The automated box and blocks test an autonomous assessment method of gross manual dexterity in stroke rehabilitation

Traditional motor assessment is carried out by clinicians using standard clinical tests in order to have objectivity in the evaluation, but this manual procedure is liable to the observer subjectivity. In this article, an automatic assessment system based on the Box and Blocks Test (BBT) of manual dexterity is presented. Also, the automatic test administration and the motor performance of the user is addressed. Through cameras RGB-D the execution of the test and the patient's movements are monitored. Based on colour segmentation, the cubes displaced by the user are detected and the traditional scoring is automatically calculated. Furthermore, a pilot trial in a hospital environment was conducted, to compare the automatic system and its e ectiveness with respect to the traditional one. The results support the use of automatic assessment methods of motor functionality, which in combination with robotic rehabilitation systems, could address an autonomous and objective rehabilitation process.The research leading to these results has received funding from the ROBOHEALTH-A project (DPI2013-47944-C4-1-R) funded by Spanish Ministry of Economy and Competitiveness and from the RoboCity2030-III-CM project (S2013/MIT-2748), funded by Programas de Actividades I+D en la Comunidad de Madrid and cofunded by Structural Funds of the EU

Validity of a Fully-Immersive VR-Based Version of the Box and Blocks Test for Upper Limb Function Assessment in Parkinson's Disease

In recent decades, gaming technology has been accepted as a feasible method for complementing traditional clinical practice, especially in neurorehabilitation; however, the viability of using 3D Virtual Reality (VR) for the assessment of upper limb motor function has not been fully explored. For that purpose, we developed a VR-based version of the Box and Blocks Test (BBT), a clinical test for the assessment of manual dexterity, as an automated alternative to the classical procedure. Our VR-based BBT (VR-BBT) integrates the traditional BBT mechanics into gameplay using the Leap Motion Controller (LMC) to capture the user’s hand motion and the Oculus Rift headset to provide a fully immersive experience. This paper focuses on evaluating the validity of our VR-BBT to reliably measure the manual dexterity in a sample of patients with Parkinson’s Disease (PD). For this study, a group of twenty individuals in a mild to moderate stage of PD were recruited. Participants were asked to perform the physical BBT (once) and our proposed VR-BBT (twice) system,separately. Correlation analysis of collected data was carried out. Statistical analysis proved that the performance data collected by the VR-BBT significantly correlated with the conventional assessment of the BBT. The VR-BBT scores have shown a significant association with PD severity measured by the Hoehn and Yahr scale. This fact suggests that the VR-BBT could be used as a reliable indicator for health improvements in patients with PD. Finally, the VR-BBT system presented high usability and acceptability rated by clinicians and patients.This work was supported in part by the Spanish Ministry of Economy and Competitiveness via the ROBOESPAS project (DPI2017-87562-C2-1-R), and in part by the RoboCity2030-DIH-CM, Madrid Robotics Digital Innovation Hub (S2018/NMT-4331), which is funded by the Programas de Actividades I+D Comunidad de Madrid and cofunded by the Structural Funds of the EU

Técnicas y métodos para el seguimiento de la evolución de la habilidad motriz fina de miembro superior : revisión de la literatura

