Biomechanical Assessment of Fugl-Meyer Score: The Case of One Post Stroke Patient Who has Undergone the Rehabilitation using Hand Exoskeleton Controlled by Brain-Computer Interface

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Objective: The study is double aimed: 1) to propose a version of common protocol for an assessment of upper limb motor impairment with the use of biomechanical characteristics of Fugl-Meyer items and 2) to apply this protocol to assess an efficacy of rehabilitation using hand exoskeleton controlled by brain-computer interface during the late stage of post stroke recovery in patient with mild paresis.Methods: One patient, 62 years old man, 10 months after ischemic stroke was recruited in the rehabilitation procedure. The patient was instructed to perform one of three tasks: to relax and to imagine kinesthetically slow extension of either paretic (left) or intact (right) hand fingers. The recorded electroencephalography was analyzed and exoskeleton extended the patient's fingers if brain-computer interface classifier recognized the imagery of their extension. The patient performed 10 daily procedures, each including three 10-minute long sessions. 14 items of Fugl-Meyer scale, describing flexor synergy (domain II), extensor synergy (domain III), movement combining synergies (domain IV) and movement out of synergy (domain V) were evaluated by standard Fugl-Meyer scores. In addition to Fugl-Meyer assessment biomechanical analysis of each item was performed. The items were recorded by electromagnetic tracking system for both paretic and intact arms. All seven degrees of freedom in each arm were taken into account. Two types of biomechanical parameters were analyzed: 1) coordination between angular velocities and 2) maximal angular velocities corresponding to seven degrees of freedom of the arm.Results: Fugl-Meyer assessment revealed motor improvements for two items only, whereas biomechanical analysis for all 14 items considered.Conclusion: The use of Fugl-Meyer scale completed by biomechanical parameters of its’ items can be a version of common protocol for assessment of upper limb motor impairment, useful for obtaining a comparable data in different clinical studies.