Posts Tagged Kinematics.
[ARTILE] Changes in gait kinematics and muscle activity in stroke patients wearing various arm slings – Full Text
In the rehabilitation training and assessment of upper limbs, the conventional kinematic model treats the arm as a serial manipulator and maps the rotations in the joint space to movements in the Cartesian space. While this model brings simplicity and convenience, and thus has been overwhelming used, its accuracy is limited, especially for the distal parts of the upper limb that execute dexterous movements.
In this paper, a novel kinematic model of the arm has been proposed, which has been inspired by the biomechanical analysis of the forearm and wrist anatomy. One additional parameter is introduced into the conventional arm model, and then both the forward and inverse kinematic models of five parameters are derived for the motion of upper arm medial/lateral rotation, elbow flexion/extension, forearm pronation/supination, wrist flexion/extension and ulnar/radial deviation. Then, experiments with an advanced haptic interface have been designed and performed to examine the presented arm kinematic model. Data analysis revealed that accuracy and robustness can be significantly improved with the new model.
This extended arm kinematic model will help device development, movement training and assessment of upper limb rehabilitation.
Walking through a narrow aperture requires unique postural configurations, i.e., body rotation in the yaw dimension. Stroke individuals may have difficulty performing the body rotations due to motor paralysis on one side of their body. The present study was therefore designed to investigate how successfully such individuals walk through apertures and how they perform body rotation behavior.
Stroke fallers (n = 10), stroke non-fallers (n = 13), and healthy controls (n = 23) participated. In the main task, participants walked for 4 m and passed through apertures of various widths (0.9–1.3 times the participant’s shoulder width). Accidental contact with the frame of an aperture and kinematic characteristics at the moment of aperture crossing were measured. Participants also performed a perceptual judgment task to measure the accuracy of their perceived aperture passability.
Results and Discussion
Stroke fallers made frequent contacts on their paretic side; however, the contacts were not frequent when they penetrated apertures from their paretic side. Stroke fallers and non-fallers rotated their body with multiple steps, rather than a single step, to deal with their motor paralysis. Although the minimum passable width was greater for stroke fallers, the body rotation angle was comparable among groups. This suggests that frequent contact in stroke fallers was due to insufficient body rotation. The fact that there was no significant group difference in the perceived aperture passability suggested that contact occurred mainly due to locomotor factors rather than perceptual factors. Two possible explanations (availability of vision and/or attention) were provided as to why accidental contact on the paretic side did not occur frequently when stroke fallers penetrated the apertures from their paretic side.
Stroke is a disease caused by infarction, or hemorrhages of the blood vessels in the brain. Stroke is the major cause of neurological disabilities that affect many aspects of daily living. As one such issue, individuals with stroke often exhibit impaired walking, primarily due to motor paralysis on one side (typically the contralateral side of the affected side of the brain) of their body. A typical symptom indicating impaired walking is gait asymmetry. Gait asymmetry is the irregular coordination between the lower limbs and is produced mainly by differences in the magnitude of force displayed between the paretic and non-paretic limbs . Walking with gait asymmetry is biomechanically inefficient for achieving forward progression and makes maintaining balance more challenging
A particularly challenging aspect of maintaining balance becomes much more evident during adaptive locomotion, i.e., when basic movement patterns need to be modified adaptively in response to environmental constraints. Previous studies have shown that, as compared to control individuals, stroke individuals had difficulty stepping over an obstacle , walking fast while performing a cognitive task concurrently , changing their walking speed in response to changes in the optic flow , changing direction while walking [7–9], and turning [10,11]. In fact, the risk of falling is likely to increase when stroke individuals turn [12–14].
In line with these studies, the present study was designed to uncover challenging aspect of maintaining during adaptive locomotion in stroke individuals. The uniqueness of this study was to test their ability to safely walk through apertures. Adaptive modification of walking through a narrow aperture includes fine-tuning the walking direction toward the center of the aperture [15,16], decrease in movement speed [17,18], and changes in body configuration such as (upper-) body rotation in the yaw dimension [17–26]. The most powerful means to avoid accidental contact is the body rotation because it effectively reduces horizontal space required for crossing. Testing the ability to safely walk through an aperture has helped not only to understand perceptual-motor control of adaptive locomotion for obstacle avoidance [17,25–27] but also to describe the reason that controlling adaptive locomotion is difficult for some types of participants. Older adults had more variability in their body rotations at various aperture widths [28,29]. Patients with Parkinson’s disease (PD) showed sharply decreased walking speeds in front of an aperture, which could be caused by episodes of freezing . When young adults used a manual wheelchair for the first time, contact with the frame of an aperture occurred more frequently with dramatically different spatial-temporal patterns of fixation [30,31]. To our knowledge, there has been no study testing the ability of stroke individuals to safely walk through an aperture.
