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[ARTICLE] Portable Motion-Analysis Device for Upper-Limb Research, Assessment, and Rehabilitation in Non-Laboratory Settings – Full Text

Abstract

This study presents the design and feasibility testing of an interactive portable motion-analysis device for the assessment of upper-limb motor functions in clinical and home settings. The device engages subjects to perform tasks that imitate activities of daily living, e.g. drinking from a cup and moving other complex objects. Sitting at a magnetic table subjects hold a 3D printed cup with an adjustable magnet and move this cup on the table to targets that can be drawn on the table surface. A ball rolling inside the cup can enhance the task challenge by introducing additional dynamics. A single video camera with a portable computer tracks real-time kinematics of the cup and the rolling ball using a custom-developed, color-based computer-vision algorithm. Preliminary verification with marker-based 3D-motion capture demonstrated that the device produces accurate kinematic measurements. Based on the real-time 2D cup coordinates, audio-visual feedback about performance can be delivered to increase motivation. The feasibility of using this device in clinical diagnostics is demonstrated on 2 neurotypical children and also 3 children with upper-extremity impairments in the hospital, where conventional motion-analysis systems are difficult to use. The device meets key needs for clinical practice: 1) a portable solution for quantitative motor assessment for upper-limb movement disorders at non-laboratory clinical settings, 2) a low-cost rehabilitation device that can increase the volume of in-home physical therapy, and 3) the device affords testing and training a variety of motor tasks inspired by daily challenges to enhance self-confidence to participate in day-to-day activities.

SECTION I.

Introduction

An integral part of clinical care for individuals with motor disorders is to assess motor function to guide and evaluate medical treatment, surgical intervention or physical therapy. One of the challenges for assessing motor function is to define sensitive and quantitative measures that can be readily obtained in clinical practice. The objective of this study was to develop a device that affords quantitative assessment of motor impairments in non-laboratory settings. The specific focus is on individuals with upper-limb movement disorders. One central goal was to ground the task in scientific research to relate clinical measures to research and capitalize on insights from fundamental research.

This paper first lays out the need for such a device particularly for children with motor disorders and post-stroke rehabilitation. We then motivate the specific motor task that was originally conceived for basic research on motor control. We then detail the design of the prototype with all hardware and software components so that it can be replicated. One design goal was to make the device low-cost, so that it can be used in many clinical environments including at home for therapeutic exercises. We conclude with first results from pilot experiments acquired both in a traditional laboratory setting and in an Epilepsy Monitoring Unit. These first data were obtained from children with dystonia. However, the device is not limited to this population and is currently further modified for the assessment of stroke patients.

A. Clinical Assessments of Motor Disorders

A motor disorder manifests as an impaired ability to execute a movement with the intended spatial and temporal pattern. This includes abnormal posturing, presence of unintended excessive movement, and normal movements occurring at unintended or inappropriate times [1]. Patients with upper-limb impairments require special assistance to perform common motor tasks associated with self-care, such as feeding and dressing. Challenges in their movement control result in frustration, which leads to less engagement and practice, and thereby fewer opportunities to attenuate their motor disabilities and improve their movement control.

Motor disorder are observed also among children. Cerebral Palsy (CP) is a common cause of movement disorders among children, affecting 3 to 4 individuals per 1000 births in the US. The dyskinetic form of CP occurs in 15% of all cases [2]. Due to inflexible postures, caused by muscle spasms and contractures together with involuntary jerky movements, children with dyskinetic CP are often prevented from participation in many daily activities. This also prevents them from acquiring age-appropriate motor skills during critical periods of skill development [3], [4]. This is particularly aggravated when the condition affects the upper limbs.

For clinical motor assessments, the current standard tools are clinical scales. For cerebral palsy, typical tests are the gross motor function classification system (GMFCS) [5], the manual ability classification system (MACS) [6], the House Scale [7], the Melbourne Assessment [8], the Assisting Hand Assessment [9], the Hypertonia Assessment Tool (HAT) [10], the Barry-Albright Dystonia (BAD) scale [11], and the Shriners Hospital for Children Upper Extremity Evaluation [12]. These outcome measures were devised to satisfy the typical criteria for effective outcome measures, including reliability, validity, specificity, and responsiveness [13]. Although useful, these rating scales rely on subjective assessment and questionnaires that are vulnerable to inter-rater and test-retest reliability, nonlinearity, multi-dimensionality, and ceiling or floor effects [14]. These shortcomings need to be overcome by more quantitative outcome measures to provide a better evaluation of the individual’s motor functions and abilities, and potentially utilize such measures to objectvely assess and titrate interventions.

