- Email: [email protected]
Criterion validity of wearable sensors in lower limb joint angle estimation: A systematic review
Abstracts / Annals of Physical and Rehabilitation Medicine 61S (2018) e435–e557
0.09 ± 0.05; CSH-RF , 0.13 ± 0.07. CW strongly correlated with CSH across the six muscles (r = 0.30, P = 0.006). This correlation was also found individually for GN (r = 0.43, P < 0.0001), GM (r = 0.22, P = 0.04) and HS (r = 0.21, P = 0.052). Conclusion While causality is not explored in this study, one may speculate that spastic myopathy (assessed through coefficient of shortening) may play a role in neurologic impairments, potentially by chronic modifications of afferent volleys to the spinal cord. Keywords Spastic co-contraction; Spastic myopathy; Chronic hemiparesis Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.1024 ISPR8-0696
Does functional mobility vary among individuals with up to one year after stroke? An analysis using the TUG-ABS
T. Ribeiro ∗ , E. Silva , I. Silva , M. Costa , R. Lindquist Universidade Federal do Rio Grande do Norte, Departamento de Fisioterapia, Natal, Brazil ∗ Corresponding author. E-mail address: ribeiro [email protected] (T. Ribeiro) Introduction/Background The Timed “Up and Go” Assessment of Biomechanical Strategies (TUG-ABS) analyses functional mobility activities of Timed “Up and Go” (TUG) test, showing to be valid and reliable for individuals with stroke. The aim of this study was to evaluate if the performance of functional mobility activities varies between subjects within the first year poststroke. Material and method Thirty-eight stroke subjects (mean age 56.5 years) of both genders and with up to one year of first stroke that caused gait deficits (gait speed < 0.8 m/s) participated in the study. Participants were instructed to perform the following activities: standing up from a chair without armrests, walking and circling (180◦ turns) a cone placed at the 1.35-m mark, walking back and sitting down. The performances of these activities were registered by the Qualisys Motion Capture System. By analyzing the images, TUGABS was applied to evaluate: sit-to-stand (STSt), walking (W), turn (T) and stand-to-sit (STSi). For statistical analysis, participants were divided into: one group with up to 3 months poststroke (n = 21), and another group with 4 to 12 months poststroke (n = 17). Study groups were compared with Mann Whitney test for TUG-ABS activities and total TUG-ABS score (TS). Results The groups were homogeneous with regard to middle age, cognitive level (Mini-Mental State Examination), neurological status (National Institute of Health Stroke Scale) and walking ability (Functional Ambulatory Category). For TUG-ABS, there was also no difference between groups for the activities: STSt: P = 0.161; W: P = 0.383; T: P = 0.052; STSi: P = 0.542, and for TS: P = 0.144. Conclusion Although motor recovery can be influenced by lesion time, the performance of functional mobility activities did not appear to be different among subjects in the first year poststroke. This suggests that biomechanical strategies for performing these activities are developed within the first three months following stroke, indicating the importance of early intervention for rehabilitation. Keywords Functional mobility; Stroke; Rehabilitation 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.2018.05.1025. https://doi.org/10.1016/j.rehab.2018.05.1025
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Does muscle output function decrease following 12-hour immobilization period? T. Inada 1,∗ , F. Kaneko 2 , S. Koyama 3 , J. Maruyama 3 , J. Shindo 4 Asahikawa Rehabilitation Hospital, Department of Rehabilitation, Asahikawa, Japan 2 Keio University School of Medicine, Department of Rehabilitation Medicine, Tokyo, Japan 3 Asahikawa Rehabilitation Hospital, Department of Internal Medicine, Asahikawa, Japan 4 Asahikawa Rehabilitation Hospital, Department of Rehabilitation Medicine, Asahikawa, Japan ∗ Corresponding author. E-mail address: [email protected] (T. Inada)
1
