Brunnstrom Stage Research Articles

A Compressed Sensing-Based Wearable Sensor Network for Quantitative Assessment of Stroke Patients.

Clinical rehabilitation assessment is an important part of the therapy process because it is the premise for prescribing suitable rehabilitation interventions. However, the commonly used assessment scales have the following two drawbacks: (1) they are susceptible to subjective factors; (2) they only have several rating levels and are influenced by a ceiling effect, making it impossible to exactly detect any further improvement in the movement. Meanwhile, energy constraints are a primary design consideration in wearable sensor network systems since they are often battery-operated. Traditionally, for wearable sensor network systems that follow the Shannon/Nyquist sampling theorem, there are many data that need to be sampled and transmitted. This paper proposes a novel wearable sensor network system to monitor and quantitatively assess the upper limb motion function, based on compressed sensing technology. With the sparse representation model, less data is transmitted to the computer than with traditional systems. The experimental results show that the accelerometer signals of Bobath handshake and shoulder touch exercises can be compressed, and the length of the compressed signal is less than 1/3 of the raw signal length. More importantly, the reconstruction errors have no influence on the predictive accuracy of the Brunnstrom stage classification model. It also indicated that the proposed system can not only reduce the amount of data during the sampling and transmission processes, but also, the reconstructed accelerometer signals can be used for quantitative assessment without any loss of useful information.

Abstract WP146: Intravenous Bone Marrow Derived Mononuclear Stem Cells in Chronic Ischemic Stroke-Paracrine Mechanisms of Recovery

Background: The emerging role of Stem cell technology and transplantation has helped scientists to study its potential role in neural repair and regeneration. The fate of stem cells is determined by its niche, consisting of surrounding cells and the secreted trophic growth factors. This present study evaluates the safety, feasibility and efficacy of bone marrow derived mononuclear stem cells (BM-MNC) in chronic ischemic stroke by studying the release of serum vascular endothelial growth factor (VEGF) and brain derived neurotrophic growth factor (BDNF). Methods: Twenty (n=20) stroke patients recruited with the inclusion criteria as: 3 months to 1.5 years of index event, power of hand muscles atleast 2; Brunnstrom stage: 2-5; conscious and comprehendible, were randomized to study and control groups receiving autologous mean 60-70 million BM-MNC and controls receiving neuromotor rehabilitation regime only for 8 weeks. Clinical assessment (FM, mBI, MRC, Ashworth) and serum VEGF & BDNF were done at baseline and 8 weeks (2 months). Results: No patients exhibited any complication or adverse events during the whole procedure. There was no statistical significant clinical improvement between study and control groups (FM: 95%CI; 15.2 to 5.35, p=0.25; mBI : 95% CI;14.3 to 4.5, p=0.31). VEGF and BDNF were increased after stem cell infusion and exercise training in both the groups (VEGF: 442.1 pg/ml vs 400.3pg/ml; p=0.67; BDNF:95% CI∼15.09 to 4.09, p=0.57), without any statistical significant result. Conclusion: Autologous mononuclear stem cell infusion is safe and tolerable by chronic ischemic stroke. The paracrine hypothesis extends the traditional concept of stem cell niche to study the influence of stem cell released growth factors (VEGF and BDNF) on the microenvironment.

Effect of mirror therapy on upper extremity motor function in stroke patients: a randomized controlled trial.

[Purpose] This study aimed to evaluate the effectiveness of mirror therapy combined with a conventional rehabilitation program on upper extremity motor and functional recovery in stroke patients. [Subjects and Methods] Thirty-one hemiplegic patients were included. The patients were randomly assigned to a mirror (n=16) or conventional group (n=15). The patients in both groups underwent conventional therapy for 4 weeks (60–120 minutes/day, 5 days/week). The mirror group received mirror therapy, consisting of periodic flexion and extension movements of the wrist and fingers on the non-paralyzed side. The patients in the conventional group performed the same exercises against the non-reflecting face of the mirror. The patients were evaluated at the beginning and end of the treatment by a blinded assessor using the Brunnstrom stage, Fugl-Meyer Assessment (FMA) upper extremity score, and the Functional Independence Measure (FIM) self-care score. [Results] There was an improvement in Brunnstrom stage and the FIM self-care score in both groups, but the post-treatment FMA score was significantly higher in the mirror therapy group than in the conventional treatment group. [Conclusion] Mirror therapy in addition to a conventional rehabilitation program was found to provide additional benefit in motor recovery of the upper extremity in stroke patients.

