[Abstract + References] Movement Quality: A Novel Biomarker Based on Principles of Neuroscience

Abstract

A major problem in neurorehabilitation is the lack of objective outcomes to measure movement quality. Movement quality features, such as coordination and stability, are essential for everyday motor actions. These features allow reacting to continuously changing environment or to resist external perturbations. Neurological disorders affect movement quality, leading to functionally impaired movements. Recent findings suggest that the central nervous system organizes motor elements (eg, muscles, joints, fingers) into task-specific ensembles to stabilize motor tasks performance. A method to quantify this feature has been previously developed based on the uncontrolled manifold (UCM) hypothesis. UCM quantifies movement quality in a spatial-temporal domain using intertrial analysis of covariation between motor elements. In this point-of-view article, we first describe major obstacles (eg, the need for group analysis) that interfere with UCM application in clinical settings. Then, we propose a process of quantifying movement quality for a single individual with a novel use of bootstrapping simulations and UCM analysis. Finally, we reanalyze previously published data from individuals with neurological disorders performing a wide range of motor tasks, that is, multi-digit pressing and postural balance tasks. Our method allows one to assess motor quality impairments in a single individual and to detect clinically important motor behavior changes. Our solution may be incorporated into a clinical setting to assess sensorimotor impairments, evaluate the effects of specific neurological treatments, or track movement quality recovery over time. We also recommended the proposed solution to be used jointly with a typical statistical analysis of UCM parameters in cohort studies.

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Source

[Abstract] Trends in rehabilitation robots and their translational research in National Rehabilitation Center, Korea – SpringerLink

Abstract

Robots are expected to play an important role in rehabilitation as rehabilitation robots can provide frequent and repetitive doses during treatment or provide seamless support in daily living activities. However, the research and development results of rehabilitation robots indicate that they are not suitable for clinical applications because of several requirements such as safety, effectiveness, long-term investment, and other barriers between bench and bedside.

This paper reviews the current trends in rehabilitation robots and then shares the experience of a translational research for rehabilitation robots in the National Rehabilitation Center (NRC) of Korea during the last three years.

The NRC translational research for rehabilitation robots consists of three parts: extramural projects of universities, research institutes, and companies for clinical applications, intramural projects within NRC, and operation of an NRC Robot Gym, i.e., a sharing space between clinicians and engineers.

This translational research provides infrastructures for clinicians and engineers conducting studies on rehabilitation robots. NRC is trying to connect robotic technology with clinical application through this translational research. In addition, a novel direction for the next three years is presented. This research will contribute visible results such as boosting the rehabilitation robot industry and improving the quality of life of people with disabilities and senior citizens.

Source: Trends in rehabilitation robots and their translational research in National Rehabilitation Center, Korea | SpringerLink http://partner.googleadservices.com/gpt/pubads_impl_94.js

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[ARTICLE] Moving Research From the Bedside Into Practice | Physical Therapy Journal – Full Text

Evidence-based practice (EBP) is firmly entrenched in the lexicon of physical therapist practice,^1,2 but beliefs about how best to translate scientific evidence into clinical practice are far from settled. There are major gaps in our scientific knowledge; however, even more disturbing is the fact that an enormous amount of existing scientific knowledge remains unused in practice. As noted in the Institute of Medicine (IOM) report titled Crossing the Quality Chasm, “Between the health care we have and the care we could have lies not just a gap, but a chasm.”³

Thankfully, the infamous 264-year period between the discovery of citrus’s benefit in preventing scurvy and the widespread use of citrus on British ships is no longer the norm.⁴ But the frequently quoted statement about the lag time between publication and adoption of research—only 14% of original research is applied for the benefit of patient care, and that takes 17 years^5,6—is alarming enough. There is consensus that the transfer of evidence from proven health care discoveries to patient care is unpredictable and highly variable and needs to be accelerated.^4,7,8

For those of us who want to speed the adoption of EBP in physical therapy and across health care more broadly, Naylor⁹ described 4 distinct phases or strategies that are instructive:

Phase 1, the “Era of Optimism,” is characterized by a belief in passive diffusion of scientific evidence into practice. In this (still-dominant) phase, students and clinicians are trained to critically appraise the scientific literature to identify valid new information that could be applied to practice.

Phase 2, the “Era of Innocence Lost and Regained,” acknowledges that much of clinical practice is not evidence based and that it is virtually impossible for clinicians to keep up with the explosion of medical literature. This understanding has led to the emergence of evidence-based clinical practice guidelines, in which the literature is systematically reviewed and summary recommendations are graded according to the strength of the supporting evidence. Guidelines are widely disseminated on the assumption that providers will read them and that practice will change accordingly.

Phase 3, the “Era of Industrialization,” is on the rise, as evidence mounts that the passive efforts of phases 1 and 2 fail to actually change practice. In this phase, aggressive strategies are implemented by regulatory entities or professions to improve care. These efforts frequently involve performance measurement and reporting,¹⁰ which are intended to encourage providers to become more accountable and more focused on quality improvement. Many professions have risen to this challenge and have developed their own approaches to change patient management as described by Naylor.⁹APTA’s Physical Therapy Outcomes Registry,¹¹ an organized system for collecting data to evaluate patient function and other clinically relevant measures, is a phase 3 effort, with improving practice and fulfilling quality reporting requirements as 2 of its major goals.

Phase 4, the final phase, is the “Era of Information Technology and Systems Engineering,” which is driven by the belief that it is not sufficient to focus on individual practitioners, but rather the redesign of service delivery systems to address barriers and incentives is required to bridge the wide gap between best evidence and common practice. For this phase, a different type of evidence base—one describing the most effective ways to change provider behavior^9,12—is needed. Hence the emergence of the relatively new field of implementation research.

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