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Zbytniewska-Mégret M, Salzmann C, Kanzler CM, Hassa T, Gassert R, Lambercy O, Liepert J. The Evolution of Hand Proprioceptive and Motor Impairments in the Sub-Acute Phase After Stroke. Neurorehabil Neural Repair 2023; 37:823-836. [PMID: 37953595 PMCID: PMC10685702 DOI: 10.1177/15459683231207355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND Hand proprioception is essential for fine movements and therefore many activities of daily living. Although frequently impaired after stroke, it is unclear how hand proprioception evolves in the sub-acute phase and whether it follows a similar pattern of changes as motor impairments. OBJECTIVE This work investigates whether there is a corresponding pattern of changes over time in hand proprioception and motor function as comprehensively quantified by a combination of robotic, clinical, and neurophysiological assessments. METHODS Finger proprioception (position sense) and motor function (force, velocity, range of motion) were evaluated using robotic assessments at baseline (<3 months after stroke) and up to 4 weeks later (discharge). Clinical assessments (among others, Box & Block Test [BBT]) as well as Somatosensory/Motor Evoked Potentials (SSEP/MEP) were additionally performed. RESULTS Complete datasets from 45 participants post-stroke were obtained. For 42% of all study participants proprioception and motor function had a dissociated pattern of changes (only 1 function considerably improved). This dissociation was either due to the absence of a measurable impairment in 1 modality at baseline, or due to a severe lesion of central somatosensory or motor tracts (absent SSEP/MEP). Better baseline BBT correlated with proprioceptive gains, while proprioceptive impairment at baseline did not correlate with change in BBT. CONCLUSIONS Proprioception and motor function frequently followed a dissociated pattern of changes in sub-acute stroke. This highlights the importance of monitoring both functions, which could help to further personalize therapies.
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Affiliation(s)
- Monika Zbytniewska-Mégret
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
| | | | - Christoph M. Kanzler
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Thomas Hassa
- Kliniken Schmieder Allensbach, Allensbach, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Joachim Liepert
- Kliniken Schmieder Allensbach, Allensbach, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
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Cheng HJ, Chin LF, Kanzler CM, Lehner R, Kuah CWK, Kager S, Josse E, Samkharadze T, Sidarta A, Gonzalez PC, Lie E, Zbytniewska-Mégret M, Wee SK, Liang P, Gassert R, Chua K, Lambercy O, Wenderoth N. Upper limb sensorimotor recovery in Asian stroke survivors: a study protocol for the development and implementation of a Technology-Assisted dIgitaL biOmaRker (TAILOR) platform. Front Neurol 2023; 14:1246888. [PMID: 38107648 PMCID: PMC10722087 DOI: 10.3389/fneur.2023.1246888] [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: 06/24/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023] Open
Abstract
Background Stroke is a leading cause of lifelong disability worldwide, partially driven by a reduced ability to use the upper limb in daily life causing increased dependence on caregivers. However, post-stroke functional impairments have only been investigated using limited clinical scores, during short-term longitudinal studies in relatively small patient cohorts. With the addition of technology-based assessments, we propose to complement clinical assessments with more sensitive and objective measures that could more holistically inform on upper limb impairment recovery after stroke, its impact on upper limb use in daily life, and on overall quality of life. This paper describes a pragmatic, longitudinal, observational study protocol aiming to gather a uniquely rich multimodal database to comprehensively describe the time course of upper limb recovery in a representative cohort of 400 Asian adults after stroke. Particularly, we will characterize the longitudinal relationship between upper limb recovery, common post-stroke impairments, functional independence and quality of life. Methods Participants with stroke will be tested at up to eight time points, from within a month to 3 years post-stroke, to capture the influence of transitioning from hospital to community settings. We will perform a battery of established clinical assessments to describe the factors most likely to influence upper limb recovery. Further, we will gather digital health biomarkers from robotic or wearable sensing technology-assisted assessments to sensitively characterize motor and somatosensory impairments and upper limb use in daily life. We will also use both quantitative and qualitative measures to understand health-related quality of life. Lastly, we will describe neurophysiological motor status using transcranial magnetic stimulation. Statistics Descriptive analyses will be first performed to understand post-stroke upper limb impairments and recovery at various time points. The relationships between digital biomarkers and various domains will be explored to inform key aspects of upper limb recovery and its dynamics using correlation matrices. Multiple statistical models will be constructed to characterize the time course of upper limb recovery post-stroke. Subgroups of stroke survivors exhibiting distinct recovery profiles will be identified. Conclusion This is the first study complementing clinical assessments with technology-assisted digital biomarkers to investigate upper limb sensorimotor recovery in Asian stroke survivors. Overall, this study will yield a multimodal data set that longitudinally characterizes post-stroke upper limb recovery in functional impairments, daily-life upper limb use, and health-related quality of life in a large cohort of Asian stroke survivors. This data set generates valuable information on post-stroke upper limb recovery and potentially allows researchers to identify different recovery profiles of subgroups of Asian stroke survivors. This enables the comparisons between the characteristics and recovery profiles of stroke survivors in different regions. Thus, this study lays out the basis to identify early predictors for upper limb recovery, inform clinical decision-making in Asian stroke survivors and establish tailored therapy programs. Clinical trial registration ClinicalTrials.gov, identifier: NCT05322837.
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Affiliation(s)
- Hsiao-Ju Cheng
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
| | - Lay Fong Chin
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Christoph M Kanzler
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Rea Lehner
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
| | - Christopher W K Kuah
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Simone Kager
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Eva Josse
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Tengiz Samkharadze
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
| | - Ananda Sidarta
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Pablo Cruz Gonzalez
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Eloise Lie
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Monika Zbytniewska-Mégret
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Seng Kwee Wee
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
- Singapore Institute of Technology (SIT), Singapore, Singapore
| | - Phyllis Liang
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Roger Gassert
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Karen Chua
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Olivier Lambercy
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Nicole Wenderoth
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Neural Control of Movement Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
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Kanzler CM, Lessard I, Gassert R, Brais B, Gagnon C, Lambercy O. Digital health metrics reveal upper limb impairment profiles in ARSACS. J Neurol Sci 2023; 448:120621. [PMID: 37004405 DOI: 10.1016/j.jns.2023.120621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Adults with autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) often present with reduced upper limb coordination affecting their independence in daily life. Previous studies in ARSACS identified reduced performance in clinical assessments requiring fine and gross dexterity as well as prehension. However, the kinematic and kinetic aspects underlying reduced upper limb coordination in ARSACS have not been systematically investigated yet. In this work, we aimed to provide a detailed characterization of alterations in upper limb movement patterns and hand grip forces in 57 participants with ARSACS. METHODS We relied on a goal-directed technology-aided assessment task, which provides eight previously validated digital health metrics describing movement efficiency, smoothness, speed, and grip force control. RESULTS First, we observed that 98.3% of the participants were impaired in at least one of the metrics, that all metrics are significantly impaired on a population level, and that grip force control during precise manipulations is most commonly and strongly impaired. Second, we identified high inter-participant variability in the kinematic and kinetic impairment profiles, thereby capturing different clinical profiles subjectively observed in this population. Lastly, abnormal goal-directed task performance in ARSACS could be best explained by reduced movement speed, efficiency, and especially force control during precise manipulations, while abnormal movement smoothness did not have a significant effect. INTERPRETATION This work helped to refine the clinical profile of ARSACS and highlights the need for characterizing individual kinematic and kinetic impairment profiles in clinical trials in ARSACS.