Introduction: This review article is the product of research on the methods, techniques and devices used in the measurement of fine motor skills of upper limbs and its respective evolution, developed at Universidad del Cauca in 2018. Problem: Objective measurement of the evolution of upper limb motor skills in the rehabilitation processes.  Objective: To identify the conventional techniques and electronic devices used in the measurement of the evolution of upper limb motor ability.  Methodology: Four scientific databases were reviewed in addition to the Google Scholar search engine. The keywords used for the search were: "fine motor skills", "hand measurement", "hand rehabilitation"and "hand function", among others.  Results: Approximately 3840 articles related to the subject were found. When applying the exclusion criteria, the article number to be revised was reduced to 63, which were analyzed in the present review. Conclusions: The tools applied by health professionals are convenient due to their rapid execution and easy access, however they can be subject to human error since they depend on the experience of the user. Electronic systems present objective measurements, however, their complexity and cost are high. Originality: This work presents information on the therapeutic techniques and technological devices used, in certain pathologies, for the evaluation of upper limb motor ability. Limitations: Not all articles analyzed have a detailed description of the people in which the studies were conducted.Introducción: El artículo es producto de una investigación sobre los métodos, técnicas y dispositivos utilizados en la medición de la habilidad motriz fina de miembro superior y su respectiva evolución, desarrollada en la Universidad del Cauca en el año 2018. Problema: Medición objetiva la evolución de la habilidad motriz de miembro superior en los procesos de rehabilitación. Objetivo: Identificar las técnicas convencionales y dispositivos electrónicos utilizados en la medición de la evolución de la habilidad motriz de miembro superior. Metodología: Se revisaron cuatro bases de datos científicas además del motor de búsqueda Google Académico. Para la búsqueda se utilizaron las palabras clave: “fine motor skills”, “hand measurement”, “hand rehabilitation”, “hand function”, entre otras. Resultados: Se encontraron aproximadamente 3840 artículos relacionados con la temática. Al aplicar los criterios de exclusión el número de artículo a revisar se redujo a 63, los cuales fueron analizados en la presente revisión. Conclusiones: Las herramientas aplicadas por profesionales de la salud son convenientes debido a su rápida ejecución y fácil acceso, sin embargo pueden estar sujetas al error humano puesto que dependen de la experiencia de quien las utiliza. Los sistemas electrónicos, presentan mediciones objetivas, no obstante, su complejidad y costo es elevado. Originalidad: Este trabajo presenta información sobre las técnicas terapéuticas y dispositivos tecnológicos, utilizados en ciertas patologías, para la evaluación de la habilidad motriz de miembro superior. Limitaciones: No todos los artículos analizados cuentan con una descripción detallada de las personas en las que los estudios fueron realizados

Técnicas y métodos para el seguimiento de la evolución de la habilidad motriz fina de miembro superior : revisión de la literatura

Introduction: This review article is the product of research on the methods, techniques and devices used in the measurement of fine motor skills of upper limbs and its respective evolution, developed at Universidad del Cauca in 2018. Problem: Objective measurement of the evolution of upper limb motor skills in the rehabilitation processes.  Objective: To identify the conventional techniques and electronic devices used in the measurement of the evolution of upper limb motor ability.  Methodology: Four scientific databases were reviewed in addition to the Google Scholar search engine. The keywords used for the search were: "fine motor skills", "hand measurement", "hand rehabilitation"and "hand function", among others.  Results: Approximately 3840 articles related to the subject were found. When applying the exclusion criteria, the article number to be revised was reduced to 63, which were analyzed in the present review. Conclusions: The tools applied by health professionals are convenient due to their rapid execution and easy access, however they can be subject to human error since they depend on the experience of the user. Electronic systems present objective measurements, however, their complexity and cost are high. Originality: This work presents information on the therapeutic techniques and technological devices used, in certain pathologies, for the evaluation of upper limb motor ability. Limitations: Not all articles analyzed have a detailed description of the people in which the studies were conducted.Introducción: El artículo es producto de una investigación sobre los métodos, técnicas y dispositivos utilizados en la medición de la habilidad motriz fina de miembro superior y su respectiva evolución, desarrollada en la Universidad del Cauca en el año 2018. Problema: Medición objetiva la evolución de la habilidad motriz de miembro superior en los procesos de rehabilitación. Objetivo: Identificar las técnicas convencionales y dispositivos electrónicos utilizados en la medición de la evolución de la habilidad motriz de miembro superior. Metodología: Se revisaron cuatro bases de datos científicas además del motor de búsqueda Google Académico. Para la búsqueda se utilizaron las palabras clave: “fine motor skills”, “hand measurement”, “hand rehabilitation”, “hand function”, entre otras. Resultados: Se encontraron aproximadamente 3840 artículos relacionados con la temática. Al aplicar los criterios de exclusión el número de artículo a revisar se redujo a 63, los cuales fueron analizados en la presente revisión. Conclusiones: Las herramientas aplicadas por profesionales de la salud son convenientes debido a su rápida ejecución y fácil acceso, sin embargo pueden estar sujetas al error humano puesto que dependen de la experiencia de quien las utiliza. Los sistemas electrónicos, presentan mediciones objetivas, no obstante, su complejidad y costo es elevado. Originalidad: Este trabajo presenta información sobre las técnicas terapéuticas y dispositivos tecnológicos, utilizados en ciertas patologías, para la evaluación de la habilidad motriz de miembro superior. Limitaciones: No todos los artículos analizados cuentan con una descripción detallada de las personas en las que los estudios fueron realizados

