Smoothness metrics for reaching performance after stroke. Part 1: which one to choose?

Abstract Background Smoothness is commonly used for measuring movement quality of the upper paretic limb during reaching tasks after stroke. Many different smoothness metrics have been used in stroke research, but a ‘valid’ metric has not been identified. A systematic review and subsequent rigorous analysis of smoothness metrics used in stroke research, in terms of their mathematical definitions and response to simulated perturbations, is needed to conclude whether they are valid for measuring smoothness. Our objective was to provide a recommendation for metrics that reflect smoothness after stroke based on: (1) a systematic review of smoothness metrics for reaching used in stroke research, (2) the mathematical description of the metrics, and (3) the response of metrics to simulated changes associated with smoothness deficits in the reaching profile. Methods The systematic review was performed by screening electronic databases using combined keyword groups Stroke, Reaching and Smoothness. Subsequently, each metric identified was assessed with mathematical criteria regarding smoothness: (a) being dimensionless, (b) being reproducible, (c) being based on rate of change of position, and (d) not being a linear transform of other smoothness metrics. The resulting metrics were tested for their response to simulated changes in reaching using models of velocity profiles with varying reaching distances and durations, harmonic disturbances, noise, and sub-movements. Two reaching tasks were simulated; reach-to-point and reach-to-grasp. The metrics that responded as expected in all simulation analyses were considered to be valid. Results The systematic review identified 32 different smoothness metrics, 17 of which were excluded based on mathematical criteria, and 13 more as they did not respond as expected in all simulation analyses. Eventually, we found that, for reach-to-point and reach-to-grasp movements, only Spectral Arc Length (SPARC) was found to be a valid metric. Conclusions Based on this systematic review and simulation analyses, we recommend the use of SPARC as a valid smoothness metric in both reach-to-point and reach-to-grasp tasks of the upper limb after stroke. However, further research is needed to understand the time course of smoothness measured with SPARC for the upper limb early post stroke, preferably in longitudinal studies.

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Tools and Techniques Used With Robotic Devices to Quantify Upper-Limb Function in Typically Developing Children: A Systematic Review

Rehabilitation Process and Outcome ◽

10.1177/1179572720979013 ◽

2020 ◽

Vol 9 ◽

pp. 117957272097901

Author(s):

Stephan CD Dobri ◽

Hana M Ready ◽

Theresa Claire Davies

Keyword(s):

Systematic Review ◽

Outcome Measures ◽

Motor Function ◽

Upper Limb ◽

Rate Of Change ◽

Typically Developing ◽

Typically Developing Children ◽

Upper Limb Function ◽

Robotic Devices ◽

Tools And Techniques

Background: Robotic devices have been used to quantify function, identify impairment, and rehabilitate motor function extensively in adults, but less-so in younger populations. The ability to perform motor actions improves as children grow. It is important to quantify this rate of change of the neurotypical population before attempting to identify impairment and target rehabilitation techniques. Objectives: For a population of typically developing children, this systematic review identifies and analyzes tools and techniques used with robotic devices to quantify upper-limb motor function. Since most of the papers also used robotic devices to compare function of neurotypical to pathological populations, a secondary objective was introduced to relate clinical outcome measures to identified robotic tools and techniques. Methods: Five databases were searched between February 2019 and August 2020, and 226 articles were found, 19 of which are included in the review. Results: Robotic devices, tasks, outcome measures, and clinical assessments were not consistent among studies from different settings but were consistent within laboratory groups. Fifteen of the 19 articles evaluated both typically developing and pathological populations. Conclusion: To optimize universally comparable outcomes in future work, it is recommended that a standard set of tasks and measures is used to assess upper-limb motor function. Standardized tasks and measures will facilitate effective rehabilitation.

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Risk Factors for Upper Limb Injury in Tennis Players: A Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17082744 ◽

2020 ◽

Vol 17 (8) ◽

pp. 2744

Author(s):

Afxentios Kekelekis ◽

Pantelis Theodoros Nikolaidis ◽

Isabel Sarah Moore ◽

Thomas Rosemann ◽

Beat Knechtle

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Upper Limb ◽

Time Course ◽

Research Question ◽

Complex Nature ◽

Scapular Dyskinesis ◽

Multiple Perspectives ◽

Tennis Players ◽

Limb Injury

Studies in tennis injuries have successfully identified the incident rate, the location, and the type of the injury. The majority of the studies have multiple perspectives (epidemiology, biomechanics, performance), however only a few studies were able to identify risk factors or mechanisms that contribute to tennis injuries. Until now, there has not been a systematic literature review that identifies risk factors for tennis injuries. The objective of this review was to identify and critically appraise the evidence related to risk factors for upper limb injury in tennis players. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, using a research question developed by the Patient Problem, (or Population) Intervention, Comparison or Control, and Outcome (PICO) methodology. The quality of the studies included was moderate to low, indicating prolonged tennis (exposure to tennis), scapular dyskinesis, muscle fatigue, scapulothoracic properties, shoulder kinetics or kinematics, skill level, and technique as risk factors for upper limb injury in tennis players. In this review, it is evidenced that the majority of tennis injuries are associated with overuse and a chronic time course, however, tennis injuries do not arise from a linear combination of isolated and predictive factors. Therefore, the multifactorial and complex nature of tennis injuries has to be further examined. The necessity of more randomized control trial studies is highly recommended.

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Faculty Opinions recommendation of Upper limb arterial thromboembolism: a systematic review on incidence, risk factors, and prognosis, including a meta-analysis of risk-modifying drugs.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717985805.793474100 ◽

2013 ◽

Author(s):

David Kuter ◽

Rachel Rosovsky

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Upper Limb ◽

Meta Analysis ◽

Arterial Thromboembolism ◽

Incidence Risk

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Faculty of 1000 evaluation for Upper limb arterial thromboembolism: A systematic review on incidence, risk factors, and prognosis including a meta-analysis of risk-modifying drugs.

