![Clinical scales
Types of measures.
1) To evaluate impairment
2) Determine the impact of the impairment on daily
activities (ADL).
5
How can these impairments be addressed?
State of Art
The most popular test for motor impairment is
Fugl-Meyer Assessment (FM) (Crow et al 2008, Wei et
al 2011, Gladstone et al 2012)
Rowe/ Occupational Therapist, V. (2008, October 15). Fugl-Meyer
Assessment of Motor Recovery after Stroke [Video file]. Retrieved
from https://www.youtube.com/watch?v=B70qDfl3LyA](https://image.slidesharecdn.com/measuringandquantifyingqualityofmovement-170713010908/85/Measuring-and-quantifying-quality-of-movement-5-320.jpg)
Measuring and quantifying quality of movement
- 1. MEASURING AND QUANTIFYING QUALITY OF MOVEMENT Enhancing evaluation and treatment techniques for rehabilitation of hemiparetic stroke patients Justyna Ausareny MASTER THESIS UPF- FINAL / 2015-2016 CENTER OF AUTONOMOUS SYSTEMS AND NEURO- ROBOTICS DEPARTMENT OF INFORMATION AND COMMUNICATION TECHNOLOGIES 1
- 2. Introduction to stroke 2 ➔ Referred to as a “brain attack”. ➔ Every year first-ever stroke incidents occur about 16 million (Mathers et al. 2006) ➔ Main causes of disability in the western world (Dobkin, 2015). ➔ 55% to 75% of stroke patients suffer from motor dysfunctions (Larsen et al. 2005) About 60% of post stroke patients receive inappropriate care (Atul Gawande, 2012) State of Art
- 3. ❖ How exactly does the motor behavior change after stroke? 3 ❖ How can we can best represent it for better evaluation and treatment? State of Art
- 4. Introduction to movement 4 Loss of somatosensation Paresis Abnormal muscle tone Loss of fractionated movement Movement planning Coordination Accuracy Movement duration Efficacy Ease Smoothness Efficiency Coordination Range State of Art
- 5. Clinical scales Types of measures. 1) To evaluate impairment 2) Determine the impact of the impairment on daily activities (ADL). 5 How can these impairments be addressed? State of Art The most popular test for motor impairment is Fugl-Meyer Assessment (FM) (Crow et al 2008, Wei et al 2011, Gladstone et al 2012) Rowe/ Occupational Therapist, V. (2008, October 15). Fugl-Meyer Assessment of Motor Recovery after Stroke [Video file]. Retrieved from https://www.youtube.com/watch?v=B70qDfl3LyA
- 6. Clinical scales 6 ➔ Robustness and Reliability (Heppner et al. 2008 and French et al. 2001) ➔ Sensitivity (Beebe et al 2008, Crow et al 2008, Woodbury et al 2007, Thompson et al 2015) What are the issues? How can we address these problems? State of Art
- 7. Problem statement ➔ clinical scales ➔ subjective tests ➔ difficult to generalize 7 So far, the Rehabilitation Gaming System Wearable (RGS-wear) has tackled this issue by providing a wearable-based solution as an intervention tool, focusing on the amount of movement. State of Art In this thesis, the aim is to enhance the current state and establish a novel measurement providing qualitative assessment of movement
- 8. ➔ Ability to objectively and repeatedly measure movement in a way that quantify motor recovery Technology 8 State of Art ➔ Low cost ➔ Provide more access for measuring movement in an evaluation activity ➔ Accelerometer has been applied for the evaluation of stroke motor recovery (Akay et al. 2003; Bonato et al. 2004). ➔ Allows for motor pattern analysis (Giansanti 2003).
- 9. Motion evaluation 9 State of Art Motion analysis systems are collections of algorithms that transform the data from one abstraction level to another (Sant'Anna and Wickstrom 2013). These systems address 2 main questions: 1. What is being performed? 2. How the activity is being performed? Retrieved from http://what-when-how.com/medical-informatics/i
- 10. Assessment and treatment ➔ Reaching task is one of the most popular activities has been extensively studied also present in everyday activities ADL (Wagner et al 2007). ➔ Circle drawing is a relatively new method that has shown to be suitable for making distinction between healthy subjects and stroke survivors. (Krabben et al 2011) 10 State of Art ➔ Task-oriented training can enhance functional plasticity in cortical organization (Chollet et al. 1991). ➔ The key elements in motor recovery are quantity and task specificity (Cirstea et al. 2007). Retrieved from http://rgs-project.eu/sites/all/themes/danland/images/slideshows/header1.jpg
- 11. Hypothesis The purpose of this study is to 11 Methods 1. Provide a technical validation of a methodology for the analysis of quality of movement of the hand, based on data from inertial motion units (accelerometer and gyroscope), in 2 specific tasks: planar reaching and planar circle drawing. We hypothesize that our system/methodology for the analysis of quality of movement is able to capture differences in performance and identify movement deficits associated with stroke.