Técnicas y métodos para el seguimiento de la evolución de la habilidad motriz fina de miembro superior : revisión de la literatura

Introduction: This review article is the product of research on the methods, techniques and devices used in the measurement of fine motor skills of upper limbs and its respective evolution, developed at Universidad del Cauca in 2018. Problem: Objective measurement of the evolution of upper limb motor skills in the rehabilitation processes.  Objective: To identify the conventional techniques and electronic devices used in the measurement of the evolution of upper limb motor ability.  Methodology: Four scientific databases were reviewed in addition to the Google Scholar search engine. The keywords used for the search were: "fine motor skills", "hand measurement", "hand rehabilitation"and "hand function", among others.  Results: Approximately 3840 articles related to the subject were found. When applying the exclusion criteria, the article number to be revised was reduced to 63, which were analyzed in the present review. Conclusions: The tools applied by health professionals are convenient due to their rapid execution and easy access, however they can be subject to human error since they depend on the experience of the user. Electronic systems present objective measurements, however, their complexity and cost are high. Originality: This work presents information on the therapeutic techniques and technological devices used, in certain pathologies, for the evaluation of upper limb motor ability. Limitations: Not all articles analyzed have a detailed description of the people in which the studies were conducted.Introducción: El artículo es producto de una investigación sobre los métodos, técnicas y dispositivos utilizados en la medición de la habilidad motriz fina de miembro superior y su respectiva evolución, desarrollada en la Universidad del Cauca en el año 2018. Problema: Medición objetiva la evolución de la habilidad motriz de miembro superior en los procesos de rehabilitación. Objetivo: Identificar las técnicas convencionales y dispositivos electrónicos utilizados en la medición de la evolución de la habilidad motriz de miembro superior. Metodología: Se revisaron cuatro bases de datos científicas además del motor de búsqueda Google Académico. Para la búsqueda se utilizaron las palabras clave: “fine motor skills”, “hand measurement”, “hand rehabilitation”, “hand function”, entre otras. Resultados: Se encontraron aproximadamente 3840 artículos relacionados con la temática. Al aplicar los criterios de exclusión el número de artículo a revisar se redujo a 63, los cuales fueron analizados en la presente revisión. Conclusiones: Las herramientas aplicadas por profesionales de la salud son convenientes debido a su rápida ejecución y fácil acceso, sin embargo pueden estar sujetas al error humano puesto que dependen de la experiencia de quien las utiliza. Los sistemas electrónicos, presentan mediciones objetivas, no obstante, su complejidad y costo es elevado. Originalidad: Este trabajo presenta información sobre las técnicas terapéuticas y dispositivos tecnológicos, utilizados en ciertas patologías, para la evaluación de la habilidad motriz de miembro superior. Limitaciones: No todos los artículos analizados cuentan con una descripción detallada de las personas en las que los estudios fueron realizados

El Automatizado Box & Blocks Test. Sistema automático de evaluación de destreza manual gruesa

