- Email: [email protected]
Apps for smartphone available through distribution platforms and validated for goniometric measurement: A systematic review
Abstracts / Annals of Physical and Rehabilitation Medicine 61S (2018) e435–e557
Keywords The medial longitudinal arch; Foot dorsiflexion range of motion; Gait analysis Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.1034 ISPR8-1209
Using inertial signals to characterize main lower limb gait patterns in individuals post-stroke N.C. Duclos 1,∗ , G. Parent 2 , R. Aissaoui 2 , C. Duclos 1 , S. Nadeau 1 Laboratoire de pathokinésiologie, centre de recherche interdisciplinaire en réadaptation, école de réadaptation, université de Montréal, Montréal, Canada 2 Laboratoire de recherche en imagerie et orthopédie, centre de recherche du centre hospitalier universitaire de Montréal, école de technologie supérieure, université de Montréal, Montréal, Canada ∗ Corresponding author. E-mail address: [email protected] (N.C. Duclos)
1
Introduction/Background Different lower limb (LL) gait patterns (spastic, flexum, hyperextension, buckling) have been described post-stroke that require specific interventions (strengthening, botox, medication, orthosis). We explored whether the analysis of angular velocities of the femur and tibia, easily recorded using wearable inertial sensors, might be a good tool to assess LL gait deviations. The objective was to define how the sagittal angular velocity of the femur (F) and tibia (T) change with walking speed, hemiparesis and LL gait patterns. Material and method Twenty chronic hemiparetic individuals, with an inertial sensor (OPAL, APDM inc.) fixed at each tibia and thigh, walked over ground at self-selected walking speed in the laboratory. A physiotherapist noted the presence of LL gait pattern and recorded with a camera the LL movement. Participants also stayed 5 seconds in upright position and did 5 squats to calibrate the system. In addition, three healthy controls walked on a treadmill at comfortable, 0.8 and 0.4 m/s speeds. A preliminary analysis confirmed that treadmill data could be used as reference for data collected over ground. The normal range of T and F was determined using ± 2 SD around the mean values at similar walking speed. Results The speed changed the amplitude of T and F and the profiles of some individuals post-stroke differed from normal limits. In seven participants with specific LL gait pattern, their T and F revealed specific profiles, with typical deviations to each LL pattern. Clear deviations from the normal T and F profiles were also observed for two participants having deviations less observable with the naked eye. Conclusion These preliminary findings suggest that wearable inertial sensors have the potential to characterize specific LL movement deviations and add objective data to gait clinical assessment. It could be an interesting complement to assess the treatment effects. Keywords Inertial sensors; Gait patterns; Stroke Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.1035 ISPR8-1510
Cognitive load during a walking task: A pilot study
I. Hoang ∗ , M. Ranchet , L. Paire-Ficout IFSTTAR, Health and security transport, Bron cedex, France ∗ Corresponding author. E-mail address: [email protected] (I. Hoang)
e445
Introduction/Background Evidence suggests that gait in complex situation is influenced by executive function in normal ageing. But to our knowledge, no study revealed what measurement is the most appropriate to assess impaired walking in older adults. The objective is to (1) test the feasibility of our protocol and (2) to explore the cognitive load during a simple vs. dual walking task in younger and older adults. Material and method To date, 6 young adults (mean = 26.7 years old; SD = 4.1) were included in this study. Fifteen young adults and 25 older adults will be included by May 2018. Participants are asked to achieve a walking task including four conditions: (1) normal pace walking, (2) subtracting while standing, (3) walking while subtracting and (4) walking while counting forward. Cognitive load is measured by changes in oxygenated and deoxygenated hemoglobin in dorsolateral prefrontal cortex (fNIRS device) and the NASA-TLX questionnaire completed after each condition. Results fNIRS analyses are in progress. Preliminary results showed that younger adults felt higher cognitive effort in both conditions 2 and 3 compared to condition 1 (NASAscorescondition2 (mean (SD)): 66 (18.7) vs NASAscorecondtion1 : 9.5 (6.3), W = −2.2, P = 0.03; NASAscorecondition3 : 78 (14.6) vs NASAscorecondition1 , W = −2.2, P = 0.03). No significant differences in speed, cadence and stride length were found between conditions 1, 3 and 4 (P > 0.05). No significant differences in subtraction performances were observed between conditions 2 and 3 (P > 0.05). Conclusion Higher cognitive load in condition 3 in younger adults confirm that our dual task walking is the most cognitively demanding condition. We expect that our fNIRS results in younger adults will be similar to those observed with NASA-TLX questionnaire. However, discrepancies between those two measures are expected in older adults. Keywords Dual-task; Walking; Cognitive load Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.1036 ISPR8-2153
