Abstract P202: Estimation of Arm Kinematics in Stroke Survivors With Wearable Sensors

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jeffrey Z Nie ◽  
James W Nie ◽  
Na-Teng Hung ◽  
Marc Slutzky
Keyword(s):  
Motor Function ◽  
Wearable Sensors ◽  
Motor Impairment ◽  
Optical Tracking ◽  
Estimation Accuracy ◽  
Stroke Survivors ◽  
Elbow Angle ◽  
Rehabilitation Outcomes ◽  
Wrist Position ◽  
Flexion Extension

Introduction: Stroke is the leading cause of long-term disability in the US, often resulting in upper extremity (UE) motor impairment. Numerous clinical metrics have been developed and used to evaluate UE motor function to assess rehabilitation outcomes, but most of these are innately subjective and/or have relatively low sensitivity to change due to the use of ordinal scales. As a result, there is a growing interest in the use of kinematics to evaluate UE motor function, as they provide completely objective, high resolution quantitative measurements. However, obtaining kinematic measurements in stroke survivors can be a challenging task, as non-ideal environments (e.g., hospital rooms), expense, and a limited ability to perform calibration poses can make traditional optical tracking systems impractical. To overcome these challenges, we developed and compared two methods using different wearable sensors to estimate elbow angle and wrist position during reaching movements in people with stroke. Methods: We developed frameworks specific for two different types of sensors, inertial measurement units (IMU) and virtual reality (Vive) trackers, to estimate elbow angle and wrist position. We assessed each sensor’s estimation accuracy during pure flexion-extension motion, performed by a manual goniometer, and pure pronation-supination motion, performed by a healthy participant. We also compared each sensor’s ability to longitudinally track a stroke survivor’s UE function by using the wrist position estimates to compute sweep areas during a sweeping task. Results: For the IMUs, our results demonstrated accuracy to within 4.8° and 1.2 cm for elbow angle and wrist position, respectively. For the Vive, our results demonstrated accuracy to within 2.2° and 0.9 cm. The change in sweep area estimated by each method agreed with each other, as the difference between estimates was approximately 4% of the change in sweep area. Conclusion: These methods can be used to develop and accurately assess kinematic metrics for use in evaluating stroke rehabilitation outcomes.

scholarly journals Estimation of arm kinematics in stroke survivors using wearable sensors

2021 ◽  
Author(s):  
Jeffrey Z. Nie ◽  
James W. Nie ◽  
Na-Teng Hung ◽  
R. James Cotton ◽  
Marc W. Slutzky
Keyword(s):  
Pearson Correlation ◽  
Wearable Sensors ◽  
Motor Impairment ◽  
Correlation Coefficients ◽  
The United States ◽  
Optical Tracking ◽  
Stroke Survivors ◽  
Reaching Task ◽  
Wrist Position ◽  
Arm Kinematics

Abstract BackgroundStroke is the leading cause of long-term disability in the United States, often resulting in upper extremity (UE) motor impairment. Most existing outcome metrics of UE function in rehabilitation are insensitive to change or subject to observer bias. There is growing interest in using movement kinematics to measure UE motor function, since they can provide high-resolution, quantitative measurements. However, measuring arm kinematics in stroke survivors, particularly in the hospital or clinic, can be challenging for traditional optical tracking systems due to non-ideal environments, expense, and a limited ability to perform required calibration poses. The aim of this study was to develop a general framework for accurate measurements of wrist position during reaching movements in people with stroke using relatively inexpensive wearable sensors.MethodsWe developed and presented two methods, one using inertial measurement units (IMUs) and using virtual reality (Vive) sensors, that practically estimate wrist position with respect to the shoulder. We then assessed the estimation accuracies of each method during a 3D reaching task by using a Vicon motion capture system. We also demonstrated each methods ability to track two kinematic metrics, sweep area and smoothness, in chronic stroke survivors. We computed Pearson correlation coefficients when appropriate.ResultsCompared to a traditional optical system, both systems tracked with high accuracy during 3D reaching, with mean absolute errors of 1.00 ± 0.80 cm and 1.09 ± 0.51 cm for the IMU and Vive, respectively. Furthermore, both methods’ estimated kinematics highly agreed with each other (p < 0.01).ConclusionsThese methods may be useful for developing kinematic metrics to evaluate stroke rehabilitation outcomes in both laboratory and clinical environments.Trial RegistrationThe clinical trial (ClinicalTrial.gov ID: NCT03401762) was registered on January 17, 2018 (https://clinicaltrials.gov/ct2/show/NCT03401762) and posted on January 1, 2018. The trial is scheduled to be completed by August 2023. The trial was updated on December 2, 2020 and is currently recruiting.

