different prosthetic devices—a mechanical knee and a microprocessor-controlled knee. Eight clinical outcomes were distilled into a single metric using a seven-layer deep autoencoder, with the developed metric compared to similar results from principal component analysis (PCA). The proposed methods were used on data collected from ten participants with a dysvascular transfemoral amputation recruited for a prosthetics research study. This single summary metric permitted a cross-validated reconstruction of all eight scores, accounting for 83.29% of the variance. The derived score is also linked to the overall functional ability in this limited trial population, as improvements in each base clinical score led to increases in this developed metric. There was a highly significant increase in this autoencoder-based metric when the subjects used the microprocessor-controlled knee (p < 0.001, repeated measures ANOVA). A traditional PCA metric led to a similar interpretation but captured only 67.3% of the variance. The autoencoder composite score represents a single-valued, succinct summary that can be useful for the holistic assessment of highly variable, individual scores in limited clinical datasets.
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Affiliation(s)
- Thasina Tabashum
- Department of Computer Science and Engineering, University of North Texas, Denton, TX 76203, USA
- Correspondence:
| | - Ting Xiao
- Department of Computer Science and Engineering, University of North Texas, Denton, TX 76203, USA
- Department of Information Science, University of North Texas, Denton, TX 76203, USA
| | - Chandrasekaran Jayaraman
- Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Chaithanya K. Mummidisetty
- Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL 60611, USA
| | - Arun Jayaraman
- Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Mark V. Albert
- Department of Computer Science and Engineering, University of North Texas, Denton, TX 76203, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Biomedical Engineering, University of North Texas, Denton, TX 76203, USA
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Hohl K, Smith AC, Macaluso R, Giffhorn M, Prokup S, O’Dell DR, Kleinschmidt L, Elliott JM, Jayaraman A. Muscle adaptations in acute SCI following overground exoskeleton + FES training: A pilot study. Front Rehabil Sci 2022; 3:963771. [PMID: 36311207 PMCID: PMC9608781 DOI: 10.3389/fresc.2022.963771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/23/2022] [Indexed: 11/21/2022]
Abstract
Objective To evaluate the combined effects of robotic exoskeleton and functional electrical stimulation (FES) training on muscle composition during over-ground gait training in persons with acute spinal cord injury (SCI). Design Randomized crossover pilot study. Setting Inpatient-rehabilitation Hospital. Participants Six individuals with acute SCI. Intervention Participants were randomized to either receive training with the Ekso® Bionics exoskeleton combined with FES in addition to standard-of-care or standard-of-care alone. Outcome measures The main outcome measures for the study were quantified using magnetic resonance imaging (MRI), specifically, lower extremity muscle volume and intramuscular adipose tissue (IMAT). Static balance and fall risk were assessed using the Berg Balance Scale. Results Significant improvements were observed in muscle volume in the exoskeleton intervention group when compared to only standard-of-care (p < 0.001). There was no significant difference between the groups in IMAT even though the intervention group saw a reduction in IMAT that trended towards statistical significance (p = 0.07). Static balance improved in both groups, with greater improvements seen in the intervention group. Conclusions Early intervention with robotic exoskeleton may contribute to improved muscle function measured using MRI in individuals with acute SCI.
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Affiliation(s)
- Kristen Hohl
- Max Näder Lab for Rehabilitation Technologies / Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Andrew C. Smith
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Rebecca Macaluso
- Max Näder Lab for Rehabilitation Technologies / Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Matthew Giffhorn
- Max Näder Lab for Rehabilitation Technologies / Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Sara Prokup
- Max Näder Lab for Rehabilitation Technologies / Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Denise R. O’Dell
- Department of Physical Therapy, University of Kentucky College of Health Sciences, Lexington, KY, United States
| | - Lina Kleinschmidt
- Department of Physical Therapy / Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jim M. Elliott
- Department of Physical Therapy / Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Northern Sydney Local Health District, The Kolling Institute and Faculty of Medicine and Health, The University of Sydney, St. Leonards, NSW, Australia
| | - Arun Jayaraman
- Max Näder Lab for Rehabilitation Technologies / Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, United States,Department of Physical Therapy / Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Department of Physical Medicine / Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Correspondence: Arun Jayaraman
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O’Brien MK, Shin SY, Khazanchi R, Fanton M, Lieber RL, Ghaffari R, Rogers JA, Jayaraman A. Wearable Sensors Improve Prediction of Post-Stroke Walking Function Following Inpatient Rehabilitation. IEEE J Transl Eng Health Med 2022; 10:2100711. [PMID: 36304845 PMCID: PMC9592048 DOI: 10.1109/jtehm.2022.3208585] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/31/2022] [Accepted: 09/19/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A primary goal of acute stroke rehabilitation is to maximize functional recovery and help patients reintegrate safely in the home and community. However, not all patients have the same potential for recovery, making it difficult to set realistic therapy goals and to anticipate future needs for short- or long-term care. The objective of this study was to test the value of high-resolution data from wireless, wearable motion sensors to predict post-stroke ambulation function following inpatient stroke rehabilitation. METHOD Supervised machine learning algorithms were trained to classify patients as either household or community ambulators at discharge based on information collected upon admission to the inpatient facility (N=33-35). Inertial measurement unit (IMU) sensor data recorded from the ankles and the pelvis during a brief walking bout at admission (10 meters, or 60 seconds walking) improved the prediction of discharge ambulation ability over a traditional prediction model based on patient demographics, clinical information, and performance on standardized clinical assessments. RESULTS Models incorporating IMU data were more sensitive to patients who changed ambulation category, improving the recall of community ambulators at discharge from 85% to 89-93%. CONCLUSIONS This approach demonstrates significant potential for the early prediction of post-rehabilitation walking outcomes in patients with stroke using small amounts of data from three wearable motion sensors. CLINICAL IMPACT Accurately predicting a patient's functional recovery early in the rehabilitation process would transform our ability to design personalized care strategies in the clinic and beyond. This work contributes to the development of low-cost, clinically-implementable prognostic tools for data-driven stroke treatment.
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Affiliation(s)
- Megan K. O’Brien
- Max Nader Laboratory for Rehabilitation Technologies and Outcomes ResearchShirley Ryan AbilityLabChicagoIL60611USA
- Department of Physical Medicine and RehabilitationNorthwestern UniversityChicagoIL60611USA
| | | | | | | | - Richard L. Lieber
- Max Nader Laboratory for Rehabilitation Technologies and Outcomes ResearchShirley Ryan AbilityLabChicagoIL60611USA
- Department of Physical Medicine and RehabilitationNorthwestern UniversityChicagoIL60611USA
- Department of Biomedical EngineeringNorthwestern UniversityEvanstonIL60208USA
| | - Roozbeh Ghaffari
- Querrey Simpson Institute for Bioelectronics, Northwestern UniversityEvanstonIL60208USA
| | - John A. Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern UniversityEvanstonIL60208USA
- Department of Materials Science and EngineeringNorthwestern UniversityEvanstonIL60208USA
- Department of ChemistryNorthwestern UniversityEvanstonIL60208USA
- Department of Mechanical EngineeringNorthwestern UniversityEvanstonIL60208USA
- Department of Electrical Engineering and Computer ScienceNorthwestern UniversityEvanstonIL60208USA
| | - Arun Jayaraman
- Max Nader Laboratory for Rehabilitation Technologies and Outcomes ResearchShirley Ryan AbilityLabChicagoIL60611USA
- Department of Physical Medicine and RehabilitationNorthwestern UniversityChicagoIL60611USA
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Shin SY, Hohl K, Giffhorn M, Awad LN, Walsh CJ, Jayaraman A. Correction to: Soft robotic exosuit augmented high intensity gait training on stroke survivors: a pilot study. J Neuroeng Rehabil 2022; 19:100. [PMID: 36123744 PMCID: PMC9484065 DOI: 10.1186/s12984-022-01080-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sung Yul Shin
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, 710 N Lake Shore Dr., Chicago, IL, 60611, USA
| | - Kristen Hohl
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL, 60611, USA
| | - Matt Giffhorn
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL, 60611, USA
| | - Louis N Awad
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, USA.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, USA
| | - Conor J Walsh
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, USA.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, USA
| | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL, 60611, USA. .,Department of Physical Medicine and Rehabilitation, Northwestern University, 710 N Lake Shore Dr., Chicago, IL, 60611, USA.
