Design and test of an automated version of the modified Jebsen test of hand function using Microsoft Kinect

Abstract Background 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. Methods 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. Results 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. Conclusions The results from the test showed that the Kinect can be used for automating the MJT

Constraint-induced movement therapy for upper extremities in people with stroke

Background In people who have had a stroke, upper limb paresis affects many activities of daily life. Reducing disability is therefore a major aim of rehabilitative interventions. Despite preserving or recovering movement ability after stroke, sometimes people do not fully realise this ability in their everyday activities. Constraint-induced movement therapy (CIMT) is an approach to stroke rehabilitation that involves the forced use and massed practice of the affected arm by restraining the unaffected arm. This has been proposed as a useful tool for recovering abilities in everyday activities. Objectives To assess the efficacy of CIMT, modified CIMT (mCIMT), or forced use (FU) for arm management in people with hemiparesis after stroke. Search methods We searched the Cochrane Stroke Group trials register (last searched June 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library Issue 1, 2015), MEDLINE (1966 to January 2015), EMBASE (1980 to January 2015), CINAHL (1982 to January 2015), and the Physiotherapy Evidence Database (PEDro; January 2015). Selection criteria Randomised control trials (RCTs) and quasi-RCTs comparing CIMT, mCIMT or FU with other rehabilitative techniques, or none. Data collection and analysis One author identified trials from the results of the electronic searches according to the inclusion and exclusion criteria, three review authors independently assessed methodological quality and risk of bias, and extracted data. The primary outcome was disability. Main results We included 42 studies involving 1453 participants. The trials included participants who had some residual motor power of the paretic arm, the potential for further motor recovery and with limited pain or spasticity, but tended to use the limb little, if at all. The majority of studies were underpowered (median number of included participants was 29) and we cannot rule out small-trial bias. Eleven trials (344 participants) assessed disability immediately after the intervention, indicating a non-significant standard mean difference (SMD) 0.24 (95% confidence interval (CI) -0.05 to 0.52) favouring CIMT compared with conventional treatment. For the most frequently reported outcome, arm motor function (28 studies involving 858 participants), the SMD was 0.34 (95% CI 0.12 to 0.55) showing a significant effect (P value 0.004) in favour of CIMT. Three studies involving 125 participants explored disability after a few months of follow-up and found no significant difference, SMD -0.20 (95% CI -0.57 to 0.16) in favour of conventional treatment. Authors' conclusions CIMT is a multi-faceted intervention where restriction of the less affected limb is accompanied by increased exercise tailored to the person\u2019s capacity. We found that CIMT was associated with limited improvements in motor impairment and motor function, but that these benefits did not convincingly reduce disability. This differs from the result of our previous meta-analysis where there was a suggestion that CIMT might be superior to traditional rehabilitation. Information about the long-term effects of CIMT is scarce. Further trials studying the relationship between participant characteristics and improved outcomes are required

Cortical thickness changes in the non-lesioned hemisphere associated with non-paretic arm immobilization in modified CI therapy

Recent evidence suggests that immobilization of the upper limb for 2–3 weeks induces changes in cortical thickness as well as motor performance. In constraint induced (CI) therapy, one of the most effective interventions for hemiplegia, the non-paretic arm is constrained to enforce the use of the paretic arm in the home setting. With the present study we aimed to explore whether non-paretic arm immobilization in CI therapy induces structural changes in the non-lesioned hemisphere, and how these changes are related to treatment benefit. 31 patients with chronic hemiparesis participated in CI therapy with (N = 14) and without (N = 17) constraint. Motor ability scores were acquired before and after treatment. Diffusion tensor imaging (DTI) data was obtained prior to treatment. Cortical thickness was measured with the Freesurfer software. In both groups cortical thickness in the contralesional primary somatosensory cortex increased and motor function improved with the intervention. However the cortical thickness change was not associated with the magnitude of motor function improvement. Moreover, the treatment effect and the cortical thickness change were not significantly different between the constraint and the non-constraint groups. There was no correlation between fractional anisotropy changes in the non-lesioned hemisphere and treatment outcome. CI therapy induced cortical thickness changes in contralesional sensorimotor regions, but this effect does not appear to be driven by the immobilization of the non-paretic arm, as indicated by the absence of differences between the constraint and the non-constraint groups. Our data does not suggest that the arm immobilization used in CI therapy is associated with noticeable cortical thinning

Review of automated systems for upper limbs functional assessment in neurorehabilitation

Traditionally, the assessment of upper limb (UL) motor function in neurorehabilitation is carried out by clinicians using standard clinical tests for objective evaluation, but which could be influenced by the clinician's subjectivity or expertise. The automation of such traditional outcome measures (tests) is an interesting and emerging field in neurorehabilitation. In this paper, a systematic review of systems focused on automation of traditional tests for assessment of UL motor function used in neurological rehabilitation is presented. A systematic search and review of related articles in the literature were conducted. The chosen works were analyzed according to the automation level, the data acquisition systems, the outcome generation method, and the focus of assessment. Finally, a series of technical requirements, guidelines, and challenges that must be considered when designing and implementing fully-automated systems for upper extremity functional assessment are summarized. This paper advocates the use of automated assessment systems (AAS) to build a rehabilitation framework that is more autonomous and objective.This work was supported in part by the Spanish Ministry of Economy and Competitiveness via the ROBOHEALTH (DPI2013-47944-C4-1-R) and ROBOESPAS (DPI2017-87562-C2-1-R) Projects, and in part by the RoboCity2030-III-CM project (S2013/MIT-2748) which is funded by the Programas de Actividades I+D Comunidad de Madrid and cofunded by the Structural Funds of the EU

Exploring the Use of the Bimanual Arm Trainer for Improving Upper Extremity Motor Function in Stroke Patients.

