Assessment Of Upper Limb Function Research Articles

Research on multi-dimensional intelligent quantitative assessment of upper limb function based on kinematic parameters

Research on multi-dimensional intelligent quantitative assessment of upper limb function based on kinematic parameters

Influence of cognition on the correlation between objective and subjective upper limb measures in people with multiple sclerosis.

A comprehensive assessment of upper limb (UL) function is mandatory in people with multiple sclerosis (PwMS), and the use of multiple objective and subjective measures is advisable. Findings on the role of cognitive impairment on the assessment of UL function are scant and inconclusive. The present study investigated the influence of cognitive function on the distribution of objective and subjective UL measures and on their association. In the cross-sectional study, subjects with a diagnosis of MS, age ≥ 18years, right-hand dominance, no presence of orthopedic UL impairment, or other neurological diseases were recruited. The assessment protocol included the Nine-Hole Peg Test (9-HPT), Box and Block Test (BBT), and hand grip strength (HGS), a validated PROM (MAM-36), and the Symbol Digit Modalities Test (SDMT). Two hundred forty-six PwMS were recruited (158 females, mean age = 51.65 ± 13.45years; mean EDSS = 5.10 ± 1.88) Subject with mild-to-moderate cognitive impairment (SDMT ≤ - 2 SD of normative values) scored lower on the 9-HPT and higher on the BBT and MAM-36 when compared with subject with no cognitive impairment. Cognitive impairment showed a small but significant effect on the association between 9-HPT scores and the MAM-36. Findings suggest that cognitive impairment is associated with subjects' performance on 9-HPT, BBT, and MAM-36 (but not HGS), resulting in scores indicating a poorer UL function. Interestingly, cognitive impairment slightly affected the congruence between subjective and objective UL measures, although only minor differences in the correlation pattern across groups reporting different cognitive performances emerged.

Attempt to Make the Upper-Limb Item of Objective Fugl-Meyer Assessment Using 9-Axis Motion Sensors.

The Fugl-Meyer Assessment (FMA) has been used as a functional assessment of upper-limb function in stroke patients. This study aimed to create a more objective and standardized evaluation based on an FMA of the upper-limb items. A total of 30 first-ever stroke patients (65.3 ± 10.3 years old) and 15 healthy participants (35.4 ± 13.4 years old) admitted to Itami Kousei Neurosurgical Hospital were included. A nine-axis motion sensor was attached to the participants, and the joint angles of 17 upper-limb items (excluding fingers) and 23 FMA upper-limb items (excluding reflexes and fingers) were measured. From the measurement results, we analyzed the time-series data of each movement and obtained the correlation between the joint angles of each part. Discriminant analysis showed that 17 and 6 items had a concordance rate of ≥80% (80.0~95.6%) and <80% (64.4~75.6%), respectively. In the multiple regression analysis of continuous variables of FMA, a good regression model was obtained to predict the FMA with three to five joint angles. The discriminant analysis for 17 evaluation items suggests the possibility of roughly calculating FMA scores from joint angles.

Reliability of the Modified Frenchay Scale for the Assessment of Upper Limb Function in Adults With Hemiparesis

ObjectivesTo investigate the reliability of the Modified Frenchay Scale (MFS) in adults with hemiparesis. DesignProspective analysis of videos. SettingStudy conducted in a Neurorehabilitation Unit of a University Hospital. ParticipantsFifty-one patients (17 women [33%], age 46±15, time since injury 5.2±6.7 years) with hemiparesis secondary to stroke (N=47), tumor (N=3), or spinal cord injury (N=1) were enrolled. InterventionThe MFS measures active upper limb function in spastic hemiparesis based on a video recording of 10 daily living tasks, each rated from 0 to 10. Six tasks are bimanual and 4 are unimanual with the paretic hand. MFS videos performed in routine care of patients with hemiparesis between 2015 and 2021 were collected. After a 3-hour group training session, each MFS video was assessed twice, 1 week apart by 4 rehabilitation professionals with various levels of experience in using the scale. Main Outcome MeasuresInternal consistency was determined using Cronbach's alpha. Intra- and inter-rater reliability was measured using intraclass correlation coefficients (ICC, mean [95% CI]), mean differences between ratings and minimal detectable change (MDC). Bland-Altman plots were also performed for inter-rater assessments. ResultsThe mean overall MFS score was 4.95±1.20 with no floor or ceiling effect. Cronbach's α was 0.97. For the overall MFS score, intra- and inter-rater ICCs were 0.99[0.99;1.00] and 0.97[0.95;0.98], respectively; mean intra- and inter-rater differences were 0.10±0.04 and 0.24±0.12, respectively; and MDC were 0.17 and 0.37, respectively. ConclusionsThe MFS is an internally consistent and reliable scale to assess upper limb function in adults with hemiparesis.