B. Quantitative Assessment of Motor Function

Motion tracking technologies have provided quantitative means of recording movements through a variety of sensing technology that tracks and stores movement. Camera-based motion capture, such as Vicon (Vicon Motion Systems, Oxford, UK) and Optitrak (Northern Digital Inc, Ontario, CA) requires external markers or sensors placed on key anatomical landmarks to reconstruct the skeletal model of human body parts. These state-of-the-art technologies track motion to very high precision with high sampling rates and they have been used for pre- and post-treatment assessment of upper- or lower-extremity pathologies. However, such data acquisition is limited to traditional laboratory settings because the multi-camera systems are expensive and not portable.

On the other hand, there are low-cost inertial measurement units (IMUs) that directly measure acceleration, rotational change and magnetic orientation. While these sensors have the advantage that they are self-contained and wearable, drawbacks are degraded accuracy due to drift, calibration errors and noise inherent to inertial sensors and the need to frequently recharge batteries for real-time data streaming [15]. Moreover, attaching sensors to body parts can be inconvenient or even impossible for certain clinical populations, and many children will not tolerate them.

In view of the above arguments, there is a strong need for less invasive devices that can provide quantitative measurements in tasks related to upper-extremeity motor function. Preferably, such a device should allow for portability and be low-cost to reach large populations.

C. Low-Cost Rehabilitation at Home

Rehabilitation follows standard practice and frequently requires one-on-one interaction with a therapist for extended periods of time. For these reasons, robotic devices have emerged to deliver higher-dosage and higher-intensity training for patients with movement disorders such as cerebral palsy and stroke [16]–[17][18][19]. However, while effective, robotic therapy is expensive and to date can only be used in clinical settings. To increase the volume in therapy, lower-cost devices that can be used at home are urgently needed.

Performance improvements with predominant home training are indeed possible. This was demonstrated by pediatric constraint-induced movement therapy (CIMT) for children with hemiparetic CP [20], [21]. Further, it was shown that even children with severe dystonia can improve their performance if they use an interface or device that enables and facilitates their severely handicapped movements [22].

A portable low-cost device for home use that is able to provide reliable quantitative measurements would help address the above shortcomings. Measurements could also be streamed to careproviders on a secure cloud protocol, for diagnosis of interventions, analysis of therapeutic outcomes, and further follow up.

D. Theoretically-Grounded Rehabilitation

Motor tasks for home therapy should be engaging to avoid boredom and attrition and should also have functional relevance. With this goal in mind, we developed a motor task that was motivated by the daily self-feeding activity of leading a cup of coffee or a spoon filled with soup to the mouth. The core challenge of actions of this kind is that moving such an object with sloshing liquid presents complex interaction forces: any force applied to the cup also applies a force to the liquid that then acts back on the hand. When such internal dynamics is present, interaction forces become quite complex, and the human performing the task needs to predict and preempt the internal dynamics of the moving liquid. Clearly, better understanding task is like guiding a cup of coffee to one’s mouth or a spoonful of soup has high functional relevance. While many such functional tasks have been developed for rehabiltation (e.g., the box-and-block and the pegboard task), the quantitative assessment should allow for more than descriptive outcome measures such as error or success rate. Monitoring the ‘process’ continuously should provide more detailed insight into coordinative challenges. This is indeed possible in the task of guiding a cup of coffee as we explain next.

In previous research, we abstracted a relevant, yet simplified model task, inspired by guiding a cup of coffee [23]–[24][25][26]. To reduce the complexity and afford theoretical analyses, the “cup of coffee” was simplified to a rigid object with a rolling ball inside. The rolling ball represents the moving liquid; this is also similar to the children’s game of transporting an egg in a spoon [27]. Fig.1A-C shows the transition from the real object to the simplified physical model. Importantly, the original task (Fig.1A) was reduced to a two-dimensional model, where the subject interacts with the object via a robotic manipulandum. The virtual model consists of a cart with a suspended pendulum, a well-known benchmark problem in control theory.

FIGURE 1.Model for the task of carrying a cup of coffee. A: The real object. B: The simplified physical model. C: The equivalent cart-and pendulum model implemented in the virtual task.