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Cheng HJ, Chin LF, Kanzler CM, Lehner R, Kuah CWK, Wee SK, Liang P, Chua KS, Lambercy O, Wenderoth N. Deep Phenotyping of Upper Limb Sensorimotor Recovery in Asian Stroke Survivors: A Study Protocol. Arch Phys Med Rehabil 2023. [DOI: 10.1016/j.apmr.2022.12.059] [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: 03/05/2023]
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Zbytniewska-Mégret M, Kanzler CM, Raats J, Yilmazer C, Feys P, Gassert R, Lambercy O, Lamers I. Reliability, validity and clinical usability of a robotic assessment of finger proprioception in persons with multiple sclerosis. Mult Scler Relat Disord 2023; 70:104521. [PMID: 36701909 DOI: 10.1016/j.msard.2023.104521] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 12/31/2022] [Accepted: 01/13/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Multiple sclerosis often leads to proprioceptive impairments of the hand. However, it is challenging to objectively assess such deficits using clinical methods, thereby also impeding accurate tracking of disease progression and hence the application of personalized rehabilitation approaches. OBJECTIVE We aimed to evaluate test-retest reliability, validity, and clinical usability of a novel robotic assessment of hand proprioceptive impairments in persons with multiple sclerosis (pwMS). METHODS The assessment was implemented in an existing one-degree of freedom end-effector robot (ETH MIKE) acting on the index finger metacarpophalangeal joint. It was performed by 45 pwMS and 59 neurologically intact controls. Additionally, clinical assessments of somatosensation, somatosensory evoked potentials and usability scores were collected in a subset of pwMS. RESULTS The test-retest reliability of robotic task metrics in pwMS was good (ICC=0.69-0.87). The task could identify individuals with impaired proprioception, as indicated by the significant difference between pwMS and controls, as well as a high impairment classification agreement with a clinical measure of proprioception (85.00-86.67%). Proprioceptive impairments were not correlated with other modalities of somatosensation. The usability of the assessment system was satisfactory (System Usability Scale ≥73.10). CONCLUSION The proposed assessment is a promising alternative to commonly used clinical methods and will likely contribute to a better understanding of proprioceptive impairments in pwMS.
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Affiliation(s)
- Monika Zbytniewska-Mégret
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - Christoph M Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland; Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | - Joke Raats
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; Universitair MS Centrum UMSC Hasselt, Pelt, Belgium
| | - Cigdem Yilmazer
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; Universitair MS Centrum UMSC Hasselt, Pelt, Belgium
| | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; Universitair MS Centrum UMSC Hasselt, Pelt, Belgium
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland; Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland; Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | - Ilse Lamers
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; Universitair MS Centrum UMSC Hasselt, Pelt, Belgium; Noorderhart Rehabilitation and MS Centre, Pelt, Belgium
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Meyer JT, Tanczak N, Kanzler CM, Pelletier C, Gassert R, Lambercy O. Design and validation of a novel online platform to support the usability evaluation of wearable robotic devices. Wearable Technol 2023; 4:e3. [PMID: 38487781 PMCID: PMC10936320 DOI: 10.1017/wtc.2022.31] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/12/2022] [Accepted: 12/05/2022] [Indexed: 03/17/2024]
Abstract
Wearable robotic devices (WRD) are still struggling to fulfill their vast potential. Inadequate daily life usability is one of the main hindrances to increased technology acceptance. Improving usability evaluation practices during the development of WRD could help address these limitations. In this work, we present the design and validation of a novel online platform aiming to fill this gap, the Interactive Usability Toolbox (IUT). This platform consists of a public website that offers an interactive, context-specific search within a database of 154 user research methods and educational information about usability. In a dedicated study, the effect of this platform to support usability evaluation was investigated. Twelve WRD experts were asked to complete the task of defining usability evaluation protocols for two specific use cases. The platform was provided to support one of the use cases. The quality and composition of the proposed protocols were assessed by (i) two blinded reviewers, (ii) the participants themselves, and (iii) the study coordinators. We showed that using the IUT significantly affected the proposed evaluation focus, shifting protocols from mainly effectiveness-oriented to more user-focused studies. The protocol quality, as rated by the external reviewers, remained equivalent to those designed with conventional strategies. A mixed-method usability evaluation of the platform yielded an overall positive image, with detailed suggestions for further improvements. The IUT is expected to positively affect the evaluation and development of WRD through its educational value, the context-specific recommendations supporting ongoing benchmarking endeavors, and highlighting the value of qualitative user research.
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Affiliation(s)
- Jan T. Meyer
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Natalie Tanczak
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Christoph M. Kanzler
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Colin Pelletier
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
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Clay I, Peerenboom N, Connors DE, Bourke S, Keogh A, Wac K, Gur-Arie T, Baker J, Bull C, Cereatti A, Cormack F, Eggenspieler D, Foschini L, Ganea R, Groenen PM, Gusset N, Izmailova E, Kanzler CM, Leyens L, Lyden K, Mueller A, Nam J, Ng WF, Nobbs D, Orfaniotou F, Perumal TM, Piwko W, Ries A, Scotland A, Taptiklis N, Torous J, Vereijken B, Xu S, Baltzer L, Vetter T, Goldhahn J, Hoffmann SC. Reverse Engineering of Digital Measures: Inviting Patients to the Conversation. Digit Biomark 2023; 7:28-44. [PMID: 37206894 PMCID: PMC10189241 DOI: 10.1159/000530413] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/07/2023] [Indexed: 05/21/2023] Open
Abstract
Background Digital measures offer an unparalleled opportunity to create a more holistic picture of how people who are patients behave in their real-world environments, thereby establishing a better connection between patients, caregivers, and the clinical evidence used to drive drug development and disease management. Reaching this vision will require achieving a new level of co-creation between the stakeholders who design, develop, use, and make decisions using evidence from digital measures. Summary In September 2022, the second in a series of meetings hosted by the Swiss Federal Institute of Technology in Zürich, the Foundation for the National Institutes of Health Biomarkers Consortium, and sponsored by Wellcome Trust, entitled "Reverse Engineering of Digital Measures," was held in Zurich, Switzerland, with a broad range of stakeholders sharing their experience across four case studies to examine how patient centricity is essential in shaping development and validation of digital evidence generation tools. Key Messages In this paper, we discuss progress and the remaining barriers to widespread use of digital measures for evidence generation in clinical development and care delivery. We also present key discussion points and takeaways in order to continue discourse and provide a basis for dissemination and outreach to the wider community and other stakeholders. The work presented here shows us a blueprint for how and why the patient voice can be thoughtfully integrated into digital measure development and that continued multistakeholder engagement is critical for further progress.