- 12. Apparatus Primary system hardware: ➔ Open Metawear wearable (model RG) with 6 axis of motion sensing 12 Methods Secondary system hardware for validation of position of Metawear: ➔ Reactable
- 13. Subjects 24 healthy subjects recruited from UPF Poblenou campus. All subjects signed a consent and approved the data acquisition process. Methods
- 14. Experiment 14 Methods ➔ Task 1. Reaching ➔ Task 2. Circle Drawing
- 17. Methods linear acceleration 17 Methods Gravity compensation using AHRS sensor fusion algorithm (Seb Madgwick, 2013) Retrieved from http://what-when-how.com/medical-informatics/i
- 18. Methodstrajectories and trails 18 Methods Trajectory reconstruction using modified AHRS sensor fusion algorithm (Seb Madgwick, 2013) Trail detection Trial detection
- 19. Methods preliminary analysis 19 Methods Example of a detected trial and analysis
- 20. Measures 20 Methods Loss of somatosensation Paresis Abnormal muscle tone Loss of fractionated movement References: Nordin et al (2011) Iwamuro et al (2008) Chang et al (2007) Johnson (2011) Balasubramania, (2015)
- 21. Results Dominant vs Non Dominant 21 Results
- 22. Results Non Constrained vs Constrained 22 Results
- 23. Correlations 23
- 24. Correlations 24
- 25. Correlations 25
- 26. Correlations 26
- 27. 27 Non constrained Constrained Reaching Circle drawing Reaching Circle drawing Dominant Non dominant Dominant Non dominant Dominant Non dominant Dominant Non dominant Ease - Temporal Efficiency 0.0018 0.0001 0.0947 8.1947 e -0.5 0.0023 0.1052 0.127 0.0310 Smoothness - Ease 0.0037 0.0134 2.5341 e -0.5 1.561 e -0.5 5.3489 e -0.5 1.3442 e -0.5 1.9739 e -0.5 8.8993 e -0.9 Smoothness - Movement Planning 4.9044 e -0.5 0.0134 1.0138 e -0.9 5.1486 e -0.6 0.0006 0.0155 0.0002 3.6502 e -0.7 Smoothness - Temporal efficiency 0.0037 0.0134 2.5341 e -0.5 1.561 e -0.5 5.3489 e -0.5 1.3442 e -0.5 1.9739 e -0.5 8.8993 e -0.9 Movement Planning - Temporal efficiency 1.7202 e -0.5 4.1917 e -0.9 1.074 e -0.6 4.5677 e -0.9 0.0004 3.2163 e -0.7 2.4044 e -0.8 0.0002 Ease - Movement Planning 0.0650 0.0004 0.0572 0.003 0.0157 0.1047 0.1271 0.1313 P values
- 28. Conclusions 28 ➔ We can objectively assess the quality of movement and repeatedly measure it ➔ When evaluating only healthy subjects the difficulty of task must be taken into account ➔ The motion systems should sample data at high frequency in order to insure accuracy ➔ The connectivity and ease of use are the current constraints in the study that should be addressed in future directions
- 29. The end Thank you ! 29
- 30. Usability 30 ➔ Overall Satisfaction and Ergonomics ➔ User Experiment - Interface Satisfaction ➔ Wearable System Usability Scale ➔ Perceived Usefulness of the Study ➔ Social and Technical Human Factors Suggestions for future developments: ➔ Add heart rate skin conductance ➔ Different study populations ➔ Implementable devices ➔ Connectivity ➔ Easier to wear ➔ Instant feedback
- 31. Overall Satisfaction and Ergonomics 31 Agree Agree
- 32. User Experiment - Interface Satisfaction 32 Comfortable
- 33. Wearable System Usability Scale 33ComfortableAgreeAgree AgreeAgree
- 34. Perceived Usefulness & Socio -Technical Human Factors 34 Agree Was there anything about the tool that surprised you? Over 50% responded no, Easier to wear Not challenging Discomfort when using only 1 hand Smartphone Uncomfortable bands How did it feel for you to have your movement assessed by a computer? Over 50% responded fine, More careful Uncomfortable “felt like a robot” Missing feedback How did it feel to have no physical cues (body language or verbal communication) Over 50% responded fine, Aroused curiosity Similar to online course Eliminates pressure of social interaction Better for concentration Boring “could have done a lot more things face to face”