[Resumen] El cada vez más elevado número de personas que requieren atención médica para rehabilitación física o cognitiva (post-traumática, post-operatoria o por envejecimiento), supone cada vez mayor saturación en los servicios médicos. Esto repercute de forma negativa en la calidad del tratamiento impartido. El proyecto RoboHealth, intenta contribuir a paliar dicha situación, proporcionando asistencia al personal sanitario en procesos de rehabilitación física. RoboHealth abarca dos aspectos durante el proceso de rehabilitación motora: la evaluación y la intervención. En este artículo, se presenta el diseño de un sistema automatizado de evaluación de destreza manual gruesa basado en el test Box and Blocks. A través de cámaras RGB y nube de puntos, se monitoriza la ejecución del test, obteniendo de forma automática el total de cubos desplazados por el usuario, además de datos adicionales como el tiempo empleado en el desplazamiento entre cada cubo y su color. La información se puede visualizar a través de una interfaz gráfica que además, ordena y registra de forma automática los resultados de cada sesión para cada usuario. En primer lugar, se muestra el desarrollo del algoritmo de conteo, la implementación de la interfaz de visualización y registro de datos, así como los resultados de una prueba piloto. Finalmente, se presentan las conclusiones y futuros trabajos.La investigación que lleva a estos resultados ha recibido financiación del proyecto ROBOHEALTH-A (DPI2013-47944-C4-1-R), financiado por el Ministerio de Economía y Competitividad español y del proyecto RoboCity2030-III-CM (S2013 / MIT-2748), financiado por Programas de Actividades de I + D en la Comunidad de Madrid y co-financiado por los Fondos Estructurales de la UEComunidad de Madrid; S2013 / MIT-2748https://doi.org/10.17979/spudc.978849749808