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Affiliation(s)
| | | | | | | | - Alison Keogh
- Insight Centre for Data Analytics, UC Dublin, Dublin, Ireland
- Mobilise-D, Newcastle University, Newcastle upon Tyne, UK
| | - Katarzyna Wac
- Quality of Life Lab, University of Geneva, Geneva, Switzerland
| | - Tova Gur-Arie
- Mobilise-D, Newcastle University, Newcastle upon Tyne, UK
| | | | - Christopher Bull
- Newcastle University, Newcastle, UK
- IDEA-FAST, Newcastle University, Newcastle upon Tyne, UK
| | - Andrea Cereatti
- Mobilise-D, Newcastle University, Newcastle upon Tyne, UK
- Polytechnic University of Torino, Torino, Italy
| | - Francesca Cormack
- IDEA-FAST, Newcastle University, Newcastle upon Tyne, UK
- Cambridge Cognition Ltd, Cambridge, UK
| | | | | | | | | | | | | | | | | | | | - Arne Mueller
- Mobilise-D, Newcastle University, Newcastle upon Tyne, UK
- Novartis, Basel, Switzerland
| | - Julian Nam
- F. Hoffmann-La Roche, Basel, Switzerland
| | - Wan-Fai Ng
- Newcastle University, Newcastle, UK
- IDEA-FAST, Newcastle University, Newcastle upon Tyne, UK
| | - David Nobbs
- IDEA-FAST, Newcastle University, Newcastle upon Tyne, UK
- F. Hoffmann-La Roche, Basel, Switzerland
| | | | | | - Wojciech Piwko
- Takeda Pharmaceuticals International, Zurich, Switzerland
| | - Anja Ries
- F. Hoffmann-La Roche, Basel, Switzerland
| | - Alf Scotland
- Biogen Digital Health International GmbH, Baar, Switzerland
| | - Nick Taptiklis
- IDEA-FAST, Newcastle University, Newcastle upon Tyne, UK
- Cambridge Cognition Ltd, Cambridge, UK
| | | | - Beatrix Vereijken
- Mobilise-D, Newcastle University, Newcastle upon Tyne, UK
- Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | | | - Jörg Goldhahn
- Swiss Federal Institute of Technology, Zurich, Switzerland
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Donegan D, Kanzler CM, Büscher J, Viskaitis P, Bracey EF, Lambercy O, Burdakov D. Hypothalamic Control of Forelimb Motor Adaptation. J Neurosci 2022; 42:6243-6257. [PMID: 35790405 PMCID: PMC9374158 DOI: 10.1523/jneurosci.0705-22.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 04/08/2022] [Revised: 05/13/2022] [Accepted: 06/12/2022] [Indexed: 11/21/2022] Open
Abstract
The ability to perform skilled arm movements is central to everyday life, as limb impairments in common neurologic disorders such as stroke demonstrate. Skilled arm movements require adaptation of motor commands based on discrepancies between desired and actual movements, called sensory errors. Studies in humans show that this involves predictive and reactive movement adaptations to the errors, and also requires a general motivation to move. How these distinct aspects map onto defined neural signals remains unclear, because of a shortage of equivalent studies in experimental animal models that permit neural-level insights. Therefore, we adapted robotic technology used in human studies to mice, enabling insights into the neural underpinnings of motivational, reactive, and predictive aspects of motor adaptation. Here, we show that forelimb motor adaptation is regulated by neurons previously implicated in motivation and arousal, but not in forelimb motor control: the hypothalamic orexin/hypocretin neurons (HONs). By studying goal-oriented mouse-robot interactions in male mice, we found distinct HON signals occur during forelimb movements and motor adaptation. Temporally-delimited optosilencing of these movement-associated HON signals impaired sensory error-based motor adaptation. Unexpectedly, optosilencing affected neither task reward or execution rates, nor motor performance in tasks that did not require adaptation, indicating that the temporally-defined HON signals studied here were distinct from signals governing general task engagement or sensorimotor control. Collectively, these results reveal a hypothalamic neural substrate regulating forelimb motor adaptation.SIGNIFICANCE STATEMENT The ability to perform skilled, adaptable movements is a fundamental part of daily life, and is impaired in common neurologic diseases such as stroke. Maintaining motor adaptation is thus of great interest, but the necessary brain components remain incompletely identified. We found that impaired motor adaptation results from disruption of cells not previously implicated in this pathology: hypothalamic orexin/hypocretin neurons (HONs). We show that temporally confined HON signals are associated with skilled movements. Without these newly-identified signals, a resistance to movement that is normally rapidly overcome leads to prolonged movement impairment. These results identify natural brain signals that enable rapid and effective motor adaptation.
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Affiliation(s)
- Dane Donegan
- Neurobehavioral Dynamics Laboratory, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zürich, Schwerzenbach 8603, Switzerland
| | - Christoph M Kanzler
- Rehabilitation Engineering Laboratory (RELab), Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zürich, Zürich 8008, Switzerland
| | - Julia Büscher
- Neurobehavioral Dynamics Laboratory, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zürich, Schwerzenbach 8603, Switzerland
| | - Paulius Viskaitis
- Neurobehavioral Dynamics Laboratory, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zürich, Schwerzenbach 8603, Switzerland
| | - Ed F Bracey
- Neurobehavioral Dynamics Laboratory, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zürich, Schwerzenbach 8603, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory (RELab), Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zürich, Zürich 8008, Switzerland
| | - Denis Burdakov
- Neurobehavioral Dynamics Laboratory, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zürich, Schwerzenbach 8603, Switzerland
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Zbytniewska-Mégret M, Decraene L, Mailleux L, Kleeren L, Kanzler CM, Gassert R, Ortibus E, Feys H, Lambercy O, Klingels K. Reliable and Valid Robotic Assessments of Hand Active and Passive Position Sense in Children With Unilateral Cerebral Palsy. Front Hum Neurosci 2022; 16:895080. [PMID: 35978982 PMCID: PMC9376476 DOI: 10.3389/fnhum.2022.895080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
Impaired hand proprioception can lead to difficulties in performing fine motor tasks, thereby affecting activities of daily living. The majority of children with unilateral cerebral palsy (uCP) experience proprioceptive deficits, but accurately quantifying these deficits is challenging due to the lack of sensitive measurement methods. Robot-assisted assessments provide a promising alternative, however, there is a need for solutions that specifically target children and their needs. We propose two novel robotics-based assessments to sensitively evaluate active and passive position sense of the index finger metacarpophalangeal joint in children. We then investigate test-retest reliability and discriminant validity of these assessments in uCP and typically developing children (TDC), and further use the robotic platform to gain first insights into fundamentals of hand proprioception. Both robotic assessments were performed in two sessions with 1-h break in between. In the passive position sense assessment, participant's finger is passively moved by the robot to a randomly selected position, and she/he needs to indicate the perceived finger position on a tablet screen located directly above the hand, so that the vision of the hand is blocked. Active position sense is assessed by asking participants to accurately move their finger to a target position shown on the tablet screen, without visual feedback of the finger position. Ten children with uCP and 10 age-matched TDC were recruited in this study. Test-retest reliability in both populations was good (intraclass correlation coefficients (ICC) >0.79). Proprioceptive error was larger for children with uCP than TDC (passive: 11.49° ± 5.57° vs. 7.46° ± 4.43°, p = 0.046; active: 10.17° ± 5.62° vs. 5.34° ± 2.03°, p < 0.001), indicating discriminant validity. The active position sense was more accurate than passive, and the scores were not correlated, underlining the need for targeted assessments to comprehensively evaluate proprioception. There was a significant effect of age on passive position sense in TDC but not uCP, possibly linked to disturbed development of proprioceptive acuity in uCP. Overall, the proposed robot-assisted assessments are reliable, valid and a promising alternative to commonly used clinical methods, which could help gain a better understanding of proprioceptive impairments in uCP, facilitating the design of novel therapies.