Measuring the behavior of walking through an aperture potentially provides some new insights into the increased risk of instability during adaptive locomotion in stroke individuals. This is particularly because stroke individuals could show difficulty performing the body rotations due to their motor paralysis on one side of their body and, as a result, they could have difficulty avoiding accidental contact with the frame of apertures. Walking through a narrow aperture with body rotation results in unique postural configurations, i.e., the body is rotated in the yaw dimension while the walking direction is maintained toward the center of the aperture. The uniqueness of the body rotation behavior becomes clear when it is compared with the turning behavior, which also involves individuals rotating their bodies, while its purpose is to change the direction of walking. Rotating the body to walk through an aperture usually involves a pivot-like turn, in which the body rotates about its vertical axis on the trailing limb at the moment it crosses the aperture. If stroke individuals penetrate an aperture from the paretic side (i.e., the trailing limb is non-paretic), then they would be able to perform a pivot-like turn. However, they would have difficulty maintaining their balance after the turn because they need to shift their body weight to the leading, or paretic, limb to progress forward. In contrast, if stroke individuals penetrate an aperture from the non-paretic side (i.e., the trailing limb is paretic), then an alternate strategy, rather than a pivot-like turn, would be selected for rotating their bodies. In both cases, taking multiple steps to rotate the body, which has been observed in the turning behavior performed of older adults [32,33], was expected to occur. This was because it was effective, at least for stroke individuals, to avoid shifting their body weight onto the paretic limb for a relatively long time. However, because there has been no study, it remains unknown as to which strategy would be more preferable for strong individuals and which strategy would lead to safe walking through apertures without making any contact with the frame of an aperture. The rationale for conducting the present study was to clarify these issues.
In the present study, two groups of stroke individuals were recruited: stroke fallers and stroke non-fallers. Stroke fallers were identified as those having a history of falling history in the past year. A systematic review of the literature showed that a history of falling in the past year most strongly predicts the likelihood of future falls among community-living older adults . Several previous studies have shown that significant gait characteristics of stroke individuals were more evident in those at high risk of falling [11,35]. Moreover, Takatori et al.(2009) reported that stroke individuals with a history of falls showed a large gap between the visual estimation of a reachable distance and the actual distance reachable . If such a large gap between perception and action exists in various types of behavior, then stroke fallers would show inaccurate judgment of the passability of an aperture, which could lead to accidental contact with the frame of an aperture. To examine whether accidental contact was related to the inaccurate judgment of the passability of the aperture, participants in the present study performed both the behavioral task of walking through apertures and the perceptual judgment task of aperture passability.
Twenty-three individuals with stroke (eleven females) participated. The mean age was 60.7 years (SD = 10.1). Twenty-three age-, gender-, and height-matched healthy individuals also participated as control participants. This study was approved by the ethics committee of the Kameda Medical Center. The tenets of the Declaration of Helsinki were followed. All participants gave their written informed consent prior to participation. Notably, the individual shown in Fig 1 has given written informed consent (as outlined in PLOS consent form) to publish an image of the participant.
[ARTICLE] Model-based variables for the kinematic assessment of upper-extremity impairments in post-stroke patients – Full Text
Common scales for clinical evaluation of post-stroke upper-limb motor recovery are often complemented with kinematic parameters extracted from movement trajectories. However, there is no a general consensus on which parameters to use. Moreover, the selected variables may be redundant and highly correlated or, conversely, may incompletely sample the kinematic information from the trajectories. Here we sought to identify a set of clinically useful variables for an exhaustive but yet economical kinematic characterization of upper limb movements performed by post-stroke hemiparetic subjects.
For this purpose, we pursued a top-down model-driven approach, seeking which kinematic parameters were pivotal for a computational model to generate trajectories of point-to-point planar movements similar to those made by post-stroke subjects at different levels of impairment.
The set of kinematic variables used in the model allowed for the generation of trajectories significantly similar to those of either sub-acute or chronic post-stroke patients at different time points during the therapy. Simulated trajectories also correctly reproduced many kinematic features of real movements, as assessed by an extensive set of kinematic metrics computed on both real and simulated curves. When inspected for redundancy, we found that variations in the variables used in the model were explained by three different underlying and unobserved factors related to movement efficiency, speed, and accuracy, possibly revealing different working mechanisms of recovery.
This study identified a set of measures capable of extensively characterizing the kinematics of upper limb movements performed by post-stroke subjects and of tracking changes of different motor improvement aspects throughout the rehabilitation process.
