The efects of an object’s height and weight on force calibration and kinematics when post‑stroke and healthy individuals reach and grasp

18 pages in total for your doctor to analyze and implement. These are obviously high functioning individuals already. I have zero grasping ability and very distorted reaching, both problems as a result of spasticity.  You have to cure spasticity first before this helps most survivors.

The efects of an object’s height and weight on force calibration and kinematics when post‑stroke and healthy individuals reach and grasp

 p Ronit Feingold‑Polak1,6, AnnaYelkin1,2,6, Shmil Edelman3 , Amir Shapiro3 & Shelly Levy‑Tzedek1,4,5* 

Impairment in force regulation and motor control impedes the independence of individuals with stroke by limiting their ability to perform daily activities. There is, at present, incomplete information about how individuals with stroke regulate the application of force and control their movement when reaching, grasping, and lifting objects of diferent weights, located at diferent heights. In this study, we assess force regulation and kinematics when reaching, grasping, and lifting a cup of two diferent weights (empty and full), located at three diferent heights, in a total of 46 participants: 30 sub-acute stroke participants, and 16 healthy individuals. We found that the height of the reached target afects both force calibration and kinematics, while its weight afects only the force calibration when poststroke and healthy individuals perform a reach-to-grasp task. There was no diference between the two groups in the mean and peak force values. The individuals with stroke had slower, jerkier, less efcient, and more variable movements compared to the control group. This diference was more pronounced with increasing stroke severity. With increasing stroke severity, post-stroke individuals demonstrated altered anticipation and preparation for lifting, which was evident for either cortical lesion side. Upper limb function following stroke. Cerebrovascular accidents (CVAs) are a leading cause of longterm disability worldwide1 , leaving up to 75% of survivors with persistent upper limb (UL) sensorimotor defcits2,3 . Impaired UL function post-stroke signifcantly impedes ability to perform activities of daily living (ADLs) such as reaching, picking up, and holding objects4 . Tese defcits limit performance and social participation, negatively afecting quality of life3,5–7 . Reach‑to‑grasp movement in healthy and post‑stroke individuals. Reach-to-grasp (RTG) movements are a primary means of interacting with the environment, allowing people to obtain and manipulate objects around them8 . RTG movement entails both the transport component, which is the change in position of the hand over time, and the grasp component9 . Both are synchronized such that the hand opens and closes, in coordination with hand movements when grasping objects10. RTG movements require precise application of grip forces11, e.g., when we move our arm while holding an object between our fngers, we unconsciously increase the grip forces to prevent the object from slipping12 or sliding13. Skilled grip force relies on prediction and sensory feedback14, such that during a grip-lif task, healthy individuals are able to rapidly establish an association between an arbitrary sensory cue with a given weight and scale grip force precisely to the actual OPEN 1 Department of Physical Therapy, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Ben‑Gurion Blvd, Beer‑Sheva, Israel. 2 Beit Hadar Rehabilitation Center, Ashdod, Israel. 3 Department of Mechanical Engineering, Ben-Gurion University of the Negev, Beer‑Sheva, Israel. 4 Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer‑Sheva, Israel. 5 Freiburg Institute for Advanced Studies (FRIAS), University of Freiburg, Freiburg, Germany. 6These authors contributed equally: Ronit Feingold-Polak and Anna Yelkin. *email: shelly@bgu.ac.i

 

Effects of Robot-assisted therapy on upper limb recovery after stroke: A Systematic Review

Interesting that significant improvement in upper limb function but not ADLs.  Ask your hospital EXACTLY what updates to this have occurred in the last 14 years.  You do expect your hospital to be competently following appropriate stroke research? Or are you giving them a pass on their incompetency?

Effects of Robot-assisted therapy on upper limb recovery after stroke: A Systematic Review

Gert Kwakkel, PhD1,2, Boudewijn J. Kollen, PhD3, and Hermano I. Krebs, PhD4,5,6
1 Department Rehabilitation and Research Institute MOVE, VU University Medical Center Amsterdam, The Netherlands 2 Department Rehabilitation, Rudolf Magnus Institute of NeuroScience, University Medical Center Utrecht, The Netherlands 3 Research Bureau, Isala Klinieken Zwolle, The Netherlands 4 Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA, USA 5 Department of Neurology and Neuroscience, Burke Institute of Medical Research, Weill Medical College, Cornell University, White Plains, NY, USA 6 Department of Neurology, University of Maryland, School of Medicine, Baltimore, MD, USA

