A wearable ring-shaped inertial system to identify action planning impairments during reach-to-grasp sequences: a pilot study

 So follow up research needed to actually get beyond just planning. Your doctor and hospital are responsible for getting such research initiated. If they don't that means the board of directors has completely failed at setting the correct goals for the stroke hospital.

A wearable ring-shaped inertial system to identify action planning impairments during reach-to-grasp sequences: a pilot study

• Erika Rovini,
• Guenda Galperti,
• Valeria Manera,
• Gianmaria Mancioppi,
• Laura Fiorini,
• Auriane Gros,
• Philippe Robert &
• Filippo Cavallo 

Journal of NeuroEngineering and Rehabilitation volume 18, Article number: 118 (2021) Cite this article

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Abstract

Background

The progressive ageing of the population is leading to an increasing number of people affected by cognitive decline, including disorders in executive functions (EFs), such as action planning. Current procedures to evaluate cognitive decline are based on neuropsychological tests, but novel methods and approaches start to be investigated. Reach-to-grasp (RG) protocols have shown that intentions can influence the EFs of action planning. In this work, we proposed a novel ring-shaped wearable inertial device, SensRing, to measure kinematic parameters during RG and after-grasp (AG) tasks with different end-goals. The aim is to evaluate whether SensRing can characterize the motor performances of people affected by Mild Neurocognitive Disorder (MND) with impairment in EFs.

Methods

Eight Individuals with dysexecutive MND, named d-MND, were compared to ten older healthy subjects (HC). They were asked to reach and grasp a can with three different intentions: to drink (DRINK), to place it on a target (PLACE), or to pass it to a partner (PASS). Twenty-one kinematic parameters were extracted from SensRing inertial data.

Results

Seven parameters resulted able to differentiate between HC and d-MND in the RG phase, and 8 features resulted significant in the AG phase. d-MND, indeed, had longer reaction times (in RG PLACE), slower peak velocities (in RG PLACE and PASS, in AG DRINK and PLACE), longer deceleration phases (in all RG and AG DRINK), and higher variability (in RG PLACE, in AG DRINK and PASS). Furthermore, d-MND showed no significant differences among conditions, suggesting that impairments in EFs influence their capabilities in modulating the action planning based on the end-goal.

Conclusions

Based on this explorative study, the system might have the potential for objectifying the clinical assessment of people affected by d-MND by administering an easy motor test. Although these preliminary results have to be investigated in-depth in a larger sample, the portability, wearability, accuracy, and ease-of use of the system make the SensRing potentially appliable for remote applications at home, including analysis of protocols for neuromotor rehabilitation in patients affected by MND.

Introduction

The progressive ageing of the global population is leading to an increasing number of people affected by cognitive decline and dementia [1]. Particularly, it is expected that the number of people suffering from Alzheimer’s Disease (AD) (accounting for 60–65% of the dementia cases) will reach 74.7 million by 2030 and 100 million by 2050 [2]. Even though dementia is mainly associated to the prototypic memory loss, different cognitive domains can be affected by different pathologies, leading to distinct cognitive symptoms. Among them, the executive functions (EFs) represent a complex construct that involves cognitive, behavioural, and emotional aspects. Deficits in EFs can be defined as “dysexecutive syndrome” [3], which includes cognitive (e.g., deficits in response inhibition, rules deduction, set-shifting, information generation, action planning, response initiation, coordination of dual-tasks) and/or behavioural (e.g., hypoactivity, apathy, distractibility, preservative behaviour, social behaviour) alterations [4].

Currently, EFs are clinically evaluated mainly administering standardized neuropsychological tests [5] such as the Frontal Assessment Battery (FAB) and the Behavioral Assessment of Dysexecutive Syndrome (that evaluate the EFs as a whole), and tests assessing specific aspects of EFs, such as the Trail Making Test (TMT, for divided attention and working memory), the Stroop Interference Test (for response inhibition), the Digit Span (for verbal working memory), or the Tower of London (for planning).. Although neuropsychological testing is today the gold standard to assess dysexecutive symptoms, a recent literature review highlighted that they present several limitations. The validity and reliability of the test results are sometimes limited because of normative data based on small datasets, some of the cognitive domains are scarcely represented, while others are assessed in different tasks, many tests are available in a restricted number of languages, and sometimes cultural habits can affect the execution of the required tasks [6].

In this context, new protocols and novel tools to assess neuropsychological functions should be investigated. In this work, we focus on the decline of EFs in motor programming that results in action planning impairments.

In the past years, some experimental studies have proposed reach-to-grasp (RG) protocols to highlight how the intentions can influence the action planning. RG sequences analyses have revealed that healthy subjects differently reach and grasp an object depending on the action final goal [7] because people are driven by prior intentions. Kinematics conveys information about these intentions [8], so that, even if the object to-be-grasped is the same, different motor parameters can be appreciated [9]. Therefore, when someone reaches and grasp a bottle to pour its content into a container or, conversely, to pass it to someone else, modulation of the kinematic action occurs. Furthermore, previous studies that implemented experimental protocols based on RG and after-grasp (AG) sequences have revealed useful information in several pathologies, such as Parkinson’s Disease [9, 10], autism spectrum disorder [11, 12], and stroke [13].

Reach-to-grasp tests are easy to be performed and can overcome languages and cultural bias. Nevertheless, up to now, the traditional methodologies employed to analyze motor performance during such tasks are mainly based on motion optical capture systems, which are expensive, require lengthy procedures and dedicated staff for set-up and analysis, and are applicable in dedicated wide settings only.

Recently, advances in Micro Electro-Mechanical Systems, and in artificial intelligence (AI) techniques, have allowed employing wearable technology, together with processing and learning algorithms, to evaluate experimental protocols, both in lab and in clinical settings. This represents a promising solution for objective and reliable monitoring, assessment, and support [14]. Hence, wearable inertial devices have been used, so far, to acquire and process high-frequency rate data to analyze motion performances within several applications, including daily activity living gestures [15], early Alzheimer’s detection [16], Parkinson’s disease assessment [17], mild cognitive impairment evaluation [18], and autism spectrum disorder assistance [19].

In this context, we propose SensRing: a non-invasive, low-cost, lightweight, easy-to-use, ergonomic device able to capture the 3D movements of a finger in the space. In a previous work, we evaluated the accuracy of this device in measuring kinematic parameters in healthy people during standard exercises [20]. Here, the device is proposed within a pilot study, for the use in a clinical application with people suffering from mild cognitive decline and healthy controls. The SensRing allows the measurement of the kinematic parameters related to the motor performance without interfering on motion capabilities.

This study proposes the use of SensRing as an alternative approach to traditional methods aiming to objectively analyze RG and AG sequences. Since Mild Neurocognitive Disorder (MND) subjects, with a decline in EFs, often show impairment in motor programming and action planning [21], the cognitive decline could be objectively confirmed through kinematic parameters’ variations. The hypothesis is that the cognitive decline could be identified objectively examining the kinematic parameters. The idea is to investigate: (i) whether the kinematic performance of people diagnosed as MND with EF impairment is different compared to older healthy controls, during a simple motor protocol, and (ii) whether there are differences in action kinematic modulation depending on the action end-goal between MND and healthy subjects. Finally, we evaluated whether the kinematic parameters could be correlated to the traditional cognitive assessment based on clinical scores.

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