Quantitative assessment based on kinematic measures of functional impairments during upper extremity movements: A review
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paper_title: Assessing Mechanisms of Recovery During Robot-Aided Neurorehabilitation of the Upper Limb

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Objective. The present study aimed to qualify and quantify the different components of motor recovery in a group of stroke patients treated by robot-aided techniques. In addition, the learning model of each motor recovery component was analyzed. Methods . Two groups of poststroke patients were treated with the use of an elbow-shoulder manipulator, respectively, within (recent) and after (chronic) the first 6 months of their cerebrovascular accident. Both groups were evaluated by means of standard clinical assessment scales and a robot-measured evaluation method. Results. These findings confirm that motor training consisting of voluntary movements assisted by the robot device led to significant improvements in motor performance in terms of the kinematic and dynamic components of the arm movements. This corresponded to improvement of impairment as confirmed by the clinical scale results. Conclusions. Knowledge of the recovery components and of the associated performance acquisition model may be useful in as...
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paper_title: Recovery of Grasp versus Reach in People with Hemiparesis Poststroke

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Background and Objective. The authors recently found that grasping was not relatively more disrupted than reaching in people with acute hemiparesis. They now extend this work to the recovery of reach versus grasp.Methods. Hemiparetic subjects were tested acutely, after 90 days, and then after 1 year poststroke, and a control group was evaluated once. Using kinematic techniques, subjects were studied performing reach and reach-to-grasp movements. The authors quantified 3 characteristics of performance for each movement: speed, accuracy, and efficiency, where an efficient movement was defined as a movement directly to the target without extraneous or abnormally circuitous movements. To evaluate the relative deficits and recovery in reach versus grasp, performance measures were converted to z scores using control group means and standard deviations.Results. The authors’ results showed that, starting with small deficits in speed acutely, both reach speed and grasp speed improved over time. Deficits in accurac...
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paper_title: Compensation in recovery of upper extremity function after stroke: the Copenhagen Stroke Study.

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Compensation by the unaffected upper extremity (UE) was studied in stroke patients who were unable to use the affected UE. The main aim was to evaluate the need of teaching compensatory techniques to stroke patients during rehabilitation of UE function. The study was prospective and community based and included 636 consecutive acute stroke patients. UE function and UE paresis were assessed weekly using the Barthel Index subscores for feeding and grooming and the Scandinavian Stroke Scale (SSS) subscores for arm and hand. Rehabilitation was performed according to the Bobath technique. Initially, 214 had severe UE paresis according to SSS; the arm could not move against gravity and the fingertips could not reach palm. In 64 of the 115 patients discharged alive, the affected UE definitely remained useless despite intensive and longstanding rehabilitation. Improvement of UE function was seen in 25 of these patients (39%) and was possible only through compensation by the unaffected UE. Patients who gained UE function by compensation were younger (p < 0.01), had less severe stroke (p < 0.01), smaller (p < 0.01), and subcortically located (p = 0.02) lesions and less affection of higher cortical function (p = 0.01). Recovery of UE function in more than half of the stroke patients with initial severe UE paresis can be achieved only by compensation by the unaffected UE.
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paper_title: Measuring Quality of Movement in Cerebral Palsy: A Review of Instruments

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There is a lack of appropriate evaluation instruments in the area of quality of movement in cerebral palsy. Ten measures of quality of movement, or gross motor performance, published between 1965 and 1990, were reviewed according to established criteria. These criteria include the purpose of the measure, validity, reliability, responsiveness, range of items, and description of qualitative components. These measures provide a foundation for further instrument development in the area of quality of movement.
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paper_title: THE INFORMATION CAPACITY OF THE HUMAN MOTOR SYSTEM IN CONTROLLING THE AMPLITUDE OF MOVEMENT 1

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Information theory has recently been employed to specify more precisely than has hitherto been possible man's capacity in certain sensory, perceptual, and perceptual-motor functions (5, 10, 13, 15, 17, 18). The experiments reported in the present paper extend the theory to the human motor system. The applicability of only the basic concepts, amount of information, noise, channel capacity, and rate of information transmission, will be examined at this time. General familiarity with these concepts as formulated by recent writers (4, 11,20, 22) is assumed. Strictly speaking, we cannot study man's motor system at the behavioral level in isolation from its associated sensory mechanisms. We can only analyze the behavior of the entire receptor-neural-effector system. However, by asking 51 to make rapid and uniform responses that have been highly overlearned, and by holding all relevant stimulus conditions constant with the exception of those resulting from 5"s own movements, we can create an experimental situation in which it is reasonable to assume that performance is limited primarily by the capacity of the motor system. The motor system in the present case is defined as including the visual and proprioceptive feedback loops that permit S to monitor his own activity. The information capacity of the motor system is specified by its ability to produce consistently one class of movement from among several alternative movement classes. The greater the number of alternative classes, the greater is the information capacity of a particular type of response. Since measurable aspects of motor responses, such as their force, direction, and amplitude, are continuous variables, their information capacity is limited only by the amount of statistical variability, or noise, that is characteristic of repeated efforts to produce the same response. The information capacity of the motor Editor's Note. This article is a reprint of an original work published in 1954 in the Journal of Experimental Psychology, 47, 381391.
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paper_title: Augmenting Clinical Evaluation of Hemiparetic Arm Movement With a Laboratory-Based Quantitative Measurement of Kinematics as a Function of Limb Loading

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Background. Kinematic and kinetic measurements used in laboratory settings can quantify upper extremity movement impairment following stroke, but their relationship to clinical methods of evaluating movement impairment is unclear. Objective. To test whether the Arm Coordination Training 3D device (ACT3D) could provide a repeatable quantitative measurement of range of motion during upper extremity reaching along a range of functional levels of loads on the arm and correlate with clinical assessments of arm impairment. Methods . Work area during reaching along clockwise and counterclockwise hand paths was measured under 9 limb-loading conditions ranging from no load to twice the weight of the upper extremity in 11 individuals with chronic hemiparetic stroke on 2 separate occasions. Participants were given a battery of clinical assessments that included the Fugl-Meyer Motor Assessment, Chedoke McMaster Stroke Assessment, Reaching Performance Scale, Modified Ashworth Scale, and the Stroke Impact Scale, by a p...
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paper_title: Relationship Between Clinical Assessments of Function and Measurements From an Upper-Limb Robotic Rehabilitation Device in Cervical Spinal Cord Injury

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Upper limb robotic rehabilitation devices can collect quantitative data about the user's movements. Identifying relationships between robotic sensor data and manual clinical assessment scores would enable more precise tracking of the time course of recovery after injury and reduce the need for time-consuming manual assessments by skilled personnel. This study used measurements from robotic rehabilitation sessions to predict clinical scores in a traumatic cervical spinal cord injury (SCI) population. A retrospective analysis was conducted on data collected from subjects using the Armeo Spring (Hocoma, AG) in three rehabilitation centers. Fourteen predictive variables were explored, relating to range-of-motion, movement smoothness, and grip ability. Regression models using up to four predictors were developed to describe the following clinical scores: the GRASSP (consisting of four sub-scores), the ARAT, and the SCIM. The resulting adjusted R(2) value was highest for the GRASSP "Quantitative Prehension" component (0.78), and lowest for the GRASSP "Sensibility" component (0.54). In contrast to comparable studies in stroke survivors, movement smoothness was least beneficial for predicting clinical scores in SCI. Prediction of upper-limb clinical scores in SCI is feasible using measurements from a robotic rehabilitation device, without the need for dedicated assessment procedures.
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paper_title: Requirements for upper extremity motions during activities of daily living

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Background. Functioning of the upper extremity after implantation of an endoprosthesis remains limited despite the achieved pain relief. Upper extremity kinematics can give insight into function after shoulder arthroplasty. Data on ranges of motion related to the performance of a selection of activities of daily living can aid the clinician in evaluating the outcome of the shoulder and elbow arthroplasties. Methods. Cross-sectional descriptive study of range of motion and activities of daily living kinematics, conducted on nonimpaired subjects. The shoulder and elbow motions of 24 healthy female subjects are measured with an electromagnetic tracking device while performing 8 range of motion tasks and five activities of daily living. The angles of shoulder and elbow are calculated during these tasks. Results. A data set with upper extremity joint angles has been obtained. Large glenohumeral rotations are found for the tasks that require high elevation angles. Large axial rotations of the humerus are found for two of the activities of daily living tasks: the perineal care task and the hair-combing task. Large elbow flexions were seen in the following tasks: combing hair, washing the axilla and eating with a spoon. Interpretation. This study shows a suitable method to describe range of motion and activities of daily living and can serve as a starting point for developing a database on how activities of daily living are performed in a larger population and which joint angles are required to perform these tasks. Results can be used to identify restrictions in upper extremity functioning in patients with shoulder impairments. 2005 Elsevier Ltd. All rights reserved.
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paper_title: Three-dimensional kinematic motion analysis of a daily activity drinking from a glass: a pilot study

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BackgroundDevelopment of reliable and objective evaluation methods is required, particularly for natural and goal-oriented upper-extremity tasks. Three-dimensional imaging measurement techniques have turned out to be a powerful tool for a quantitative and qualitative assessment of multijoint movements. The purpose of this study was to develop and test a method of three-dimensional motion analysis for the activity "drinking from a glass" and describe the drinking task with kinematic variables in control subjects.MethodsA protocol was developed for the drinking activity including the set-up of cameras and positions of the markers and the subject. The drinking task included reaching, forward transport with glass, drinking, back transport and returning the hand to the initial position. An optoelectronic system was used for the three-dimensional kinematic motion capture. Movement times, velocities, joint angles and interjoint coordination for shoulder and elbow were computed and analyzed for twenty control subjects. Test-retest consistency was evaluated for six subjects.ResultsThe test protocol showed good consistency in test-retest. Phase definitions for the drinking task were defined and verified. Descriptive kinematic variables were obtained for movement times, positions, velocities and joint angles for shoulder and elbow joint. Interjoint coordination between shoulder and elbow joint in reaching phase showed a high correlation.ConclusionThis study provides a detailed description of the three-dimensional kinematic analysis of the drinking task. Our approach to investigate and analyze a goal-oriented daily activity has a great clinical potential. Consequently, the next step is to use and test this protocol on persons with impairments and disabilities from upper extremities.
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paper_title: A Robust and Sensitive Metric for Quantifying Movement Smoothness

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The need for movement smoothness quantification to assess motor learning and recovery has resulted in various measures that look at different aspects of a movement's profile. This paper first shows that most of the previously published smoothness measures lack validity, consistency, sensitivity, or robustness. It then introduces and evaluates the spectral arc-length metric that uses a movement speed profile's Fourier magnitude spectrum to quantify movement smoothness. This new metric is systematically tested and compared to other smoothness metrics, using experimental data from stroke and healthy subjects as well as simulated movement data. The results indicate that the spectral arc-length metric is a valid and consistent measure of movement smoothness, which is both sensitive to modifications in motor behavior and robust to measurement noise. We hope that the systematic analysis of this paper is a step toward the standardization of the quantitative assessment of movement smoothness.
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paper_title: Upper extremity kinematics during functional activities: Three-dimensional studies in a normal pediatric population

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Children with brachial plexus birth palsy, burns, cerebral palsy, spinal cord injury and upper limb malformations may have diminished ability to perform activities of daily living (ADLs) due to limited upper extremity (UE) motion. Three-dimensional (3D) imaging techniques provide a way to document multi-planar functional limitations in the UE. These techniques have not been routinely used for this purpose primarily due to a lack of standardized protocols stemming from the complex nature of UE motion. Before 3D techniques can be routinely used for quantitative analysis and determination of functional limitations, standard activities and nomenclature for UE motion must be determined, and normal arm motion defined. This study establishes a normative pediatric database of 3D kinematic values during selected ADLs, enabling future comparisons with pathologic movements. Regardless of their underlying condition, children with limited UE function and ADL performance can be studied using this protocol and compared with this age-matched normal population.
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paper_title: Temporal-spatial parameters of the upper limb during a Reach & Grasp Cycle for children

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Abstract The objective of this study was to characterize normal temporal–spatial patterns during the Reach & Grasp Cycle and to identify upper limb motor deficits in children with cerebral palsy (CP). The Reach & Grasp Cycle encompasses six sequential tasks: reach, grasp cylinder, transport to self (T1), transport back to table (T2), release cylinder, and return to initial position. Three-dimensional motion data were recorded from 25 typically developing children (11 males, 14 females; ages 5–18 years) and 12 children with hemiplegic CP (2 males, 10 females; ages 5–17 years). Within-day and between-day coefficients of variation for the control group ranged from 0 to 0.19, indicating good repeatability of all parameters. The mean duration of the Cycle for children with CP was nearly twice as long as controls, 9.5 ± 4.3 s versus 5.1 ± 1.2 s (U = 37.0, P = .002), partly due to prolonged grasp and release durations. Peak hand velocity occurred at approximately 40% of each phase and was greater during the transport (T1, T2) than non-transport phases (reach, return) in controls (P
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paper_title: Effect of task context on reaching performance in children with spastic hemiparesis

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OBJECTIVE ::: To investigate the effect of task context on the quality of reaching movements in children with spastic hemiparesis. ::: ::: ::: DESIGN ::: Randomized controlled experimental trial. ::: ::: ::: SETTING ::: Institute for the Study of Education and Human Development (ISED). ::: ::: ::: SUBJECTS ::: Twelve children (8-14 years of age) with spastic hemiplegic cerebral palsy. ::: ::: ::: INTERVENTIONS ::: Subjects made fast reaching movements with the affected or nonaffected arm on a digitizer in three context conditions: (a) reach to press a light switch to turn on a red light (functional), (b) reach to press the light switch; no light (semi-functional), and (c) reach to a marker (nonfunctional). ::: ::: ::: MAIN OUTCOME MEASURES ::: Kinematics of reaching movements of affected and nonaffected arms: movement time (MT), peak velocity (PV), time to PV, percentage of MT where peak velocity occurred (PPV), and smoothness (i.e. number of movement units (MU)). ::: ::: ::: RESULTS ::: The functional condition elicited better quality of reaching for the nonaffected, but particularly the affected arm. Reaching of the affected arm was faster (larger MT; F = 10.21, p < 0.01), smoother (fewer MU; F = 19.95, p < 0.001), and better-controlled (right shift of PPV; F = 16.03, p < 0.001) compared with the semi- and nonfunctional condition. Reaching of the nonaffected arm was also faster (longer MT, F = 4.81, p < 0.05), and more smooth (fewer MU, F = 7.23, p < 0.05). ::: ::: ::: CONCLUSIONS ::: These findings suggest that providing a functional context to perform a task may enhance the quality of reaching movements of the affected arm in children with spastic hemiparesis.
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paper_title: Quantifying the quality of hand movement in stroke patients through three-dimensional curvature

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BackgroundTo more accurately evaluate rehabilitation outcomes in stroke patients, movement irregularities should be quantified. Previous work in stroke patients has revealed a reduction in the trajectory smoothness and segmentation of continuous movements. Clinically, the Stroke Impairment Assessment Set (SIAS) evaluates the clumsiness of arm movements using an ordinal scale based on the examiner's observations. In this study, we focused on three-dimensional curvature of hand trajectory to quantify movement, and aimed to establish a novel measurement that is independent of movement duration. We compared the proposed measurement with the SIAS score and the jerk measure representing temporal smoothness.MethodsSixteen stroke patients with SIAS upper limb proximal motor function (Knee-Mouth test) scores ranging from 2 (incomplete performance) to 4 (mild clumsiness) were recruited. Nine healthy participant with a SIAS score of 5 (normal) also participated. Participants were asked to grasp a plastic glass and repetitively move it from the lap to the mouth and back at a conformable speed for 30 s, during which the hand movement was measured using OPTOTRAK. The position data was numerically differentiated and the three-dimensional curvature was computed. To compare against a previously proposed measure, the mean squared jerk normalized by its minimum value was computed. Age-matched healthy participants were instructed to move the glass at three different movement speeds.ResultsThere was an inverse relationship between the curvature of the movement trajectory and the patient's SIAS score. The median of the -log of curvature (MedianLC) correlated well with the SIAS score, upper extremity subsection of Fugl-Meyer Assessment, and the jerk measure in the paretic arm. When the healthy participants moved slowly, the increase in the jerk measure was comparable to the paretic movements with a SIAS score of 2 to 4, while the MedianLC was distinguishable from paretic movements.ConclusionsMeasurement based on curvature was able to quantify movement irregularities and matched well with the examiner's observations. The results suggest that the quality of paretic movements is well characterized using spatial smoothness represented by curvature. The smaller computational costs associated with this measurement suggest that this method has potential clinical utility.
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paper_title: Motion quality evaluation of upper limb target-reaching movements

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Abstract Fitts’ Law was extended in the polar coordinate system, and a set of indices for human motion evaluation is proposed. In this paper, the index of difficulty and the index of performance are introduced as the general indices for the quality measure of plane target-to-target movement. As an example, the target-reaching movement of the upper limb, which is a basic functional action of upper limbs in the activities of daily living, was experimentally investigated. Five healthy subjects were asked to perform six target-reaching tasks with different indices of difficulty. All movements were recorded using a Vicon motion analysis system. The movement quality was measured using these evaluation indices.
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paper_title: Three-dimensional motion of the upper extremity joints during various activities of daily living.

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Highly reliable information on the range of motion (ROM) required to perform activities of daily living (ADL) is important to allow rehabilitation professionals to make appropriate clinical judgments of patients with limited ROM of the upper extremity joints. There are, however, no data available that take full account of corrections for gimbal-lock and soft tissue artifacts, which affect estimation errors for joint angles. We used an electromagnetic three-dimensional tracking system (FASTRAK) to measure the three-dimensional ROM of the upper extremity joints of healthy adults (N=20, age range 18-34) during 16 ADL movement tasks. The ROM required for the performance of each movement was shown in terms of the joint angle at the completion of the task, using a new definition of joint angle and regression analysis to compensate for estimation errors. The results of this study may be useful in setting goals for the treatment of upper extremity joint function.
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paper_title: Kinematic Robot-Based Evaluation Scales and Clinical Counterparts to Measure Upper Limb Motor Performance in Patients With Chronic Stroke

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Background. Human-administered clinical scales are the accepted standard for quantifying motor performance of stroke subjects. Although they are widely accepted, these measurement tools are limited by interrater and intrarater reliability and are time-consuming to apply. In contrast, robot-based measures are highly repeatable, have high resolution, and could potentially reduce assessment time. Although robotic and other objective metrics have proliferated in the literature, they are not as well established as clinical scales and their relationship to clinical scales is mostly unknown. Objective. To test the performance of linear regression models to estimate clinical scores for the upper extremity from systematic robot-based metrics. Methods. Twenty kinematic and kinetic metrics were derived from movement data recorded with the shoulder-and-elbow InMotion2 robot (Interactive Motion Technologies, Inc), a commercial version of the MIT-Manus. Kinematic metrics were aggregated into macro-metrics and micro-met...
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paper_title: SCIM – spinal cord independence measure: a new disability scale for patients with spinal cord lesions

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The Spinal Cord Independence Measure (SCIM) is a new disability scale developed specifically for patients with spinal cord lesions in order to make the functional assessments of patients with paraplegia or tetraplegia more sensitive to changes. The SCIM includes the following areas of function: self-care (subscore (0-20), respiration and sphincter management (0-40) and mobility (0-40). Each area is scored according to its proportional weight in these patients' general activity. The final score ranges from 0 to 100. This study was performed to evaluate the reliability of the SCIM and its sensitivity to functional changes in spinal cord lesion patients compared with the Functional Independence Measure (FIM). Thirty patients were included. Scores were recorded one week after admission and thereafter every month during hospitalization. Each area of function was assessed by a pair of staff members from the relevant discipline. The comparison of scores between each pair of rates revealed a remarkable consistency (r = 0.91-0.99; P < 0.0001; slope approximately 1; constant approximately 0). The total SCIM score (mean = 51, SD = 21) was lower than the total FIM score (mean = 87, SD = 23) owing to the difference in scale range structure and the relatively high cognitive scores of our patients; however, a relationship was noted between the scores of both scales (r = 0.85, P < 0.01). The SCIM was more sensitive than the FIM to changes in function of spinal cord lesion patients: the SCIM detected all the functional changes detected by the FIM total scoring, but the FIM missed 26% of the changes detected by the SCIM total scoring. The mean difference between consecutive scores was higher for the SCIM (P < 0.01). We conclude that the SCIM is a reliable disability scale and is more sensitive to changes in function in spinal cord lesion patients than the FIM. The SCIM when administered by a multidisciplinary team, may be a useful instrument for assessing changes in everyday performance in patients with spinal cord lesion.
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paper_title: Kinematic analysis of upper extremity movement during drinking in hemiplegic subjects.