scholarly journals Portable, open-source solutions for estimating wrist position during reaching in people with stroke

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jeffrey Z. Nie ◽  
James W. Nie ◽  
Na-Teng Hung ◽  
R. James Cotton ◽  
Marc W. Slutzky
Keyword(s):  
Open Source ◽  
Tracking System ◽  
Wearable Sensors ◽  
Correlation Coefficients ◽  
Arm Movement ◽  
Optical Tracking ◽  
Optical Tracking System ◽  
Reaching Task ◽  
Rehabilitation Outcomes ◽  
Wrist Position

AbstractArm movement kinematics may provide a more sensitive way to assess neurorehabilitation outcomes than existing metrics. However, measuring arm kinematics in people with stroke can be challenging for traditional optical tracking systems due to non-ideal environments, expense, and difficulty performing required calibration. Here, we present two open-source methods, one using inertial measurement units (IMUs) and another using virtual reality (Vive) sensors, for accurate measurements of wrist position with respect to the shoulder during reaching movements in people with stroke. We assessed the accuracy of each method during a 3D reaching task. We also demonstrated each method’s ability to track two metrics derived from kinematics-sweep area and smoothness-in people with chronic stroke. We computed correlation coefficients between the kinematics estimated by each method when appropriate. Compared to a traditional optical tracking system, both methods accurately tracked the wrist during reaching, with mean signed errors of 0.09 ± 1.81 cm and 0.48 ± 1.58 cm for the IMUs and Vive, respectively. Furthermore, both methods’ estimated kinematics were highly correlated with each other (p < 0.01). By using relatively inexpensive wearable sensors, these methods may be useful for developing kinematic metrics to evaluate stroke rehabilitation outcomes in both laboratory and clinical environments.

scholarly journals Functional Deficits in the Less-Impaired Arm of Stroke Survivors Depend on Hemisphere of Damage and Extent of Paretic Arm Impairment

2019 ◽  
Vol 34 (1) ◽  
pp. 39-50 ◽  
Author(s):  
Candice Maenza ◽  
David C. Good ◽  
Carolee J. Winstein ◽  
David A. Wagstaff ◽  
Robert L. Sainburg
Keyword(s):  
Grip Strength ◽  
Motor Function ◽  
Right Hemisphere ◽  
Functional Performance ◽  
Hand Function ◽  
Motor Impairment ◽  
Functional Independence ◽  
Motor Deficit ◽  
Motor Deficits ◽  
Stroke Survivors

Background. Previous research has detailed the hemisphere dependence and specific kinematic deficits observed for the less-affected arm of patients with unilateral stroke. Objective. We now examine whether functional motor deficits in the less-affected arm, measured by standardized clinical measures of motor function, also depend on the hemisphere that was damaged and on the severity of contralesional impairment. Methods. We recruited 48 left-hemisphere-damaged (LHD) participants, 62 right-hemisphere-damaged participants, and 54 age-matched control participants. Measures of motor function included the following: (1) Jebsen-Taylor Hand Function Test (JHFT), (2) Grooved Pegboard Test (GPT), and (3) grip strength. We measured the extent of contralesional arm impairment with the upper-extremity component of the Fugl-Meyer (UEFM) assessment of motor impairment. Results. Ipsilesional limb functional performance deficits (JHFT) varied with both the damaged hemisphere and severity of contralesional arm impairment, with the most severe deficits expressed in LHD participants with severe contralesional impairment (UEFM). GPT and grip strength varied with severity of contralesional impairment but not with hemisphere. Conclusions. Stroke survivors with the most severe paretic arm impairment, who must rely on their ipsilesional arm for performing daily activities, have the greatest motor deficit in the less-affected arm. We recommend remediation of this arm to improve functional independence in this group of stroke patients.