Action Observation Training to Improve Upper Limb Function in Infants with Unilateral Brain Lesion – a Feasibility Study

ABSTRACT In this study, the feasibility of Action Observation Training (AOT) in combination with sensor-based measurements in infants at high risk of Unilateral Spastic Cerebral Palsy (UCP) were evaluated. Over a four-week period, eight infants at high risk of UCP performed AOT at home while wearing sensors with assistance of caregivers. Sensor data were compared to clinical assessments of upper limb function, the Hand Assessment for Infants (HAI) and the Mini-Assisting Hand Assessment (Mini-AHA). AOT training time and acceptance by the caregivers were considered as indicators for feasibility. The excellent training adherence and positive feedback of the caregivers showed that the AOT was feasible in this patient group and setting. Sensor measurements were accepted and displayed significant correlations with hand function. These preliminary results indicate the potential of wearable sensors to record upper limb function over the course of AOT for infants at high risk of UCP. Thus, AOT in combination with sensor measurements are proposed as a feasible training tool to complement usual care.

Testing the Use of Advanced Upper Limb Prostheses: Towards Quantifying the Movement Quality with Inertial-Magnetic Measurement Units

Background: A thorough assessment of upper limb prostheses could help facilitate their transfer from scientific developments into the daily lives of users. Ideally, routine clinical testing would include assessments of upper limb function using motion-capturing technology. This is particularly relevant for the state-of-the-art upper limb prostheses. Methods: We designed a test based on an activity of daily life (“tray-task”) which could be completed outside the laboratory, and developed a set of outcome measures aimed at characterizing the movement quality. For this purpose, kinematics of the thorax and the humerus were captured with an inertial–magnetic measurement unit (IMMU) motion-capture system. Six prosthesis users and ten able-bodied participants were recruited to test the feasibility of the proposed assessment procedure and to evaluate the outcome variables. Results: All participants completed the test either at home or in our lab. The prosthesis users needed more time to complete the task and showed a larger range of motion in the thoracic flexion and a smaller range of motion in the humeral elevation, compared to the able-bodied participants. Furthermore, the prosthesis users’ movements were less smooth and characterized by less stable coordination patterns between the humerus and thorax. Conclusion: A new test method and associated outcome variables have been proposed.

Development of a Clinical Framework for the Assessment of Dyskinesia and Function in the Upper Limb in Children with Cerebral Palsy

Objective Dyskinesia in cerebral palsy (CP) is a complex movement disorder that can significantly impact upper limb function. Despite a range of available tools, there is no consensus on best practice assessment of upper limb function in children with CP and dyskinesia. This study aimed to develop a clinical framework for the assessment of the impact of dyskinesia on upper limb function in children with CP. Design Modified Delphi study using expert consensus. Methods An expert panel of six highly experienced Australian therapists ranked assessment tools sourced from existing evidence-based literature using a five-point Likert scale. Tools rated as important for use “most” or “all” of the time, by 80% of respondents were accepted into the framework following two survey rounds and a third stage discussion. Results Of 21 tools, 12 were included in the framework under five categories: (i) screening for dyskinesia; (ii) measuring the severity of dyskinesia; (iii) Classifying upper limb functional ability; (iv) measuring upper limb functional ability; and (v) measuring upper limb movement. Conclusions The framework for assessing the impact of dyskinesia on upper limb function in CP aims to guide clinicians to improve assessment consistency and facilitate individualized goal-directed management. Further studies with a larger number of expert clinicians and researchers will further strengthen the utility of the framework.

Quantifying upper-limb motor impairment in people with multiple sclerosis: A physiological profiling approach.