Introduction/Background Long-term immobilization of skeletal muscle results in a loss of muscle force. Previous research has revealed that one week of immobilization affects maximum voluntary contraction (MVC), MVC potential, low-level force modulation, and corticospinal excitation. Corticomotor excitability is reduced by short-term immobilization, even over days or hours. However, the effect of 12-hour immobilization period on muscle output function is unclear. Therefore, the aim of the present study was to investigate the change in motor function after immobilization of the upper limb for 12 hours. Material and method Twenty subjects were assigned to the following two groups: immobilization, control (n = 10 in each group). The left hand of the subjects in the immobilization group were wrapped with an elastic bandage and further limited the arm movement using an arm sling to the upper extremity for 12-hours. MVC during isometric abduction of the index finger, fluctuation of force (force-fluctuation) during a force modulation task, and twitch force evoked by supramaximal electrical stimulation at rest were measured before (pre-test) and after the immobilization period (post-test). The control group performed these tests, but were not immobilized. The data were analyzed using two-way (time × group) repeated measures analysis of variance. Results MVC decreased significantly in the immobilization group in the post-test compared with the pre-test. Force-fluctuation increased significantly in the immobilization group in the post-test compared with the pre-test. Twitch force revealed that a significant main effect for time. Conclusion The results of the study demonstrate that MVC and force-fluctuation were affected by 12-hour immobilization period, but twitch force was not affected. These findings have significant implications for preventing declines in muscle output function with time (for example, during cast immobilization). Keywords 12-hour immobilization; Muscle output function Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.1026 ISPR8-1776
Criterion validity of wearable sensors in lower limb joint angle estimation: A systematic review
I. Poitras ∗ , M. Bielmann , C. Mercier , L.J. Bouyer , J.S. Roy Laval University, Rehabilitation, Quebec, Canada ∗ Corresponding author. E-mail address: [email protected] (I. Poitras) Introduction/Background Motion capture systems are extensively used to measure human joint kinematics. These systems, however, lack portability and can only be used in laboratory settings. Recently, portable and wireless systems, such as inertial measurement units (IMU), have been developed and are seen as an alternative to quantify human movement outside of the laboratory.
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Abstracts / Annals of Physical and Rehabilitation Medicine 61S (2018) e435–e557
Several studies have established their psychometric properties. However, the variety of systems used and joints evaluated make it difficult to conclude on the validity of the different systems available. The aim of this systematic review is to determine the criterion validity of IMUs for the evaluation of lower limb kinematics when compared to motion capture systems. Material and method Five different databases were screened (Pubmed, Cinhal, Embase, Ergonomic abstract and Compendex). Included articles had to report on criterion validity of IMUs (vs. motion capture systems) of at least one joint in healthy adults. Only articles published after 2005 were considered. Pairs of raters conducted data extraction and critical appraisal using structured tools, and consensus had to be reached. Results A total of ten articles was included. Quality ratings of 30% of the studies reviewed were characterized as high, and 70% as moderated (interrater reliability: ICC = 0.7). Knee and trunk movements showed moderate to good criterion validity, while hip and ankle movements were characterized as having poor to good validity. Conclusion IMU systems are valid to evaluate knee and trunk kinematics. For the hip and ankle, however, the validity varies according to movement studied. The measurement of hip flexion/extension, abduction/adduction and ankle plantar flexion/dorsiflexion with IMU can be considered as valid. For ankle inversion/eversion and hip internal/external rotation, the validity is poor. More studies are therefore needed to optimize the use of IMU for these movements (e.g. different calibration or biomechanical models). Keywords Validation; Range of motion; Inertial measurement unit Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.1027 ISPR8-2008
Forced use of the paretic leg induced by repeated exposure to constraint force applied to the non-paretic leg of individuals post-stroke during walking