Upper limb functions are altered in about 80 % of acute stroke survivors and in about 50 % of chronic post-stroke patients . With the increasing of life expectancy, it has been estimated that stroke related impairments will be ranked to the fourth most important causes of adult disability in 2030 , prompting the need to design more effective diagnostic and rehabilitative tools [3, 4].
Together with more traditional and widely accepted clinical scales in the last two decades investigators have characterized post-stroke motor recovery also in terms of kinematic parameters extracted from hand and arm task-oriented movements [3, 5], which offer more objective measures of motor performance . Indeed, clinical scales, whose reliability has often been questioned [7, 8, 9], may not be sensitive to small and more specific changes  and could be of limited use to distinguish different aspects of motor improvement [11, 12].
Previous robot-assisted clinical and pilot studies have proposed a large set of kinematic parameters to characterize motor improvements [5, 6, 11]. A few of them focused on finding a significant relationship between robotic measures collected longitudinally in post-stroke patients and clinical outcome measures, to increase acceptance of kinematic evaluation scales in practice [5, 6]. Too little effort, however, has been made to identify the different aspects of movement improvement, how they can be described by kinematic robot-based measures , and whether they may dissociate with respect to recovery time course and to training response .
Indeed the range of potential changes in limb trajectory during recovery is not known a priori  and might not be fully represented by a set of arbitrarily selected parameters extracted from limb trajectories, even if the parameters were chosen according to a certain number of study hypotheses or to significant relationships with clinical scales. Moreover, these variables can be highly correlated and, thus, redundant. Although redundancy can be tackled by data reduction algorithms, such as Principal Component Analysis (PCA) or Independent Component Analysis (ICA) [5, 6], incomplete representation of information might still remain an overlooked issue.
In the present study we aimed at devising a novel method for identifying a set of kinematic measures potentially capable of fully highlighting and tracking changes of different aspects of movement performance throughout the rehabilitation training. Instead of starting from a certain number of a priori hypotheses, we sought to find which variables were essential for modeling trajectories of post-stroke patients and were, thus, informative of kinematic features of upper limb movements. We then tested whether the identified kinematic parameters i) were capable of highlighting changes in movement performance, ii) were to some extent redundant, and iii) were informative of different factors of post-stroke motor impairment, such as paresis, loss of fractionated movement and somatosensation, and abnormal muscle tone .
Objective: To determine if persons with chronic stroke and decreased hip and knee flexion during swing can walk with improved swing-phase kinematics when the task demands constrained gait to the sagittal plane.
Design: A one-day, within-subject design comparing gait kinematics under two conditions: Unconstrained treadmill walking and a constrained condition in which the treadmill walking space is reduced to limit limb advancement to occur in the sagittal plane.
Setting: Outpatient physical therapy clinic.
Subjects: Eight individuals (mean age, 64.1 ±9.3, 2 F) with mild-moderate paresis were enrolled.
Main measures: Spatiotemporal gait characteristics and swing-phase hip and knee range of motion during unconstrained and constrained treadmill walking were compared using paired t-test and Cohen’s d (d) to determine effect size.
Results: There was a significant, moderate-to-large effect of the constraint on hip flexion (p < 0.001, d = –1.1) during initial swing, and hip (p < 0.05, d = –0.8) and knee (p < 0.001, d = –1.1) flexion during midswing. There was a moderate effect of constraint on terminal swing knee flexion (p = 0.238, d = –0.6). Immediate and significant changes in step width (p < 0.05, d = 0.9) and paretic step length (p < 0.05, d = –0.5) were noted in the constrained condition compared with unconstrained.
Conclusion: Constraining the treadmill walking path altered the gait patterns among the study’s participants. The immediate change during constrained walking suggests that patients with chronic stroke may have underlying movement capability that they do not preferentially utilize.
[Abstract] Design and Analysis of a Cable-Driven Articulated Rehabilitation System for Gait Training – ASME
Assisted motor therapies play a critical role in enhancing functional musculoskeletal recovery and neurological rehabilitation. Our long term goal is to assist and automate the performance of repetitive motor-therapy of the human lower limbs. Hence, in this paper, we examine the viability of a light-weight and reconfigurable hybrid (articulated-multibody and cable) robotic system for assisting lower-extremity rehabilitation and analyze its performance. A hybrid cable-actuated articulated multibody system is formed when multiple cables are attached from a ground-frame to various locations on an articulated-linkage based orthosis. Our efforts initially focus on developing an analysis and simulation framework for the kinematics and dynamics of the cable-driven lower limb orthosis. A Monte Carlo approach is employed to select configuration parameters including cuff sizes, cuff locations, and the position of fixed winches. The desired motions for the rehabilitative exercises are prescribed based upon motion patterns from a normative subject cohort. We examine the viability of using two controllers — a joint-space feedback linearized PD controller and a task-space force-control strategy — to realize trajectory- and path- tracking of the desired motions within a simulation environment. In particular, we examine performance in terms of (i) coordinated control of the redundant system; (ii) reducing internal stresses within the lower-extremity joints; and (iii) continued satisfaction of the unilateral cable-tension constraints throughout the workspace.
