109 research outputs found
Development and validation of upper extremity kinematic movement analysis for people with stroke. Reaching and drinking from a glass.
No full textKinematic analysis is a powerful method for objective assessment of movement performance, and is increasingly employed as outcome measure after stroke. The number of studies investigating natural, goal-oriented daily tasks is however small. Likewise, little is known how the actual movement performance measured with kinematics is related to the traditional clinical assessment scales. Furthermore, only few studies investigated longitudinal changes and evaluated what these changes mean in context of an individual’s functioning after stroke.
The overall aim of this thesis was to develop a method of three-dimensional movement analysis for a purposeful upper extremity task “drinking from a glass” and to evaluate the cross-sectional and longitudinal validity of the kinematic measures in relation to impairments and activity limitations in people with motor deficits after stroke.
Methods: The studies reported in the current thesis included 29 healthy individuals and 82 individuals with stroke. A standardized test protocol for the drinking task was developed and its consistency was examined. A five camera optoelectronic motion capture system with passive markers was used to measure both temporal and spatial kinematic characteristics of movement performance. The clinical outcomes used in the different studies were: Fugl-Meyer Assessment for Upper Extremity, Action Research Arm Test and ABILHAND questionnaire. The construct and criterion validity was examined in subacute and chronic stages after stroke; the longitudinal change and responsiveness was evaluated during the first three months after stroke.
Results: The test protocol of the drinking task demonstrated a good consistency in test-retest. The explorative analysis of kinematic data revealed that the drinking task can be described with two major factors in people with stroke. One of them included predominantly measures of temporal nature (movement time, smoothness, velocity) and the other comprised primarily spatial movement pattern measures (joint angles, trunk displacement). Four kinematic measures: movement time, movement smoothness, angular velocity of the elbow and compensatory trunk displacement; demonstrated to be most effective in discriminating among individuals with moderate or mild impairment level after stroke and healthy persons. Subsequently, three kinematic measures: movement smoothness, movement time and trunk displacement emerged demonstrating strongest association with upper extremity activity capacity level after stroke, measured with Action Research Arm Test. Finally, all those three kinematic measures showed to be responsive for capturing improvements in upper extremity activity during the first three months after stroke.
Conclusions and clinical implications: Three kinematic measures of the drinking task: movement smoothness, movement time and trunk displacement; demonstrated to be valid and responsive measures for characterizing the upper extremity function and to capture an improvement over time after stroke. It can be concluded, that the test protocol of the drinking task as described in this thesis is feasible for clinical studies and provides objective, valid and clinically interpretable data of an individual’s actual movement performance during the drinking task. This knowledge facilitates both clinical and movement analysis research and can be valuable in the area of bioengineering when assessment methods for new technology based devices are developed
sj-docx-1-nnr-10.1177_15459683231222026 – Supplemental material for Criteria and Indicators for Centers of Clinical Excellence in Stroke Recovery and Rehabilitation: A Global Consensus Facilitated by ISRRA
No full textSupplemental material, sj-docx-1-nnr-10.1177_15459683231222026 for Criteria and Indicators for Centers of Clinical Excellence in Stroke Recovery and Rehabilitation: A Global Consensus Facilitated by ISRRA by Rachel C. Stockley, Marion F. Walker, Margit Alt Murphy, Noor Azah Abd Aziz, Philemon Amooba, Leonid Churliov, Amanda Farrin, Natalie A. Fini, Emma Ghaziani, Erin Godecke, Tania Gutierrez-Panchana, Jie Jia, Thoshenthri Kandasamy, Patrice Lindsay, John Solomon, Vincent Thijs, Tierney Tindall, Donna C. Tippett, Caroline Watkins and Elizabeth Lynch in Neurorehabilitation and Neural Repair</p
European evidence-based recommendations for clinical assessment of upper limb in neurorehabilitation (CAULIN): data synthesis from systematic reviews, clinical practice guidelines and expert consensus: data synthesis from systematic reviews, clinical practice guidelines and expert consensus