Effect of Upper Extremity Robot-Assisted Exercise on Spasticity in Stroke Patients.

ObjectiveTo determine the efficacy of a stretching and strengthening exercise program using an upper extremity robot, as compared with a conventional occupational therapy program for upper extremity spasticity in stroke patients.MethodsSubjects were randomly divided into a robot-assisted therapy (RT) group and a conventional rehabilitation therapy (CT) group. RT group patients received RT and CT once daily for 30 minutes each, 5 days a week, for 2 weeks. RT was performed using an upper-extremity robot (Neuro-X; Apsun Inc., Seoul, Korea), and CT was administered by occupational therapists. CT group patients received CT alone twice daily for 30 minutes, 5 days a week, for 2 weeks. Modified Ashworth Scale (MAS) was used to measure the spasticity of upper extremity. Manual muscle tests (MMT), Manual Function Tests (MFT), Brunnstrom stage, and the Korean version of Modified Barthel Index (K-MBI) were used to measure the strength and function of upper extremity. All measurements were obtained before and after 2-week treatment.ResultsThe RT and CT groups included 22 subjects each. After treatment, both groups showed significantly lower MAS scores and significant improvement in the MMT, MFT, Brunnstrom stage, and K-MBI scores. Treatment effects showed no significant differences between the two groups.ConclusionRT showed similar treatment benefits on spasticity, as compared to CT. The study results suggested that RT could be a useful method for continuous, repeatable, and relatively accurate range of motion exercise in stroke patients with spasticity.

ロボットスーツHALおよび単関節HAL-SJを用いた脳卒中急性期リハビリテーション

Neurorehabilitation for acute stroke patients is essential for functional recovery and better prognosis. An exoskeleton-type robot, the “hybrid assistive limb” (HAL), has been developed for post-stroke care. Three types of HAL robots are currently available: bilateral leg type, single leg type, and single joint type. In this study, we aimed to investigate the clinical outcomes of a neurorehabilitation approach using multiple types of HAL robots in acute stroke patients with hemiparesis. The Brunnstrom stage scores and the modified Rankin scale (mRS) were used as outcome measures. These scales were evaluated when the HAL robots were introduced and patients were transferred to another hospital. Fourteen stroke patients (seven men, seven women; six ischemic stroke cases, eight hemorrhagic stroke cases) treated at Fukuoka University hospital were evaluated during the period between October 2013 and August 2015. The mean age of the cohort was 57.8 ± 11.0 years, and the patients underwent a total of 13.7 ± 7.9 HAL sessions. Brunnstrom stage and mRS scores were significantly improved after rehabilitation (p < 0.05). The present study showed that our neurorehabilitation approach using multiple types of HAL robots in stroke patients may be useful. We advocate that the rehabilitation approach should be tailored for each patient at various levels of recovery.

Analysis of Trunk Rolling Performances by Mattress Mobility Detection System in Poststroke Patients: A Pilot Study.

Purpose. The purpose of this study was to investigate the correlation of kinematic variables with quality of trunk control in poststroke patients. Methods. This cross-sectional study included stroke subjects with mild to moderate motor deficit corresponding to Brunnstrom stages 3-4. Trunk functional performance was measured using bed mobility monitor system. All tasks were repeated ten times for both directions in each subject. Outcome measurements included the movement time and displacement of center of pressure (CoP) from supine to side lying and returning. Results. The results revealed that a significant longer turning time was observed when turning from the paretic side toward the nonparetic side compared to the other direction, with an estimated mean difference of 0.427 sec (P = 0.005). We found a significant difference in the time of rolling back to supine position between two directions. The displacement of CoP in rolling back from side lying on the nonparetic side was smaller than that from the paretic side with an estimated mean difference of −0.797 cm (P = 0.023). Conclusions. The impaired trunk mobility was associated with increased movement time and decreased displacement of CoP in poststroke patients. Trunk rolling performance has potential in assessment of stroke patients.

複数台RGB-Dセンサを用いた片麻痺者の状態推定システム

複数台RGB-Dセンサを用いた片麻痺者の状態推定システム

Application of RFID technology-upper extremity rehabilitation training.