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Affiliation(s)
- Monika Zbytniewska-Mégret
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- *Correspondence: Monika Zbytniewska-Mégret
| | - Lisa Decraene
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Faculty of Rehabilitation Sciences, Rehabilitation Research Center (REVAL), University of Hasselt, Diepenbeek, Belgium
| | - Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Lize Kleeren
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Christoph M. Kanzler
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Faculty of Rehabilitation Sciences, Rehabilitation Research Center (REVAL), University of Hasselt, Diepenbeek, Belgium
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Zbytniewska-Megret M, Salzmann C, Ranzani R, Kanzler CM, Gassert R, Liepert J, Lambercy O. Design and Preliminary Evaluation of a Robot-assisted Assessment-driven Finger Proprioception Therapy. IEEE Int Conf Rehabil Robot 2022; 2022:1-6. [PMID: 36176119 DOI: 10.1109/icorr55369.2022.9896602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Neurological injuries such as stroke often lead to motor and somatosensory impairments of the hand. Deficits in somatosensation, especially proprioception, result in difficulties performing activities of daily living involving fine motor tasks. However, it is challenging to accurately detect those impairments due to the limitations of clinical assessments. Hence therapies rarely focus on proprioception specifically, while such training could promote functional benefits. In this work we propose and preliminarily evaluate a robot-assisted, assessment-driven therapy of finger proprioception. We designed and implemented two therapeutic exercises, one targeting passive and the other active position sense. The difficulty level of the therapy exercises was adapted to each patient's proprioceptive impairment. We evaluated the exercises and their usability with 7 stroke participants and 8 clinicians in a 45-minutes protocol. We found that the exercises were feasible for stroke participants, as 5 individuals progressed in difficulty levels over multiple exercise repetitions, indicating adequacy of the adaptation algorithm. Moreover, usability was rated mostly as satisfactory by the patients (System Usability Scale = 73), and they also found the exercises interesting. Clinicians rated the exercises as difficult but clinically meaningful. Overall, these promising preliminary results pave the way for further development and validation of the proposed therapy approach.
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Kanzler CM, Sylvester R, Gassert R, Kool J, Lambercy O, Gonzenbach R. Goal-directed upper limb movement patterns and hand grip forces in multiple sclerosis. Mult Scler J Exp Transl Clin 2022; 8:20552173221116272. [PMID: 35982915 PMCID: PMC9380226 DOI: 10.1177/20552173221116272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background Upper limb disability in persons with Multiple Sclerosis (pwMS) leads to increased dependence on caregivers. To better understand upper limb disability, observer-based or time-based clinical assessments have been applied. However, these only poorly capture the behavioural aspects underlying goal-directed task performance. Objective We aimed to document alterations in goal-directed upper limb movement patterns and hand grip forces in a cohort of pwMS (n = 123) with mild to moderate upper limb impairments. Methods We relied on the Virtual Peg Insertion Test (VPIT), a technology-aided assessment with a goal-directed pick-and-place task providing a set of validated digital health metrics. Results All metrics indicated significant differences to an able-bodied reference sample (p < 0.001), with smoothness, speed, and grip force control during object manipulation being most affected in pwMS. Such abnormalities negatively influenced the time to complete the goal-directed task (p < 0.001, R2 = 0.77), thereby showing their functional relevance. Lastly, abnormalities in movement patterns and grip force control were consistently found even in pwMS with clinically normal gross dexterity and grip strength. Conclusion This work provides a systematic documentation on goal-directed upper limb movement patterns and hand grip forces in pwMS, ultimately paving the way for an early detection of MS sign using digital health metrics.
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Affiliation(s)
- Christoph M Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | | | - Roger Gassert
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | - Jan Kool
- Rehabilitation Center Valens, Valens, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
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Tanczak N, Ranzani R, Meyer JT, Devittori G, Califfi A, Dinacci D, Gassert R, Lambercy O, Kanzler CM. A Novel Mixed-Method Approach to Identify Needs and Requirements for Upper Limb Assistive Technology for Persons after Stroke. IEEE Int Conf Rehabil Robot 2022; 2022:1-6. [PMID: 36176118 DOI: 10.1109/icorr55369.2022.9896516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Following stroke, a significant portion of individuals suffer from upper limb impairments and struggle with activities of daily living. Dedicated assistive technology (AT), such as robotic hand orthoses (RHO), can help facilitate upper limb usage and allow users to regain independence in their daily lives. Often, users' needs and requirements are neglected in AT design, thereby contributing to poor technology acceptance. In this work, we propose and apply a mixed-method focus group combining qualitative and quantitative components to gather user expectations in view of a user-centred redesign of a RHO. Three main themes emerged from a thematic analysis of two focus groups (n=5): Experience after stroke, desired design features, and reflections and realisations. Participants listed device features they would look for in AT and ranked them relative to what they deem important and necessary for a satisfactory device. Participants primarily looked for AT that is effective, intuitive and easy to use. These insights complement traditional technical design requirements for RHO by considering user desires, aspects unfortunately often neglected in the early design process. This work provides guidelines allowing for the optimization of AT design to better match the needs of persons after stroke and improve technology acceptance.
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Kanzler CM, Lessard I, Gassert R, Brais B, Gagnon C, Lambercy O. Reliability and validity of digital health metrics for assessing arm and hand impairments in an ataxic disorder. Ann Clin Transl Neurol 2022; 9:432-443. [PMID: 35224896 PMCID: PMC8994987 DOI: 10.1002/acn3.51493] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/01/2021] [Accepted: 12/08/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives Autosomal recessive spastic ataxia of Charlevoix‐Saguenay (ARSACS) is the second most frequent recessive ataxia and commonly features reduced upper limb coordination. Sensitive outcome measures of upper limb coordination are essential to track disease progression and the effect of interventions. However, available clinical assessments are insufficient to capture behavioral variability and detailed aspects of motor control. While digital health metrics extracted from technology‐aided assessments promise more fine‐grained outcome measures, these have not been validated in ARSACS. Thus, the aim was to document the metrological properties of metrics from a technology‐aided assessment of arm and hand function in ARSACS. Methods We relied on the Virtual Peg Insertion Test (VPIT) and used a previously established core set of 10 digital health metrics describing upper limb movement and grip force patterns during a pick‐and‐place task. We evaluated reliability, measurement error, and learning effects in 23 participants with ARSACS performing three repeated assessment sessions. In addition, we documented concurrent validity in 57 participants with ARSACS performing one session. Results Eight metrics had excellent test–retest reliability (intraclass correlation coefficient 0.89 ± 0.08), five low measurement error (smallest real difference % 25.4 ± 5.7), and none strong learning effects (systematic change η −0.11 ± 2.5). Significant correlations (ρ 0.39 ± 0.13) with clinical scales describing gross and fine dexterity and lower limb coordination were observed. Interpretation This establishes eight digital health metrics as valid and robust endpoints for cross‐sectional studies and five metrics as potentially sensitive endpoints for longitudinal studies in ARSACS, thereby promising novel insights into upper limb sensorimotor control.
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Affiliation(s)
- Christoph M Kanzler
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | - Isabelle Lessard
- Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN), Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-St-Jean, Saguenay, Quebec, Canada
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | - Bernard Brais
- The Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Cynthia Gagnon
- Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN), Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-St-Jean, Saguenay, Quebec, Canada.,Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
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Wyser DG, Kanzler CM, Salzmann L, Lambercy O, Wolf M, Scholkmann F, Gassert R. Characterizing reproducibility of cerebral hemodynamic responses when applying short-channel regression in functional near-infrared spectroscopy. Neurophotonics 2022; 9:015004. [PMID: 35265732 PMCID: PMC8901194 DOI: 10.1117/1.nph.9.1.015004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/11/2022] [Indexed: 05/06/2023]
Abstract
Significance: Functional near-infrared spectroscopy (fNIRS) enables the measurement of brain activity noninvasively. Optical neuroimaging with fNIRS has been shown to be reproducible on the group level and hence is an excellent research tool, but the reproducibility on the single-subject level is still insufficient, challenging the use for clinical applications. Aim: We investigated the effect of short-channel regression (SCR) as an approach to obtain fNIRS measurements with higher reproducibility on a single-subject level. SCR simultaneously considers contributions from long- and short-separation channels and removes confounding physiological changes through the regression of the short-separation channel information. Approach: We performed a test-retest study with a hand grasping task in 15 healthy subjects using a wearable fNIRS device, optoHIVE. Relevant brain regions were localized with transcranial magnetic stimulation to ensure correct placement of the optodes. Reproducibility was assessed by intraclass correlation, correlation analysis, mixed effects modeling, and classification accuracy of the hand grasping task. Further, we characterized the influence of SCR on reproducibility. Results: We found a high reproducibility of fNIRS measurements on a single-subject level ( ICC single = 0.81 and correlation r = 0.81 ). SCR increased the reproducibility from 0.64 to 0.81 ( ICC single ) but did not affect classification (85% overall accuracy). Significant intersubject variability in the reproducibility was observed and was explained by Mayer wave oscillations and low raw signal strength. The raw signal-to-noise ratio (threshold at 40 dB) allowed for distinguishing between persons with weak and strong activations. Conclusions: We report, for the first time, that fNIRS measurements are reproducible on a single-subject level using our optoHIVE fNIRS system and that SCR improves reproducibility. In addition, we give a benchmark to easily assess the ability of a subject to elicit sufficiently strong hemodynamic responses. With these insights, we pave the way for the reliable use of fNIRS neuroimaging in single subjects for neuroscientific research and clinical applications.