Apps for smartphone available through distribution platforms and validated for goniometric measurement: A systematic review
G. Ferriero ∗ , L. Longoni , R. Brunati Scientific Institute of Lissone, IRCCS, Istituti Clinici Scientifici Maugeri, Department of Physical Medicine and Rehabilitation, Lissone, Italy ∗ Corresponding author. E-mail address: [email protected] (G. Ferriero) Introduction/Background The use of smartphones for medical purposes is increasing due to the steadily growing number of downloadable applications (apps) that transform the mobile phone into a medical device. Apps make use of the inbuilt smartphone to obtain fast measurements useful for clinical practice, in particular for goniometry. Medical apps are an emerging technology that need to be appropriately validated to ensure their safe and effective operation. The objective of this review was to provide a systematic review of apps validated for goniometry available through distribution platforms, relevant to physical medicine and rehabilitation (PMR) practitioners. Material and method A literature search was conducted by two independent reviewers on relevant articles indexed by PubMed before April, 2017. We selected only research papers published in English. Papers dealing with apps not relevant to PMR or unavailable on the market were excluded. We analyzed the following information for all apps: target population, object of the measure, body segment evaluated, modality of use, operating platform system, and validation results.
e446
Abstracts / Annals of Physical and Rehabilitation Medicine 61S (2018) e435–e557
Results The literature search produced 91 papers, 39 of which met the inclusion criteria. The included papers featured 20 different apps: 13 exclusively for upper/lower limb joint angles, 4 for spine, and 3 for both limbs and spine measurement. The 20 apps used the inbuilt smartphone magnetometer, accelerometer or camera to produce angle measurements. The overwhelming majority of the selected apps are available in the App Store for iOS. No goniometric app has been validated in dynamic conditions. Conclusion Our report highlights the availability—for angle measurement of diverse body segments—of a large body of validated goniometer apps that physiatrists and other healthcare practitioners can use with confidence in research and clinical practice. There is a need for validation studies on apps focused on goniometric measurement in dynamic conditions, such as during gait or during performance of therapeutic exercises. Keywords Rehabilitation; Goniometer; Mobile phone Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.1037 ISPR8-2293
EEG evaluation of stroke patients with hand dysfunction S. Chen 1,∗ , J. Jia 1 , X. Shu 2 Huashan Hospital, Fudan University, Rehabilitation Medicine, Shanghai, China 2 Shanghai Jiaotong University, College of mechanical and power engineering, Shanghai, China ∗ Corresponding author. E-mail address: [email protected] (S. Chen)
1
Introduction/Background EEG-based BCI evaluation was a noninvasive way to assess the brain function of stroke patients. With higher temporal resolution, it can be used to see the brain activation change when patients were asked to perform a specific task like motor imagery (MI). For patients with hand dysfunction after stroke, specific task-based EEG evaluation can not only be used to assess brain function but also be a reference in BCI rehabilitation system improvement suitable for stroke patients. Material and method The research recruited 31 stroke patients with hand and upper extremity motor dysfunction. Patients were asked to perform motor imagery task according to the tips on the screen. EEG signals of stroke patients were recorded. BCI performances of this system were evaluated. We chose 12 and 14 channels to respectively calculate the BCI performances. They total 12 are C3, FC1, FC5, CP1, CP5, P3 in the left hemisphere and C4, FC2, FC6, CP2, CP6, P4 in the right hemisphere. In addition, we add F3 and F4 to a total 14 channels. Results We found that in the lower alpha-␣, the BCI performance of ischemia was significant higher than that of hemorrhage (P < 0.05) both in the 12 and 14 channels. We also found that the higher the BCI accuracy, the higher FMA score the patient will get (P < 0.05). And there was no statistical significance in other EEG frequencies related to motor imagery task. Conclusion The brain activation and BCI accuracy can be used as monitor and assessment for stroke patients. The difference in BCI accuracy between ischemia and hemorrhage may be an improvement reference in BCI system. For hemorrhagic patients, the BCI feedback threshold may be lower in other to get a better interaction. And the correlative result between FMA scores and BCI accuracies suggests that the person with higher hand function, the higher BCI accuracy he may get. Keywords BCI; Motor imagery; Stroke Disclosure of interest The authors have not supplied their declaration of competing interest.