. Upper-limb sensory and motor impairments are common in people with multiple sclerosis (MS), yet the current gold standard criteria for documenting functional impairment largely focuses on mobility, balance and postural stability. . We aimed to determine the validity of the upper-limb Physiological Profile Assessment (PPA) in people with MS by investigating whether the included domains of muscle strength, dexterity, arm stability, position sense, skin sensation and bimanual coordination 1) are sensitive in differentiating people with MS from healthy controls and 2) correlate with a validated measure of upper-limb function and a scale for quantifying disability in MS. . In a cross-sectional study, 40 participants with MS and 80 healthy controls completed all 13 of the upper-limb PPA tests within a single session. . People with MS were impaired across all physiological domains tested. Performance in 4 of the 13 tests was correlated with a validated measure of self-reported upper-limb function (Pearson's r or Spearman's rho -0.333-0.441), whereas 3 tests were associated with the degree of MS-specific disability (Spearman's rho -0.318; 0.456). . The upper-limb PPA offers a valid and clinically suitable assessment of upper-limb function in people with MS. Clinicians should prioritize assessments of motor speed, fine motor control and functional tasks in their assessment of upper-limb function in people with MS because these domains are the most commonly and significantly impaired.

Accelerometer assessed upper limb activity in people with stroke: a validation study considering ambulatory and non-ambulatory activities

Purpose Accelerometry measurements are a promising method to provide quantitative information of upper limb function in daily life post stroke. Our purpose was to investigate i) the validity of accelerometer-based vector magnitude ratios (VMR) to distinguish upper limb function between individuals post-stroke and healthy controls during ambulatory and non-ambulatory activities and, ii) the association between the VMR and clinical assessment of upper limb function for individuals post-stroke. Methods Forty persons with stroke and 32 healthy controls wore wrist and hip accelerometers while performing three upper limb activities in a clinical setting and during three days in daily living. Clinical assessment of upper limb function was assessed with the Chedoke-McMaster Stroke Assessment measure and ABILHand. Results In the clinical setting and daily living, the VMR was significantly lower for individuals post-stroke compared to controls during non-ambulatory activities but not during ambulatory activities. There was a moderate to strong association between VMR and clinical assessment of upper limb function during all conditions, except for walking in the clinical setting. Conclusion The VMR could be used as a sensitive objective marker to measure upper limb function post-stroke during ambulatory and non-ambulatory daily activities. Implications for rehabilitation Accelerometer-based assessment of upper limb function is a sensitive measure of upper limb function post stroke during different activity domains. Accelerometers-based assessment of arm function can detect differences in arm function outside the clinical setting (daily living) over a prolonged period that are not always identified by clinical assessment or perceived ability.

Kinematic descriptions of upper limb function using simulated tasks in activities of daily living after stroke.

Assessment of upper limb function poststroke is critical for clinical management and determining the efficacy of interventions. We designed a unilateral upper limb task to simulate activities of daily living to examine how chronic stroke survivors manage reaching, grasping and handling skills simultaneously to perform the functional task using kinematic analysis. The aim of the study was to compare the motor strategies for performing a functional task between paretic and nonparetic arms. Sixteen chronic stroke survivors were instructed to control an ergonomic spoon to transfer liquid from a large bowl to a small bowl using paretic or nonparetic arm. Kinematic data were recorded using a Vicon motion capture system. Outcome measures included movement duration, relative timing, path length, joint excursions, and trial-to-trial variability. Results showed that movement duration, spoon path length, and trunk path length increased significantly when participants used paretic arm to perform the task. Participants tended to reduce shoulder and elbow excursions, and increase trunk excursions to perform the task with paretic arm and altered the relative timing of the task. Although participants used different motor strategies to perform the task with their paretic arms, we did not find the significant differences in trial-to trial variability of joint excursions between paretic and nonparetic arms. The results revealed differences in temporal and spatial aspects of motor strategies between paretic and nonparetic arms. Clinicians should explore the underlying causes of pathological movement patterns and facilitate preferred movement patterns of paretic arm.