M. Wu ∗ , C.J. Hsu , J. Kim Shirley Ryan Abilitylab, Legs and Walking Lab 23rd floor, Chicago, USA ∗ Corresponding author. E-mail address: [email protected] (M. Wu) Introduction/Background Locomotor training has been used to improve walking function of individuals post-stroke. However, the functional gains are relatively small, which may be due to the compensatory movements of the non-paretic leg during locomotor training. Our previous study indicated that applying a constraint force to the non-paretic leg could increase muscle activations of the paretic leg during treadmill walking. It is still unclear whether muscle responses in the paretic leg are acquired through feedback correction mechanisms or feedforward control mechanisms. The goal of this study was to examine electromyography (EMG) responses in the paretic leg to a repeated constraint force applied to the non-paretic leg during treadmill walking. Material and method Fifteen individuals with chronic stroke participated in this study. Subjects walked on a treadmill with no force for 1 minute, i.e., baseline. A controlled resistance force was then applied to the non-paretic leg starting from toe-off to midswing through a custom designed cable-driven robotic system for 7 minutes, i.e., adaptation period. The force was released and subjects continued walking on the treadmill for another 1 minute, i.e., post-adaptation period. The magnitude of resistance force was ∼18% of MVC of the hip flexion. EMG from 8 muscles of the paretic leg were recorded using electrodes and ankle movement of both legs were measured using position sensors.
Results Integrated EMGs of ankle plantarflexors and hip extensors during stance phase significantly increased (33–50% increase, P < 0.01) during the early and late adaptation periods, and partially retained (17–22%) during the post-adaptation period. Conclusion Our results suggest that both feedback correction and feedforward control mechanisms may be involved in response to the constraint force applied to the non-paretic leg. Results from this study may be used to develop a long-term training paradigm to induce a forced use of the paretic leg and improve walking function of individuals post-stroke. Keywords Locomotion; Stroke; Forced use Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.1028 ISPR8-1269
Predictive diabetic foot ulcer risk factors correlated with elevated forefoot peak plantar pressure M.A. Assucena 1,∗ , M.D. Sanchez 2 , R. Navarro 3 1 Hospital of Requena, Rehabilitation, Requena, Spain 2 Hospital La Fe, Rehabilitation, Valencia, Spain 3 Hospital Clinical, Rehabilitation, Valencia, Spain ∗ Corresponding author. E-mail address: [email protected] (M.A. Assucena) Introduction/Background Polyneuropathy and foot deformity, such as Claw and hammer-toes (CHT), together with hyperkeratosis, are predictive diabetic foot ulcer (DFU) factors. These factors are correlated with increased forefoot peak plantar pressure (PPP). Increased PPP at metatarsal heads is correlated with forefoot DFU development. The aim of this study was to observe that the presence of CHT, hyperkeratosis and polyneuropathy is correlated with high forefoot PPP (FPPP). Material and method An observational transversal survey with 103 diabetic patients, with or without CHT, hyperkeratosis and polyneuropathy, and without peripheral arterial disease, previous or current DFU and lower limb amputation was conducted. Mean age was 74 years old, 41 male and 62 women. Variables were CHT, hyperkeratosis, polyneuropathy and FPPP of each foot. PPP was obtained through the BIOFOOT/IBV baropodometric system. An analysis of difference between means of two samples was performed. Results “Hyperkeratosis” is correlated with higher FPPP than “CHT and hyperkeratosis”, and both with higher FPPP than those who had none of these features. There is no significant difference between FPPP of the groups without and with polyneuropathy, both without hyperkeratosis. Conclusion Hyperkeratosis is correlated with higher FPPP, independently of polyneuropathy. The mean FPPP of up to 840 KpPa may be considered as indicative of a lower risk of DFU, in this sample and with this baropodometric system. Keywords Diabetic foot; Foot ulcer; Plantar pressure 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.2018.05.1029. https://doi.org/10.1016/j.rehab.2018.05.1029 ISPR8-1833
Coupling of postural sway to somatosensory drive: Effects of unilateral versus bilateral light touch F. Vérité 1,∗ , W. Bachta 2 1 Aix-Marseille université, institut des sciences du mouvement, Marseille, France
0.09 ± 0.05; CSH-RF , 0.13 ± 0.07. CW strongly correlated with CSH across the six muscles (r = 0.30, P = 0.006). This correlation was also found individually for GN (r = 0.43, P < 0.0001), GM (r = 0.22, P = 0.04) and HS (r = 0.21, P = 0.052). Conclusion While causality is not explored in this study, one may speculate that spastic myopathy (assessed through coefficient of shortening) may play a role in neurologic impairments, potentially by chronic modifications of afferent volleys to the spinal cord. Keywords Spastic co-contraction; Spastic myopathy; Chronic hemiparesis Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.1024 ISPR8-0696
Does functional mobility vary among individuals with up to one year after stroke? An analysis using the TUG-ABS