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Affiliation(s)
- Dominik G. Wyser
- ETH Zurich, Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Zurich, Switzerland
- University Hospital Zurich, University of Zurich, Biomedical Optics Research Laboratory, Department of Neonatology, Zurich, Switzerland
- Address all correspondence to Dominik G. Wyser,
| | - Christoph M. Kanzler
- ETH Zurich, Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Zurich, Switzerland
| | - Lena Salzmann
- ETH Zurich, Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Zurich, Switzerland
| | - Olivier Lambercy
- ETH Zurich, Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Zurich, Switzerland
| | - Martin Wolf
- University Hospital Zurich, University of Zurich, Biomedical Optics Research Laboratory, Department of Neonatology, Zurich, Switzerland
| | - Felix Scholkmann
- University Hospital Zurich, University of Zurich, Biomedical Optics Research Laboratory, Department of Neonatology, Zurich, Switzerland
- University of Bern, Institute of Complementary and Integrative Medicine, Bern, Switzerland
| | - Roger Gassert
- ETH Zurich, Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Zurich, Switzerland
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Zbytniewska M, Kanzler CM, Jordan L, Salzmann C, Liepert J, Lambercy O, Gassert R. Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke. J Neuroeng Rehabil 2021; 18:115. [PMID: 34271954 PMCID: PMC8283922 DOI: 10.1186/s12984-021-00904-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 11/12/2020] [Accepted: 06/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background Neurological injuries such as stroke often differentially impair hand motor and somatosensory function, as well as the interplay between the two, which leads to limitations in performing activities of daily living. However, it is challenging to identify which specific aspects of sensorimotor function are impaired based on conventional clinical assessments that are often insensitive and subjective. In this work we propose and validate a set of robot-assisted assessments aiming at disentangling hand proprioceptive from motor impairments, and capturing their interrelation (sensorimotor impairments). Methods A battery of five complementary assessment tasks was implemented on a one degree-of-freedom end-effector robotic platform acting on the index finger metacarpophalangeal joint. Specifically, proprioceptive impairments were assessed using a position matching paradigm. Fast target reaching, range of motion and maximum fingertip force tasks characterized motor function deficits. Finally, sensorimotor impairments were assessed using a dexterous trajectory following task. Clinical feasibility (duration), reliability (intra-class correlation coefficient ICC, smallest real difference SRD) and validity (Kruskal-Wallis test, Spearman correlations \documentclass[12pt]{minimal}
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\begin{document}$$\rho$$\end{document}ρ with Fugl-Meyer Upper Limb Motor Assessment, kinesthetic Up-Down Test, Box & Block Test) of robotic tasks were evaluated with 36 sub-acute stroke subjects and 31 age-matched neurologically intact controls. Results Eighty-three percent of stroke survivors with varied impairment severity (mild to severe) could complete all robotic tasks (duration: <15 min per tested hand). Further, the study demonstrated good to excellent reliability of the robotic tasks in the stroke population (ICC>0.7, SRD<30%), as well as discriminant validity, as indicated by significant differences (p-value<0.001) between stroke and control subjects. Concurrent validity was shown through moderate to strong correlations (\documentclass[12pt]{minimal}
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\begin{document}$$\rho$$\end{document}ρ=0.4-0.8) between robotic outcome measures and clinical scales. Finally, robotic tasks targeting different deficits (motor, sensory) were not strongly correlated with each other (\documentclass[12pt]{minimal}
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\begin{document}$$\rho \le$$\end{document}ρ≤0.32, p-value>0.1), thereby presenting complementary information about a patient’s impairment profile. Conclusions The proposed robot-assisted assessments provide a clinically feasible, reliable, and valid approach to distinctly characterize impairments in hand proprioceptive and motor function, along with the interaction between the two. This opens new avenues to help unravel the contributions of unique aspects of sensorimotor function in post-stroke recovery, as well as to contribute to future developments towards personalized, assessment-driven therapies. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00904-5.
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Affiliation(s)
- Monika Zbytniewska
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - Christoph M Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
| | - Lisa Jordan
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Christian Salzmann
- Kliniken Schmieder Allensbach, Zum Tafelholz 8, 78476, Allensbach, Germany
| | - Joachim Liepert
- Kliniken Schmieder Allensbach, Zum Tafelholz 8, 78476, Allensbach, Germany
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
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Averta G, Barontini F, Catrambone V, Haddadin S, Handjaras G, Held JPO, Hu T, Jakubowitz E, Kanzler CM, Kühn J, Lambercy O, Leo A, Obermeier A, Ricciardi E, Schwarz A, Valenza G, Bicchi A, Bianchi M. U-Limb: A multi-modal, multi-center database on arm motion control in healthy and post-stroke conditions. Gigascience 2021; 10:giab043. [PMID: 34143875 PMCID: PMC8212873 DOI: 10.1093/gigascience/giab043] [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: 01/05/2021] [Revised: 04/26/2021] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Shedding light on the neuroscientific mechanisms of human upper limb motor control, in both healthy and disease conditions (e.g., after a stroke), can help to devise effective tools for a quantitative evaluation of the impaired conditions, and to properly inform the rehabilitative process. Furthermore, the design and control of mechatronic devices can also benefit from such neuroscientific outcomes, with important implications for assistive and rehabilitation robotics and advanced human-machine interaction. To reach these goals, we believe that an exhaustive data collection on human behavior is a mandatory step. For this reason, we release U-Limb, a large, multi-modal, multi-center data collection on human upper limb movements, with the aim of fostering trans-disciplinary cross-fertilization. CONTRIBUTION This collection of signals consists of data from 91 able-bodied and 65 post-stroke participants and is organized at 3 levels: (i) upper limb daily living activities, during which kinematic and physiological signals (electromyography, electro-encephalography, and electrocardiography) were recorded; (ii) force-kinematic behavior during precise manipulation tasks with a haptic device; and (iii) brain activity during hand control using functional magnetic resonance imaging.