Cerebellar Dysfunction in Multiple Sclerosis: Considerations for Research and Rehabilitation Therapy

2021 ◽  
pp. 154596832110654
Author(s):  
Erin M. Edwards ◽  
Nora E. Fritz ◽  
Amanda S. Therrien
Keyword(s):  
Multiple Sclerosis ◽  
Motor Control ◽  
Motor Impairment ◽  
Future Research ◽  
Disability Progression ◽  
Cerebellar Dysfunction ◽  
Motor Disability ◽  
Rehabilitation Outcomes ◽  
Critical Knowledge ◽  
The Impact

Introduction. Cerebellar pathology is common among persons with multiple sclerosis (PwMS). The cerebellum is well recognized for its role in motor control and motor learning and cerebellar pathology in multiple sclerosis is associated with enhanced motor impairment and disability progression. The Problem. To mitigate motor disability progression, PwMS are commonly prescribed exercise and task-specific rehabilitation training. Yet, whether cerebellar dysfunction differentially affects rehabilitation outcomes in this population remains unknown. Furthermore, we lack rehabilitation interventions targeting cerebellar dysfunction. The Solution. Here, we summarize the current understanding of the impact of cerebellar dysfunction on motor control, motor training, and rehabilitation in persons with multiple sclerosis. Recommendations. Additionally, we highlight critical knowledge gaps and propose that these guide future research studying cerebellar dysfunction in persons with multiple sclerosis.

scholarly journals Virtual Reality for Stroke Rehabilitation: assessment, training and the effect of virtual therapy

2011 ◽  
Vol 14 (2) ◽  
pp. 23-32 ◽  
Author(s):  
Paweł Kiper ◽  
Andrea Turolla ◽  
Lamberto Piron ◽  
Michela Agostini ◽  
Alfonc Baba ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Motor Function ◽  
Negative Impact ◽  
Innovative Technology ◽  
Rehabilitation Outcomes ◽  
Function Impairment ◽  
Sensory Modalities ◽  
Task Practice ◽  
Adaptive Nature ◽  
Virtual Therapy

The motor function impairment deriving from stroke injury has a negative impact on autonomy and on the activities of daily living. Several studies have demonstrated that learning new motor skills is important to induce neuroplasticity and functional recovery. To facilitate the activation of brain areas and consequently neuroplasticity, it may be advantageous to combine traditional motor rehabilitation with innovative technology, in order to promote motor re-learning and skill re-acquisition by means of an enhanced training. Following these principles, exercises should involve multiple sensory modalities exploiting the adaptive nature of the nervous system, in order to promote active patient participation. Movement re-learning could be improved by means of training in an enriched environment focused on optimizing the affordances between the motor system and the physical environment: virtual reality technologies allow for the possibility to create specific settings where the affordances are optimized. Several autors report that patients treated in virtual representation could, in both acute and chronic stroke, improve their arm motor function. Reinforced Feedback in a Virtual Environment (RFVE), can incorporate the elements necessary to maximize motor learning, such as repetitive and differentiated task practice, feedback of performance and results, and reinforcement of the motivation. The RFVE approach may lead to better rehabilitation outcomes in the treatment of the upper limb in stroke patients.

