[THESIS] Advanced Techniques for Robotic Assessment of Neurological Impairments In Stroke Patients – Full Text PDF

Abstract

Stroke is an acute injury of the central nervous system and is caused by the disruption of blood flow or by the rupture of blood vessels. A stroke can impact many body functions, often causing motor, speech, memory, vision and other sensory impairments.

It is highly prevalent and often requires long hospitalizations and post-stroke rehabilitation. The key to successful rehabilitation after stroke is an accurate assessment of the impairment. Current clinical assessments of stroke-related impairments involve physical assessment and visual observation by physicians. Existing clinical scores of upper limb function often use observer-based ordinal scales that are subjective and commonly have floor and ceiling effects. Therefore, these methods are not adequate to reliably discriminate different levels of performance. Robotics and integrated virtual reality systems have a tremendous potential to be used in computational systems that analyze, visualize and aid clinicians to identify and assess sensory-motor impairments.

This thesis presents a framework for analysis and extraction of reliable and valid features from robotic data that can be used to accurately and objectively assess neurological impairments. The framework was applied on the Object Hit task that assesses the ability of participants to select and engage motor actions with both hands.

In addition, the Object Hit Task was compared to the Object Hit and Avoid itask, which is a slight modification of the original task. The comparison was done using a developed feature and task analysis framework. This framework encompasses similarities and differences between tasks in a given experiment in terms of feature information. The results showed that for the data used in the analysis, Object Hit task is able to identify impairments more effectively than the Object Hit and Avoid task.

The overall results demonstrate that the Object Hit task provides an objective and easy approach to quantify upper limb motor function and visuospatial skills after stroke. The developed assessment tool can also be applied for diagnosis and prognosis of other neurological deficits, beyond stroke assessment.

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[ARTICLE] Retraining and assessing hand movement after stroke using the MusicGlove: comparison with conventional hand therapy and isometric grip training – Full Text PDF

Abstract

Background: It is thought that therapy should be functional, be highly repetitive, and promote afferent input to best stimulate hand motor recovery after stroke, yet patients struggle to access such therapy. We developed the MusicGlove, an instrumented glove that requires the user to practice gripping-like movements and thumb-finger opposition to play a highly engaging, music-based, video game.The purpose of this study was to 1) compare the effect of training with MusicGlove to conventional hand therapy 2) determine if MusicGlove training was more effective than a matched form of isometric hand movement training; and 3) determine if MusicGlove game scores predict clinical outcomes.

Methods: 12 chronic stroke survivors with moderate hemiparesis were randomly assigned to receive MusicGlove, isometric, and conventional hand therapy in a within-subjects design. Each subject participated in six one-hour treatment sessions three times per week for two weeks, for each training type, for a total of 18 treatment sessions. A blinded rater assessed hand impairment before and after each training type and at one-month follow-up including the Box and Blocks (B & B) test as the primary outcome measure. Subjects also completed the Intrinsic Motivation Inventory (IMI).

Results: Subjects improved hand function related to grasping small objects more after MusicGlove compared to conventional training, as measured by the B & B score (improvement of 3.21±3.82 vs. -0.29±2.27 blocks; P=0.010) and the 9 Hole Peg test (improvement of 2.14±2.98 vs. -0.85±1.29 pegs/minute; P=0.005). There was no significant difference between training types in the broader assessment batteries of hand function. Subjects benefited less from isometric therapy than MusicGlove training, but the difference was not significant (P>0.09). Subjects sustained improvements in hand function at a one month follow-up, and found the MusicGlove more motivating than the other two therapies, as measured by the IMI. MusicGlove games scores correlated strongly with the B & B score.

Conclusions: These results support the hypothesis that hand therapy that is engaging, incorporates high numbers of repetitions of gripping and thumb-finger opposition movements, and promotes afferent input is a promising approach to improving an individual’s ability to manipulate small objects. The MusicGlove provides a simple way to access such therapy.

Keywords: Stroke rehabilitation device, Hand, Music therapy, Video game therapy, Stroke assessment, Outcome measures

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