Using an Accelerometer-Based Step Counter in Post-Stroke Patients: Validation of a Low-Cost Tool

Monitoring the real-life mobility of stroke patients could be extremely useful for clinicians. Step counters are a widely accessible, portable, and cheap technology that can be used to monitor patients in different environments. The aim of this study was to validate a low-cost commercial tri-axial accelerometer-based step counter for stroke patients and to determine the best positioning of the step counter (wrists, ankles, and waist). Ten healthy subjects and 43 post-stroke patients were enrolled and performed four validated clinical tests (10 m, 50 m, and 6 min walking tests and timed up and go tests) while wearing five step counters in different positions while a trained operator counted the number of steps executed in each test manually. Data from step counters and those collected manually were compared using the intraclass coefficient correlation and mean average percentage error. The Bland–Altman plot was also used to describe agreement between the two quantitative measurements (step counter vs. manual counting). During walking tests in healthy subjects, the best reliability was found for lower limbs and waist placement (intraclass coefficient correlations (ICCs) from 0.46 to 0.99), and weak reliability was observed for upper limb placement in every test (ICCs from 0.06 to 0.38). On the contrary, in post-stroke patients, moderate reliability was found only for the lower limbs in the 6 min walking test (healthy ankle ICC: 0.69; pathological ankle ICC: 0.70). Furthermore, the Bland–Altman plot highlighted large average discrepancies between methods for the pathological group. However, while the step counter was not able to reliably determine steps for slow patients, when applied to the healthy ankle of patients who walked faster than 0.8 m/s, it counted steps with excellent precision, similar to that seen in the healthy subjects (ICCs from 0.36 to 0.99). These findings show that a low-cost accelerometer-based step counter could be useful for measuring mobility in select high-performance patients and could be used in clinical and real-world settings.

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Assessment of an Assistive Control Approach Applied in an Active Knee Orthosis Plus Walker for Post-Stroke Gait Rehabilitation

Sensors ◽

10.3390/s20092452 ◽

2020 ◽

Vol 20 (9) ◽

pp. 2452

Author(s):

Ana Cecilia Villa-Parra ◽

Jessica Lima ◽

Denis Delisle-Rodriguez ◽

Laura Vargas-Valencia ◽

Anselmo Frizera-Neto ◽

...

Keyword(s):

Healthy Subjects ◽

Muscle Activation ◽

Inertial Sensors ◽

Lower Limbs ◽

Trunk Muscles ◽

Control Group ◽

Gait Rehabilitation ◽

Control Approach ◽

Post Stroke ◽

Knee Orthosis

The goal of this study is the assessment of an assistive control approach applied to an active knee orthosis plus a walker for gait rehabilitation. The study evaluates post-stroke patients and healthy subjects (control group) in terms of kinematics, kinetics, and muscle activity. Muscle and gait information of interest were acquired from their lower limbs and trunk, and a comparison was conducted between patients and control group. Signals from plantar pressure, gait phase, and knee angle and torque were acquired during gait, which allowed us to verify that the stance control strategy proposed here was efficient at improving the patients’ gaits (comparing their results to the control group), without the necessity of imposing a fixed knee trajectory. An innovative evaluation of trunk muscles related to the maintenance of dynamic postural equilibrium during gait assisted by our active knee orthosis plus walker was also conducted through inertial sensors. An increase in gait cycle (stance phase) was also observed when comparing the results of this study to our previous work. Regarding the kinematics, the maximum knee torque was lower for patients when compared to the control group, which implies that our orthosis did not demand from the patients a knee torque greater than that for healthy subjects. Through surface electromyography (sEMG) analysis, a significant reduction in trunk muscle activation and fatigability, before and during the use of our orthosis by patients, was also observed. This suggest that our orthosis, together with the assistive control approach proposed here, is promising and could be considered to complement post-stroke patient gait rehabilitation.

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Comparison of Objective Indicators of Proprioception of Single–joint Arm Movements in Healthy Subjects and Post–Stroke Patients in Sitting and Lying Positions

Human Physiology ◽

10.1134/s0362119719040133 ◽

2019 ◽

Vol 45 (4) ◽

pp. 397-404

Author(s):

V. Y. Roschin ◽

O. G. Pavlova ◽

V. A. Selionov ◽

I. A. Solopova ◽

D. S. Zhvansky ◽

...