Abstract Background and Purpose— 

To present a systematic review of studies that investigates the effects of robot-assisted therapy on motor and functional recovery in patients with stroke. Summary of Review—A database of articles published up to October 2006 was compiled using the following MEDLINE key words: cerebral vascular accident, cerebral vascular disorders, stroke, paresis, hemiplegia, upper extremity, arm and robot. References listed in relevant publications were also screened. Studies that satisfied the following selection criteria were included: (1) patients were diagnosed with cerebral vascular accident; (2) effects of robot-assisted therapy for the upper limb were investigated; (3) the outcome was measured in terms of motor and/or functional recovery of the upper paretic limb; (4) The study was a randomised clinical trial (RCT). For each outcome measure, the estimated effect size (ES) and the summary effect size (SES) expressed in standard deviation units (SDU) were calculated for motor recovery and functional ability (ADL) using fixed and random effect models. Ten studies, involving 218 patients, were included in the synthesis. Their methodological quality ranged from 4 to 8 on a (maximum) 10 point scale. Meta-analysis showed a non-significant heterogeneous SES in terms of upper limb motor recovery. Sensitivity analysis of studies involving only shoulder-elbow robotics subsequently demonstrated a significant homogeneous SES for motor recovery of the upper paretic limb. No significant SES was observed for functional ability (ADL). 

Conclusion—

As a result of marked heterogeneity in studies between distal and proximal arm robotics, no overall significant effect in favour of robot-assisted therapy was found in the present meta-analysis. However, subsequent sensitivity analysis showed a significant improvement in upper limb motor function after stroke for upper arm robotics. No significant improvement was found in ADL function. However, the administered ADL scales in the reviewed studies fail to adequately reflect recovery of the paretic upper limb and valid instruments that measure outcome of dexterity of the paretic arm and hand are mostly absent in selected studies. Future research on the effects of robot-assisted therapy should therefore distinguish between upper and lower robotics arm training and concentrate on kinematical analysis to differentiate between genuine upper limb motor recovery and functional recovery due to compensation strategies by proximal control of the trunk and upper limb.

Correspondence: G. Kwakkel (PhD), Senior Researcher, Dept. Rehabilitation Medicine, VU University Medical Center, de Boelelaan 1117, 1081 HV Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands, E-mail: g.kwakkel@vumc.nl.

Bilateral reaching deficits after unilateral perinatal ischemic stroke: a population-based case-control study

Worthless, survivors want to know what protocol will fix those reaching deficits but you instead did nothing useful. Your senior researchers and mentors need to be fired. 

Bilateral reaching deficits after unilateral perinatal ischemic stroke: a population-based case-control study

• Andrea M. KuczynskiView ORCID ID profile,
• Adam Kirton,
• Jennifer A. Semrau and
• Sean P. DukelowEmail author

Journal of NeuroEngineering and Rehabilitation201815:77

https://doi.org/10.1186/s12984-018-0420-9

©  The Author(s). 2018

• Received: 8 January 2018
• Accepted: 31 July 2018
• Published: 17 August 2018

Abstract

Background

Detailed kinematics of motor impairment of the contralesional (“affected”) and ipsilesional (“unaffected”) limbs in children with hemiparetic cerebral palsy are not well understood. We aimed to 1) quantify the kinematics of reaching in both arms of hemiparetic children with perinatal stroke using a robotic exoskeleton, and 2) assess the correlation of kinematic reaching parameters with clinical motor assessments.

Methods

This prospective, case-control study involved the Alberta Perinatal Stroke Project, a population-based research cohort, and the Foothills Medical Center Stroke Robotics Laboratory in Calgary, Alberta over a four year period. Prospective cases were collected through the Calgary Stroke Program and included term-born children with magnetic resonance imaging confirmed perinatal ischemic stroke and upper extremity deficits. Control participants were recruited from the community. Participants completed a visually guided reaching task in the KINARM robot with each arm separately, with 10 parameters quantifying motor function. Kinematic measures were compared to clinical assessments and stroke type.

Results

Fifty children with perinatal ischemic stroke (28 arterial, mean age: 12.5 ± 3.9 years; 22 venous, mean age: 11.5 ± 3.8 years) and upper extremity deficits were compared to healthy controls (n = 147, mean age: 12.7 ± 3.9 years). Perinatal stroke groups demonstrated contralesional motor impairments compared to controls when reaching out (arterial = 10/10, venous = 8/10), and back (arterial = 10/10, venous = 6/10) with largest errors in reaction time, initial direction error, movement length and time. Ipsilesional impairments were also found when reaching out (arterial = 7/10, venous = 1/10) and back (arterial = 6/10). The arterial group performed worse than venous on both contralesional and ipsilesional parameters. Contralesional reaching parameters showed modest correlations with clinical measures in the arterial group.