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[Abstract + References] eConHand: A Wearable Brain-Computer Interface System for Stroke Rehabilitation

Abstract

Brain-Computer Interface (BCI) combined with assistive robots has been developed as a promising method for stroke rehabilitation. However, most of the current studies are based on complex system setup, expensive and bulky devices. In this work, we designed a wearable Electroencephalography(EEG)-based BCI system for hand function rehabilitation of the stroke. The system consists of a customized EEG cap, a small-sized commercial amplifer and a lightweight hand exoskeleton. In addition, visualized interface was designed for easy use. Six healthy subjects and two stroke patients were recruited to validate the safety and effectiveness of our proposed system. Up to 79.38% averaged online BCI classification accuracy was achieved. This study is a proof of concept, suggesting potential clinical applications in outpatient environments.

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[Abstract + References] Self-paced movement intention recognition from EEG signals during upper limb robot-assisted rehabilitation

Abstract

Currently, one of the challenges in EEG-based brain-computer interfaces (BCI) for neurorehabilitation is the recognition of the intention to perform different movements from same limb. This would allow finer control of neurorehabilitation and motor recovery devices by end-users [1]. To address this issue, we assess the feasibility of recognizing two self-paced movement intentions of the right upper limb plus a rest state from EEG signals recorded during robot-assisted rehabilitation therapy. In addition, the work proposes the use of Multi-CSP features and deep learning classifiers to recognize movement intentions of the same limb. The results showed performance peaked greater at (80%) using a novel classification models implemented in a multiclass classification scenario. On the basis of these results, the decoding of the movement intention could potentially be used to develop more natural and intuitive robot assisted neurorehabilitation therapies
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2. P. Ofner , A. Schwarz , J. Pereira , and G. R. Müller-Putz , “Upper limb movements can be decoded from the time-domain of low-frequency EEG,” PLoS One, vol. 12, no. 8, p. e0182578, Aug 2017, poNE-D- 17-04785[PII].

3. F. Shiman , E. Lopez-Larraz , A. Sarasola-Sanz , N. Irastorza-Landa , M. Spler , N. Birbaumer , and A. Ramos-Murguialday , “Classification of different reaching movements from the same limb using EEG,” Journal of Neural Engineering, vol. 14, no. 4, p. 046018, 2017.

4. J. Pereira , A. I. Sburlea , and G. R. Müller-Putz , “EEG patterns of self- paced movement imaginations towards externally-cued and internally- selected targets,” Scientific Reports, vol. 8, no. 1, p. 13394, 2018.

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[Abstract] The SonicHand Protocol for Rehabilitation of Hand Motor Function: a validation and feasibility study

Abstract

Musical sonification therapy is a new technique that can reinforce conventional rehabilitation treatments by increasing therapy intensity and engagement through challenging and motivating exercises. Aim of this study is to evaluate the feasibility and validity of the SonicHand protocol, a new training and assessment method for the rehabilitation of hand function. The study was conducted in 15 healthy individuals and 15 stroke patients. The feasibility of implementation of the training protocol was tested in stroke patients only, who practiced a series of exercises concurrently to music sequences produced by specific movements. The assessment protocol evaluated hand motor performance during pronation/supination, wrist horizontal flexion/extension and hand grasp without sonification. From hand position data, 15 quantitative parameters were computed evaluating mean velocity, movement smoothness and angular excursions of hand/fingers. We validated this assessment in terms of its ability to discriminate between patients and healthy subjects, test-retest reliability and concurrent validity with the upper limb section of the Fugl-Meyer scale (FM), the Functional Independence Measure (FIM) and the Box & Block Test (BBT). All patients showed good understanding of the assigned tasks and were able to correctly execute the proposed training protocol, confirming its feasibility. A moderate-to-excellent intraclass correlation coefficient was found in 8/15 computed parameters. Moderate-to-strong correlation was found between the measured parameters and the clinical scales. The SonicHand training protocol is feasible and the assessment protocol showed good to excellent between-group discrimination ability, reliability and concurrent validity, thus enabling the implementation of new personalized and motivating training programs employing sonification for the rehabilitation of hand function.