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Chen PW, O’Brien MK, Horin AP, McGee Koch LL, Lee JY, Xu S, Zee PC, Arora VM, Jayaraman A. Sleep Monitoring during Acute Stroke Rehabilitation: Toward Automated Measurement Using Multimodal Wireless Sensors. Sensors (Basel) 2022; 22:6190. [PMID: 36015951 PMCID: PMC9414899 DOI: 10.3390/s22166190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
Sleep plays a critical role in stroke recovery. However, there are limited practices to measure sleep for individuals with stroke, thus inhibiting our ability to identify and treat poor sleep quality. Wireless, body-worn sensors offer a solution for continuous sleep monitoring. In this study, we explored the feasibility of (1) collecting overnight biophysical data from patients with subacute stroke using a simple sensor system and (2) constructing machine-learned algorithms to detect sleep stages. Ten individuals with stroke in an inpatient rehabilitation hospital wore two wireless sensors during a single night of sleep. Polysomnography served as ground truth to classify different sleep stages. A population model, trained on data from multiple patients and tested on data from a separate patient, performed poorly for this limited sample. Personal models trained on data from one patient and tested on separate data from the same patient demonstrated markedly improved performance over population models and research-grade wearable devices to detect sleep/wake. Ultimately, the heterogeneity of biophysical signals after stroke may present a challenge in building generalizable population models. Personal models offer a provisional method to capture high-resolution sleep metrics from simple wearable sensors by leveraging a single night of polysomnography data.
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Affiliation(s)
- Pin-Wei Chen
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan Ability Lab, Chicago, IL 60611, USA
| | - Megan K. O’Brien
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan Ability Lab, Chicago, IL 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL 60611, USA
| | - Adam P. Horin
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan Ability Lab, Chicago, IL 60611, USA
| | - Lori L. McGee Koch
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan Ability Lab, Chicago, IL 60611, USA
| | | | - Shuai Xu
- Sibel Health Inc., Niles, IL 60714, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Phyllis C. Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Chicago, IL 60611, USA
| | - Vineet M. Arora
- Department of Medicine, University of Chicago Medicine, Chicago, IL 60637, USA
| | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan Ability Lab, Chicago, IL 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL 60611, USA
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Botonis OK, Harari Y, Embry KR, Mummidisetty CK, Riopelle D, Giffhorn M, Albert MV, Heike V, Jayaraman A. Wearable airbag technology and machine learned models to mitigate falls after stroke. J Neuroeng Rehabil 2022; 19:60. [PMID: 35715823 PMCID: PMC9205156 DOI: 10.1186/s12984-022-01040-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are a common complication experienced after a stroke and can cause serious detriments to physical health and social mobility, necessitating a dire need for intervention. Among recent advancements, wearable airbag technology has been designed to detect and mitigate fall impact. However, these devices have not been designed nor validated for the stroke population and thus, may inadequately detect falls in individuals with stroke-related motor impairments. To address this gap, we investigated whether population-specific training data and modeling parameters are required to pre-detect falls in a chronic stroke population. METHODS We collected data from a wearable airbag's inertial measurement units (IMUs) from individuals with (n = 20 stroke) and without (n = 15 control) history of stroke while performing a series of falls (842 falls total) and non-falls (961 non-falls total) in a laboratory setting. A leave-one-subject-out crossvalidation was used to compare the performance of two identical machine learned models (adaptive boosting classifier) trained on cohort-dependent data (control or stroke) to pre-detect falls in the stroke cohort. RESULTS The average performance of the model trained on stroke data (recall = 0.905, precision = 0.900) had statistically significantly better recall (P = 0.0035) than the model trained on control data (recall = 0.800, precision = 0.944), while precision was not statistically significantly different. Stratifying models trained on specific fall types revealed differences in pre-detecting anterior-posterior (AP) falls (stroke-trained model's F1-score was 35% higher, P = 0.019). Using activities of daily living as non-falls training data (compared to near-falls) significantly increased the AUC (Area under the receiver operating characteristic) for classifying AP falls for both models (P < 0.04). Preliminary analysis suggests that users with more severe stroke impairments benefit further from a stroke-trained model. The optimal lead time (time interval pre-impact to detect falls) differed between control- and stroke-trained models. CONCLUSIONS These results demonstrate the importance of population sensitivity, non-falls data, and optimal lead time for machine learned pre-impact fall detection specific to stroke. Existing fall mitigation technologies should be challenged to include data of neurologically impaired individuals in model development to adequately detect falls in other high fall risk populations. Trial registration https://clinicaltrials.gov/ct2/show/NCT05076565 ; Unique Identifier: NCT05076565. Retrospectively registered on 13 October 2021.
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Affiliation(s)
- Olivia K Botonis
- Max Nader Rehabilitation Technologies and Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Yaar Harari
- Max Nader Rehabilitation Technologies and Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Kyle R Embry
- Max Nader Rehabilitation Technologies and Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | | | - David Riopelle
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matt Giffhorn
- Max Nader Rehabilitation Technologies and Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Mark V Albert
- Department of Computer Science and Engineering, Department of Biomedical Engineering, University of North Texas, Denton, TX, USA
| | - Vallery Heike
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Arun Jayaraman
- Max Nader Rehabilitation Technologies and Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, USA. .,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.
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Shin SY, Hohl K, Giffhorn M, Awad LN, Walsh CJ, Jayaraman A. Soft robotic exosuit augmented high intensity gait training on stroke survivors: a pilot study. J Neuroeng Rehabil 2022; 19:51. [PMID: 35655180 PMCID: PMC9164465 DOI: 10.1186/s12984-022-01034-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/19/2022] [Indexed: 12/01/2022] Open
Abstract
Background Stroke is a leading cause of serious gait impairments and restoring walking ability is a major goal of physical therapy interventions. Soft robotic exosuits are portable, lightweight, and unobtrusive assistive devices designed to improve the mobility of post-stroke individuals through facilitation of more natural paretic limb function during walking training. However, it is unknown whether long-term gait training using soft robotic exosuits will clinically impact gait function and quality of movement post-stroke. Objective The objective of this pilot study was to examine the therapeutic effects of soft robotic exosuit-augmented gait training on clinical and biomechanical gait outcomes in chronic post-stroke individuals. Methods Five post-stroke individuals received high intensity gait training augmented with a soft robotic exosuit, delivered in 18 sessions over 6–8 weeks. Performance based clinical outcomes and biomechanical gait quality parameters were measured at baseline, midpoint, and completion. Results Clinically meaningful improvements were observed in walking speed (\documentclass[12pt]{minimal}
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\begin{document}$$p$$\end{document}p < 0.05). We also observed an increase in bilateral ankle angular velocities (\documentclass[12pt]{minimal}
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\begin{document}$$p$$\end{document}p < 0.05), suggesting biomechanical improvements in walking function. Conclusions The results in this study offer preliminary evidence that a soft robotic exosuit can be a useful tool to augment high intensity gait training in a clinical setting. This study justifies more expanded research on soft exosuit technology with a larger post-stroke population for more reliable generalization. Trial registration This study is registered with ClinicalTrials.gov (ID: NCT04251091)
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Affiliation(s)
- Sung Yul Shin
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, 710 N Lake Shore Dr, Chicago, IL, 60611, USA
| | - Kristen Hohl
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL, 60611, USA
| | - Matt Giffhorn
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL, 60611, USA
| | - Louis N Awad
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, USA.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, USA
| | - Conor J Walsh
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, USA.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, USA
| | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL, 60611, USA. .,Department of Physical Medicine and Rehabilitation, Northwestern University, 710 N Lake Shore Dr, Chicago, IL, 60611, USA.
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McKenzie K, Kim J, Veit N, Allie L, Jasmine H, Moon Y, Barry A, Sandhu M, Rymer W, Jayaraman A. Combining Neuromodulation Strategies to Improve Locomotor Function in SCI: A Proof of Concept Case Study. Arch Phys Med Rehabil 2022. [DOI: 10.1016/j.apmr.2022.01.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lonini L, Moon Y, Embry K, Cotton RJ, McKenzie K, Jenz S, Jayaraman A. Video-Based Pose Estimation for Gait Analysis in Stroke Survivors during Clinical Assessments: A Proof-of-Concept Study. Digit Biomark 2022; 6:9-18. [PMID: 35224426 PMCID: PMC8832219 DOI: 10.1159/000520732] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/02/2021] [Indexed: 10/10/2023] Open
Abstract
Recent advancements in deep learning have produced significant progress in markerless human pose estimation, making it possible to estimate human kinematics from single camera videos without the need for reflective markers and specialized labs equipped with motion capture systems. Such algorithms have the potential to enable the quantification of clinical metrics from videos recorded with a handheld camera. Here we used DeepLabCut, an open-source framework for markerless pose estimation, to fine-tune a deep network to track 5 body keypoints (hip, knee, ankle, heel, and toe) in 82 below-waist videos of 8 patients with stroke performing overground walking during clinical assessments. We trained the pose estimation model by labeling the keypoints in 2 frames per video and then trained a convolutional neural network to estimate 5 clinically relevant gait parameters (cadence, double support time, swing time, stance time, and walking speed) from the trajectory of these keypoints. These results were then compared to those obtained from a clinical system for gait analysis (GAITRite®, CIR Systems). Absolute accuracy (mean error) and precision (standard deviation of error) for swing, stance, and double support time were within 0.04 ± 0.11 s; Pearson's correlation with the reference system was moderate for swing times (r = 0.4-0.66), but stronger for stance and double support time (r = 0.93-0.95). Cadence mean error was -0.25 steps/min ± 3.9 steps/min (r = 0.97), while walking speed mean error was -0.02 ± 0.11 m/s (r = 0.92). These preliminary results suggest that single camera videos and pose estimation models based on deep networks could be used to quantify clinically relevant gait metrics in individuals poststroke, even while using assistive devices in uncontrolled environments. Such development opens the door to applications for gait analysis both inside and outside of clinical settings, without the need of sophisticated equipment.
