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McDonald C, Camino E, Escandon R, Finkel RS, Fischer R, Flanigan K, Furlong P, Juhasz R, Martin AS, Villa C, Sweeney HL. Draft Guidance for Industry Duchenne Muscular Dystrophy, Becker Muscular Dystrophy, and Related Dystrophinopathies - Developing Potential Treatments for the Entire Spectrum of Disease. J Neuromuscul Dis 2024; 11:499-523. [PMID: 38363616 DOI: 10.3233/jnd-230219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Background Duchenne muscular dystrophy (DMD) and related dystrophinopathies are neuromuscular conditions with great unmet medical needs that require the development of effective medical treatments. Objective To aid sponsors in clinical development of drugs and therapeutic biological products for treating DMD across the disease spectrum by integrating advancements, patient registries, natural history studies, and more into a comprehensive guidance. Methods This guidance emerged from collaboration between the FDA, the Duchenne community, and industry stakeholders. It entailed a structured approach, involving multiple committees and boards. From its inception in 2014, the guidance underwent revisions incorporating insights from gene therapy studies, cardiac function research, and innovative clinical trial designs. Results The guidance provides a deeper understanding of DMD and its variants, focusing on patient engagement, diagnostic criteria, natural history, biomarkers, and clinical trials. It underscores patient-focused drug development, the significance of dystrophin as a biomarker, and the pivotal role of magnetic resonance imaging in assessing disease progression. Additionally, the guidance addresses cardiomyopathy's prominence in DMD and the burgeoning field of gene therapy. Conclusions The updated guidance offers a comprehensive understanding of DMD, emphasizing patient-centric approaches, innovative trial designs, and the importance of biomarkers. The focus on cardiomyopathy and gene therapy signifies the evolving realm of DMD research. It acts as a crucial roadmap for sponsors, potentially leading to improved treatments for DMD.
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Affiliation(s)
| | - Eric Camino
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Rafael Escandon
- DGBI Consulting, LLC, Bainbridge Island, Washington, DC, USA
| | | | - Ryan Fischer
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Kevin Flanigan
- Center for Experimental Neurotherapeutics, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Pat Furlong
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Rose Juhasz
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Ann S Martin
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Chet Villa
- Trinity Health Michigan, Grand Rapids, MI, USA
| | - H Lee Sweeney
- Cincinnati Children's Hospital Medical Center within the UC Department of Pediatrics, Cincinnati, OH, USA
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Bai J, Wang Z, Lu X, Wen X. Improved spatial-temporal graph convolutional networks for upper limb rehabilitation assessment based on precise posture measurement. Front Neurosci 2023; 17:1219556. [PMID: 37496735 PMCID: PMC10368130 DOI: 10.3389/fnins.2023.1219556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/20/2023] [Indexed: 07/28/2023] Open
Abstract
After regular rehabilitation training, paralysis sequelae can be significantly reduced in patients with limb movement disorders caused by stroke. Rehabilitation assessment is the basis for the formulation of rehabilitation training programs and the objective standard for evaluating the effectiveness of training. However, the quantitative rehabilitation assessment is still in the experimental stage and has not been put into clinical practice. In this work, we propose improved spatial-temporal graph convolutional networks based on precise posture measurement for upper limb rehabilitation assessment. Two Azure Kinect are used to enlarge the angle range of the visual field. The rigid body model of the upper limb with multiple degrees of freedom is established. And the inverse kinematics is optimized based on the hybrid particle swarm optimization algorithm. The self-attention mechanism map is calculated to analyze the role of each upper limb joint in rehabilitation assessment, to improve the spatial-temporal graph convolution neural network model. Long short-term memory is built to explore the sequence dependence in spatial-temporal feature vectors. An exercise protocol for detecting the distal reachable workspace and proximal self-care ability of the upper limb is designed, and a virtual environment is built. The experimental results indicate that the proposed posture measurement method can reduce position jumps caused by occlusion, improve measurement accuracy and stability, and increase Signal Noise Ratio. By comparing with other models, our rehabilitation assessment model achieved the lowest mean absolute deviation, root mean square error, and mean absolute percentage error. The proposed method can effectively quantitatively evaluate the upper limb motor function of stroke patients.
