AUTOMATED MULTI-FEATURE SEGMENTATION OF TREADMILL RUNNING

The definition of gait events and phases have been well established in the literature through the use of qualitative movement descriptors. The repeatable, objective definitions of gait events and phases is the cornersone of sucess when performin a multi-center trial. A correlation-based multi-feature automated segmentation algorithm was developed and applied to treadmill running data. The features used were soley from 3D kinematic marker trajectory data, including generated features such as vectors between kinematic markers. The algorithm was compared against a trained tester who used visual inspection and threshold limits of the vGRF to segment stance. The automated segmentation approach was shown to consistently identify the same gait events as the trained tester, representing a significant time savings for the signal processing of large volume treadmill running data

Graceful User Following for Mobile Balance Assistive Robot in Daily Activities Assistance

Numerous diseases and aging can cause degeneration of people's balance ability resulting in limited mobility and even high risks of fall. Robotic technologies can provide more intensive rehabilitation exercises or be used as assistive devices to compensate for balance ability. However, With the new healthcare paradigm shifting from hospital care to home care, there is a gap in robotic systems that can provide care at home. This paper introduces Mobile Robotic Balance Assistant (MRBA), a compact and cost-effective balance assistive robot that can provide both rehabilitation training and activities of daily living (ADLs) assistance at home. A three degrees of freedom (3-DoF) robotic arm was designed to mimic the therapist arm function to provide balance assistance to the user. To minimize the interference to users' natural pelvis movements and gait patterns, the robot must have a Human-Robot Interface(HRI) that can detect user intention accurately and follow the user's movement smoothly and timely. Thus, a graceful user following control rule was proposed. The overall control architecture consists of two parts: an observer for human inputs estimation and an LQR-based controller with disturbance rejection. The proposed controller is validated in high-fidelity simulation with actual human trajectories, and the results successfully show the effectiveness of the method in different walking modes

RECOMMENDATIONS FOR MINIMUM TRIAL NUMBERS DURING WALKING GAIT

In a rehabilitation context, athletes may not be able to complete large numbers of trials during testing due to joint edema and pain. The purpose of this research was to determine the minimum number of trials needed to achieve a negligibly fluctuating temporal variance profile during walking gait. The time-series kinematics of the hip, knee and ankle were recorded from 10 participants, completing 11 trials each. The time-series variance of each kinematic variables were calculated for ten trials and used as a reference. Using a two-sample SPM1D {t} (α=0.05), all variance combinations (9, 8, 7, ... 3 of 11 trials) from the same participants were compared to the reference. Results showed a minimum of 7 trials were needed to achieve ’stable‘ kinematic variance during walking gait. This study provides evidence for selecting an appropriate number of walking trials in gait analysis, especially in early-stage rehabilitation for patients with joint pain or edema

Characteristics and functional impact of unplanned acute care unit readmissions during inpatient traumatic brain injury rehabilitation: a retrospective cohort study

Background: This study investigated the incidence, characteristics and functional outcomes associated with unplanned Acute Care Unit Readmissions (ACUR) during inpatient traumatic brain injury (TBI) rehabilitation in an Asian cohort. Methods: A retrospective review of electronic medical records from a single rehabilitation unit was conducted from 1 January 2012 to 31 December 2014. Inclusion criteria were first TBI, aged >18 years, admitted <6 months of TBI. ACUR were characterized into neurological, medical or neurosurgical subtypes. The main outcome measure was discharge and Functional Independence Measure (FIM™). Secondary outcomes included rehabilitation length of stay (RLOS). Results: Of 121 eligible TBI records, the incidence of ACUR was 14% (n = 17), comprising neurologic (76.5%) and medical (23.5%) subtypes occurring at median of 13 days (IQR 6, 28.5) after rehabilitation admission. Patients without ACUR had a significantly higher admission mean (SD) FIM score compared to those with ACUR (FIM ACUR-negative 63.4 (21.1) vs. FIM ACUR-positive 50.53(25.4), p = 0.026). Significantly lower discharge FIM was noted in those with ACUR compared to those without. (FIM ACUR-positive 65.8(31.4) vs. FIM ACUR-negative 85.4 (21.1), p = 0.023) Furthermore, a significant near-doubling of RLOS was noted in ACUR patients compared to non-ACUR counterparts (ACUR-positive median 55 days (IQR 34.50, 87.50) vs. ACUR-negative median 28 days (IQR 16.25, 40.00), p = 0.002). Conclusions: This study highlights the significant negative functional impact and lengthening of rehabilitation duration of ACUR on inpatient rehabilitation outcome for TBI.Published versio