Conclusions

Robotic assessment of reaching behavior can quantify complex, upper limb dysfunction in children with perinatal ischemic stroke. The ipsilesional, “unaffected” limb is often abnormal and may be a target for therapeutic interventions in stroke-induced hemiparetic cerebral palsy.

Recovery of kinematic arm function in well-performing people with subacute stroke: a longitudinal cohort study

Whatever the hell kinematics means. Useless, an analysis of the problem but NOTHING to recover from that problem.
https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-018-0409-4

• Gyrd ThraneEmail authorView ORCID ID profile,
• Margit Alt Murphy and
• Katharina Stibrant Sunnerhagen

Journal of NeuroEngineering and Rehabilitation201815

:67

https://doi.org/10.1186/s12984-018-0409-4

©  The Author(s). 2018

• Received: 17 January 2018
• 29 June 2018

18 July 2018

Abstract

Background

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

.

The restoration of the shoulder joint function in the patients presenting with hemiparesis during the acute phase of hemispheric stroke

Nothing in here even suggests they got an objective damage diagnosis. Thus this research is totally not repeatable and useless. If you don't even know the starting point you can't measure an ending point.
https://europepmc.org/abstract/med/29985378

(PMID:29985378)

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Federal research and clinical centre for specialized types of medical assistance and medical technologies of the Federal medical-biological Agency of Russia, Moscow, Russia; N.I. Pirogov Russian National Research Medical University, Moscow, Russia.More

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D V Skvortsov

Federal research and clinical centre for specialized types of medical assistance and medical technologies of the Federal medical-biological Agency of Russia, Moscow, Russia; N.I. Pirogov Russian National Research Medical University, Moscow, Russia.More

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Voprosy Kurortologii, Fizioterapii, i Lechebnoi Fizicheskoi Kultury [01 Jan 2018, 95(3):26-34]

2018/01

Type: Journal Article, English Abstract (lang: rus)
DOI: 10.17116/kurort201895326

Abstract

The impaired function of the shoulder joint resulting from cerebral stroke is a common disorder involving permanent total disability as well as impaired capability of self-care. The functional pathological changes in the shoulder joint and the dynamics of the patients' health status during the acute period of cerebral stroke remain virtually unexplored.The objective of the present study was to obtain a deeper insight into the process of recovery of the movements in the shoulder joint of the patients presenting with hemiparesis during the acute period of hemispheric stroke based on the results of the analysis of the biomechanical data and the targeted training with biofeedback (BFB).The study included three groups comprised of 25 subjects each. One (control) group included the subjects having neither neurological nor orthopedic pathology. The second group consisted of the patients receiving the conventional treatment in the combination with therapeutic physical exercises (TPE). Group 3 was composed of the patients given the standard course of conventional and physical (TPE) therapy complemented by biofeedback training (the TPE/BFB group). The study included clinical investigations and biomechanical registration of the movements of the shoulder joints and trunk.The results of the study gave evidence that the patients presenting with hemiparesis during the acute period of hemispheric ischemic stroke including those treated with the application of the active means and methods of rehabilitation, such as BFB training, showed no appreciable dynamics of the parameters being evaluated with the use of the relevant clinical scales. The biomechanical study has demonstrated that the movements in the shoulder joints (in a single plain) of the patients comprising the control group are characterized by the presence of the main component with a maximum amplitude in the plane of this movement and additional components (in other planes with a significantly lower amplitude); they are accompanied by the ancillary movements of the trunk. Functionally, the condition of paresis at the level of the shoulder joint is characterized by a decrease in the amplitude of the primary movement and the increase of one of the additional amplitudes, with the growing amplitude of the auxiliary movements of the trunk. The biomechanical methods for the objective assessment have revealed the following functional changes in the shoulder joints: the 6% improvement of flexion in the group of the patients treated with the use of therapeutic physical exercises and the 10% improvement in those treated with the combination of TPE and BFB. Moreover, abduction in the patients of these two groups improved by 4% and 9% respectively.The method for the study of kinematics of the movements in the shoulder joints appears to be most sensitive and informative for the purpose of diagnostics of disorders of the motor function and assessment of the process of its restoration in the patients presenting with hemiparesis during the acute period of hemispheric stroke.