Perspectives and recommendations of individuals with tetraplegia regarding wearable cameras for monitoring hand function at home: Insights from a community-based study

Context Wearable cameras have great potential for producing novel outcome measures of upper limb (UL) function and guiding care in individuals with cervical spinal cord injury (cSCI) living in the community. However, little is known about the perspectives of individuals with cSCI on the potential adoption of this technology. Objective To analyze feedback from individuals with cSCI regarding the use of wearable cameras to record daily activities at home, in order to define guidelines for improving the design of this technology and fostering its implementation to optimize UL rehabilitation. Design Mixed-methods study. Participants Thirteen adults with cSCI C3-C8 AIS A-D impairment. Measures Interview including survey and semi-structured questions. Results Participants felt that this technology can provide naturalistic information regarding hand use to clinicians and researchers, which in turn can lead to better assessments of UL function and optimized therapies. Participants described the technology as easy-to-use but often reported discomfort that prevented them from conducting long recordings of fully natural activities. Privacy concerns included the possibility to capture household members and personal information displayed on objects (e.g. smartphones). Conclusion We provide the first set of guidelines to help researchers and therapists understand which steps need to be taken to translate wearable cameras into outpatient care and community-based research for UL rehabilitation. These guidelines include miniaturized and easy-to-wear cameras, as well as multiple measures for preventing privacy concerns such as avoiding public spaces and providing control over the recordings (e.g. start and stop the recordings at any time, keep or delete a recording).

Quantifying upper limb motor impairment in people with Parkinson's disease: a physiological profiling approach.

BackgroundUpper limb motor impairments, such as slowness of movement and difficulties executing sequential tasks, are common in people with Parkinson’s disease (PD).ObjectiveTo evaluate the validity of the upper limb Physiological Profile Assessment (PPA) as a standard clinical assessment battery in people with PD, by determining whether the tests, which encompass muscle strength, dexterity, arm stability, position sense, skin sensation and bimanual coordination can (a) distinguish people with PD from healthy controls, (b) detect differences in upper limb test domains between “off” and “on” anti-Parkinson medication states and (c) correlate with a validated measure of upper limb function.MethodsThirty-four participants with PD and 68 healthy controls completed the upper limb PPA tests within a single session.ResultsPeople with PD exhibited impaired performance across most test domains. Based on validity, reliability and feasibility, six tests (handgrip strength, finger-press reaction time, 9-hole peg test, bimanual pole test, arm stability, and shirt buttoning) were identified as key tests for the assessment of upper limb function in people with PD.ConclusionsThe upper limb PPA provides a valid, quick and simple means of quantifying specific upper limb impairments in people with PD. These findings indicate clinical assessments should prioritise tests of muscle strength, unilateral movement and dexterity, bimanual coordination, arm stability and functional tasks in people with PD as these domains are the most commonly and significantly impaired.

Robotic Assessment of Upper Limb Function in a Nonhuman Primate Model of Chronic Stroke.

Stroke is a leading cause of death and disability worldwide and survivors are frequently left with long-term disabilities that diminish their autonomy and result in the need for chronic care. There is an urgent need for the development of therapies that improve stroke recovery, as well as accurate and quantitative tools to measure function. Nonhuman primates closely resemble humans in neuroanatomy and upper limb function and may be crucial in randomized pre-clinical trials for testing the efficacy of stroke therapies. To test the feasibility of robotic assessment of motor function in a NHP model of stroke, two cynomolgus macaques were trained to perform a visually guided reaching task and were also assessed in a passive stretch task using the Kinarm robot. Strokes were then induced in these animals by transiently occluding the middle cerebral artery, and their motor performance on the same tasks was assessed after recovery. Relative to pre-stroke performance, post-stroke hand movements of the affected limb became slower and less accurate. Regression analyses revealed both recovered and compensatory movements to complete movements in different spatial directions. Lastly, we noted decreased range of motion in the elbow joint of the affected limb post-stroke associated with spasticity during passive stretch. Taken together, these studies highlight that sensorimotor deficits in reaching movements following stroke in cynomolgus macaques resemble those in human patients and validate the use of robotic assessment tools in a nonhuman primate model of stroke for identifying and characterizing such deficits.

