Posts Tagged UE

[ARTICLE] Design and test of an automated version of the modified Jebsen test of hand function using Microsoft Kinect – Full Text



The present paper describes the design and evaluation of an automated version of the Modified Jebsen Test of Hand Function (MJT) based on the Microsoft Kinect sensor.


The MJT was administered twice to 11 chronic stroke subjects with varying degrees of hand function deficits. The test times of the MJT were evaluated manually by a therapist using a stopwatch, and automatically using the Microsoft Kinect sensor. The ground truth times were assessed based on inspection of the video-recordings. The agreement between the methods was evaluated along with the test-retest performance.


The results from Bland-Altman analysis showed better agreement between the ground truth times and the automatic MJT time evaluations compared to the agreement between the ground truth times and the times estimated by the therapist. The results from the test-retest performance showed that the subjects significantly improved their performance in several subtests of the MJT, indicating a practice effect.


The results from the test showed that the Kinect can be used for automating the MJT.


Deficits in motor function, in the form of hemiparesis or hemiplegia, are a frequent consequence of cerebral stroke [1]. Even though motor function may be regained to some extent through intensive rehabilitative training following acute treatment of stroke, deficits in hand function often remain [23]. Following discharge from the rehabilitation unit, patients are typically asked to perform unsupervised self-training in their own home. The lack of supervision during training at home will likely have an impact on the patient’s training compliance and training quality. Therefore, it is important to perform regular evaluations of the patient’s functional level in order to provide useful supervision and to maintain patient motivation. The patients’ performance in a specific motor function test provides valuable insight into whether the training scheme chosen for a patient is effective or it should be changed. Thus, it is very important that the motor function tests being used are objective and reflect the actual functional level of the patient being tested. Several validated motor function tests including assessment of hand function exist, e.g. Jebsen Test of Hand Function [4], Action Research Arm Test [5], Fugl-Meyer Assessment [6], Wolf Motor Function Test (WMFT) [7], Box and Blocks Test [8] and Nine Hole Peg Test [9]. Common for all these tests is that they must be administered by a therapist, which might be a source for variability in the test results, and cause the test results not always to be completely reproducible and objective. In tests including performance time as an outcome measure, e.g. the WMFT, the reaction time of the subject could introduce a bias to the results, as suggested by previous studies [1011]. Likewise, the end time of the test would likely be subjected to a bias, since the examiner has a finite reaction time. Thus, both the reaction time of the examiner and the subject could be potential sources of bias and variability in timed motor function tests. The sensitivity of a motor function test is affected by sources of bias and variability and therefore it is of interest to minimize these, to make detection of even small changes possible.

By automating motor function tests, the objectivity of the tests would be increased. This might also make possible to use the tests at remote sites, without direct supervision, as a part of a tele-rehabilitation service. Finally, automated tests could be administered more frequently. Previous studies have shown that selected parts of the WMFT can be automated by use of motion sensors mounted on the body of healthy subjects [10] and stroke patients [11]. Both systems automated the test by analyzing three-dimensional kinematics data from body-worn sensors (inertial measurement units) mounted on the most affected wrist, arm and shoulder of stroke patients [1011]. Similarly, using inertial measurement unit sensors, Yang et al. (2013) showed that when administering the 10 m walking test, the output from their system was in close agreement with the walking speeds estimated using a stop-watch [12]. These systems require though correct positioning and mounting of the motion sensors [10]. Huang et al. (2012) showed that also a computer vision based approach, consisting of a monitor camera and a Xilinx Virtex II Pro Field Programmable Gate Array (for computation), may be used for automating the WMFT. All participants being tested had to wear a black sweatband on the wrist of the extremity being tested [13]. Another low-price method for capturing the movements of a patient performing a motor function test is the Microsoft Kinect sensor (Kinect). By using a Kinect, the need for body mounted sensors is eliminated, thus lowering the susceptibility to data loss and easing donning and doffing of the system. Furthermore, the Microsoft Kinect sensor is a low-cost commercially available device. In this paper, we describe the design and test of a Kinect based system for automatic evaluation of a standardized, validated motor function test, administered to stroke patients with hand function deficits. The Modified Jebsen Test of Hand Function (MJT) [14], initially proposed by Bovend’Eerdt et al. (2004) as a test for assessment of gross functional dexterity in stroke patients, was selected for automation as this test is easy to administer and takes short time to complete.