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Affiliation(s)
- Luca Lonini
- Shirley Ryan Ability Lab, Chicago, Illinois, USA
- Dept. of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Yaejin Moon
- Shirley Ryan Ability Lab, Chicago, Illinois, USA
| | - Kyle Embry
- Shirley Ryan Ability Lab, Chicago, Illinois, USA
- Dept. of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Chicago, Illinois, USA
| | - R. James Cotton
- Shirley Ryan Ability Lab, Chicago, Illinois, USA
- Dept. of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Sophia Jenz
- Shirley Ryan Ability Lab, Chicago, Illinois, USA
| | - Arun Jayaraman
- Shirley Ryan Ability Lab, Chicago, Illinois, USA
- Dept. of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Chicago, Illinois, USA
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Edwards DJ, Forrest G, Cortes M, Weightman MM, Sadowsky C, Chang SH, Furman K, Bialek A, Prokup S, Carlow J, VanHiel L, Kemp L, Musick D, Campo M, Jayaraman A. Walking improvement in chronic incomplete spinal cord injury with exoskeleton robotic training (WISE): a randomized controlled trial. Spinal Cord 2022; 60:522-532. [PMID: 35094007 PMCID: PMC9209325 DOI: 10.1038/s41393-022-00751-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Clinical trial. OBJECTIVE To demonstrate that a 12-week exoskeleton-based robotic gait training regimen can lead to a clinically meaningful improvement in independent gait speed, in community-dwelling participants with chronic incomplete spinal cord injury (iSCI). SETTING Outpatient rehabilitation or research institute. METHODS Multi-site (United States), randomized, controlled trial, comparing exoskeleton gait training (12 weeks, 36 sessions) with standard gait training or no gait training (2:2:1 randomization) in chronic iSCI (>1 year post injury, AIS-C, and D), with residual stepping ability. The primary outcome measure was change in robot-independent gait speed (10-meter walk test, 10MWT) post 12-week intervention. Secondary outcomes included: Timed-Up-and-Go (TUG), 6-min walk test (6MWT), Walking Index for Spinal Cord Injury (WISCI-II) (assistance and devices), and treating therapist NASA-Task Load Index. RESULTS Twenty-five participants completed the assessments and training as assigned (9 Ekso, 10 Active Control, 6 Passive Control). Mean change in gait speed at the primary endpoint was not statistically significant. The proportion of participants with improvement in clinical ambulation category from home to community speed post-intervention was greatest in the Ekso group (>1/2 Ekso, 1/3 Active Control, 0 Passive Control, p < 0.05). Improvements in secondary outcome measures were not significant. CONCLUSIONS Twelve weeks of exoskeleton robotic training in chronic SCI participants with independent stepping ability at baseline can improve clinical ambulatory status. Improvements in raw gait speed were not statistically significant at the group level, which may guide future trials for participant inclusion criteria. While generally safe and tolerable, larger gains in ambulation might be associated with higher risk for non-serious adverse events.
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Affiliation(s)
- Dylan J. Edwards
- grid.421874.c0000 0001 0016 6543Moss Rehabilitation Research Institute, Elkins Park, PA USA ,grid.1038.a0000 0004 0389 4302School of Medical and Health Sciences, and Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA Australia
| | - Gail Forrest
- grid.419761.c0000 0004 0412 2179Kessler Foundation, West Orange, NJ USA
| | - Mar Cortes
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Margaret M. Weightman
- grid.413636.50000 0000 8739 9261Courage Kenny Research Center-Allina Health, Minneapolis, MN USA
| | - Cristina Sadowsky
- grid.240023.70000 0004 0427 667XKennedy Krieger Institute, Baltimore, MD USA ,grid.21107.350000 0001 2171 9311John Hopkins School of Medicine, 733 N Broadway, Baltimore, MD 21205 USA
| | - Shuo-Hsiu Chang
- grid.267308.80000 0000 9206 2401Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX USA ,grid.414053.70000 0004 0434 8100NeuroRecovery Research Center at TIRR Memorial Hermann, Houston, TX USA
| | - Kimberly Furman
- grid.416420.50000 0000 9821 3960Marianjoy Rehabilitation Hospital, Wheaton, IL USA
| | - Amy Bialek
- grid.413734.60000 0000 8499 1112Burke Neurological Institute, White Plains, NY USA
| | - Sara Prokup
- grid.280535.90000 0004 0388 0584Shirley Ryan AbilityLab, Chicago, IL USA
| | | | | | - Laura Kemp
- Kemp Clinical Consulting Co. LLC, Carlsbad, CA USA
| | | | - Marc Campo
- grid.419740.f0000 0004 0396 6863Mercy College, Dobbs Ferry, NY USA
| | - Arun Jayaraman
- grid.280535.90000 0004 0388 0584Shirley Ryan AbilityLab, Chicago, IL USA
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O'Brien MK, Botonis OK, Larkin E, Carpenter J, Martin-Harris B, Maronati R, Lee K, Cherney LR, Hutchison B, Xu S, Rogers JA, Jayaraman A. Advanced Machine Learning Tools to Monitor Biomarkers of Dysphagia: A Wearable Sensor Proof-of-Concept Study. Digit Biomark 2021; 5:167-175. [PMID: 34723069 DOI: 10.1159/000517144] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/10/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Difficulty swallowing (dysphagia) occurs frequently in patients with neurological disorders and can lead to aspiration, choking, and malnutrition. Dysphagia is typically diagnosed using costly, invasive imaging procedures or subjective, qualitative bedside examinations. Wearable sensors are a promising alternative to noninvasively and objectively measure physiological signals relevant to swallowing. An ongoing challenge with this approach is consolidating these complex signals into sensitive, clinically meaningful metrics of swallowing performance. To address this gap, we propose 2 novel, digital monitoring tools to evaluate swallows using wearable sensor data and machine learning. Methods Biometric swallowing and respiration signals from wearable, mechano-acoustic sensors were compared between patients with poststroke dysphagia and nondysphagic controls while swallowing foods and liquids of different consistencies, in accordance with the Mann Assessment of Swallowing Ability (MASA). Two machine learning approaches were developed to (1) classify the severity of impairment for each swallow, with model confidence ratings for transparent clinical decision support, and (2) compute a similarity measure of each swallow to nondysphagic performance. Task-specific models were trained using swallow kinematics and respiratory features from 505 swallows (321 from patients and 184 from controls). Results These models provide sensitive metrics to gauge impairment on a per-swallow basis. Both approaches demonstrate intrasubject swallow variability and patient-specific changes which were not captured by the MASA alone. Sensor measures encoding respiratory-swallow coordination were important features relating to dysphagia presence and severity. Puree swallows exhibited greater differences from controls than saliva swallows or liquid sips (p < 0.037). Discussion Developing interpretable tools is critical to optimize the clinical utility of novel, sensor-based measurement techniques. The proof-of-concept models proposed here provide concrete, communicable evidence to track dysphagia recovery over time. With refined training schemes and real-world validation, these tools can be deployed to automatically measure and monitor swallowing in the clinic and community for patients across the impairment spectrum.