Abstract TP75: Normal Appearing White Matter Integrity and Motor Impairment Severity in Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Carson Ingo ◽  
Chen Lin ◽  
James Higgins ◽  
Yurany Arevalo ◽  
Shyam Prabhakaran
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Acute Ischemic Stroke ◽  
Motor Function ◽  
Motor Impairment ◽  
Internal Capsule ◽  
Posterior Limb ◽  
Normal Appearing White Matter ◽  
Stroke Group ◽  
Microstructural Integrity

Introduction: The effect of white matter hyperintensities (WMH) as measured by fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging on functional impairment and recovery after ischemic stroke has been investigated thoroughly. However, there has been growing interest to investigate normal-appearing white matter (NAWM) microstructural integrity following ischemic stroke onset with techniques such as diffusion tensor imaging (DTI). Methods: 52 patients with acute ischemic stroke and 36 without stroke were evaluated with a DTI and FLAIR imaging protocol and clinically assessed for severity of motor impairment using the Motricity Index within 72 hours of suspected symptom onset. Results: There were widespread decreases in fractional anisotropy (FA) and increases in mean diffusivity (MD) and radial diffusivity (RD) for the acute stroke group compared to the non-stroke group. As shown in the abstract figure with the blue voxels, there was a significant positive association between FA and motor function and a significant negative association between MD/RD and motor function. The NAWM regions of interest that were most sensitive to the Motricity Index were the anterior/posterior limb of the internal capsule in the infarcted hemisphere and the splenium of the corpus callosum, external capsule, posterior limb/retrolenticular part of the internal capsule, superior longitudinal fasciculus, and cingulum (hippocampus) of the intra-/contralateral hemisphere. Conclusion: The microstructural integrity of NAWM is a significant parameter to identify neural differences not only between those individuals with and without acute ischemic stroke, but also correlated with severity of acute motor impairment.

Functional Electrical Stimulation (FES) Control for Restoration and Rehabilitation of Motor Function

2012 ◽  
pp. 80-93
Author(s):  
Takashi Watanabe ◽  
Naoto Miura
Keyword(s):  
Electrical Stimulation ◽  
Motor Function ◽  
Functional Electrical Stimulation ◽  
Wearable Sensors ◽  
Integrated System ◽  
Rehabilitation Training ◽  
Cord Injury ◽  
Feedback Error Learning ◽  
Feedback Error ◽  
Functional Movements

Functional electrical stimulation (FES) has been studied and clinically applied to restoring or assisting motor functions lost due to spinal cord injury or cerebrovascular disease. Electrical stimulation without control of functional movements is also used for therapy or in rehabilitation training. In recent years, one of the main focuses of FES studies has been its application for rehabilitation of motor function. In this review, the authors first present the basics of applying electrical stimulation to the neuromuscular system for motor control. Then, two methods of FES control are discussed: controllers for FES based on feedback error learning (FEL) and on cycle-to-cycle control of limb movements. The FEL-FES controller can be practical in FES applications that need to control the musculoskeletal system that involves various nonlinear characteristics and delay in its responses to electrical stimulation. The cycle-to-cycle control is expected to be effective in controlling repetitive movements for rehabilitation training. Finally, a study on ankle dorsiflexion control during the swing phase using an integrated system of FES control and motion measurement with wearable sensors for rehabilitation is presented.

Stroke

2008 ◽  
Author(s):  
Hochang Ben Lee ◽  
John R. Lipsey
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Vascular Dementia ◽  
Cognitive Deficits ◽  
Cognitive Rehabilitation ◽  
Right Hemisphere ◽  
Stroke Survivors ◽  
Language Therapy ◽  
Rehabilitation Outcomes ◽  
Psychiatric Complication