[Purpose] Upper extremity rehabilitation after an injury is very important. This study proposes radio frequency identification (RFID) technology to improve and enhance the effectiveness of the upper extremity rehabilitation. [Subjects and Methods] People use their upper extremities to conduct daily activities. When recovering from injuries, many patients neglect the importance of rehabilitation, which results in degraded function. This study recorded the training process using the traditional rehabilitation hand gliding cart with a RFID reader, RFID tags in the panel, and a servo host computer. [Results] Clinical evidence, time taken to achieve a full score, counts of missing the specified spots, and Brunnstrom stage of aided recovery, the proximal part of the upper extremity show that the RFID-based upper extremity training significantly and reduce negative impacts of the disability in daily life and activities. [Conclusion] This study combined a hand-gliding cart with an RFID reader, and when patients moved the cart, the movement could be observed via the activated RFID tags. The training data was collected and quantified for a better understanding of the recovery status of the patients. Each of the participating patients made progress as expected.

Factors Predicting the Effects of Hybrid Assistive Limb Robot Suit during the Acute Phase of Central Nervous System Injury.

To improve the activities of daily living of patients with injury to the central nervous system, physical therapy starting from the acute phase of the injury is important. Recently, the efficacy of physical therapy using a hybrid assistive limb (HAL) robot suit was reported. However, individual differences exist in the effects of HAL. We investigated factors predicting the effects of HAL in 15 patients at our institution with central nervous system injury, primarily due to stroke, who underwent training using HAL during the acute phase. Patients were classified as either “with HAL suitability” or “without HAL suitability” based on scores from 10-m walking speed, gait, satisfaction, and pain. In both groups, Brunnstrom stage before HAL intervention, Fugl-Meyer assessment (FMA), stroke impairment assessment set (SIAS), and functional independence measure (FIM) were evaluated. Although motor function items did not differ significantly, FIM cognitive function items (P = 0.036), visuospatial perception items on SIAS (P = 0.0277), and pain items on SIAS (P = 0.0122) differed significantly between groups. These results indicated that training using HAL does not involve pain in patients with central nervous system injury during the acute phase, and exhibits positive effects in patients without pain and with high communication ability and visuospatial perception function. When conducting HAL intervention, incorporating functional assessment scores (FIM and SIAS), including peripheral items, may be useful to predict the suitability of HAL.

스마트폰을 이용한 뇌졸중 후 상지 편마비 환자의 상지 게임재활훈련 프로그램 개발 및 임상적 유용성 평가에 대한 예비연구

In the paper, we developed the mobile based rehabilitation system for patients with upper extremity hemiplegia after stroke and evaluated clinical usefulness and effectiveness of the system. The sensors built in the smartphone were used to track patients' upper limb motion and the movements was transferred to the tablet PC through bluetooth connection so that the game contents could be interact with the movements. The rehabilitation game contents was based on Brunnstrom stage(B-stage), and was designed to lead accurate movement of upper limb. For the clinical evaluation of the effectiveness, 11 patients were recruited and make them perform an exercise of their wrist, shoulder, and forearm using the system for two weeks. The change of upper limb motor function was measured using fugl-meyer assessment(FMA), Brunnstrom stage(B-stage). And the change of quality of life was measured using EuroQoL-5 Dimension(EQ-5D), Beck Depression Inventory(BDI). The results showed significant improvement in upper limb function but not in quality of life. We verified mobile based rehabilitation program could be useful and effective for the clinical use.

Tailor-made rehabilitation approach using multiple types of hybrid assistive limb robots for acute stroke patients: A pilot study

ABSTRACTThis article investigated the feasibility of a tailor-made neurorehabilitation approach using multiple types of hybrid assistive limb (HAL) robots for acute stroke patients. We investigated the clinical outcomes of patients who underwent rehabilitation using the HAL robots. The Brunnstrom stage, Barthel index (BI), and functional independence measure (FIM) were evaluated at baseline and when patients were transferred to a rehabilitation facility. Scores were compared between the multiple-robot rehabilitation and single-robot rehabilitation groups. Nine hemiplegic acute stroke patients (five men and four women; mean age 59.4 ± 12.5 years; four hemorrhagic stroke and five ischemic stroke) underwent rehabilitation using multiple types of HAL robots for 19.4 ± 12.5 days, and 14 patients (six men and eight women; mean age 63.2 ± 13.9 years; nine hemorrhagic stroke and five ischemic stroke) underwent rehabilitation using a single type of HAL robot for 14.9 ± 8.9 days. The multiple-robot rehabilitation group showed significantly better outcomes in the Brunnstrom stage of the upper extremity, BI, and FIM scores. To the best of the authors’ knowledge, this is the first pilot study demonstrating the feasibility of rehabilitation using multiple exoskeleton robots. The tailor-made rehabilitation approach may be useful for the treatment of acute stroke.

