Faculty Bibliography

BACKGROUND:Residual motor deficits of the upper limb in patients with chronic stroke are common and have a negative impact on autonomy, participation and quality of life. Music-Supported Therapy (MST) is an effective intervention to enhance motor and cognitive function, emotional well-being and quality of life in chronic stroke patients. We have adapted the original MST training protocol to a home-based intervention, which incorporates increased training intensity and variability, group sessions, and optimisation of learning to promote autonomy and motivation. METHODS:A randomised controlled trial will be conducted to test the effectiveness of this enriched MST (eMST) protocol in improving motor functions, cognition, emotional well-being and quality of life of chronic stroke patients when compared to a program of home-based exercises utilizing the Graded Repetitive Arm Supplementary Program (GRASP). Sixty stroke patients will be recruited and randomly allocated to an eMST group (n = 30) or a control GRASP intervention group (n = 30). Patients will be evaluated before and after a 10-week intervention, as well as at 3-month follow-up. The primary outcome of the study is the functionality of the paretic upper limb measured with the Action Research Arm Test. Secondary outcomes include other motor and cognitive functions, emotional well-being and quality of life measures as well as self-regulation and self-efficacy outcomes. DISCUSSION/CONCLUSIONS:We hypothesize that patients treated with eMST will show larger improvements in their motor and cognitive functions, emotional well-being and quality of life than patients treated with a home-based GRASP intervention. TRIAL REGISTRATION/BACKGROUND:The trial has been registered at ClinicalTrials.gov and identified as NCT04507542 on 8 August 2020.

The COVID-19 pandemic has transformed daily life, as individuals engage in social distancing to prevent the spread of the disease. Consequently, patients' access to outpatient rehabilitation care was curtailed and their prospect for recovery has been compromised. Telerehabilitation has the potential to provide these patients with equally-efficacious therapy in their homes. Using commercial gaming devices with embedded motion sensors, data on movement can be collected toward objective assessment of motor performance, followed by training and documentation of progress. Herein, we present a low-cost telerehabilitation system dedicated to bimanual exercise, wherein the healthy arm drives movements of the affected arm. In the proposed setting, a patient manipulates a dowel embedded with a sensor in front of a Microsoft Kinect sensor. In order to provide an engaging environment for the exercise, the dowel is interfaced with a personal computer, to serve as a controller. The patient's gestures are translated into interactive actions in a custom-made citizen-science project. Along with the system, we introduce an algorithm for classification of the bimanual movements, whose inner workings are detailed in terms of the procedures performed for dimensionality reduction, feature extraction, and movement classification. We demonstrate the feasibility of our system on eight healthy subjects, offering support to the validity of the algorithm. These preliminary findings set forth the development of precise motion analysis algorithms in affordable home-based rehabilitation.

Background/UNASSIGNED:Accurate assessment of movement limitations and compliance monitoring of exercises to restore movement are necessary to tailor treatments for individuals with motor deficits. Although several commercial-grade technologies are available to clinicians for evaluating movement limitations, they require one-on-one time-consuming assessments with limited reproducibility across care settings. To address these limitations, a wearable inertial sensors for exergames (WISE) system has been designed with: (I) an animated virtual coach to deliver instruction and (II) a subject-model whose movements are animated by real-time sensor measurements from the WISE system worn by a subject. This paper examines the WISE system's accuracy and usability for the assessment of upper limb range of motion (ROM). Methods/UNASSIGNED:Seventeen neurologically intact subjects were recruited to participate in a usability study of the WISE system. The subjects performed five shoulder and elbow exercises for each arm instructed by the animated virtual coach. The accuracy of ROM measurements obtained with the WISE system versus those obtained with the Kinect™ were compared using the root mean square error (RMSE) of the computed joint angles. The subjects additionally completed a system usability scale (SUS) to evaluate the usability of the virtual coach for tutoring ROM exercises. Results/UNASSIGNED:The absolute agreement between the WISE and Kinect devices was moderate to very good and it was limited because the Kinect sensor suffers from occlusion. The Bland-Altman limits of agreement for the exercises in the coronal and transverse planes were within the acceptable limits of ±10°. The SUS response data produced relatively high third and first quartile scores of 97.5 and 82.5, respectively, with the interquartile range of 15 and the minimum score of 65, suggesting that the subjects were interested in using the animated virtual coach for tutoring ROM exercises. Conclusions/UNASSIGNED:An animated virtual coach-based WISE system for mHealth is presented, tested, and validated for guided upper limb ROM exercises. Future studies with patient populations will facilitate the use of these devices in clinical and telerehabilitation settings.

In this paper, we present the design and development of a game-assisted stroke rehabilitation system RehabFork that allows a user to train their upper-limb to perform certain functions related to the task of eating. The task of eating is divided into several components: (i) grasping the eating utensils such as a fork and knife; (ii) lifting the eating utensils; (iii) using the eating utensils to cut a piece of food; (iv) transferring the food to the mouth; and (v) chewing the food. The RehabFork supports the user through sub-tasks (i)-(iii). The hardware components of RehabFork consist of an instrumented fork and knife, and a 3D printed pressure pad, that measure and communicate information on user performance to a gaming environment to render an integrated rehabilitation system. The gaming environment consists of an interactive game that utilizes sensory data as well as user information about the severity of their disability and current level of progress to adjust the difficulty levels of the game to maintain user motivation. Information pertaining to the user, including performance data, is stored and can be shared with care providers for ongoing oversight.