Background and purpose There are few evidence-based treatment options to address recovery in patients with severe upper extremity impairment post-stroke. Although robotic treatment options have been widely explored with variable outcomes, the contribution of bimanual training to improve upper extremity control and coordination has not yet been fully explored. To date, the mirrored motion Bimanual Arm Trainer (BAT) has not specifically been investigated for its effectiveness in stroke patients. This study explored the usefulness of the bimanual arm trainer in improving upper extremity function in stroke patients with severe deficits and its impact on quality of life. Methods Twenty-three patients poststroke underwent 1 hour of training over 12 sessions provided two to three times a week on the bimanual arm trainer. The training consisted of bimanual simultaneous movements interspersed with unimanual affected arm training using the bimanual arm trainer (Mirrored Motion Works, Inc.). The Fugl- Meyer Assessment of Motor Recovery after Stroke (FMA-UE), the streamlined Wolf Motor Function Test (WMFT), the Stroke Impact Scale (SIS), and the Modified Rankin Scale (MRS- SI) were assessed pre and post intervention. Results of study Upper extremity arm motor impairment as measured by FMA-UE showed statistically significant change from Pre1 (M = 23.59, SD = 10.11) to Pre-2 (M = 25.00, SD = 10.57) to post bimanual arm training intervention (M = 27.45, SD = 10.22). The mean increase was 3.86, 95% CI [-1.68, -6.05], p0.05). However, a paired samples t-test comparing SIS post intervention (220.97 ±19.46) to the Pre1 (213.52 ±21.04) showed a statistically significant increase of 6.652 (95% CI, -12.933 to -.371), t (22) = 2.196, p \u3c 0.05). The Modified Rankin Scale did not change from Pre1 (M = 2.05, SD = 0.29) to Pre2 (M = 2.05, SD = 0.29) to post-intervention (M = 2.05, SD = 0.29). Discussion and conclusion Both measures of upper extremity motor impairment and function indicated a significant increase with only 12 sessions of bimanual arm training using the bimanual arm trainer as a treatment intervention. However, although function improved, participants’ perceptions of changes in quality of life were not observed, perhaps because the changes were not yet assimilated into daily life activities to impact quality of life

Exploring the Use of the Bimanual Arm Trainer for Improving Upper Extremity Motor Function in Stroke Patients.

Background and purpose There are few evidence-based treatment options to address recovery in patients with severe upper extremity impairment post-stroke. Although robotic treatment options have been widely explored with variable outcomes, the contribution of bimanual training to improve upper extremity control and coordination has not yet been fully explored. To date, the mirrored motion Bimanual Arm Trainer (BAT) has not specifically been investigated for its effectiveness in stroke patients. This study explored the usefulness of the bimanual arm trainer in improving upper extremity function in stroke patients with severe deficits and its impact on quality of life. Methods Twenty-three patients poststroke underwent 1 hour of training over 12 sessions provided two to three times a week on the bimanual arm trainer. The training consisted of bimanual simultaneous movements interspersed with unimanual affected arm training using the bimanual arm trainer (Mirrored Motion Works, Inc.). The Fugl- Meyer Assessment of Motor Recovery after Stroke (FMA-UE), the streamlined Wolf Motor Function Test (WMFT), the Stroke Impact Scale (SIS), and the Modified Rankin Scale (MRS- SI) were assessed pre and post intervention. Results of study Upper extremity arm motor impairment as measured by FMA-UE showed statistically significant change from Pre1 (M = 23.59, SD = 10.11) to Pre-2 (M = 25.00, SD = 10.57) to post bimanual arm training intervention (M = 27.45, SD = 10.22). The mean increase was 3.86, 95% CI [-1.68, -6.05], p0.05). However, a paired samples t-test comparing SIS post intervention (220.97 ±19.46) to the Pre1 (213.52 ±21.04) showed a statistically significant increase of 6.652 (95% CI, -12.933 to -.371), t (22) = 2.196, p \u3c 0.05). The Modified Rankin Scale did not change from Pre1 (M = 2.05, SD = 0.29) to Pre2 (M = 2.05, SD = 0.29) to post-intervention (M = 2.05, SD = 0.29). Discussion and conclusion Both measures of upper extremity motor impairment and function indicated a significant increase with only 12 sessions of bimanual arm training using the bimanual arm trainer as a treatment intervention. However, although function improved, participants’ perceptions of changes in quality of life were not observed, perhaps because the changes were not yet assimilated into daily life activities to impact quality of life