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

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

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

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

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