Heather Hayes

A feasibility study of an upper limb rehabilitation system using kinect and computer games

A new low-cost system for rehabilitation of the impaired upper limb for stroke survivors is presented. A computer game was developed specifically for this purpose and the users impaired upper extremity is tracked using a downward-pointed Kinect, an inexpensive motion capture system commercially available from Microsoft. A Kalman filter was implemented to reduce data jittering. Patients are required to move their impaired arm, sliding it on top of a transparent support, in order to play the game. The game is personalized to the patient through specific settings that adapt to the patients range of motion and motor control at the start of the game as well as performance during the game. The final score is proportional to the arms movement speed. A feasibility study was carried out with one stroke survivor. The game was played for ten days and usability surveys were answered before and after the study. The patient was engaged with the game, found it easy to understand and reported willingness to use it in the home environment and enjoyment of the use in the clinic.

Kinetic Gait Analysis Using a Low-Cost Insole

Abnormal gait caused by stroke or other pathological reasons can greatly impact the life of an individual. Being able to measure and analyze that gait is often critical for rehabilitation. Motion analysis labs and many current methods of gait analysis are expensive and inaccessible to most individuals. The low-cost, wearable, and wireless insole-based gait analysis system in this study provides kinetic measurements of gait by using low-cost force sensitive resistors. This paper describes the design and fabrication of the insole and its evaluation in six control subjects and four hemiplegic stroke subjects. Subject-specific linear regression models were used to determine ground reaction force plus moments corresponding to ankle dorsiflexion/plantarflexion, knee flexion/extension, and knee abduction/adduction. Comparison with data simultaneously collected from a clinical motion analysis laboratory demonstrated that the insole results for ground reaction force and ankle moment were highly correlated (all >0.95) for all subjects, while the two knee moments were less strongly correlated (generally >0.80). This provides a means of cost-effective and efficient healthcare delivery of mobile gait analysis that can be used anywhere from large clinics to an individuals home.

Effects of high-intensity resistance training on strength, mobility, balance, and fatigue in individuals with multiple sclerosis: a randomized controlled trial.

Background and Purpose: Resistance exercise via negative, eccentrically induced work (RENEW) has been shown to be associated with improvements in strength, mobility, and balance in multiple clinical populations. However, RENEW has not been reported for individuals with multiple sclerosis (MS). Methods: Nineteen individuals with MS (8 men, 11 women; age mean = 49 ± 11 years; Expanded Disability Status Scale [EDSS] mean = 5.2 ± 0.9) were randomized into either standard exercise (STAND) or standard exercise and RENEW training (RENEW) for 3×/week for 12 weeks. Outcome measures were lower extremity strength (hip/knee flexion and extension, ankle plantar and dorsiflexion, and the sum of these individual values [sum strength]); Timed Up and Go (TUG), 10-m walk, self-selected pace (TMWSS) and maximal-pace (TMWMP), stair ascent (S-A) and descent (S-D) and 6-Minute Walk Test (6MWT), Berg Balance Scale (BBS), Fatigue Severity Scale (FSS). Results: No significant time effects or interactions were observed for strength, TUG, TMWSS, TMWMP, or 6MWT. However, the mean difference in sum strength in the RENEW group was 38.60 (representing a 15% increase) compared to the sum strength observed in the STAND group with a mean difference of 5.58 (a 2% increase). A significant interaction was observed for S-A, S-D, and BBS as the STAND group improved whereas the RENEW group did not improve in these measures. Discussion and Conclusions: Contrary to results in other populations, the addition of eccentric training to standard exercises did not result in significantly greater lower extremity strength gains in this group of individuals with MS. Further this training was not as effective as standard exercise alone in improving balance or the ability to ascend and descend stairs. Following data collection, reassessment of required sample size indicates we were likely underpowered to detect strength differences between groups.

Does Dopamine Replacement Medication Affect Postural Sequence Learning in Parkinson’s Disease?

The aim of this study was to examine (1) the temporal structures of variation in rowers’ (natural) ergometer strokes to make inferences about the underlying motor organization, and (2) the relation between these temporal structures and skill level. Four high-skilled and five lower-skilled rowers completed 550 strokes on a rowing ergometer. Detrended Fluctuation Analysis was used to quantify the temporal structure of the intervals between force peaks. Results showed that the temporal structure differed from random, and revealed prominent patterns of pink noise for each rower. Furthermore, the high-skilled rowers demonstrated more pink noise than the lower-skilled rowers. The presence of pink noise suggeststhat rowing performance emerges from the coordination among interacting component processes across multiple time scales. The difference in noise pattern between high-skilled and lower-skilled athletes indicates that the complexity of athletes’ motor organization is a potential key characteristic of elite performance.Deficits in sequence-specific learning (SSL) may be a product of Parkinsons disease (PD) but this deficit could also be related to dopamine replacement. The purpose of this study was to determine whether dopamine replacement affected acquisition and retention of a standing Continuous Tracking Task in individuals with PD. SSL (difference between random/repeated Root Mean Square Error across trials) was calculated over 2 days of practice and 1 day of retention for 4 groups; 10 healthy young (HY), 10 healthy elders, 10 individuals with PD on, 9 individuals with PD off their usual dosage of dopamine replacement. Improvements in acquisition were observed for all groups; however, only the HY demonstrated retention. Therefore, age appeared to have the largest effect on SSL with no significant effect of medication. Additional research is needed to understand the influence of factors such as practice amount, task difficulty, and dopamine replacement status on SSL deficits during postural tasks.