No full textPublisher Copyright: © 2021, The Author(s).Background: Technology-supported rehabilitation can help alleviate the increasing need for cost-effective rehabilitation of neurological conditions, but use in clinical practice remains limited. Agreement on a core set of reliable, valid and accessible outcome measures to assess rehabilitation outcomes is needed to generate strong evidence about effectiveness of rehabilitation approaches, including technologies. This paper collates and synthesizes a core set from multiple sources; combining existing evidence, clinical practice guidelines and expert consensus into European recommendations for Clinical Assessment of Upper Limb In Neurorehabilitation (CAULIN). Methods: Data from systematic reviews, clinical practice guidelines and expert consensus (Delphi methodology) were systematically extracted and synthesized using strength of evidence rating criteria, in addition to recommendations on assessment procedures. Three sets were defined: a core set: strong evidence for validity, reliability, responsiveness and clinical utility AND recommended by at least two sources; an extended set: strong evidence OR recommended by at least two sources and a supplementary set: some evidence OR recommended by at least one of the sources. Results: In total, 12 measures (with primary focus on stroke) were included, encompassing body function and activity level of the International Classification of Functioning and Health. The core set recommended for clinical practice and research: Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT); the extended set recommended for clinical practice and/or clinical research: kinematic measures, Box and Block Test (BBT), Chedoke Arm Hand Activity Inventory (CAHAI), Wolf Motor Function Test (WMFT), Nine Hole Peg Test (NHPT) and ABILHAND; the supplementary set recommended for research or specific occasions: Motricity Index (MI); Chedoke-McMaster Stroke Assessment (CMSA), Stroke Rehabilitation Assessment Movement (STREAM), Frenchay Arm Test (FAT), Motor Assessment Scale (MAS) and body-worn movement sensors. Assessments should be conducted at pre-defined regular intervals by trained personnel. Global measures should be applied within 24 h of hospital admission and upper limb specific measures within 1 week. Conclusions: The CAULIN recommendations for outcome measures and assessment procedures provide a clear, simple, evidence-based three-level structure for upper limb assessment in neurological rehabilitation. Widespread adoption and sustained use will improve quality of clinical practice and facilitate meta-analysis, critical for the advancement of technology-supported neurorehabilitation.Peer reviewe
A Systematic Review of International Clinical Guidelines for Rehabilitation of People With Neurological Conditions : What Recommendations Are Made for Upper Limb Assessment?
No full textBackground: Upper limb impairment is a common problem for people with neurological disabilities, affecting activity, performance, quality of life, and independence. Accurate, timely assessments are required for effective rehabilitation, and development of novel interventions. International consensus on upper limb assessment is needed to make research findings more meaningful, provide a benchmark for quality in clinical practice, more cost-effective neurorehabilitation and improved outcomes for neurological patients undergoing rehabilitation.
Aim: To conduct a systematic review, as part of the output of a European COST Action, to identify what recommendations are made for upper limb assessment.
Methods: We systematically reviewed published guidance on measures and protocols for assessment of upper limb function in neurological rehabilitation via electronic databases from January 2007-December 2017. Additional records were then identified through other sources. Records were selected for inclusion based on scanning of titles, abstracts and full text by two authors working independently, and a third author if there was disagreement. Records were included if they referred to "rehabilitation" and "assessment" or "measurement". Reasons for exclusion were documented.
Results: From the initial 552 records identified (after duplicates were removed), 34 satisfied our criteria for inclusion, and only six recommended specific outcome measures and /or protocols. Records were divided into National Guidelines and other practice guidelines published in peer reviewed Journals. There was agreement that assessment is critical, should be conducted early and at regular intervals and that there is a need for standardized measures. Assessments should be conducted by a healthcare professional trained in using the measure and should encompass body function and structure, activity and participation.
Conclusions: We present a comprehensive, critical, and original summary of current recommendations. Defining a core set of measures and agreed protocols requires international consensus between experts representing the diverse and multi-disciplinary field of neurorehabilitation including clinical researchers and practitioners, rehabilitation technology researchers, and commercial developers. Current lack of guidance may hold-back progress in understanding function and recovery. Together with a Delphi consensus study and an overview of systematic reviews of outcome measures it will contribute to the development of international guidelines for upper limb assessment in neurological conditions.peerReviewe
Letter by Murphy et al Regarding Article, “Fugl-Meyer Assessment of Sensorimotor Function After Stroke: Standardized Training Procedure for Clinical Practice and Clinical Trials”
No full textKinematic analysis of the upper extremity after stroke - How far have we reached and what have we grasped?
No full textWhat has been gained from the recent advances in kinematic analysis of the upper extremity after stroke?
No full textA review of international clinical guidelines for rehabilitation of people with neurological conditions: what recommendations are made for upper limb assessment?