F1000 - Post-publication peer review of the biomedical literature ◽

10.3410/f.717985805.793473210 ◽

2013 ◽

Author(s):

Paolo Della Bella ◽

Pasquale Vergara

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Upper Limb ◽

Meta Analysis ◽

Arterial Thromboembolism ◽

Incidence Risk

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Effects of upper limb exercise programs on the arteriovenous fistula in patients on hemodialysis: A systematic review and meta-analysis

The Journal of Vascular Access ◽

10.1177/11297298211001166 ◽

2021 ◽

pp. 112972982110011

Author(s):

Francini Porcher Andrade ◽

Heloíse Benvenutti ◽

Kacylen Costa da Silva ◽

Paula Maria Eidt Rovedder

Keyword(s):

Systematic Review ◽

Arteriovenous Fistula ◽

Flow Rate ◽

Upper Limb ◽

Handgrip Strength ◽

Meta Analysis ◽

Blood Flow Rate ◽

Exercise Programs ◽

Exercise Interventions ◽

Limb Exercise

Background: The arteriovenous fistula (AVF) is a commonly used vascular access for chronic kidney disease (CKD) patients; exercise interventions may boost its maturation and help in its maintenance. A systematic review and meta-analysis of clinical trials on the effects of upper limb exercise programs on the AVF was conducted. Methods: The primary outcomes were draining vein diameter (DVD) and draining vein blood flow rate (DVBFR), and secondary outcomes were handgrip strength (HGS) and brachial artery flow rate (BAFR). Quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results: Four studies met the inclusion criteria. When compared to usual care groups, the experimental groups did not improve DVD (mean difference [MD] 0.23, confidence interval [CI] −0.20–0.65). There were significant differences in DVBFR (mL/min) according to the fixed-effect model (MD 141.13, CI 36.84–245.42). HGS (kg) was significantly different between groups (MD 2.95, CI 0.55–5.35), but BAFR (mL/min) was not (MD 91.65, CI −94.72–278.01). Conclusions: Although exercise programs did not improve DVD and BAFR, they increased muscle strength and DVBFR. Therefore, experimental exercise programs should be emphasized for AVF maturation and maintenance. Research Registry number: reviewregistry924.

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Effect of sentinel lymph node biopsy on upper limb function in women with early breast cancer: A systematic review of clinical trials

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2021.01.024 ◽

2021 ◽

Author(s):

Taynara Louisi Pilger ◽

Daniely Franco Francisco ◽

Francisco Jose Candido dos Reis

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Clinical Trials ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Upper Limb ◽

Lymph Node Biopsy ◽

Upper Limb Function ◽

Node Biopsy

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Robotic assistive and rehabilitation devices leading to motor recovery in upper limb: a systematic review

Disability and Rehabilitation Assistive Technology ◽

10.1080/17483107.2021.1906960 ◽

2021 ◽

pp. 1-15

Author(s):

Sumayya Khalid ◽

Fady Alnajjar ◽

Munkhjargal Gochoo ◽

Shingo Shimoda

Keyword(s):

Systematic Review ◽

Upper Limb ◽

Motor Recovery ◽

Rehabilitation Devices

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Effect of post-stroke spasticity on voluntary movement of the upper limb

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-021-00876-6 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Hadar Lackritz ◽

Yisrael Parmet ◽

Silvi Frenkel-Toledo ◽

Melanie C. Baniña ◽

Nachum Soroker ◽

...

Keyword(s):

Upper Limb ◽

Target Location ◽

Distance Measure ◽

Movement Time ◽

Motor Impairment ◽

Reach To Grasp ◽

Motion Patterns ◽

Post Stroke ◽

The Impact ◽

Elbow Motion

Abstract Background Hemiparesis following stroke is often accompanied by spasticity. Spasticity is one factor among the multiple components of the upper motor neuron syndrome that contributes to movement impairment. However, the specific contribution of spasticity is difficult to isolate and quantify. We propose a new method of quantification and evaluation of the impact of spasticity on the quality of movement following stroke. Methods Spasticity was assessed using the Tonic Stretch Reflex Threshold (TSRT). TSRT was analyzed in relation to stochastic models of motion to quantify the deviation of the hemiparetic upper limb motion from the normal motion patterns during a reaching task. Specifically, we assessed the impact of spasticity in the elbow flexors on reaching motion patterns using two distinct measures of the ‘distance’ between pathological and normal movement, (a) the bidirectional Kullback–Liebler divergence (BKLD) and (b) Hellinger’s distance (HD). These measures differ in their sensitivity to different confounding variables. Motor impairment was assessed clinically by the Fugl-Meyer assessment scale for the upper extremity (FMA-UE). Forty-two first-event stroke patients in the subacute phase and 13 healthy controls of similar age participated in the study. Elbow motion was analyzed in the context of repeated reach-to-grasp movements towards four differently located targets. Log-BKLD and HD along with movement time, final elbow extension angle, mean elbow velocity, peak elbow velocity, and the number of velocity peaks of the elbow motion were computed. Results Upper limb kinematics in patients with lower FMA-UE scores (greater impairment) showed greater deviation from normality when the distance between impaired and normal elbow motion was analyzed either with the BKLD or HD measures. The severity of spasticity, reflected by the TSRT, was related to the distance between impaired and normal elbow motion analyzed with either distance measure. Mean elbow velocity differed between targets, however HD was not sensitive to target location. This may point at effects of spasticity on motion quality that go beyond effects on velocity. Conclusions The two methods for analyzing pathological movement post-stroke provide new options for studying the relationship between spasticity and movement quality under different spatiotemporal constraints.

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