Cathy Chou

A standardized approach to the Fugl-Meyer assessment and its implications for clinical trials.

Background. Standardizing scoring reduces variability and increases accuracy. A detailed scoring and training method for the Fugl-Meyer motor assessment (FMA) is described and assessed, and implications for clinical trials considered. Methods. A standardized FMA scoring approach and training materials were assembled, including a manual, scoring sheets, and instructional video plus patient videos. Performance of this approach was evaluated for the upper extremity portion. Results. Inter- and intrarater reliability in 31 patients were excellent (intraclass correlation coefficient = 0.98-0.99), validity was excellent (r = 0.74-0.93, P < .0001), and minimal detectable change was low (3.2 points). Training required 1.5 hours and significantly reduced error and variance among 50 students, with arm FMA scores deviating from the answer key by 3.8 ± 6.2 points pretraining versus 0.9 ± 4.9 points posttraining. The current approach was implemented without incident into training for a phase II trial. Among 66 patients treated with robotic therapy, change in FMA was smaller (P ≤ .01) at the high and low ends of baseline FMA scores. Conclusions. Training with the current method improved accuracy, and reduced variance, of FMA scoring; the 20% FMA variance reduction with training would decrease sample size requirements from 137 to 88 in a theoretical trial aiming to detect a 7-point FMA difference. Minimal detectable change was much smaller than FMA minimal clinically important difference. The variation in FMA gains in relation to baseline FMA suggests that future trials consider a sliding outcome approach when FMA is an outcome measure. The current training approach may be useful for assessing motor outcomes in restorative stroke trials.

Comparison of three-dimensional, assist-as-needed robotic arm/hand movement training provided with Pneu-WREX to conventional tabletop therapy after chronic stroke.

ObjectivesRobot-assisted movement training can help individuals with stroke reduce arm and hand impairment, but robot therapy is typically only about as effective as conventional therapy. Refining the way that robots assist during training may make them more effective than conventional therapy. Here, the authors measured the therapeutic effect of a robot that required individuals with a stroke to achieve virtual tasks in three dimensions against gravity. DesignThe robot continuously estimated how much assistance patients needed to perform the tasks and provided slightly less assistance than needed to reduce patient slacking. Individuals with a chronic stroke (n = 26; baseline upper limb Fugl-Meyer score, 23 ± 8) were randomized into two groups and underwent 24 one-hour training sessions over 2 mos. One group received the assist-as-needed robot training and the other received conventional tabletop therapy with the supervision of a physical therapist. ResultsTraining helped both groups significantly reduce their motor impairment, as measured by the primary outcome measure, the Fugl-Meyer score, but the improvement was small (3.0 ± 4.9 points for robot therapy vs. 0.9 ± 1.7 for conventional therapy). There was a trend for greater reduction for the robot-trained group (P = 0.07). The robot group largely sustained this gain at the 3-mo follow-up. The robot-trained group also experienced significant improvements in Box and Blocks score and hand grip strength, whereas the control group did not, but these improvements were not sustained at follow-up. In addition, the robot-trained group showed a trend toward greater improvement in sensory function, as measured by the Nottingham Sensory Test (P = 0.06). ConclusionsThese results suggest that in patients with chronic stroke and moderate-severe deficits, assisting in three-dimensional virtual tasks with an assist-as-needed controller may make robotic training more effective than conventional tabletop training.

The feasibility of a brain-computer interface functional electrical stimulation system for the restoration of overground walking after paraplegia

BackgroundDirect brain control of overground walking in those with paraplegia due to spinal cord injury (SCI) has not been achieved. Invasive brain-computer interfaces (BCIs) may provide a permanent solution to this problem by directly linking the brain to lower extremity prostheses. To justify the pursuit of such invasive systems, the feasibility of BCI controlled overground walking should first be established in a noninvasive manner. To accomplish this goal, we developed an electroencephalogram (EEG)-based BCI to control a functional electrical stimulation (FES) system for overground walking and assessed its performance in an individual with paraplegia due to SCI.MethodsAn individual with SCI (T6 AIS B) was recruited for the study and was trained to operate an EEG-based BCI system using an attempted walking/idling control strategy. He also underwent muscle reconditioning to facilitate standing and overground walking with a commercial FES system. Subsequently, the BCI and FES systems were integrated and the participant engaged in several real-time walking tests using the BCI-FES system. This was done in both a suspended, off-the-ground condition, and an overground walking condition. BCI states, gyroscope, laser distance meter, and video recording data were used to assess the BCI performance.ResultsDuring the course of 19 weeks, the participant performed 30 real-time, BCI-FES controlled overground walking tests, and demonstrated the ability to purposefully operate the BCI-FES system by following verbal cues. Based on the comparison between the ground truth and decoded BCI states, he achieved information transfer rates >3 bit/s and correlations >0.9. No adverse events directly related to the study were observed.ConclusionThis proof-of-concept study demonstrates for the first time that restoring brain-controlled overground walking after paraplegia due to SCI is feasible. Further studies are warranted to establish the generalizability of these results in a population of individuals with paraplegia due to SCI. If this noninvasive system is successfully tested in population studies, the pursuit of permanent, invasive BCI walking prostheses may be justified. In addition, a simplified version of the current system may be explored as a noninvasive neurorehabilitative therapy in those with incomplete motor SCI.

