Markerless Analysis of Upper Extremity Kinematics during Standardized Pediatric Assessment

Children with hemiplegic cerebral palsy experience reduced motor performance in the affected upper extremity and are typically evaluated based on degree of functional impairment using activity-based assessments such as the Shriners Hospitals for Children Upper Extremity Evaluation (SHUEE), a validated clinical measure, to describe performance prior to and following rehabilitative or surgical interventions. Evaluations rely on subjective therapist scoring techniques and lack sensitivity to detect change. Objective clinical motion analysis systems are an available but time-consuming and cost-intensive alternative, requiring uncomfortable application of markers to the patient. There is currently no available markerless, low-cost system that quantitatively assesses upper extremity kinematics to improve sensitivity of evaluation during standardized task performance. A motion analysis system was developed, using Microsoft Kinect hardware to track motion during broad arm and subtle hand and finger movements. Algorithms detected and recorded skeletal position and calculated angular kinematics. Lab-developed articulating hand model and elbow fixation devices were used to evaluate accuracy, intra-trial, and inter-trial reliability of the Kinect platform. Results of technical evaluation indicate reasonably accurate detection and differentiation between hand and arm positions. Twelve typically-developing adolescent subjects were tested to characterize and evaluate performance scores obtained from the SHUEE and Kinect motion analysis system. Feasibility of the platform was determined in terms of kinematics and as an enhancement of quantitative kinematic reporting to the SHUEE, and a population mean of typically developing subject kinematics obtained for future development of performance scoring algorithms. The system was observed to be easily operable and clinically effective in subject testing. The Kinect motion analysis platform developed to quantify upper extremity motion during standardized tasks is a low-cost, portable, accurate, and reliable system in kinematic reporting, and has demonstrated quality of results in both technical evaluation of the system and a study of its applicability to standardized task-based evaluation, but has hardware and software limitations which will be resolved in future improvements of the system. The SHUEE benefits from improved quantitative data, and the Kinect system provides enhanced sensitivity in clinical upper extremity analysis for children with hemiplegic cerebral palsy

Markerless Kinematics of Pediatric Manual Wheelchair Mobility

Pediatric manual wheelchair users face substantial risk of orthopaedic injury to the upper extremities, particularly the shoulders, during transition to wheelchair use and during growth and development. Propulsion strategy can influence mobility efficiency, activity participation, and quality of life. The current forefront of wheelchair biomechanics research includes translating findings from adult to pediatric populations, improving the quality and efficiency of care under constrained clinical funding, and understanding injury mechanisms and risk factors. Typically, clinicians evaluate wheelchair mobility using marker-based motion capture and instrumentation systems that are precise and accurate but also time-consuming, inconvenient, and expensive for repeated assessments. There is a substantial need for technology that evaluates and improves wheelchair mobility outside of the laboratory to provide better outcomes for wheelchair users, enhancing clinical data. Advancement in this area gives physical therapists better tools and the supporting research necessary to improve treatment efficacy, mobility, and quality of life in pediatric wheelchair users. This dissertation reports on research studies that evaluate the effect of physiotherapeutic training on manual wheelchair mobility. In particular, these studies (1) develop and characterize a novel markerless motion capture-musculoskeletal model systems interface for kinematic assessment of manual wheelchair propulsion biomechanics, (2) conduct a longitudinal investigation of pediatric manual wheelchair users undergoing intensive community-based therapy to determine predictors of kinematic response, and (3) evaluate propulsion pattern-dependent training efficacy and musculoskeletal behavior using visual biofeedback.Results of the research studies show that taking a systems approach to the kinematic interface produces an effective and reliable system for kinematic assessment and training of manual wheelchair propulsion. The studies also show that the therapeutic outcomes and orthopaedic injury risk of pediatric manual wheelchair users are significantly related to the propulsion pattern employed. Further, these subjects can change their propulsion pattern in response to therapy even in the absence of wheelchair-based training, and have pattern-dependent differences in joint kinematics, musculotendon excursion, and training response. Further clinical research in this area is suggested, with a focus on refining physiotherapeutic training strategies for pediatric manual wheelchair users to develop safer and more effective propulsion patterns

A Portable, Low-Cost Wheelchair Ergometer Design Based on a Mathematical Model of Pediatric Wheelchair Dynamics

Evaluation and training of wheelchair propulsion improves efficiency and prevents orthopaedic injury in pediatric manual wheelchair users. Ergometers allow static propulsion and emulate typical conditions. Currently available ergometers have deficiencies that limit their use in motion analysis. A new ergometer is developed and evaluated based on a model of wheelchair inertial dynamics that eliminates these deficiencies. This makes integrated motion analysis of wheelchair propulsion in current community, home, and international outreach efforts possible

Evaluation of Upper Extremity Movement Characteristics during Standardized Pediatric Functional Assessment with a Kinect®-based Markerless Motion Analysis System