Appendix A Supplementary data Supplementary data associated with this article can be found, in the online version, at https://doi.org/10.1016/j.rehab.2018.05.1038. https://doi.org/10.1016/j.rehab.2018.05.1038 ISPR8-2336
Changes in lower extremity biomechanics and muscle activity after six-minute fast-walk in individuals with flatfoot
C.Y. Chiang ∗ , K.W. Lin , W.W. Yang , Y.C. Chang , L.W. Chou National Yang-Ming University, Physical Therapy and Assistive Technology, Taipei, Taiwan R.O.C. ∗ Corresponding author. E-mail address: [email protected] (C.Y. Chiang) Introduction/Background Flatfoot is a common disorder, which is caused by dysfunction of medial longitudinal arch. Individuals with flatfoot usually exhibit symptoms such as fatigue and discomfort after fast walking, and association syndromes to other lower extremity joints. Therefore, it is important to understand how flatfoot affects the biomechanics and muscle activities of the lower extremity, especially after a challenging walking activity. Material and method Fourteen individuals with flatfoot (8M6F, age: 24.5 ± 2.47) participated in this study. All subjects performed maximal voluntary isometric contraction (MVIC) and functional tasks including walking, single-leg standing and sit-to-stand before and immediately after a 6-minute fast-walking protocol. The motion capture (Vicon Motion Systems Ltd, Oxford, UK) system, force plate and the surface electromyography (sEMG) system (MP150, BIOPAC Systems Inc., CA, USA) were used to collect kinematics and muscle activation data respectively. Median frequency and RMS amplitude of EMG, as well as joint angles and moments were calculated and compared using paired t-tests. Results Most of subjects showed decrease in median frequency (fatigue) in tibialis anterior, but increase in abductor hallucis after 6-minute fast-walking. Also, during stance phase of gait, ankle joint showed more adduction and hip joint showed more flexion at heel contact, decreased knee extension moments at 30% to 50% of stance phase, and decreased hip internal rotation moments at 30% of stance phase. Conclusion Our study found that tibialis anterior became fatigue after 6-minute fast walking, and as a result abductor hallucis increased muscle recruitment to compensate and provide support to the foot arch. Along with the altered biomechanics of the proximal joints, this challenging fast walking protocol could help explain the mechanism of overuse injury and associated syndromes in individuals with flat foot. Keywords Flatfoot; Biomechanics; Six-minute fast-walk Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.1039 ISPR8-2471
Investigating changes in global conduction velocity estimates from biceps brachii muscles of stroke survivors T. Pinto 1,∗ , A. Turolla 2 , M. Gazzoni 1 , M. Agostini 2 , T. Vieira 1 Politecnico di Torino, DET, LISiN, Turin, Italy 2 IRCCS Fondazione Ospedale San Camillo, Laboratory of Kinematics and Robotics, Venice, Italy ∗ Corresponding author. E-mail address: [email protected] (T. Pinto)
1
Introduction/Background It has been inferred that stroke-induced alterations of the lower motor neurons and their muscle fibres may
Keywords The medial longitudinal arch; Foot dorsiflexion range of motion; Gait analysis Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.1034 ISPR8-1209
Using inertial signals to characterize main lower limb gait patterns in individuals post-stroke N.C. Duclos 1,∗ , G. Parent 2 , R. Aissaoui 2 , C. Duclos 1 , S. Nadeau 1 Laboratoire de pathokinésiologie, centre de recherche interdisciplinaire en réadaptation, école de réadaptation, université de Montréal, Montréal, Canada 2 Laboratoire de recherche en imagerie et orthopédie, centre de recherche du centre hospitalier universitaire de Montréal, école de technologie supérieure, université de Montréal, Montréal, Canada ∗ Corresponding author. E-mail address: [email protected] (N.C. Duclos)
1