No full textBackground: upper limb impairment is a common problem for people with neurological disabilities, affecting activity, performance, quality of life and independence. Accurate, timely assessments are required for effective rehabilitation, and development of novel interventions. International consensus on upper limb assessment is needed to make research findings be more meaningful, provide a benchmark for quality in clinical practice, more cost-effective neurorehabilitation and improved outcomes for neurological patients undergoing rehabilitation.Aim: to conduct a systematic review, as part of the output of a European COST Action, to identify what recommendations aremade for upper limb assessment.Methods: we systematically reviewed published guidance on measures and protocols for assessing upper limb function inneurological rehabilitation via electronic databases from January 2007 – December 2017. Additional records were then identified through other sources. Records were selected for inclusion based on scanning of titles, abstracts and full text by two authors working independently, and a third author if there was disagreement. Records were included if they referred to ‘rehabilitation’ and ‘assessment’ or ‘measurement’. Reasons for exclusion were documented.Results: From the initial 552 records identified (after duplicates were removed), 34 satisfied our criteria for inclusion and only six recommended specific outcome measures and /or protocols. Records were divided into National Guidelines and other practice guidelines published in peer reviewed journals. There was agreement that assessment is critical, should be conducted early and at regular intervals and that there is a need for standardised measures. Assessments should be conducted by a healthcare professional trained in using the measure and should encompass body function and structure, activity and participation.Conclusions: we present a comprehensive, critical and original summary of current recommendations. Defining a core set of measures and agreed protocols requires international consensus between experts representing the diverse and multi-disciplinary field of neurorehabilitation including clinical researchers and practitioners, rehabilitation technology researchers and commercial developers. Current lack of guidance may hold-back progress in understanding function and recovery. Together with a Delphi consensus study and an overview of systematic reviews of outcome measures it will contribute to the development of international guidelines for upper limb assessment in neurological conditions
Responsiveness of Upper Extremity Kinematic Measures and Clinical Improvement During the First Three Months After Stroke
No full textBACKGROUND: . Kinematic movement analysis is increasingly used as an outcome measure in evaluation of upper extremity function after stroke. Little is known, however, about what observed longitudinal changes in kinematics mean in the context of an individual's functioning. In this study, the responsiveness and expected change in kinematic measures associated with clinically meaningful improvement in the upper extremity were evaluated. METHODS: . Kinematic movement analysis of a drinking task and Action Research Arm Test (ARAT) were performed early (9 days poststroke) and at 3 months after stroke in 51 subjects. The receiver-operating characteristic curve and linear regression analyses were used to evaluate responsiveness of kinematic parameters. RESULTS: . Movement time, smoothness, and trunk displacement discriminated those subjects demonstrating clinically meaningful improvements. Significant associations of 31% to 36% were found between the change in ARAT and kinematic measures. A real clinical improvement in kinematics lies in the range of 2.5 to 5 seconds, 3 to 7 units, and 2 to 5 cm in movement time, smoothness, and trunk displacement, respectively. CONCLUSIONS: . All kinematic measures reported in this study are responsive measures for capturing improvements in the upper extremity during the first 3 months after stroke. Approximate estimates for the expected change in kinematics associated with clinically meaningful improvement in upper extremity activity capacity illustrate the usefulness of the linear regression analysis for assessing responsiveness. This knowledge facilitates the selection of kinematic measures for clinical and movement analysis research as well as for technology-based devices
Recovery of kinematic arm function in well-performing people with subacute stroke: A longitudinal cohort study
No full textBackground: Most motor function improvements in people who have experienced strokes occur within the first 3 months. However, individuals showing complete or nearly complete arm function recovery, as assessed using clinical scales, still show certain movement kinematic deficits at 3 months, post-stroke. This study evaluated the changes in upper extremity kinematics, in individuals demonstrating minor clinical motor impairments, 3–12 months post-stroke, and also examined the association between kinematics and the subjects’s self-perceived hand abilities during the chronic stage, 12 months post-stroke.
Methods: Forty-two subjects recovering from strokes and having Fugl-Meyer upper extremity motor assessment scores ≥60 were included from the Stroke Arm Longitudinal Study at the University of Gothenburg (SALGOT). Kinematic analyses of a drinking task, performed 3, 6, and 12 months post-stroke, were compared with kinematic analyses performed in 35 healthy controls. The Stroke Impact Scale-Hand domain was evaluated at the 12-month follow-up.
Results: There were no significant changes in kinematic performance between 3 and 12 months, post-stroke. The patients recovering from stroke showed lower peak elbow extension velocities, and increased shoulder abduction and trunk displacement during drinking than did healthy controls, at all time points. At 12 months, post-stroke, better self-perceived arm functions correlated with improved trunk displacements, movement times, movement units, and time to peak velocity percentages.
Conclusion: Kinematic movement deficits, observed at 3 months post-stroke, remained unchanged at 12 months. Movement kinematics were associated with the patient’s self-perceived ability to use their more affected hand.
Trial registration: ClinicalTrials: NCT01115348
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