New data published in PLOS Digital Health
suggest that a novel digital tool called Primseq, a sensor-equipped
computer program, can aid in patients’ recovery from stroke with
accurate tracking of the movement intensity during stroke rehabilitation
therapy.1,2
The tool showed that it was 77% effective
in identifying and counting arm motions prescribed to patients as part
of their stroke rehabilitation exercises. Using sensors strapped to the
arms and back, the tool assessed 12,545 recorded movements according to
their function. The study included 41 adults post stroke who were
prescribed rehabilitation movements—using a fork to eat and using a comb
in their hair—resulting in more than 51,000 upper body movements
recorded from Primseq’s 9 sensors. The artificial intelligence machine
learning platform was then used to match the recorded movements to
patterns and functional categories.1,2
“Knowing how
much physical rehabilitation stroke patients need to recover has been
hampered by the inability to easily count training movements,” cosenior
investigator Heidi Schambra, MD, associate professor, Department of
Neurology and Department of Rehabilitation Medicine, NYU Langone , told NeurologyLive ® .
“Here, we show that it is possible to identify and count training
movements in the impaired arm with an approach that uses wearable motion
sensors and machine learning. Our measurement tool is an exciting step
toward objectively capturing and dosing rehabilitation to maximize
recovery.
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Schambra
and colleagues noted in an NYU news release that they intend to use
Primseq to define the intensity of movements in order to select those
that promote recovery toward independent movement post stroke. She told NeurologyLive ®
that the investigators plan to streamline the wearable sensor array and
package the algorithm into clinical software to improve the tool’s
user-friendliness. She and colleagues intend to make PrimSeq freely
available worldwide to stroke rehabilitation professionals and have
posted the data used to construct the program online here: SimTK wesbite: Primseq .3
“Ultimately,
it will be important to have this tool readily available to researchers
and therapists, and to this end, we have made our machine learning
algorithm freely available. This tool could be used by researchers to
identify training intensities that work best to maximize recovery. It
could also be used by therapists to track and adjust training during a
rehabilitation session,” Schambra said. “We will continue to refine the
tool and improve its measurement performance by training it on
additional stroke patients.”
Existing preclinical literature
suggests that upper body exercise of certain intensities can promote
recovery post stroke, but in-human research has suggested that patients
with stroke receive one-tenth of the exercise training proven effective
in animals, on average. Part of this challenge has been attributed to
the difficulty in tracking movements. Per the US Centers for Disease
Control and Prevention almost 800,000 Americans suffer strokes annual,
and arm mobility—as well as for other limbs—is seriously reduced in more
than 50% of these patients.4
“PrimSeq has
state-of-the-art performance in terms of identifying and counting
functional movements in stroke patients, and we are gathering more data
to continue increasing its accuracy,” cosenior investigator Carlos
Fernandez-Granda, PhD, associate professor of mathematics and data
science, New York University, said in a statement.1
With
regard to the future assessments of such a tool, Schembra and
colleagues acknowledged some limitations of the tool, namely that it
lacks measurements of how often the exercises/movements are performed,
which they wrote, "is important for tracking recovery and tailoring
rehabilitation." Additionally, they suggested characterizing and
referencing normative kinematics of the primitive varieties to "generate
continuous measurements of abnormal primitive performance." As well,
they noted that PrimSeq's clinical utility could be boosted with
additional model training and real-world refinement. "Finally, the
classification performance of Seq2Seq was limited in some cases (e.g.
stabilizations, tooth-brushing activity). Future work could employ
alternative deep learning models with explainable artificial
intelligence to identify sources of confusion, which could then be
targeted to improve classification performance," they wrote.
REFERENCES 1.
Computer tool can track stroke rehabilitation to boost recovery. News
release. NYU Langone Health. June 16, 2022. Accessed June 16, 2022.
https://www.prnewswire.com/news-releases/computer-tool-can-track-stroke-rehabilitation-to-boost-recovery-301567501.html 2. Parnandi A, Kaku A, Venkatesan A, et al. PrimSeq: A deep learning-based pipeline to quantitate rehabilitation training. PLOS Digital Health . Published online June 16, 2022. doi:10.1371/journal.pdig.0000044 3.
PrimSeq: a deep learning-based pipeline to quantitate rehabilitation
training. SimTK website. Updated May 19, 2022. Accessed June 16, 2022.
https://simtk.org/projects/primseq 4. Stroke Facts. CDC website. Updated April 5, 2022. Accessed June 16, 2022. https://www.cdc.gov/stroke/facts.htm
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