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Affiliation(s)
- Giuseppe Averta
- Research Center “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, University of Pisa Largo Lucio Lazzarino 1, 56122 Pisa, Italy
- Soft Robotics for Human Cooperation and Rehabilitation, Fondazione Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy
| | - Federica Barontini
- Research Center “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, University of Pisa Largo Lucio Lazzarino 1, 56122 Pisa, Italy
- Soft Robotics for Human Cooperation and Rehabilitation, Fondazione Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy
| | - Vincenzo Catrambone
- Research Center “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, University of Pisa Largo Lucio Lazzarino 1, 56122 Pisa, Italy
| | - Sami Haddadin
- RSI - Chair of Robotics and Systems Intelligence, Munich School of Robotics and Machine Intelligence, Technical University Munich (TUM), Heßstr. 134, 80797 München, Germany
| | - Giacomo Handjaras
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Piazza S. Francesco 19, 55100 Lucca, Italy
| | - Jeremia P O Held
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, Frauenklinikstrasse 26, 8006 Zürich, Switzerland
| | - Tingli Hu
- RSI - Chair of Robotics and Systems Intelligence, Munich School of Robotics and Machine Intelligence, Technical University Munich (TUM), Heßstr. 134, 80797 München, Germany
| | - Eike Jakubowitz
- Laboratory for Biomechanics and Biomaterials (LBB), Department of Orthopaedic Surgery, Hannover Medical School, L384, 30625 Hannover, Germany
| | - Christoph M Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, CLA H 1.1 Tannenstrasse 3, 8092 Zurich, Switzerland
| | - Johannes Kühn
- RSI - Chair of Robotics and Systems Intelligence, Munich School of Robotics and Machine Intelligence, Technical University Munich (TUM), Heßstr. 134, 80797 München, Germany
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, CLA H 1.1 Tannenstrasse 3, 8092 Zurich, Switzerland
| | - Andrea Leo
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Piazza S. Francesco 19, 55100 Lucca, Italy
| | - Alina Obermeier
- Laboratory for Biomechanics and Biomaterials (LBB), Department of Orthopaedic Surgery, Hannover Medical School, L384, 30625 Hannover, Germany
| | - Emiliano Ricciardi
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Piazza S. Francesco 19, 55100 Lucca, Italy
| | - Anne Schwarz
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, Frauenklinikstrasse 26, 8006 Zürich, Switzerland
| | - Gaetano Valenza
- Research Center “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, University of Pisa Largo Lucio Lazzarino 1, 56122 Pisa, Italy
| | - Antonio Bicchi
- Research Center “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, University of Pisa Largo Lucio Lazzarino 1, 56122 Pisa, Italy
- Soft Robotics for Human Cooperation and Rehabilitation, Fondazione Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy
| | - Matteo Bianchi
- Research Center “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, University of Pisa Largo Lucio Lazzarino 1, 56122 Pisa, Italy
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Lambercy O, Lehner R, Chua K, Wee SK, Rajeswaran DK, Kuah CWK, Ang WT, Liang P, Campolo D, Hussain A, Aguirre-Ollinger G, Guan C, Kanzler CM, Wenderoth N, Gassert R. Neurorehabilitation From a Distance: Can Intelligent Technology Support Decentralized Access to Quality Therapy? Front Robot AI 2021; 8:612415. [PMID: 34026855 PMCID: PMC8132098 DOI: 10.3389/frobt.2021.612415] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 09/30/2020] [Accepted: 04/20/2021] [Indexed: 12/18/2022] Open
Abstract
Current neurorehabilitation models primarily rely on extended hospital stays and regular therapy sessions requiring close physical interactions between rehabilitation professionals and patients. The current COVID-19 pandemic has challenged this model, as strict physical distancing rules and a shift in the allocation of hospital resources resulted in many neurological patients not receiving essential therapy. Accordingly, a recent survey revealed that the majority of European healthcare professionals involved in stroke care are concerned that this lack of care will have a noticeable negative impact on functional outcomes. COVID-19 highlights an urgent need to rethink conventional neurorehabilitation and develop alternative approaches to provide high-quality therapy while minimizing hospital stays and visits. Technology-based solutions, such as, robotics bear high potential to enable such a paradigm shift. While robot-assisted therapy is already established in clinics, the future challenge is to enable physically assisted therapy and assessments in a minimally supervized and decentralized manner, ideally at the patient’s home. Key enablers are new rehabilitation devices that are portable, scalable and equipped with clinical intelligence, remote monitoring and coaching capabilities. In this perspective article, we discuss clinical and technological requirements for the development and deployment of minimally supervized, robot-assisted neurorehabilitation technologies in patient’s homes. We elaborate on key principles to ensure feasibility and acceptance, and on how artificial intelligence can be leveraged for embedding clinical knowledge for safe use and personalized therapy adaptation. Such new models are likely to impact neurorehabilitation beyond COVID-19, by providing broad access to sustained, high-quality and high-dose therapy maximizing long-term functional outcomes.
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Affiliation(s)
- Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Rea Lehner
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,Neural Control of Movement Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Karen Chua
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore.,Rehabilitation Research Institute Singapore, Nanyang Technological University, Singapore, Singapore
| | - Seng Kwee Wee
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore.,Singapore Institute of Technology (SIT), Singapore, Singapore
| | - Deshan Kumar Rajeswaran
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Christopher Wee Keong Kuah
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Wei Tech Ang
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,Rehabilitation Research Institute Singapore, Nanyang Technological University, Singapore, Singapore.,School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Phyllis Liang
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,Rehabilitation Research Institute Singapore, Nanyang Technological University, Singapore, Singapore
| | - Domenico Campolo
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Asif Hussain
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore.,Articares Pte Ltd, Singapore, Singapore
| | | | - Cuntai Guan
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Christoph M Kanzler
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Nicole Wenderoth
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,Neural Control of Movement Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
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18
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Kanzler CM, Schwarz A, Held JPO, Luft AR, Gassert R, Lambercy O. Technology-aided assessment of functionally relevant sensorimotor impairments in arm and hand of post-stroke individuals. J Neuroeng Rehabil 2020; 17:128. [PMID: 32977810 PMCID: PMC7517659 DOI: 10.1186/s12984-020-00748-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 08/20/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Assessing arm and hand sensorimotor impairments that are functionally relevant is essential to optimize the impact of neurorehabilitation interventions. Technology-aided assessments should provide a sensitive and objective characterization of upper limb impairments, but often provide arm weight support and neglect the importance of the hand, thereby questioning their functional relevance. The Virtual Peg Insertion Test (VPIT) addresses these limitations by quantifying arm and hand movements as well as grip forces during a goal-directed manipulation task requiring active lifting of the upper limb against gravity. The aim of this work was to evaluate the ability of the VPIT metrics to characterize arm and hand sensorimotor impairments that are relevant for performing functional tasks. METHODS Arm and hand sensorimotor impairments were systematically characterized in 30 chronic stroke patients using conventional clinical scales and the VPIT. For the latter, ten previously established kinematic and kinetic core metrics were extracted. The validity and robustness of these metrics was investigated by analyzing their clinimetric properties (test-retest reliability, measurement error, learning effects, concurrent validity). RESULTS Twenty-three of the participants, the ones with mild to moderate sensorimotor impairments and without strong cognitive deficits, were able to successfully complete the VPIT protocol (duration 16.6 min). The VPIT metrics detected impairments in arm and hand in 90.0% of the participants, and were sensitive to increased muscle tone and pathological joint coupling. Most importantly, significant moderate to high correlations between conventional scales of activity limitations and the VPIT metrics were found, thereby indicating their functional relevance when grasping and transporting objects, and when performing dexterous finger manipulations. Lastly, the robustness of three out of the ten VPIT core metrics in post-stroke individuals was confirmed. CONCLUSIONS This work provides evidence that technology-aided assessments requiring goal-directed manipulations without arm weight support can provide an objective, robust, and clinically feasible way to assess functionally relevant sensorimotor impairments in arm and hand in chronic post-stroke individuals with mild to moderate deficits. This allows for a better identification of impairments with high functional relevance and can contribute to optimizing the functional benefits of neurorehabilitation interventions.