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[Abstract] A Greedy Assist-as-Needed Controller for Upper Limb Rehabilitation

Abstract

Previous studies on robotic rehabilitation have shown that subjects’ active participation and effort involved in rehabilitation training can promote the performance of therapies. In order to improve the voluntary effort of participants during the rehabilitation training, assist-as-needed (AAN) control strategies regulating the robotic assistance according to subjects’ performance and conditions have been developed. Unfortunately, the heterogeneity of patients’ motor function capability in task space is not taken into account during the implementation of these controllers. In this paper, a new scheme called greedy AAN (GAAN) controller is designed for the upper limb rehabilitation training of neurologically impaired subjects. The proposed GAAN control paradigm includes a baseline controller and a Gaussian RBF network that is utilized to model the functional capability of subjects and to provide corresponding a task challenge for them. In order to avoid subjects’ slacking and encourage their active engagement, the weight vectors of RBF networks evaluating subjects’ impairment level are updated based on a greedy strategy that makes the networks progressively learn the maximum forces over time provided by subjects. Simultaneously, a challenge level modification algorithm is employed to adjust the task challenge according to the task performance of subjects. Experiments on 12 subjects with neurological impairment are conducted to validate the performance and feasibility of the GAAN controller. The results show that the proposed GAAN controller has significant potential to promote the subjects’ voluntary engagement during training exercises.

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[Abstract + References] Synergy-Based FES for Post-Stroke Rehabilitation of Upper-Limb Motor Functions

Abstract

Functional electrical stimulation (FES) is capable of activating muscles that are under-recruited in neurological diseases, such as stroke. Therefore, FES provides a promising technology for assisting upper-limb motor functions in rehabilitation following stroke. However, the full benefits of FES may be limited due to lack of a systematic approach to formulate the pattern of stimulation. Our preliminary work demonstrated that it is feasible to use muscle synergy to guide the generation of FES patterns.In this paper, we present a methodology of formulating FES patterns based on muscle synergies of a normal subject using a programmable multi-channel FES device. The effectiveness of the synergy-based FES was tested in two sets of experiments. In experiment one, the instantaneous effects of FES to improve movement kinematics were tested in three patients post ischemic stroke. Patients performed frontal reaching and lateral reaching tasks, which involved coordinated movements in the elbow and shoulder joints. The FES pattern was adjusted in amplitude and time profile for each subject in each task. In experiment two, a 5-day session of intervention using synergy-based FES was delivered to another three patients, in which patients performed task-oriented training in the same reaching movements in one-hour-per-day dose. The outcome of the short-term intervention was measured by changes in Fugl–Meyer scores and movement kinematics. Results on instantaneous effects showed that FES assistance was effective to increase the peak hand velocity in both or one of the tasks. In short-term intervention, evaluations prior to and post intervention showed improvements in both Fugl–Meyer scores and movement kinematics. The muscle synergy of patients also tended to evolve towards that of the normal subject. These results provide promising evidence of benefits using synergy-based FES for upper-limb rehabilitation following stroke. This is the first step towards a clinical protocol of applying FES as therapeutic intervention in stroke rehabilitation.

I. Introduction

Muscle activation during movement is commonly disrupted due to neural injuries from stroke. A major challenge for stroke rehabilitation is to re-establish the normal ways of muscle activation through a general restoration of motor control, otherwise impairments may be compensated by the motor system through a substitution strategy of task control [1]. In post-stroke intervention, new technologies such as neuromuscular electrical stimulation (NMES) or functional electrical stimulation (FES) offer advantages for non-invasively targeting specific groups of muscles [2]–[4] to restore the pattern of muscle activation. Nevertheless, their effectiveness is limited by lack of a systematic methodology to optimize the stimulation pattern, to implement the optimal strategy in clinical settings, and to design a protocol of training towards the goal of restoring motor functions. This pioneer study addresses these issues in clinical application with a non-invasive FES technology.

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[Abstract] A Virtual Reality based Training and Assessment System for Hand Rehabilitation – IEEE Conference Publication

Abstract

Virtual reality is widely applied in rehabilitation robot to help post-stoke patients complete rehabilitation training for the body function recovery. Most of virtual rehabilitation training systems lack scientific assessment standards and doctors don’t usually use quantitative examinations but qualitative observation and conversation with patients to evaluate the motor function of limb. Based on this situation, a virtual rehabilitation training and assessment system is designed, which contains two rehabilitation training games and one assessment system. The virtual system can attract patient attention and decrease the boredom of rehabilitation training and assessment. Compared with the existing rehabilitation assessment methods, the proposed virtual assessment system can give the assessment results similar to Fugl-Meyer Assessment, which is more quantitative, interesting and convenient. Five volunteers participate in the study of assessment system and the experimental results confirm the effectiveness of assessment system.