This paper presents the design and development of an exergame for the wearable inertial sensor (WIS) system for performing range of motion (ROM) exercises. The salient features of the exergame include: (i) a sensor calibration user-interface (UI); (ii) a sensor mounting UI, (iii) a patient gaming UI; (iv) an instructor playback UI; and (v) an instructor exercise development UI. Along with the WIS system, the developed exergame UIs enable a user to perform ROM exercises in clinical and home-based environments. The exergame UIs can also be employed in a telerehabilitation setting for remote monitoring and assessment. Preliminary results on the efficacy of using the exergame environment is documented with: (i) sensor calibration time; (ii) sensor mounting and alignment time on the human body; and (iii) examination of user adherence to instructor programmed exercise routines.

Limb contractures are debilitating complications associated with various muscle and nervous system disorders. This report summarizes a conference at the Shirley Ryan AbilityLab in Chicago, IL on April 19-20, 2018 involving researchers and physicians from diverse disciplines convened to discuss current clinical and preclinical understanding of contractures in Duchenne muscular dystrophy, stroke, cerebral palsy and other conditions. Presenters described changes in muscle architecture, activation, extracellular matrix, satellite cells and muscle fiber sarcomeric structure that accompany or predispose muscles to contracture. Participants identified ongoing and future research directions that may lead to understanding of the intersecting factors that trigger contractures. These include additional studies of changes in muscle, tendon, joint and neuronal tissues during contracture development using imaging, molecular and physiologic approaches. Participants identified the need for improved biomarkers and outcome measures to identify patients likely to develop contractures and to accurately measure efficacy of treatments currently available and under development. This article is protected by copyright. All rights reserved.

This paper presents the design and development of wearable inertial sensors (WIS) for real-time simultaneous triplanar motion capture of the upper extremity (UE). The sensors simultaneously capture in the frontal, sagittal, and horizontal planes UE range of motion (ROM), which is critical to assess an individual's movement limitations and determine appropriate rehabilitative treatments. Off-the-shelf sensors and microcontrollers are used to develop the WIS system, which wirelessly streams real-time joint orientation for UE ROM measurement. Key developments include: 1) two novel approaches, using earth's gravity (EG approach) and magnetic field (EGM approach) as references, to correct misalignments in the orientation between the sensor and its housing to minimize measurement errors; 2) implementation of the joint coordinate system (JCS)-based method for triplanar ROM measurements for clinical use; and 3) an in-situ guided mounting technique for accurate sensor placement and alignment on human body. The results 1) compare computational time between two orientation misalignment correction approaches (EG approach = 325.05 μs and EGM approach = 92.05μs); 2) demonstrate the accuracy and repeatability of measurements from the WIS system (percent deviation of measured angle from applied angle is less than ±6.5% and percent coefficient of variation is less than 11%, indicating acceptable accuracy and repeatability, respectively); and 3) demonstrate the feasibility of using the WIS system within the JCS framework for providing anatomically-correct simultaneous triplanar ROM measurements of shoulder, elbow, and forearm movements during several upper limb exercises.

Background. High-intensity repetitive training is challenging to provide poststroke. Robotic approaches can facilitate such training by unweighting the limb and/or by improving trajectory control, but the extent to which these types of assistance are necessary is not known. Objective. The purpose of this study was to examine the extent to which robotic path assistance and/or weight support facilitate repetitive 3D movements in high functioning and low functioning subjects with poststroke arm motor impairment relative to healthy controls. Methods. Seven healthy controls and 18 subjects with chronic poststroke right-sided hemiparesis performed 300 repetitions of a 3D circle-drawing task using a 3D Cable-driven Arm Exoskeleton (CAREX) robot. Subjects performed 100 repetitions each with path assistance alone, weight support alone, and path assistance plus weight support in a random order over a single session. Kinematic data from the task were used to compute the normalized error and speed as well as the speed-error relationship. Results. Low functioning stroke subjects (Fugl-Meyer Scale score = 16.6 ± 6.5) showed the lowest error with path assistance plus weight support, whereas high functioning stroke subjects (Fugl-Meyer Scale score = 59.6 ± 6.8) moved faster with path assistance alone. When both speed and error were considered together, low functioning subjects significantly reduced their error and increased their speed but showed no difference across the robotic conditions. Conclusions. Robotic assistance can facilitate repetitive task performance in individuals with severe arm motor impairment, but path assistance provides little advantage over weight support alone. Future studies focusing on antigravity arm movement control are warranted poststroke.

Diagnosis and management of musculoskeletal pain is a major clinical challenge. Following this need, the first aim of our study was to provide an innovative magnetic resonance technique called T_1ρ to quantify possible alterations in elbow pain, a common musculoskeletal pain syndrome that has not a clear etiology. Five patients were recruited presenting chronic elbow pain (>3 months), with an age between 30 and 70 years old. Patients underwent two T_1ρ-mapping evaluations, one before and one after the series of Fascial Manipulation^® (FM) treatments. After the first MRI evaluation, a Disability of the Arm, Shoulder and Hand (DASH) questionnaire was administered to quantify the symptoms and pain intensity. Patients then received three sessions of FM, once a week for 40 min each. A statistically significant difference was found between bound and unbound water concentration before and after FM treatment. Our preliminary data suggest that the application of the manual method seems to decrease the concentration of unbound water inside the deep fascia in the most chronic patients. This could explain the change in viscosity perceived by many practitioners as well as the decrease of symptoms due to the restoration of the normal property of the loose connective tissue. Being able to identify an altered deep fascial area may better guide therapies, contributing to a more nuanced view of the mechanisms of pain.