Abstract
BackgroundThere is a need to develop cost-effective, sensitive stroke assessment instruments. One approach is examining kinematic measures derived from goal-directed tasks, which can potentially be sensitive to the subtle changes in the stroke rehabilitation process. This paper presents the findings from a pilot study that uses a computer-assisted neurorehabilitation platform, interfaced with a conventional force-reflecting joystick, to examine the assessment capability of the system by various types of goal-directed tasks.MethodsBoth stroke subjects with hemiparesis and able-bodied subjects used the force-reflecting joystick to complete a suite of goal-directed tasks under various task settings. Kinematic metrics, developed for specific types of goal-directed tasks, were used to assess various aspects of upper-extremity motor performance across subjects.ResultsA number of metrics based on kinematic performance were able to differentiate subjects with different impairment levels, with metrics associated with accuracy, steadiness and speed consistency showing the best capability. Significant differences were also shown on these metrics between various force field settings.ConclusionThe results support the potential of using UniTherapy software with a conventional joystick system as an upper-extremity assessment instrument. We demonstrated the ability of using various types of goal-directed tasks to distinguish between subjects with different impairment levels. In addition, we were able to show that different force fields have a significant effect on the performance across subjects with different impairment levels in the trajectory tracking task. These results provide motivation for studies with a larger sample size that can more completely span the impairment space, and can use insights presented here to refine considerations of various task settings so as to generalize and extend our conclusions.
Highlights
There is a need to develop cost-effective, sensitive stroke assessment instruments
The results for all of these metrics show significant differences between low functional stroke group and controls/high functional stroke group, which suggests that the performance of able-bodied/high functional stroke subjects in the trajectory tracking tasks tend to be more accurate (PTT, Root Mean Square Error (RMSE)), stable (PTT), with less path deviation (Deviation) and better speed consistency (SM, SS) than subjects with low functional stroke
We were able to show that different force fields have a significant effect on the performance across subjects with different impairment levels in the trajectory tracking task
Summary
There is a need to develop cost-effective, sensitive stroke assessment instruments. One approach is examining kinematic measures derived from goal-directed tasks, which can potentially be sensitive to the subtle changes in the stroke rehabilitation process. In today's rehabilitation practice, stroke assessment in clinical settings generally involves use of observer-based, ordinal scale instruments, such as the Functional Independence Measure (FIM) [4], Fugl-Meyer Assessment [5], Wolf Motor Function Test [6], Chedoke-McMaster Stroke Assessment [7] and so on. These ordinal instruments are well established and have proven to be reliable and sensitive for measuring gross changes in functional performance, they can be problematic because of poor consistency in the differences between scale increments [8]. There is a need to develop cost-effective, semi-autonomous/autonomous, yet sensitive assessment instruments for patients with stroke at home, which is characterized by low cost and under-supervision from rehabilitation practitioners
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