End-point kinematics using virtual reality explaining upper limb impairment and activity capacity in stroke

BackgroundFor evaluation of upper limb impairment and activity capacity, Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT) are recommended to be included in stroke trials. To improve the understanding of mechanisms of motor recovery, and differentiate between restitution and compensation, kinematic analysis is also recommended for assessment of upper limb function after stroke.AimTo determine the extent to which end-point kinematic variables obtained from the target-to-target pointing task were associated with upper limb impairment or activity limitation as assessed by traditional clinical scales in individuals with stroke.MethodsSixty-four individuals, from acute stage up to one year after stroke, were included from the Stroke Arm Longitudinal study at the University of Gothenburg (SALGOT) cohort. They performed a target-to-target pointing task in a virtual environment using a haptic stylus which also captured the kinematic parameters. Multiple linear regression was done to determine the amount of variance explained by kinematic variables on FMA-UE and ARAT scores after controlling for confounding variables.ResultsMean velocity and number of velocity peaks explained 11 and 9% of the FMA-UE score uniquely and 16% when taken together. Movement time and number of velocity peaks explained 13 and 10% of the ARAT score respectively.ConclusionThe kinematic variables of movement time, velocity and smoothness explain only a part of the variance captured by using clinical observational scales, reinforcing the importance of multi-level assessment using both kinematic analysis and clinical scales in upper limb evaluation after stroke.Trial registrationThe trial was registered with register number NCT01115348 at clinicaltrials.gov, on May 4, 2010. URL: https://clinicaltrials.gov/ct2/show/NCT01115348.

An Instrumented Measurement Scheme for the Assessment of Upper Limb Function in Individuals with Friedreich Ataxia.

Continuous and objective assessment is essential for accurate monitoring of the progression of neurodegenerative conditions such as Friedreich ataxia. However, current clinical assessments predominantly rely on the ability of the affected individual to complete specific clinical tests which may not capture the intricate kinematic details associated with ataxia Moreover, such testing often consists of a level of subjectivity of the assessing clinician. In this paper, we propose an objective measuring instrument, in the form of a spoon, equipped with the Internet-of-Things (IoT) based system and relevant machine learning techniques to quantitatively assess impairment levels while engaged in routine daily activity. In a clinical study involving individuals diagnosed with Friedreich ataxia, movement patterns during a simulated eating task were captured and kinematic biomarkers were extracted that were consistent with the frequently-used clinical rating scales. Multivariate analysis of these biomarkers allows us to accurately classify individuals with Friedreich ataxia and control subjects to an accuracy of 91%. Furthermore, the kinematic information captured from the spoon can be used to introduce an alternative assessment scheme with a greater sensitivity to ataxic movements and with less inter-rater discrepancy.

Quantitative Evaluation of Cerebellar Ataxia Through Automated Assessment of Upper Limb Movements.

Cerebellar damage can result in peripheral dysfunction manifesting as poor and inaccurate coordination, irregular movements, and tremors. Conventionally, the severity assessment of Cerebellar ataxia (CA) is primarily based on expert clinical opinion and hence likely to be subjective. In order to establish inter-rater concordance with enhanced reliability and effectiveness in the assessment of upper limb function, a novel automated system employing Microsoft Kinect© is considered to capture the motion of the patient's finger for objective assessment. This essentially mimics the commonly used finger tracking task clinically assessed through subjective observation. A clinical trial was conducted involving 42 CA patients and 18 age-matched healthy subjects. The relevant kinematically diagnostic features of CA patients allowed a classification accuracy of 97% using the Bayesian Quadratic Discriminant Analysis (QDA). The correlation (severity) between the extracted features and the independent severity scores from expert clinicians were collated to achieve a high correlation ( r = 0.86 , ) with the Scale for the Assessment and Rating of Ataxia (SARA). The proposed system can efficiently generate objective information of severity as a result of features that are not necessarily observable during standard bedside clinical testing. Furthermore, the superior performance of the Ballistic (finger chase) test indeed supports the credence of the Ramp test redundancy that exists among the wider clinical community.