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Affiliation(s)
- Christoph M. Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Anne Schwarz
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- cereneo, Center for Neurology and Rehabilitation, Zurich, Switzerland
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands
| | - Jeremia P. O. Held
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andreas R. Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- cereneo, Center for Neurology and Rehabilitation, Zurich, Switzerland
| | - Roger Gassert
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- cereneo, Center for Neurology and Rehabilitation, Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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19
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Adans-Dester CP, Bamberg S, Bertacchi FP, Caulfield B, Chappie K, Demarchi D, Erb MK, Estrada J, Fabara EE, Freni M, Friedl KE, Ghaffari R, Gill G, Greenberg MS, Hoyt RW, Jovanov E, Kanzler CM, Katabi D, Kernan M, Kigin C, Lee SI, Leonhardt S, Lovell NH, Mantilla J, McCoy TH, Luo NM, Miller GA, Moore J, O'Keeffe D, Palmer J, Parisi F, Patel S, Po J, Pugliese BL, Quatieri T, Rahman T, Ramasarma N, Rogers JA, Ruiz-Esparza GU, Sapienza S, Schiurring G, Schwamm L, Shafiee H, Kelly Silacci S, Sims NM, Talkar T, Tharion WJ, Toombs JA, Uschnig C, Vergara-Diaz GP, Wacnik P, Wang MD, Welch J, Williamson L, Zafonte R, Zai A, Zhang YT, Tearney GJ, Ahmad R, Walt DR, Bonato P. Can mHealth Technology Help Mitigate the Effects of the COVID-19 Pandemic? IEEE Open J Eng Med Biol 2020; 1:243-248. [PMID: 34192282 PMCID: PMC8023427 DOI: 10.1109/ojemb.2020.3015141] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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: 06/28/2020] [Accepted: 07/19/2020] [Indexed: 01/08/2023] Open
Abstract
Goal: The aim of the study herein reported was to review mobile health (mHealth) technologies and explore their use to monitor and mitigate the effects of the COVID-19 pandemic. Methods: A Task Force was assembled by recruiting individuals with expertise in electronic Patient-Reported Outcomes (ePRO), wearable sensors, and digital contact tracing technologies. Its members collected and discussed available information and summarized it in a series of reports. Results: The Task Force identified technologies that could be deployed in response to the COVID-19 pandemic and would likely be suitable for future pandemics. Criteria for their evaluation were agreed upon and applied to these systems. Conclusions: mHealth technologies are viable options to monitor COVID-19 patients and be used to predict symptom escalation for earlier intervention. These technologies could also be utilized to monitor individuals who are presumed non-infected and enable prediction of exposure to SARS-CoV-2, thus facilitating the prioritization of diagnostic testing.
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Affiliation(s)
- Catherine P Adans-Dester
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Stacy Bamberg
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Francesco P Bertacchi
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Brian Caulfield
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Kara Chappie
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Danilo Demarchi
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - M Kelley Erb
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Juan Estrada
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Eric E Fabara
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Michael Freni
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Karl E Friedl
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Roozbeh Ghaffari
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Geoffrey Gill
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Mark S Greenberg
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Reed W Hoyt
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Emil Jovanov
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Christoph M Kanzler
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Dina Katabi
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Meredith Kernan
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Colleen Kigin
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Sunghoon I Lee
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Steffen Leonhardt
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Nigel H Lovell
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Jose Mantilla
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Thomas H McCoy
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Nell Meosky Luo
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Glenn A Miller
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - John Moore
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Derek O'Keeffe
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Jeffrey Palmer
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Federico Parisi
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Shyamal Patel
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Jack Po
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Benito L Pugliese
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Thomas Quatieri
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Tauhidur Rahman
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Nathan Ramasarma
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - John A Rogers
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Guillermo U Ruiz-Esparza
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Stefano Sapienza
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Gregory Schiurring
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Lee Schwamm
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Hadi Shafiee
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Sara Kelly Silacci
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Nathaniel M Sims
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Tanya Talkar
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - William J Tharion
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - James A Toombs
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Christopher Uschnig
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Gloria P Vergara-Diaz
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Paul Wacnik
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - May D Wang
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - James Welch
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Lina Williamson
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Ross Zafonte
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Adrian Zai
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Yuan-Ting Zhang
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Guillermo J Tearney
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Rushdy Ahmad
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - David R Walt
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
| | - Paolo Bonato
- Paolo Bonato is with the Department of Physical Medicine and RehabilitationHarvard Medical School at Spaulding Rehabilitation HospitalBostonMA02129USA.,Wyss InstituteHarvard UniversityCambridgeMA02138USA
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20
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Kanzler CM, Rinderknecht MD, Schwarz A, Lamers I, Gagnon C, Held JPO, Feys P, Luft AR, Gassert R, Lambercy O. A data-driven framework for selecting and validating digital health metrics: use-case in neurological sensorimotor impairments. NPJ Digit Med 2020; 3:80. [PMID: 32529042 PMCID: PMC7260375 DOI: 10.1038/s41746-020-0286-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/28/2020] [Indexed: 01/29/2023] Open
Abstract
Digital health metrics promise to advance the understanding of impaired body functions, for example in neurological disorders. However, their clinical integration is challenged by an insufficient validation of the many existing and often abstract metrics. Here, we propose a data-driven framework to select and validate a clinically relevant core set of digital health metrics extracted from a technology-aided assessment. As an exemplary use-case, the framework is applied to the Virtual Peg Insertion Test (VPIT), a technology-aided assessment of upper limb sensorimotor impairments. The framework builds on a use-case-specific pathophysiological motivation of metrics, models demographic confounds, and evaluates the most important clinimetric properties (discriminant validity, structural validity, reliability, measurement error, learning effects). Applied to 77 metrics of the VPIT collected from 120 neurologically intact and 89 affected individuals, the framework allowed selecting 10 clinically relevant core metrics. These assessed the severity of multiple sensorimotor impairments in a valid, reliable, and informative manner. These metrics provided added clinical value by detecting impairments in neurological subjects that did not show any deficits according to conventional scales, and by covering sensorimotor impairments of the arm and hand with a single assessment. The proposed framework provides a transparent, step-by-step selection procedure based on clinically relevant evidence. This creates an interesting alternative to established selection algorithms that optimize mathematical loss functions and are not always intuitive to retrace. This could help addressing the insufficient clinical integration of digital health metrics. For the VPIT, it allowed establishing validated core metrics, paving the way for their integration into neurorehabilitation trials.
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Affiliation(s)
- Christoph M. Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Mike D. Rinderknecht
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Anne Schwarz
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Ilse Lamers
- REVAL, Rehabilitation Research Center, BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Rehabilitation and MS Center, Pelt, Belgium
| | - Cynthia Gagnon
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Jeremia P. O. Held
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Peter Feys
- REVAL, Rehabilitation Research Center, BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Andreas R. Luft
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
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21
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Kanzler CM, Catalano MG, Piazza C, Bicchi A, Gassert R, Lambercy O. An Objective Functional Evaluation of Myoelectrically-Controlled Hand Prostheses: A Pilot Study Using the Virtual Peg Insertion Test. IEEE Int Conf Rehabil Robot 2020; 2019:392-397. [PMID: 31374661 DOI: 10.1109/icorr.2019.8779550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Assessing upper limb prostheses and their influence when performing goal-directed activities is essential to compare the quality of different devices and optimize their control settings. Currently available assessments are often subjective, insensitive, and cannot provide a detailed evaluation of prostheses and their usage. The goal of this pilot study was to explore the feasibility of using the Virtual Peg Insertion Test (VPIT) to provide an in-depth assessment of a prosthesis and its functional performance. One transradial amputee performed the goal-directed manipulation task of the VPIT with the sound body side and four different myoelectrically-controlled prostheses. The subject was able to complete the VPIT protocol successfully with technically advanced prosthesis (two out of four devices). The kinematic- and kinetic-based objective evaluation measures extracted from the VPIT were able to capture clear differences between the sound and amputated body side and were able to identify varying movement patterns for different prostheses. Additionally, the outcome measures were sensitive to changes in prosthesis control settings and showed clear trends across measures of subjectively perceived prosthesis quality assessed through a questionnaire. This work demonstrates the general feasibility of objectively evaluating functional prosthesis usage with the VPIT.
