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The latest research articles published by Journal of NeuroEngineering and Rehabilitation
Updated: 2 years 15 weeks ago

Autonomous exoskeleton reduces metabolic cost of human walking

Mon, 11/03/2014 - 00:00
Background: Passive exoskeletons that assist with human locomotion are often lightweight and compact, but are unable to provide net mechanical power to the exoskeletal wearer. In contrast, powered exoskeletons often provide biologically appropriate levels of mechanical power, but the size and mass of their actuator/power source designs often lead to heavy and unwieldy devices. In this study, we extend the design and evaluation of a lightweight and powerful autonomous exoskeleton evaluated for loaded walking in (J Neuroeng Rehab 11:80, 2014) to the case of unloaded walking conditions.FindingsThe metabolic energy consumption of seven study participants (85 +/- 12 kg body mass) was measured while walking on a level treadmill at 1.4 m/s. Testing conditions included not wearing the exoskeleton and wearing the exoskeleton, in both powered and unpowered modes. When averaged across the gait cycle, the autonomous exoskeleton applied a mean positive mechanical power of 26 +/- 1 W (13 W per ankle) with 2.12 kg of added exoskeletal foot-shank mass (1.06 kg per leg). Use of the leg exoskeleton significantly reduced the metabolic cost of walking by 35 +/- 4 W, which was an improvement of 10 +/- 3% (p =0.023) relative to the control condition of not wearing the exoskeleton. Conclusions: The results of this study highlight the advantages of developing lightweight and powerful exoskeletons that can comfortably assist the body during walking.

Chronic stroke patients show early and robust improvements in muscle and functional performance in response to eccentric-overload flywheel resistance training: a pilot study

Thu, 10/30/2014 - 00:00
Background: Resistance exercise comprising eccentric (ECC) muscle actions enhances muscle strength and function to aid stroke patients in conducting daily tasks. The purpose of this study was to assess the efficacy of a novel ECC-overload flywheel resistance exercise paradigm to induce muscle and functional performance adaptations in chronic stroke patients. Methods: Twelve patients (~8 years after stroke onset) performed 4 sets of 7 coupled concentric (CON) and ECC actions using the affected limb on a flywheel leg press (LP) device twice weekly for 8 weeks. Maximal CON and ECC isokinetic torque at 30, 60 and 90[degree sign]/s, isometric knee extension and LP force, and CON and ECC peak power in LP were measured before and after training. Balance (Berg Balance Scale, BBS), gait (6-Min Walk test, 6MWT; Timed-Up-and-Go, TUG), functional performance (30-s Chair-Stand Test, 30CST), spasticity (Modified Ashworth Scale) and perceived participation (Stroke Impact Scale, SIS) were also determined. Results: CON and ECC peak power increased in both the trained affected (34 and 44%; P < 0.01), and the untrained, non-affected leg (25 and 34%; P < 0.02). Power gains were greater (P = 0.008) for ECC than CON actions. ECC isokinetic torque at 60 and 90[degree sign]/s increased in the affected leg (P < 0.04). The increase in isometric LP force for the trained, affected leg across tests ranged 10-20% (P < 0.05). BBS (P = 0.004), TUG (P = 0.018), 30CST (P = 0.024) and SIS (P = 0.058) scores improved after training. 6MWT and spasticity remained unchanged. Conclusions: This novel, short-term ECC-overload flywheel RE training regime emerges as a valid, safe and viable method to improve muscle function, balance, gait and functional performance in men and women suffering from chronic stroke.

Age-related cognitive task effects on gait characteristics: do different working memory components make a difference?

