Iris Dimbwadyo-Terrer

A novel motion tracking system for evaluation of functional rehabilitation of the upper limbs

Upper limb function impairment is one of the most common sequelae of central nervous system injury, especially in stroke patients and when spinal cord injury produces tetraplegia. Conventional assessment methods cannot provide objective evaluation of patient performance and the tiveness of therapies. The most common assessment tools are based on rating scales, which are inefficient when measuring small changes and can yield subjective bias. In this study, we designed an inertial sensor-based monitoring system composed of five sensors to measure and analyze the complex movements of the upper limbs, which are common in activities of daily living. We developed a kinematic model with nine degrees of freedom to analyze upper limb and head movements in three dimensions. This system was then validated using a commercial optoelectronic system. These findings suggest that an inertial sensor-based motion tracking system can be used in patients who have upper limb impairment through data integration with a virtual reality-based neuroretation system.

Kinematic metrics based on the virtual reality system Toyra as an assessment of the upper limb rehabilitation in people with spinal cord injury.

The aim of this study was to develop new strategies based on virtual reality that can provide additional information to clinicians for the rehabilitation assessment. Virtual reality system Toyra has been used to record kinematic information of 15 patients with cervical spinal cord injury (SCI) while performing evaluation sessions using the mentioned system. Positive correlation, with a moderate and very strong association, has been found between clinical scales and kinematic data, considering only the subscales more closely related to the upper limb function. A set of metrics was defined combining these kinematic data to obtain parameters of reaching amplitude, joint amplitude, agility, accuracy, and repeatability during the evaluation sessions of the virtual reality system Toyra. Strong and moderate correlations have been also found between the metrics reaching and joint amplitude and the clinical scales.

Upper limb rehabilitation after spinal cord injury: a treatment based on a data glove and an immersive virtual reality environment

Abstract Purpose state: The aim of this preliminary study was to test a data glove, CyberTouch™, combined with a virtual reality (VR) environment, for using in therapeutic training of reaching movements after spinal cord injury (SCI). Method: Nine patients with thoracic SCI were selected to perform a pilot study by comparing two treatments: patients in the intervention group (IG) conducted a VR training based on the use of a data glove, CyberTouch™ for 2 weeks, while patients in the control group (CG) only underwent the traditional rehabilitation. Furthermore, two functional parameters were implemented in order to assess patient’s performance of the sessions: normalized trajectory lengths and repeatability. Results: Although no statistical significance was found, the data glove group seemed to obtain clinical changes in the muscle balance (MB) and functional parameters, and in the dexterity, coordination and fine grip tests. Moreover, every patient showed variations in at least one of the functional parameters, either along Y-axis trajectory or Z-axis trajectory. Conclusions: This study might be a step forward for the investigation of new uses of motion capture systems in neurorehabilitation, making it possible to train activities of daily living (ADLs) in motivational environments while measuring objectively the patient’s functional evolution. Implications for Rehabilitation Key findings: A motion capture application based on a data glove is presented, for being used as a virtual reality tool for rehabilitation. This application has provided objective data about patient’s functional performance. What the study has added: (1) This study allows to open new areas of research based on the use of different motion capture systems as rehabilitation tools, making it possible to train Activities of Daily Living in motivational environments. (2) Furthermore, this study could be a contribution for the development of clinical protocols to identify which types of patients will benefit most from the VR treatments, which interfaces are more suitable to be used in neurorehabilitation, and what types of virtual exercises will work best.

Novel kinematic indices for quantifying movement agility and smoothness after cervical Spinal Cord Injury

BACKGROUND After cervical Spinal Cord Injury (SCI), upper limb movements made by patients have a lack of smoothness and a hand velocity profile characterized by a high number of velocity peaks. OBJECTIVE The aim of the present paper is to propose three novel kinematic indices for quantifying movement agility and smoothness, and to analyze their discriminative capability between healthy and pathological people. METHODS 18 people, healthy and two groups of patients with cervical SCI, participated in the study. Kinematic indices in relation to movement agility and smoothness were computed from hand trajectories and velocity profiles during the performance of the ADL of drinking from a glass. RESULTS The proposed indices discriminated between healthy and SCI people. The results are greater in healthy than SCI people. Both smoothness indices detected significant differences between healthy and both SCI groups. Moreover, the Agility index showed capacity for discriminating between both patients groups. CONCLUSIONS The main contribution of this research consists on the proposal of kinematic indices from experimental data, whose results are dimensionless and relative to a pattern of healthy subjects. We hope that kinematic indices proposed are a step toward the standardization of the quantitative assessment of movement characteristics and functional impairments.

Objective metrics for functional evaluation of upper limb during the ADL of drinking: Application in SCI

Three-dimensional kinematic analysis provides quantitative assessment of upper limb motion and is used as an outcome measure to evaluate movement disorders. The aim of the present study is to present a set of kinematic metrics for quantifying characteristics of movement performance and the functional status of the subject during the execution of the activity of daily living (ADL) of drinking from a glass. Then, the objective is to apply these metrics in healthy people and a population with cervical spinal cord injury (SCI), and to analyze the metrics ability to discriminate between healthy and pathologic people. 19 people participated in the study: 7 subjects with metameric level C6 tetraplegia, 4 subjects with metameric level C7 tetraplegia and 8 healthy subjects. The movement was recorded with a photogrammetry system. The ADL of drinking was divided into a series of clearly identifiable phases to facilitate analysis. Metrics describing the time of the reaching phase, the range of motion of the joints analyzed, and characteristics of movement performance such as the efficiency, accuracy and smoothness of the distal segment and inter-joint coordination were obtained. The performance of the drinking task was more variable in people with SCI compared to the control group in relation to the metrics measured. Reaching time was longer in SCI groups. The proposed metrics showed capability to discriminate between healthy and pathologic people. Relative deficits in efficiency were larger in SCI people than in controls. These metrics can provide useful information in a clinical setting about the quality of the movement performed by healthy and SCI people during functional activities.