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Affiliation(s)
- Megan K O'Brien
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
| | - Olivia K Botonis
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Elissa Larkin
- Think and Speak Lab, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Julia Carpenter
- Think and Speak Lab, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Bonnie Martin-Harris
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois, USA
| | - Rachel Maronati
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | | | - Leora R Cherney
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA.,Think and Speak Lab, Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois, USA
| | - Brianna Hutchison
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Shuai Xu
- Departments of Materials Science and Engineering, Center for Bio-Integrated Electronics, Biomedical Engineering, Electrical Engineering and Computer Science, Northwestern University, Evanston, Illinois, USA
| | - John A Rogers
- Departments of Materials Science and Engineering, Center for Bio-Integrated Electronics, Biomedical Engineering, Electrical Engineering and Computer Science, Northwestern University, Evanston, Illinois, USA
| | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
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Garnier-Villarreal M, Pinto D, Mummidisetty CK, Jayaraman A, Tefertiller C, Charlifue S, Taylor HB, Chang SH, McCombs N, Furbish CL, Field-Fote EC, Heinemann AW. Predicting Duration of Outpatient Physical Therapy Episodes for Individuals with Spinal Cord Injury Based on Locomotor Training Strategy. Arch Phys Med Rehabil 2021; 103:665-675. [PMID: 34648804 DOI: 10.1016/j.apmr.2021.07.815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/17/2021] [Accepted: 07/02/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To characterize individuals with spinal cord injuries (SCI) who use outpatient physical therapy or community wellness services for locomotor training and predict the duration of services, controlling for demographic, injury, quality of life, and service and financial characteristics. We explore how the duration of services is related to locomotor strategy. DESIGN Observational study of participants at 4 SCI Model Systems centers with survival. Weibull regression model to predict the duration of services. SETTING Rehabilitation and community wellness facilities at 4 SCI Model Systems centers. PARTICIPANTS Eligibility criteria were SCI or dysfunction resulting in motor impairment and the use of physical therapy or community wellness programs for locomotor/gait training. We excluded those who did not complete training or who experienced a disruption in training greater than 45 days. Our sample included 62 participants in conventional therapy and 37 participants in robotic exoskeleton training. INTERVENTIONS Outpatient physical therapy or community wellness services for locomotor/gait training. MAIN OUTCOME MEASURES SCI characteristics (level and completeness of injury) and the duration of services from medical records. Self-reported perceptions of SCI consequences using the SCI-Functional Index for basic mobility and SCI-Quality of Life measurement system for bowel difficulties, bladder difficulties, and pain interference. RESULTS After controlling for predictors, the duration of services for the conventional therapy group was an average of 63% longer than for the robotic exoskeleton group, however each visit was 50% shorter in total time. Men had an 11% longer duration of services than women had. Participants with complete injuries had a duration of services that was approximately 1.72 times longer than participants with incomplete injuries. Perceived improvement was larger in the conventional group. CONCLUSIONS Locomotor/gait training strategies are distinctive for individuals with SCI using a robotic exoskeleton in a community wellness facility as episodes are shorter but individual sessions are longer. Participants' preferences and the ability to pay for ongoing services may be critical factors associated with the duration of outpatient services.
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Affiliation(s)
| | - Daniel Pinto
- College of Health Sciences, Marquette University, Milwaukee, Wisconsin.
| | - Chaithanya K Mummidisetty
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois
| | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois; Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Candy Tefertiller
- Craig Hospital, Englewood, Colorado; University of Colorado, Denver, Colorado
| | - Susan Charlifue
- Craig Hospital, Englewood, Colorado; University of Colorado, Denver, Colorado
| | | | - Shuo-Hsiu Chang
- UT Health Science Center at Houston, Houston, Texas; Neurorecovery Research Center, TIRR Memorial Hermann, Houston, Texas
| | - Nicholas McCombs
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois
| | | | - Edelle C Field-Fote
- Shepherd Center, Atlanta, Georgia; Division of Physical Therapy, Emory University School of Medicine, Atlanta, Georgia
| | - Allen W Heinemann
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois; Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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35
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Nolan KJ, Karunakaran KK, Roberts P, Tefertiller C, Walter AM, Zhang J, Leslie D, Jayaraman A, Francisco GE. Utilization of Robotic Exoskeleton for Overground Walking in Acute and Chronic Stroke. Front Neurorobot 2021; 15:689363. [PMID: 34539371 PMCID: PMC8442911 DOI: 10.3389/fnbot.2021.689363] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Stroke commonly results in gait deficits which impacts functional ambulation and quality of life. Robotic exoskeletons (RE) for overground walking are devices that are programmable to provide high dose and movement-impairment specific assistance thus offering new rehabilitation possibilities for recovery progression in individuals post stroke. The purpose of this investigation is to present preliminary utilization data in individuals with acute and chronic stroke after walking overground with an RE. Secondary analysis on a subset of individuals is presented to understand the mechanistic changes due to RE overground walking. Thirty-eight participants with hemiplegia secondary to stroke were enrolled in a clinical trial conducted at eight rehabilitation centers. Data is presented for four sessions of overground walking in the RE over the course of 2 weeks. Participants continued their standard of care if they had any ongoing therapy at the time of study enrollment. Gait speed during the 10 Meter Walk Test, Gait deviations and the Functional Ambulation Category (FAC) data were collected before (baseline) and after (follow-up) the RE walking sessions. Walking speed significantly increased between baseline and follow-up for participants in the chronic (p <0.01) and acute (p < 0.05) stage of stroke recovery. FAC level significantly improved (p < 0.05) and there were significantly fewer (p < 0.05) gait deviations observed for participants in the acute stages of stroke recovery between baseline and follow-up. Secondary analysis on a subset of eight participants indicated that after four sessions of overground walking with the RE, the participants significantly improved their spatial symmetry. The walk time, step count and ratio of walk time to up time increased from first session to the last session for participants in the chronic and acute stages of stroke. The RE was effectively utilized for overground walking for individuals with acute and chronic stroke with varying severity levels. The results demonstrated an increase in walking speed, improvement in FAC and a decrease in gait deviations (from baseline to follow-up) after four sessions of overground walking in the RE for participants. In addition, preliminary data indicated that spatial symmetry and step length also improved after utilization of an RE for overground walking.
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Affiliation(s)
- Karen J Nolan
- Kessler Foundation, Center for Mobility and Engineering Research, West Orange, NJ, United States.,Rutgers-New Jersey Medical School, Department of Physical Medicine and Rehabilitation, Newark, NJ, United States
| | - Kiran K Karunakaran
- Kessler Foundation, Center for Mobility and Engineering Research, West Orange, NJ, United States.,Rutgers-New Jersey Medical School, Department of Physical Medicine and Rehabilitation, Newark, NJ, United States
| | - Pamela Roberts
- Cedars-Sinai Medical Center, Department of Physical Medicine and Rehabilitation, Los Angeles, CA, United States
| | - Candy Tefertiller
- Craig Hospital, Department of Physical Therapy, Englewood, CO, United States
| | - Amber M Walter
- Sheltering Arms Physical Rehabilitation Centers, Mechanicsville, VA, United States
| | - Jun Zhang
- St. Charles Hospital, Port Jefferson, NY, United States
| | | | - Arun Jayaraman
- Shirley Ryan AbilityLab, Max Nader Center for Rehabilitation Technologies and Outcomes Research, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Gerard E Francisco
- University of Texas at Houston McGovern Medical School, Houston, TX, United States.,TIRR Memorial Hermann, Houston, TX, United States
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36
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Hoppe-Ludwig S, Armitage J, Turner KL, O'Brien MK, Mummidisetty CK, Koch LM, Kocherginsky M, Jayaraman A. Usability, functionality, and efficacy of a custom myoelectric elbow-wrist-hand orthosis to assist elbow function in individuals with stroke. J Rehabil Assist Technol Eng 2021; 8:20556683211035057. [PMID: 34471545 PMCID: PMC8404626 DOI: 10.1177/20556683211035057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction After stroke, upper limb impairment affects independent performance of activities of daily living. We evaluated the usability, functionality, and efficacy of a myoelectric elbow-wrist-hand orthosis to provide support, limit unsafe motion, and enhance the functional motion of paralyzed or weak upper limbs. Methods Individuals with stroke participated in a single-session study to evaluate the device. Ability to activate the device was tested in supported and unsupported shoulder position, as well as the elbow range of motion, ability to maintain elbow position, and ability to lift and hold a range of weights while using the device. Results No adverse events were reported. 71% of users were able to operate the device in all three active myoelectric activation modes (Biceps, Triceps, Dual) during testing. Users were able to hold a range of wrist weights (0.5–2 lbs) for 10–120 seconds, with the largest percentage of participants able to hold weights with the device in Biceps Mode. Conclusions The myoelectric elbow-wrist-hand orthosis improved range of motion during use and was efficacious at remediating upper extremity impairment after stroke. All users could operate the device in at least one mode, and most could lift and hold weights representative of some everyday objects using the device.