Mon, 10/27/2014 - 00:00
Background: Though it is well recognized that gait characteristics are affected by concurrent cognitive tasks, how different working memory components contribute to dual task effects on gait is still unknown. The objective of the present study was to investigate dual-task effects on gait characteristics, specifically the application of cognitive tasks involving different working memory components. In addition, we also examined age-related differences in such dual-task effects. Methods: Three cognitive tasks (i.e. ‘Random Digit Generation’, ‘Brooks’ Spatial Memory’, and ‘Counting Backward’) involving different working memory components were examined. Twelve young (6 males and 6 females, 20 ~ 25 years old) and 12 older participants (6 males and 6 females, 60 ~ 72 years old) took part in two phases of experiments. In the first phase, each cognitive task was defined at three difficulty levels, and perceived difficulty was compared across tasks. The cognitive tasks perceived to be equally difficult were selected for the second phase. In the second phase, four testing conditions were defined, corresponding to a baseline and the three equally difficult cognitive tasks. Participants walked on a treadmill at their self-selected comfortable speed in each testing condition. Body kinematics were collected during treadmill walking, and gait characteristics were assessed using spatial-temporal gait parameters. Results: Application of the concurrent Brooks’ Spatial Memory task led to longer step times compared to the baseline condition. Larger step width variability was observed in both the Brooks’ Spatial Memory and Counting Backward dual-task conditions than in the baseline condition. In addition, cognitive task effects on step width variability differed between two age groups. In particular, the Brooks’ Spatial Memory task led to significantly larger step width variability only among older adults. Conclusion: These findings revealed that cognitive tasks involving the visuo-spatial sketchpad interfered with gait more severely in older versus young adults. Thus, dual-task training, in which a cognitive task involving the visuo-spatial sketchpad (e.g. the Brooks’ Spatial Memory task) is concurrently performed with walking, could be beneficial to mitigate impairments in gait among older adults.

Changes in activation timing of knee and ankle extensors during gait are related to changes in heteronymous spinal pathways after stroke

Fri, 10/24/2014 - 00:00
Background: Extensor synergy is often observed in the paretic leg of stroke patients. Extensor synergy consists of an abnormal stereotyped co-activation of the leg extensors as patients attempt to move. As a component of this synergy, the simultaneous activation of knee and ankle extensors in the paretic leg during stance often affects gait pattern after stroke. The mechanisms involved in extensor synergy are still unclear. The first objective of this study is to compare the co-activation of knee and ankle extensors during the stance phase of gait between stroke and healthy individuals. The second objective is to explore whether this co-activation is related to changes in heteronymous spinal modulations between quadriceps and soleus muscles on the paretic side in post-stroke individuals. Methods: Thirteen stroke patients and ten healthy individuals participated in gait and heteronymous spinal modulation evaluations. Co-activation was measured using peak EMG activation intervals (PAI) and co-activation amplitude indexes (CAI) between knee and ankle extensors during the stance phase of gait in both groups. The evaluation of heteronymous spinal modulations was performed on the paretic leg in stroke participants and on one leg in healthy participants. This evaluation involved assessing the early facilitation and later inhibition of soleus voluntary EMG induced by femoral nerve stimulation. Results: All PAI were lower and most CAI were higher on the paretic side of stroke participants compared with the co-activation indexes among control participants. CAI and PAI were moderately correlated with increased heteronymous facilitation of soleus on the paretic side in stroke individuals. Conclusions: Increased co-activation of knee and ankle extensors during gait is related to changes in intersegmental facilitative pathways linking quadriceps to soleus on the paretic side in stroke individuals. Malfunction of intersegmental pathways could contribute to abnormal timing of leg extensors during the stance phase of gait in hemiparetic individuals.

Analysis of relative displacement between the HX wearable robotic exoskeleton and the user¿s hand

Sat, 10/18/2014 - 00:00
Background: Advances in technology are allowing for the production of several viable wearable robotic devices to assist with activities of daily living and with rehabilitation. One of the most pressing limitations to user satisfaction is the lack of consistency in motion between the user and the robotic device. The displacement between the robot and the body segment may not correspond because of differences in skin and tissue compliance, mechanical backlash, and/or incorrect fit.FindingsThis report presents the results of an analysis of relative displacement between the user’s hand and a wearable exoskeleton, the HX. HX has been designed to maximize comfort, wearability and user safety, exploiting chains with multiple degrees-of-freedom with a modular architecture. These appealing features may introduce several uncertainties in the kinematic performances, especially when considering the anthropometry, morphology and degree of mobility of the human hand. The small relative displacements between the hand and the exoskeleton were measured with a video-based motion capture system, while the user executed several different grips in different exoskeleton modes. Conclusions: The analysis furnished quantitative results about the device performance, differentiated among device modules and test conditions. In general, the global relative displacement for the distal part of the device was in the range 0.5–1.5 mm, while within 3 mm (worse but still acceptable) for displacements nearest to the hand dorsum. Conclusions over the HX design principles have been drawn, as well as guidelines for future developments.