Implicit motor sequence learning in individuals with Parkinson disease: A meta-analysis

BACKGROUND Deficits in implicit motor sequence learning (IMSL) in individuals with Parkinson disease (PD) compared to age matched healthy controls (HC) are unclear. OBJECTIVE The purpose of this paper is to present results of a systematic review with a meta-analysis examining the hypothesis that IMSL is impaired in individuals with PD when compared to HC. METHODS Fifteen articles met our final criteria and assessed 299 individuals with PD and 244 HC. Raw mean and standard deviation data for the final block of repeated and final block of random practice trials were obtained to calculate sequence-specific learning (SSL) for individuals with PD and HC. Forest plots were used to depict the comparison of the groups by assessing standardized mean difference with random effect size. RESULTS A significant and moderate effect size, 0.83 was found suggesting that individuals with PD demonstrated impaired SSL of motor sequences compared to HC. CONCLUSIONS Individuals with PD demonstrate a deficit compared with HC in their ability to implicitly learn motor tasks. Existing research lacks detail on the factors which may alter IMSL, either negatively or positively, such as the design features of current IMSL paradigms utilized and disease-specific characteristics. Successful motor rehabilitation of functional tasks in persons with PD is highly dependent on IMSL; therefore, an improved knowledge of the influence of these additional variables is critical.

Disease burden and functional outcomes in congenital myotonic dystrophy A cross-sectional study

Objective: Herein, we describe the disease burden and age-related changes of congenital-onset myotonic dystrophy (CDM) in childhood. Methods: Children with CDM and age-matched controls aged 0 to 13 years were enrolled. Participants were divided into cohorts based on the following age groups: 0–2, 3–6, and 7–13 years. Each cohort received age-appropriate evaluations including functional testing, oral facial strength testing, neuropsychological testing, quality-of-life measurements, and ECG. Independent-samples t test or Wilcoxon 2-sample test was used to compare the differences between children with CDM and controls. Probability values less than 0.05 are reported as significant. Results: Forty-one participants with CDM and 29 healthy controls were enrolled. The 6-minute walk was significantly different between CDM (258.3 m [SD 176.0]) and control participants (568.2 m [SD 73.2]). The mean lip force strength was significantly different in CDM (2.1 N [SD 2.8)] compared to control participants (17.8 N [SD 7.6]). In participants with CDM, the mean IQ (65.8; SD 18.4) was 3 SDs below the mean compared to standardized norms. Measurements of grip strength, sleep quality, and quality of life were also significantly different. Strength measures (oral facial strength, grip strength, and 6-minute walk) correlated with each other but not with participant IQ. Conclusions: This work identifies important phenotypes associated with CDM during childhood. Several measures of strength and function were significantly different between participants with CDM and controls and may be useful during future therapeutic trials.

Poster 90: Assessing Stroke Patients' Steps using the Garmin Vivofit3: A Validity Study

Disclosures: Allison Capizzi: I Have No Relevant Financial Relationships To Disclose Objective: To determine whether a commercially available fitness tracker can offer valid and reliable step counts for ambulatory, hemiparetic stroke patients. Design: The commercial activity tracker, the Garmin Vivofit3, was chosen based on low price, ability to sync wirelessly with a smart phone and long battery life. Each participant wore 2 devices, one on each wrist, and was videotaped while ambulating at a self-selected pace for a total of 6 minutes. Steps tracked by each Garmin Vivofit3 was recorded. Two separate research investigators watched the videos independently and counted total steps, which is considered the gold standard. Step counts recorded by the Garmin Vivofit3 on the unaffected arm and the hemiparetic arm were compared to the video gold standard. Setting: An outpatient tertiary care center. Participants: Five stroke patients (2 males and 3 females; mean age 1⁄4 52.4 years) who were ambulatory with a minimum Functional Ambulation Classification (FAC) of 5. Interventions: Not applicable Main Outcome Measures: Total steps taken during a 6-minute walk test. Results: There were large-sized correlations between step counts measured by video and those measured by Vivofit for normal limbs (r 1⁄4 0.958). The intraclass correlation was 0.929 (95% confidence interval 1⁄4 0.562 to 0.992). For hemiside limbs, the correlation was also large (r 1⁄4 0.723), yet producing more variability in the step counts. Conclusions: Findings suggest the commercially available Garmin Vivofit3 may be a reasonable alternative to medical grade activity trackers in assessment of step counts in stroke survivors. This offers a more cost-effective approach to motivating and tracking physical activity compared to current research-grade devices (e.g. StepWatch) which are cost prohibitive and do not allow patients to interact with their activity data. We realize the limitations of this small sample size. We intend to use these results for a larger study evaluating commercial activity trackers in motivating ambulation in the post-stroke population. Level of Evidence: Level III