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A Short and Distinct Time Window for Recovery of Arm Motor Control Early After Stroke Revealed With a Global Measure of Trajectory Kinematics

I don't see any use for research that doesn't come up with solutions to the problems described. 
http://journals.sagepub.com/doi/abs/10.1177/1545968317697034

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Juan C. Cortes, MD, Jeff Goldsmith, PhD, Michelle D. Harran, Jing Xu, PhD, Nathan Kim, Heidi M. Schambra, MD, Andreas R. Luft, MD, Pablo Celnik, MD, John W. Krakauer, MD, Tomoko Kitago, MD

First Published March 16, 2017

Abstract

Background. Studies demonstrate that most arm motor recovery occurs within three months after stroke, when measured with standard clinical scales. Improvements on these measures, however, reflect a combination of recovery in motor control, increases in strength, and acquisition of compensatory strategies.  
Objective. To isolate and characterize the time course of recovery of arm motor control over the first year poststroke.
Methods. Longitudinal study of 18 participants with acute ischemic stroke. Motor control was evaluated using a global kinematic measure derived from a 2-dimensional reaching task designed to minimize the need for antigravity strength and prevent compensation. Arm impairment was evaluated with the Fugl-Meyer Assessment of the upper extremity (FMA-UE), activity limitation with the Action Research Arm Test (ARAT), and strength with biceps dynamometry. Assessments were conducted at: 1.5, 5, 14, 27, and 54 weeks poststroke.  
Results. Motor control in the paretic arm improved up to week 5, with no further improvement beyond this time point. In contrast, improvements in the FMA-UE, ARAT, and biceps dynamometry continued beyond 5 weeks, with a similar magnitude of improvement between weeks 5 and 54 as the one observed between weeks 1.5 and 5.
Conclusions. Recovery after stroke plateaued much earlier for arm motor control, isolated with a global kinematic measure, compared to motor function assessed with clinical scales. This dissociation between the time courses of kinematic and clinical measures of recovery may be due to the contribution of strength improvement to the latter. Novel interventions, focused on the first month poststroke, will be required to exploit the narrower window of spontaneous recovery for motor control.

A Short and Distinct Time Window for Recovery of Arm Motor Control Early After Stroke Revealed With a Global Measure of Trajectory Kinematics

Since plateau doesn't exist in stroke these people need to be slapped on the hands and upside the head. It is research conclusions like this that cause a defeatist attitude amongst stroke survivors. Stop promoting the nocebo effect.
http://journals.sagepub.com/doi/abs/10.1177/1545968317697034

Show all authors

Juan C. Cortes, MD, Jeff Goldsmith, PhD, Michelle D. Harran, Jing Xu, PhD, Nathan Kim, Heidi M. Schambra, MD, Andreas R. Luft, MD, Pablo Celnik, MD, John W. Krakauer, MD, Tomoko Kitago, MD

First Published March 16, 2017

Abstract

Background. Studies demonstrate that most arm motor recovery occurs within three months after stroke, when measured with standard clinical scales. Improvements on these measures, however, reflect a combination of recovery in motor control, increases in strength, and acquisition of compensatory strategies.  
Objective. To isolate and characterize the time course of recovery of arm motor control over the first year poststroke.  
Methods. Longitudinal study of 18 participants with acute ischemic stroke. Motor control was evaluated using a global kinematic measure derived from a 2-dimensional reaching task designed to minimize the need for antigravity strength and prevent compensation. Arm impairment was evaluated with the Fugl-Meyer Assessment of the upper extremity (FMA-UE), activity limitation with the Action Research Arm Test (ARAT), and strength with biceps dynamometry. Assessments were conducted at: 1.5, 5, 14, 27, and 54 weeks poststroke.  
Results. Motor control in the paretic arm improved up to week 5, with no further improvement beyond this time point. In contrast, improvements in the FMA-UE, ARAT, and biceps dynamometry continued beyond 5 weeks, with a similar magnitude of improvement between weeks 5 and 54 as the one observed between weeks 1.5 and 5.  
Conclusions. Recovery after stroke plateaued much earlier for arm motor control, isolated with a global kinematic measure, compared to motor function assessed with clinical scales. This dissociation between the time courses of kinematic and clinical measures of recovery may be due to the contribution of strength improvement to the latter. Novel interventions, focused on the first month poststroke, will be required to exploit the narrower window of spontaneous recovery for motor control.

Effects of Stroke on Ipsilesional End-Effector Kinematics in a Multi-Step Activity of Daily Living

I don't see how anything here will help any stroke survivor get closer to 100% recovery, so go ask your doctor how this will help recovery.
http://journal.frontiersin.org/article/10.3389/fnhum.2017.00042/full?