Lower-extremity joint kinematics and muscle activations during semi-reclined cycling at different workloads in healthy individuals

Fri, 10/17/2014 - 00:00
Background: A better understanding of lower-extremity muscles’ activation patterns and joint kinematics during different workloads could help rehabilitation professionals with prescribing more effective exercise regimen for elderly and those with compromised muscles. We examined the relative contribution, as well as activation and co-activation patterns, of lower-extremity muscles during semi-reclined cycling at different workloads during a constant cadence. Methods: Fifteen healthy novice cyclists participated at three 90-second cycling trials with randomly assigned workloads of 0, 50, and 100 W, at a constant cadence of 60 rpm. During all trials, electromyograms were recorded from four lower-extremity muscles: rectus femoris (RF), biceps femoris (BF), tibialis anterior (TA), and gastrocnemius medialis (GT). Joint kinematics were also recorded and synchronized with the EMG data. Muscle burst onset, offset, duration of activity, peak magnitude, and peak timing, as well as mean joint angles and mean ranges of motion were extracted from the recorded data and compared across workloads. Results: As workload increased, BF and TA displayed earlier activations and delayed deactivations in each cycle that resulted in a significantly (p < 0.05) longer duration of activity at higher workloads. RF showed a significantly longer duration of activity between 0 and 50 W as well as 0 and 100 W (p < 0.05); however, the activity duration of GT was not appeared to be affected significantly by workload. EMG peak-magnitude of RF, BF, and TA changed significantly (p < 0.05) as workload increased, but no changes were observed in the EMG peak-timing across workloads. Durations of co-activation in the RF-BF pair as well as the RF-TA pair increased significantly with workload, while the RF-TA and TA-GT pairs were only significantly different (p < 0.05) between the 0 and 100 W workload levels. Increased workload did not lead to any significant changes in the joint kinematics. Conclusions: Muscles’ activity patterns as well as co-activation patterns are significantly affected by changes in cycling workloads in healthy individuals. These variations should be considered during cycling, especially in the elderly and those with compromised musculoskeletal systems. Future research should evaluate such changes specific to these populations.

Cardiopulmonary exercise testing early after stroke using feedback-controlled robotics-assisted treadmill exercise: test-retest reliability and repeatability

Sat, 10/11/2014 - 00:00
Background: Exercise capacity is seriously reduced after stroke. While cardiopulmonary assessment and intervention strategies have been validated for the mildly and moderately impaired populations post-stroke, there is a lack of effective concepts for stroke survivors suffering from severe motor limitations. This study investigated the test-retest reliability and repeatability of cardiopulmonary exercise testing (CPET) using feedback-controlled robotics-assisted treadmill exercise (FC-RATE) in severely motor impaired individuals early after stroke. Methods: 20 subjects (age 44–84 years, <6 month post-stroke) with severe motor limitations (Functional Ambulatory Classification 0–2) were selected for consecutive constant load testing (CLT) and incremental exercise testing (IET) within a powered exoskeleton, synchronised with a treadmill and a body weight support system. A manual human-in-the-loop feedback system was used to guide individual work rate levels. Outcome variables focussed on standard cardiopulmonary performance parameters. Relative and absolute test-retest reliability were assessed by intraclass correlation coefficients (ICC), standard error of the measurement (SEM), and minimal detectable change (MDC). Mean difference, limits of agreement, and coefficient of variation (CoV) were estimated to assess repeatability. Results: Peak performance parameters during IET yielded good to excellent relative reliability: absolute peak oxygen uptake (ICC =0.82), relative peak oxygen uptake (ICC =0.72), peak work rate (ICC =0.91), peak heart rate (ICC =0.80), absolute gas exchange threshold (ICC =0.91), relative gas exchange threshold (ICC =0.88), oxygen cost of work (ICC =0.87), oxygen pulse at peak oxygen uptake (ICC =0.92), ventilation rate versus carbon dioxide output slope (ICC =0.78). For these variables, SEM was 4-13%, MDC 12-36%, and CoV 0.10-0.36. CLT revealed high mean differences and insufficient test-retest reliability for all variables studied. Conclusions: This study presents first evidence on reliability and repeatability for CPET in severely motor impaired individuals early after stroke using a feedback-controlled robotics-assisted treadmill. The results demonstrate good to excellent test-retest reliability and appropriate repeatability for the most important peak cardiopulmonary performance parameters. These findings have important implications for the design and implementation of cardiovascular exercise interventions in severely impaired populations. Future research needs to develop advanced control strategies to enable the true limit of functional exercise capacity to be reached and to further assess test-retest reliability and repeatability in larger samples.