Virtual Reality System Toyra: A New Tool to Assess and Treatment for Upper Limb Motor Impairment in Patients with Spinal Cord Injury

Virtual reality (VR) systems could induce a better activity of the motor control system and promote a cortical reorganization with the observation and imitation of actions, through the mirror neurons system activation. The aim of this study was to assess the efficacy of VR system named Toyra® as a tool for assessment and treatment of upper limbs in people with cervical spinal cord injury (SCI). A randomized clinical trial of 14 complete cervical spinal cord injury participants was carried out. Kinematic and functional parameters were registered with Toyra® and assessments scales. The intervention group performed Evaluation and Activities of Daily Living sessions with Toyra®. The control group only did Evaluation Toyra® sessions and traditional therapy. Statistically significant differences were obtained after treatment in the intervention group (p <0.05) in parameters relationship with dexterity, coordination and grip functions, and also it was also observed a trend of improvement in kinematic and functional parameters.

Novel kinematic indices for quantifying upper limb ability and dexterity after cervical spinal cord injury

Loss of motor function is a consequence after cervical spinal cord injury. Three-dimensional kinematic analysis equipments are used for quantifying human movements in clinical laboratories. These systems may provide objectivity to the patient assessments. Nowadays, the kinematic variables found in the literature have some deficiencies, and the efficient management of these data sets is a demand and a challenge in the clinical setting. The aim of the present paper is to propose a set of novel kinematic indices, as a combination of kinematic variables, for quantifying upper limb motor disorders in terms of characteristics in relation to ability and dexterity such as accuracy, efficiency, and coordination. These indices are defined for measuring patients’ motor performance during the activity of daily living of drinking from a glass. This task is included within the upper limb rehabilitative process that patients receive. The main contribution of this research, with the aim of detecting upper limb impairments in patients, consists of the proposal of three kinematic indices from experimental data, whose results are dimensionless and relative to a pattern of healthy subjects. We hope that kinematic indices proposed are a step toward the standardization of the quantitative assessment of movement characteristics and functional impairments.

Kinematic Indices for Upper Extremity Assessment After Spinal Cord Injury: A Case of Study

A 38-year-old man, with incomplete spinal cord injury at the C6 level, classified as American Spinal Injury Impairment Scale C (AIS), right-handed, participated in a study for assessing the upper extremity functionality in an objective way by means of a set of kinematic indices for quantifying upper extremity ability and dexterity. Along his rehabilitative treatment, the participant was evaluated twice over 6 weeks, with the main objective of analyzing the upper extremity functional changes in the kinematic indices proposed between both assessments in relation to accuracy, agility, efficiency, coordination and smoothness movement characteristics during the performance of the drinking activity of daily living. Results: The kinematic indices proposed showed more functional changes within the patient that the clinical scales. Conclusion: Data from one subject showed important information on the feasibility and effectiveness of the kinematic indices for detecting upper extremity functional changes after incomplete spinal cord injury.

Activities of daily living assessment in spinal cord injury using the virtual reality system Toyra®: functional and kinematic correlations

Abstract The main objective of this study was to analyze the correlations between functional scales and kinematic data collected during the execution of upper limb (UL) basic activities of daily living in an immersive virtual reality (VR) environment. Fifteen people with tetraplegia participated in the study. Moreover, we also want to confirm if changes in UL functional performance detected by functional scales are also detected by the VR system Toyra®. Patients were assessed before and after 4 weeks of daily conventional rehabilitation treatment complemented with a training with the VR system. Significant positive correlations between kinematic and functional parameters were found in the post assessment, verifying that changes in UL functional performance detected by functional scales are also measured by the VR system Toyra®, concretely the related to shoulder movements. Additionally, a predefined Agility metric has been applied, showing inversely proportional results to the level of injury, as we expected. The self-care category of the Spinal Cord Independence Measure (SCIM III) and the ranges of motion (ROM) captured with the VR system were analyzed, showing statistical significance changes between pre-post evaluations, supporting the hypothesis that kinematic analysis complements clinical and functional assessments of patients with tetraplegia.

A data-globe and immersive virtual reality environment for upper limb rehabilitation after spinal cord injury

While a number of virtual data-gloves have been used in stroke, there is little evidence about their use in spinal cord injury (SCI). A pilot clinical experience with nine SCI subjects was performed comparing two groups: one carried out a virtual rehabilitation training based on the use of a data glove, CyberTouch combined with traditional rehabilitation, during 30 minutes a day twice a week along two weeks; while the other made only conventional rehabilitation. Furthermore, two functional indexes were developed in order to assess the patient’s performance of the sessions: normalized trajectory lengths and repeatability. While differences between groups were not statistically significant, the data-glove group seemed to obtain better results in the muscle balance and functional parameters, and in the dexterity, coordination and fine grip tests. Related to the indexes that we implemented, normalized trajectory lengths and repeatability, every patient showed an improvement in at least one of the indexes, either along Y-axis trajectory or Z-axis trajectory. This study might be a step in investigating new ways of treatments and objective measures in order to obtain more accurate data about the patient’s evolution, allowing the clinicians to develop rehabilitation treatments, adapted to the abilities and needs of the patients.