Corticospinal Excitability as a Predictor of Functional Gains at the Affected Upper Limb Following Robotic Training in Chronic Stroke Survivors

Background. Robotic training can help improve function of a paretic limb following a stroke, but individuals respond differently to the training. A predictor of functional gains might improve the ability to select those individuals more likely to benefit from robot-based therapy. Studies evaluating predictors of functional improvement after a robotic training are scarce. One study has found that white matter tract integrity predicts functional gains following a robotic training of the hand and wrist. Objective. To determine the predictive ability of behavioral and brain measures in order to improve selection of individuals for robotic training. Methods: Twenty subjects with chronic stroke participated in an 8-week course of robotic exoskeletal training for the arm. Before training, a clinical evaluation, functional magnetic resonance imaging (fMRI), diffusion tensor imaging, and transcranial magnetic stimulation (TMS) were each measured as predictors. Final functional gain was defined as change in the Box and Block Test (BBT). Measures significant in bivariate analysis were fed into a multivariate linear regression model. Results. Training was associated with an average gain of 6 ± 5 blocks on the BBT (P < .0001). Bivariate analysis revealed that lower baseline motor-evoked potential (MEP) amplitude on TMS, and lower laterality M1 index on fMRI each significantly correlated with greater BBT change. In the multivariate linear regression analysis, baseline MEP magnitude was the only measure that remained significant. Conclusion. Subjects with lower baseline MEP magnitude benefited the most from robotic training of the affected arm. These subjects might have reserve remaining for the training to boost corticospinal excitability, translating into functional gains.

Brain-computer interface driven functional electrical stimulation system for overground walking in spinal cord injury participant

The current treatment for ambulation after spinal cord injury (SCI) is to substitute the lost behavior with a wheelchair; however, this can result in many co-morbidities. Thus, novel solutions for the restoration of walking, such as brain-computer interfaces (BCI) and functional electrical stimulation (FES) devices, have been sought. This study reports on the first electroencephalogram (EEG) based BCI-FES system for overground walking, and its performance assessment in an individual with paraplegia due to SCI. The results revealed that the participant was able to purposefully operate the system continuously in real time. If tested in a larger population of SCI individuals, this system may pave the way for the restoration of overground walking after SCI.

SDO-AIA telescope design

The design of the 4 telescopes that make up the Solar Dynamics Observatory Atmospheric Imaging Assembly (SDOAIA) is described. This includes the optical design, optical mounting system, front aperture filters, and launch protection system. SDO-AIA is a study of taking a difficult telescope design and making four of them. We describe the technical challenges associated with the telescope mounting, mirror mounting, and the front aperture filter design and launch protection.

Alignment and calibration of the ICON-FUV instrument: Development of a vacuum UV facility

The optical calibration of the ICON-FUV instrument requires designing specific ground support equipment (GSE). The ICON-FUV instrument is a spectrographic imager that operates on two specific wavelengths in the UV (135.6 nm and 157 nm). All the operations have to be performed under vacuum UV light. The optical setup is based on a VUV monochromator coupled with a collimator that illuminates the FUV entrance slit. The instrument is placed on a manipulator providing fields pointing. Image quality and spectral properties can be then characterized for each field. OGSE, MGSE, optical calibration plan and vacuum alignment of the instrument are described.

VUV optical ground system equipment and its application to the ICON FUV flight grating characterization and selection

ICON FUV is a two channel spectrographic imager that measures intensity and spatial distribution of oxygen (135.6 nm) and molecular nitrogen (157 nm) of the ionosphere. As those wavelengths are strongly absorbed by the atmosphere, the optical elements of the system have to be tested inside vacuum chambers. Prior to the instrument alignment and calibration, two 3600 gr/mm gratings were characterized. The primary focus is the measurement of the diffraction efficiencies; while the second objective is to select the best grating and to define which is the flight and the spare. A dedicated setup has been developed to assess the grating optical performances under vacuum. A 1 cm diameter collimated beam is generated using an off-axis parabola and a UV source at its focal point. The grating is placed at the center of two rotation stages collinearly aligned. One detector is placed on a rotating arm, deported from its rotation center. A PMT detector records diffracted light intensity with respect to its angular position and its wavelength. Angular incidence on the grating is tuned with the help of the second rotation stage. The grating efficiency homogeneity and scattering properties are measured through a Y-X scan.

V-UV spectrographic imager (FUV) for Icon mission: from optical design to vacuum calibration

The ICON mission is led by the University of California-Berkeley (Space Sciences Laboratory). In the frame of this mission the Space Center of Liege was involved in the optical design optimization and related analysis, and VUV on ground calibration.

Optical design and optical properties of a VUV spectrographic imager for ICON mission

In the frame of the ICON (Ionospheric Connection Explorer) mission of NASA led by UC Berkeley, CSL and SSL Berkeley have designed in cooperation a new Far UV spectro-imager. The instrument is based on a Czerny-Turner spectrograph coupled with two back imagers. The whole field of view covers [± 12° vertical, ± 9° horizontal]. The instrument is surmounted by a rotating mirror to adjust the horizontal field of view pointing by ± 30°. To meet the scientific imaging and spectral requirements the instrument has been optimized. The optimization philosophy and related analysis are presented in the present paper. PSF, distortion map and spectral properties are described. A tolerance study and alignment cases were performed to prove the instrument can be built and aligned. Finally straylight and out of band properties are discussed.