Accelerometer measurement of upper extremity movement after stroke: a systematic review of clinical studies

Thu, 10/09/2014 - 00:00
The aim of this review was to identify and summarise publications, which have reported clinical applications of upper limb accelerometry for stroke within free-living environments and make recommendations for future studies. Data was searched from MEDLINE®, Scopus, IEEExplore and Compendex databases. The final search was 31st October 2013. Any study was included which reported clinical assessments in parallel with accelerometry in a free-living hospital or home setting. Study quality is reflected by participant numbers, methodological approach, technical details of the equipment used, blinding of clinical measures, whether safety and compliance data was collected. First author screened articles for inclusion and inclusion of full text articles and data extraction was confirmed by the third author. Out of 1375 initial abstracts, 8 articles were included. All participants were stroke patients. Accelerometers were worn for either 24 hours or 3 days. Data were collected as summed acceleration counts over a specified time or as the duration of active/inactive periods. Activity in both arms was reported by all studies and the ratio of impaired to unimpaired arm activity was calculated in six studies. The correlation between clinical assessments and accelerometry was tested in five studies and significant correlations were found. The efficacy of a rehabilitation intervention was assessed using accelerometry by three studies: in two studies both accelerometry and clinical test scores detected a post-treatment difference but in one study accelerometry data did not change despite clinical test scores showing motor and functional improvements. Further research is needed to understand the additional value of accelerometry as a measure of upper limb use and function in a clinical context. A simple and easily interpretable accelerometry approach is required.

Association between toe flexor strength and spatiotemporal gait parameters in community-dwelling older people

Wed, 10/08/2014 - 00:00
Background: The toe flexor muscles perform a crucial function to control foot movement and assist with propulsive force when walking. However, the association between toe flexor strength and spatio-temporal gait parameters is largely unknown. Spatiotemporal gait parameters represent gait characteristics, and are good measures of the functional status and degree of safe ambulation among community-dwelling older adults. Herein, we examined the association between the toe flexor strength and spatiotemporal gait parameters in community-dwelling older adults. Methods: Ninety-three community-dwelling older people (mean age: 73.2 ± 4.2 years, 53 women) participated in this study. The strength of the toe flexor muscles was assessed using a toe strength measuring instrument and a strain gauge. The measurements were performed once on each foot, and the average of the right and left was used in the analysis. Gait analysis was performed on a 15-m walkway under usual- and fast-pace conditions. The medial 10-m walking time was measured and walking speed was calculated. Acceleration and angular velocity of the right heel were measured using a wireless miniature sensor unit and used to compute cadence, percent of swing time in gait cycle (%swing time), and stride length. Results: In multiple regression analyses adjusted for age, sex, body height, body weight, and hand grip strength, no associations between toe flexor strength and spatiotemporal gait parameters at usual pace were found. Conversely, under the fast-pace condition, decreased toe flexor strength was significantly associated with slower walking speed (β = 0.22, p = 0.049), lower%swing time (β = 0.34, p = 0.009), and shorter stride length (β = 0.22, p = 0.011) after adjustment. Conclusion: In community-dwelling older people, decreased strength of toe flexor was correlated with slower walking speed, shorter periods of single-limb support phase, and shorter stride length during fast-pace walking. These data provide further support for an important role of toe flexor muscles in walking.

Perspectives on human-human sensorimotor interactions for the design of rehabilitation robots

Mon, 10/06/2014 - 00:00
Physical interactions between patients and therapists during rehabilitation have served as motivation for the design of rehabilitation robots, yet we lack a fundamental understanding of the principles governing such human-human interactions (HHI). Here we review the literature and pose important open questions regarding sensorimotor interaction during HHI that could facilitate the design of human-robot interactions (HRI) and haptic interfaces for rehabilitation. Based on the goals of physical rehabilitation, three subcategories of sensorimotor interaction are identified: sensorimotor collaboration, sensorimotor assistance, and sensorimotor education. Prior research has focused primarily on sensorimotor collaboration and is generally limited to relatively constrained visuomotor tasks. Moreover, the mechanisms by which performance improvements are achieved during sensorimotor cooperation with haptic interaction remains unknown. We propose that the effects of role assignment, motor redundancy, and skill level in sensorimotor cooperation should be explicitly studied. Additionally, the importance of haptic interactions may be better revealed in tasks that do not require visual feedback. Finally, cooperative motor tasks that allow for motor improvement during solo performance to be examined may be particularly relevant for rehabilitation robotics. Identifying principles that guide human-human sensorimotor interactions may lead to the development of robots that can physically interact with humans in more intuitive and biologically inspired ways, thereby enhancing rehabilitation outcomes.