T. Ribeiro ∗ , E. Silva , I. Silva , M. Costa , R. Lindquist Universidade Federal do Rio Grande do Norte, Departamento de Fisioterapia, Natal, Brazil ∗ Corresponding author. E-mail address: ribeiro [email protected] (T. Ribeiro) Introduction/Background The Timed “Up and Go” Assessment of Biomechanical Strategies (TUG-ABS) analyses functional mobility activities of Timed “Up and Go” (TUG) test, showing to be valid and reliable for individuals with stroke. The aim of this study was to evaluate if the performance of functional mobility activities varies between subjects within the first year poststroke. Material and method Thirty-eight stroke subjects (mean age 56.5 years) of both genders and with up to one year of first stroke that caused gait deficits (gait speed < 0.8 m/s) participated in the study. Participants were instructed to perform the following activities: standing up from a chair without armrests, walking and circling (180◦ turns) a cone placed at the 1.35-m mark, walking back and sitting down. The performances of these activities were registered by the Qualisys Motion Capture System. By analyzing the images, TUGABS was applied to evaluate: sit-to-stand (STSt), walking (W), turn (T) and stand-to-sit (STSi). For statistical analysis, participants were divided into: one group with up to 3 months poststroke (n = 21), and another group with 4 to 12 months poststroke (n = 17). Study groups were compared with Mann Whitney test for TUG-ABS activities and total TUG-ABS score (TS). Results The groups were homogeneous with regard to middle age, cognitive level (Mini-Mental State Examination), neurological status (National Institute of Health Stroke Scale) and walking ability (Functional Ambulatory Category). For TUG-ABS, there was also no difference between groups for the activities: STSt: P = 0.161; W: P = 0.383; T: P = 0.052; STSi: P = 0.542, and for TS: P = 0.144. Conclusion Although motor recovery can be influenced by lesion time, the performance of functional mobility activities did not appear to be different among subjects in the first year poststroke. This suggests that biomechanical strategies for performing these activities are developed within the first three months following stroke, indicating the importance of early intervention for rehabilitation. Keywords Functional mobility; Stroke; Rehabilitation 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.2018.05.1025. https://doi.org/10.1016/j.rehab.2018.05.1025
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Does muscle output function decrease following 12-hour immobilization period? T. Inada 1,∗ , F. Kaneko 2 , S. Koyama 3 , J. Maruyama 3 , J. Shindo 4 Asahikawa Rehabilitation Hospital, Department of Rehabilitation, Asahikawa, Japan 2 Keio University School of Medicine, Department of Rehabilitation Medicine, Tokyo, Japan 3 Asahikawa Rehabilitation Hospital, Department of Internal Medicine, Asahikawa, Japan 4 Asahikawa Rehabilitation Hospital, Department of Rehabilitation Medicine, Asahikawa, Japan ∗ Corresponding author. E-mail address: [email protected] (T. Inada)
1
Introduction/Background Long-term immobilization of skeletal muscle results in a loss of muscle force. Previous research has revealed that one week of immobilization affects maximum voluntary contraction (MVC), MVC potential, low-level force modulation, and corticospinal excitation. Corticomotor excitability is reduced by short-term immobilization, even over days or hours. However, the effect of 12-hour immobilization period on muscle output function is unclear. Therefore, the aim of the present study was to investigate the change in motor function after immobilization of the upper limb for 12 hours. Material and method Twenty subjects were assigned to the following two groups: immobilization, control (n = 10 in each group). The left hand of the subjects in the immobilization group were wrapped with an elastic bandage and further limited the arm movement using an arm sling to the upper extremity for 12-hours. MVC during isometric abduction of the index finger, fluctuation of force (force-fluctuation) during a force modulation task, and twitch force evoked by supramaximal electrical stimulation at rest were measured before (pre-test) and after the immobilization period (post-test). The control group performed these tests, but were not immobilized. The data were analyzed using two-way (time × group) repeated measures analysis of variance. Results MVC decreased significantly in the immobilization group in the post-test compared with the pre-test. Force-fluctuation increased significantly in the immobilization group in the post-test compared with the pre-test. Twitch force revealed that a significant main effect for time. Conclusion The results of the study demonstrate that MVC and force-fluctuation were affected by 12-hour immobilization period, but twitch force was not affected. These findings have significant implications for preventing declines in muscle output function with time (for example, during cast immobilization). Keywords 12-hour immobilization; Muscle output function Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.1026 ISPR8-1776