Continue —> Design and test of an automated version of the modified Jebsen test of hand function using Microsoft Kinect | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 3 The edge of the table was detected in the binary image (lower) produced by thresholding the depth image (upper) into two parts, one part containing all pixels with a depth value lower than a depth level of 300 mm below the surface of the table and the other part containing pixels with depth values above this threshold

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[ARTICLE] Exercising daily living activities in robot-mediated therapy – Full Text PDF


[Purpose] Investigation of the efficacy of robot-mediated therapy of the upper limb in patients with chronic stroke, in task-oriented training activities of daily living in real environment.

[Subjects and Methods] 20 patients, each more than one year post-stroke (13–71 months) received 20 sessions of upper limb robot-mediated therapy. No other treatment was given. Each therapy session consisted of a passive motion and an active task therapy. During the active therapy, subjects exercised 5 activities of daily living. Assessments of the subjects were blind, and conducted one month prior to, at the start, at the end, and three months after the therapy course. The following outcome measures were recorded: Fugl-Meyer Scale—upper extremity subsection, Modified Ashworth Scale, Action Research Arm Test, Functional Independence Measure, Barthel Index.

[Results] Significant improvements were observed between the start and the end of the therapy, except for Modified Ashworth Scale and Barthel Index. Results still held up at the follow-up visit three months later.

[Conclusion] Practicing activities of daily living in real environment with robot-mediated physical therapy can improve the motor and functional ability of patients, even with relatively good initial functions, and even years post-stroke.

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[Student Thesis] Design and development of two medical devices to assist the rehabilitation of the upper limb mobility in post-stroke – Full Text PDF


This internship is divided into two different projects, a hand exerciser and a toy-like assistive device one. These projects are thought to assist the rehabilitation of patients that lost, partially or completely, their upper limb mobility.

To work on these projects a team of three intern students was made by the company. We all worked together since the beginning until the end of this internship. The idea generation and concept development for each project was done by brainstorming and team session meetings. We followed a traditional design assignment structure.

In the case of the first project, two final ideas were proposed to generate the desired rehabilitation. These devices are assembled on a robotic arm-skate already developed by the company before the beginning of this internship. They both promote the hand grasp/release and the arm pronation/supination movements. These prototypes are printed in poli-lactic acid (PLA) due to its reduced price and good material properties. They were designed in SolidWorks 2016 CAD program. A microprocessor based on Arduino UNO was used to control the system and its electrical components (such as motors and resistors). These motors actively drive the device to generate such movements on the patient.

In the case of the second project, a final Toy device was developed. This final product is thought to assist hand detailed and arm bulk movements on the patient. It has 10 special features that resemble daily actions that these patients may require to recover after suffering from a stroke. Actions such as opening a door knob or sliding a zipper are introduced in this device. The same material, production process and microprocessor used for the first project was used in this one. In that case, it is not an active but a passive device that waits for the patient to actuate on it. It doesn’t generate any active movement on any part of the patient’s body.

After the products were developed, several validation processes were followed. Every week a stroke patient came to the company to undergo his rehabilitation and test these devices. His feedback was used during the entire process to improve the performance of the devices. After that, a group of medical specialists came to the company to validate the ideas and products once they were finished and completely functional. Some extra recommendations and ideas were extracted from that validation sessions. These can be applied for further improvement and analysis on the prototypes.