Modified dynamic gait index and limits of stability in myotonic dystrophy type 1: Balance and Falls in DM1

Introduction: The purpose of this study was to describe and compare the performance of balance and walking tests in relation to self‐reported fall history in adults with myotonic dystrophy type 1 (DM1). Methods: Twenty‐two (13 male) participants with DM1 completed, a 6‐month fall history questionnaire, the modified Dynamic Gait Index (mDGI), limits of stability (LoS) testing, and 10‐m walking tests. Results: Mean (SD) falls in 6 months was 3.7 (3.1), and 19 (86%) participants reported at least 1 fall. Significant differences in mDGI scores (P = 0.006) and 10‐m fast walking gait velocity (P = 0.02) were found between those who had been classified as “fallers” and those who had been classified as “nonfallers.” Significant correlations were found between mDGI scores and 10‐m walking time. Discussion: Falls are common in DM1, and the mDGI may have potential to distinguish fallers from nonfallers, whereas the LoS failed to detect such impairment. Future studies should further explore use of the mDGI in DM1. Muscle Nerve 58: 694–699, 2018

Increased practice of a standing motor sequence task in healthy young and healthy elders: Short communication

BACKGROUND Sequence-specific learning (SSL); the ability to implicitly integrate repeated sequences compared to random sequences during a motor sequence paradigm, is impaired in healthy elders (HE) compared to healthy young (HY). Prior studies have provided limited practice (small repetitions and only 1 to 3 days). RESEARCH QUESTION Using a standing, postural control task we sought to assess if more practice (7 days) would remediate the differences observed in SSL for HE. METHODS We used a continuous tracking task following a sinusoidal path of randomly presented random and repeated patterns. Root mean square error (RMSE) was the primary dependent variable, and the difference in RMSE between the random and repeated sequences was calculated to determine if SSL occurred. RESULTS Improvement in SSL was documented as a decreasing value of the mean repeated sequence and less or no change in the random sequence. Eight HY and 8 HE practiced the repeated sequences 420 times over 7 days. No differences were observed between the groups on cognition, balance, and mobility. HE did not demonstrate the ability to integrate the repeated sequence on day 1, but with increased practice, they integrated the repeated sequence similar to HY by the end of practice. The results of this study suggest that sustained practice over 7 days remediated differences in performance of a standing, implicit, sequence-specific task between HY and HE. SIGNIFICANCE Clinically, it is important to provide individuals with sufficient practice amount to achieve integration of a standing task. Results suggest that older adults need more practice to demonstrate SSL.

Reviews of wellness and physical activity web sites for persons with neurological disability.

National Center on Health, Physical Activity, and Disability Web Site T he National Center on Health, Physical Activity, and Disability has a mission to improve health behaviors and weight management for children and adults with disabilities. The Web site (www.ncpad.org) is supported by a grant from the Centers for Disease Control and Prevention and managed by the University of Alabama and Lakeshore Foundation Research Collaborative. The majority of the Web site is focused on providing information related to exercise, physical activity, and nutrition, specifically for individuals with various chronic health conditions and disability levels, who may have difficulty participating in traditional exercise programs. The home page contains links to numerous articles with diagnosis-specific advice for increasing participation in exercise, wellness, and improving nutrition. A wide range of both mental and physical health conditions are covered in the articles, from arthritis and autism, to spinal cord and brain injuries. Links are also provided for articles about community physical activity program development and competitive sports. For those less familiar with exercise, a fact sheet describing various exercise techniques and methods such as aquatic therapy and tai chi is also available. On the home page, individuals will also find links to an adaptive fitness program that includes both aerobic and resistive exercise. The program has 3 levels, and has been adapted to accommodate a multitude of functional abilities. The three levels target individuals who have the use of all four limbs, individuals who have the use of upper body including some core muscles, and individuals with a limited use of upper body and core muscles. This exercise program is updated weekly with new exercises, although it is currently unclear who actually develops the exercise program. The weekly program relies on the use of standard fitness equipment. For those who do not have access to the necessary equipment, links are available to a 14-week program that is customized on the basis of responses to questions concerning physical ability and available equipment. While the Web site is a wealth of information with many good articles and fitness programs, it is sometimes both troublesome to navigate and difficult to find specific content. For example, under Articles, there is a long list subheadings with a number of redundancies, including Spinal Cord Injury, Paraplegia, Quadriplegia, and Tetraplegia. Furthermore, the system for allocating articles between these categories is not clear. The design of the Web site is also text-heavy, requiring a large amount of time and scrolling to find specific content. In addi-