Criterion validity of wearable sensors in lower limb joint angle estimation: A systematic review
I. Poitras ∗ , M. Bielmann , C. Mercier , L.J. Bouyer , J.S. Roy Laval University, Rehabilitation, Quebec, Canada ∗ Corresponding author. E-mail address: [email protected] (I. Poitras) Introduction/Background Motion capture systems are extensively used to measure human joint kinematics. These systems, however, lack portability and can only be used in laboratory settings. Recently, portable and wireless systems, such as inertial measurement units (IMU), have been developed and are seen as an alternative to quantify human movement outside of the laboratory.
e442
Abstracts / Annals of Physical and Rehabilitation Medicine 61S (2018) e435–e557
Several studies have established their psychometric properties. However, the variety of systems used and joints evaluated make it difficult to conclude on the validity of the different systems available. The aim of this systematic review is to determine the criterion validity of IMUs for the evaluation of lower limb kinematics when compared to motion capture systems. Material and method Five different databases were screened (Pubmed, Cinhal, Embase, Ergonomic abstract and Compendex). Included articles had to report on criterion validity of IMUs (vs. motion capture systems) of at least one joint in healthy adults. Only articles published after 2005 were considered. Pairs of raters conducted data extraction and critical appraisal using structured tools, and consensus had to be reached. Results A total of ten articles was included. Quality ratings of 30% of the studies reviewed were characterized as high, and 70% as moderated (interrater reliability: ICC = 0.7). Knee and trunk movements showed moderate to good criterion validity, while hip and ankle movements were characterized as having poor to good validity. Conclusion IMU systems are valid to evaluate knee and trunk kinematics. For the hip and ankle, however, the validity varies according to movement studied. The measurement of hip flexion/extension, abduction/adduction and ankle plantar flexion/dorsiflexion with IMU can be considered as valid. For ankle inversion/eversion and hip internal/external rotation, the validity is poor. More studies are therefore needed to optimize the use of IMU for these movements (e.g. different calibration or biomechanical models). Keywords Validation; Range of motion; Inertial measurement unit Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.1027 ISPR8-2008
Forced use of the paretic leg induced by repeated exposure to constraint force applied to the non-paretic leg of individuals post-stroke during walking
M. Wu ∗ , C.J. Hsu , J. Kim Shirley Ryan Abilitylab, Legs and Walking Lab 23rd floor, Chicago, USA ∗ Corresponding author. E-mail address: [email protected] (M. Wu) Introduction/Background Locomotor training has been used to improve walking function of individuals post-stroke. However, the functional gains are relatively small, which may be due to the compensatory movements of the non-paretic leg during locomotor training. Our previous study indicated that applying a constraint force to the non-paretic leg could increase muscle activations of the paretic leg during treadmill walking. It is still unclear whether muscle responses in the paretic leg are acquired through feedback correction mechanisms or feedforward control mechanisms. The goal of this study was to examine electromyography (EMG) responses in the paretic leg to a repeated constraint force applied to the non-paretic leg during treadmill walking. Material and method Fifteen individuals with chronic stroke participated in this study. Subjects walked on a treadmill with no force for 1 minute, i.e., baseline. A controlled resistance force was then applied to the non-paretic leg starting from toe-off to midswing through a custom designed cable-driven robotic system for 7 minutes, i.e., adaptation period. The force was released and subjects continued walking on the treadmill for another 1 minute, i.e., post-adaptation period. The magnitude of resistance force was ∼18% of MVC of the hip flexion. EMG from 8 muscles of the paretic leg were recorded using electrodes and ankle movement of both legs were measured using position sensors.