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Source: Design and development of two medical devices to assist the rehabilitation of the upper limb mobility in post-stroke – University of Twente Student Theses

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[Case Study] Improved functional independence measure facilitates return to home after paralyzed upper-limb training: a case report – Full Text PDF


[Purpose] We report a case in which rehabilitation that targeted the paralyzed side’s upper limb in a hemiplegic stroke patient remarkably accelerated the patient’s ability to perform activities of daily living, improved her Functional Independence Measure score, and facilitated the patient’s return to home.

[Subject and Methods] We provided rehabilitation training to a female patient who experienced a cerebral infarction at a nursing home for the elderly and was admitted to the Kaifukuki recovery phase rehabilitation ward in order to improve her activities of daily living and return home. An intensive rehabilitation program incorporating occupational therapy and physical training for upper-limb function on the affected side was instituted over 170 days.

[Results] At presentation, the patient had functional disorders and load-induced pain in both lower limbs requiring her to walk with a fixed-type walker. After the intensive rehabilitation program, her activities of daily living improved and she was able to return home.

[Conclusion] This case suggests that activities of daily living training and simultaneous active training of upper-limb function on the affected side in patients with functional disorders or lower-limb pain could effectively improve their Functional Independence Measure scores, promote functional recovery, and facilitate their return to home.


Motor and cognitive impairments in stroke patients result in disability or dependence during activities of daily living (ADL) among the elderly. ADL performance requires optimal motor function in the trunk and upper and lower extremities. Self-reported disability measures, such as the Functional Independence Measure (FIM), are used to determine functional limitations1) . As it is more difficult to recover function in affected upper extremities than it is in the lower extremities, and since ADL can often be performed with only the unaffected side2, 3) , rehabilitation is aimed at improving function in the unaffected upper extremity4, 5) or switching hand dominance6) . Strategies are designed to improve FIM scores and reduce return-to-home times, as these measures are often also used to evaluate the productivity of rehabilitation clinics and determine budget- and reimbursement-related questions as well7) . In this setting where training to improve function in the affected upper extremity is seldom prioritized, we experienced a rare case wherein functional improvement in the affected dominant upper extremity greatly improved FIM scores and allowed the patient to return home.

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[Abstract] Play seriously: Effectiveness of serious games and their features in motor rehabilitation. A meta-analysis.



Evidence for the effectiveness of serious games (SGs) and their various features is inconsistent in the motor rehabilitation field, which makes evidence based development of SGs a rare practice.


To investigate the effectiveness of SGs in motor rehabilitation for upper limb and movement/balance and to test the potential moderating role of SGs features like feedback, activities, characters and background.


We ran a meta-analysis including 61 studies reporting randomized controlled trials (RCTs), controlled trials (CTs) or case series designs in which at least one intervention for motor rehabilitation included the use of SGs as standalone or in combination.


There was an overall moderate effect of SGs on motor indices, d = 0.59, [95% CI, 0.48, 0.71], p <  0.001. Regarding the game features, only two out of 17 moderators were statistically different in terms of effect sizes: type of activity (combination of group with individual activities had the highest effects), and realism of the scenario (fantasy scenarios had the highest effects).


While we showed that SGs are more effective in improving motor upper limb and movement/balance functions compared to conventional rehabilitation, there were no consistent differences between various game features in their contribution to effects. Further research should systematically investigate SGs features that might have added value in improving effectiveness.

Source: Play seriously: Effectiveness of serious games and their features in motor rehabilitation. A meta-analysis. – PubMed – NCBI

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[Abstract] Functional Brain Stimulation in a Chronic Stroke Survivor With Moderate Impairment  


OBJECTIVE. To determine the impact of transcranial direct current stimulation (tDCS) combined with repetitive, task-specific training (RTP) on upper-extremity (UE) impairment in a chronic stroke survivor with moderate impairment.