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Affiliation(s)
- Shenan Hoppe-Ludwig
- Max Nader Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA.,Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, USA
| | - Jodi Armitage
- Max Nader Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA.,Northwestern Memorial Hospital, Chicago, USA
| | - Kristi L Turner
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, USA
| | - Megan K O'Brien
- Max Nader Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA.,Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, USA.,Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, USA
| | - Chaithanya K Mummidisetty
- Max Nader Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA.,Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, USA
| | - Lori McGee Koch
- Max Nader Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA.,Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, USA
| | - Masha Kocherginsky
- Department of Preventive Medicine (Biostatistics), Northwestern University, Chicago, USA
| | - Arun Jayaraman
- Max Nader Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA.,Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, USA.,Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, USA
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Harari Y, Shawen N, Mummidisetty CK, Albert MV, Kording KP, Jayaraman A. A smartphone-based online system for fall detection with alert notifications and contextual information of real-life falls. J Neuroeng Rehabil 2021; 18:124. [PMID: 34376199 PMCID: PMC8353784 DOI: 10.1186/s12984-021-00918-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 07/28/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Falls are a leading cause of accidental deaths and injuries worldwide. The risk of falling is especially high for individuals suffering from balance impairments. Retrospective surveys and studies of simulated falling in lab conditions are frequently used and are informative, but prospective information about real-life falls remains sparse. Such data are essential to address fall risks and develop fall detection and alert systems. Here we present the results of a prospective study investigating a proof-of-concept, smartphone-based, online system for fall detection and notification. METHODS The system uses the smartphone's accelerometer and gyroscope to monitor the participants' motion, and falls are detected using a regularized logistic regression. Data on falls and near-fall events (i.e., stumbles) is stored in a cloud server and fall-related variables are logged onto a web portal developed for data exploration, including the event time and weather, fall probability, and the faller's location and activity before the fall. RESULTS In total, 23 individuals with an elevated risk of falling carried the phones for 2070 days in which the model classified 14,904,000 events. The system detected 27 of the 37 falls that occurred (sensitivity = 73.0 %) and resulted in one false alarm every 46 days (specificity > 99.9 %, precision = 37.5 %). 42.2 % of the events falsely classified as falls were validated as stumbles. CONCLUSIONS The system's performance shows the potential of using smartphones for fall detection and notification in real-life. Apart from functioning as a practical fall monitoring instrument, this system may serve as a valuable research tool, enable future studies to scale their ability to capture fall-related data, and help researchers and clinicians to investigate real-falls.
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Affiliation(s)
- Yaar Harari
- Max Nader Rehabilitation Technologies and Outcomes Lab, Shirley Ryan Ability Lab, IL, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Nicholas Shawen
- Max Nader Rehabilitation Technologies and Outcomes Lab, Shirley Ryan Ability Lab, IL, Chicago, USA
- Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Mark V Albert
- Department of Computer Science and Engineering, University of North Texas, Denton, TX, USA
| | - Konrad P Kording
- Departments of Bioengineering and Neuroscience, University of Pennsylvania, Philadelphia, PA, USA
| | - Arun Jayaraman
- Max Nader Rehabilitation Technologies and Outcomes Lab, Shirley Ryan Ability Lab, IL, Chicago, USA.
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.
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Brennan K, Curran J, Barlow A, Jayaraman A. Telerehabilitation in neurorehabilitation: has it passed the COVID test? Expert Rev Neurother 2021; 21:833-836. [PMID: 34282965 DOI: 10.1080/14737175.2021.1958676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - Ann Barlow
- Center for Bionic Medicine, Shirley Ryan Ability Lab, Chicago, IL, USA
| | - Arun Jayaraman
- Departments of Physical Medicine and Rehabilitation; Medical Social Sciences; and Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.,Max Näder Center for Rehabilitation Technologies and Outcomes, Shirley Ryan Ability LabShirley Ryan Ability Lab, Chicago, IL, USA
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39
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Lonini L, Shawen N, Hoppe-Ludwig S, Deems-Dluhy S, Mummidisetty CK, Eisenberg Y, Jayaraman A. Combining Accelerometer and GPS Features to Evaluate Community Mobility in Knee Ankle Foot Orthoses (KAFO) Users. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1386-1393. [PMID: 34252030 PMCID: PMC8363134 DOI: 10.1109/tnsre.2021.3096434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Orthotic and assistive devices such as knee ankle foot orthoses (KAFO), come in a variety of forms and fits, with several levels of available features that could help users perform daily activities more naturally. However, objective data on the actual use of these devices outside of the research lab is usually not obtained. Such data could enhance traditional lab-based outcome measures and inform clinical decision-making when prescribing new orthotic and assistive technology. Here, we link data from a GPS unit and an accelerometer mounted on the orthotic device to quantify its usage in the community and examine the correlations with clinical metrics. We collected data from 14 individuals over a period of 2 months as they used their personal KAFO first, and then a novel research KAFO; for each device we quantified number of steps, cadence, time spent at community locations and time wearing the KAFO at those locations. Sensor-derived metrics showed that mobility patterns differed widely between participants (mean steps: 591.3, SD =704.2). The novel KAFO generally enabled participants to walk faster during clinical tests ( ∆6 Minute-Walk-Test=71.5m, p=0.006). However, some participants wore the novel device less often despite improved performance on these clinical measures, leading to poor correlation between changes in clinical outcome measures and changes in community mobility ( ∆6 Minute-Walk-Test - ∆ Community Steps: r=0.09, p=0.76). Our results suggest that some traditional clinical outcome measures may not be associated with the actual wear time of an assistive device in the community, and obtaining personalized data from real-world use through wearable technology is valuable.
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40
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Kim M, Moon Y, Hunt J, McKenzie KA, Horin A, McGuire M, Kim K, Hargrove LJ, Jayaraman A. A Novel Technique to Reject Artifact Components for Surface EMG Signals Recorded During Walking With Transcutaneous Spinal Cord Stimulation: A Pilot Study. Front Hum Neurosci 2021; 15:660583. [PMID: 34149379 PMCID: PMC8209256 DOI: 10.3389/fnhum.2021.660583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/06/2021] [Indexed: 11/13/2022] Open
Abstract
Transcutaneous spinal cord electrical stimulation (tSCS) is an emerging technology that targets to restore functionally integrated neuromuscular control of gait. The purpose of this study was to demonstrate a novel filtering method, Artifact Component Specific Rejection (ACSR), for removing artifacts induced by tSCS from surface electromyogram (sEMG) data for investigation of muscle response during walking when applying spinal stimulation. Both simulated and real tSCS contaminated sEMG data from six stroke survivors were processed using ACSR and notch filtering, respectively. The performance of the filters was evaluated with data collected in various conditions (e.g., simulated artifacts contaminating sEMG in multiple degrees, various tSCS intensities in five lower-limb muscles of six participants). In the simulation test, after applying the ACSR filter, the contaminated-signal was well matched with the original signal, showing a high correlation (r = 0.959) and low amplitude difference (normalized root means square error = 0.266) between them. In the real tSCS contaminated data, the ACSR filter showed superior performance on reducing the artifacts (96% decrease) over the notch filter (25% decrease). These results indicate that ACSR filtering is capable of eliminating artifacts from sEMG collected during tSCS application, improving the precision of quantitative analysis of muscle activity.