Introduction/Background Different lower limb (LL) gait patterns (spastic, flexum, hyperextension, buckling) have been described post-stroke that require specific interventions (strengthening, botox, medication, orthosis). We explored whether the analysis of angular velocities of the femur and tibia, easily recorded using wearable inertial sensors, might be a good tool to assess LL gait deviations. The objective was to define how the sagittal angular velocity of the femur (F) and tibia (T) change with walking speed, hemiparesis and LL gait patterns. Material and method Twenty chronic hemiparetic individuals, with an inertial sensor (OPAL, APDM inc.) fixed at each tibia and thigh, walked over ground at self-selected walking speed in the laboratory. A physiotherapist noted the presence of LL gait pattern and recorded with a camera the LL movement. Participants also stayed 5 seconds in upright position and did 5 squats to calibrate the system. In addition, three healthy controls walked on a treadmill at comfortable, 0.8 and 0.4 m/s speeds. A preliminary analysis confirmed that treadmill data could be used as reference for data collected over ground. The normal range of T and F was determined using ± 2 SD around the mean values at similar walking speed. Results The speed changed the amplitude of T and F and the profiles of some individuals post-stroke differed from normal limits. In seven participants with specific LL gait pattern, their T and F revealed specific profiles, with typical deviations to each LL pattern. Clear deviations from the normal T and F profiles were also observed for two participants having deviations less observable with the naked eye. Conclusion These preliminary findings suggest that wearable inertial sensors have the potential to characterize specific LL movement deviations and add objective data to gait clinical assessment. It could be an interesting complement to assess the treatment effects. Keywords Inertial sensors; Gait patterns; Stroke Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.1035 ISPR8-1510
Cognitive load during a walking task: A pilot study
I. Hoang ∗ , M. Ranchet , L. Paire-Ficout IFSTTAR, Health and security transport, Bron cedex, France ∗ Corresponding author. E-mail address: [email protected] (I. Hoang)
e445
Introduction/Background Evidence suggests that gait in complex situation is influenced by executive function in normal ageing. But to our knowledge, no study revealed what measurement is the most appropriate to assess impaired walking in older adults. The objective is to (1) test the feasibility of our protocol and (2) to explore the cognitive load during a simple vs. dual walking task in younger and older adults. Material and method To date, 6 young adults (mean = 26.7 years old; SD = 4.1) were included in this study. Fifteen young adults and 25 older adults will be included by May 2018. Participants are asked to achieve a walking task including four conditions: (1) normal pace walking, (2) subtracting while standing, (3) walking while subtracting and (4) walking while counting forward. Cognitive load is measured by changes in oxygenated and deoxygenated hemoglobin in dorsolateral prefrontal cortex (fNIRS device) and the NASA-TLX questionnaire completed after each condition. Results fNIRS analyses are in progress. Preliminary results showed that younger adults felt higher cognitive effort in both conditions 2 and 3 compared to condition 1 (NASAscorescondition2 (mean (SD)): 66 (18.7) vs NASAscorecondtion1 : 9.5 (6.3), W = −2.2, P = 0.03; NASAscorecondition3 : 78 (14.6) vs NASAscorecondition1 , W = −2.2, P = 0.03). No significant differences in speed, cadence and stride length were found between conditions 1, 3 and 4 (P > 0.05). No significant differences in subtraction performances were observed between conditions 2 and 3 (P > 0.05). Conclusion Higher cognitive load in condition 3 in younger adults confirm that our dual task walking is the most cognitively demanding condition. We expect that our fNIRS results in younger adults will be similar to those observed with NASA-TLX questionnaire. However, discrepancies between those two measures are expected in older adults. Keywords Dual-task; Walking; Cognitive load Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.1036 ISPR8-2153
Apps for smartphone available through distribution platforms and validated for goniometric measurement: A systematic review