Relation between abnormal synergy and gait in patients after stroke

Thu, 09/25/2014 - 00:00
Background: The abnormal synergy seen in patients after stroke is considered to limit the ability of these patients. However, in the lower extremity, antigravity torque generation rather than precise movement is needed for functions such as sit-to-stand movement and gait. Therefore, the ability to generate torque may be important either as a primary movement or as an abnormal synergy. We attempted to quantify the torque generation in the lower limb, selectively and as an abnormal synergy, and its relation with gait. Methods: Selectively generated plantar flexion torque in the ankle and plantar flexion torque secondarily generated accompanying maximal hip extension (i.e., torque generated with abnormal synergy) were measured in subjects after stroke and control subjects. In subjects after stroke, secondary torque generation while controlling hip extension torque as 25%, 50%, and 75% of the maximal hip extension was also measured. The relation of torque generation with the gait speed and timed-up-and go test (TUG) was also analyzed. Results: In subjects after stroke, there was no difference between the amount of plantar flexion torque generated secondarily and the selectively generated torque, whereas the selective torque was significantly greater in control subjects. Pearson product–moment correlation coefficient analysis revealed that TUG speed is related to secondarily generated torque accompanying maximal hip extension but not with selectively generated torque. Conclusion: Secondarily generated torque was found to be a factor that affects TUG speed, and the ability to generate torque even through abnormal synergy may help for gait ability in subjects after stroke.

TagTrainer: supporting exercise variability and tailoring in technology supported upper limb training

Wed, 09/24/2014 - 00:00
Background: Rehabilitation technology for upper limb training can potentially increase the amount, duration, and quality of therapy offered to patients by targeting the needs of individual patients. Empirical evaluations of such technologies focus on clinical effectiveness; however, little is known regarding the implications of their implementation in daily practice. Tailoring training content to patients requires active participation by therapists, and requires an extension of their role to include authoring and modifying exercises. It is not yet known whether this is feasible, and the socio-technical requirements that will make it successful in practice have not yet been explored. The current study investigates the extent to which therapists can take the role of authoring patient-specific training content and whether effort savings can be achieved by sharing the created content.MethodWe present TagTrainer: an interactive tabletop system for rehabilitation that can be operated by manipulating every day physical objects in order to carry out exercises that simulate daily living tasks. TagTrainer supports therapists in creating their own exercises that fit individual patient needs, in adjusting existing exercises, and in putting together personalized exercise programs for and with patients. Four therapists in stroke- and paraplegia-rehabilitation have used TagTrainer for three weeks. Semi-structured interviews were conducted with the therapists, questionnaires were administered to them, and observation notes and usage logs were collected. Results: A total of 20 exercises were created from scratch, while another three exercises were created as variations of the existing ones. Importantly, all these exercises were created to address specific needs that patients expressed. The patients found the exercises motivating and these exercises were integrated into their regular training. Conclusions: TagTrainer can support arm-hand rehabilitation training by increasing therapy variability and tailoring. Therapists consider TagTrainer most suited for group sessions where they supervise many patients at once. Therapists are motivated and are able to, with minimal training, create and tailor exercises for patients fitting individual needs and capabilities. Future research will examine the socio-technical conditions that will encourage therapists to contribute and share training content, and provide the peer support needed for the adoption of a new technology.

An animal study to examine the effects of the bilateral, epidural cortical stimulation on the progression of amyotrophic lateral sclerosis

Sun, 09/21/2014 - 00:00
Background: We examined the effects of the unilateral cortical stimulation on the survival of neurons showing degenerative changes and compared those in delaying the progression of amyotrophic lateral sclerosis (ALS) between the unilateral cortical stimulation and the bilateral one in an animal experimental model using mice. Methods: We used 19 G93A transgenic mice and randomly divided into three groups: the control group (n = 6) (the implantation of electrodes in the bilateral motor cortex without electrical stimulation), the unilateral stimulation group (n = 7) (the implantation of electrodes in the unilateral motor cortex with a 24-hour cortical stimulation) and the bilateral stimulation group (n = 6) (the implantation of electrodes in the bilateral motor cortex with a 24-hour cortical stimulation). Results: The mean survival period was significantly longer in the bilateral stimulation group as compared with the control group (124.33 ± 11.00 days vs. 109.50 ± 10.41 days) (P < 0.05). In addition, on postoperative weeks 11, 12, 13, 14 and 15, the mean Rota-rod score was significantly higher in the unilateral stimulation group as compared with the control group (P < 0.05). Furthermore, despite a lack of statistical significance, it was the lowest in the bilateral stimulation group on postoperative weeks 13, 14, 15 and 17. On postoperative weeks 11, 12, 13, 14 and 16, the mean score of paw-grip endurance was significantly higher in the unilateral stimulation group as compared with the control group (P < 0.05). Furthermore, despite a lack of statistical significance, it was the lowest in the bilateral stimulation group on postoperative weeks 13, 14, 15 and 17. Conclusions: In conclusion, our results indicate that the bilateral epidural cortical stimulation might have a treatment effect in a murine model of ALS. But it is the limitation that we examined a small number of experimental animals. Further studies are therefore warranted to establish our results and to identify the optimal parameters of the epidural cortical stimulation in a larger number of experimental animals.