Inpatient rehabilitation outcomes after primary severe haemorrhagic stroke: a retrospective study comparing surgical versus non-surgical management

Background: Haemorrhagic stroke, accounting for 10–20% of all strokes, often requires decompressive surgery as a life-saving measure for cases with massive oedema and raised intracranial pressure. This study was conducted to compare the demographics, characteristics and rehabilitation profiles of patients with severe haemorrhagic stroke who were managed surgically versus those who were managed non-surgically. Methods: A single-centre retrospective study of electronic medical records was conducted over a 3-year period from 1 January 2018 to 31 December 2020. The inclusion criteria were first haemorrhagic stroke, age of >18 years and an admission Functional Independence Measure (FIM™) score of 18–40 upon admission to the rehabilitation centre. The primary outcome measure was discharge FIM™. Secondary outcome measures included modified Rankin Scale (mRS), rehabilitation length of stay (RLOS) and complication rates. Results: A total of 107 patients’ records were analysed; 45 (42.1%) received surgical intervention and 62 (57.9%) patients underwent non-surgical management. Surgically managed patients were significantly younger than non-surgical patients, with a mean age of [surgical 53.1 (SD 12) vs. non-surgical 61.6 (SD 12.3), p = 0.001]. Admission FIM was significantly lower in the surgical vs. non-surgical group [23.7 (SD6.7) vs. 26.71 (SD 7.4), p = 0.031). However, discharge FIM was similar between both groups [surgical 53.91 (SD23.0) vs. non-surgical 57.0 (SD23.6), p = 0.625). Similarly, FIM gain (surgical 30.1 (SD 21.1) vs. non-surgical 30.3 (SD 21.1), p = 0.094) and RLOS [surgical 56.2 days (SD 21.5) vs. non-surgical 52.0 days (SD 23.4), p = 0.134) were not significantly different between groups. The majority of patients were discharged home (surgical 73.3% vs. non-surgical 74.2%, p = 0.920) despite a high level of dependency. Conclusions: Our findings suggest that patients with surgically managed haemorrhagic stroke, while older and more dependent on admission to rehabilitation, achieved comparable FIM gains, discharge FIM and discharge home rates after ~8 weeks of rehabilitation. This highlights the importance of rehabilitation, especially for surgically managed haemorrhagic stroke patients.Published versio

Long-Term Outcomes of Patients with Primary Brain Tumors after Acute Rehabilitation: A Retrospective Analyses of Factors

Although primary brain tumors are relatively rare, they cause significant morbidity and mortality due to the high rates of neurological impairment. The purpose of this study was to examine the physical and functional outcomes of patients with primary brain tumors who had undergone inpatient rehabilitation. This was a retrospective study which recruited 163 patients who had been admitted for inpatient rehabilitation. Rehabilitation outcomes, including the Functional Independence Measure (FIM) and Glasgow Outcome Scale (GOS), were recorded up to 1 year post-discharge. The majority of patients (79.1%) had low-grade (WHO Class I-II) tumors, 35 (21.5%) were diagnosed with GBM and 52 (31.9%) had recurrent brain tumors. Rehabilitation outcomes were sustained, with 125 (76.7%) and 113 (69.3%) patients having a GOS of &ge;4 at 6 months and 1 year after discharge, respectively. A GOS of &ge;4 at 1 year was negatively associated with high-grade tumors (p &lt; 0.001) and radiotherapy (p = 0.028), and positively associated with a higher discharge FIM motor score (p &lt; 0.001) and the presence of a caregiver after discharge (p = 0.034). Our study demonstrates significant positive functional benefits from 4 weeks of inpatient neuro-oncological rehabilitation for patients with primary brain tumors, as well as the importance of supportive care from caregivers

The impact of stroke subtype on recovery and functional outcome after inpatient rehabilitation: a retrospective analysis of factors