Philipp Gulde^1*, Charmayne Mary Lee Hughes² and Joachim Hermsdörfer¹

• ¹Institute of Movement Science, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
• ²Department of Kinesiology, San Francisco State University, San Francisco, CA, USA

Background: Stroke frequently impairs activities of daily living (ADL) and deteriorates the function of the contra- as well as the ipsilesional limbs. In order to analyze alterations of higher motor control unaffected by paresis or sensory loss, the kinematics of ipsilesional upper limb movements in patients with stroke has previously been analyzed during prehensile movements and simple tool use actions. By contrast, motion recording of multi-step ADL is rare and patient-control comparisons for movement kinematics are largely lacking. Especially in clinical research, objective quantification of complex externally valid tasks can improve the assessment of neurological impairments.
Methods: In this preliminary study we employed three-dimensional motion recording and applied kinematic analysis in a multi-step ADL (tea-making). The trials were examined with respect to errors and sub-action structure, durations, path lengths (PLs), peak velocities, relative activity (RA) and smoothness. In order to check for specific burdens the sub-actions of the task were extracted and compared. To examine the feasibility of the approach, we determined the behavioral and kinematic metrics of the (ipsilesional) unimanual performance of seven chronic stroke patients (64a ± 11a, 3 with right/4 with left brain damage (LBD), 2 with signs of apraxia, variable severity of paresis) and compared the results with data of 14 neurologically healthy age-matched control participants (70a ± 7a).
Results: T-tests revealed that while the quantity and structure of sub-actions of the task were similar. The analysis of end-effector kinematics was able to detect clear group differences in the associated parameters. Specifically, trial duration (TD) was increased (Cohen’s d = 1.77); the RA (Cohen’s d = 1.72) and the parameters of peak velocities (Cohen’s d = 1.49/1.97) were decreased in the patient group. Analysis of the task’s sub-actions repeated measures analysis of variance (rmANOVA) revealed no impact of the different demands of the sub-actions on the relative performance of the patient group.
Conclusion: The analyses revealed kinematic peculiarities in the performance with the ipsilesional hand. These deficits apparently arose from the cognitive demands like sequencing rather than motor constraints. End-effector kinematics proved as a sensitive method to detect and quantify aspects of disturbed multi-step ADL performance after stroke. If standardized, the examination and the analysis are quick and deliver objective data supporting clinical research.

Introduction

Strokes frequently impair the ability to perform activities of daily living (ADL; Foundas et al., 1995; Forde and Humphreys, 2000; Hartmann et al., 2005; Schwartz, 2006; Wisneski and Johnson, 2007). Stroke related syndromes like apraxia, action disorganization syndrome, hemiparesis and neglect can cause such deficits in ADL. According to a previous estimate 37%–55% of chronic stroke patients are impaired in ADL (Bieńkiewicz et al., 2015).

Following stroke, the behavioral deficits in multi-step ADL arising from impaired action planning are mostly omissions of sub-actions and disorders in the sequencing of subsequent steps, as has been shown in studies on food preparation (Buxbaum, 1998; Schwartz et al., 1999; Bickerton et al., 2007, 2012; Bieńkiewicz et al., 2014), dressing (Sunderland et al., 2006) or hygiene procedures (Humphreys and Forde, 1998). Kinematic analyses do not directly address these types of errors. Kinematics rather quantifies basic aspects of movement execution such as speed, coordination, directness, fluency, smoothness and variability (de los Reyes-Guzmán et al., 2014), although errors can alter kinematic parameters, e.g., the omission of sub-actions can shorten the trajectory of a task or conceptual deficits in handling tools can prolong trial durations (TDs). In this study we consider kinematic measures that can be obtained with only the positional data of the end-effectors.

Up to now, only a few studies employed the approach in the study of multi-step ADL tasks of stroke patients. One investigated scenario is drinking from a glass (Weiss et al., 2000; Alt Murphy et al., 2006, 2011, 2012, 2013; Thies et al., 2009; Kim et al., 2014). Alt Murphy et al. (2011) compared the performance of stroke patients with the performance of age-matched healthy controls. The patients revealed longer movement times, slower peak velocities of the hand and of the elbow (angular peak velocity), a higher number of movement units (less movement smoothness) and an increased trunk displacement when executing the task with their paretic arm. The task was also segmented into five single sub-actions. An analysis of the relative movement times in the different sub-actions showed no differences between healthy subjects and stroke patients indicating that none of the sub-actions was specifically impaired in the patients (Alt Murphy et al., 2011). Notably, parameters representing the patients’ kinematics correlated well with motor function tests like the ARAT, ABILHAND or FMA (Alt Murphy et al., 2012) and reflected changes in motor performance during the first 3 months after a stroke (Alt Murphy et al., 2013). The drinking from a glass task as a multi-step ADL is in comparison to e.g., the tea-making task of moderate complexity (Wood, 1986) since its small set of sub-actions (component complexity) can only be realized in one order (coordinative complexity) and only one of the components changes one of its characteristics (weight of the glass; dynamic complexity).