G. Ferriero ∗ , L. Longoni , R. Brunati Scientific Institute of Lissone, IRCCS, Istituti Clinici Scientifici Maugeri, Department of Physical Medicine and Rehabilitation, Lissone, Italy ∗ Corresponding author. E-mail address: [email protected] (G. Ferriero) Introduction/Background The use of smartphones for medical purposes is increasing due to the steadily growing number of downloadable applications (apps) that transform the mobile phone into a medical device. Apps make use of the inbuilt smartphone to obtain fast measurements useful for clinical practice, in particular for goniometry. Medical apps are an emerging technology that need to be appropriately validated to ensure their safe and effective operation. The objective of this review was to provide a systematic review of apps validated for goniometry available through distribution platforms, relevant to physical medicine and rehabilitation (PMR) practitioners. Material and method A literature search was conducted by two independent reviewers on relevant articles indexed by PubMed before April, 2017. We selected only research papers published in English. Papers dealing with apps not relevant to PMR or unavailable on the market were excluded. We analyzed the following information for all apps: target population, object of the measure, body segment evaluated, modality of use, operating platform system, and validation results.
e446
Abstracts / Annals of Physical and Rehabilitation Medicine 61S (2018) e435–e557
Results The literature search produced 91 papers, 39 of which met the inclusion criteria. The included papers featured 20 different apps: 13 exclusively for upper/lower limb joint angles, 4 for spine, and 3 for both limbs and spine measurement. The 20 apps used the inbuilt smartphone magnetometer, accelerometer or camera to produce angle measurements. The overwhelming majority of the selected apps are available in the App Store for iOS. No goniometric app has been validated in dynamic conditions. Conclusion Our report highlights the availability—for angle measurement of diverse body segments—of a large body of validated goniometer apps that physiatrists and other healthcare practitioners can use with confidence in research and clinical practice. There is a need for validation studies on apps focused on goniometric measurement in dynamic conditions, such as during gait or during performance of therapeutic exercises. Keywords Rehabilitation; Goniometer; Mobile phone Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.1037 ISPR8-2293
EEG evaluation of stroke patients with hand dysfunction S. Chen 1,∗ , J. Jia 1 , X. Shu 2 Huashan Hospital, Fudan University, Rehabilitation Medicine, Shanghai, China 2 Shanghai Jiaotong University, College of mechanical and power engineering, Shanghai, China ∗ Corresponding author. E-mail address: [email protected] (S. Chen)
1
Introduction/Background EEG-based BCI evaluation was a noninvasive way to assess the brain function of stroke patients. With higher temporal resolution, it can be used to see the brain activation change when patients were asked to perform a specific task like motor imagery (MI). For patients with hand dysfunction after stroke, specific task-based EEG evaluation can not only be used to assess brain function but also be a reference in BCI rehabilitation system improvement suitable for stroke patients. Material and method The research recruited 31 stroke patients with hand and upper extremity motor dysfunction. Patients were asked to perform motor imagery task according to the tips on the screen. EEG signals of stroke patients were recorded. BCI performances of this system were evaluated. We chose 12 and 14 channels to respectively calculate the BCI performances. They total 12 are C3, FC1, FC5, CP1, CP5, P3 in the left hemisphere and C4, FC2, FC6, CP2, CP6, P4 in the right hemisphere. In addition, we add F3 and F4 to a total 14 channels. Results We found that in the lower alpha-␣, the BCI performance of ischemia was significant higher than that of hemorrhage (P < 0.05) both in the 12 and 14 channels. We also found that the higher the BCI accuracy, the higher FMA score the patient will get (P < 0.05). And there was no statistical significance in other EEG frequencies related to motor imagery task. Conclusion The brain activation and BCI accuracy can be used as monitor and assessment for stroke patients. The difference in BCI accuracy between ischemia and hemorrhage may be an improvement reference in BCI system. For hemorrhagic patients, the BCI feedback threshold may be lower in other to get a better interaction. And the correlative result between FMA scores and BCI accuracies suggests that the person with higher hand function, the higher BCI accuracy he may get. Keywords BCI; Motor imagery; Stroke Disclosure of interest The authors have not supplied their declaration of competing interest.