A recently developed and evaluated upper extremity (UE) markerless motion analysis system based on the Microsoft® Kinect® has potential for improving functional assessment of patients with hemiplegic cerebral palsy. 12 typically-developing adolescents ages 12-17 were evaluated using both the Kinect-based system and the Shriners Hospitals for Children Upper Extremity Evaluation (SHUEE), a validated measure of UE motion. The study established population means of UE kinematic parameters for each activity. Statistical correlation analysis was used to identify key kinematic metrics used to develop automatic scoring algorithms. The Kinect motion analysis platform is technically sound and can be applied to standardized task-based UE evaluation while providing enhanced sensitivity in clinical analysis and automation through scoring algorithms

Promoting global clinical care and research for children with orthopaedic disabilities through motion analysis technology

Human motion analysis is a tool used to understand orthopaedic disabilities in children and to plan and monitor treatment strategies. It enables clinicians to quantitatively describe rehabilitative progress, plan surgeries, and conduct research. While this technology is prevalent in major academic medical centers, access is lacking in many regions throughout the world. This paper presents a novel approach to offer more accessible technology at greatly reduced cost. Current applications are underway in the Philippines, Mexico, and Colombia. Through international partnerships, improvements in clinical care, medical education, and research have been observed

Inverse Kinematic Assessment of Rehabilitative Therapy in Children Using Orthotics

Pathologic movement patterns are characterized by abnormal kinematics that alter how muscles support the body during walking. Individual muscles are often the target of interventions with physical therapy and surgery alike, yet the tools to assess individual muscles clinically remain limited. The aim of this study is to assess OpenSim as a clinical tool for individualized rehabilitative evaluation of children using orthotics. This anatomic and kinematic modeling study was focused on pre- and post-treatment assessment of gait characteristics in fourteen children using orthotic devices. A range of four to twelve acceptable gait capture trials was collected for each child before therapy began and again after four weeks of treatment. The effects of therapy were significant in four of the lower extremity muscle analyses, three of the temporal parameters, and eighteen of the spatial parameters. All muscle lengths showed less deviation from normal values after physical therapy across all subjects. Results of this study support the further evaluation of OpenSim as a tool to improve quantitative assessment of musculoskeletal dynamics during the course of rehabilitative therapy in children using orthotics

Assessment of a markerless motion analysis system for manual wheelchair application

Abstract Background Wheelchair biomechanics research advances accessibility and clinical care for manual wheelchair users. Standardized outcome assessments are vital tools for tracking progress, but there is a strong need for more quantitative methods. A system offering kinematic, quantitative detection, with the ease of use of a standardized outcome assessment, would be optimal for repeated, longitudinal assessment of manual wheelchair users’ therapeutic progress, but has yet to be offered. Results This work evaluates a markerless motion analysis system for manual wheelchair mobility in clinical, community, and home settings. This system includes Microsoft® Kinect® 2.0 sensors, OpenSim musculoskeletal modeling, and an automated detection, processing, and training interface. The system is designed to be cost-effective, easily used by caregivers, and capable of detecting key kinematic metrics involved in manual wheelchair propulsion. The primary technical advancements in this research are the software components necessary to detect and process the upper extremity kinematics during manual wheelchair propulsion, along with integration of the components into a complete system. The study defines and evaluates an adaptable systems methodology for processing kinematic data using motion capture technology and open-source musculoskeletal models to assess wheelchair propulsion pattern and biomechanics, and characterizes its accuracy, sensitivity and repeatability. Inter-trial repeatability of spatiotemporal parameters, joint range of motion, and musculotendon excursion were all found to be significantly correlated (p < 0.05). Conclusions The system is recommended for use in clinical settings for frequent wheelchair propulsion assessment, provided the limitations in precision are considered. The motion capture-model software bridge methodology could be applied in the future to any motion-capture system or specific application, broadening access to detailed kinematics while reducing assessment time and cost

Upper Extremity Assessment in Children with Physical Impairments Receiving Intensive Rehabilitative Therapy in a Community Setting

This prospective study examined upper extremity (UE) assessment results in a pediatric community setting and evaluated whether significant kinematic (motion) and functional changes would be observed after rehabilitative intervention. Children with physical impairments (n = 34) receiving 3 weeks of intensive therapy at a health camp completed pre-/postintervention assessments. The assessments included both an UE motion analysis system and the Shriners Hospital for Children Upper Extremity Evaluation (SHUEE). Chart review provided demographic and health background information. Therapeutic intervention was documented and included descriptive functional assessments. Linear regression was used to examine changes after 3 weeks of intensive therapy. There were significant improvements in all three components of the SHUEE for the affected UE. Ranges of motion increased across eight of 10 tasks measured by motion analysis (p \u3c 0.01). We conclude that intensive therapy in a community setting improves UE functional scores and increases ranges of motion in children with physical impairments