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Evaluation of the FAMP-coach protocol in clinical gait analysis
Abstracts / Gait & Posture 36 (2012) S1–S101
S75
P36
P37
The use of an off-the-shelf gaming technology for tracking movement and upper limb stroke rehabilitation
Evaluation of the FAMP-coach protocol in clinical gait analysis
J.M. Hijmans 1,∗ , M. King 2 1
Department of Rehabilitation Medicine, University Medical Center Groningen, Groningen, Netherlands 2 Assistive Devices, Industrial Research Ltd., Christchurch, New Zealand Introduction: We have developed a system that utilises low-cost gaming technology to track the movements of the upper limb. The device was a CyWee Z, a movement based computer game controller similar to the Nintendo Wii remote. Accelerometers and gyroscopes are used to track the movement and interact with the computer. To make bilateral upper limb exercises possible, the game controller was attached to a handlebar. This bilateral strategy allowed the unaffected side to support and assist the affected side (Fig. 1). The intervention consisted of playing computer games with the device. The device was used to interact with computer games while exercising the affected upper limb of chronic stroke patients with their less affected arm supporting and assisting the movements of the affected arm in a bilateral manner. We have investigated the effects on motor recovery and motivation to use the system, designed to provide repetitive, computer game-assisted upper limb rehabilitation, in a cohort of adults with chronic stroke. Patients/materials and methods: Fourteen participants who had a stroke more than a year ago received a control treatment first, followed by a washout period and then the intervention. Both the control treatment (playing mouse based computer games with the unaffected limb) and the intervention (playing computer games with the CyWee Z and handlebar) comprised 8–10 sessions of 45–60 min, over a period of 2.5 weeks. The upper limb section of the Fugl Meyer Assessment (FMA-UL) was used as the primary outcome. The Wolf Motor Function Test and the Disabilities of Arm, Shoulder, and Hand questionnaire were used as secondary outcomes. Three of these participants were asked to continue the use at home. Their motivation to use the system was measured with the Intrinsic Motivation Inventory. Results: Post intervention, motor performance, measured by the FMA-UL, was significantly improved compared with all pre intervention assessments (p < 0.001), whereas no changes were found on both secondary outcomes. Discussion and conclusion: It can be concluded from this pilot study that a movement based game controller can effectively be used to track the movements of the upper limb, to interact with the computer, and is suitable for upper limb rehabilitation of stroke survivors. Upper limb motor performance of adults with chronic stroke improves with repetitive, computer game assisted, self-supported bilateral exercises. Moreover participants were motivated to use the system in a home-based manner. Disclosure: No significant relationships. Reference [1] Hijmans JM, Hale L, Satherley J, McMillan N, King M. Bilateral upper limb rehabilitation after stroke using a movement based game controller. Journal of Rehabilitation Research and Development, accepted for publication.