METHOD. The participant was a 54-yr-old woman with chronic, moderate UE hemiparesis after a single stroke that had occurred 10 yr before study enrollment. She participated in 45-min RTP sessions 3 days/wk for 8 wk. tDCS was administered concurrent to the first 20 min of each RTP session.

RESULTS. Immediately after intervention, the participant demonstrated marked score increases on the UE section of the Fugl–Meyer Scale and the Motor Activity Log (on both the Amount of Use and the Quality of Movement subscales).

CONCLUSION. These data support the use of tDCS combined with RTP to decrease impairment and increase UE use in chronic stroke patients with moderate impairment. This finding is crucial, given the paucity of efficacious treatment approaches in this impairment level.

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Source: Functional Brain Stimulation in a Chronic Stroke Survivor With Moderate Impairment | American Journal of Occupational Therapy

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[Abstract] Supporting Stroke Motor Recovery Through a Mobile Application: A Pilot Study


Neuroplasticity and motor learning are promoted with repetitive movement, appropriate challenge, and performance feedback. ARMStrokes, a smartphone application, incorporates these qualities to support motor recovery. Engaging exercises are easily accessible for improved compliance. In a multiple-case, mixed-methods pilot study, the potential of this technology for stroke motor recovery was examined. Exercises calibrated to the participant’s skill level targeted forearm, elbow, and shoulder motions for a 6-wk protocol. Visual, auditory, and vibration feedback promoted self-assessment. Pre- and posttest data from 6 chronic stroke survivors who used the app in different ways (i.e., to measure active or passive motion, to track endurance) demonstrated improvements in accuracy of movements, fatigue, range of motion, and performance of daily activities. Statistically significant changes were not obtained with this pilot study. Further study on the efficacy of this technology is supported.

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Source: Supporting Stroke Motor Recovery Through a Mobile Application: A Pilot Study | American Journal of Occupational Therapy

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[BLOG POST] Study Compares Intento Device and Traditional Occupational Therapy  

The Intento device is designed to enable patients to control the functional electronic stimulation that they receive, to help patients regain mobility in arms weakened by a stroke.

The Intento device is designed to enable patients to control the functional electronic stimulation that they receive, to help them regain mobility in arms weakened by a stroke.

A device from Ecole Polytechnique Fédérale de Lausanne startup company Intento is designed to enable stroke patients to self-administer functional electrical stimulation to help regain mobility in their arms weakened by the stroke.

The system consists of electrode patches, a device the patients control using their working hand, and tablet software. The therapist selects one of several programmed movements on the tablet and loads it, with a single click, onto the device. The program shows where the electrodes need to be placed and automatically configures the electrical pulse settings to generate the desired movement. Patients then move their functioning hand to control the electrical stimulation needed.

The ultimate aim is for patients to eventually perform the movements without using the device, explains a media release from Ecole Polytechnique Fédérale.

Results from a study investigating Intento’s device were published recently in Archives of Physical Medicine and Rehabilitation.

In the study, researchers from Lausanne University Hospital (CHUV) compared the device to conventional occupational therapy among 11 patients who were severely paralyzed as the result of a stroke. These patients experienced the stroke more than 6 months prior to the study, and other therapies did not work for them.

Over a period of 10 days, the 11 patients underwent 1.5-hour sessions using the Intento device.

Their mobility results from using the device were then compared to the results following conventional occupational therapy conducted over the same amount of time. The patients’ mobility was measured before and after each type of treatment, according to the release.

The results suggest that 70% of the patients experienced significant improvement in their motor functions, versus only 30% of the patients with the conventional occupational therapy.

“Above and beyond the study’s findings, several of the patients told us a few weeks later that they were already using their arms more than before,” says Andrea Maesani, Intento’s CEO and other cofounder, in the release.

Patients were still making steady progress 6 months after the study was conducted, suggesting that the treatment produces long-term effects, according to the release.

The next step will be a clinical study on a larger group before marketing the device, the founders state in the release.