Fatty replacement of rotator cuff in brain-injured patients is associated with hemiplegic arm function, but not with tendon tear: A multicenter study.

The association between fatty replacement of rotator cuff and hemiplegic upper extremity function has not been defined yet. Moreover, the relationships among rotator cuff tears, shoulder pain, spasticity, and fatty replacement were not clearly studied. We investigated the association of fatty replacement of the supraspinatus and infraspinatus muscles with tendon tear in stroke or brain-injured patients. A total of 72 hemiplegic patients were enrolled in 3 hospitals, and ultrasonography of both shoulders was performed once. Fatty replacement of the supraspinatus and infraspinatus was graded by the visibility of outer contours, pennate pattern, central tendon, and echogenicity. Fatty replacement was observed in 22 (30.6%) out of the 72 patients (in 18 supraspinatus muscles and 12 infraspinatus). Inter-rater agreement (kappa value) between the 2 physiatrists was 0.530 for the supraspinatus, and 0.411 for the infraspinatus. The Fugl-Meyer assessment score, Brunnstrom stage, and modified Barthel index were significantly lower in patients with fatty replacement of the supraspinatus or infraspinatus (group 1) than in those without (group 2). The motor power of both shoulders, the pain-free range of motion, spasticity, and hemiplegic shoulder pain were comparable between the two groups. The tear rate of the supraspinatus, infraspinatus, or subscapularis tendon at the hemiplegic side was higher than that at the contralesional side in each group, although there was no significant difference between group 1 and group 2. Disuse leading to muscle atrophy rather than rotator cuff tear might be the cause of fatty replacement of these muscles, which may be associated with decreased function of the hemiplegic upper extremities.

EFFECTIVENESS OF MIRROR THERAPY ON HANDFUNCTIONS IN SUBACUTE STROKE PATIENTS

Background: Mirror therapy is a relatively new therapeutic intervention that focuses on moving the unimpaired limb. In stroke patients, it involves performing movements of the unimpaired limb while watching its mirror reflection superimposed over the (unseen) impaired limb, thus creating a visual illusion of enhanced movement capability of the impaired limb. The aim of this study was to evaluate the effects of mirror therapy on upper extremity motor recovery, spasticity and hand related functions of patients with sub-acute stroke.Methods: The clinical trial was conducted at the department of Physiotherapy (SIMS College of Physiotherapy, Guntur), for the duration of 6 weeks. Thirty patients divided into two groups: Group A: Experimental treated with mirror therapy along with conventional therapy and Group B: Control group treated with conventional physiotherapy only. Data analyzed using SPSS, Mean, SD and T test for independent samples used.Results: Comparison of pre-treatment and post treatment scores of experimental group of Brunnstrom stages showed extremely significant; while the control groupconsidered not significant. For Modified Ashworth Scale the pretreatment and post, treatment scores of experimental and control groupswere extremely significant. In addition, Functional Independence Measure showed extremely significant for experimental group and not significant for the control group.Conclusions: Mirror therapy shared and a predictable rehabilitation program enhanced upper-extremity motor recovery and functioning in our sub-acute stroke inpatients. It is beneficial in improving the effects and outcome on upper extremity motor recovery and function.

Mirror therapy enhances upper extremity motor recovery in stroke patients

The purpose of this study was to evaluate the effects of mirror therapy program in addition with physical therapy methods on upper limb recovery in patients with subacute ischemic stroke. 15 subjects followed a comprehensive rehabilitative treatment, 8 subjects received only control therapy (CT) and 7 subjects received mirror therapy (MT) for 30 min every day, five times a week, for 6 weeks in addition to the conventional therapy. Brunnstrom stages, Fugl-Meyer Assessment (upper extremity), the Ashworth Scale, and Bhakta Test (finger flexion scale) were used to assess changes in upper limb motor recovery and motor function after intervention. After 6 weeks of treatment, patients in both groups showed significant improvements in the variables measured. Patients who received MT showed greater improvements compared to the CT group. The MT treatment results included: improvement of motor functions, manual skills and activities of daily living. The best results were obtained when the treatment was started soon after the stroke. MT is an easy and low-cost method to improve motor recovery of the upper limb.