Appendix A Supplementary data Supplementary data associated with this article can be found, in the online version, at https://doi.org/10.1016/j.rehab.2018.05.1038. https://doi.org/10.1016/j.rehab.2018.05.1038 ISPR8-2336
Changes in lower extremity biomechanics and muscle activity after six-minute fast-walk in individuals with flatfoot
C.Y. Chiang ∗ , K.W. Lin , W.W. Yang , Y.C. Chang , L.W. Chou National Yang-Ming University, Physical Therapy and Assistive Technology, Taipei, Taiwan R.O.C. ∗ Corresponding author. E-mail address: [email protected] (C.Y. Chiang) Introduction/Background Flatfoot is a common disorder, which is caused by dysfunction of medial longitudinal arch. Individuals with flatfoot usually exhibit symptoms such as fatigue and discomfort after fast walking, and association syndromes to other lower extremity joints. Therefore, it is important to understand how flatfoot affects the biomechanics and muscle activities of the lower extremity, especially after a challenging walking activity. Material and method Fourteen individuals with flatfoot (8M6F, age: 24.5 ± 2.47) participated in this study. All subjects performed maximal voluntary isometric contraction (MVIC) and functional tasks including walking, single-leg standing and sit-to-stand before and immediately after a 6-minute fast-walking protocol. The motion capture (Vicon Motion Systems Ltd, Oxford, UK) system, force plate and the surface electromyography (sEMG) system (MP150, BIOPAC Systems Inc., CA, USA) were used to collect kinematics and muscle activation data respectively. Median frequency and RMS amplitude of EMG, as well as joint angles and moments were calculated and compared using paired t-tests. Results Most of subjects showed decrease in median frequency (fatigue) in tibialis anterior, but increase in abductor hallucis after 6-minute fast-walking. Also, during stance phase of gait, ankle joint showed more adduction and hip joint showed more flexion at heel contact, decreased knee extension moments at 30% to 50% of stance phase, and decreased hip internal rotation moments at 30% of stance phase. Conclusion Our study found that tibialis anterior became fatigue after 6-minute fast walking, and as a result abductor hallucis increased muscle recruitment to compensate and provide support to the foot arch. Along with the altered biomechanics of the proximal joints, this challenging fast walking protocol could help explain the mechanism of overuse injury and associated syndromes in individuals with flat foot. Keywords Flatfoot; Biomechanics; Six-minute fast-walk Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.1039 ISPR8-2471
Investigating changes in global conduction velocity estimates from biceps brachii muscles of stroke survivors T. Pinto 1,∗ , A. Turolla 2 , M. Gazzoni 1 , M. Agostini 2 , T. Vieira 1 Politecnico di Torino, DET, LISiN, Turin, Italy 2 IRCCS Fondazione Ospedale San Camillo, Laboratory of Kinematics and Robotics, Venice, Italy ∗ Corresponding author. E-mail address: [email protected] (T. Pinto)
1
Introduction/Background It has been inferred that stroke-induced alterations of the lower motor neurons and their muscle fibres may