Technology-supported training of arm-hand skills in stroke

Impaired arm-hand performance is a serious consequence of stroke that is associated with reduced self-efficacy and poor quality of life. Task-oriented arm training is a therapy approach that is known to improve skilled arm-hand performance, even in chronic stages after stroke. At the start of this project, little knowledge had been consolidated regarding taskoriented arm training characteristics, especially in the field of technology-supported rehabilitation. The feasibility and effects of technology-supported client-centred task-oriented training on skilled arm-hand performance had not been investigated but to a very limited degree. Reviewing literature on rehabilitation and motor learning in stroke led to the identification of therapy oriented criteria for rehabilitation technology aiming to influence skilled arm-hand performance (chapter 2). Most rehabilitation systems reported in literature to date are robotic systems that are aimed at providing an engaging exercise environment and feedback on motor performance. Both, feedback and engaging exercises are important for motivating patients to perform a high number of exercise repetitions and prolonged training, which are important factors for motor learning. The review also found that current rehabilitation technology is focussed mainly on providing treatment at a function level, thereby improving joint range of motion, muscle strength and parameters such as movement speed and smoothness of movement during analytical movements. However, related research has found no effects of robot-supported training at the activity level. The review concluded that a challenge exists for upper extremity rehabilitation technology in stroke patients to also provide more patienttailored task-oriented arm-hand training in natural environments to support the learning of skilled arm-hand performance. Besides mapping the strengths of different technological solutions, the use of outcome measures and training protocols needs to become more standardized across similar interventions, in order to help determine which training solutions are most suitable for specific patient categories. Chapter 4 contributes towards such a standardization of outcome measurement. A concept is introduced which may guide the clinician/researcher to choose outcome measures for evaluating specific and generalized training effects. As an initial operationalization of this concept, 28 test batteries that have been used in 16 task-oriented training interventions were rated as to whether measurement components were measured by the test. Future research is suggested that elaborates the concept with information on the relative weighing of components in each test, with more test batteries (which may lead to additional components) and by adding more test properties into the concept (e.g. psychometric properties of the tests, possible floor- or ceiling effects). Task-oriented training is one of the training approaches that has been shown to be beneficial for skilled arm-hand performance after stroke. Important mechanisms for motor learning that are identified are patient motivation for such training, and the learning of efficient goaloriented movement strategies and task-specific problem solving. In this thesis we operationalize task-oriented training in terms of 15 components (chapter 3). A systematic review that included 16 randomized controlled trials using task-oriented training in stroke patients, evaluated the effects of these training components on skilled arm-hand performance. The number of training components used in an intervention aimed at improving arm-hand performance after stroke was not associated with the post-treatment effect size. Distributed practice and feedback were associated with the largest post-intervention effect sizes. Random practice and use of clear functional training goals were associated with the largest follow-up effect sizes. It may be that training components that optimize the storage of learned motor performance in the long-term memory are associated with larger treatment effects. Unfortunately, feedback, random practice and distributed practice were reported in very few of the included randomized controlled trials (in only 6,3 and 1 out of the 17 studies respectively). Client-centred training, i.e. training on exercises that support goals that are selected by the patients themselves, improves patient motivation for training. Motivation in turn has proven to positively influence motor learning in stroke patients, as attention during training is heightened and storage of information in the long-term memory improves. Chapter 5 reports on an interview of 40 stroke patients, investigating into training preferences. A list of 46 skills, ranked according to descending training preference scores, was provided that can be used for implementation of exercises in rehabilitation technology, in order for technologysupported training to be client-centred. Chapter 6 introduces T-TOAT, a technology supported task-oriented arm training method that was developed together with colleagues at Adelante (Hoensbroek, NL). T-TOAT enables the implementation of exercises that support task-oriented training in rehabilitation technology. The training method is applicable for different technological systems, e.g. robot and sensor systems, or in combination with functional electrical stimulation, etc. To enable the use of TTOAT for training with the Haptic Master Robot (MOOG-FCS, NL), special software named Haptic TOAT was developed in Adelante together with colleagues at the Centre of Technology in Care of Zuyd University (chapter 6). The software enables the recording of the patient’s movement trajectories, given task constraints and patient possibilities, using the Haptic Master as a recording device. A purpose-made gimbal was attached to the endeffector, leaving the hand free for the use and manipulating objects. The recorded movement can be replayed in a passive mode or in an active mode (active, active-assisted or activeresisted). Haptic feedback is provided when the patient deviates from the recorded movement trajectory, as the patient receives the sensation of bouncing into a wall, as well as feeling a spring that pulls him/her back to the recorded path. The diameter of the tunnel around the recorded trajectory (distance to the wall), and the spring force can be adjusted for each patient. An ongoing clinical trial in which chronic stroke patients train with Haptic-TOAT examines whether Haptic Master provides additional value compared to supporting the same exercises by video-instruction only. Together with Philips Research Europe (Eindhoven,Aachen), the T-TOAT method has been implemented in a sensor based prototype, called Philips Stroke Rehabilitation Exerciser. This system included movement tracking sensors and an exercise board interacting with real life objects. A very strong feature of the system is that feedback is provided to patients (real-time and after exercise performance), based on a comparison of the patient’s exercise performance to individual targets set by the therapist. Chapter 7 reports on a clinical trial investigating arm-hand treatment outcome and patient motivation for technology-supported task-oriented training in chronic stroke patients. It was found that 8 weeks of T-TOAT training improved arm-hand performance in chronic stroke patients significantly on Fugl-Meyer, Action Research Arm Test, and Motor Activity Log. An improvement was found in health-related quality of life. Training effects lasted at least 6 months post-training. Participants reported feeling intrinsically motivated and competent to use the system. The results of this study showed that T-TOAT is feasible. Despite the small number of stroke patients tested (n=9), significant and clinically relevant improvements in skilled arm-hand performance were found. In conclusion, this thesis has made several contributions. It motivated the need for clientcentred task-oriented training, which it has operationalized in terms of 15 components. Four of these 15 components were identified as most beneficial for the patient. A prioritized inventory of arm-hand training preferences of stroke patients was compiled by means of an interview study of 40 subacute and chronic stroke patients. T-TOAT, a method for technology-supported, client-centred, task-oriented training, was conceived and implemented in two target technologies (Haptic Master and Philips Stroke Rehabilitation Exerciser). Its feasibility was demonstrated in a clinical trial showing substantial and durable benefits for the stroke patients. Finally, the thesis contributes towards the standardization of outcome measures which is necessary for charting progress and guiding future developments of technology-supported stroke rehabilitation. Methodological considerations were discussed and several suggestions for future research were presented. The variety of treatment approaches and the various ways of support and challenge that are offered by existing rehabilitation technologies hold a large potential for offering a variety of extra training opportunities to stroke patients that may improve their arm-hand performance. Such solutions will be of increasing importance, to alleviate therapists and reduce economic pressure on the health care system, as the stroke incidence is increasing rapidly over the coming decades