The aims of this study were to compare inpatient rehabilitation outcomes between acute stroke subtypes of Cerebral Infarction (CI) and Intracerebral Hemorrhage (ICH), and to determine the predictors of discharge outcomes. A retrospective study of stroke inpatients was carried out using the discharge Functional Independence Measure (FIM) as the primary outcome measure. Relationships between stroke subtype, rehabilitation impairments, and medical complications on FIM -gain were analyzed. Altogether, 280 datasets including 211 (75.4%) CI and 69 (24.6%) ICH were analyzed. ICH patients were significantly younger than CI patients (55 years ICH vs. 64.0 years CI years, p < 0.001), had a 10-fold higher proportion needing ICU admission (ICH 82.6% vs. CI 7.6%, p < 0.001), and had significantly lower total admission FIM scores (67 points ICH vs. 74 CI points, p = 0.006), with lower motor-FIM scores in particular (38 points ICH vs. 48 points CI, p = 0.003). Significant functional improvements after inpatient rehabilitation, i.e., FIM gain, occurred regardless of stroke subtype (FIM-ICH Δ 27 vs. FIM-CI Δ 21, p = 0.05). Despite significantly worse initial stroke severity, ICH patients achieved similar functional gains, independence levels, and return-home rates compared with their CI counterparts after inpatient rehabilitation.Published versio

Versatile clinical movement analysis using statistical parametric mapping in MovementRx

Clinical gait analysis is an important biomechanics field that is often influenced by subjectivity in time-varying analysis leading to type I and II errors. Statistical Parametric Mapping can operate on all time-varying joint dynamics simultaneously, thereby overcoming subjectivity errors. We present MovementRx, the first gait analysis modelling application that correctly models the deviations of joints kinematics and kinetics both in 3 and 1 degrees of freedom; presented with easy-to-understand color maps for clinicians with limited statistical training. MovementRx is a python-based versatile GUI-enabled movement analysis decision support system, that provides a holistic view of all lower limb joints fundamental to the kinematic/kinetic chain related to functional gait. The user can cascade the view from single 3D multivariate result down to specific single joint individual 1D scalar movement component in a simple, coherent, objective, and visually intuitive manner. We highlight MovementRx benefit by presenting a case-study of a right knee osteoarthritis (OA) patient with otherwise undetected postintervention contralateral OA predisposition. MovementRx detected elevated frontal plane moments of the patient's unaffected knee. The patient also revealed a surprising adverse compensation to the contralateral limb.Agency for Science, Technology and Research (A*STAR)Nanyang Technological UniversityPublished versionRehabilitation Research Institute of Singapore (RRIS) is funded by tripartite funding: Agency for Science, Technology and Research (A-STAR), National Health Group (NHG), and Nanyang Technological University (NTU Singapore). Tis work is part of the Ability data project in RRIS

Interactive robot assistance for upper-limb training

Burdet E, Li Y, Kager S, Chua Sui Geok K, Hussain A, Campolo D. Interactive robot assistance for upper-limb training. In: Colombo R, Sanguineti V, eds. Rehabilitation Robotics. Technology and application. London: Elsevier; 2018: 137-148

Changing epidemiology and functional outcomes of inpatient rehabilitation in Asian traumatic brain injury cases before and during the COVID-19 pandemic: a retrospective cohort study

Background: This study aimed to compare acute injury and rehabilitation characteristics for traumatic brain injury (TBI) inpatients during the pre and post COVID-19 pandemic periods. Methods: A retrospective study of TBI inpatients between 1 April 2018 and 31 December 2019 (pre COVID-19 period), and 1 July 2020 and 31 March 2022 (post COVID-19 period) was performed to compare demographics, premorbid comorbidity, TBI characteristics, rehabilitation complications, admission and discharge functional independence measure (FIM®), length of stay and discharge status. Results: A total of 187 data sets were analyzed (82 pre COVID-19 and 105 post COVID-19). Post COVID-19 TBI inpatients were older by 11 years (pre COVID-19 mean 55 years vs. post COVID-19 mean 66 years, and p < 0.001), with 23% higher female inpatients (pre COVID-19 13.4% vs. post COVID-19 36.2%, and p < 0.001) and 25% higher presence of comorbidities (pre COVID-19 52.4% vs. post COVID-19 77.1%, and p < 0.001). In the post COVID-19 group, total discharge FIM (Td-FIM) was significantly lower by ~12 points (pre COVID-19 94.5 vs. post COVID-19 82, and p = 0.011), Td-FIM ≥ 91 was lower by ~18% (pre COVID-19 53.7% vs. post COVID-19 36.2%, and p = 0.017), and the need for caregivers increased by ~17% (pre COVID-19 68% vs. post COVID-19 85.4%, and p = 0.006) Conclusions: Our findings signal a demographic shift towards older, frailer TBI with lower functional independence levels post COVID-19.Published versio