Outcome Assessment of Hemiparesis due to Intracerebral Hemorrhage Using Diffusion Tensor Fractional Anisotropy

This study aimed to evaluate the prognostic efficacy of magnetic resonance diffusion tensor fractional anisotropy (FA) for patients with hemiparesis due to intracerebral hemorrhage. Diffusion tensor FA brain images were acquired 14-21days after putaminal and/or thalamic hemorrhage. The ratio of FA values within the cerebral peduncles of the affected and unaffected hemispheres (rFA) was calculated for each patient (n=40) and assessed for correlation with Brunnstrom stage (BRS, 1-6), motor component of the functional independence measure (FIM-motor, 13-91), and the total length of stay (LOS) until discharge from rehabilitation (P<.05). Ordinal logistic regression analyses were conducted to determine the relationships between rFA and specific outcomes as measured by BRS range (poor, BRS 1 or 2; moderate, BRS 3 or 4; and good, BRS 5 or 6; P<.05). The rFA values were .571-1.043 (median, .856) and BRS scores were 1-6 (median, 4) for shoulder/elbow/forearm, 1-6 (median, 4) for hand, and 2-6 (median, 4) for lower extremities. FIM-motor scores were 58-86 (median, 78) and LOS ranged from 42 to 225days (median, 175.5days). Correlation coefficients were statistically significant between rFA and shoulder/elbow/forearm BRS (.696), hand BRS (.779), lower extremity BRS (.631), FIM-motor (.442), and LOS (-.598). Logistic model fit was moderate for shoulder/elbow/forearm BRS (R(2)=.221) and lower extremity BRS (R(2)=.277), but was much higher for hand BRS (R(2)=.441). Diffusion tensor FA values are predictive of clinical outcome from hemiparesisduetoputaminal and/or thalamic hemorrhage, particularly hand function recovery.

Analysis of Vertical Ground Reaction Force Variables Using Foot Scans in Hemiplegic Patients.

ObjectiveTo analyze the differences in the vertical ground reaction force (GRF) variables of hemiplegic patients compared with a control group, and between the affected and unaffected limbs of hemiplegic patients using foot scans.MethodsPatients (n=20) with hemiplegia and healthy volunteers (n=20) underwent vertical force analysis. We measured the following: the first and second peak forces (F1, F2) and the percent stances at which they occurred (T1, T2); the vertical force impulse (VFI) and stance times. The GRF results were compared between the hemiplegic patients and control individuals, and between the affected and unaffected limbs of hemiplegic patients. Additionally, we analyzed the impulse of the unaffected limb according to the motor assessment scale (MAS), Brunnstrom stage, and a Timed Up and Go Test.ResultsThe F1s and F2s of the affected and unaffected limbs were significantly less than those of the normal control individuals (p<0.05). The T1s of both the affected and unaffected limbs of the patients were greater than control individuals, whilst the T2s were lower (p<0.05). Greater impulses and stance times were recorded on both sides of the patients than in the limbs of the control individuals (p<0.05). The MAS, Brunnstrom stage and Timed Up and Go Test results were significantly correlated with the VFI of the unaffected limbs (p<0.05).ConclusionThe high impulse values of the unaffected limb were associated with complications during gait rehabilitation. Therefore, these results suggest that unaffected limbs should also be taken into consideration in these patients.

Different cutoff values for 10-m walking speed simply classification of walking independence in stroke patients with or without cognitive impairment.