Keyword(s):

Healthy Subjects ◽

Arm Movements ◽

Stroke Patients ◽

Post Stroke ◽

Objective Indicators

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Temporal Dynamics of Corticomuscular Coherence Reflects Alteration of the Central Mechanisms of Neural Motor Control in Post-Stroke Patients

Frontiers in Human Neuroscience ◽

10.3389/fnhum.2021.682080 ◽

2021 ◽

Vol 15 ◽

Author(s):

Maxime Fauvet ◽

David Gasq ◽

Alexandre Chalard ◽

Joseph Tisseyre ◽

David Amarantini

Keyword(s):

Motor Control ◽

Healthy Subjects ◽

Voluntary Movement ◽

Temporal Dynamics ◽

Elbow Extension ◽

Stroke Patients ◽

Post Stroke ◽

Antagonist Muscles ◽

Agonist And Antagonist ◽

Agonist And Antagonist Muscles

The neural control of muscular activity during a voluntary movement implies a continuous updating of a mix of afferent and efferent information. Corticomuscular coherence (CMC) is a powerful tool to explore the interactions between the motor cortex and the muscles involved in movement realization. The comparison of the temporal dynamics of CMC between healthy subjects and post-stroke patients could provide new insights into the question of how agonist and antagonist muscles are controlled related to motor performance during active voluntary movements. We recorded scalp electroencephalography activity, electromyography signals from agonist and antagonist muscles, and upper limb kinematics in eight healthy subjects and seventeen chronic post-stroke patients during twenty repeated voluntary elbow extensions and explored whether the modulation of the temporal dynamics of CMC could contribute to motor function impairment. Concomitantly with the alteration of elbow extension kinematics in post-stroke patients, dynamic CMC analysis showed a continuous CMC in both agonist and antagonist muscles during movement and highlighted that instantaneous CMC in antagonist muscles was higher for post-stroke patients compared to controls during the acceleration phase of elbow extension movement. In relation to motor control theories, our findings suggest that CMC could be involved in the online control of voluntary movement through the continuous integration of sensorimotor information. Moreover, specific alterations of CMC in antagonist muscles could reflect central command alterations of the selectivity in post-stroke patients.

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Wrist Actimetry Biomarker Development of Paretic Upper Limb Use in Post Stroke Patients for Ecological Monitoring.

10.21203/rs.3.rs-845425/v1 ◽

2021 ◽

Author(s):

Gilles Dusfour ◽

Denis Mottet ◽

Makii Muthalib ◽

Isabelle Laffont ◽

Karima K.A. Bakhti

Keyword(s):

Home Environment ◽

Upper Limb ◽

Healthy Subjects ◽

Limiting Factors ◽

Cumulative Probability ◽

Limiting Factor ◽

Upper Limbs ◽

Stroke Patients ◽

Post Stroke ◽

Paretic Side

Abstract Background In post-stroke patients it is unclear which wrist actimetry biomarkers to use to estimate the degree of upper limb hemiparesis. The objective of this study was to develop a general and objective framework for monitoring hemiparetic patients in their home environment via different biomarkers based on 7 days of actimetry data. A secondary objective was to use all of these biomarkers to better understand the mechanism for potential non-use of the paretic upper limb. Methods Accelerometers were worn continuously for a period of 7 days on both wrists of 10 post-stroke hemiparetic patients as well as 6 healthy subjects. Various wrist actimetry biomarkers were calculated, including the Jerk ratio 50 (JR50, cumulative probability that the Jerk Ratio is between 0 and 0.5), absolute and relative amounts of functional use of movements of the upper limbs (FuncUse and FuncUseR) and absolute and relative velocities of the upper limbs during functional use (VUL and VULR). For each biomarker, the values of stroke and healthy groups were compared. The correlations between all the biomarkers were studied. Results We studied 10 participants with mild-to-moderate chronic hemiparesis and 6 healthy control participants. FuncUse and VUL of the paretic upper limb of stroke patients were significantly lower than in the non-dominant upper limb of healthy subjects. Similarly, FuncUseR (paretic/non-paretic vs non-dominant/dominant), JR and VULR are significantly lower in stroke patients than in healthy subjects. FuncUseR, VULR and JR50 seem to be complementary biomarkers for monitoring patient strokes. Conclusion The stroke patients do not seem to compensate for the decrease in functional movement on the paretic side by an increase on the non-paretic side. The speed of execution of functional movements on the paretic side could be the limiting factor to a normal use of the paretic upper limb. A thorough clinical study is needed to identify the limiting factors. In conclusion, this study for the first time has shown actimetry is a robust and non-obtrusive lightweight technology for continuously acquiring objective upper limb data of paretic arm use/ non-use over an extended period in a home environment for monitoring stroke patients.

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Stable or able? Effect of virtual reality stimulation on static balance of post-stroke patients and healthy subjects

Human Movement Science ◽

10.1016/j.humov.2020.102569 ◽

2020 ◽

Vol 70 ◽

pp. 102569

Author(s):

Erika D'Antonio ◽

Gaetano Tieri ◽

Fabrizio Patané ◽

Giovanni Morone ◽

Marco Iosa

Keyword(s):

Virtual Reality ◽

Healthy Subjects ◽

Static Balance ◽

Stroke Patients ◽

Post Stroke

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Induction of cortical plastic changes in wrist muscles by paired associative stimulation in healthy subjects and post-stroke patients