This book presents a comprehensive framework for model-based electrical stimulation (ES) controller design, covering the whole process needed to develop a system for helping people with physical impairments perform functional upper limb tasks such as eating, grasping and manipulating objects.
The book first demonstrates procedures for modelling and identifying biomechanical models of the response of ES, covering a wide variety of aspects including mechanical support structures, kinematics, electrode placement, tasks, and sensor locations. It then goes on to demonstrate how complex functional activities of daily living can be captured in the form of optimisation problems, and extends ES control design to address this case. It then lays out a design methodology, stability conditions, and robust performance criteria that enable control schemes to be developed systematically and transparently, ensuring that they can operate effectively in the presence of realistic modelling uncertainty, physiological variation and measurement noise.
[ARTICLE] Kinematic analysis of upper limb motion: Feasibility, preliminary results in controls and hemiparetic subjects, prospects
The aim of this study is to develop a valid and standardized instrumental analysis of upper limb (UL) motion in stroke patients.
Sixteen controls and 15 hemiparetic subjects (mean age = 54 ± 18,2 years old; Fugl-Meyer Upper Limb 41,4 ± 12,4) underwent kinematic motion analysis (passive markers, Optitrack) of pointing and grasping tasks. We examined the ability to perform a single pointing task and three reach-to-grasp tasks: key turning, reaching and grasping a can, reaching and grasping a cube; at a self-selected speed and as fast as possible. Speed, accuracy and efficiency of each movement were quantified and compared between controls and hemiparetic subjects, and between the ipsilateral of control subjects and the affected side; to describe reaching and grasping.
For reaching, movement time of hemiparetic UL was longer, less smooth (peak velocity, jerk), less direct (higher index path ratio) and associated with more trunk compensation (higher trunk/hand ratio). Movement time, jerks and trunk/hand ratio were the most discriminant variables between hemiparetic UL and ipsilateral/control UL, in any task analysed. Trunk displacement was greater in grasping than in reaching tasks. For grapsing tasks, movement time is the most discriminant factor between hemiparetic and control/ipsilateral UL, especially for the key turn task. Movement alterations were also found for ipsilateral limb. Association between kinematic variables and clinical features during reaching time (Fugl-Meyer, MAL, WFMT, ARAT) was greater for the task “grasping a can”.
Our results are similar to those of the literature, but suggest that we have to privilege some of the most relevant kinematic parameters. This standardization phase emerging after a validation phase of the techniques can make the biomechanical analysis of the upper limb as easy and valid as gait analysis and should help to develop the quantified measurement of prehension. This protocol is currently in process to objectively assess the therapeutic effects of rehabilitation treatments (botulinum toxin, induced constraint therapy).
This paper presents LIGHTarm, a passive gravity compensated exoskeleton for upper-limb rehabilitation suitable for the use both in the clinical environment and at home. Despite the low-cost and not actuated design, LIGHTarm aims at providing remarkable back-drivability in wide portions of the upper-limb workspace. The weight-support and back-drivability features are experimentally investigated on three healthy subjects through the analysis of the EMG activity recorded in static conditions and during functional movements. Kinematics is also monitored. Preliminary results suggest that LIGHTarm sharply reduces muscular effort required for limb support, quite uniformly in the workspace, and that remarkable back-drivability is achieved during the execution of functional movements.
[ARTICLE] The use of virtual reality-based therapy to augment poststroke upper limb recovery – Full Text HTML
Stroke remains one of the major causes of disability worldwide. This case report illustrates the complementary use of biomechanical and kinematic in-game markers, in addition to standard clinical outcomes, to comprehensively assess and track a patient’s disabilities.
A 65-year-old patient was admitted for right-sided weakness and clinically diagnosed with acute ischaemic stroke. She participated in a short trial of standard stroke occupational therapy and physiotherapy with additional daily virtual reality (VR)-based therapy. Outcomes were tracked using kinematic data and conventional clinical assessments. Her Functional Independence Measure score improved from 87 to 113 and Fugl-Meyer motor score improved from 56 to 62, denoting clinically significant improvement. Corresponding kinematic analysis revealed improved hand path ratios and a decrease in velocity peaks.
Further research is being undertaken to elucidate the optimal type, timing, setting and duration of VR-based therapy, as well as the use of neuropharmacological adjuncts.