Time-division multiplexing for myoelectric closed-loop control using electrotactile feedback

Mon, 09/15/2014 - 00:00
Background: Restoring sensory feedback in myoelectric prostheses is still an open challenge. Closing the loop might lead to a more effective utilization and better integration of these systems into the body scheme of the user. Electrotactile stimulation can be employed to transmit the feedback information to the user, but it represents a strong interference to the recording of the myoelectric signals that are used for control. Time-division multiplexing (TDM) can be applied to avoid this interference by performing the stimulation and recording in dedicated, non-overlapping time windows. Methods: A closed-loop compensatory tracking task with myocontrol and electrotactile stimulation was used to investigate how the duration of the feedback window (FW) influences the ability to perceive the feedback information and react with an appropriate control action. Nine subjects performed eight trials with continuous recording and contralateral feedback (CONT-CLT) and TDM with ispilateral stimulation and recording using the FW of 40 ms (TDM40), 100 ms (TDM100) and 300 ms (TDM300). The tracking quality was evaluated by comparing the reference and generated trajectories using cross-correlation coefficient (CCCOEF), time delay, root mean square tracking error, and the amount of overshoot. Results: The control performance in CONT-CLT was the best in all the outcome measures. The overall worst performance was obtained using TDM with the shortest FW (TDM40). There was no significant difference between TDM100 and TDM300, and the quality of tracking in these two conditions was high (CCCOEF ~ 0.95). The results demonstrated that FW duration is indeed an important parameter in TDM, which appears to have an optimal value. Among the tested cases, the FW duration of 100 ms seems to be the best trade-off between the quality of perception and a limited command update rate. Conclusions: This study represents the first systematic evaluation of a TDM-based approach for closing the loop using electrotactile feedback in myoelectric systems. The overall conclusion is that TDM is a feasible and attractive method for closed-loop myocontrol, since it is easy to implement (software-only solution), has limited impact on the performance when using proper FW duration, and might decrease habituation due to burst-like stimulation delivery.

Assessment of movement quality in robot- assisted upper limb rehabilitation after stroke: a review

Fri, 09/12/2014 - 00:00
Studies of stroke patients undergoing robot-assisted rehabilitation have revealed various kinematic parameters describing movement quality of the upper limb. However, due to the different level of stroke impairment and different assessment criteria and interventions, the evaluation of the effectiveness of rehabilitation program is undermined. This paper presents a systematic review of kinematic assessments of movement quality of the upper limb and identifies the suitable parameters describing impairments in stroke patients. A total of 41 different clinical and pilot studies on different phases of stroke recovery utilizing kinematic parameters are evaluated. Kinematic parameters describing movement accuracy are mostly reported for chronic patients with statistically significant outcomes and correlate strongly with clinical assessments. Meanwhile, parameters describing feed-forward sensorimotor control are the most frequently reported in studies on sub-acute patients with significant outcomes albeit without correlation to any clinical assessments. However, lack of measures in coordinated movement and proximal component of upper limb enunciate the difficulties to distinguish the exploitation of joint redundancies exhibited by stroke patients in completing the movement. A further study on overall measures of coordinated movement is recommended.