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BACKGROUND ::: It is necessary to analyze the kinematic properties of a paralyzed extremity to quantitatively determine the degree of impairment of hemiplegic people during functional activities of daily living (ADL) such as a drinking task. This study aimed to identify the kinematic differences between 16 hemiplegic and 32 able-bodied participants in relation to the task phases when drinking with a cup and the kinematic strategy used during motion with respect to the gravity direction. ::: ::: ::: METHODS ::: The subjects performed a drinking task that was divided into five phases according to Murphy's phase definition: reaching, forward transport, drinking, backward transport, and returning. We found that the groups differed in terms of the movement times and the joint angles and angular velocities of the shoulder, elbow, and wrist joints. ::: ::: ::: FINDINGS ::: Compared to the control group, the hemiplegic participants had a larger shoulder abduction angle of at most 17.1° during all the phases, a larger shoulder flexion angle of 7.6° during the reaching phase, and a smaller shoulder flexion angle of 6.4° during the backward transporting phase. Because of these shoulder joint patterns, a smaller elbow pronation peak angle of at most 13.1° and a larger wrist extension peak angle of 12.0° were found in the motions of the hemiplegic participants, as compensation to complete the drinking task. The movement in the gravity direction during the backward transporting phase resulted in a 15.9% larger peak angular velocity for elbow extension in the hemiplegic participants compared to that of the control group. ::: ::: ::: INTERPRETATION ::: These quantitative kinematic patterns help provide an understanding of the movements of an affected extremity and can be useful in designing rehabilitation robots to assist hemiplegic people with ADL.
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paper_title: Measurement in neurological rehabilitation

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Part 1 Background to the choice and use of measures: pathology, impairment, disability, handicap - a useful model measurement and assessment - what and why? classification of impairment, disability and handicap choosing a measure. Part 2 Measurement at different levels: measures of pathology motor and sensory impairments cognitive and emotional impairments personal physical disability global disability measures, extended ADL and social interaction handicap and quality of life. Part 3 Measurement in practice: measurement in some specific diseases measurement in some specific circumstances. Part 4 Measures for use in neurological disability: measures of cognitive impairment and disability measures of motor impairment measures of "focal" disability activities of daily living (ADL) and extended ADL tests global measures of disability measures of handicap and quality of life measures of emotion and social interaction multiple sclerosis stroke scales head injury Parkinson's disease and other movement disorders miscellaneous measures.
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paper_title: Defining functional shoulder range of motion for activities of daily living.

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INTRODUCTION ::: The range of motion (ROM) in the wrist and elbow required for daily activities has been reported to be less than the normal anatomic ROM. This functional ROM has not been defined for the shoulder. Many shoulder outcome assessment tools use specific functional tasks of daily living to score functional results of treatment. This study quantified the total shoulder ROM required to perform the functional tasks of the American Shoulder and Elbow Surgeon (ASES), Simple Shoulder Test (SST), and University of Pennsylvania (U-Penn) Shoulder Score (PSS). ::: ::: ::: MATERIALS AND METHODS ::: The FASTRAK electromagnetic tracking system (Colchester, VT, USA) was used to test 40 shoulders in 20 volunteers with no shoulder pathology found on physical examination. Three sensors were used: 1 each on the T3 spinous process, the scapular spine, and the arm over the distal humerus. Subjects performed each functional task of the ASES, SST, and PSS while flexion, extension, abduction, adduction, external rotation, and internal rotation were recorded. ::: ::: ::: RESULTS ::: Average shoulder motions required to perform the 10 functional tasks were flexion, 121° ± 6.7°; extension, 46° ± 5.3°; abduction, 128° ± 7.9°; cross-body adduction, 116° ± 9.1°; external rotation with the arm 90° abducted, 59° ± 10°; and internal rotation with the arm at the side, 102° ± 7.7°. ::: ::: ::: CONCLUSION ::: Although attaining full motion is a reasonable goal of all shoulder treatment, our results indicate that less ROM is required to perform the functional tasks used in common outcome tools.
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paper_title: The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance.

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Abstract A system for evaluation of motor function, balance, some sensation qualities and joint function in hemiplegic patients is described in detail. The system applies a cumulative numerical score. A series of hemiplegic patients has been followed from within one week post-stroke and throughout one year. When initially nearly flaccid hemiparalysis prevails, the motor recovery, if any occur, follows a definable course. The findings in this study substantiate the validity of ontogenetic principles as applicable to the assessment of motor behaviour in hemiplegic patients, and foocus the importance of early therapeutic measures against contractures.
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paper_title: Kinematic Variables Quantifying Upper-Extremity Performance After Stroke During Reaching and Drinking From a Glass

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Background. Three-dimensional kinematic analysis provides quantitative and qualitative assessment of upper-limb motion and is used as an outcome measure to evaluate impaired movement after stroke. The number of kinematic variables used, however, is diverse, and models for upper-extremity motion analysis vary. Objective. The authors aim to identify a set of clinically useful and sensitive kinematic variables to quantify upper-extremity motor control during a purposeful daily activity, that is, drinking from a glass. Methods. For this purpose, 19 participants with chronic stroke and 19 healthy controls reached for a glass of water, took a sip, and placed it back on a table in a standardized way. An optoelectronic system captured 3-dimensional kinematics. Kinematical parameters describing movement time, velocity, strategy and smoothness, interjoint coordination, and compensatory movements were analyzed between groups. Results. The majority of kinematic variables showed significant differences between study g...
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paper_title: Taking a Lesson From Patients' Recovery Strategies to Optimize Training During Robot-Aided Rehabilitation

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In robot-assisted neurorehabilitation, matching the task difficulty level to the patient's needs and abilities, both initially and as the relearning process progresses, can enhance the effectiveness of training and improve patients' motivation and outcome. This study presents a Progressive Task Regulation algorithm implemented in a robot for upper limb rehabilitation. It evaluates the patient's performance during training through the computation of robot-measured parameters, and automatically changes the features of the reaching movements, adapting the difficulty level of the motor task to the patient's abilities. In particular, it can select different types of assistance (time-triggered, activity-triggered, and negative assistance) and implement varied therapy practice to promote generalization processes. The algorithm was tuned by assessing the performance data obtained in 22 chronic stroke patients who underwent robotic rehabilitation, in which the difficulty level of the task was manually adjusted by the therapist. Thus, we could verify the patient's recovery strategies and implement task transition rules to match both the patient's and therapist's behavior. In addition, the algorithm was tested in a sample of five chronic stroke patients. The findings show good agreement with the therapist decisions so indicating that it could be useful for the implementation of training protocols allowing individualized and gradual treatment of upper limb disabilities in patients after stroke. The application of this algorithm during robot-assisted therapy should allow an easier management of the different motor tasks administered during training, thereby facilitating the therapist's activity in the treatment of different pathologic conditions of the neuromuscular system.
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paper_title: Quantization of human motions and learning of accurate movements

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This paper presents a mathematical model for the learning of accurate human arm movements. Its main features are that the movement is the superposition of smooth submovements, the intrinsic deviation of arm movements is considered, visual and kinesthetic feed-back are integrated in the motion control, and the movement duration and accuracy are optimized with practice. This model is consistent with the jerky arm movements of infants, and may explain how the adult motion behavior emerges from the infant behavior. Comparison with measurements of adult movements shows that the kinematics of accurate movements are well predicted by the model.
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paper_title: Motion capture of the upper extremity during activities of daily living in patients with spastic hemiplegic cerebral palsy

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Abstract Investigations using motion capture to analyze limitations in range of motion (ROM) of the upper extremity in adults with cerebral palsy (CP) are scarce. To evaluate the influence of those limitations on activities of daily living (ADL) and to determine potential mechanisms of compensation, we investigated 15 adults with hemiplegic CP using motion capture while they performed 10 defined ADLs. Data from the nonaffected body side and those from an age-matched able-bodied group were also collected and compared with our subjects. We measured motion of the elbow, shoulder, and trunk and found significant differences in ROM at these sites. The most pronounced reduction in ROM was observed distally in supination and pronation of the elbow. Here, the affected body side of the adults showed a reduction in supination of 45° compared to the able-bodied group. Furthermore we found a correlation between the Manual Ability Classification System (MACS) and the limitations in ROM. In summary, adults with spastic, hemiplegic CP show limitations in ROM accentuated distally during ADLs. The MACS gives conclusive information about those limitations.
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paper_title: Loss of arm function after stroke: measurement, frequency, and recovery

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This study aims to establish the frequency of paralysis and other arm problems after stroke; the recovery of lost function; and to compare various tests of the affected arm. Thirteen per cent of the sample had no arm paralysis when first seen within 14 days. At 3 months 24 per cent of survivors had moderate or severe paralysis; 57 per cent could place nine pegs into holes within 50 seconds; 19 per cent had significant sensory disturbance; 5 per cent had shoulder pain; 8 per cent had restricted passive shoulder movement; and 17 per cent had some paralysis of the dominant arm. Between 3 and 6 months, improvement of motor power was seen in 40 per cent of patients, and 13 per cent of patients improved their function. Severity of initial paralysis was an important prognostic factor.
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paper_title: Responsiveness of Upper Extremity Kinematic Measures and Clinical Improvement During the First Three Months After Stroke

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Background. Kinematic movement analysis is increasingly used as an outcome measure in evaluation of upper extremity function after stroke. Little is known, however, about what observed longitudinal changes in kinematics mean in the context of an individual’s functioning. In this study, the responsiveness and expected change in kinematic measures associated with clinically meaningful improvement in the upper extremity were evaluated. Methods. Kinematic movement analysis of a drinking task and Action Research Arm Test (ARAT) were performed early (9 days poststroke) and at 3 months after stroke in 51 subjects. The receiver-operating characteristic curve and linear regression analyses were used to evaluate responsiveness of kinematic parameters. Results. Movement time, smoothness, and trunk displacement discriminated those subjects demonstrating clinically meaningful improvements. Significant associations of 31% to 36% were found between the change in ARAT and kinematic measures. A real clinical improvement i...
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paper_title: The use of kinematic and parametric information to highlight lack of movement and compensation in the upper extremities during activities of daily living

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Abstract A problem that is common to the study of upper limb kinematics and gait analysis is the translation of the evidence from kinematic measurements into easily interpretable information on the status of the patient, such as the amount of compensation or lack of motion. In this study parameters that can be helpful in the rapid and clear identification of limited wrist motion and compensation were derived from kinematic data. A group of six subjects (group A) with no hand impairment, average age 32.5 ys SD 10.7 ys, and another group of five subjects (group B), average age 34.2 ys SD 16.8 ys, having suffered from distal radius fracture were tested during a cyclic activity of daily living. The activity simulated page turning. Thorax, shoulder, elbow and wrist angles were measured during this task using a motion capture system. Corresponding angle ranges were also calculated. The active range of motion (AROM) found for Group B was generally lower than that of Group A, particularly for elbow supination and wrist movements, with wrist flexion/extension statistically smaller for group B ( P = 0.02). Additional parameters that took into account lack of movements at the wrist and compensation from shoulder elevation, rotation and elbow pronation/supination proved to be more useful at identifying those subjects of group B outside the normative range and can provide clinicians with a rapid and efficient tool that can shorten the analysis process and help make more informed decisions on therapeutic treatments.
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paper_title: Requirements for upper extremity motions during activities of daily living

paper_content:

Background. Functioning of the upper extremity after implantation of an endoprosthesis remains limited despite the achieved pain relief. Upper extremity kinematics can give insight into function after shoulder arthroplasty. Data on ranges of motion related to the performance of a selection of activities of daily living can aid the clinician in evaluating the outcome of the shoulder and elbow arthroplasties. Methods. Cross-sectional descriptive study of range of motion and activities of daily living kinematics, conducted on nonimpaired subjects. The shoulder and elbow motions of 24 healthy female subjects are measured with an electromagnetic tracking device while performing 8 range of motion tasks and five activities of daily living. The angles of shoulder and elbow are calculated during these tasks. Results. A data set with upper extremity joint angles has been obtained. Large glenohumeral rotations are found for the tasks that require high elevation angles. Large axial rotations of the humerus are found for two of the activities of daily living tasks: the perineal care task and the hair-combing task. Large elbow flexions were seen in the following tasks: combing hair, washing the axilla and eating with a spoon. Interpretation. This study shows a suitable method to describe range of motion and activities of daily living and can serve as a starting point for developing a database on how activities of daily living are performed in a larger population and which joint angles are required to perform these tasks. Results can be used to identify restrictions in upper extremity functioning in patients with shoulder impairments. 2005 Elsevier Ltd. All rights reserved.
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paper_title: Three-dimensional kinematic motion analysis of a daily activity drinking from a glass: a pilot study

paper_content:

BackgroundDevelopment of reliable and objective evaluation methods is required, particularly for natural and goal-oriented upper-extremity tasks. Three-dimensional imaging measurement techniques have turned out to be a powerful tool for a quantitative and qualitative assessment of multijoint movements. The purpose of this study was to develop and test a method of three-dimensional motion analysis for the activity "drinking from a glass" and describe the drinking task with kinematic variables in control subjects.MethodsA protocol was developed for the drinking activity including the set-up of cameras and positions of the markers and the subject. The drinking task included reaching, forward transport with glass, drinking, back transport and returning the hand to the initial position. An optoelectronic system was used for the three-dimensional kinematic motion capture. Movement times, velocities, joint angles and interjoint coordination for shoulder and elbow were computed and analyzed for twenty control subjects. Test-retest consistency was evaluated for six subjects.ResultsThe test protocol showed good consistency in test-retest. Phase definitions for the drinking task were defined and verified. Descriptive kinematic variables were obtained for movement times, positions, velocities and joint angles for shoulder and elbow joint. Interjoint coordination between shoulder and elbow joint in reaching phase showed a high correlation.ConclusionThis study provides a detailed description of the three-dimensional kinematic analysis of the drinking task. Our approach to investigate and analyze a goal-oriented daily activity has a great clinical potential. Consequently, the next step is to use and test this protocol on persons with impairments and disabilities from upper extremities.
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paper_title: Upper extremity kinematics during functional activities: Three-dimensional studies in a normal pediatric population

paper_content:

Children with brachial plexus birth palsy, burns, cerebral palsy, spinal cord injury and upper limb malformations may have diminished ability to perform activities of daily living (ADLs) due to limited upper extremity (UE) motion. Three-dimensional (3D) imaging techniques provide a way to document multi-planar functional limitations in the UE. These techniques have not been routinely used for this purpose primarily due to a lack of standardized protocols stemming from the complex nature of UE motion. Before 3D techniques can be routinely used for quantitative analysis and determination of functional limitations, standard activities and nomenclature for UE motion must be determined, and normal arm motion defined. This study establishes a normative pediatric database of 3D kinematic values during selected ADLs, enabling future comparisons with pathologic movements. Regardless of their underlying condition, children with limited UE function and ADL performance can be studied using this protocol and compared with this age-matched normal population.
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paper_title: Temporal-spatial parameters of the upper limb during a Reach & Grasp Cycle for children

paper_content:

Abstract The objective of this study was to characterize normal temporal–spatial patterns during the Reach & Grasp Cycle and to identify upper limb motor deficits in children with cerebral palsy (CP). The Reach & Grasp Cycle encompasses six sequential tasks: reach, grasp cylinder, transport to self (T1), transport back to table (T2), release cylinder, and return to initial position. Three-dimensional motion data were recorded from 25 typically developing children (11 males, 14 females; ages 5–18 years) and 12 children with hemiplegic CP (2 males, 10 females; ages 5–17 years). Within-day and between-day coefficients of variation for the control group ranged from 0 to 0.19, indicating good repeatability of all parameters. The mean duration of the Cycle for children with CP was nearly twice as long as controls, 9.5 ± 4.3 s versus 5.1 ± 1.2 s (U = 37.0, P = .002), partly due to prolonged grasp and release durations. Peak hand velocity occurred at approximately 40% of each phase and was greater during the transport (T1, T2) than non-transport phases (reach, return) in controls (P
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paper_title: Three-dimensional motion of the upper extremity joints during various activities of daily living.

paper_content:

Highly reliable information on the range of motion (ROM) required to perform activities of daily living (ADL) is important to allow rehabilitation professionals to make appropriate clinical judgments of patients with limited ROM of the upper extremity joints. There are, however, no data available that take full account of corrections for gimbal-lock and soft tissue artifacts, which affect estimation errors for joint angles. We used an electromagnetic three-dimensional tracking system (FASTRAK) to measure the three-dimensional ROM of the upper extremity joints of healthy adults (N=20, age range 18-34) during 16 ADL movement tasks. The ROM required for the performance of each movement was shown in terms of the joint angle at the completion of the task, using a new definition of joint angle and regression analysis to compensate for estimation errors. The results of this study may be useful in setting goals for the treatment of upper extremity joint function.
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paper_title: Kinematic analysis of upper extremity movement during drinking in hemiplegic subjects.

paper_content:

BACKGROUND ::: It is necessary to analyze the kinematic properties of a paralyzed extremity to quantitatively determine the degree of impairment of hemiplegic people during functional activities of daily living (ADL) such as a drinking task. This study aimed to identify the kinematic differences between 16 hemiplegic and 32 able-bodied participants in relation to the task phases when drinking with a cup and the kinematic strategy used during motion with respect to the gravity direction. ::: ::: ::: METHODS ::: The subjects performed a drinking task that was divided into five phases according to Murphy's phase definition: reaching, forward transport, drinking, backward transport, and returning. We found that the groups differed in terms of the movement times and the joint angles and angular velocities of the shoulder, elbow, and wrist joints. ::: ::: ::: FINDINGS ::: Compared to the control group, the hemiplegic participants had a larger shoulder abduction angle of at most 17.1° during all the phases, a larger shoulder flexion angle of 7.6° during the reaching phase, and a smaller shoulder flexion angle of 6.4° during the backward transporting phase. Because of these shoulder joint patterns, a smaller elbow pronation peak angle of at most 13.1° and a larger wrist extension peak angle of 12.0° were found in the motions of the hemiplegic participants, as compensation to complete the drinking task. The movement in the gravity direction during the backward transporting phase resulted in a 15.9% larger peak angular velocity for elbow extension in the hemiplegic participants compared to that of the control group. ::: ::: ::: INTERPRETATION ::: These quantitative kinematic patterns help provide an understanding of the movements of an affected extremity and can be useful in designing rehabilitation robots to assist hemiplegic people with ADL.
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paper_title: Defining functional shoulder range of motion for activities of daily living.

paper_content:

INTRODUCTION ::: The range of motion (ROM) in the wrist and elbow required for daily activities has been reported to be less than the normal anatomic ROM. This functional ROM has not been defined for the shoulder. Many shoulder outcome assessment tools use specific functional tasks of daily living to score functional results of treatment. This study quantified the total shoulder ROM required to perform the functional tasks of the American Shoulder and Elbow Surgeon (ASES), Simple Shoulder Test (SST), and University of Pennsylvania (U-Penn) Shoulder Score (PSS). ::: ::: ::: MATERIALS AND METHODS ::: The FASTRAK electromagnetic tracking system (Colchester, VT, USA) was used to test 40 shoulders in 20 volunteers with no shoulder pathology found on physical examination. Three sensors were used: 1 each on the T3 spinous process, the scapular spine, and the arm over the distal humerus. Subjects performed each functional task of the ASES, SST, and PSS while flexion, extension, abduction, adduction, external rotation, and internal rotation were recorded. ::: ::: ::: RESULTS ::: Average shoulder motions required to perform the 10 functional tasks were flexion, 121° ± 6.7°; extension, 46° ± 5.3°; abduction, 128° ± 7.9°; cross-body adduction, 116° ± 9.1°; external rotation with the arm 90° abducted, 59° ± 10°; and internal rotation with the arm at the side, 102° ± 7.7°. ::: ::: ::: CONCLUSION ::: Although attaining full motion is a reasonable goal of all shoulder treatment, our results indicate that less ROM is required to perform the functional tasks used in common outcome tools.
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paper_title: Kinematic Variables Quantifying Upper-Extremity Performance After Stroke During Reaching and Drinking From a Glass

paper_content:

Background. Three-dimensional kinematic analysis provides quantitative and qualitative assessment of upper-limb motion and is used as an outcome measure to evaluate impaired movement after stroke. The number of kinematic variables used, however, is diverse, and models for upper-extremity motion analysis vary. Objective. The authors aim to identify a set of clinically useful and sensitive kinematic variables to quantify upper-extremity motor control during a purposeful daily activity, that is, drinking from a glass. Methods. For this purpose, 19 participants with chronic stroke and 19 healthy controls reached for a glass of water, took a sip, and placed it back on a table in a standardized way. An optoelectronic system captured 3-dimensional kinematics. Kinematical parameters describing movement time, velocity, strategy and smoothness, interjoint coordination, and compensatory movements were analyzed between groups. Results. The majority of kinematic variables showed significant differences between study g...
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paper_title: The use of kinematic and parametric information to highlight lack of movement and compensation in the upper extremities during activities of daily living

paper_content:

Abstract A problem that is common to the study of upper limb kinematics and gait analysis is the translation of the evidence from kinematic measurements into easily interpretable information on the status of the patient, such as the amount of compensation or lack of motion. In this study parameters that can be helpful in the rapid and clear identification of limited wrist motion and compensation were derived from kinematic data. A group of six subjects (group A) with no hand impairment, average age 32.5 ys SD 10.7 ys, and another group of five subjects (group B), average age 34.2 ys SD 16.8 ys, having suffered from distal radius fracture were tested during a cyclic activity of daily living. The activity simulated page turning. Thorax, shoulder, elbow and wrist angles were measured during this task using a motion capture system. Corresponding angle ranges were also calculated. The active range of motion (AROM) found for Group B was generally lower than that of Group A, particularly for elbow supination and wrist movements, with wrist flexion/extension statistically smaller for group B ( P = 0.02). Additional parameters that took into account lack of movements at the wrist and compensation from shoulder elevation, rotation and elbow pronation/supination proved to be more useful at identifying those subjects of group B outside the normative range and can provide clinicians with a rapid and efficient tool that can shorten the analysis process and help make more informed decisions on therapeutic treatments.
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paper_title: Assessing Mechanisms of Recovery During Robot-Aided Neurorehabilitation of the Upper Limb

paper_content:

Objective. The present study aimed to qualify and quantify the different components of motor recovery in a group of stroke patients treated by robot-aided techniques. In addition, the learning model of each motor recovery component was analyzed. Methods . Two groups of poststroke patients were treated with the use of an elbow-shoulder manipulator, respectively, within (recent) and after (chronic) the first 6 months of their cerebrovascular accident. Both groups were evaluated by means of standard clinical assessment scales and a robot-measured evaluation method. Results. These findings confirm that motor training consisting of voluntary movements assisted by the robot device led to significant improvements in motor performance in terms of the kinematic and dynamic components of the arm movements. This corresponded to improvement of impairment as confirmed by the clinical scale results. Conclusions. Knowledge of the recovery components and of the associated performance acquisition model may be useful in as...
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paper_title: Reproducibility and Minimal Detectable Change of Three-Dimensional Kinematic Analysis of Reaching Tasks in People With Hemiparesis After Stroke

paper_content:

Background and Purpose: Three-dimensional kinematic analysis of reaching has emerged as an evaluative measure of upper-extremity motor performance in people after stroke. However, the psychometric properties supporting the use of kinematic data for evaluating longitudinal change in motor performance have not been established. The objective of this study was to determine, in a test-retest reliability manner, the reproducibility and minimal detectable change for reaching kinematics in people after stroke. ::: ::: Subjects and Methods: Fourteen participants with hemiparesis after stroke performed forward reaching tasks on 2 occasions 37.3 (SD=9.8) days apart. At each session, participants performed 4 forward reaching tasks produced by the combination of 2 target heights (low and high [109 and 153 cm from the floor, respectively]) and 2 instructed movement speeds (self-selected and as fast as possible). Two analytical methods were used to calculate kinematic parameters. ::: ::: Results: Relative reliability (intraclass correlation coefficient) ranged from .04 to .99, and absolute reliability (standard error of measurement) ranged from 2.7% to 76.8%, depending on the kinematic variable, the demands of the motor task (target height and movement speed), and the analytical method. Bland-Altman analysis, a statistical method used to assess the repeatability of a method, revealed few systematic errors between sessions. The minimal detectable change ranged from 7.4% to 98.9%. ::: ::: Discussion and Conclusion: Depending on the demands of the motor task and the analytical method, most kinematic outcome measures (such as peak hand velocity, endpoint error, reach extent, maximum shoulder flexion range of motion, and minimum elbow extension range of motion) are reliable measures of motor performance in people after stroke. However, because of the magnitude of within-subject measurement error, some variables (such as peak hand velocity, time to peak hand velocity, and movement time) must change considerably (>50%) to indicate a real change in individual participants. The results of our reliability analysis, which are based on our cohort of participants with hemiparesis after stroke and our specific paradigm, may not be generalizable to different subpopulations of people with hemiparesis after stroke or to the myriad movement tasks and kinematic variables used for the assessment of reaching performance in people after stroke.
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paper_title: Three-Dimensional Upper Limb Movement Characteristics in Children with Hemiplegic Cerebral Palsy and Typically Developing Children.

paper_content:

Abstract The aim of this study was to measure which three-dimensional spatiotemporal and kinematic parameters differentiate upper limb movement characteristics in children with hemiplegic cerebral palsy (HCP) from those in typically developing children (TDC), during various clinically relevant tasks. We used a standardized protocol containing three reach tasks (forwards, upwards, and sideways), two reach-to-grasp tasks (with objects requiring different hand orientations), and three gross motor tasks. Spatiotemporal (movement duration, trajectory straightness, maximum velocity, and timing of maximum velocity), as well as kinematic parameters (discrete angles and waveforms of the trunk, scapula, shoulder, elbow and wrist), were compared between 20 children with HCP (age 10.9 ± 2.9 years) and 20 individually age-matched TDC (age 10.9 ± 3.0 years). Kinematic calculations followed the recommendations from the International Society of Biomechanics. Results showed that children with HCP had longer movement durations, less straight hand trajectories, and lower maximum velocities compared to the TDC. Timing of maximum velocity did not differ between both groups. The movement pathology in children with HCP was highlighted by increased trunk movements and reduced shoulder elevation during reaching and reach-to-grasp. We also measured an increased anterior tilting and protraction of the scapula in children with HCP, although differences were not significant for all tasks. Finally, compared to the TDC, children with HCP used less elbow extension and supination and more wrist flexion to execute all tasks. This study reported distinct 3D upper limb movement characteristics in children with HCP and age-matched TDC, establishing the discriminative ability of the measurement procedure. From a clinical perspective, combining spatiotemporal and kinematic parameters may facilitate the identification of the pathological movement patterns seen in children with HCP and thereby add to a well-targeted upper limb treatment planning.
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paper_title: Relationship Between Clinical Assessments of Function and Measurements From an Upper-Limb Robotic Rehabilitation Device in Cervical Spinal Cord Injury

paper_content:

Upper limb robotic rehabilitation devices can collect quantitative data about the user's movements. Identifying relationships between robotic sensor data and manual clinical assessment scores would enable more precise tracking of the time course of recovery after injury and reduce the need for time-consuming manual assessments by skilled personnel. This study used measurements from robotic rehabilitation sessions to predict clinical scores in a traumatic cervical spinal cord injury (SCI) population. A retrospective analysis was conducted on data collected from subjects using the Armeo Spring (Hocoma, AG) in three rehabilitation centers. Fourteen predictive variables were explored, relating to range-of-motion, movement smoothness, and grip ability. Regression models using up to four predictors were developed to describe the following clinical scores: the GRASSP (consisting of four sub-scores), the ARAT, and the SCIM. The resulting adjusted R(2) value was highest for the GRASSP "Quantitative Prehension" component (0.78), and lowest for the GRASSP "Sensibility" component (0.54). In contrast to comparable studies in stroke survivors, movement smoothness was least beneficial for predicting clinical scores in SCI. Prediction of upper-limb clinical scores in SCI is feasible using measurements from a robotic rehabilitation device, without the need for dedicated assessment procedures.
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paper_title: Quantifying the quality of hand movement in stroke patients through three-dimensional curvature

paper_content:

BackgroundTo more accurately evaluate rehabilitation outcomes in stroke patients, movement irregularities should be quantified. Previous work in stroke patients has revealed a reduction in the trajectory smoothness and segmentation of continuous movements. Clinically, the Stroke Impairment Assessment Set (SIAS) evaluates the clumsiness of arm movements using an ordinal scale based on the examiner's observations. In this study, we focused on three-dimensional curvature of hand trajectory to quantify movement, and aimed to establish a novel measurement that is independent of movement duration. We compared the proposed measurement with the SIAS score and the jerk measure representing temporal smoothness.MethodsSixteen stroke patients with SIAS upper limb proximal motor function (Knee-Mouth test) scores ranging from 2 (incomplete performance) to 4 (mild clumsiness) were recruited. Nine healthy participant with a SIAS score of 5 (normal) also participated. Participants were asked to grasp a plastic glass and repetitively move it from the lap to the mouth and back at a conformable speed for 30 s, during which the hand movement was measured using OPTOTRAK. The position data was numerically differentiated and the three-dimensional curvature was computed. To compare against a previously proposed measure, the mean squared jerk normalized by its minimum value was computed. Age-matched healthy participants were instructed to move the glass at three different movement speeds.ResultsThere was an inverse relationship between the curvature of the movement trajectory and the patient's SIAS score. The median of the -log of curvature (MedianLC) correlated well with the SIAS score, upper extremity subsection of Fugl-Meyer Assessment, and the jerk measure in the paretic arm. When the healthy participants moved slowly, the increase in the jerk measure was comparable to the paretic movements with a SIAS score of 2 to 4, while the MedianLC was distinguishable from paretic movements.ConclusionsMeasurement based on curvature was able to quantify movement irregularities and matched well with the examiner's observations. The results suggest that the quality of paretic movements is well characterized using spatial smoothness represented by curvature. The smaller computational costs associated with this measurement suggest that this method has potential clinical utility.
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paper_title: Kinematic Variables Quantifying Upper-Extremity Performance After Stroke During Reaching and Drinking From a Glass

paper_content:

Background. Three-dimensional kinematic analysis provides quantitative and qualitative assessment of upper-limb motion and is used as an outcome measure to evaluate impaired movement after stroke. The number of kinematic variables used, however, is diverse, and models for upper-extremity motion analysis vary. Objective. The authors aim to identify a set of clinically useful and sensitive kinematic variables to quantify upper-extremity motor control during a purposeful daily activity, that is, drinking from a glass. Methods. For this purpose, 19 participants with chronic stroke and 19 healthy controls reached for a glass of water, took a sip, and placed it back on a table in a standardized way. An optoelectronic system captured 3-dimensional kinematics. Kinematical parameters describing movement time, velocity, strategy and smoothness, interjoint coordination, and compensatory movements were analyzed between groups. Results. The majority of kinematic variables showed significant differences between study g...
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paper_title: Kinematic analysis of unimanual reaching and grasping movements in children with hemiplegic cerebral palsy.

paper_content:

Kinematic analysis of unimanual reaching and grasping movements in children with hemiplegic cerebral palsy
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paper_title: Three-Dimensional Upper Limb Movement Characteristics in Children with Hemiplegic Cerebral Palsy and Typically Developing Children.

paper_content:

Abstract The aim of this study was to measure which three-dimensional spatiotemporal and kinematic parameters differentiate upper limb movement characteristics in children with hemiplegic cerebral palsy (HCP) from those in typically developing children (TDC), during various clinically relevant tasks. We used a standardized protocol containing three reach tasks (forwards, upwards, and sideways), two reach-to-grasp tasks (with objects requiring different hand orientations), and three gross motor tasks. Spatiotemporal (movement duration, trajectory straightness, maximum velocity, and timing of maximum velocity), as well as kinematic parameters (discrete angles and waveforms of the trunk, scapula, shoulder, elbow and wrist), were compared between 20 children with HCP (age 10.9 ± 2.9 years) and 20 individually age-matched TDC (age 10.9 ± 3.0 years). Kinematic calculations followed the recommendations from the International Society of Biomechanics. Results showed that children with HCP had longer movement durations, less straight hand trajectories, and lower maximum velocities compared to the TDC. Timing of maximum velocity did not differ between both groups. The movement pathology in children with HCP was highlighted by increased trunk movements and reduced shoulder elevation during reaching and reach-to-grasp. We also measured an increased anterior tilting and protraction of the scapula in children with HCP, although differences were not significant for all tasks. Finally, compared to the TDC, children with HCP used less elbow extension and supination and more wrist flexion to execute all tasks. This study reported distinct 3D upper limb movement characteristics in children with HCP and age-matched TDC, establishing the discriminative ability of the measurement procedure. From a clinical perspective, combining spatiotemporal and kinematic parameters may facilitate the identification of the pathological movement patterns seen in children with HCP and thereby add to a well-targeted upper limb treatment planning.
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paper_title: Augmenting Clinical Evaluation of Hemiparetic Arm Movement With a Laboratory-Based Quantitative Measurement of Kinematics as a Function of Limb Loading

paper_content:

Background. Kinematic and kinetic measurements used in laboratory settings can quantify upper extremity movement impairment following stroke, but their relationship to clinical methods of evaluating movement impairment is unclear. Objective. To test whether the Arm Coordination Training 3D device (ACT3D) could provide a repeatable quantitative measurement of range of motion during upper extremity reaching along a range of functional levels of loads on the arm and correlate with clinical assessments of arm impairment. Methods . Work area during reaching along clockwise and counterclockwise hand paths was measured under 9 limb-loading conditions ranging from no load to twice the weight of the upper extremity in 11 individuals with chronic hemiparetic stroke on 2 separate occasions. Participants were given a battery of clinical assessments that included the Fugl-Meyer Motor Assessment, Chedoke McMaster Stroke Assessment, Reaching Performance Scale, Modified Ashworth Scale, and the Stroke Impact Scale, by a p...
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paper_title: Relationship Between Clinical Assessments of Function and Measurements From an Upper-Limb Robotic Rehabilitation Device in Cervical Spinal Cord Injury

paper_content:

Upper limb robotic rehabilitation devices can collect quantitative data about the user's movements. Identifying relationships between robotic sensor data and manual clinical assessment scores would enable more precise tracking of the time course of recovery after injury and reduce the need for time-consuming manual assessments by skilled personnel. This study used measurements from robotic rehabilitation sessions to predict clinical scores in a traumatic cervical spinal cord injury (SCI) population. A retrospective analysis was conducted on data collected from subjects using the Armeo Spring (Hocoma, AG) in three rehabilitation centers. Fourteen predictive variables were explored, relating to range-of-motion, movement smoothness, and grip ability. Regression models using up to four predictors were developed to describe the following clinical scores: the GRASSP (consisting of four sub-scores), the ARAT, and the SCIM. The resulting adjusted R(2) value was highest for the GRASSP "Quantitative Prehension" component (0.78), and lowest for the GRASSP "Sensibility" component (0.54). In contrast to comparable studies in stroke survivors, movement smoothness was least beneficial for predicting clinical scores in SCI. Prediction of upper-limb clinical scores in SCI is feasible using measurements from a robotic rehabilitation device, without the need for dedicated assessment procedures.
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paper_title: Three-dimensional kinematic motion analysis of a daily activity drinking from a glass: a pilot study

paper_content:

BackgroundDevelopment of reliable and objective evaluation methods is required, particularly for natural and goal-oriented upper-extremity tasks. Three-dimensional imaging measurement techniques have turned out to be a powerful tool for a quantitative and qualitative assessment of multijoint movements. The purpose of this study was to develop and test a method of three-dimensional motion analysis for the activity "drinking from a glass" and describe the drinking task with kinematic variables in control subjects.MethodsA protocol was developed for the drinking activity including the set-up of cameras and positions of the markers and the subject. The drinking task included reaching, forward transport with glass, drinking, back transport and returning the hand to the initial position. An optoelectronic system was used for the three-dimensional kinematic motion capture. Movement times, velocities, joint angles and interjoint coordination for shoulder and elbow were computed and analyzed for twenty control subjects. Test-retest consistency was evaluated for six subjects.ResultsThe test protocol showed good consistency in test-retest. Phase definitions for the drinking task were defined and verified. Descriptive kinematic variables were obtained for movement times, positions, velocities and joint angles for shoulder and elbow joint. Interjoint coordination between shoulder and elbow joint in reaching phase showed a high correlation.ConclusionThis study provides a detailed description of the three-dimensional kinematic analysis of the drinking task. Our approach to investigate and analyze a goal-oriented daily activity has a great clinical potential. Consequently, the next step is to use and test this protocol on persons with impairments and disabilities from upper extremities.
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paper_title: Kinematic analysis of the upper limb: a useful tool in children with cerebral palsy.

paper_content:

Upper limb involvement in cerebral palsy is usually more complex than lower limb involvement. Each child has a specific brain lesion and the clinical pattern is highly variable. Current clinical methods of assessment do not fully evaluate the kinematic activity during simple activities of daily life. We defined an upper limb three-dimensional kinematic protocol in order to complete the clinical analysis of such patients and reproducibility tests are in progress. Data were presented for one of the patients studied and showed some important differences between the clinical analysis and the kinematic one. A three-dimensional upper limb motion analysis gives a more complete kinematic evaluation and should help better measure the results of treatments.
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paper_title: A Robust and Sensitive Metric for Quantifying Movement Smoothness

paper_content:

The need for movement smoothness quantification to assess motor learning and recovery has resulted in various measures that look at different aspects of a movement's profile. This paper first shows that most of the previously published smoothness measures lack validity, consistency, sensitivity, or robustness. It then introduces and evaluates the spectral arc-length metric that uses a movement speed profile's Fourier magnitude spectrum to quantify movement smoothness. This new metric is systematically tested and compared to other smoothness metrics, using experimental data from stroke and healthy subjects as well as simulated movement data. The results indicate that the spectral arc-length metric is a valid and consistent measure of movement smoothness, which is both sensitive to modifications in motor behavior and robust to measurement noise. We hope that the systematic analysis of this paper is a step toward the standardization of the quantitative assessment of movement smoothness.
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paper_title: Upper extremity kinematics during functional activities: Three-dimensional studies in a normal pediatric population

paper_content:

Children with brachial plexus birth palsy, burns, cerebral palsy, spinal cord injury and upper limb malformations may have diminished ability to perform activities of daily living (ADLs) due to limited upper extremity (UE) motion. Three-dimensional (3D) imaging techniques provide a way to document multi-planar functional limitations in the UE. These techniques have not been routinely used for this purpose primarily due to a lack of standardized protocols stemming from the complex nature of UE motion. Before 3D techniques can be routinely used for quantitative analysis and determination of functional limitations, standard activities and nomenclature for UE motion must be determined, and normal arm motion defined. This study establishes a normative pediatric database of 3D kinematic values during selected ADLs, enabling future comparisons with pathologic movements. Regardless of their underlying condition, children with limited UE function and ADL performance can be studied using this protocol and compared with this age-matched normal population.
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paper_title: Three-dimensional motion of the upper extremity joints during various activities of daily living.

paper_content:

Highly reliable information on the range of motion (ROM) required to perform activities of daily living (ADL) is important to allow rehabilitation professionals to make appropriate clinical judgments of patients with limited ROM of the upper extremity joints. There are, however, no data available that take full account of corrections for gimbal-lock and soft tissue artifacts, which affect estimation errors for joint angles. We used an electromagnetic three-dimensional tracking system (FASTRAK) to measure the three-dimensional ROM of the upper extremity joints of healthy adults (N=20, age range 18-34) during 16 ADL movement tasks. The ROM required for the performance of each movement was shown in terms of the joint angle at the completion of the task, using a new definition of joint angle and regression analysis to compensate for estimation errors. The results of this study may be useful in setting goals for the treatment of upper extremity joint function.
---
paper_title: Kinematic analysis of upper extremity movement during drinking in hemiplegic subjects.

paper_content:

BACKGROUND ::: It is necessary to analyze the kinematic properties of a paralyzed extremity to quantitatively determine the degree of impairment of hemiplegic people during functional activities of daily living (ADL) such as a drinking task. This study aimed to identify the kinematic differences between 16 hemiplegic and 32 able-bodied participants in relation to the task phases when drinking with a cup and the kinematic strategy used during motion with respect to the gravity direction. ::: ::: ::: METHODS ::: The subjects performed a drinking task that was divided into five phases according to Murphy's phase definition: reaching, forward transport, drinking, backward transport, and returning. We found that the groups differed in terms of the movement times and the joint angles and angular velocities of the shoulder, elbow, and wrist joints. ::: ::: ::: FINDINGS ::: Compared to the control group, the hemiplegic participants had a larger shoulder abduction angle of at most 17.1° during all the phases, a larger shoulder flexion angle of 7.6° during the reaching phase, and a smaller shoulder flexion angle of 6.4° during the backward transporting phase. Because of these shoulder joint patterns, a smaller elbow pronation peak angle of at most 13.1° and a larger wrist extension peak angle of 12.0° were found in the motions of the hemiplegic participants, as compensation to complete the drinking task. The movement in the gravity direction during the backward transporting phase resulted in a 15.9% larger peak angular velocity for elbow extension in the hemiplegic participants compared to that of the control group. ::: ::: ::: INTERPRETATION ::: These quantitative kinematic patterns help provide an understanding of the movements of an affected extremity and can be useful in designing rehabilitation robots to assist hemiplegic people with ADL.
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paper_title: Defining functional shoulder range of motion for activities of daily living.

paper_content:

INTRODUCTION ::: The range of motion (ROM) in the wrist and elbow required for daily activities has been reported to be less than the normal anatomic ROM. This functional ROM has not been defined for the shoulder. Many shoulder outcome assessment tools use specific functional tasks of daily living to score functional results of treatment. This study quantified the total shoulder ROM required to perform the functional tasks of the American Shoulder and Elbow Surgeon (ASES), Simple Shoulder Test (SST), and University of Pennsylvania (U-Penn) Shoulder Score (PSS). ::: ::: ::: MATERIALS AND METHODS ::: The FASTRAK electromagnetic tracking system (Colchester, VT, USA) was used to test 40 shoulders in 20 volunteers with no shoulder pathology found on physical examination. Three sensors were used: 1 each on the T3 spinous process, the scapular spine, and the arm over the distal humerus. Subjects performed each functional task of the ASES, SST, and PSS while flexion, extension, abduction, adduction, external rotation, and internal rotation were recorded. ::: ::: ::: RESULTS ::: Average shoulder motions required to perform the 10 functional tasks were flexion, 121° ± 6.7°; extension, 46° ± 5.3°; abduction, 128° ± 7.9°; cross-body adduction, 116° ± 9.1°; external rotation with the arm 90° abducted, 59° ± 10°; and internal rotation with the arm at the side, 102° ± 7.7°. ::: ::: ::: CONCLUSION ::: Although attaining full motion is a reasonable goal of all shoulder treatment, our results indicate that less ROM is required to perform the functional tasks used in common outcome tools.
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paper_title: Kinematic Variables Quantifying Upper-Extremity Performance After Stroke During Reaching and Drinking From a Glass

paper_content:

Background. Three-dimensional kinematic analysis provides quantitative and qualitative assessment of upper-limb motion and is used as an outcome measure to evaluate impaired movement after stroke. The number of kinematic variables used, however, is diverse, and models for upper-extremity motion analysis vary. Objective. The authors aim to identify a set of clinically useful and sensitive kinematic variables to quantify upper-extremity motor control during a purposeful daily activity, that is, drinking from a glass. Methods. For this purpose, 19 participants with chronic stroke and 19 healthy controls reached for a glass of water, took a sip, and placed it back on a table in a standardized way. An optoelectronic system captured 3-dimensional kinematics. Kinematical parameters describing movement time, velocity, strategy and smoothness, interjoint coordination, and compensatory movements were analyzed between groups. Results. The majority of kinematic variables showed significant differences between study g...
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paper_title: The use of kinematic and parametric information to highlight lack of movement and compensation in the upper extremities during activities of daily living

paper_content:

Abstract A problem that is common to the study of upper limb kinematics and gait analysis is the translation of the evidence from kinematic measurements into easily interpretable information on the status of the patient, such as the amount of compensation or lack of motion. In this study parameters that can be helpful in the rapid and clear identification of limited wrist motion and compensation were derived from kinematic data. A group of six subjects (group A) with no hand impairment, average age 32.5 ys SD 10.7 ys, and another group of five subjects (group B), average age 34.2 ys SD 16.8 ys, having suffered from distal radius fracture were tested during a cyclic activity of daily living. The activity simulated page turning. Thorax, shoulder, elbow and wrist angles were measured during this task using a motion capture system. Corresponding angle ranges were also calculated. The active range of motion (AROM) found for Group B was generally lower than that of Group A, particularly for elbow supination and wrist movements, with wrist flexion/extension statistically smaller for group B ( P = 0.02). Additional parameters that took into account lack of movements at the wrist and compensation from shoulder elevation, rotation and elbow pronation/supination proved to be more useful at identifying those subjects of group B outside the normative range and can provide clinicians with a rapid and efficient tool that can shorten the analysis process and help make more informed decisions on therapeutic treatments.
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paper_title: Kinematical measure for spastic reaching in children with cerebral palsy

paper_content:

Abstract Background. Practitioners need more sensitive measure to quantify reaching movement for judgment of the treatment effects and reflecting the degrees of motor impairment in upper extremities. The purposes of this study were to identify the specific kinematic characteristics between normal and spastic reaching under different levels of accuracy, and to determine the most sensitive kinematic variable for quantifying the interference of spasticity on reaching. Methods. Ten normal subjects as control group and ten subjects with spastic cerebral palsy as experimental group were studied. Participants were asked to reach, at a self-selected pace, toward two different sizes of buttons (one with accuracy constraint and the other with non-accuracy constraint) away from normalized distance. Motion analysis system was used to record the trajectory of reaching performance. Kinematic variables of reaching movement were computed and analyzed. Findings . Measure for movement smoothness presented larger effect size (0.24–0.43) than other kinematic variables adopted in this study. Under high-accuracy reaching, children with spastic cerebral palsy had a prolonged movement time than normal children ( P r =0.56–0.75). Number of movement unit was the most sensitive kinematic variable to discriminate between normal and spastic reaching. Interpretation. Development of reliable, valid, and sensitive multi-joint biomechanical evaluation is required, particularly for natural and goal-oriented reaching movement. It is concluded that measure of movement smoothness may be applied as valid and sensitive index to quantify the level of coordinative motor performance for subjects with spastic movement disorder.
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paper_title: Three-Dimensional Upper Limb Movement Characteristics in Children with Hemiplegic Cerebral Palsy and Typically Developing Children.

paper_content:

Abstract The aim of this study was to measure which three-dimensional spatiotemporal and kinematic parameters differentiate upper limb movement characteristics in children with hemiplegic cerebral palsy (HCP) from those in typically developing children (TDC), during various clinically relevant tasks. We used a standardized protocol containing three reach tasks (forwards, upwards, and sideways), two reach-to-grasp tasks (with objects requiring different hand orientations), and three gross motor tasks. Spatiotemporal (movement duration, trajectory straightness, maximum velocity, and timing of maximum velocity), as well as kinematic parameters (discrete angles and waveforms of the trunk, scapula, shoulder, elbow and wrist), were compared between 20 children with HCP (age 10.9 ± 2.9 years) and 20 individually age-matched TDC (age 10.9 ± 3.0 years). Kinematic calculations followed the recommendations from the International Society of Biomechanics. Results showed that children with HCP had longer movement durations, less straight hand trajectories, and lower maximum velocities compared to the TDC. Timing of maximum velocity did not differ between both groups. The movement pathology in children with HCP was highlighted by increased trunk movements and reduced shoulder elevation during reaching and reach-to-grasp. We also measured an increased anterior tilting and protraction of the scapula in children with HCP, although differences were not significant for all tasks. Finally, compared to the TDC, children with HCP used less elbow extension and supination and more wrist flexion to execute all tasks. This study reported distinct 3D upper limb movement characteristics in children with HCP and age-matched TDC, establishing the discriminative ability of the measurement procedure. From a clinical perspective, combining spatiotemporal and kinematic parameters may facilitate the identification of the pathological movement patterns seen in children with HCP and thereby add to a well-targeted upper limb treatment planning.
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paper_title: A new tool for assessing human movement: the Kinematic Assessment Tool.

paper_content:

The study of human behaviour ultimately requires the documentation of human movement. In some instances movements can be recorded through a simple button press on a computer input device. In other situations responses can be captured through questionnaire surveys. Nevertheless, there is a need within many neuroscience settings to capture how complex movements unfold over time (human kinematics). Current methods of measuring human kinematics range from accurate but multifarious laboratory configurations to portable but simplistic and time-consuming paper and pen methods. We describe a new system for recording the end-point of human movement that has the power of laboratory measures but the advantages of pen-and-paper tests: the Kinematic Assessment Tool. KAT provides a highly portable system capable of measuring human movement in configurable visual-spatial tasks. The usefulness of the system is shown in a study where 12 participants undertook a tracing and copying task using their preferred and non-preferred hand. The results show that it is possible to capture behaviour within complex tasks and quantify performance using objective measures automatically generated by the KAT system. The utility of these measures was indexed by our ability to distinguish the performance of the preferred and non-preferred hand using a single variable.
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paper_title: Relationship Between Clinical Assessments of Function and Measurements From an Upper-Limb Robotic Rehabilitation Device in Cervical Spinal Cord Injury

paper_content:

Upper limb robotic rehabilitation devices can collect quantitative data about the user's movements. Identifying relationships between robotic sensor data and manual clinical assessment scores would enable more precise tracking of the time course of recovery after injury and reduce the need for time-consuming manual assessments by skilled personnel. This study used measurements from robotic rehabilitation sessions to predict clinical scores in a traumatic cervical spinal cord injury (SCI) population. A retrospective analysis was conducted on data collected from subjects using the Armeo Spring (Hocoma, AG) in three rehabilitation centers. Fourteen predictive variables were explored, relating to range-of-motion, movement smoothness, and grip ability. Regression models using up to four predictors were developed to describe the following clinical scores: the GRASSP (consisting of four sub-scores), the ARAT, and the SCIM. The resulting adjusted R(2) value was highest for the GRASSP "Quantitative Prehension" component (0.78), and lowest for the GRASSP "Sensibility" component (0.54). In contrast to comparable studies in stroke survivors, movement smoothness was least beneficial for predicting clinical scores in SCI. Prediction of upper-limb clinical scores in SCI is feasible using measurements from a robotic rehabilitation device, without the need for dedicated assessment procedures.
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paper_title: Three-dimensional kinematic motion analysis of a daily activity drinking from a glass: a pilot study

paper_content:

BackgroundDevelopment of reliable and objective evaluation methods is required, particularly for natural and goal-oriented upper-extremity tasks. Three-dimensional imaging measurement techniques have turned out to be a powerful tool for a quantitative and qualitative assessment of multijoint movements. The purpose of this study was to develop and test a method of three-dimensional motion analysis for the activity "drinking from a glass" and describe the drinking task with kinematic variables in control subjects.MethodsA protocol was developed for the drinking activity including the set-up of cameras and positions of the markers and the subject. The drinking task included reaching, forward transport with glass, drinking, back transport and returning the hand to the initial position. An optoelectronic system was used for the three-dimensional kinematic motion capture. Movement times, velocities, joint angles and interjoint coordination for shoulder and elbow were computed and analyzed for twenty control subjects. Test-retest consistency was evaluated for six subjects.ResultsThe test protocol showed good consistency in test-retest. Phase definitions for the drinking task were defined and verified. Descriptive kinematic variables were obtained for movement times, positions, velocities and joint angles for shoulder and elbow joint. Interjoint coordination between shoulder and elbow joint in reaching phase showed a high correlation.ConclusionThis study provides a detailed description of the three-dimensional kinematic analysis of the drinking task. Our approach to investigate and analyze a goal-oriented daily activity has a great clinical potential. Consequently, the next step is to use and test this protocol on persons with impairments and disabilities from upper extremities.
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paper_title: A Robust and Sensitive Metric for Quantifying Movement Smoothness

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The need for movement smoothness quantification to assess motor learning and recovery has resulted in various measures that look at different aspects of a movement's profile. This paper first shows that most of the previously published smoothness measures lack validity, consistency, sensitivity, or robustness. It then introduces and evaluates the spectral arc-length metric that uses a movement speed profile's Fourier magnitude spectrum to quantify movement smoothness. This new metric is systematically tested and compared to other smoothness metrics, using experimental data from stroke and healthy subjects as well as simulated movement data. The results indicate that the spectral arc-length metric is a valid and consistent measure of movement smoothness, which is both sensitive to modifications in motor behavior and robust to measurement noise. We hope that the systematic analysis of this paper is a step toward the standardization of the quantitative assessment of movement smoothness.
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paper_title: Robotic techniques for upper limb evaluation and rehabilitation of stroke patients

paper_content:

This paper presents two robot devices for use in the rehabilitation of upper limb movements and reports the quantitative parameters obtained to characterize the rate of improvement, thus allowing a precise monitoring of patient's recovery. A one degree of freedom (DoF) wrist manipulator and a two-DoF elbow-shoulder manipulator were designed using an admittance control strategy; if the patient could not move the handle, the devices completed the motor task. Two groups of chronic post-stroke patients (G1 n=7, and G2 n=9) were enrolled in a three week rehabilitation program including standard physical therapy (45 min daily) plus treatment by means of robot devices, respectively, for wrist and elbow-shoulder movements (40 min, twice daily). Both groups were evaluated by means of standard clinical assessment scales and a new robot measured evaluation metrics that included an active movement index quantifying the patient's ability to execute the assigned motor task without robot assistance, the mean velocity, and a movement accuracy index measuring the distance of the executed path from the theoretic one. After treatment, both groups improved their motor deficit and disability. In G1, there was a significant change in the clinical scale values (p 0.53 p<0.03). Our findings suggest that robot-aided neurorehabilitation may improve the motor outcome and disability of chronic post-stroke patients. The new robot measured parameters may provide useful information about the course of treatment and its effectiveness at discharge.
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paper_title: Temporal-spatial parameters of the upper limb during a Reach & Grasp Cycle for children

paper_content:

Abstract The objective of this study was to characterize normal temporal–spatial patterns during the Reach & Grasp Cycle and to identify upper limb motor deficits in children with cerebral palsy (CP). The Reach & Grasp Cycle encompasses six sequential tasks: reach, grasp cylinder, transport to self (T1), transport back to table (T2), release cylinder, and return to initial position. Three-dimensional motion data were recorded from 25 typically developing children (11 males, 14 females; ages 5–18 years) and 12 children with hemiplegic CP (2 males, 10 females; ages 5–17 years). Within-day and between-day coefficients of variation for the control group ranged from 0 to 0.19, indicating good repeatability of all parameters. The mean duration of the Cycle for children with CP was nearly twice as long as controls, 9.5 ± 4.3 s versus 5.1 ± 1.2 s (U = 37.0, P = .002), partly due to prolonged grasp and release durations. Peak hand velocity occurred at approximately 40% of each phase and was greater during the transport (T1, T2) than non-transport phases (reach, return) in controls (P
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paper_title: Effect of task context on reaching performance in children with spastic hemiparesis

paper_content:

OBJECTIVE ::: To investigate the effect of task context on the quality of reaching movements in children with spastic hemiparesis. ::: ::: ::: DESIGN ::: Randomized controlled experimental trial. ::: ::: ::: SETTING ::: Institute for the Study of Education and Human Development (ISED). ::: ::: ::: SUBJECTS ::: Twelve children (8-14 years of age) with spastic hemiplegic cerebral palsy. ::: ::: ::: INTERVENTIONS ::: Subjects made fast reaching movements with the affected or nonaffected arm on a digitizer in three context conditions: (a) reach to press a light switch to turn on a red light (functional), (b) reach to press the light switch; no light (semi-functional), and (c) reach to a marker (nonfunctional). ::: ::: ::: MAIN OUTCOME MEASURES ::: Kinematics of reaching movements of affected and nonaffected arms: movement time (MT), peak velocity (PV), time to PV, percentage of MT where peak velocity occurred (PPV), and smoothness (i.e. number of movement units (MU)). ::: ::: ::: RESULTS ::: The functional condition elicited better quality of reaching for the nonaffected, but particularly the affected arm. Reaching of the affected arm was faster (larger MT; F = 10.21, p < 0.01), smoother (fewer MU; F = 19.95, p < 0.001), and better-controlled (right shift of PPV; F = 16.03, p < 0.001) compared with the semi- and nonfunctional condition. Reaching of the nonaffected arm was also faster (longer MT, F = 4.81, p < 0.05), and more smooth (fewer MU, F = 7.23, p < 0.05). ::: ::: ::: CONCLUSIONS ::: These findings suggest that providing a functional context to perform a task may enhance the quality of reaching movements of the affected arm in children with spastic hemiparesis.
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paper_title: Movement smoothness changes during stroke recovery

paper_content:

Smoothness is characteristic of coordinated human movements, and stroke patients' movements seem to grow more smooth with recovery. We used a robotic therapy device to analyze five different measures of movement smoothness in the hemiparetic arm of 31 patients recovering from stroke. Four of the five metrics showed general increases in smoothness for the entire patient population. However, according to the fifth metric, the movements of patients with recent stroke grew less smooth over the course of therapy. This pattern was reproduced in a computer simulation of recovery based on submovement blending, suggesting that progressive blending of submovements underlies stroke recovery.
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paper_title: Kinematic Robot-Based Evaluation Scales and Clinical Counterparts to Measure Upper Limb Motor Performance in Patients With Chronic Stroke

paper_content:

Background. Human-administered clinical scales are the accepted standard for quantifying motor performance of stroke subjects. Although they are widely accepted, these measurement tools are limited by interrater and intrarater reliability and are time-consuming to apply. In contrast, robot-based measures are highly repeatable, have high resolution, and could potentially reduce assessment time. Although robotic and other objective metrics have proliferated in the literature, they are not as well established as clinical scales and their relationship to clinical scales is mostly unknown. Objective. To test the performance of linear regression models to estimate clinical scores for the upper extremity from systematic robot-based metrics. Methods. Twenty kinematic and kinetic metrics were derived from movement data recorded with the shoulder-and-elbow InMotion2 robot (Interactive Motion Technologies, Inc), a commercial version of the MIT-Manus. Kinematic metrics were aggregated into macro-metrics and micro-met...
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paper_title: Upper limb evaluation with robotic exoskeleton. Normative values for indices of accuracy, speed and smoothness

paper_content:

BACKGROUND: Robotic rehabilitation devices for upper limb function (ULF) provide global indicators of a patient’s ability, but the temporal evolution of motion related to motor control is disregarded. OBJECTIVE: To determine normative values for indices of accuracy, speed and smoothness in the evaluation of upper limb function. Twenty-five healthy individuals performed the Armeo ® Spring device “Vertical Capture” task. Custom stand-alone software was developed to provide the following indices: global Hand Path Ratio (HPR), local HPR in the target area (locHPR), vertical and horizontal overshoot (vertOS, horOS), maximum and mean velocity (maxVel, meanVel), mean/maximum velocity, number of peaks in velocity profiles (NVelPeaks) and normalized jerk (NormJerk). The dependence of indices on task characteristics was analyzed by an ANCOVA test. Indices inner relationships were assessed by a correlation and a factor analysis. Normative values were then provided. RESULTS: 4,268 single reaching movements were analyzed. Four indices were not affected by movement direction. Indices were minimally influenced by the difficulty level. Based upon correlation and factor analysis indices and can be grouped into three assessment fields, dealing with precision, velocity and smoothness. CONCLUSIONS: We have developed a tool to assess ULF in dynamic condition. Normative values were obtained to be used as references in assessing patients.
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paper_title: Kinematic Variables Quantifying Upper-Extremity Performance After Stroke During Reaching and Drinking From a Glass

paper_content:

Background. Three-dimensional kinematic analysis provides quantitative and qualitative assessment of upper-limb motion and is used as an outcome measure to evaluate impaired movement after stroke. The number of kinematic variables used, however, is diverse, and models for upper-extremity motion analysis vary. Objective. The authors aim to identify a set of clinically useful and sensitive kinematic variables to quantify upper-extremity motor control during a purposeful daily activity, that is, drinking from a glass. Methods. For this purpose, 19 participants with chronic stroke and 19 healthy controls reached for a glass of water, took a sip, and placed it back on a table in a standardized way. An optoelectronic system captured 3-dimensional kinematics. Kinematical parameters describing movement time, velocity, strategy and smoothness, interjoint coordination, and compensatory movements were analyzed between groups. Results. The majority of kinematic variables showed significant differences between study g...
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paper_title: Effect of Instructions on Functional Reach in Persons With and Without Cerebrovascular Accident

paper_content:

OBJECTIVE. Verbal instructions comprise an important element of clinical practice, however, their effectiveness in promoting movement organization in persons with cerebrovascular accident (CVA) has not been well investigated. METHOD. A counterbalanced, repeated-measures design was used to examine the effects of externally focused (task-related) versus internally focused (movement-related) instructions on movement kinematics during three functional reaching tasks. Participants included 16 persons with stroke who were able to perform the tasks with their affected arm and 17 age-matched adults without neurological impairments. RESULTS. Significantly shorter movement time and greater peak velocity were evident when reaching under the external-focus condition of all tasks than for the internal-focus condition. CONCLUSION. One clinical implication is that internally focused instructions can contribute to slower and less forceful reach in adults with and without CVA. This research reinforces the need for therapists to consider their use of instruction during the evaluation and treatment of movement disorders.
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paper_title: Taking a Lesson From Patients' Recovery Strategies to Optimize Training During Robot-Aided Rehabilitation

paper_content:

In robot-assisted neurorehabilitation, matching the task difficulty level to the patient's needs and abilities, both initially and as the relearning process progresses, can enhance the effectiveness of training and improve patients' motivation and outcome. This study presents a Progressive Task Regulation algorithm implemented in a robot for upper limb rehabilitation. It evaluates the patient's performance during training through the computation of robot-measured parameters, and automatically changes the features of the reaching movements, adapting the difficulty level of the motor task to the patient's abilities. In particular, it can select different types of assistance (time-triggered, activity-triggered, and negative assistance) and implement varied therapy practice to promote generalization processes. The algorithm was tuned by assessing the performance data obtained in 22 chronic stroke patients who underwent robotic rehabilitation, in which the difficulty level of the task was manually adjusted by the therapist. Thus, we could verify the patient's recovery strategies and implement task transition rules to match both the patient's and therapist's behavior. In addition, the algorithm was tested in a sample of five chronic stroke patients. The findings show good agreement with the therapist decisions so indicating that it could be useful for the implementation of training protocols allowing individualized and gradual treatment of upper limb disabilities in patients after stroke. The application of this algorithm during robot-assisted therapy should allow an easier management of the different motor tasks administered during training, thereby facilitating the therapist's activity in the treatment of different pathologic conditions of the neuromuscular system.
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paper_title: Quantization of human motions and learning of accurate movements

paper_content:

This paper presents a mathematical model for the learning of accurate human arm movements. Its main features are that the movement is the superposition of smooth submovements, the intrinsic deviation of arm movements is considered, visual and kinesthetic feed-back are integrated in the motion control, and the movement duration and accuracy are optimized with practice. This model is consistent with the jerky arm movements of infants, and may explain how the adult motion behavior emerges from the infant behavior. Comparison with measurements of adult movements shows that the kinematics of accurate movements are well predicted by the model.
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paper_title: Responsiveness of Upper Extremity Kinematic Measures and Clinical Improvement During the First Three Months After Stroke

paper_content:

Background. Kinematic movement analysis is increasingly used as an outcome measure in evaluation of upper extremity function after stroke. Little is known, however, about what observed longitudinal changes in kinematics mean in the context of an individual’s functioning. In this study, the responsiveness and expected change in kinematic measures associated with clinically meaningful improvement in the upper extremity were evaluated. Methods. Kinematic movement analysis of a drinking task and Action Research Arm Test (ARAT) were performed early (9 days poststroke) and at 3 months after stroke in 51 subjects. The receiver-operating characteristic curve and linear regression analyses were used to evaluate responsiveness of kinematic parameters. Results. Movement time, smoothness, and trunk displacement discriminated those subjects demonstrating clinically meaningful improvements. Significant associations of 31% to 36% were found between the change in ARAT and kinematic measures. A real clinical improvement i...
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paper_title: Assessing Mechanisms of Recovery During Robot-Aided Neurorehabilitation of the Upper Limb

paper_content:

Objective. The present study aimed to qualify and quantify the different components of motor recovery in a group of stroke patients treated by robot-aided techniques. In addition, the learning model of each motor recovery component was analyzed. Methods . Two groups of poststroke patients were treated with the use of an elbow-shoulder manipulator, respectively, within (recent) and after (chronic) the first 6 months of their cerebrovascular accident. Both groups were evaluated by means of standard clinical assessment scales and a robot-measured evaluation method. Results. These findings confirm that motor training consisting of voluntary movements assisted by the robot device led to significant improvements in motor performance in terms of the kinematic and dynamic components of the arm movements. This corresponded to improvement of impairment as confirmed by the clinical scale results. Conclusions. Knowledge of the recovery components and of the associated performance acquisition model may be useful in as...
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paper_title: Design strategies to improve patient motivation during robot-aided rehabilitation

paper_content:

BackgroundMotivation is an important factor in rehabilitation and frequently used as a determinant of rehabilitation outcome. Several factors can influence patient motivation and so improve exercise adherence. This paper presents the design of two robot devices for use in the rehabilitation of upper limb movements, that can motivate patients during the execution of the assigned motor tasks by enhancing the gaming aspects of rehabilitation. In addition, a regular review of the obtained performance can reinforce in patients' minds the importance of exercising and encourage them to continue, so improving their motivation and consequently adherence to the program. In view of this, we also developed an evaluation metric that could characterize the rate of improvement and quantify the changes in the obtained performance.MethodsTwo groups (G1, n = 8 and G2, n = 12) of patients with chronic stroke were enrolled in a 3-week rehabilitation program including standard physical therapy (45 min. daily) plus treatment by means of robot devices (40 min., twice daily) respectively for wrist (G1) and elbow-shoulder movements (G2). Both groups were evaluated by means of standard clinical assessment scales and the new robot measured evaluation metric. Patients' motivation was assessed in 9/12 G2 patients by means of the Intrinsic Motivation Inventory (IMI) questionnaire.ResultsBoth groups reduced their motor deficit and showed a significant improvement in clinical scales and the robot measured parameters. The IMI assessed in G2 patients showed high scores for interest, usefulness and importance subscales and low values for tension and pain subscales.ConclusionThanks to the design features of the two robot devices the therapist could easily adapt training to the individual by selecting different difficulty levels of the motor task tailored to each patient's disability. The gaming aspects incorporated in the two rehabilitation robots helped maintain patients' interest high during execution of the assigned tasks by providing feedback on performance. The evaluation metric gave a precise measure of patients' performance and thus provides a tool to help therapists promote patient motivation and hence adherence to the training program.
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paper_title: Taking a Lesson From Patients' Recovery Strategies to Optimize Training During Robot-Aided Rehabilitation

paper_content:

In robot-assisted neurorehabilitation, matching the task difficulty level to the patient's needs and abilities, both initially and as the relearning process progresses, can enhance the effectiveness of training and improve patients' motivation and outcome. This study presents a Progressive Task Regulation algorithm implemented in a robot for upper limb rehabilitation. It evaluates the patient's performance during training through the computation of robot-measured parameters, and automatically changes the features of the reaching movements, adapting the difficulty level of the motor task to the patient's abilities. In particular, it can select different types of assistance (time-triggered, activity-triggered, and negative assistance) and implement varied therapy practice to promote generalization processes. The algorithm was tuned by assessing the performance data obtained in 22 chronic stroke patients who underwent robotic rehabilitation, in which the difficulty level of the task was manually adjusted by the therapist. Thus, we could verify the patient's recovery strategies and implement task transition rules to match both the patient's and therapist's behavior. In addition, the algorithm was tested in a sample of five chronic stroke patients. The findings show good agreement with the therapist decisions so indicating that it could be useful for the implementation of training protocols allowing individualized and gradual treatment of upper limb disabilities in patients after stroke. The application of this algorithm during robot-assisted therapy should allow an easier management of the different motor tasks administered during training, thereby facilitating the therapist's activity in the treatment of different pathologic conditions of the neuromuscular system.
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paper_title: Assessing Mechanisms of Recovery During Robot-Aided Neurorehabilitation of the Upper Limb

paper_content:

Objective. The present study aimed to qualify and quantify the different components of motor recovery in a group of stroke patients treated by robot-aided techniques. In addition, the learning model of each motor recovery component was analyzed. Methods . Two groups of poststroke patients were treated with the use of an elbow-shoulder manipulator, respectively, within (recent) and after (chronic) the first 6 months of their cerebrovascular accident. Both groups were evaluated by means of standard clinical assessment scales and a robot-measured evaluation method. Results. These findings confirm that motor training consisting of voluntary movements assisted by the robot device led to significant improvements in motor performance in terms of the kinematic and dynamic components of the arm movements. This corresponded to improvement of impairment as confirmed by the clinical scale results. Conclusions. Knowledge of the recovery components and of the associated performance acquisition model may be useful in as...
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paper_title: Reproducibility and Minimal Detectable Change of Three-Dimensional Kinematic Analysis of Reaching Tasks in People With Hemiparesis After Stroke

paper_content:

Background and Purpose: Three-dimensional kinematic analysis of reaching has emerged as an evaluative measure of upper-extremity motor performance in people after stroke. However, the psychometric properties supporting the use of kinematic data for evaluating longitudinal change in motor performance have not been established. The objective of this study was to determine, in a test-retest reliability manner, the reproducibility and minimal detectable change for reaching kinematics in people after stroke. ::: ::: Subjects and Methods: Fourteen participants with hemiparesis after stroke performed forward reaching tasks on 2 occasions 37.3 (SD=9.8) days apart. At each session, participants performed 4 forward reaching tasks produced by the combination of 2 target heights (low and high [109 and 153 cm from the floor, respectively]) and 2 instructed movement speeds (self-selected and as fast as possible). Two analytical methods were used to calculate kinematic parameters. ::: ::: Results: Relative reliability (intraclass correlation coefficient) ranged from .04 to .99, and absolute reliability (standard error of measurement) ranged from 2.7% to 76.8%, depending on the kinematic variable, the demands of the motor task (target height and movement speed), and the analytical method. Bland-Altman analysis, a statistical method used to assess the repeatability of a method, revealed few systematic errors between sessions. The minimal detectable change ranged from 7.4% to 98.9%. ::: ::: Discussion and Conclusion: Depending on the demands of the motor task and the analytical method, most kinematic outcome measures (such as peak hand velocity, endpoint error, reach extent, maximum shoulder flexion range of motion, and minimum elbow extension range of motion) are reliable measures of motor performance in people after stroke. However, because of the magnitude of within-subject measurement error, some variables (such as peak hand velocity, time to peak hand velocity, and movement time) must change considerably (>50%) to indicate a real change in individual participants. The results of our reliability analysis, which are based on our cohort of participants with hemiparesis after stroke and our specific paradigm, may not be generalizable to different subpopulations of people with hemiparesis after stroke or to the myriad movement tasks and kinematic variables used for the assessment of reaching performance in people after stroke.
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paper_title: Three-Dimensional Upper Limb Movement Characteristics in Children with Hemiplegic Cerebral Palsy and Typically Developing Children.

paper_content:

Abstract The aim of this study was to measure which three-dimensional spatiotemporal and kinematic parameters differentiate upper limb movement characteristics in children with hemiplegic cerebral palsy (HCP) from those in typically developing children (TDC), during various clinically relevant tasks. We used a standardized protocol containing three reach tasks (forwards, upwards, and sideways), two reach-to-grasp tasks (with objects requiring different hand orientations), and three gross motor tasks. Spatiotemporal (movement duration, trajectory straightness, maximum velocity, and timing of maximum velocity), as well as kinematic parameters (discrete angles and waveforms of the trunk, scapula, shoulder, elbow and wrist), were compared between 20 children with HCP (age 10.9 ± 2.9 years) and 20 individually age-matched TDC (age 10.9 ± 3.0 years). Kinematic calculations followed the recommendations from the International Society of Biomechanics. Results showed that children with HCP had longer movement durations, less straight hand trajectories, and lower maximum velocities compared to the TDC. Timing of maximum velocity did not differ between both groups. The movement pathology in children with HCP was highlighted by increased trunk movements and reduced shoulder elevation during reaching and reach-to-grasp. We also measured an increased anterior tilting and protraction of the scapula in children with HCP, although differences were not significant for all tasks. Finally, compared to the TDC, children with HCP used less elbow extension and supination and more wrist flexion to execute all tasks. This study reported distinct 3D upper limb movement characteristics in children with HCP and age-matched TDC, establishing the discriminative ability of the measurement procedure. From a clinical perspective, combining spatiotemporal and kinematic parameters may facilitate the identification of the pathological movement patterns seen in children with HCP and thereby add to a well-targeted upper limb treatment planning.
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paper_title: A new tool for assessing human movement: the Kinematic Assessment Tool.

paper_content:

The study of human behaviour ultimately requires the documentation of human movement. In some instances movements can be recorded through a simple button press on a computer input device. In other situations responses can be captured through questionnaire surveys. Nevertheless, there is a need within many neuroscience settings to capture how complex movements unfold over time (human kinematics). Current methods of measuring human kinematics range from accurate but multifarious laboratory configurations to portable but simplistic and time-consuming paper and pen methods. We describe a new system for recording the end-point of human movement that has the power of laboratory measures but the advantages of pen-and-paper tests: the Kinematic Assessment Tool. KAT provides a highly portable system capable of measuring human movement in configurable visual-spatial tasks. The usefulness of the system is shown in a study where 12 participants undertook a tracing and copying task using their preferred and non-preferred hand. The results show that it is possible to capture behaviour within complex tasks and quantify performance using objective measures automatically generated by the KAT system. The utility of these measures was indexed by our ability to distinguish the performance of the preferred and non-preferred hand using a single variable.
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paper_title: Recovery of Grasp versus Reach in People with Hemiparesis Poststroke

paper_content:

Background and Objective. The authors recently found that grasping was not relatively more disrupted than reaching in people with acute hemiparesis. They now extend this work to the recovery of reach versus grasp.Methods. Hemiparetic subjects were tested acutely, after 90 days, and then after 1 year poststroke, and a control group was evaluated once. Using kinematic techniques, subjects were studied performing reach and reach-to-grasp movements. The authors quantified 3 characteristics of performance for each movement: speed, accuracy, and efficiency, where an efficient movement was defined as a movement directly to the target without extraneous or abnormally circuitous movements. To evaluate the relative deficits and recovery in reach versus grasp, performance measures were converted to z scores using control group means and standard deviations.Results. The authors’ results showed that, starting with small deficits in speed acutely, both reach speed and grasp speed improved over time. Deficits in accurac...
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paper_title: THE INFORMATION CAPACITY OF THE HUMAN MOTOR SYSTEM IN CONTROLLING THE AMPLITUDE OF MOVEMENT 1

paper_content:

Information theory has recently been employed to specify more precisely than has hitherto been possible man's capacity in certain sensory, perceptual, and perceptual-motor functions (5, 10, 13, 15, 17, 18). The experiments reported in the present paper extend the theory to the human motor system. The applicability of only the basic concepts, amount of information, noise, channel capacity, and rate of information transmission, will be examined at this time. General familiarity with these concepts as formulated by recent writers (4, 11,20, 22) is assumed. Strictly speaking, we cannot study man's motor system at the behavioral level in isolation from its associated sensory mechanisms. We can only analyze the behavior of the entire receptor-neural-effector system. However, by asking 51 to make rapid and uniform responses that have been highly overlearned, and by holding all relevant stimulus conditions constant with the exception of those resulting from 5"s own movements, we can create an experimental situation in which it is reasonable to assume that performance is limited primarily by the capacity of the motor system. The motor system in the present case is defined as including the visual and proprioceptive feedback loops that permit S to monitor his own activity. The information capacity of the motor system is specified by its ability to produce consistently one class of movement from among several alternative movement classes. The greater the number of alternative classes, the greater is the information capacity of a particular type of response. Since measurable aspects of motor responses, such as their force, direction, and amplitude, are continuous variables, their information capacity is limited only by the amount of statistical variability, or noise, that is characteristic of repeated efforts to produce the same response. The information capacity of the motor Editor's Note. This article is a reprint of an original work published in 1954 in the Journal of Experimental Psychology, 47, 381391.
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paper_title: Alterations in reaching after stroke and their relation to movement direction and impairment severity.

paper_content:

Kamper DG, McKenna-Cole AN, Kahn LE, Reinkensmeyer DJ. Alterations in reaching after stroke and their relation to movement direction and impairment severity. Arch Phys Med Rehabil 2002;83:702-7. Objectives: To examine the effects of stroke severity and target location on reaching (1) to identify regions in space that are difficult to reach, (2) to determine whether specific alter- ations in reaching are associated with particular clinical im- pairment levels, and (3) to characterize relationships between reaching alterations. Design: Participants reached toward a screen of 75 targets spanning an approximate range from 90° side to side and from waistt o head. Setting: Rehabilitation research center. Participants: Sixteen chronic stroke patients with a wide range in residual arm function and 4 control subjects. Interventions: Notapplicable. Main Outcome Measures: Chedoke-McMaster Stroke Arm Assessment, distance, velocity, smoothness, straight- ness, and direction of the hand path during each reach. Hand position trajectories were recorded with an electromagnetic sensor. Results: Reaches performed with the impaired arms showed significant degradation in all performance measures. Although only modestly dependent on the target location, these features correlated strongly with impairment level, as well as with each other. Reaching distance showed the strongest correlations with the other parameters. Conclusions: Stroke alters a broad array of features of reaching, yetlargely t he same degree of movementcont rol is preserved across a range of target locations. The only consis- tently problematic task is to reach far out from the torso, independent of the movement direction. Thus, active range of motion (AROM), rather than control over a specific subset of movement directions, is a logical focus for therapy. In addition, measuring AROM is a simple clinical measure that yields much information.
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paper_title: Temporal-spatial parameters of the upper limb during a Reach & Grasp Cycle for children

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Abstract The objective of this study was to characterize normal temporal–spatial patterns during the Reach & Grasp Cycle and to identify upper limb motor deficits in children with cerebral palsy (CP). The Reach & Grasp Cycle encompasses six sequential tasks: reach, grasp cylinder, transport to self (T1), transport back to table (T2), release cylinder, and return to initial position. Three-dimensional motion data were recorded from 25 typically developing children (11 males, 14 females; ages 5–18 years) and 12 children with hemiplegic CP (2 males, 10 females; ages 5–17 years). Within-day and between-day coefficients of variation for the control group ranged from 0 to 0.19, indicating good repeatability of all parameters. The mean duration of the Cycle for children with CP was nearly twice as long as controls, 9.5 ± 4.3 s versus 5.1 ± 1.2 s (U = 37.0, P = .002), partly due to prolonged grasp and release durations. Peak hand velocity occurred at approximately 40% of each phase and was greater during the transport (T1, T2) than non-transport phases (reach, return) in controls (P
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paper_title: Quantifying the quality of hand movement in stroke patients through three-dimensional curvature

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BackgroundTo more accurately evaluate rehabilitation outcomes in stroke patients, movement irregularities should be quantified. Previous work in stroke patients has revealed a reduction in the trajectory smoothness and segmentation of continuous movements. Clinically, the Stroke Impairment Assessment Set (SIAS) evaluates the clumsiness of arm movements using an ordinal scale based on the examiner's observations. In this study, we focused on three-dimensional curvature of hand trajectory to quantify movement, and aimed to establish a novel measurement that is independent of movement duration. We compared the proposed measurement with the SIAS score and the jerk measure representing temporal smoothness.MethodsSixteen stroke patients with SIAS upper limb proximal motor function (Knee-Mouth test) scores ranging from 2 (incomplete performance) to 4 (mild clumsiness) were recruited. Nine healthy participant with a SIAS score of 5 (normal) also participated. Participants were asked to grasp a plastic glass and repetitively move it from the lap to the mouth and back at a conformable speed for 30 s, during which the hand movement was measured using OPTOTRAK. The position data was numerically differentiated and the three-dimensional curvature was computed. To compare against a previously proposed measure, the mean squared jerk normalized by its minimum value was computed. Age-matched healthy participants were instructed to move the glass at three different movement speeds.ResultsThere was an inverse relationship between the curvature of the movement trajectory and the patient's SIAS score. The median of the -log of curvature (MedianLC) correlated well with the SIAS score, upper extremity subsection of Fugl-Meyer Assessment, and the jerk measure in the paretic arm. When the healthy participants moved slowly, the increase in the jerk measure was comparable to the paretic movements with a SIAS score of 2 to 4, while the MedianLC was distinguishable from paretic movements.ConclusionsMeasurement based on curvature was able to quantify movement irregularities and matched well with the examiner's observations. The results suggest that the quality of paretic movements is well characterized using spatial smoothness represented by curvature. The smaller computational costs associated with this measurement suggest that this method has potential clinical utility.
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paper_title: Motion quality evaluation of upper limb target-reaching movements

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Abstract Fitts’ Law was extended in the polar coordinate system, and a set of indices for human motion evaluation is proposed. In this paper, the index of difficulty and the index of performance are introduced as the general indices for the quality measure of plane target-to-target movement. As an example, the target-reaching movement of the upper limb, which is a basic functional action of upper limbs in the activities of daily living, was experimentally investigated. Five healthy subjects were asked to perform six target-reaching tasks with different indices of difficulty. All movements were recorded using a Vicon motion analysis system. The movement quality was measured using these evaluation indices.
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paper_title: Deficits in grasp versus reach during acute hemiparesis

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We studied how acute hemiparesis affects the ability to perform purposeful movements of proximal versus distal upper extremity segments. Given the gradient of corticospinal input to the spinal motoneuron pools, we postulated that movement performance requiring distal segment control (grasping) should be more impaired than movement performance requiring proximal segment control (reaching) in people with hemiparesis. We tested subjects with acute hemiparesis and control subjects performing reach and reach-to-grasp movements. Three characteristics of movement performance were quantified for each movement: speed, accuracy, and efficiency. For the reach, we calculated peak wrist velocity, endpoint error, and reach path ratio. For the grasp, we calculated peak aperture rate, aperture at touch, and aperture path ratio. To evaluate the relative deficits in reaching versus grasping, performance measures were converted to z-scores using control group means and standard deviations. For both the movements, movement times were longer and performance was more variable in the hemiparetic group compared to the control group. Hemiparetic z-scores indicated that relative deficits in movement speed were small in the two movements, with deficits in grasp being slightly greater than deficits in reach. Relative deficits in accuracy showed a trend for being larger in the reach compared to the grasp, but this difference did not reach statistical significance. In contrast, relative deficits in efficiency were larger in the grasp compared to the reach, with reaching efficiency near the range of normal performance. When considering data across all three movement characteristics, the ability to perform a purposeful movement with the distal segments was not clearly more disrupted than the ability to perform a purposeful movement with the proximal segments in people with acute hemiparesis.
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paper_title: Effect of rehabilitation tasks on organization of movement after stroke.