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Affiliation(s)
- Minjae Kim
- Shirley Ryan AbilityLab, Chicago, IL, United States.,Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Interaction and Robotics Research Center, Korea Institute of Science and Technology (KIST), Seoul, South Korea
| | - Yaejin Moon
- Shirley Ryan AbilityLab, Chicago, IL, United States.,Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jasmine Hunt
- Shirley Ryan AbilityLab, Chicago, IL, United States
| | | | - Adam Horin
- Shirley Ryan AbilityLab, Chicago, IL, United States.,Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Matt McGuire
- Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Keehoon Kim
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, South Korea
| | - Levi J Hargrove
- Shirley Ryan AbilityLab, Chicago, IL, United States.,Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Arun Jayaraman
- Shirley Ryan AbilityLab, Chicago, IL, United States.,Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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41
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Jayaraman C, Mummidisetty CK, Albert MV, Lipschutz R, Hoppe-Ludwig S, Mathur G, Jayaraman A. Using a microprocessor knee (C-Leg) with appropriate foot transitioned individuals with dysvascular transfemoral amputations to higher performance levels: a longitudinal randomized clinical trial. J Neuroeng Rehabil 2021; 18:88. [PMID: 34034753 PMCID: PMC8146219 DOI: 10.1186/s12984-021-00879-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/14/2021] [Indexed: 12/02/2022] Open
Abstract
Background Individuals with transfemoral amputations who are considered to be limited community ambulators are classified as Medicare functional classification (MFCL) level K2. These individuals are usually prescribed a non-microprocessor controlled knee (NMPK) with an appropriate foot for simple walking functions. However, existing research suggests that these individuals can benefit from using a microprocessor controlled knee (MPK) and appropriate foot for their ambulation, but cannot obtain one due to insurance policy restrictions. With a steady increase in older adults with amputations due to vascular conditions, it is critical to evaluate whether advanced prostheses can provide better safety and performance capabilities to maintain and improve quality of life in individuals who are predominantly designated MFCL level K2. To decipher this we conducted a 13 month longitudinal clinical trial to determine the benefits of using a C-Leg and 1M10 foot in individuals at K2 level with transfemoral amputation due to vascular disease. This longitudinal clinical trial incorporated recommendations prescribed by the lower limb prosthesis workgroup to design a study that can add evidence to improve reimbursement policy through clinical outcomes using an MPK in K2 level individuals with transfemoral amputation who were using an NMPK for everyday use. Methods Ten individuals (mean age: 63 ± 9 years) with unilateral transfemoral amputation due to vascular conditions designated as MFCL K2 participated in this longitudinal crossover randomized clinical trial. Baseline outcomes were collected with their current prosthesis. Participants were then randomized to one of two groups, either an intervention with the MPK with a standardized 1M10 foot or their predicate NMPK with a standardized 1M10 foot. On completion of the first intervention, participants crossed over to the next group to complete the study. Each intervention lasted for 6 months (3 months of acclimation and 3 months of take-home trial to monitor home use). At the end of each intervention, clinical outcomes and self-reported outcomes were collected to compare with their baseline performance. A generalized linear model ANOVA was used to compare the performance of each intervention with respect to their own baseline. Results Statistically significant and clinically meaningful improvements were observed in gait performance, safety, and participant-reported measures when using the MPK C-Leg + 1M10 foot. Most participants were able to achieve higher clinical scores in gait speed, balance, self-reported mobility, and fall safety, while using the MPK + 1M10 combination. The improvement in scores were within range of scores achieved by individuals with K3 functional level as reported in previous studies. Conclusions Individuals with transfemoral amputation from dysvascular conditions designated MFCL level K2 benefited from using an MPK + appropriate foot. The inference and evidence from this longitudinal clinical trial will add to the knowledgebase related to reimbursement policy-making. Trial registration This study is registered on clinical trials.gov with the study title “Functional outcomes in dysvascular transfemoral amputees” and the associated ClinicalTrials.gov Identifier: NCT01537211. The trial was retroactively registered on February 7, 2012 after the first participant was enrolled. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00879-3.
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Affiliation(s)
- Chandrasekaran Jayaraman
- Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Chaithanya K Mummidisetty
- Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA
| | - Mark V Albert
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, USA.,Department of Computer Science and Engineering, University of North Texas, Denton, USA.,Department of Biomedical Engineering, University of North Texas, Denton, USA
| | - Robert Lipschutz
- Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA
| | - Shenan Hoppe-Ludwig
- Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA
| | - Gayatri Mathur
- Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA
| | - Arun Jayaraman
- Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA. .,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, USA.
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Ni X, Ouyang W, Jeong H, Kim JT, Tzaveils A, Mirzazadeh A, Wu C, Lee JY, Keller M, Mummidisetty CK, Patel M, Shawen N, Huang J, Chen H, Ravi S, Chang JK, Lee K, Wu Y, Lie F, Kang YJ, Kim JU, Chamorro LP, Banks AR, Bharat A, Jayaraman A, Xu S, Rogers JA. Automated, multiparametric monitoring of respiratory biomarkers and vital signs in clinical and home settings for COVID-19 patients. Proc Natl Acad Sci U S A 2021; 118:e2026610118. [PMID: 33893178 PMCID: PMC8126790 DOI: 10.1073/pnas.2026610118] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/22/2021] [Indexed: 11/18/2022] Open
Abstract
Capabilities in continuous monitoring of key physiological parameters of disease have never been more important than in the context of the global COVID-19 pandemic. Soft, skin-mounted electronics that incorporate high-bandwidth, miniaturized motion sensors enable digital, wireless measurements of mechanoacoustic (MA) signatures of both core vital signs (heart rate, respiratory rate, and temperature) and underexplored biomarkers (coughing count) with high fidelity and immunity to ambient noises. This paper summarizes an effort that integrates such MA sensors with a cloud data infrastructure and a set of analytics approaches based on digital filtering and convolutional neural networks for monitoring of COVID-19 infections in sick and healthy individuals in the hospital and the home. Unique features are in quantitative measurements of coughing and other vocal events, as indicators of both disease and infectiousness. Systematic imaging studies demonstrate correlations between the time and intensity of coughing, speaking, and laughing and the total droplet production, as an approximate indicator of the probability for disease spread. The sensors, deployed on COVID-19 patients along with healthy controls in both inpatient and home settings, record coughing frequency and intensity continuously, along with a collection of other biometrics. The results indicate a decaying trend of coughing frequency and intensity through the course of disease recovery, but with wide variations across patient populations. The methodology creates opportunities to study patterns in biometrics across individuals and among different demographic groups.
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Affiliation(s)
- Xiaoyue Ni
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708
| | - Wei Ouyang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208
| | - Hyoyoung Jeong
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208
| | - Jin-Tae Kim
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208
| | - Andreas Tzaveils
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208
- Medical Scientist Training Program, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Ali Mirzazadeh
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332
| | - Changsheng Wu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208
| | | | | | - Chaithanya K Mummidisetty
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL 60611
| | - Manish Patel
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208
- College of Medicine, University of Illinois at Chicago, Chicago, IL 60612
| | - Nicholas Shawen
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL 60611
| | - Joy Huang
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Hope Chen
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Sowmya Ravi
- Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Jan-Kai Chang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208
- Wearifi Inc., Evanston, IL 60201
| | - KunHyuck Lee
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208
| | - Yixin Wu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208
| | - Ferrona Lie
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208
| | - Youn J Kang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208
| | - Jong Uk Kim
- School of Chemical Engineering, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Leonardo P Chamorro
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Champaign, IL 61801
| | - Anthony R Banks
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208
| | - Ankit Bharat
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL 60611
| | - Shuai Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208;
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208;
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208
- Department of Chemistry, Northwestern University, Evanston, IL 60208
- Department of Electrical Engineering and Computer Science, Northwestern University, Evanston, IL 60208
- Department of Neurological Surgery, Northwestern University, Evanston, IL 60208
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43
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Jeong H, Lee JY, Lee K, Kang YJ, Kim JT, Avila R, Tzavelis A, Kim J, Ryu H, Kwak SS, Kim JU, Banks A, Jang H, Chang JK, Li S, Mummidisetty CK, Park Y, Nappi S, Chun KS, Lee YJ, Kwon K, Ni X, Chung HU, Luan H, Kim JH, Wu C, Xu S, Banks A, Jayaraman A, Huang Y, Rogers JA. Differential cardiopulmonary monitoring system for artifact-canceled physiological tracking of athletes, workers, and COVID-19 patients. Sci Adv 2021; 7:eabg3092. [PMID: 33980495 PMCID: PMC8115927 DOI: 10.1126/sciadv.abg3092] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/22/2021] [Indexed: 05/27/2023]
Abstract
Soft, skin-integrated electronic sensors can provide continuous measurements of diverse physiological parameters, with broad relevance to the future of human health care. Motion artifacts can, however, corrupt the recorded signals, particularly those associated with mechanical signatures of cardiopulmonary processes. Design strategies introduced here address this limitation through differential operation of a matched, time-synchronized pair of high-bandwidth accelerometers located on parts of the anatomy that exhibit strong spatial gradients in motion characteristics. When mounted at a location that spans the suprasternal notch and the sternal manubrium, these dual-sensing devices allow measurements of heart rate and sounds, respiratory activities, body temperature, body orientation, and activity level, along with swallowing, coughing, talking, and related processes, without sensitivity to ambient conditions during routine daily activities, vigorous exercises, intense manual labor, and even swimming. Deployments on patients with COVID-19 allow clinical-grade ambulatory monitoring of the key symptoms of the disease even during rehabilitation protocols.
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Affiliation(s)
- Hyoyoung Jeong
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Jong Yoon Lee
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Sibel Health, Niles, IL 60714, USA
| | - KunHyuck Lee
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Youn J Kang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Jin-Tae Kim
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Raudel Avila
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Andreas Tzavelis
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Joohee Kim
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Hanjun Ryu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Sung Soo Kwak
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- School of Advanced Materials Science and Engineering, Sungkyunkwan University (SKKU), Suwon 16419, Republic of Korea
| | - Jong Uk Kim
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- School of Chemical Engineering, SKKU, Suwon 16419, Republic of Korea
| | - Aaron Banks
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Hokyung Jang
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
| | | | - Shupeng Li
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Chaithanya K Mummidisetty
- Max Nader Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL 60611, USA
| | - Yoonseok Park
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Simone Nappi
- Department of Civil Engineering and Computer Science Engineering, University of Rome Tor Vergata, Via del Politecnico, 1, 00133, Rome, Italy
| | - Keum San Chun
- Electrical and Computer Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX 78712, USA
| | - Young Joong Lee
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Kyeongha Kwon
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Xiaoyue Ni
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708, USA
| | | | - Haiwen Luan
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Jae-Hwan Kim
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Changsheng Wu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Shuai Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Sibel Health, Niles, IL 60714, USA
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Anthony Banks
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Wearifi Inc., Evanston, IL 60201, USA
| | - Arun Jayaraman
- Max Nader Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL 60611, USA
- Departments of Physical Medicine and Rehabilitation and Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Yonggang Huang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA.