doi:10.1016/j.gaitpost.2011.10.309
M. Janssen, B.E. Groen ∗ , A.M. van der Zijden, B. Nienhuis Research Development and Education, Maartenskliniek, Nijmegen, Netherlands Introduction: Using the Vicon Clinical Manager (VCM) model, accurate and consistent marker placement is of crucial importance for adequate 3D-gait analysis. The identification of the anatomical landmarks for marker placement varies between observers; its variability can raise up to 25 mm [1]. Using the VCM model, the knee axis orientation is particularly prone to errors, due to inconsistent knee and thigh marker placement resulting in a large variability in the knee kinematics. To reduce the errors in the knee axis orientation, the From Functional Axis to Marker Placement (FAMP) coach has been developed. This tool uses the functional knee axis [2] to identify the optimal knee and thigh marker positions and guides the clinical user to place the markers on these positions [3]. The purpose of this study was to evaluate the FAMP-coach protocol with respect to the inter-observer reliability of the knee kinematics. Patients/materials and methods: Six experienced physiotherapists collected the data for a healthy adult with spastic hemiplegic cerebral palsy and eight physiotherapists collected the data for a healthy control. Each measurement consisted of two gait sessions using the modified Helen Hayes marker set [4]. For the first session, the markers were placed on the anatomical landmarks using the VCM protocol. For the second session, the knee and thigh markers were (re)placed using the FAMP-coach protocol [3]. Kinematic data were collected using an eight-camera VICON system (100 Hz). To determine the interobserver reliability of the knee kinematics, the mean standard deviation (SD) and intra class correlation (ICC(3,1), absolute agreement) were calculated for both subjects (left side). Results: SD (◦ )
Subject Protocol ICC
Sagittal Frontal Transverse Sagittal Frontal Transverse Control VCM FAMP
0.98 0.99
0.44 0.80
0.15 0.21
2.7 2.0
3.7 2.4
8.7 5.7
VCM FAMP
0.97 0.98
0.10 0.72
0.21 0.13
2.8 2.3
4.2 1.8
9.3 10.3
CP
Discussion and conclusion: The inter-observer reliability was high for the sagittal plane knee kinematics for both protocols. The FAMPcoach protocol did improve the inter-observer reliability for the frontal plane knee kinematics. For some physiotherapist, crosstalk was not reduced by the FAMP-coach, which may be due to its dependency on a correct hip joint center position. The FAMPcoach could not improve the poor interobserver reliability for the transverse plane knee kinematics. The large interobserver variability for the transverse plane knee kinematics was probably due to interobserver variability in the pelvic and shank marker placement. In conclusion, the interobserver reliability for the sagittal and frontal plane knee kinematics were good when using the FAMPcoach protocol, but remained poor for the transverse plane knee kinematics. The FAMP-coach protocol may be improved by reducing the interobserver variability of the hip joint center and shank marker position. Disclosure: No significant relationships. References [1] [2] [3] [4]
Della Croce, et al. Gait Posture 2005;21:226–73. Rozumalski, Schwartz. Gait Posture 2008;28:S74–5. Van der Zijden, et al. Gait Posture 2009;30(S2):S35–6. Davis, et al. Hum Mov Sci 1991;10:575–87.
doi:10.1016/j.gaitpost.2011.10.310
S75
P36
P37
The use of an off-the-shelf gaming technology for tracking movement and upper limb stroke rehabilitation
Evaluation of the FAMP-coach protocol in clinical gait analysis
J.M. Hijmans 1,∗ , M. King 2 1
Department of Rehabilitation Medicine, University Medical Center Groningen, Groningen, Netherlands 2 Assistive Devices, Industrial Research Ltd., Christchurch, New Zealand Introduction: We have developed a system that utilises low-cost gaming technology to track the movements of the upper limb. The device was a CyWee Z, a movement based computer game controller similar to the Nintendo Wii remote. Accelerometers and gyroscopes are used to track the movement and interact with the computer. To make bilateral upper limb exercises possible, the game controller was attached to a handlebar. This bilateral strategy allowed the unaffected side to support and assist the affected side (Fig. 1). The intervention consisted of playing computer games with the device. The device was used to interact with computer games while exercising the affected upper limb of chronic stroke patients with their less affected arm supporting and assisting the movements of the affected arm in a bilateral manner. We have investigated the effects on motor recovery and motivation to use the system, designed to provide repetitive, computer game-assisted upper limb rehabilitation, in a cohort of adults with chronic stroke. Patients/materials and methods: Fourteen participants who had a stroke more than a year ago received a control treatment first, followed by a washout period and then the intervention. Both the control treatment (playing mouse based computer games with the unaffected limb) and the intervention (playing computer games with the CyWee Z and handlebar) comprised 8–10 sessions of 45–60 min, over a period of 2.5 weeks. The upper limb section of the Fugl Meyer Assessment (FMA-UL) was used as the primary outcome. The Wolf Motor Function Test and the Disabilities of Arm, Shoulder, and Hand questionnaire were used as secondary outcomes. Three of these participants were asked to continue the use at home. Their motivation to use the system was measured with the Intrinsic Motivation Inventory. Results: Post intervention, motor performance, measured by the FMA-UL, was significantly improved compared with all pre intervention assessments (p < 0.001), whereas no changes were found on both secondary outcomes. Discussion and conclusion: It can be concluded from this pilot study that a movement based game controller can effectively be used to track the movements of the upper limb, to interact with the computer, and is suitable for upper limb rehabilitation of stroke survivors. Upper limb motor performance of adults with chronic stroke improves with repetitive, computer game assisted, self-supported bilateral exercises. Moreover participants were motivated to use the system in a home-based manner. Disclosure: No significant relationships. Reference [1] Hijmans JM, Hale L, Satherley J, McMillan N, King M. Bilateral upper limb rehabilitation after stroke using a movement based game controller. Journal of Rehabilitation Research and Development, accepted for publication.