The present study aimed to examine the feasibility of kinematic parameters when assessing the performance of stroke patients in a complex, multi-step ADL. As a secondary goal we also wanted to gain a better understanding of the reasons underlying impaired ADL performance following stroke. Knowledge of the basic deficits would offer specific targets for interventions in therapy (Bieńkiewicz et al., 2015). Partial results of a pilot of this study have been published in a conference proceeding (Gulde et al., 2014). In order to achieve our main goal we introduced adapted kinematic parameters: relative activity (RA) as a measure of activity, mean peak velocity to describe the average movement speed in tasks with phases of inactivity and number of (velocity) peaks per meter to describe smoothness independent of the amount of executed actions. Such adapted parameters are necessary to analyze irregular signals resulting from the execution of many sub-actions in varying order. The examination of tasks of higher complexity is already being used in the clinical setting, but the assessment is so far qualitative and not quantitative, e.g., trail making tasks or “Multistep Object Use” in the Birmingham Cognitive Screen (BCoS; Bickerton et al., 2012).

The reaction time from the instruction to movement start has been successfully used to quantify the duration of action planning time during simple ADL tasks (Hermsdörfer et al., 2013). During multi-step ADL actions, multiple phases of action planning and movement pauses have to be expected. Consequently, movement pauses were determined with a velocity criterion. The new parameter “RA” resulted, which represents the composition of TD into percentages of activity and inactivity. It is able to indicate prolongations of movement planning and preparation. Such prolongations can be caused by slowed planning of movement trajectories and/or slowed planning of the next action step of a sequence, visual allocation of objects or backwards checking of already performed steps. The second new parameter introduced is the mean peak velocity that quantifies the general movement speed by the average value of action-related velocity peaks.

Considering the literature we expect a number of deviations from normal performance in stroke patients in our ADL-scenario of preparing a cup of tea with milk and sugar, (e.g., Thies et al., 2009; Alt Murphy et al., 2011; Osu et al., 2011; Kim et al., 2014). Due to the, in comparison to e.g., the drinking from a glass task, high complexity (Wood, 1986) of the task (in all three dimensions stated by Wood: component, coordinative and dynamic), we expected the kinematic performance of stroke patients to diverge from the performance of age-matched control subjects. We anticipated increased TDs (Thies et al., 2009; Alt Murphy et al., 2011; Kim et al., 2014) resulting from a reduced movement speed and a higher relative and absolute amount of inactivity. We also expected reduced maximum velocity peaks (Alt Murphy et al., 2011; Osu et al., 2011) and mean peak velocities and reduced movement smoothness (in our study an increased number of (velocity) peaks per meter; Alt Murphy et al., 2011; Osu et al., 2011). Additionally, we hypothesized that path length (PL) may be increased due to sequencing problems and misuse of objects in the patients. Since the sub-actions of the task differ in physical and cognitive demands, we also expected differences in the relative performance of stroke patients in comparison to the age-matched control subjects between the different sub-actions. Such differences can be detected by changes of the relative performance of specific sub-actions (Kim et al., 2014).

Model-based variables for the kinematic assessment of upper-extremity impairments in post-stroke patients

So right now your occupational therapist has no clue how to assess your upper extremity impairments. Without that there is no way to map changes in function to the exercises used or needed. You are once again a one person clinical trial, known as a guinea pig, with no way to write up your results without any objective endpoints or measurements. 

Model-based variables for the kinematic assessment of upper-extremity impairments in post-stroke patients

• Alessandro Panarese†Email author,
• Elvira Pirondini†Email author,
• Peppino Tropea,
• Benedetta Cesqui,
• Federico Posteraro and
• Silvestro Micera

†Contributed equally

Journal of NeuroEngineering and Rehabilitation201613:81

DOI: 10.1186/s12984-016-0187-9

©  The Author(s). 2016

Received: 6 February 2016

Accepted: 26 August 2016

Published: 8 September 2016

Abstract

Background

Common scales for clinical evaluation of post-stroke upper-limb motor recovery are often complemented with kinematic parameters extracted from movement trajectories. However, there is no a general consensus on which parameters to use. Moreover, the selected variables may be redundant and highly correlated or, conversely, may incompletely sample the kinematic information from the trajectories. Here we sought to identify a set of clinically useful variables for an exhaustive but yet economical kinematic characterization of upper limb movements performed by post-stroke hemiparetic subjects.

Methods

For this purpose, we pursued a top-down model-driven approach, seeking which kinematic parameters were pivotal for a computational model to generate trajectories of point-to-point planar movements similar to those made by post-stroke subjects at different levels of impairment.