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Departments of Electrical and Computer Engineering and Chemistry, Northwestern University, Evanston, IL 60208, USA
- Department of Neurological Surgery, Northwestern University, Evanston, IL 60208, USA
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44
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McGibbon C, Sexton A, Jayaraman A, Deems-Dluhy S, Fabara E, Adans-Dester C, Bonato P, Marquis F, Turmel S, Belzile E. Evaluation of a lower-extremity robotic exoskeleton for people with knee osteoarthritis. Assist Technol 2021; 34:543-556. [PMID: 33571072 DOI: 10.1080/10400435.2021.1887400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
A multi-site study was conducted to evaluate the efficacy of the Keeogo™ exoskeleton as a mobility assist device for use in the clinic and at home in people with knee osteoarthritis (KOA). Twenty-four participants were randomized in a two-stage cross-over design that evaluated the immediate effects of using the exoskeleton in the clinic and the cumulative effects of training and home use. Immediate effects were quantified by comparing 1) physical performance with|without (W|WO) the device during a battery of mobility tests, and 2) physical activity levels at home (actigraphy) for one month, two weeks W|WO the device. Cumulative effects were quantified as change in physical performance W and WO over time. WOMAC and other self-report scales were measured and usability assessed. There were no immediate effects on physical performance or physical activity at home; however, there were cumulative effects as indicated by improved stair time (p = .001) as well as improved WOMAC pain (p = .004) and function (p = .003). There was a direct relationship between improved physical function and improved WOMAC pain (r = -.677, p < .001) and stiffness (r = .537, p = .007). Weight and battery life were identified as important to usability. A full-scale RCT with more participants, longer study period, and better usage monitoring is warranted.
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Affiliation(s)
- Chris McGibbon
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Andrew Sexton
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Arun Jayaraman
- Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago), Chicago, Illinois, USA
| | - Susan Deems-Dluhy
- Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago), Chicago, Illinois, USA
| | - Eric Fabara
- Dept of Physical Medicine & Rehabilitation, Harvard Medical School at Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Catherine Adans-Dester
- Dept of Physical Medicine & Rehabilitation, Harvard Medical School at Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Paolo Bonato
- Dept of Physical Medicine & Rehabilitation, Harvard Medical School at Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Francois Marquis
- Dept of Surgery, Division of Orthopedic Surgery, CHU de Québec-Université Laval, Québec, Québec City, Canada
| | - Sylvie Turmel
- Dept of Surgery, Division of Orthopedic Surgery, CHU de Québec-Université Laval, Québec, Québec City, Canada
| | - Etienne Belzile
- Dept of Surgery, Division of Orthopedic Surgery, CHU de Québec-Université Laval, Québec, Québec City, Canada
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45
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Shin SY, Kim Y, Jayaraman A, Park HS. Relationship between gait quality measures and modular neuromuscular control parameters in chronic post-stroke individuals. J Neuroeng Rehabil 2021; 18:58. [PMID: 33827607 PMCID: PMC8028248 DOI: 10.1186/s12984-021-00860-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 03/24/2021] [Indexed: 12/17/2022] Open
Abstract
Background Recent evidence suggests that disinhibition and/or hyperexcitation of the brainstem descending pathways and intraspinal motor network diffuse spastic synergistic activation patterns after stroke. This results in simplified or merged muscle sets (i.e., muscle modules or synergies) compared to non-impaired individuals and this leads to poor walking performance. However, the relations of how these neuromuscular deficits influence gait quality (e.g., symmetry or natural walking patterns) are still unclear. The objective of this exploratory study was to investigate the relations of modular neuromuscular framework and gait quality measures in chronic stroke individuals. Methods Sixteen chronic post-stroke individuals participated in this study. Full lower body three-dimensional kinematics and electromyography (EMG) were concurrently measured during overground walking at a comfortable speed. We first examined changes in gait quality measures across the number of muscle modules using linear regression model. Then, a stepwise multiple regression was used to investigate the optimal combination of the neuromuscular parameters that associates with gait quality measures. Results We observed that subjects who had a lower number of muscle modules revealed reduced function (i.e., speed) and greater asymmetry in the kinematic parameters including limb length, footpath area, knee flexion/extension, and hip abduction/adduction (all p < 0.05). We also found that the combination of input variables from the modular neuromuscular control framework significantly associated with gait quality measures (average \documentclass[12pt]{minimal}
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\begin{document}$${R}^{2}=42.5\mathrm{\%}$$\end{document}R2=42.5%). Those variables included variability accounted for (\documentclass[12pt]{minimal}
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\begin{document}$$VAF$$\end{document}VAF) information from the muscle modules and area under the EMG envelope curves of the quadriceps (i.e., rectus femoris and vastus lateralis) and tibialis anterior muscles. Conclusions The results suggest that there exists a significant correlation between the neuromuscular control framework and the gait quality measures. This study helps to understand the underlying mechanism of disturbances in gait quality and provides insight for a more comprehensive outcome measure to assess gait impairment after stroke. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00860-0.
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Affiliation(s)
- Sung Yul Shin
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daehak-ro 291, Yuseong-gu, Daejeon, 34141, Republic of Korea.,Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, 355 E Erie St, Chicago, IL, 60611, USA
| | - Yusung Kim
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daehak-ro 291, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, 355 E Erie St, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, 710 N Lake Shore Dr, Chicago, IL, 60611, USA
| | - Hyung-Soon Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daehak-ro 291, Yuseong-gu, Daejeon, 34141, Republic of Korea.
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Lonini L, Shawen N, Botonis O, Fanton M, Jayaraman C, Mummidisetty CK, Shin SY, Rushin C, Jenz S, Xu S, Rogers JA, Jayaraman A. Rapid Screening of Physiological Changes Associated With COVID-19 Using Soft-Wearables and Structured Activities: A Pilot Study. IEEE J Transl Eng Health Med 2021; 9:4900311. [PMID: 33665044 PMCID: PMC7924653 DOI: 10.1109/jtehm.2021.3058841] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/15/2021] [Accepted: 02/06/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Controlling the spread of the COVID-19 pandemic largely depends on scaling up the testing infrastructure for identifying infected individuals. Consumer-grade wearables may present a solution to detect the presence of infections in the population, but the current paradigm requires collecting physiological data continuously and for long periods of time on each individual, which poses limitations in the context of rapid screening. Technology: Here, we propose a novel paradigm based on recording the physiological responses elicited by a short (~2 minutes) sequence of activities (i.e. "snapshot"), to detect symptoms associated with COVID-19. We employed a novel body-conforming soft wearable sensor placed on the suprasternal notch to capture data on physical activity, cardio-respiratory function, and cough sounds. RESULTS We performed a pilot study in a cohort of individuals (n=14) who tested positive for COVID-19 and detected altered heart rate, respiration rate and heart rate variability, relative to a group of healthy individuals (n=14) with no known exposure. Logistic regression classifiers were trained on individual and combined sets of physiological features (heartbeat and respiration dynamics, walking cadence, and cough frequency spectrum) at discriminating COVID-positive participants from the healthy group. Combining features yielded an AUC of 0.94 (95% CI=[0.92, 0.96]) using a leave-one-subject-out cross validation scheme. Conclusions and Clinical Impact: These results, although preliminary, suggest that a sensor-based snapshot paradigm may be a promising approach for non-invasive and repeatable testing to alert individuals that need further screening.