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22
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Abstract
Background and Purpose- Assessing upper limb movements poststroke is crucial to monitor and understand sensorimotor recovery. Kinematic assessments are expected to enable a sensitive quantification of movement quality and distinguish between restitution and compensation. The nature and practice of these assessments are highly variable and used without knowledge of their clinimetric properties. This presents a challenge when interpreting and comparing results. The purpose of this review was to summarize the state of the art regarding kinematic upper limb assessments poststroke with respect to the assessment task, measurement system, and performance metrics with their clinimetric properties. Subsequently, we aimed to provide evidence-based recommendations for future applications of upper limb kinematics in stroke recovery research. Methods- A systematic search was conducted in PubMed, Embase, CINAHL, and IEEE Xplore. Studies investigating clinimetric properties of applied metrics were assessed for risk of bias using the Consensus-Based Standards for the Selection of Health Measurement Instruments checklist. The quality of evidence for metrics was determined according to the Grading of Recommendations Assessment, Development, and Evaluation approach. Results- A total of 225 studies (N=6197) using 151 different kinematic metrics were identified and allocated to 5 task and 3 measurement system groups. Thirty studies investigated clinimetrics of 62 metrics: reliability (n=8), measurement error (n=5), convergent validity (n=22), and responsiveness (n=2). The metrics task/movement time, number of movement onsets, number of movement ends, path length ratio, peak velocity, number of velocity peaks, trunk displacement, and shoulder flexion/extension received a sufficient evaluation for one clinimetric property. Conclusions- Studies on kinematic assessments of upper limb sensorimotor function are poorly standardized and rarely investigate clinimetrics in an unbiased manner. Based on the available evidence, recommendations on the assessment task, measurement system, and performance metrics were made with the goal to increase standardization. Further high-quality studies evaluating clinimetric properties are needed to validate kinematic assessments, with the long-term goal to elucidate upper limb sensorimotor recovery poststroke. Clinical Trial Registration- URL: https://www.crd.york.ac.uk/prospero/ . Unique identifier: CRD42017064279.
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Affiliation(s)
- Anne Schwarz
- From the Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (A.S., A.R.L., J.M.V.).,cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland (A.S., A.R.L., J.M.V.).,Biomedical Signals and Systems, Technical Medical Centre (TechMed Centre), University of Twente, Enschede, the Netherlands (A.S.)
| | - Christoph M Kanzler
- Department of Health Sciences and Technology, Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, ETH Zurich, Switzerland (C.M.K., O.L.)
| | - Olivier Lambercy
- Department of Health Sciences and Technology, Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, ETH Zurich, Switzerland (C.M.K., O.L.)
| | - Andreas R Luft
- From the Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (A.S., A.R.L., J.M.V.).,cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland (A.S., A.R.L., J.M.V.)
| | - Janne M Veerbeek
- From the Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (A.S., A.R.L., J.M.V.).,cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland (A.S., A.R.L., J.M.V.)
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23
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Kanzler CM, Barth J, Klucken J, Eskofier BM. Inertial sensor based gait analysis discriminates subjects with and without visual impairment caused by simulated macular degeneration. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:4979-4982. [PMID: 28269386 DOI: 10.1109/embc.2016.7591845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Macular degeneration is the third leading cause of blindness worldwide and the leading cause of blindness in the developing world. The analysis of gait parameters can be used to assess the influence of macular degeneration on gait. This study examines the effect of macular degeneration on gait using inertial sensor based 3D spatio-temporal gait parameters. We acquired gait data from 21 young and healthy subjects during a 40 m obstacle walk. All subjects had to perform the gait trial with and without macular degeneration simulation glasses. The order of starting with or without glasses alternated between each subject in order to test for training effects. Multiple 3D spatio-temporal gait parameters were calculated for the normal vision as well as the impaired vision groups. The parameters trial time, stride time, stride time coefficient of variation (CV), stance time, stance time CV, stride length, cadence, gait velocity and angle at toe off showed statistically significant differences between the two groups. Training effects were visible for the trials which started without vision impairment. Inter-group differences in the gait pattern occurred due to an increased sense of insecurity related with the loss of visual acuity from the simulation glasses. In summary, we showed that 3D spatio-temporal gait parameters derived from inertial sensor data are viable to detect differences in the gait pattern of subjects with and without a macular degeneration simulation. We believe that this study provides the basis for an in-depth analysis regarding the impact of macular degeneration on gait.
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24
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Kanzler CM, Barth J, Rampp A, Schlarb H, Rott F, Klucken J, Eskofier BM. Inertial sensor based and shoe size independent gait analysis including heel and toe clearance estimation. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:5424-7. [PMID: 26737518 DOI: 10.1109/embc.2015.7319618] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Falls are a major cause for morbidity and mortality in the ageing society. Inertial sensor based gait assessment including the analysis of the heel and toe clearance can be an indicator for the risk of falling. This paper presents a method for calculating the continuous heel and toe clearance without the knowledge of the shoe dimensions as well as the foot angle in the sagittal plane. These gait parameters were validated using an optical motion capture system. 20 healthy subjects from 3 different age groups (young, mid age, old) performed gait trials with different stride lengths and stride velocities. We obtained low mean absolute errors, low standard deviations and high Pearson correlations (0.91-0.99) for all gait parameters. In summary, we implemented a viable algorithm for the calculation of the heel and toe clearance without knowing the shoe dimensions as well as the foot angle in sagittal plane. We conclude that the given method is applicable for a mobile and unobtrusive gait assessment for healthy subjects from all age classes.
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25
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Mullan P, Kanzler CM, Lorch B, Schroeder L, Winkler L, Laich L, Riedel F, Richer R, Luckner C, Leutheuser H, Eskofier BM, Pasluosta C. Unobtrusive heart rate estimation during physical exercise using photoplethysmographic and acceleration data. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2015:6114-6117. [PMID: 26737687 DOI: 10.1109/embc.2015.7319787] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Photoplethysmography (PPG) is a non-invasive, inexpensive and unobtrusive method to achieve heart rate monitoring during physical exercises. Motion artifacts during exercise challenge the heart rate estimation from wrist-type PPG signals. This paper presents a methodology to overcome these limitation by incorporating acceleration information. The proposed algorithm consisted of four stages: (1) A wavelet based denoising, (2) an acceleration based denoising, (3) a frequency based approach to estimate the heart rate followed by (4) a postprocessing step. Experiments with different movement types such as running and rehabilitation exercises were used for algorithm design and development. Evaluation of our heart rate estimation showed that a mean absolute error 1.96 bpm (beats per minute) with standard deviation of 2.86 bpm and a correlation of 0.98 was achieved with our method. These findings suggest that the proposed methodology is robust to motion artifacts and is therefore applicable for heart rate monitoring during sports and rehabilitation.
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