A suite of automated tools to quantify hand and wrist motor function after cervical spinal cord injury

BackgroundCervical spinal cord injury (cSCI) often causes chronic upper extremity disability. Reliable measurement of arm function is critical for development of therapies to improve recovery after cSCI. In this study, we report a suite of automated rehabilitative tools to allow simple, quantitative assessment of hand and wrist motor function.MethodsWe measured range of motion and force production using these devices in cSCI participants with a range of upper limb disability and in neurologically intact participants at two time points separated by approximately 4 months. Additionally, we determined whether measures collected with the rehabilitative tools correlated with standard upper limb assessments, including the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP) and the Jebsen Hand Function Test (JHFT).ResultsWe find that the rehabilitative devices are useful to provide assessment of upper limb function in physical units over time in SCI participants and are well-correlated with standard assessments.ConclusionsThese results indicate that these tools represent a reliable system for longitudinal evaluation of upper extremity function after cSCI and may provide a framework to assess the efficacy of strategies aimed at improving recovery of upper limb function.

Nonlinear mixed-effects scalar-on-function models and variable selection

This paper is motivated by our collaborative research and the aim is to model clinical assessments of upper limb function after stroke using 3D-position and 4D-orientation movement data. We present a new nonlinear mixed-effects scalar-on-function regression model with a Gaussian process prior focusing on the variable selection from a large number of candidates including both scalar and function variables. A novel variable selection algorithm has been developed, namely functional least angle regression. As it is essential for this algorithm, we studied the representation of functional variables with different methods and the correlation between a scalar and a group of mixed scalar and functional variables. We also propose a new stopping rule for practical use. This algorithm is efficient and accurate for both variable selection and parameter estimation even when the number of functional variables is very large and the variables are correlated. And thus the prediction provided by the algorithm is accurate. Our comprehensive simulation study showed that the method is superior to other existing variable selection methods. When the algorithm was applied to the analysis of the movement data, the use of the nonlinear random-effect model and the function variables significantly improved the prediction accuracy for the clinical assessment.

A single-subject study of robotic upper limb training in the subacute phase for four persons with cervical spinal cord injury.

Study designSingle-subject design, standard training (“B”) compared with Robotic training (“C”).ObjectivesTo explore the impact of robotic training on upper limb function, activities of daily living (ADL) and training experience in subacute tetraplegic inpatients.SettingInpatient subacute Norwegian spinal cord injury (SCI) unit.MethodsFour participants (C4–7, AIS A-C) completed 11 sessions of robotic training using a passive robotic exoskeleton (Armeo Spring®). Descriptive statistics and visual analyses were used for comparing standard occupational therapy and robotic training. Outcome measures included the Spinal Cord Independence Measure (SCIM-III), the Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP), and a questionnaire.ResultsAll of the participants exhibited an increase in assessments of upper limb function (GRASSP-total) right side (0.4%–61.2%), and all except for one participant (−8%) showed an increase on their left side (20.9%–106.2%). Three out of four participants had improvements in ADL function SCIM-III (ranging from 5.6% to 46.7%). Results demonstrated improvements during the robotic intervention period in five out of 28 measurements. The participants enjoyed the exercise, and found it motivating and relevant to their injury (median ranged from 3.5 to 6.5 on a 0–7 scale).ConclusionsThree out of four participants improved upper limb function and ADL independence, but the study could not confirm that improvements were due to the robotic intervention. The participants enjoyed the robotic training and found it relevant to their injury.

A comparative study of motion recognition methods for efficacy assessment of upper limb function

SummaryPhysical disorders are considered to be the most severe disability in patients with hemiplegia after stroke. Currently, most studies have used motion feature extraction methods and machine learning–based methods to evaluate the functional degree of post stroke in hemiplegic patients. This research collected feature data from patients under diverse experimental conditions and then fed them into different machine learning classifiers. However, few studies have compared which classifiers and experimental condition could achieve more precise assessments in a specific condition. In this paper, we compared the accuracy of four different classifiers in a conservative motion recognition method. A motion sensor was used for monitoring the upper limb action, and four conservative machine learning classifiers, which map the features to Fugl‐Meyer scale, were chosen for comparison. Ten post‐stroke hemiplegic‐simulated subjects performed a group of predefined actions, and these motion data were used to generate a group of features reflecting the information of each predefined action. We input the features into four classifiers to generate corresponding classifiers. With the Support Vector Machine classifier, prediction accuracy at 97.79% was achieved in the experiment data, which outperformed previous reports. In conclusion, Support Vector Machines perform better than the other three classifiers in the assessment of the degree of post‐stroke hemiplegics. It is encouraging that results have been generated with the proposed assessment method in this exploratory study.