Design and Validation of an MR Conditional Upper Extremity Evaluation System to Study Brain Activation Patterns after Stroke

Stroke is the third leading cause of death and second most frequent cause of disability in the United States. Stroke rehabilitation methods have been developed to induce the cortical reorganization and motor-relearning that leads to stroke recovery. In this thesis, we designed and developed an MR conditional upper extremity reach and grasp movement evaluation system for the stroke survivors to study their kinematic performances in reach and grasp movement and the relationship between kinematic metrics and the recovery level measured by clinical assessment methods. We also applied the system into the functional MRI experiments to identify the ability to study motor performance with the system inside the scanner and the reach, grasp and reach-to-grasp movements related brain activation patterns. Our experiments demonstrates that ours system is an MR conditional system in the 3.0 Tesla magnetic field. It is able to measure the stroke survivors\u27 reach and grasp movement in terms of grasp aperture and elbow joint angles. We used the Mann Whitney U test to examine the significant metrics in each tasks and principle component analysis to decide the major metrics that are associated with the outcome. Then we discovered better recovery scores are associated with these major kinematic metrics such as larger maximal velocity, larger mean velocity, larger maximal movement angle, and longer time to peak velocity. Additional to these metrics, time to maximal angle, time to target and time to peak velocity could also be used as additional metrics to help predict the recovery and assess robot-assisted therapy and optimize task-oriented rehabilitation strategy. We also identified the movement related brain activations in the motor and sensory areas as well as cerebellum in both normal and stroke survivors

Moving beyond the pros and cons of automating cognitive testing in pathological aging and dementia: the case for equal opportunity.

This is the final version of the article. Available from BioMed Central via the DOI in this record.The lack of progress over the last decade in developing treatments for Alzheimer's disease has called into question the quality of the cognitive assessments used while also shifting the emphasis from treatment to prophylaxis by studying the disorder at earlier stages, even prior to the development of cognitive symptoms. This has led various groups to seek cognitive tests which are more sensitive than those currently used and which can be meaningfully administered to individuals with mild or even no cognitive impairment. Although computerized tests have long been used in this field, they have made little inroads compared with non-automated tests. This review attempts to put in perspective the relative utilities of automated and non-automated tests of cognitive function in therapeutic trials of pathological aging and the dementias. Also by a review of the automation of cognitive tests over the last 150 years, it is hoped that the notion that such procedures are novel compared with pencil-and-paper testing will be dispelled. Furthermore, data will be presented to illustrate that older individuals and patients with dementia are neither stressed nor disadvantaged when tested with appropriately developed computerized methods. An important aspect of automated testing is that it can assess all aspects of task performance, including the speed of cognitive processes, and data are presented on the advantages this can confer in clinical trials. The ultimate objectives of the review are to encourage decision making in the field to move away from the automated/non-automated dichotomy and to develop criteria pertinent to each trial against which all available procedures are evaluated. If we are to make serious progress in this area, we must use the best tools available, and the evidence suggests that automated testing has earned the right to be judged against the same criteria as non-automated tests