Validation of the angular measurements of a new inertial-measurement-unit based rehabilitation system: comparison with state-of-the-art gait analysis

Thu, 09/11/2014 - 00:00
Background: Several rehabilitation systems based on inertial measurement units (IMU) are entering the market for the control of exercises and to measure performance progression, particularly for recovery after lower limb orthopaedic treatments. IMU are easy to wear also by the patient alone, but the extent to which IMU’s malpositioning in routine use can affect the accuracy of the measurements is not known. A new such system (Riablo™, CoRehab, Trento, Italy), using audio-visual biofeedback based on videogames, was assessed against state-of-the-art gait analysis as the gold standard. Methods: The sensitivity of the system to errors in the IMU’s position and orientation was measured in 5 healthy subjects performing two hip joint motion exercises. Root mean square deviation was used to assess differences in the system’s kinematic output between the erroneous and correct IMU position and orientation.In order to estimate the system’s accuracy, thorax and knee joint motion of 17 healthy subjects were tracked during the execution of standard rehabilitation tasks and compared with the corresponding measurements obtained with an established gait protocol using stereophotogrammetry. Results: A maximum mean error of 3.1 ± 1.8 deg and 1.9 ± 0.8 deg from the angle trajectory with correct IMU position was recorded respectively in the medio-lateral malposition and frontal-plane misalignment tests. Across the standard rehabilitation tasks, the mean distance between the IMU and gait analysis systems was on average smaller than 5°. Conclusions: These findings showed that the tested IMU based system has the necessary accuracy to be safely utilized in rehabilitation programs after orthopaedic treatments of the lower limb.

Effects of STN DBS and auditory cueing on the performance of sequential movements and the occurrence of action tremor in Parkinson¿s disease

Thu, 09/11/2014 - 00:00
Background: Parkinson’s disease (PD) patients show a higher ability to perform repetitive movements when they are cued by external stimuli, suggesting that rhythmic synchronization with an auditory timekeeper can be achieved in the absence of intact basal ganglia function. Deep brain stimulation (DBS) is another therapeutic method that improves movement performance in PD and may suppress or enhance action tremor. However, the combined effect of these therapies on action tremor has not been studied yet. In this pilot study, we thus test the effect of both DBS in the subthalamic nucleus (STN) and auditory cueing on movement performance and action tremor. Methods: 7 PD patients treated with (bilateral) STN DBS were asked to move one hand or foot between two dots, separated by 30 cm as indicated on the table or the floor. The movement frequency was dictated by a metronome with a frequency in the range of 1.6 to 4.8 Hz. Each test was repeated three times for each extremity, with different stimulation settings applied during each repetition. The power spectral density patterns of recorded movements were studied. Tremor intermittency was taken into account by classifying each 2-second window of the recorded angular velocity signals as a tremor or non-tremor window. By determining the phase locking value it was tested whether movement or tremor was synchronized with the auditory cue. Results: While action tremor presence or absence did not affect the level of synchronization of the movement signal with the auditory cue for the different metronome frequencies, the number of extremities showing action tremor was significantly reduced under external cueing conditions in combination with DBS. In this respect the cueing frequencies of 1.6 and 4.8 Hz showed similar effects, suggesting that the frequency of the cueing signal is not that critical. Conclusion: The combination of deep brain stimulation and auditory cueing, which both are proposed to involve the activation of cerebellar circuits, shows an enhanced action tremor reduction in Parkinson’s disease.

Functional principal component analysis as a new methodology for the analysis of the impact of two rehabilitation protocols in functional recovery after stroke

Wed, 09/10/2014 - 00:00
Background: This study addressed the problem of evaluating the effectiveness of two protocols of physiotherapy for functional recovery after stroke. In particular, the study explored the use of Functional Principal Component Analysis (FPCA), a multivariate data analysis in order to assess and clarify the process of regaining independence after stroke. Methods: A randomized double-blind controlled trial was performed. Thirteen subjects with residual hemiparesis after a single stroke episode were measured in both in- and outpatient settings at a district hospital. All subjects were able to walk before suffering the stroke and were hemodynamically stable within the first week after stroke. Control and target groups were treated with conventional physiotherapy for stroke, but specific techniques were added for treatment of the target group depending on patients’ functional levels.Independence level was assessed with the Barthel Index (BI) throughout 7 evolution stages (hemodynamic stability, beginning of standing, beginning of physical therapy sessions in the physiotherapy ward and monthly assessment for 6 months after stroke). Results: FPCA was applied for data analysis. Statistically significant differences were found in the dynamics of the recovery process between the two physiotherapy protocols. The target group showed a trend of improvement six months after stroke that was not present in the control group. Conclusions: FPCA is a method which may be used to provide greater insight into the analysis of the rehabilitation process than that provided by conventional parametric methods. So, by using the whole curves as basic data parameters, subtle differences in the rehabilitation process can be found.FPCA represents a future aid for the fine analysis of similar physiotherapy techniques, when applied in subjects with a huge variability of functional recovery, as in the case of post-stroke patients.