Results

The set of kinematic variables used in the model allowed for the generation of trajectories significantly similar to those of either sub-acute or chronic post-stroke patients at different time points during the therapy. Simulated trajectories also correctly reproduced many kinematic features of real movements, as assessed by an extensive set of kinematic metrics computed on both real and simulated curves. When inspected for redundancy, we found that variations in the variables used in the model were explained by three different underlying and unobserved factors related to movement efficiency, speed, and accuracy, possibly revealing different working mechanisms of recovery.

Conclusion

This study identified a set of measures capable of extensively characterizing the kinematics of upper limb movements performed by post-stroke subjects and of tracking changes of different motor improvement aspects throughout the rehabilitation process.

Keywords

Stroke Robotic rehabilitation Kinematics Modeling

Background

Upper limb functions are altered in about 80 % of acute stroke survivors and in about 50 % of chronic post-stroke patients [1]. With the increasing of life expectancy, it has been estimated that stroke related impairments will be ranked to the fourth most important causes of adult disability in 2030 [2], prompting the need to design more effective diagnostic and rehabilitative tools [3, 4].

Together with more traditional and widely accepted clinical scales in the last two decades investigators have characterized post-stroke motor recovery also in terms of kinematic parameters extracted from hand and arm task-oriented movements [3, 5], which offer more objective measures of motor performance [6]. Indeed, clinical scales, whose reliability has often been questioned [7, 8, 9], may not be sensitive to small and more specific changes [10] and could be of limited use to distinguish different aspects of motor improvement [11, 12].

Previous robot-assisted clinical and pilot studies have proposed a large set of kinematic parameters to characterize motor improvements [5, 6, 11]. A few of them focused on finding a significant relationship between robotic measures collected longitudinally in post-stroke patients and clinical outcome measures, to increase acceptance of kinematic evaluation scales in practice [5, 6]. Too little effort, however, has been made to identify the different aspects of movement improvement, how they can be described by kinematic robot-based measures [11], and whether they may dissociate with respect to recovery time course and to training response [11].

Indeed the range of potential changes in limb trajectory during recovery is not known a priori [12] and might not be fully represented by a set of arbitrarily selected parameters extracted from limb trajectories, even if the parameters were chosen according to a certain number of study hypotheses or to significant relationships with clinical scales. Moreover, these variables can be highly correlated and, thus, redundant. Although redundancy can be tackled by data reduction algorithms, such as Principal Component Analysis (PCA) or Independent Component Analysis (ICA) [5, 6], incomplete representation of information might still remain an overlooked issue.

In the present study we aimed at devising a novel method for identifying a set of kinematic measures potentially capable of fully highlighting and tracking changes of different aspects of movement performance throughout the rehabilitation training. Instead of starting from a certain number of a priori hypotheses, we sought to find which variables were essential for modeling trajectories of post-stroke patients and were, thus, informative of kinematic features of upper limb movements. We then tested whether the identified kinematic parameters i) were capable of highlighting changes in movement performance, ii) were to some extent redundant, and iii) were informative of different factors of post-stroke motor impairment, such as paresis, loss of fractionated movement and somatosensation, and abnormal muscle tone [13].

Assessment of movement quality in robot- assisted upper limb rehabilitation after stroke: a review

This is mainly for your therapist but you can look at table 2 on page 8 which lists a whole bunch of upper limb robots, some I haven't even heard of. This is rather appalling that robot rehabilitation is being used with no knowledge of the best way to apply it. Once again stroke survivors are guinea pigs.
https://www.google.com/url?rct=j&sa=t&url=http://www.jneuroengrehab.com/content/pdf/1743-0003-11-137.pdf&ct=ga&cd=CAEYACoTMzYyNDczNzg0MjQwNjIwMTA3NzIaY2NlMGE1MDc2NjBiNDZhODpjb206ZW46VVM&usg=AFQjCNGh1uk_UJO6IGcsZibJGjoPo4-T9Q
Corresponding author
Email: nurdiana@utem.edu.my
Sheng Quan Xie

Email: s.xie@auckland.ac.nz
Burkhard Wünsche

Email: burkhard@cs.auckland.ac.nz
Department of Mechanical Engineering, The University of Auckland, 2
0 Symonds Street,
Auckland, New Zealand

Department of Computer Science, The University of Auckland, 23 Symond
s Street,
Auckland, New Zealand

Faculty of Electrical Engineering, Universiti Teknikal Malaysia Melaka,
Hang Tuah Jaya,
Melaka, Malaysia
State Key Laboratory of Digital Equipment and Technology, Huazhong Un
iversity of
Science & Technology, Wuhan, China
Abstract