With an annual incidence of more than 600,000 cases, thromboembolic stroke is the third leading cause of death in the United States after heart disease and cancer (Kochanek et al., 2004). The number of stroke survivors has increased to 4.5 million adults nationally as the management of acute stroke continues to improve (AHA, 2002). Psychiatric syndromes are common complications of stroke and are associated with psychologic distress, increased impairment, poor rehabilitation outcomes, and excess morbidity. The purpose of this chapter is to describe clinically important poststroke psychiatric disorders and suggest appropriate treatment. Cognitive deficits are the most common psychiatric complication of stroke and affect nearly all stroke survivors. The type of cognitive disturbance depends on the location of the brain injury. Left hemisphere strokes frequently cause aphasia. Right hemisphere strokes cause substantial (but often underrecognized) cognitive impairments such as diminished insight, decreased attention, impaired spatial reasoning, and neglect syndromes. Furthermore, depending on the location of a stroke, other functions such as motivation, memory, judgment, and impulse control may also be affected. A large stroke or a series of small strokes affecting both hemispheres may lead to the global cognitive impairment of dementia. When a series of strokes is involved, the cognitive decline develops in a stepwise manner. This vascular dementia or multi-infarct dementia may be difficult to distinguish from Alzheimer’s disease. Autopsy studies of patients diagnosed with vascular dementia have often demonstrated the presence of Alzheimer’s disease pathology. As many as 25% of all dementia cases are attributable to a combined neuropathology of Alzheimer’s disease and multiple infarcts (Massoud et al., 1999). In addition to strategies such as speech and language therapy, physical and occupational therapy, and cognitive rehabilitation, pharmacologic treatment may improve cognitive deficits in some stroke patients. The parallels between vascular dementia and Alzheimer’s disease, as well as the evidence that reduced cholinergic function may play a role in both (Gottfries et al., 1994) have encouraged the use of acetylcholinesterase inhibitors (eg, donepezil) in vascular dementia. These drugs have shown modest benefits in such patients (Roman et al., 2005), and their use is described in Chapter 20.

scholarly journals Translation, cultural adaptation and reliability of the brazilian version of the Graded Wolf Motor Function Test in adults with severe hemiparesis

2015 ◽  
Vol 28 (4) ◽  
pp. 667-676 ◽  
Author(s):  
Natalia Duarte Pereira ◽  
Luciane Vieira ◽  
Fernanda Priscila Pompeu ◽  
Isabella De Souza Menezes ◽  
Sarah Monteiro Dos Anjos ◽  
...  
Keyword(s):  
Motor Function ◽  
Cultural Adaptation ◽  
Motor Impairment ◽  
Correlation Coefficients ◽  
Rater Reliability ◽  
Brazilian Version ◽  
Function Test ◽  
Wolf Motor Function Test ◽  
Quality Of Movement ◽  
Upper Extremity Motor Impairment

Abstract Introduction : The Graded Wolf Motor Function Test (GWMFT) was developed as a modification of the Wolf Motor Function Test (WMFT), designed to address moderate-to-severe upper-extremity motor impairment, consequent to a stroke or brain injury, by combining time and quality of movement measures in both isolated movements and functional tasks. Objectives : To translate and adapt the GWMFT form and instructions manual to Brazilian Portuguese and evaluate the inter-rater reliability. Materials and methods : Ten individuals, mean age 53.2 ± 11.39 (range: 28-72) years and a mean time since stroke onset of 82.5 ± 85.83 (16-288) months participated in the study. After translation and cultural adaptation, two independent evaluators, based on the instructions manual information, administered GWMFT. Video observations were used to rate the time and the compensatory movements in the Functional Ability Scale (FAS). Intra-class Correlation Coefficients (ICCs) and Bland-Altman plots were calculated to examine the inter-rater reliability for performance time and FAS. Results : The translated and adapted version obtained a total ICC inter-rater time 0.99 (0.95-1.00), showing less reliability in the task of lifting a pen, with ICC = 0.71 (- 0.15-0.93). The ICC of the total FAS was 0.98 (0.92-0.99) and the task of elbow extension has shown the lowest ICC rate = 0.83 (0.31-0.96). Conclusion : The GWMFT scale reliability proved to be appropriate to evaluate the paretic upper limb in individuals with chronic hemiparesis post severe stroke.

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