[Purpose] The aim of this study was to determine the threshold for classifying walking independence in stroke patients with and without cognitive disorders. [Subjects] The subjects were 130 patients with initial stroke hemiplegia. [Methods] The following factors were analyzed for associations with walking independence: Brunnstrom stage, one-leg standing time on the paralytic side, one-leg standing time on the non-paralytic side, and 10-m walking speed. We classified the patients with Mini-Mental State Examination (MMSE) scores ≥24 points into the high-score group and those with MMSE scores of ≤23 points into the low-score group and examined the main factors and cutoff values associated with walking independence in each group. [Results] The high-score group included 69 subjects (53.1%), and the low-score group included 61 subjects (46.9%). The primary factor associated with high MMSE scores among the stroke patients was the 10-m walking time. Using a cutoff level for the 10-m walking speed of 41.4 m/min resulted in a positive likelihood ratio of 6.3. The primary factor associated with low MMSE scores among the stroke patients was the 10-m walking time. Using a cutoff level for the 10-m walking speed of 48.0 m/min resulted in a positive likelihood ratio of 7.6. [Conclusion] The cutoff value for the 10-m walking speed can be used to evaluate walking independence in patients with stroke among patients with high or low MMSE scores.

Effectiveness of Acute Phase Hybrid Assistive Limb Rehabilitation in Stroke Patients Classified by Paralysis Severity.

The purpose of the present study was to investigate the effectiveness of acute phase hybrid assistive limb (HAL) rehabilitation training for patients after stroke by measuring the difference in the severity of paralysis. Fifty-three acute stroke patients were enrolled in this prospective cohort study. HAL training was administered about twice per week, and the mean number of sessions was 3.9 ± 2.7. The walking training was performed on a treadmill with individually adjustable body weight support and speed and there was a 10-m walk test (10MWT) before and after each session. Assessment at baseline and at endpoint consisted of the Glasgow Coma Scale (GCS), Revised Hasegawa’s Dementia Scale (HDS-R), Brunnstrom stage (Brs), Functional Independence Measure (FIM), Barthel index (BI), and 10MWT. We measured these assessments at the first walking training session and at the end of the final training session without the HAL. To evaluate the feasibility of training with the HAL, the outcome measures of BI, FIM, and speed and number of steps of 10MWT were compared before and after training using a paired Wilcoxon’s signed-rank test in different Brs. Except for Brs IV, the Brs III or higher subgroups displayed significant amelioration in BI, and the Brs III subgroup displayed significant amelioration in FIM. The Brs V and VI subgroups displayed significant amelioration in 10-m walking speed and steps. In acute phase rehabilitation after stroke, it is thought that the HAL is more effective for patients with less lower-limb paralysis, such as Brs III or higher.

Objective Assessment of Upper-Limb Mobility for Poststroke Rehabilitation.

The assessment of the limb mobility of stroke patients is an essential part of poststroke rehabilitation. Conventionally, the assessment is manually performed by clinicians using chart-based ordinal scales, which can be subjective and inefficient. By introducing quantitative evaluation measures, the sensitivity and efficiency of the assessment process can be significantly improved. In this paper, a novel single-index-based assessment approach for quantitative upper-limb mobility evaluation has been proposed for poststroke rehabilitation. Instead of the traditional human-observation-based measures, the proposed assessment system utilizes the kinematic information automatically collected during a regular rehabilitation training exercise using a wearable inertial measurement unit. By calculating a single index, the system can efficiently generate objective and consistent quantitative results that can reflect the stroke patient's upper-limb mobility. In order to verify and validate the proposed assessment system, experiments have been conducted using 145 motion samples collected from 21 stroke patients (12 males, nine females, mean age 58.7±19.3) and eight healthy participants. The results have suggested that the proposed assessment index can not only differentiate the levels of limb function impairment clearly (p < 0.001, two-tailed Welch's t-test), but also strongly correlate with the Brunnstrom stages of recovery (r = 0.86, p < 0.001). The assessment index is also proven to have great potential in automatic Brunnstrom stage classification application with an 82.1% classification accuracy, while using a K-nearest-neighbor classifier.

1A1-I10 RGB-Dセンサを用いた障碍者の状態推定システムの開発 : 複数RGB-Dセンサを用いた動作計測

In this study, to support handicapped people, especially focusing on a hemiplegic person, a life support system is proposed. For improving their QoL, the system is required to support their early rehabilitation rather than care for whole ADLs. Therefore, we propose a system, which measures and estimates a state or a condition of a patient using multiple RGB-D sensors. In the system, by calculating angle and estimating position of each joints, the Brunnstrom stage of patient is estimated based on a method proposed by Ueda. On the other hand, in the case of measurement using only a RGB-D sensor, some joints are occluded by the other objects and their positions are not able to be estimated. In this paper, to avoid occlusions, a way of measurement a motion of patients using multiple RGB-D sensors is described.