doi:10.1016/j.gaitpost.2011.10.309
M. Janssen, B.E. Groen ∗ , A.M. van der Zijden, B. Nienhuis Research Development and Education, Maartenskliniek, Nijmegen, Netherlands Introduction: Using the Vicon Clinical Manager (VCM) model, accurate and consistent marker placement is of crucial importance for adequate 3D-gait analysis. The identification of the anatomical landmarks for marker placement varies between observers; its variability can raise up to 25 mm [1]. Using the VCM model, the knee axis orientation is particularly prone to errors, due to inconsistent knee and thigh marker placement resulting in a large variability in the knee kinematics. To reduce the errors in the knee axis orientation, the From Functional Axis to Marker Placement (FAMP) coach has been developed. This tool uses the functional knee axis [2] to identify the optimal knee and thigh marker positions and guides the clinical user to place the markers on these positions [3]. The purpose of this study was to evaluate the FAMP-coach protocol with respect to the inter-observer reliability of the knee kinematics. Patients/materials and methods: Six experienced physiotherapists collected the data for a healthy adult with spastic hemiplegic cerebral palsy and eight physiotherapists collected the data for a healthy control. Each measurement consisted of two gait sessions using the modified Helen Hayes marker set [4]. For the first session, the markers were placed on the anatomical landmarks using the VCM protocol. For the second session, the knee and thigh markers were (re)placed using the FAMP-coach protocol [3]. Kinematic data were collected using an eight-camera VICON system (100 Hz). To determine the interobserver reliability of the knee kinematics, the mean standard deviation (SD) and intra class correlation (ICC(3,1), absolute agreement) were calculated for both subjects (left side). Results: SD (◦ )
Subject Protocol ICC
Sagittal Frontal Transverse Sagittal Frontal Transverse Control VCM FAMP
0.98 0.99
0.44 0.80
0.15 0.21
2.7 2.0
3.7 2.4
8.7 5.7
VCM FAMP
0.97 0.98
0.10 0.72
0.21 0.13
2.8 2.3
4.2 1.8
9.3 10.3
CP
Discussion and conclusion: The inter-observer reliability was high for the sagittal plane knee kinematics for both protocols. The FAMPcoach protocol did improve the inter-observer reliability for the frontal plane knee kinematics. For some physiotherapist, crosstalk was not reduced by the FAMP-coach, which may be due to its dependency on a correct hip joint center position. The FAMPcoach could not improve the poor interobserver reliability for the transverse plane knee kinematics. The large interobserver variability for the transverse plane knee kinematics was probably due to interobserver variability in the pelvic and shank marker placement. In conclusion, the interobserver reliability for the sagittal and frontal plane knee kinematics were good when using the FAMPcoach protocol, but remained poor for the transverse plane knee kinematics. The FAMP-coach protocol may be improved by reducing the interobserver variability of the hip joint center and shank marker position. Disclosure: No significant relationships. References [1] [2] [3] [4]
Della Croce, et al. Gait Posture 2005;21:226–73. Rozumalski, Schwartz. Gait Posture 2008;28:S74–5. Van der Zijden, et al. Gait Posture 2009;30(S2):S35–6. Davis, et al. Hum Mov Sci 1991;10:575–87.
doi:10.1016/j.gaitpost.2011.10.310