Results Integrated EMGs of ankle plantarflexors and hip extensors during stance phase significantly increased (33–50% increase, P < 0.01) during the early and late adaptation periods, and partially retained (17–22%) during the post-adaptation period. Conclusion Our results suggest that both feedback correction and feedforward control mechanisms may be involved in response to the constraint force applied to the non-paretic leg. Results from this study may be used to develop a long-term training paradigm to induce a forced use of the paretic leg and improve walking function of individuals post-stroke. Keywords Locomotion; Stroke; Forced use Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.1028 ISPR8-1269
Predictive diabetic foot ulcer risk factors correlated with elevated forefoot peak plantar pressure M.A. Assucena 1,∗ , M.D. Sanchez 2 , R. Navarro 3 1 Hospital of Requena, Rehabilitation, Requena, Spain 2 Hospital La Fe, Rehabilitation, Valencia, Spain 3 Hospital Clinical, Rehabilitation, Valencia, Spain ∗ Corresponding author. E-mail address: [email protected] (M.A. Assucena) Introduction/Background Polyneuropathy and foot deformity, such as Claw and hammer-toes (CHT), together with hyperkeratosis, are predictive diabetic foot ulcer (DFU) factors. These factors are correlated with increased forefoot peak plantar pressure (PPP). Increased PPP at metatarsal heads is correlated with forefoot DFU development. The aim of this study was to observe that the presence of CHT, hyperkeratosis and polyneuropathy is correlated with high forefoot PPP (FPPP). Material and method An observational transversal survey with 103 diabetic patients, with or without CHT, hyperkeratosis and polyneuropathy, and without peripheral arterial disease, previous or current DFU and lower limb amputation was conducted. Mean age was 74 years old, 41 male and 62 women. Variables were CHT, hyperkeratosis, polyneuropathy and FPPP of each foot. PPP was obtained through the BIOFOOT/IBV baropodometric system. An analysis of difference between means of two samples was performed. Results “Hyperkeratosis” is correlated with higher FPPP than “CHT and hyperkeratosis”, and both with higher FPPP than those who had none of these features. There is no significant difference between FPPP of the groups without and with polyneuropathy, both without hyperkeratosis. Conclusion Hyperkeratosis is correlated with higher FPPP, independently of polyneuropathy. The mean FPPP of up to 840 KpPa may be considered as indicative of a lower risk of DFU, in this sample and with this baropodometric system. Keywords Diabetic foot; Foot ulcer; Plantar pressure 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.2018.05.1029. https://doi.org/10.1016/j.rehab.2018.05.1029 ISPR8-1833
Coupling of postural sway to somatosensory drive: Effects of unilateral versus bilateral light touch F. Vérité 1,∗ , W. Bachta 2 1 Aix-Marseille université, institut des sciences du mouvement, Marseille, France