Experimental Brain Research ◽

10.1007/s00221-006-0844-5 ◽

2007 ◽

Vol 180 (1) ◽

pp. 113-122 ◽

Cited By ~ 42

Author(s):

Evelyne Castel-Lacanal ◽

Angélique Gerdelat-Mas ◽

Philippe Marque ◽

Isabelle Loubinoux ◽

Marion Simonetta-Moreau

Keyword(s):

Healthy Subjects ◽

Stroke Patients ◽

Paired Associative Stimulation ◽

Post Stroke ◽

Plastic Changes

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A Low-Cost Lower-Limb Brain-Machine Interface Triggered by Pedaling Motor Imagery for Post-Stroke Patients Rehabilitation

IEEE Transactions on Neural Systems and Rehabilitation Engineering ◽

10.1109/tnsre.2020.2974056 ◽

2020 ◽

Vol 28 (4) ◽

pp. 988-996

Author(s):

Maria Alejandra Romero-Laiseca ◽

Denis Delisle-Rodriguez ◽

Vivianne Cardoso ◽

Dharmendra Gurve ◽

Flavia Loterio ◽

...

Keyword(s):

Motor Imagery ◽

Lower Limb ◽

Low Cost ◽

Brain Machine Interface ◽

Stroke Patients ◽

Post Stroke ◽

Machine Interface

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Multi-Fingered Grasping and Manipulation in Virtual Environments Using an Isometric Finger Device

Presence Teleoperators & Virtual Environments ◽

10.1162/pres.16.3.293 ◽

2007 ◽

Vol 16 (3) ◽

pp. 293-306 ◽

Cited By ~ 6

Author(s):

Gregorij Kurillo ◽

Matjaž Mihelj ◽

Marko Munih ◽

Tadej Bajd

Keyword(s):

Virtual Reality ◽

Muscle Strength ◽

Virtual Environments ◽

Healthy Subjects ◽

Haptic Feedback ◽

Virtual Object ◽

Input Device ◽

Haptic Information ◽

Stroke Patients ◽

Post Stroke

In this article we present a new isometric input device for multi-fingered grasping in virtual environments. The device was designed to simultaneously assess forces applied by the thumb, index, and middle finger. A mathematical model of grasping, adopted from the analysis of multi-fingered robot hands, was applied to achieve multi-fingered interaction with virtual objects. We used the concept of visual haptic feedback where the user was presented with visual cues to acquire haptic information from the virtual environment. The virtual object corresponded dynamically to the forces and torques applied by the three fingers. The application of the isometric finger device for multi-fingered interaction is demonstrated in four tasks aimed at the rehabilitation of hand function in stroke patients. The tasks include opening the combination lock on a safe, filling and pouring water from a glass, muscle strength training with an elastic torus, and a force tracking task. The training tasks were designed to train patients' grip force coordination and increase muscle strength through repetitive exercises. The presented virtual reality system was evaluated in a group of healthy subjects and two post-stroke patients (early post-stroke and chronic) to obtain overall performance results. The healthy subjects demonstrated consistent performance with the finger device after the first few trials. The two post-stroke patients completed all four tasks, however, with much lower performance scores as compared to healthy subjects. The results of the preliminary assessment suggest that the patients could further improve their performance through virtual reality training.

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Learning of a postural control task by elderly post-stroke patients

Motricidade ◽

10.6063/motricidade.7004 ◽

2016 ◽

Vol 12 (1) ◽

pp. 141

Author(s):

Giordano Marcio Gatinho Bonuzzi ◽

Tatiana Beline Freitas ◽

Umberto Cesar Corrêa ◽

Andrea Michele Freudenheim ◽

José Eduardo Pompeu ◽

...

Keyword(s):

Motor Learning ◽

Postural Control ◽

Learning Process ◽

Healthy Subjects ◽

Task Complexity ◽

Control Group ◽

Control Task ◽

Stroke Patients ◽

Post Stroke ◽

Experimental Group

<p class="ResumoAbstract">The aim of this study was to compare the learning process of a postural control task between post-stroke patients and healthy subjects. The sample was composed of 20 post-stroke individuals (Experimental Group) and 20 aged matched healthy individuals (Control Group). Participants practiced a postural control task in a virtual environment with increasing of complexity. The study design involved four phases: pre-test (five trials), acquisition phase (four blocks of thirty minutes), post-test (five trials), and retention test (five trials after a week without practice). The statistical analysis was run by a 2 x 3 ANOVA (groups x learning tests). Results: There was no difference in motor learning between Experimental Group and Control Group (F= 41.22; p=0.88). In addition, it was founded that the Control Group could learn the task in a higher-level complexity than Experimental Group (F = 4.77; p = 0.01), and both groups increased the error during the trials of practice (F = 0.53; p = 0.00) because of task complexity. Conclusion: Therefore has been found that post-stroke individuals have the ability to learn a postural control task similar to healthy subjects, and the task complexity seems to be a key-factor in order to differentiate stroke from healthy subject's motor learning process.</p>

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