[Source(s): Ecole Polytechnique Fédérale, EurekAlert]

Source: Study Compares Intento Device and Traditional Occupational Therapy – Rehab Managment

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[Abstract] Upper limb motor training using a Saebo™ orthosis is feasible for increasing task-specific practice in hospital after stroke



Assistive technologies have the potential to increase the amount of movement practice provided during inpatient stroke rehabilitation. The primary aim of this study was to investigate the feasibility of using the Saebo-Flex device in a subacute stroke setting to increase task-specific practice for people with little or no active hand movement. The secondary aim was to collect preliminary data comparing hand/upper limb function between a control group that received usual rehabilitation and an intervention group that used, in addition, the Saebo-Flex device.


Nine inpatients (mean three months (median six weeks) post-stroke) participated in this feasibility study conducted in an Australian rehabilitation setting, using a randomised pre-test and post-test design with concealed allocation and blinded outcome assessment. In addition to usual rehabilitation, the intervention group received eight weeks of daily motor training using the Saebo-Flex device. The control group received usual rehabilitation (task-specific motor training) only. Participants were assessed at baseline (pre-randomisation) and at the end of the eight-week study period. Feasibility was assessed with respect to ease of recruitment, application of the device, compliance with the treatment programme and safety. Secondary outcome measures included the Motor Assessment Scale (upper limb items), Box and Block Test, grip strength and the Stroke Impact Scale.


Recruitment to the study was very slow because of the low number of patients with little or no active hand movement. Otherwise, the study was feasible in terms of being able to apply the Saebo-Flex device and compliance with the treatment programme. There were no adverse events, and a greater amount of upper limb rehabilitation was provided to the intervention group. While there were trends in favour of the intervention group, particularly for dexterity, no between-group differences were seen for any of the secondary outcomes.


This pilot feasibility study showed that the use of assistive technology, specifically the Saebo-Flex device, could be successfully used in a sample of stroke patients with little or no active hand movement. However, recruitment to the trial was very slow. The use of the Saebo-FlexTM device had variable results on outcomes, with some positive trends seen in hand function, particularly dexterity.

Source: Upper limb motor training using a Saebo™ orthosis is feasible for increasing task-specific practice in hospital after stroke – Lannin – 2016 – Australian Occupational Therapy Journal – Wiley Online Library

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[Abstract+References] A therapy-driven gamification framework for hand rehabilitation


Rehabilitative therapy is usually very expensive and confined to specialized rehabilitation centers or hospitals, leading to slower recovery times for corresponding patients. Therefore, there is a high demand for the development of technology-based personalized solutions to guide and encourage patients towards performing online rehabilitation program that can help them live independently at home. This paper introduces an innovative e-health framework that develops adaptive serious games for people with hand disabilities. The aim of this work is to provide a patient-adaptive environment for the gamification of hand therapies in order to facilitate and encourage rehabilitation issues. Theoretical foundations (i.e., therapy and patient models) and algorithms to match therapy-based hand gestures to navigational movements in 3D space within the serious game environment have been developed. A novel game generation module is introduced, which translates those movements into a 3D therapy-driven route on a real-world map and with different levels of difficulty based on the patient profile and capabilities. In order to enrich the user navigation experience, a 3D spatio-temporal validation region is also generated, which tracks and adjusts the patient movements throughout the session. The gaming environment also creates and adds semantics to different types of attractive and repellent objects in space depending on the difficulty level of the game. Relevant benchmarks to assess the patient interaction with the environment along with a usability and performance testing of our framework are introduced to ensure quantitative as well as qualitative improvements. Trial tests in one disability center were conducted with a total number of five subjects, having hand motor controls problems, who used our gamified physiotherapy solution to help us in measuring the usability and users’ satisfaction levels. The obtained results and feedback from therapists and patients are very encouraging.

Source: A therapy-driven gamification framework for hand rehabilitation | SpringerLink

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