I. Introduction

In recent years, according to American Heart Association, stroke is the leading cause of serious long-term disability in the US and about 795,000 people suffer from a stroke each year [1]. China is also facing the same problem. The stroke is the first leading cause of death. Every year, 2.4 million people suffer from stroke [2]. Fortunately, about 60-75 percent of those can survive. However, about 65 percent of them still remain severely handicapped because of the neurological damage caused by stroke, for example, movement disorders, hemiparesis and so on [3], [4]. Those sequelae have an effect on body movement function, especially arm and hand function [4], [5]. The lost of hand movement function will affect the Activities of Daily Living (ADLs), which will decrease the quality of life [6].[…]

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[Abstract] EMG Feature Extractions for Upper-Limb Functional Movement During Rehabilitation

Abstract

Rehabilitation is important treatment for post stroke patient to regain their muscle strength and motor coordination as well as to retrain their nervous system. Electromyography (EMG) has been used by researcher to enhance conventional rehabilitation method as a tool to monitor muscle electrical activity however EMG signal is very stochastic in nature and contains some noise. Special technique is yet to be researched in processing EMG signal to make it useful and effective both to researcher and to patient in general. Feature extraction is among the signal processing technique involved and the best method for specific EMG study needs to be applied. In this works, nine feature extractions techniques are applied to EMG signals recorder from subjects performing upper limb rehabilitation activity based on suggested movement sequence pattern. Three healthy subjects perform the experiment with three trials each and EMG data were recorded from their bicep and deltoid muscle. The applied features for every trials of each subject were analyzed statistically using student T-Test their significant of p-value. The results were then totaled up and compared between the nine features applied and Auto Regressive coefficient (AR) present the best result and consistent with each subjects’ data. This feature will be used later in our future research work of Upper-limb Virtual Reality Rehabilitation.

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[Abstract + References] Novel Assessment Measures of Upper-Limb Function in Pre and Poststroke Rehabilitation: A Pilot Study – IEEE Conference Publication

Abstract

Hand function assessment is essential for upper limb rehabilitation of stroke survivors. Conventional acquisition devices have inherent and restrictive difficulties for their clinical usage. Data gloves are limited for applications outside the medical environment, and motion tracking systems setup are time and personnel demanding. We propose a novel instrument designed as a replica of a glass, equipped with an omnidirectional vision system to capture hand images and an inertial measurement unit for movements kinematic data acquisition. Four stroke survivors were invited as volunteers in pre and post-treatment experiments for its evaluating. The exercise of drinking water from a glass was elected for the trails. Before treatment, subjects used their contralesional and ipsilateral hands to perform them. Two main functional features were found in the data analysis. There were differences between limbs in the grasping hand postures, mainly in the index and thumb abduction angle, and in the task timing. After treatment, two volunteers repeated the protocol with their contralesional hands. Changes in the features were observed, index and thumb abduction angles were greater in both cases, and tasks timing were altered in distinct ways. These preliminary results suggest the instrument can be used both in evaluation of hand functional deficit and rehabilitation progress. Improvements and future work are also presented.
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[Abstract + References] Patient Evaluation of an Upper-Limb Rehabilitation Robotic Device for Home Use – IEEE Conference Publication

Abstract

The paper presents a user study to compare the performance of two rehabilitation robotic systems, called HomeRehab and PupArm. The first one is a novel tele-rehabilitation system for delivering therapy to stroke patients at home and the second one has been designed and developed to provide rehabilitation therapy to patients in clinical settings. Nine patients with different neurological disorders participated in the study. The patients performed 16 movements with each robotic platform and after that they filled a usability survey. Moreover, to evaluate the patient’s performance with each robotic device, 8 movement parameters were computed from each trial and for the two robotic devices. Based on the analysis of subjective assessments of usability and the data acquired objectively by the robotic devices, we can conclude that the performance and user experience with both systems are very similar. This finding will be the base of more extensive studies to demonstrate that home-therapy with HomeRehab could be as efficient as therapy in clinical settings assisted by PupArm robot.

 

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