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OBJECTIVE ::: The purpose of this study was to examine the effect of presence or absence of an object (goal-directed action vs. rote exercise) and the effect of functional specificity of the object on the organization of reaching movements of persons who have had a stroke. ::: ::: ::: METHOD ::: A repeated-measure counterbalanced design was used in each of two experiments. Eighteen persons who had been hospitalized after stroke were recruited from the roster of a rehabilitation hospital and through stroke clubs and volunteered to participate. Fourteen of these became the data-producing sample. In Experiment 1, the OPTO-TRAK/3020 motion analysis system was used to record movement when the participants reached for preferred food (goal-directed action) or to a spatial location (rote exercise). In Experiment 2, the system recorded movement when participants reached to pick up the receiver of an active telephone (natural context), a detached receiver (partial context), and a stick (simulated context). The organization of the reach movement was described kinematically as the number of zero crossings of the acceleration profile (smoothness), movement time (speed), displacement, peak velocity (an indication of force), and location of peak velocity in the velocity profile (planning strategy). ::: ::: ::: RESULTS ::: Goal-directed action produced significantly smoother, faster, more forceful, and more preplanned movement than did the rote exercise condition. Functional specificity of the context did not significantly affect organization of the reach. ::: ::: ::: CONCLUSION ::: Goal-directed reach enabled persons with stroke to display characteristics typical of reach to a target by persons who have not had a stroke better than reaching out in space. These findings support the occupational therapy practice of using objects in a functional context to improve coordinated movement. However, the nature of the objects to be used requires further study.
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paper_title: Upper limb evaluation with robotic exoskeleton. Normative values for indices of accuracy, speed and smoothness

paper_content:

BACKGROUND: Robotic rehabilitation devices for upper limb function (ULF) provide global indicators of a patient’s ability, but the temporal evolution of motion related to motor control is disregarded. OBJECTIVE: To determine normative values for indices of accuracy, speed and smoothness in the evaluation of upper limb function. Twenty-five healthy individuals performed the Armeo ® Spring device “Vertical Capture” task. Custom stand-alone software was developed to provide the following indices: global Hand Path Ratio (HPR), local HPR in the target area (locHPR), vertical and horizontal overshoot (vertOS, horOS), maximum and mean velocity (maxVel, meanVel), mean/maximum velocity, number of peaks in velocity profiles (NVelPeaks) and normalized jerk (NormJerk). The dependence of indices on task characteristics was analyzed by an ANCOVA test. Indices inner relationships were assessed by a correlation and a factor analysis. Normative values were then provided. RESULTS: 4,268 single reaching movements were analyzed. Four indices were not affected by movement direction. Indices were minimally influenced by the difficulty level. Based upon correlation and factor analysis indices and can be grouped into three assessment fields, dealing with precision, velocity and smoothness. CONCLUSIONS: We have developed a tool to assess ULF in dynamic condition. Normative values were obtained to be used as references in assessing patients.
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paper_title: Effects of accuracy constraints on reach-to-grasp movements in cerebellar patients

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Reach-to-grasp movements of patients with pathology restricted to the cerebellum were compared with those of normal controls. Two types of paradigms with different accuracy constraints were used to examine whether cerebellar impairment disrupts the stereotypic relationship between arm transport and grip aperture and whether the variability of this relationship is altered when greater accuracy is required. The movements were made to either a vertical dowel or to a cross bar of a small cross. All subjects were asked to reach for either target at a fast but comfortable speed, grasp the object between the index finger and thumb, and lift it a short distance off the table. In terms of the relationship between arm transport and grip aperture, the control subjects showed a high consistency in grip aperture and wrist velocity profiles from trial to trial for movements to both the dowel and the cross. The relationship between the maximum velocity of the wrist and the time at which grip aperture was maximal during the reach was highly consistent throughout the experiment. In contrast, the time of maximum grip aperture and maximum wrist velocity of the cerebellar patients was quite variable from trial to trial, and the relationship of these measurements also varied considerably. These abnormalities were present regardless of the accuracy requirement. In addition, the cerebellar patients required a significantly longer time to grasp and lift the objects than the control subjects. Furthermore, the patients exhibited a greater grip aperture during reach than the controls. These data indicate that the cerebellum contributes substantially to the coordination of movements required to perform reach-to-grasp movements. Specifically, the cerebellum is critical for executing this behavior with a consistent, well-timed relationship between the transport and grasp components. This contribution is apparent even when accuracy demands are minimal.
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paper_title: Assessing Mechanisms of Recovery During Robot-Aided Neurorehabilitation of the Upper Limb

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Objective. The present study aimed to qualify and quantify the different components of motor recovery in a group of stroke patients treated by robot-aided techniques. In addition, the learning model of each motor recovery component was analyzed. Methods . Two groups of poststroke patients were treated with the use of an elbow-shoulder manipulator, respectively, within (recent) and after (chronic) the first 6 months of their cerebrovascular accident. Both groups were evaluated by means of standard clinical assessment scales and a robot-measured evaluation method. Results. These findings confirm that motor training consisting of voluntary movements assisted by the robot device led to significant improvements in motor performance in terms of the kinematic and dynamic components of the arm movements. This corresponded to improvement of impairment as confirmed by the clinical scale results. Conclusions. Knowledge of the recovery components and of the associated performance acquisition model may be useful in as...
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paper_title: Movement variability in stroke patients and controls performing two upper limb functional tasks: a new assessment methodology

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BackgroundIn the evaluation of upper limb impairment post stroke there remains a gap between detailed kinematic analyses with expensive motion capturing systems and common clinical assessment tests. In particular, although many clinical tests evaluate the performance of functional tasks, metrics to characterise upper limb kinematics are generally not applicable to such tasks and very limited in scope. This paper reports on a novel, user-friendly methodology that allows for the assessment of both signal magnitude and timing variability in upper limb movement trajectories during functional task performance. In order to demonstrate the technique, we report on a study in which the variability in timing and signal magnitude of data collected during the performance of two functional tasks is compared between a group of subjects with stroke and a group of individually matched control subjects.MethodsWe employ dynamic time warping for curve registration to quantify two aspects of movement variability: 1) variability of the timing of the accelerometer signals' characteristics and 2) variability of the signals' magnitude. Six stroke patients and six matched controls performed several trials of a unilateral ('drinking') and a bilateral ('moving a plate') functional task on two different days, approximately 1 month apart. Group differences for the two variability metrics were investigated on both days.ResultsFor 'drinking from a glass' significant group differences were obtained on both days for the timing variability of the acceleration signals' characteristics (p = 0.002 and p = 0.008 for test and retest, respectively); all stroke patients showed increased signal timing variability as compared to their corresponding control subject. 'Moving a plate' provided less distinct group differences.ConclusionThis initial application establishes that movement variability metrics, as determined by our methodology, appear different in stroke patients as compared to matched controls during unilateral task performance ('drinking'). Use of a user-friendly, inexpensive accelerometer makes this methodology feasible for routine clinical evaluations. We are encouraged to perform larger studies to further investigate the metrics' usefulness when quantifying levels of impairment.
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paper_title: A Robust and Sensitive Metric for Quantifying Movement Smoothness

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The need for movement smoothness quantification to assess motor learning and recovery has resulted in various measures that look at different aspects of a movement's profile. This paper first shows that most of the previously published smoothness measures lack validity, consistency, sensitivity, or robustness. It then introduces and evaluates the spectral arc-length metric that uses a movement speed profile's Fourier magnitude spectrum to quantify movement smoothness. This new metric is systematically tested and compared to other smoothness metrics, using experimental data from stroke and healthy subjects as well as simulated movement data. The results indicate that the spectral arc-length metric is a valid and consistent measure of movement smoothness, which is both sensitive to modifications in motor behavior and robust to measurement noise. We hope that the systematic analysis of this paper is a step toward the standardization of the quantitative assessment of movement smoothness.
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paper_title: Design strategies to improve patient motivation during robot-aided rehabilitation

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BackgroundMotivation is an important factor in rehabilitation and frequently used as a determinant of rehabilitation outcome. Several factors can influence patient motivation and so improve exercise adherence. This paper presents the design of two robot devices for use in the rehabilitation of upper limb movements, that can motivate patients during the execution of the assigned motor tasks by enhancing the gaming aspects of rehabilitation. In addition, a regular review of the obtained performance can reinforce in patients' minds the importance of exercising and encourage them to continue, so improving their motivation and consequently adherence to the program. In view of this, we also developed an evaluation metric that could characterize the rate of improvement and quantify the changes in the obtained performance.MethodsTwo groups (G1, n = 8 and G2, n = 12) of patients with chronic stroke were enrolled in a 3-week rehabilitation program including standard physical therapy (45 min. daily) plus treatment by means of robot devices (40 min., twice daily) respectively for wrist (G1) and elbow-shoulder movements (G2). Both groups were evaluated by means of standard clinical assessment scales and the new robot measured evaluation metric. Patients' motivation was assessed in 9/12 G2 patients by means of the Intrinsic Motivation Inventory (IMI) questionnaire.ResultsBoth groups reduced their motor deficit and showed a significant improvement in clinical scales and the robot measured parameters. The IMI assessed in G2 patients showed high scores for interest, usefulness and importance subscales and low values for tension and pain subscales.ConclusionThanks to the design features of the two robot devices the therapist could easily adapt training to the individual by selecting different difficulty levels of the motor task tailored to each patient's disability. The gaming aspects incorporated in the two rehabilitation robots helped maintain patients' interest high during execution of the assigned tasks by providing feedback on performance. The evaluation metric gave a precise measure of patients' performance and thus provides a tool to help therapists promote patient motivation and hence adherence to the training program.
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paper_title: Self-adaptive robot training of stroke survivors for continuous tracking movements

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BackgroundAlthough robot therapy is progressively becoming an accepted method of treatment for stroke survivors, few studies have investigated how to adapt the robot/subject interaction forces in an automatic way. The paper is a feasibility study of a novel self-adaptive robot controller to be applied with continuous tracking movements.MethodsThe haptic robot Braccio di Ferro is used, in relation with a tracking task. The proposed control architecture is based on three main modules: 1) a force field generator that combines a non linear attractive field and a viscous field; 2) a performance evaluation module; 3) an adaptive controller. The first module operates in a continuous time fashion; the other two modules operate in an intermittent way and are triggered at the end of the current block of trials. The controller progressively decreases the gain of the force field, within a session, but operates in a non monotonic way between sessions: it remembers the minimum gain achieved in a session and propagates it to the next one, which starts with a block whose gain is greater than the previous one. The initial assistance gains are chosen according to a minimal assistance strategy. The scheme can also be applied with closed eyes in order to enhance the role of proprioception in learning and control.ResultsThe preliminary results with a small group of patients (10 chronic hemiplegic subjects) show that the scheme is robust and promotes a statistically significant improvement in performance indicators as well as a recalibration of the visual and proprioceptive channels. The results confirm that the minimally assistive, self-adaptive strategy is well tolerated by severely impaired subjects and is beneficial also for less severe patients.ConclusionsThe experiments provide detailed information about the stability and robustness of the adaptive controller of robot assistance that could be quite relevant for the design of future large scale controlled clinical trials. Moreover, the study suggests that including continuous movement in the repertoire of training is acceptable also by rather severely impaired subjects and confirms the stabilizing effect of alternating vision/no vision trials already found in previous studies.
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paper_title: Taking a Lesson From Patients' Recovery Strategies to Optimize Training During Robot-Aided Rehabilitation

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In robot-assisted neurorehabilitation, matching the task difficulty level to the patient's needs and abilities, both initially and as the relearning process progresses, can enhance the effectiveness of training and improve patients' motivation and outcome. This study presents a Progressive Task Regulation algorithm implemented in a robot for upper limb rehabilitation. It evaluates the patient's performance during training through the computation of robot-measured parameters, and automatically changes the features of the reaching movements, adapting the difficulty level of the motor task to the patient's abilities. In particular, it can select different types of assistance (time-triggered, activity-triggered, and negative assistance) and implement varied therapy practice to promote generalization processes. The algorithm was tuned by assessing the performance data obtained in 22 chronic stroke patients who underwent robotic rehabilitation, in which the difficulty level of the task was manually adjusted by the therapist. Thus, we could verify the patient's recovery strategies and implement task transition rules to match both the patient's and therapist's behavior. In addition, the algorithm was tested in a sample of five chronic stroke patients. The findings show good agreement with the therapist decisions so indicating that it could be useful for the implementation of training protocols allowing individualized and gradual treatment of upper limb disabilities in patients after stroke. The application of this algorithm during robot-assisted therapy should allow an easier management of the different motor tasks administered during training, thereby facilitating the therapist's activity in the treatment of different pathologic conditions of the neuromuscular system.
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paper_title: Deficits in grasp versus reach during acute hemiparesis

paper_content:

We studied how acute hemiparesis affects the ability to perform purposeful movements of proximal versus distal upper extremity segments. Given the gradient of corticospinal input to the spinal motoneuron pools, we postulated that movement performance requiring distal segment control (grasping) should be more impaired than movement performance requiring proximal segment control (reaching) in people with hemiparesis. We tested subjects with acute hemiparesis and control subjects performing reach and reach-to-grasp movements. Three characteristics of movement performance were quantified for each movement: speed, accuracy, and efficiency. For the reach, we calculated peak wrist velocity, endpoint error, and reach path ratio. For the grasp, we calculated peak aperture rate, aperture at touch, and aperture path ratio. To evaluate the relative deficits in reaching versus grasping, performance measures were converted to z-scores using control group means and standard deviations. For both the movements, movement times were longer and performance was more variable in the hemiparetic group compared to the control group. Hemiparetic z-scores indicated that relative deficits in movement speed were small in the two movements, with deficits in grasp being slightly greater than deficits in reach. Relative deficits in accuracy showed a trend for being larger in the reach compared to the grasp, but this difference did not reach statistical significance. In contrast, relative deficits in efficiency were larger in the grasp compared to the reach, with reaching efficiency near the range of normal performance. When considering data across all three movement characteristics, the ability to perform a purposeful movement with the distal segments was not clearly more disrupted than the ability to perform a purposeful movement with the proximal segments in people with acute hemiparesis.
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paper_title: Relationship Between Clinical Assessments of Function and Measurements From an Upper-Limb Robotic Rehabilitation Device in Cervical Spinal Cord Injury

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Upper limb robotic rehabilitation devices can collect quantitative data about the user's movements. Identifying relationships between robotic sensor data and manual clinical assessment scores would enable more precise tracking of the time course of recovery after injury and reduce the need for time-consuming manual assessments by skilled personnel. This study used measurements from robotic rehabilitation sessions to predict clinical scores in a traumatic cervical spinal cord injury (SCI) population. A retrospective analysis was conducted on data collected from subjects using the Armeo Spring (Hocoma, AG) in three rehabilitation centers. Fourteen predictive variables were explored, relating to range-of-motion, movement smoothness, and grip ability. Regression models using up to four predictors were developed to describe the following clinical scores: the GRASSP (consisting of four sub-scores), the ARAT, and the SCIM. The resulting adjusted R(2) value was highest for the GRASSP "Quantitative Prehension" component (0.78), and lowest for the GRASSP "Sensibility" component (0.54). In contrast to comparable studies in stroke survivors, movement smoothness was least beneficial for predicting clinical scores in SCI. Prediction of upper-limb clinical scores in SCI is feasible using measurements from a robotic rehabilitation device, without the need for dedicated assessment procedures.
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paper_title: Movement smoothness changes during stroke recovery

paper_content:

Smoothness is characteristic of coordinated human movements, and stroke patients' movements seem to grow more smooth with recovery. We used a robotic therapy device to analyze five different measures of movement smoothness in the hemiparetic arm of 31 patients recovering from stroke. Four of the five metrics showed general increases in smoothness for the entire patient population. However, according to the fifth metric, the movements of patients with recent stroke grew less smooth over the course of therapy. This pattern was reproduced in a computer simulation of recovery based on submovement blending, suggesting that progressive blending of submovements underlies stroke recovery.
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paper_title: Kinematic Robot-Based Evaluation Scales and Clinical Counterparts to Measure Upper Limb Motor Performance in Patients With Chronic Stroke

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Background. Human-administered clinical scales are the accepted standard for quantifying motor performance of stroke subjects. Although they are widely accepted, these measurement tools are limited by interrater and intrarater reliability and are time-consuming to apply. In contrast, robot-based measures are highly repeatable, have high resolution, and could potentially reduce assessment time. Although robotic and other objective metrics have proliferated in the literature, they are not as well established as clinical scales and their relationship to clinical scales is mostly unknown. Objective. To test the performance of linear regression models to estimate clinical scores for the upper extremity from systematic robot-based metrics. Methods. Twenty kinematic and kinetic metrics were derived from movement data recorded with the shoulder-and-elbow InMotion2 robot (Interactive Motion Technologies, Inc), a commercial version of the MIT-Manus. Kinematic metrics were aggregated into macro-metrics and micro-met...
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paper_title: Upper limb evaluation with robotic exoskeleton. Normative values for indices of accuracy, speed and smoothness

paper_content:

BACKGROUND: Robotic rehabilitation devices for upper limb function (ULF) provide global indicators of a patient’s ability, but the temporal evolution of motion related to motor control is disregarded. OBJECTIVE: To determine normative values for indices of accuracy, speed and smoothness in the evaluation of upper limb function. Twenty-five healthy individuals performed the Armeo ® Spring device “Vertical Capture” task. Custom stand-alone software was developed to provide the following indices: global Hand Path Ratio (HPR), local HPR in the target area (locHPR), vertical and horizontal overshoot (vertOS, horOS), maximum and mean velocity (maxVel, meanVel), mean/maximum velocity, number of peaks in velocity profiles (NVelPeaks) and normalized jerk (NormJerk). The dependence of indices on task characteristics was analyzed by an ANCOVA test. Indices inner relationships were assessed by a correlation and a factor analysis. Normative values were then provided. RESULTS: 4,268 single reaching movements were analyzed. Four indices were not affected by movement direction. Indices were minimally influenced by the difficulty level. Based upon correlation and factor analysis indices and can be grouped into three assessment fields, dealing with precision, velocity and smoothness. CONCLUSIONS: We have developed a tool to assess ULF in dynamic condition. Normative values were obtained to be used as references in assessing patients.
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paper_title: Kinematical measure for spastic reaching in children with cerebral palsy

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Abstract Background. Practitioners need more sensitive measure to quantify reaching movement for judgment of the treatment effects and reflecting the degrees of motor impairment in upper extremities. The purposes of this study were to identify the specific kinematic characteristics between normal and spastic reaching under different levels of accuracy, and to determine the most sensitive kinematic variable for quantifying the interference of spasticity on reaching. Methods. Ten normal subjects as control group and ten subjects with spastic cerebral palsy as experimental group were studied. Participants were asked to reach, at a self-selected pace, toward two different sizes of buttons (one with accuracy constraint and the other with non-accuracy constraint) away from normalized distance. Motion analysis system was used to record the trajectory of reaching performance. Kinematic variables of reaching movement were computed and analyzed. Findings . Measure for movement smoothness presented larger effect size (0.24–0.43) than other kinematic variables adopted in this study. Under high-accuracy reaching, children with spastic cerebral palsy had a prolonged movement time than normal children ( P r =0.56–0.75). Number of movement unit was the most sensitive kinematic variable to discriminate between normal and spastic reaching. Interpretation. Development of reliable, valid, and sensitive multi-joint biomechanical evaluation is required, particularly for natural and goal-oriented reaching movement. It is concluded that measure of movement smoothness may be applied as valid and sensitive index to quantify the level of coordinative motor performance for subjects with spastic movement disorder.
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paper_title: Temporal-spatial parameters of the upper limb during a Reach & Grasp Cycle for children

paper_content:

Abstract The objective of this study was to characterize normal temporal–spatial patterns during the Reach & Grasp Cycle and to identify upper limb motor deficits in children with cerebral palsy (CP). The Reach & Grasp Cycle encompasses six sequential tasks: reach, grasp cylinder, transport to self (T1), transport back to table (T2), release cylinder, and return to initial position. Three-dimensional motion data were recorded from 25 typically developing children (11 males, 14 females; ages 5–18 years) and 12 children with hemiplegic CP (2 males, 10 females; ages 5–17 years). Within-day and between-day coefficients of variation for the control group ranged from 0 to 0.19, indicating good repeatability of all parameters. The mean duration of the Cycle for children with CP was nearly twice as long as controls, 9.5 ± 4.3 s versus 5.1 ± 1.2 s (U = 37.0, P = .002), partly due to prolonged grasp and release durations. Peak hand velocity occurred at approximately 40% of each phase and was greater during the transport (T1, T2) than non-transport phases (reach, return) in controls (P
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paper_title: Movement smoothness changes during stroke recovery

paper_content:

Smoothness is characteristic of coordinated human movements, and stroke patients' movements seem to grow more smooth with recovery. We used a robotic therapy device to analyze five different measures of movement smoothness in the hemiparetic arm of 31 patients recovering from stroke. Four of the five metrics showed general increases in smoothness for the entire patient population. However, according to the fifth metric, the movements of patients with recent stroke grew less smooth over the course of therapy. This pattern was reproduced in a computer simulation of recovery based on submovement blending, suggesting that progressive blending of submovements underlies stroke recovery.
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paper_title: Upper limb evaluation with robotic exoskeleton. Normative values for indices of accuracy, speed and smoothness

paper_content:

BACKGROUND: Robotic rehabilitation devices for upper limb function (ULF) provide global indicators of a patient’s ability, but the temporal evolution of motion related to motor control is disregarded. OBJECTIVE: To determine normative values for indices of accuracy, speed and smoothness in the evaluation of upper limb function. Twenty-five healthy individuals performed the Armeo ® Spring device “Vertical Capture” task. Custom stand-alone software was developed to provide the following indices: global Hand Path Ratio (HPR), local HPR in the target area (locHPR), vertical and horizontal overshoot (vertOS, horOS), maximum and mean velocity (maxVel, meanVel), mean/maximum velocity, number of peaks in velocity profiles (NVelPeaks) and normalized jerk (NormJerk). The dependence of indices on task characteristics was analyzed by an ANCOVA test. Indices inner relationships were assessed by a correlation and a factor analysis. Normative values were then provided. RESULTS: 4,268 single reaching movements were analyzed. Four indices were not affected by movement direction. Indices were minimally influenced by the difficulty level. Based upon correlation and factor analysis indices and can be grouped into three assessment fields, dealing with precision, velocity and smoothness. CONCLUSIONS: We have developed a tool to assess ULF in dynamic condition. Normative values were obtained to be used as references in assessing patients.
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paper_title: Kinematic Variables Quantifying Upper-Extremity Performance After Stroke During Reaching and Drinking From a Glass

paper_content:

Background. Three-dimensional kinematic analysis provides quantitative and qualitative assessment of upper-limb motion and is used as an outcome measure to evaluate impaired movement after stroke. The number of kinematic variables used, however, is diverse, and models for upper-extremity motion analysis vary. Objective. The authors aim to identify a set of clinically useful and sensitive kinematic variables to quantify upper-extremity motor control during a purposeful daily activity, that is, drinking from a glass. Methods. For this purpose, 19 participants with chronic stroke and 19 healthy controls reached for a glass of water, took a sip, and placed it back on a table in a standardized way. An optoelectronic system captured 3-dimensional kinematics. Kinematical parameters describing movement time, velocity, strategy and smoothness, interjoint coordination, and compensatory movements were analyzed between groups. Results. The majority of kinematic variables showed significant differences between study g...
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paper_title: Effect of Instructions on Functional Reach in Persons With and Without Cerebrovascular Accident

paper_content:

OBJECTIVE. Verbal instructions comprise an important element of clinical practice, however, their effectiveness in promoting movement organization in persons with cerebrovascular accident (CVA) has not been well investigated. METHOD. A counterbalanced, repeated-measures design was used to examine the effects of externally focused (task-related) versus internally focused (movement-related) instructions on movement kinematics during three functional reaching tasks. Participants included 16 persons with stroke who were able to perform the tasks with their affected arm and 17 age-matched adults without neurological impairments. RESULTS. Significantly shorter movement time and greater peak velocity were evident when reaching under the external-focus condition of all tasks than for the internal-focus condition. CONCLUSION. One clinical implication is that internally focused instructions can contribute to slower and less forceful reach in adults with and without CVA. This research reinforces the need for therapists to consider their use of instruction during the evaluation and treatment of movement disorders.
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paper_title: Responsiveness of Upper Extremity Kinematic Measures and Clinical Improvement During the First Three Months After Stroke

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Background. Kinematic movement analysis is increasingly used as an outcome measure in evaluation of upper extremity function after stroke. Little is known, however, about what observed longitudinal changes in kinematics mean in the context of an individual’s functioning. In this study, the responsiveness and expected change in kinematic measures associated with clinically meaningful improvement in the upper extremity were evaluated. Methods. Kinematic movement analysis of a drinking task and Action Research Arm Test (ARAT) were performed early (9 days poststroke) and at 3 months after stroke in 51 subjects. The receiver-operating characteristic curve and linear regression analyses were used to evaluate responsiveness of kinematic parameters. Results. Movement time, smoothness, and trunk displacement discriminated those subjects demonstrating clinically meaningful improvements. Significant associations of 31% to 36% were found between the change in ARAT and kinematic measures. A real clinical improvement i...
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paper_title: Movement smoothness changes during stroke recovery

paper_content:

Smoothness is characteristic of coordinated human movements, and stroke patients' movements seem to grow more smooth with recovery. We used a robotic therapy device to analyze five different measures of movement smoothness in the hemiparetic arm of 31 patients recovering from stroke. Four of the five metrics showed general increases in smoothness for the entire patient population. However, according to the fifth metric, the movements of patients with recent stroke grew less smooth over the course of therapy. This pattern was reproduced in a computer simulation of recovery based on submovement blending, suggesting that progressive blending of submovements underlies stroke recovery.
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paper_title: Three-dimensional motion of the upper extremity joints during various activities of daily living.

paper_content:

Highly reliable information on the range of motion (ROM) required to perform activities of daily living (ADL) is important to allow rehabilitation professionals to make appropriate clinical judgments of patients with limited ROM of the upper extremity joints. There are, however, no data available that take full account of corrections for gimbal-lock and soft tissue artifacts, which affect estimation errors for joint angles. We used an electromagnetic three-dimensional tracking system (FASTRAK) to measure the three-dimensional ROM of the upper extremity joints of healthy adults (N=20, age range 18-34) during 16 ADL movement tasks. The ROM required for the performance of each movement was shown in terms of the joint angle at the completion of the task, using a new definition of joint angle and regression analysis to compensate for estimation errors. The results of this study may be useful in setting goals for the treatment of upper extremity joint function.
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paper_title: Effect of rehabilitation tasks on organization of movement after stroke.

paper_content:

OBJECTIVE ::: The purpose of this study was to examine the effect of presence or absence of an object (goal-directed action vs. rote exercise) and the effect of functional specificity of the object on the organization of reaching movements of persons who have had a stroke. ::: ::: ::: METHOD ::: A repeated-measure counterbalanced design was used in each of two experiments. Eighteen persons who had been hospitalized after stroke were recruited from the roster of a rehabilitation hospital and through stroke clubs and volunteered to participate. Fourteen of these became the data-producing sample. In Experiment 1, the OPTO-TRAK/3020 motion analysis system was used to record movement when the participants reached for preferred food (goal-directed action) or to a spatial location (rote exercise). In Experiment 2, the system recorded movement when participants reached to pick up the receiver of an active telephone (natural context), a detached receiver (partial context), and a stick (simulated context). The organization of the reach movement was described kinematically as the number of zero crossings of the acceleration profile (smoothness), movement time (speed), displacement, peak velocity (an indication of force), and location of peak velocity in the velocity profile (planning strategy). ::: ::: ::: RESULTS ::: Goal-directed action produced significantly smoother, faster, more forceful, and more preplanned movement than did the rote exercise condition. Functional specificity of the context did not significantly affect organization of the reach. ::: ::: ::: CONCLUSION ::: Goal-directed reach enabled persons with stroke to display characteristics typical of reach to a target by persons who have not had a stroke better than reaching out in space. These findings support the occupational therapy practice of using objects in a functional context to improve coordinated movement. However, the nature of the objects to be used requires further study.
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paper_title: Kinematical measure for spastic reaching in children with cerebral palsy

paper_content:

Abstract Background. Practitioners need more sensitive measure to quantify reaching movement for judgment of the treatment effects and reflecting the degrees of motor impairment in upper extremities. The purposes of this study were to identify the specific kinematic characteristics between normal and spastic reaching under different levels of accuracy, and to determine the most sensitive kinematic variable for quantifying the interference of spasticity on reaching. Methods. Ten normal subjects as control group and ten subjects with spastic cerebral palsy as experimental group were studied. Participants were asked to reach, at a self-selected pace, toward two different sizes of buttons (one with accuracy constraint and the other with non-accuracy constraint) away from normalized distance. Motion analysis system was used to record the trajectory of reaching performance. Kinematic variables of reaching movement were computed and analyzed. Findings . Measure for movement smoothness presented larger effect size (0.24–0.43) than other kinematic variables adopted in this study. Under high-accuracy reaching, children with spastic cerebral palsy had a prolonged movement time than normal children ( P r =0.56–0.75). Number of movement unit was the most sensitive kinematic variable to discriminate between normal and spastic reaching. Interpretation. Development of reliable, valid, and sensitive multi-joint biomechanical evaluation is required, particularly for natural and goal-oriented reaching movement. It is concluded that measure of movement smoothness may be applied as valid and sensitive index to quantify the level of coordinative motor performance for subjects with spastic movement disorder.
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paper_title: Reproducibility and Minimal Detectable Change of Three-Dimensional Kinematic Analysis of Reaching Tasks in People With Hemiparesis After Stroke

paper_content:

Background and Purpose: Three-dimensional kinematic analysis of reaching has emerged as an evaluative measure of upper-extremity motor performance in people after stroke. However, the psychometric properties supporting the use of kinematic data for evaluating longitudinal change in motor performance have not been established. The objective of this study was to determine, in a test-retest reliability manner, the reproducibility and minimal detectable change for reaching kinematics in people after stroke. ::: ::: Subjects and Methods: Fourteen participants with hemiparesis after stroke performed forward reaching tasks on 2 occasions 37.3 (SD=9.8) days apart. At each session, participants performed 4 forward reaching tasks produced by the combination of 2 target heights (low and high [109 and 153 cm from the floor, respectively]) and 2 instructed movement speeds (self-selected and as fast as possible). Two analytical methods were used to calculate kinematic parameters. ::: ::: Results: Relative reliability (intraclass correlation coefficient) ranged from .04 to .99, and absolute reliability (standard error of measurement) ranged from 2.7% to 76.8%, depending on the kinematic variable, the demands of the motor task (target height and movement speed), and the analytical method. Bland-Altman analysis, a statistical method used to assess the repeatability of a method, revealed few systematic errors between sessions. The minimal detectable change ranged from 7.4% to 98.9%. ::: ::: Discussion and Conclusion: Depending on the demands of the motor task and the analytical method, most kinematic outcome measures (such as peak hand velocity, endpoint error, reach extent, maximum shoulder flexion range of motion, and minimum elbow extension range of motion) are reliable measures of motor performance in people after stroke. However, because of the magnitude of within-subject measurement error, some variables (such as peak hand velocity, time to peak hand velocity, and movement time) must change considerably (>50%) to indicate a real change in individual participants. The results of our reliability analysis, which are based on our cohort of participants with hemiparesis after stroke and our specific paradigm, may not be generalizable to different subpopulations of people with hemiparesis after stroke or to the myriad movement tasks and kinematic variables used for the assessment of reaching performance in people after stroke.
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paper_title: Three-Dimensional Upper Limb Movement Characteristics in Children with Hemiplegic Cerebral Palsy and Typically Developing Children.

paper_content:

Abstract The aim of this study was to measure which three-dimensional spatiotemporal and kinematic parameters differentiate upper limb movement characteristics in children with hemiplegic cerebral palsy (HCP) from those in typically developing children (TDC), during various clinically relevant tasks. We used a standardized protocol containing three reach tasks (forwards, upwards, and sideways), two reach-to-grasp tasks (with objects requiring different hand orientations), and three gross motor tasks. Spatiotemporal (movement duration, trajectory straightness, maximum velocity, and timing of maximum velocity), as well as kinematic parameters (discrete angles and waveforms of the trunk, scapula, shoulder, elbow and wrist), were compared between 20 children with HCP (age 10.9 ± 2.9 years) and 20 individually age-matched TDC (age 10.9 ± 3.0 years). Kinematic calculations followed the recommendations from the International Society of Biomechanics. Results showed that children with HCP had longer movement durations, less straight hand trajectories, and lower maximum velocities compared to the TDC. Timing of maximum velocity did not differ between both groups. The movement pathology in children with HCP was highlighted by increased trunk movements and reduced shoulder elevation during reaching and reach-to-grasp. We also measured an increased anterior tilting and protraction of the scapula in children with HCP, although differences were not significant for all tasks. Finally, compared to the TDC, children with HCP used less elbow extension and supination and more wrist flexion to execute all tasks. This study reported distinct 3D upper limb movement characteristics in children with HCP and age-matched TDC, establishing the discriminative ability of the measurement procedure. From a clinical perspective, combining spatiotemporal and kinematic parameters may facilitate the identification of the pathological movement patterns seen in children with HCP and thereby add to a well-targeted upper limb treatment planning.
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paper_title: A new tool for assessing human movement: the Kinematic Assessment Tool.

paper_content:

The study of human behaviour ultimately requires the documentation of human movement. In some instances movements can be recorded through a simple button press on a computer input device. In other situations responses can be captured through questionnaire surveys. Nevertheless, there is a need within many neuroscience settings to capture how complex movements unfold over time (human kinematics). Current methods of measuring human kinematics range from accurate but multifarious laboratory configurations to portable but simplistic and time-consuming paper and pen methods. We describe a new system for recording the end-point of human movement that has the power of laboratory measures but the advantages of pen-and-paper tests: the Kinematic Assessment Tool. KAT provides a highly portable system capable of measuring human movement in configurable visual-spatial tasks. The usefulness of the system is shown in a study where 12 participants undertook a tracing and copying task using their preferred and non-preferred hand. The results show that it is possible to capture behaviour within complex tasks and quantify performance using objective measures automatically generated by the KAT system. The utility of these measures was indexed by our ability to distinguish the performance of the preferred and non-preferred hand using a single variable.
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paper_title: Three-dimensional kinematic motion analysis of a daily activity drinking from a glass: a pilot study

paper_content:

BackgroundDevelopment of reliable and objective evaluation methods is required, particularly for natural and goal-oriented upper-extremity tasks. Three-dimensional imaging measurement techniques have turned out to be a powerful tool for a quantitative and qualitative assessment of multijoint movements. The purpose of this study was to develop and test a method of three-dimensional motion analysis for the activity "drinking from a glass" and describe the drinking task with kinematic variables in control subjects.MethodsA protocol was developed for the drinking activity including the set-up of cameras and positions of the markers and the subject. The drinking task included reaching, forward transport with glass, drinking, back transport and returning the hand to the initial position. An optoelectronic system was used for the three-dimensional kinematic motion capture. Movement times, velocities, joint angles and interjoint coordination for shoulder and elbow were computed and analyzed for twenty control subjects. Test-retest consistency was evaluated for six subjects.ResultsThe test protocol showed good consistency in test-retest. Phase definitions for the drinking task were defined and verified. Descriptive kinematic variables were obtained for movement times, positions, velocities and joint angles for shoulder and elbow joint. Interjoint coordination between shoulder and elbow joint in reaching phase showed a high correlation.ConclusionThis study provides a detailed description of the three-dimensional kinematic analysis of the drinking task. Our approach to investigate and analyze a goal-oriented daily activity has a great clinical potential. Consequently, the next step is to use and test this protocol on persons with impairments and disabilities from upper extremities.
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paper_title: Robotic assessment of upper limb motor function after stroke.

paper_content:

Traditional assessment of a stroke subject’s motor ability, carried out by a therapist who observes and rates the subject’s motor behavior using ordinal measurements scales, is subjective, time consuming and lacks sensitivity. Rehabilitation robots, which have been the subject of intense inquiry over the last decade, are equipped with sensors that are used to develop objective measures of motor behaviors in a semiautomated way during therapy. This article reviews the current contributions of robot-assisted motor assessment of the upper limb. It summarizes the various measures related to movement performance, the models of motor recovery in stroke subjects and the relationship of robotic measures to standard clinical measures. It analyses the possibilities offered by current robotic assessment techniques and the aspects to address to make robotic assessment a mainstream motor assessment method.
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paper_title: Temporal-spatial parameters of the upper limb during a Reach & Grasp Cycle for children

paper_content:

Abstract The objective of this study was to characterize normal temporal–spatial patterns during the Reach & Grasp Cycle and to identify upper limb motor deficits in children with cerebral palsy (CP). The Reach & Grasp Cycle encompasses six sequential tasks: reach, grasp cylinder, transport to self (T1), transport back to table (T2), release cylinder, and return to initial position. Three-dimensional motion data were recorded from 25 typically developing children (11 males, 14 females; ages 5–18 years) and 12 children with hemiplegic CP (2 males, 10 females; ages 5–17 years). Within-day and between-day coefficients of variation for the control group ranged from 0 to 0.19, indicating good repeatability of all parameters. The mean duration of the Cycle for children with CP was nearly twice as long as controls, 9.5 ± 4.3 s versus 5.1 ± 1.2 s (U = 37.0, P = .002), partly due to prolonged grasp and release durations. Peak hand velocity occurred at approximately 40% of each phase and was greater during the transport (T1, T2) than non-transport phases (reach, return) in controls (P
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paper_title: Movement smoothness changes during stroke recovery

paper_content:

Smoothness is characteristic of coordinated human movements, and stroke patients' movements seem to grow more smooth with recovery. We used a robotic therapy device to analyze five different measures of movement smoothness in the hemiparetic arm of 31 patients recovering from stroke. Four of the five metrics showed general increases in smoothness for the entire patient population. However, according to the fifth metric, the movements of patients with recent stroke grew less smooth over the course of therapy. This pattern was reproduced in a computer simulation of recovery based on submovement blending, suggesting that progressive blending of submovements underlies stroke recovery.
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paper_title: Review of quantitative measurements of upper limb movements in hemiplegic cerebral palsy

paper_content:

This review provides an overview of results found in literature on objective measurements of upper limb movements in children with hemiplegic cerebral palsy (HCP). Seventeen articles were selected following a systematic search. Analysed tasks varied from simple reaching and gross motor functions to complex, fine motor tasks. Spatiotemporal characteristics have been extensively studied and longer movement durations, slower movement speed and reduced trajectory straightness at the affected upper limb, compared to the non-affected side or healthy children, were most frequently reported. Joint kinematics has been far less studied. The limited data confirm the clinical impression of children with HCP using less elbow extension and supination to reach for an object, which is compensated by increased trunk flexion. Increased trunk involvement was also reported during gross motor functions. Although three-dimensional (3D) movement analysis seems promising to provide additional insights in the pathological upper limb movements observed in HCP, future standardisation of the entire protocol is crucial. No consensus exists on the procedures for data collection, processing, analysing and reporting of results, or what upper limb tasks should be assessed. The International Society of Biomechanics recently proposed recommendations on the definition of upper limb joint coordinate systems and rotation sequences. These guidelines were not yet applied in these studies. Although the diverse methodological approaches used in the studies complicate the comparison of published results, some general conclusions could be drawn. A further standardisation of the protocol for 3D upper limb movement analysis will provide the foundation for comparable and repeatable results and eventually facilitate the selection and planning of treatment interventions.
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paper_title: Sensitivity of Smoothness Measures to Movement Duration, Amplitude, and Arrests

paper_content:

ABSTRACT Studies of sensory-motor performance, including those concerned with changes because of age, disease, or therapeutic intervention, often use measures based on jerk, the time derivative of acceleration, to quantify smoothness and coordination. However, results have been mixed: some researchers report sensitive discrimination of subtle differences, whereas others fail to find significant differences even when they are obviously present. One reason for this is that different measures have been used with different scaling factors. These measures are sensitive to movement amplitude or duration to different degrees. The authors show that jerk-based measures with dimensions vary counterintuitively with movement smoothness, whereas a dimensionless jerk-based measure properly quantifies common deviations from smooth, coordinated movement.
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paper_title: Effect of rehabilitation tasks on organization of movement after stroke.

paper_content:

OBJECTIVE ::: The purpose of this study was to examine the effect of presence or absence of an object (goal-directed action vs. rote exercise) and the effect of functional specificity of the object on the organization of reaching movements of persons who have had a stroke. ::: ::: ::: METHOD ::: A repeated-measure counterbalanced design was used in each of two experiments. Eighteen persons who had been hospitalized after stroke were recruited from the roster of a rehabilitation hospital and through stroke clubs and volunteered to participate. Fourteen of these became the data-producing sample. In Experiment 1, the OPTO-TRAK/3020 motion analysis system was used to record movement when the participants reached for preferred food (goal-directed action) or to a spatial location (rote exercise). In Experiment 2, the system recorded movement when participants reached to pick up the receiver of an active telephone (natural context), a detached receiver (partial context), and a stick (simulated context). The organization of the reach movement was described kinematically as the number of zero crossings of the acceleration profile (smoothness), movement time (speed), displacement, peak velocity (an indication of force), and location of peak velocity in the velocity profile (planning strategy). ::: ::: ::: RESULTS ::: Goal-directed action produced significantly smoother, faster, more forceful, and more preplanned movement than did the rote exercise condition. Functional specificity of the context did not significantly affect organization of the reach. ::: ::: ::: CONCLUSION ::: Goal-directed reach enabled persons with stroke to display characteristics typical of reach to a target by persons who have not had a stroke better than reaching out in space. These findings support the occupational therapy practice of using objects in a functional context to improve coordinated movement. However, the nature of the objects to be used requires further study.
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paper_title: Upper limb evaluation with robotic exoskeleton. Normative values for indices of accuracy, speed and smoothness

paper_content:

BACKGROUND: Robotic rehabilitation devices for upper limb function (ULF) provide global indicators of a patient’s ability, but the temporal evolution of motion related to motor control is disregarded. OBJECTIVE: To determine normative values for indices of accuracy, speed and smoothness in the evaluation of upper limb function. Twenty-five healthy individuals performed the Armeo ® Spring device “Vertical Capture” task. Custom stand-alone software was developed to provide the following indices: global Hand Path Ratio (HPR), local HPR in the target area (locHPR), vertical and horizontal overshoot (vertOS, horOS), maximum and mean velocity (maxVel, meanVel), mean/maximum velocity, number of peaks in velocity profiles (NVelPeaks) and normalized jerk (NormJerk). The dependence of indices on task characteristics was analyzed by an ANCOVA test. Indices inner relationships were assessed by a correlation and a factor analysis. Normative values were then provided. RESULTS: 4,268 single reaching movements were analyzed. Four indices were not affected by movement direction. Indices were minimally influenced by the difficulty level. Based upon correlation and factor analysis indices and can be grouped into three assessment fields, dealing with precision, velocity and smoothness. CONCLUSIONS: We have developed a tool to assess ULF in dynamic condition. Normative values were obtained to be used as references in assessing patients.
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paper_title: Kinematic Variables Quantifying Upper-Extremity Performance After Stroke During Reaching and Drinking From a Glass

paper_content:

Background. Three-dimensional kinematic analysis provides quantitative and qualitative assessment of upper-limb motion and is used as an outcome measure to evaluate impaired movement after stroke. The number of kinematic variables used, however, is diverse, and models for upper-extremity motion analysis vary. Objective. The authors aim to identify a set of clinically useful and sensitive kinematic variables to quantify upper-extremity motor control during a purposeful daily activity, that is, drinking from a glass. Methods. For this purpose, 19 participants with chronic stroke and 19 healthy controls reached for a glass of water, took a sip, and placed it back on a table in a standardized way. An optoelectronic system captured 3-dimensional kinematics. Kinematical parameters describing movement time, velocity, strategy and smoothness, interjoint coordination, and compensatory movements were analyzed between groups. Results. The majority of kinematic variables showed significant differences between study g...
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paper_title: Effect of Instructions on Functional Reach in Persons With and Without Cerebrovascular Accident

paper_content:

OBJECTIVE. Verbal instructions comprise an important element of clinical practice, however, their effectiveness in promoting movement organization in persons with cerebrovascular accident (CVA) has not been well investigated. METHOD. A counterbalanced, repeated-measures design was used to examine the effects of externally focused (task-related) versus internally focused (movement-related) instructions on movement kinematics during three functional reaching tasks. Participants included 16 persons with stroke who were able to perform the tasks with their affected arm and 17 age-matched adults without neurological impairments. RESULTS. Significantly shorter movement time and greater peak velocity were evident when reaching under the external-focus condition of all tasks than for the internal-focus condition. CONCLUSION. One clinical implication is that internally focused instructions can contribute to slower and less forceful reach in adults with and without CVA. This research reinforces the need for therapists to consider their use of instruction during the evaluation and treatment of movement disorders.
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paper_title: Kinematical measure for spastic reaching in children with cerebral palsy

paper_content:

Abstract Background. Practitioners need more sensitive measure to quantify reaching movement for judgment of the treatment effects and reflecting the degrees of motor impairment in upper extremities. The purposes of this study were to identify the specific kinematic characteristics between normal and spastic reaching under different levels of accuracy, and to determine the most sensitive kinematic variable for quantifying the interference of spasticity on reaching. Methods. Ten normal subjects as control group and ten subjects with spastic cerebral palsy as experimental group were studied. Participants were asked to reach, at a self-selected pace, toward two different sizes of buttons (one with accuracy constraint and the other with non-accuracy constraint) away from normalized distance. Motion analysis system was used to record the trajectory of reaching performance. Kinematic variables of reaching movement were computed and analyzed. Findings . Measure for movement smoothness presented larger effect size (0.24–0.43) than other kinematic variables adopted in this study. Under high-accuracy reaching, children with spastic cerebral palsy had a prolonged movement time than normal children ( P r =0.56–0.75). Number of movement unit was the most sensitive kinematic variable to discriminate between normal and spastic reaching. Interpretation. Development of reliable, valid, and sensitive multi-joint biomechanical evaluation is required, particularly for natural and goal-oriented reaching movement. It is concluded that measure of movement smoothness may be applied as valid and sensitive index to quantify the level of coordinative motor performance for subjects with spastic movement disorder.
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paper_title: Assessing Mechanisms of Recovery During Robot-Aided Neurorehabilitation of the Upper Limb

paper_content:

Objective. The present study aimed to qualify and quantify the different components of motor recovery in a group of stroke patients treated by robot-aided techniques. In addition, the learning model of each motor recovery component was analyzed. Methods . Two groups of poststroke patients were treated with the use of an elbow-shoulder manipulator, respectively, within (recent) and after (chronic) the first 6 months of their cerebrovascular accident. Both groups were evaluated by means of standard clinical assessment scales and a robot-measured evaluation method. Results. These findings confirm that motor training consisting of voluntary movements assisted by the robot device led to significant improvements in motor performance in terms of the kinematic and dynamic components of the arm movements. This corresponded to improvement of impairment as confirmed by the clinical scale results. Conclusions. Knowledge of the recovery components and of the associated performance acquisition model may be useful in as...
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paper_title: Three-dimensional kinematic motion analysis of a daily activity drinking from a glass: a pilot study

paper_content:

BackgroundDevelopment of reliable and objective evaluation methods is required, particularly for natural and goal-oriented upper-extremity tasks. Three-dimensional imaging measurement techniques have turned out to be a powerful tool for a quantitative and qualitative assessment of multijoint movements. The purpose of this study was to develop and test a method of three-dimensional motion analysis for the activity "drinking from a glass" and describe the drinking task with kinematic variables in control subjects.MethodsA protocol was developed for the drinking activity including the set-up of cameras and positions of the markers and the subject. The drinking task included reaching, forward transport with glass, drinking, back transport and returning the hand to the initial position. An optoelectronic system was used for the three-dimensional kinematic motion capture. Movement times, velocities, joint angles and interjoint coordination for shoulder and elbow were computed and analyzed for twenty control subjects. Test-retest consistency was evaluated for six subjects.ResultsThe test protocol showed good consistency in test-retest. Phase definitions for the drinking task were defined and verified. Descriptive kinematic variables were obtained for movement times, positions, velocities and joint angles for shoulder and elbow joint. Interjoint coordination between shoulder and elbow joint in reaching phase showed a high correlation.ConclusionThis study provides a detailed description of the three-dimensional kinematic analysis of the drinking task. Our approach to investigate and analyze a goal-oriented daily activity has a great clinical potential. Consequently, the next step is to use and test this protocol on persons with impairments and disabilities from upper extremities.
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paper_title: Robotic assessment of upper limb motor function after stroke.

paper_content:

Traditional assessment of a stroke subject’s motor ability, carried out by a therapist who observes and rates the subject’s motor behavior using ordinal measurements scales, is subjective, time consuming and lacks sensitivity. Rehabilitation robots, which have been the subject of intense inquiry over the last decade, are equipped with sensors that are used to develop objective measures of motor behaviors in a semiautomated way during therapy. This article reviews the current contributions of robot-assisted motor assessment of the upper limb. It summarizes the various measures related to movement performance, the models of motor recovery in stroke subjects and the relationship of robotic measures to standard clinical measures. It analyses the possibilities offered by current robotic assessment techniques and the aspects to address to make robotic assessment a mainstream motor assessment method.
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paper_title: Alterations in reaching after stroke and their relation to movement direction and impairment severity.

paper_content:

Kamper DG, McKenna-Cole AN, Kahn LE, Reinkensmeyer DJ. Alterations in reaching after stroke and their relation to movement direction and impairment severity. Arch Phys Med Rehabil 2002;83:702-7. Objectives: To examine the effects of stroke severity and target location on reaching (1) to identify regions in space that are difficult to reach, (2) to determine whether specific alter- ations in reaching are associated with particular clinical im- pairment levels, and (3) to characterize relationships between reaching alterations. Design: Participants reached toward a screen of 75 targets spanning an approximate range from 90° side to side and from waistt o head. Setting: Rehabilitation research center. Participants: Sixteen chronic stroke patients with a wide range in residual arm function and 4 control subjects. Interventions: Notapplicable. Main Outcome Measures: Chedoke-McMaster Stroke Arm Assessment, distance, velocity, smoothness, straight- ness, and direction of the hand path during each reach. Hand position trajectories were recorded with an electromagnetic sensor. Results: Reaches performed with the impaired arms showed significant degradation in all performance measures. Although only modestly dependent on the target location, these features correlated strongly with impairment level, as well as with each other. Reaching distance showed the strongest correlations with the other parameters. Conclusions: Stroke alters a broad array of features of reaching, yetlargely t he same degree of movementcont rol is preserved across a range of target locations. The only consis- tently problematic task is to reach far out from the torso, independent of the movement direction. Thus, active range of motion (AROM), rather than control over a specific subset of movement directions, is a logical focus for therapy. In addition, measuring AROM is a simple clinical measure that yields much information.
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paper_title: A Robust and Sensitive Metric for Quantifying Movement Smoothness

paper_content:

The need for movement smoothness quantification to assess motor learning and recovery has resulted in various measures that look at different aspects of a movement's profile. This paper first shows that most of the previously published smoothness measures lack validity, consistency, sensitivity, or robustness. It then introduces and evaluates the spectral arc-length metric that uses a movement speed profile's Fourier magnitude spectrum to quantify movement smoothness. This new metric is systematically tested and compared to other smoothness metrics, using experimental data from stroke and healthy subjects as well as simulated movement data. The results indicate that the spectral arc-length metric is a valid and consistent measure of movement smoothness, which is both sensitive to modifications in motor behavior and robust to measurement noise. We hope that the systematic analysis of this paper is a step toward the standardization of the quantitative assessment of movement smoothness.
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paper_title: Temporal-spatial parameters of the upper limb during a Reach & Grasp Cycle for children

paper_content:

Abstract The objective of this study was to characterize normal temporal–spatial patterns during the Reach & Grasp Cycle and to identify upper limb motor deficits in children with cerebral palsy (CP). The Reach & Grasp Cycle encompasses six sequential tasks: reach, grasp cylinder, transport to self (T1), transport back to table (T2), release cylinder, and return to initial position. Three-dimensional motion data were recorded from 25 typically developing children (11 males, 14 females; ages 5–18 years) and 12 children with hemiplegic CP (2 males, 10 females; ages 5–17 years). Within-day and between-day coefficients of variation for the control group ranged from 0 to 0.19, indicating good repeatability of all parameters. The mean duration of the Cycle for children with CP was nearly twice as long as controls, 9.5 ± 4.3 s versus 5.1 ± 1.2 s (U = 37.0, P = .002), partly due to prolonged grasp and release durations. Peak hand velocity occurred at approximately 40% of each phase and was greater during the transport (T1, T2) than non-transport phases (reach, return) in controls (P
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paper_title: Quantifying the quality of hand movement in stroke patients through three-dimensional curvature

paper_content:

BackgroundTo more accurately evaluate rehabilitation outcomes in stroke patients, movement irregularities should be quantified. Previous work in stroke patients has revealed a reduction in the trajectory smoothness and segmentation of continuous movements. Clinically, the Stroke Impairment Assessment Set (SIAS) evaluates the clumsiness of arm movements using an ordinal scale based on the examiner's observations. In this study, we focused on three-dimensional curvature of hand trajectory to quantify movement, and aimed to establish a novel measurement that is independent of movement duration. We compared the proposed measurement with the SIAS score and the jerk measure representing temporal smoothness.MethodsSixteen stroke patients with SIAS upper limb proximal motor function (Knee-Mouth test) scores ranging from 2 (incomplete performance) to 4 (mild clumsiness) were recruited. Nine healthy participant with a SIAS score of 5 (normal) also participated. Participants were asked to grasp a plastic glass and repetitively move it from the lap to the mouth and back at a conformable speed for 30 s, during which the hand movement was measured using OPTOTRAK. The position data was numerically differentiated and the three-dimensional curvature was computed. To compare against a previously proposed measure, the mean squared jerk normalized by its minimum value was computed. Age-matched healthy participants were instructed to move the glass at three different movement speeds.ResultsThere was an inverse relationship between the curvature of the movement trajectory and the patient's SIAS score. The median of the -log of curvature (MedianLC) correlated well with the SIAS score, upper extremity subsection of Fugl-Meyer Assessment, and the jerk measure in the paretic arm. When the healthy participants moved slowly, the increase in the jerk measure was comparable to the paretic movements with a SIAS score of 2 to 4, while the MedianLC was distinguishable from paretic movements.ConclusionsMeasurement based on curvature was able to quantify movement irregularities and matched well with the examiner's observations. The results suggest that the quality of paretic movements is well characterized using spatial smoothness represented by curvature. The smaller computational costs associated with this measurement suggest that this method has potential clinical utility.
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paper_title: Review of quantitative measurements of upper limb movements in hemiplegic cerebral palsy

paper_content:

This review provides an overview of results found in literature on objective measurements of upper limb movements in children with hemiplegic cerebral palsy (HCP). Seventeen articles were selected following a systematic search. Analysed tasks varied from simple reaching and gross motor functions to complex, fine motor tasks. Spatiotemporal characteristics have been extensively studied and longer movement durations, slower movement speed and reduced trajectory straightness at the affected upper limb, compared to the non-affected side or healthy children, were most frequently reported. Joint kinematics has been far less studied. The limited data confirm the clinical impression of children with HCP using less elbow extension and supination to reach for an object, which is compensated by increased trunk flexion. Increased trunk involvement was also reported during gross motor functions. Although three-dimensional (3D) movement analysis seems promising to provide additional insights in the pathological upper limb movements observed in HCP, future standardisation of the entire protocol is crucial. No consensus exists on the procedures for data collection, processing, analysing and reporting of results, or what upper limb tasks should be assessed. The International Society of Biomechanics recently proposed recommendations on the definition of upper limb joint coordinate systems and rotation sequences. These guidelines were not yet applied in these studies. Although the diverse methodological approaches used in the studies complicate the comparison of published results, some general conclusions could be drawn. A further standardisation of the protocol for 3D upper limb movement analysis will provide the foundation for comparable and repeatable results and eventually facilitate the selection and planning of treatment interventions.
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paper_title: Deficits in grasp versus reach during acute hemiparesis

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We studied how acute hemiparesis affects the ability to perform purposeful movements of proximal versus distal upper extremity segments. Given the gradient of corticospinal input to the spinal motoneuron pools, we postulated that movement performance requiring distal segment control (grasping) should be more impaired than movement performance requiring proximal segment control (reaching) in people with hemiparesis. We tested subjects with acute hemiparesis and control subjects performing reach and reach-to-grasp movements. Three characteristics of movement performance were quantified for each movement: speed, accuracy, and efficiency. For the reach, we calculated peak wrist velocity, endpoint error, and reach path ratio. For the grasp, we calculated peak aperture rate, aperture at touch, and aperture path ratio. To evaluate the relative deficits in reaching versus grasping, performance measures were converted to z-scores using control group means and standard deviations. For both the movements, movement times were longer and performance was more variable in the hemiparetic group compared to the control group. Hemiparetic z-scores indicated that relative deficits in movement speed were small in the two movements, with deficits in grasp being slightly greater than deficits in reach. Relative deficits in accuracy showed a trend for being larger in the reach compared to the grasp, but this difference did not reach statistical significance. In contrast, relative deficits in efficiency were larger in the grasp compared to the reach, with reaching efficiency near the range of normal performance. When considering data across all three movement characteristics, the ability to perform a purposeful movement with the distal segments was not clearly more disrupted than the ability to perform a purposeful movement with the proximal segments in people with acute hemiparesis.
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paper_title: Upper limb evaluation with robotic exoskeleton. Normative values for indices of accuracy, speed and smoothness

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BACKGROUND: Robotic rehabilitation devices for upper limb function (ULF) provide global indicators of a patient’s ability, but the temporal evolution of motion related to motor control is disregarded. OBJECTIVE: To determine normative values for indices of accuracy, speed and smoothness in the evaluation of upper limb function. Twenty-five healthy individuals performed the Armeo ® Spring device “Vertical Capture” task. Custom stand-alone software was developed to provide the following indices: global Hand Path Ratio (HPR), local HPR in the target area (locHPR), vertical and horizontal overshoot (vertOS, horOS), maximum and mean velocity (maxVel, meanVel), mean/maximum velocity, number of peaks in velocity profiles (NVelPeaks) and normalized jerk (NormJerk). The dependence of indices on task characteristics was analyzed by an ANCOVA test. Indices inner relationships were assessed by a correlation and a factor analysis. Normative values were then provided. RESULTS: 4,268 single reaching movements were analyzed. Four indices were not affected by movement direction. Indices were minimally influenced by the difficulty level. Based upon correlation and factor analysis indices and can be grouped into three assessment fields, dealing with precision, velocity and smoothness. CONCLUSIONS: We have developed a tool to assess ULF in dynamic condition. Normative values were obtained to be used as references in assessing patients.
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paper_title: Defining functional shoulder range of motion for activities of daily living.

paper_content:

INTRODUCTION ::: The range of motion (ROM) in the wrist and elbow required for daily activities has been reported to be less than the normal anatomic ROM. This functional ROM has not been defined for the shoulder. Many shoulder outcome assessment tools use specific functional tasks of daily living to score functional results of treatment. This study quantified the total shoulder ROM required to perform the functional tasks of the American Shoulder and Elbow Surgeon (ASES), Simple Shoulder Test (SST), and University of Pennsylvania (U-Penn) Shoulder Score (PSS). ::: ::: ::: MATERIALS AND METHODS ::: The FASTRAK electromagnetic tracking system (Colchester, VT, USA) was used to test 40 shoulders in 20 volunteers with no shoulder pathology found on physical examination. Three sensors were used: 1 each on the T3 spinous process, the scapular spine, and the arm over the distal humerus. Subjects performed each functional task of the ASES, SST, and PSS while flexion, extension, abduction, adduction, external rotation, and internal rotation were recorded. ::: ::: ::: RESULTS ::: Average shoulder motions required to perform the 10 functional tasks were flexion, 121° ± 6.7°; extension, 46° ± 5.3°; abduction, 128° ± 7.9°; cross-body adduction, 116° ± 9.1°; external rotation with the arm 90° abducted, 59° ± 10°; and internal rotation with the arm at the side, 102° ± 7.7°. ::: ::: ::: CONCLUSION ::: Although attaining full motion is a reasonable goal of all shoulder treatment, our results indicate that less ROM is required to perform the functional tasks used in common outcome tools.
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paper_title: Kinematic Variables Quantifying Upper-Extremity Performance After Stroke During Reaching and Drinking From a Glass

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Background. Three-dimensional kinematic analysis provides quantitative and qualitative assessment of upper-limb motion and is used as an outcome measure to evaluate impaired movement after stroke. The number of kinematic variables used, however, is diverse, and models for upper-extremity motion analysis vary. Objective. The authors aim to identify a set of clinically useful and sensitive kinematic variables to quantify upper-extremity motor control during a purposeful daily activity, that is, drinking from a glass. Methods. For this purpose, 19 participants with chronic stroke and 19 healthy controls reached for a glass of water, took a sip, and placed it back on a table in a standardized way. An optoelectronic system captured 3-dimensional kinematics. Kinematical parameters describing movement time, velocity, strategy and smoothness, interjoint coordination, and compensatory movements were analyzed between groups. Results. The majority of kinematic variables showed significant differences between study g...
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paper_title: Effect of Instructions on Functional Reach in Persons With and Without Cerebrovascular Accident

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OBJECTIVE. Verbal instructions comprise an important element of clinical practice, however, their effectiveness in promoting movement organization in persons with cerebrovascular accident (CVA) has not been well investigated. METHOD. A counterbalanced, repeated-measures design was used to examine the effects of externally focused (task-related) versus internally focused (movement-related) instructions on movement kinematics during three functional reaching tasks. Participants included 16 persons with stroke who were able to perform the tasks with their affected arm and 17 age-matched adults without neurological impairments. RESULTS. Significantly shorter movement time and greater peak velocity were evident when reaching under the external-focus condition of all tasks than for the internal-focus condition. CONCLUSION. One clinical implication is that internally focused instructions can contribute to slower and less forceful reach in adults with and without CVA. This research reinforces the need for therapists to consider their use of instruction during the evaluation and treatment of movement disorders.
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paper_title: Responsiveness of Upper Extremity Kinematic Measures and Clinical Improvement During the First Three Months After Stroke

paper_content:

Background. Kinematic movement analysis is increasingly used as an outcome measure in evaluation of upper extremity function after stroke. Little is known, however, about what observed longitudinal changes in kinematics mean in the context of an individual’s functioning. In this study, the responsiveness and expected change in kinematic measures associated with clinically meaningful improvement in the upper extremity were evaluated. Methods. Kinematic movement analysis of a drinking task and Action Research Arm Test (ARAT) were performed early (9 days poststroke) and at 3 months after stroke in 51 subjects. The receiver-operating characteristic curve and linear regression analyses were used to evaluate responsiveness of kinematic parameters. Results. Movement time, smoothness, and trunk displacement discriminated those subjects demonstrating clinically meaningful improvements. Significant associations of 31% to 36% were found between the change in ARAT and kinematic measures. A real clinical improvement i...
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paper_title: The use of kinematic and parametric information to highlight lack of movement and compensation in the upper extremities during activities of daily living

paper_content:

Abstract A problem that is common to the study of upper limb kinematics and gait analysis is the translation of the evidence from kinematic measurements into easily interpretable information on the status of the patient, such as the amount of compensation or lack of motion. In this study parameters that can be helpful in the rapid and clear identification of limited wrist motion and compensation were derived from kinematic data. A group of six subjects (group A) with no hand impairment, average age 32.5 ys SD 10.7 ys, and another group of five subjects (group B), average age 34.2 ys SD 16.8 ys, having suffered from distal radius fracture were tested during a cyclic activity of daily living. The activity simulated page turning. Thorax, shoulder, elbow and wrist angles were measured during this task using a motion capture system. Corresponding angle ranges were also calculated. The active range of motion (AROM) found for Group B was generally lower than that of Group A, particularly for elbow supination and wrist movements, with wrist flexion/extension statistically smaller for group B ( P = 0.02). Additional parameters that took into account lack of movements at the wrist and compensation from shoulder elevation, rotation and elbow pronation/supination proved to be more useful at identifying those subjects of group B outside the normative range and can provide clinicians with a rapid and efficient tool that can shorten the analysis process and help make more informed decisions on therapeutic treatments.
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Title: Quantitative assessment based on kinematic measures of functional impairments during upper extremity movements: A review

Section 1: Introduction
Description 1: This section provides background information about quantitative measures of human movement quality in the rehabilitation field and the importance of objective assessments for upper extremity movements.

Section 2: Search strategy
Description 2: This section outlines the search strategy used to find relevant articles, including databases searched, keywords used, and search methodology.

Section 3: Inclusion and exclusion criteria
Description 3: This section describes the criteria used to include or exclude articles from the study, including study focus, purpose, and type of publications considered.

Section 4: Search yield
Description 4: This section presents the results of the search, including the number of articles initially found, and the selection process leading to the final set of reviewed articles.

Section 5: Movement analyzed
Description 5: This section classifies and discusses the types of upper extremity movements analyzed in the reviewed articles.

Section 6: Movement capture systems
Description 6: This section details the motion capture techniques and technologies used in the reviewed studies for recording upper extremity movements.

Section 7: CNS injuries
Description 7: This section focuses on the use of kinematic metrics for assessing motor performance in healthy people and those with neurological injuries such as stroke, spinal cord injury, and cerebral palsy.

Section 8: Purpose of the metrics
Description 8: This section explores the different purposes of kinematic metrics, such as discriminative, evaluative, and predictive measures.

Section 9: Upper extremity movement-related metrics
Description 9: This section proposes and discusses various kinematic metrics related to upper extremity movements, including definitions and applications.

Section 10: Discussion
Description 10: This section reviews the literature in relation to quantitative metrics for upper extremity function, highlighting the relevance, challenges, and limitations found.

Section 11: Conclusions
Description 11: This section presents the conclusions drawn from the review, emphasizing the need for further research and the development of objective metrics for clinical application.