Infant trunk posture and arm movement assessment using pressure mattress, inertial and magnetic measurement units (IMUs)

Sat, 09/06/2014 - 00:00
Background: Existing motor pattern assessment methods, such as digital cameras and optoelectronic systems, suffer from object obstruction and require complex setups. To overcome these drawbacks, this paper presents a novel approach for biomechanical evaluation of newborn motor skills development. Multi-sensor measurement system comprising pressure mattress and IMUs fixed on trunk and arms is proposed and used as alternative to existing methods. Observed advantages seem appealing for the focused field and in general. Combined use of pressure distribution data and kinematic information is important also for posture assessment, ulcer prevention, and non-invasive sleep pattern analysis of adults. Methods: Arm kinematic parameters, such as root-mean-square acceleration, spectral arc length of hand velocity profile, including arm workspace surface area, and travelled hand path are obtained with the multi-sensor measurement system and compared to normative motion capture data for evaluation of adequacy. Two IMUs per arm, only one IMU on upper arm, and only one IMU on forearm sensor placement options are studied to assess influence of system configuration on method precision. Combination of pressure mattress and IMU fixed on the trunk is used to measure trunk position (obtained from mat), rotation (from IMUs) and associated movements on surface (from both). Measurement system is first validated on spontaneous arm and trunk movements of a dedicated baby doll having realistic anthropometric characteristics of newborns. Next, parameters of movements in a healthy infant are obtained with pressure mattress, along with trunk and forearm IMU sensors to verify appropriateness of method and parameters. Results: Evaluation results confirm that full sensor set, comprising pressure mattress and two IMUs per arm is a reliable substitution to optoelectronic systems. Motor pattern parameter errors are under 10% and kinematic estimation error is in range of 2 cm. Although, use of only forearm IMU is not providing best possible kinematic precision, the simplicity of use and still acceptable accuracy are convincing for frequent practical use. Measurements demonstrated system high mobility and usability. Conclusions: Study results confirm adequacy of the proposed multi-sensor measurement system, indicating its enviable potential for accurate infant trunk posture and arm movement assessment.

Comparison of range-of-motion and variability in upper body movements between transradial prosthesis users and able-bodied controls when executing goal-oriented tasks

Sat, 09/06/2014 - 00:00
Background: Current upper limb prostheses do not replace the active degrees-of-freedom distal to the elbow inherent to intact physiology. Limited evidence suggests that transradial prosthesis users demonstrate shoulder and trunk movements to compensate for these missing volitional degrees-of-freedom. The purpose of this study was to enhance understanding of the effects of prosthesis use on motor performance by comparing the movement quality of upper body kinematics between transradial prosthesis users and able-bodied controls when executing goal-oriented tasks that reflect activities of daily living. Methods: Upper body kinematics were collected on six able-bodied controls and seven myoelectric transradial prosthesis users during execution of goal-oriented tasks. Range-of-motion, absolute kinematic variability (standard deviation), and kinematic repeatability (adjusted coefficient-of-multiple-determination) were quantified for trunk motion in three planes, shoulder flexion/extension, shoulder ab/adduction, and elbow flexion/extension across five trials per task. Linear mixed models analysis assessed between-group differences and correlation analysis evaluated association between prosthesis experience and kinematic repeatability. Results: Across tasks, prosthesis users demonstrated increased trunk motion in all three planes and shoulder abduction compared to controls (p ≤ 0.004). Absolute kinematic variability was greater for prosthesis users for all degrees-of-freedom irrespective of task, but was significant only for degrees-of-freedom that demonstrated increased range-of-motion (p ≤ 0.003). For degrees-of-freedom that did not display increased absolute variability for prosthesis users, able-bodied kinematics were characterized by significantly greater repeatability (p ≤ 0.015). Prosthesis experience had a strong positive relationship with average kinematic repeatability (r = 0.790, p = 0.034). Conclusions: The use of shoulder and trunk movements by prosthesis users as compensatory motions to execute goal-oriented tasks demonstrates the flexibility and adaptability of the motor system. Increased variability in movement suggests that prosthesis users do not converge on a defined motor strategy to the same degree as able-bodied individuals. Kinematic repeatability may increase with prosthesis experience, or encourage continued device use, and future work is warranted to explore these relationships. As compensatory dynamics may be necessary to improve functionality of transradial prostheses, users may benefit from dedicated training that encourages optimization of these dynamics to facilitate execution of daily living activity, and fosters adaptable but reliable motor strategies.

HIVE is supported by the European Commission under the Future and Emerging Technologies program.

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