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Affiliation(s)
- Luca Lonini
- Shirley Ryan AbilityLabChicagoIL60611USA
- Department of Physical Medicine and RehabilitationFeinberg School of MedicineNorthwestern UniversityChicagoIL60611USA
| | - Nicholas Shawen
- Shirley Ryan AbilityLabChicagoIL60611USA
- Department of Physical Medicine and RehabilitationFeinberg School of MedicineNorthwestern UniversityChicagoIL60611USA
| | | | - Michael Fanton
- Shirley Ryan AbilityLabChicagoIL60611USA
- Department of Biomedical EngineeringMcCormick School of EngineeringNorthwestern UniversityChicagoIL60611USA
| | - Chadrasekaran Jayaraman
- Shirley Ryan AbilityLabChicagoIL60611USA
- Department of Physical Medicine and RehabilitationFeinberg School of MedicineNorthwestern UniversityChicagoIL60611USA
| | | | - Sung Yul Shin
- Shirley Ryan AbilityLabChicagoIL60611USA
- Department of Physical Medicine and RehabilitationFeinberg School of MedicineNorthwestern UniversityChicagoIL60611USA
| | | | | | - Shuai Xu
- Simpson Querrey Institute, Northwestern UniversityChicagoIL60611USA
| | - John A. Rogers
- Simpson Querrey Institute, Northwestern UniversityChicagoIL60611USA
| | - Arun Jayaraman
- Shirley Ryan AbilityLabChicagoIL60611USA
- Department of Physical Medicine and RehabilitationFeinberg School of MedicineNorthwestern UniversityChicagoIL60611USA
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47
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McGibbon C, Sexton A, Gryfe P, Dutta T, Jayaraman A, Deems-Dluhy S, Novak A, Fabara E, Adans-Dester C, Bonato P. Effect of using of a lower-extremity exoskeleton on disability of people with multiple sclerosis. Disabil Rehabil Assist Technol 2021:1-8. [DOI: 10.1080/17483107.2021.1874064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Chris McGibbon
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
| | - Andrew Sexton
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, Canada
| | - Pearl Gryfe
- Assistive Technology Clinic, Toronto, Canada
| | - Tilak Dutta
- Toronto Rehabilitation Institute, Toronto, Canada
| | - Arun Jayaraman
- Shirley Ryan AbilityLab/Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Susan Deems-Dluhy
- Shirley Ryan AbilityLab/Rehabilitation Institute of Chicago, Chicago, IL, USA
| | | | - Eric Fabara
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Catherine Adans-Dester
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
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48
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Peyton C, Sukal Moulton T, Carroll AJ, Anderson E, Brozek A, Davis MM, Horowitz J, Jayaraman A, O'Brien M, Patrick C, Pouppirt N, Villamar J, Xu S, Lieber RL, Wakschlag LS, Krogh-Jespersen S. Starting at Birth: An Integrative, State-of-the-Science Framework for Optimizing Infant Neuromotor Health. Front Pediatr 2021; 9:787196. [PMID: 35141178 PMCID: PMC8820372 DOI: 10.3389/fped.2021.787196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/17/2021] [Indexed: 11/18/2022] Open
Abstract
Numerous conditions and circumstances place infants at risk for poor neuromotor health, yet many are unable to receive treatment until a definitive diagnosis is made, sometimes several years later. In this integrative perspective, we describe an extensive team science effort to develop a transdiagnostic approach to neuromotor health interventions designed to leverage the heightened neuroplasticity of the first year of life. We undertook the following processes: (1) conducted a review of the literature to extract common principles and strategies underlying effective neuromotor health interventions; (2) hosted a series of expert scientific exchange panels to discuss common principles, as well as practical considerations and/or lessons learned from application in the field; and (3) gathered feedback and input from diverse stakeholders including infant caregivers and healthcare providers. The resultant framework was a pragmatic, evidence-based, transdiagnostic approach to optimize neuromotor health for high-risk infants based on four principles: (a) active learning, (b) environmental enrichment, (c) caregiver engagement, and (d) strength-based approaches. In this perspective paper, we delineate these principles and their potential applications. Innovations include: engagement of multiple caregivers as critical drivers of the intervention; promoting neuromotor health in the vulnerability phase, rather than waiting to treat neuromotor disease; integrating best practices from adjacent fields; and employing a strengths-based approach. This framework holds promise for implementation as it is scalable, pragmatic, and holistically addresses both the needs of the infant and their family.
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Affiliation(s)
- Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Theresa Sukal Moulton
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Allison J Carroll
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Erica Anderson
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States
| | - Alexandra Brozek
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Matthew M Davis
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Ann and Robert H. Lurie Children's Hospital, Stanley Manne Children's Research Institute, Chicago, IL, United States
| | - Jessica Horowitz
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | | | | | - Cheryl Patrick
- Division of Rehabilitative Services, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Nicole Pouppirt
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Juan Villamar
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Shuai Xu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Richard L Lieber
- Shirley Ryan AbilityLab, Chicago, IL, United States.,Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lauren S Wakschlag
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sheila Krogh-Jespersen
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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49
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Vivodtzev I, Tan AQ, Hermann M, Jayaraman A, Stahl V, Rymer WZ, Mitchell GS, Hayes HB, Trumbower RD. Mild to Moderate Sleep Apnea Is Linked to Hypoxia-induced Motor Recovery after Spinal Cord Injury. Am J Respir Crit Care Med 2020; 202:887-890. [PMID: 32369393 DOI: 10.1164/rccm.202002-0245le] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Isabelle Vivodtzev
- Harvard Medical School Boston, Massachusetts.,Spaulding Rehabilitation Hospital Boston, Massachusetts.,Sorbonne Université Paris, France.,Inserm Paris, France
| | - Andrew Q Tan
- Harvard Medical School Boston, Massachusetts.,Spaulding Rehabilitation Hospital Boston, Massachusetts
| | | | | | - Victoria Stahl
- Emory University School of Medicine Atlanta, Georgia and
| | | | | | | | - Randy D Trumbower
- Harvard Medical School Boston, Massachusetts.,Spaulding Rehabilitation Hospital Boston, Massachusetts
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50
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Ehrlich-Jones L, Crown DS, Kinnett-Hopkins D, Field-Fote E, Furbish C, Mummidisetty CK, Bond RA, Forrest G, Jayaraman A, Heinemann AW. Clinician Perceptions of Robotic Exoskeletons for Locomotor Training After Spinal Cord Injury: A Qualitative Approach. Arch Phys Med Rehabil 2020; 102:203-215. [PMID: 33171130 DOI: 10.1016/j.apmr.2020.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the experiences of clinicians who have used robotic exoskeletons in their practice and acquire information that can guide clinical decisions and training strategies related to robotic exoskeletons. DESIGN Qualitative, online survey study, and 4 single-session focus groups followed by thematic analysis to define themes. SETTING Focus groups were conducted at 3 regional rehabilitation hospitals and 1 Veteran's Administration (VA) Medical Center. PARTICIPANTS Clinicians (N=40) reported their demographic characteristics and clinical experience using robotic exoskeletons. Twenty-nine clinicians participated in focus groups at regional hospitals that use robotic exoskeletons, as well as 1 VA Medical Center. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Clinicians' preferences, experiences, training strategies, and clinical decisions on how robotic exoskeleton devices are used with Veterans and civilians with spinal cord injury. RESULTS Clinicians had an average of 3 years of experience using exoskeletons in clinical and research settings. Major themes emerging from focus group discussions included appropriateness of patient goals, patient selection criteria, realistic patient expectations, patient and caregiver training for use of exoskeletons, perceived benefits, preferences regarding specific exoskeletons, and device limitations and therapy recommendations. CONCLUSIONS Clinicians identified benefits of exoskeleton use including decreased physical burden and fatigue while maximizing patient mobility, increased safety of clinicians and patients, and expanded device awareness and preferences. Suitability of exoskeletons for patients with various characteristics and managing expectations were concerns. Clinicians identified research opportunities as technology continues to advance toward safer, lighter, and hands-free devices.
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Affiliation(s)
- Linda Ehrlich-Jones
- Shirley Ryan AbilityLab, Center for Rehabilitation Outcomes Research, Chicago, IL; Northwestern University Feinberg School of Medicine, Department of Physical Medicine & Rehabilitation, Chicago, IL.
| | - Deborah S Crown
- Shirley Ryan AbilityLab, Center for Rehabilitation Outcomes Research, Chicago, IL
| | - Dominique Kinnett-Hopkins
- Northwestern University Feinberg School of Medicine, Department of Physical Medicine & Rehabilitation, Chicago, IL
| | - Edelle Field-Fote
- Shepherd Center, Spinal Cord Injury Research, Atlanta, GA; Emory University, Division of Physical Therapy, Atlanta, GA
| | - Cathy Furbish
- Shepherd Center, Spinal Cord Injury Research, Atlanta, GA
| | - Chaithanya K Mummidisetty
- Northwestern University Feinberg School of Medicine, Department of Physical Medicine & Rehabilitation, Chicago, IL
| | - Rachel A Bond
- Shirley Ryan AbilityLab, Center for Rehabilitation Outcomes Research, Chicago, IL
| | - Gail Forrest
- Kessler Foundation, Center for Spinal Stimulation, East Hanover, NJ; Rutgers New Jersey Medical School, Newark, NJ
| | - Arun Jayaraman
- Northwestern University Feinberg School of Medicine, Department of Physical Medicine & Rehabilitation, Chicago, IL
| | - Allen W Heinemann
- Northwestern University Feinberg School of Medicine, Department of Physical Medicine & Rehabilitation, Chicago, IL
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