Studies of stroke patients undergoing robot-assisted rehabilitation have re
vealed various kinematic parameters describing movement quality of the upper limb. However, due to the different level of stroke impairment and different assessment criteria and interventions, the evaluation of the
effectiveness of rehabilitation program is undermined.This paper prese
nts a systematic review of kinematic assessments of movement quality of the upper limb and identifies the suitable parameters describing impairments in stroke patients. A total of 41 different clinical and pilot studies on different phases of stroke recovery utilizing kinematic parameters are evaluated. Kinematic parameters describing movement accuracy are mostly reported for chronic patients with statistically significant outcomes and correlate strongly with clinical assessments. Meanwhile, parameters describing feed-forward sensorimotor control are the most frequently reported in studies on sub-acute patients
with significant outcomes albeit without correlation to any clinical assessments. However, lack of measures in coordinated movement and proximal component of upper limb enunciate the difficulties to distinguish the exploitation of joint redundancies exhibited by stroke patients in completing the movement. A further study on overall measures of coordinated movement is recommended.

Changes in Bimanual Coordination During the First 6 Weeks After Moderate Hemiparetic Stroke

Your doctor can explain to you what bimanual rehabilitation is. And how the natural evolution of reaching kinematics is used in your recovery.
 http://nnr.sagepub.com/content/27/3/251.abstract?etoc

Abstract

Background. Better understanding of how bimanual coordination changes over the first weeks of recovery after stroke is required to address the potential utility for bimanual rehabilitation. Three-dimensional kinematic analysis can provide quantitative assessment of unimanual and bimanual movements. Objective. To assess the natural evolution of reaching kinematics during standard poststroke rehabilitation, focusing on bimanual coordination. Methods. A total of 12 hemiparetic, moderately impaired patients were included within 30 days after a first unilateral ischemic/hemorrhagic stroke; 7 kinematic assessments were performed once a week for 6 weeks and at 3 months after inclusion. The reach-to-grasp task was performed in 3 different conditions: unimanual with the healthy limb (UN), unimanual with the paretic limb (UP), and bimanual (BN/BP). Results. For the paretic limb, movement fluency (number of movement units and total movement time) was lower for bimanual reaching compared with unimanual reaching. For bimanual reaching, (1) movement kinematics were similar for both limbs, (2) recovery patterns of both limbs followed a similar profile with a plateau phase at 6 weeks poststroke, and (3) intertrial variability of between-hands synchronization decreased over sessions, although the mean delays remained the same. Conclusions. Bimanual coordination started to become efficient 6 weeks after onset of stroke, so for patients such as those we tested, this time could be most opportune to start bimanual-oriented rehabilitation. The challenge in future research includes determining the characteristics of patients who may best benefit from bimanual therapy.

Movement Kinematics During a Drinking Task Are Associated With the Activity Capacity Level After Stroke

And the first thing I thought of was drinking alcohol(specifically beer). Sign me up for those elbow bending exercises.
 But objective would be great, make sure your therapists objectively analyze your movement problems. How else are they going to be able to document improvements?
  http://nnr.sagepub.com/content/26/9/1106.abstract?etoc

Abstract

Background. Kinematic analysis is a powerful method for an objective assessment of movements and is increasingly used as an outcome measure after stroke. Little is known about how the actual movement performance measured with kinematics is related to the common traditional assessment scales. The aim of this study was to determine the relationships between movement kinematics from a drinking task and the impairment or activity limitation level after stroke. Methods. Kinematic analysis of movement performance in a drinking task was used to measure movement time, smoothness, and angular velocity of elbow and trunk displacement (TD) in 30 individuals with stroke. Sensorimotor impairment was assessed with the Fugl-Meyer Assessment (FMA), activity capacity limitation with the Action Research Arm Test (ARAT), and self-perceived activity difficulties with the ABILHAND questionnaire. Results. Backward multiple regression revealed that the movement smoothness (similarly to movement time) and TD together explain 67% of the total variance in ARAT. Both variables uniquely contributed 37% and 11%, respectively. The TD alone explained 20% of the variance in the FMA, and movement smoothness explained 6% of the variance in the ABILHAND. Conclusions. The kinematic movement performance measures obtained during a drinking task are more strongly associated with activity capacity than with impairment. The movement smoothness and time, possibly together with compensatory movement of the trunk, are valid measures of activity capacity and can be considered as key variables in the evaluation of upper-extremity function after stroke. This increased knowledge is of great value for better interpretation and application of kinematic data in clinical studies.