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Affiliation(s)
- Jing Bai
- Industrial Technology Research Institute of Intelligent Equipment, Nanjing Institute of Technology, Nanjing, China
- Jiangsu Provincial Engineering Laboratory of Intelligent Manufacturing Equipment, Nanjing, China
| | - Zhixian Wang
- ‘School of Automation, Nanjing Institute of Technology, Nanjing, China
| | - Xuanming Lu
- Industrial Technology Research Institute of Intelligent Equipment, Nanjing Institute of Technology, Nanjing, China
- Jiangsu Provincial Engineering Laboratory of Intelligent Manufacturing Equipment, Nanjing, China
| | - Xiulan Wen
- ‘School of Automation, Nanjing Institute of Technology, Nanjing, China
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Gerhalter T, Müller C, Maron E, Thielen M, Schätzl T, Mähler A, Schütte T, Boschmann M, Herzer R, Spuler S, Gazzerro E. "suMus," a novel digital system for arm movement metrics and muscle energy expenditure. Front Physiol 2023; 14:1057592. [PMID: 36776973 PMCID: PMC9909604 DOI: 10.3389/fphys.2023.1057592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023] Open
Abstract
Objective: In the field of non-treatable muscular dystrophies, promising new gene and cell therapies are being developed and are entering clinical trials. Objective assessment of therapeutic effects on motor function is mandatory for economical and ethical reasons. Main shortcomings of existing measurements are discontinuous data collection in artificial settings as well as a major focus on walking, neglecting the importance of hand and arm movements for patients' independence. We aimed to create a digital tool to measure muscle function with an emphasis on upper limb motility. Methods: suMus provides a custom-made App running on smartwatches. Movement data are sent to the backend of a suMus web-based platform, from which they can be extracted as CSV data. Fifty patients with neuromuscular diseases assessed the pool of suMus activities in a first orientation phase. suMus performance was hence validated in four upper extremity exercises based on the feedback of the orientation phase. We monitored the arm metrics in a cohort of healthy volunteers using the suMus application, while completing each exercise at low frequency in a metabolic chamber. Collected movement data encompassed average acceleration, rotation rate as well as activity counts. Spearman rank tests correlated movement data with energy expenditure from the metabolic chamber. Results: Our novel application "suMus," sum of muscle activity, collects muscle movement data plus Patient-Related-Outcome-Measures, sends real-time feedback to patients and caregivers and provides, while ensuring data protection, a long-term follow-up of disease course. The application was well received from the patients during the orientation phase. In our pilot study, energy expenditure did not differ between overnight fasted and non-fasted participants. Acceleration ranged from 1.7 ± 0.7 to 3.2 ± 0.5 m/sec2 with rotation rates between 0.9 ± 0.5 and 2.0 ± 3.4 rad/sec. Acceleration and rotation rate as well as derived activity counts correlated with energy expenditure values measured in the metabolic chamber for one exercise (r = 0.58, p < 0.03). Conclusion: In the analysis of slow frequency movements of upper extremities, the integration of the suMus application with smartwatch sensors characterized motion parameters, thus supporting a use in clinical trial outcome measures. Alternative methodologies need to complement indirect calorimetry in validating accelerometer-derived energy expenditure data.
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Affiliation(s)
- Teresa Gerhalter
- Muscle Research Unit, Charité-Universitätsmedizin Berlin, Berlin, Germany,Experimental and Clinical Research Center, a joint Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, Berlin, Germany,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | | | | | - Teresa Schätzl
- Muscle Research Unit, Charité-Universitätsmedizin Berlin, Berlin, Germany,Experimental and Clinical Research Center, a joint Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, Berlin, Germany,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anja Mähler
- Experimental and Clinical Research Center, a joint Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, Berlin, Germany,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Till Schütte
- Experimental and Clinical Research Center, a joint Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, Berlin, Germany,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany,Clinical Study Center (CSC), Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Boschmann
- Experimental and Clinical Research Center, a joint Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, Berlin, Germany,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | | | - Simone Spuler
- Muscle Research Unit, Charité-Universitätsmedizin Berlin, Berlin, Germany,Experimental and Clinical Research Center, a joint Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, Berlin, Germany,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany,*Correspondence: Simone Spuler, ; Elisabetta Gazzerro,
| | - Elisabetta Gazzerro
- Muscle Research Unit, Charité-Universitätsmedizin Berlin, Berlin, Germany,Experimental and Clinical Research Center, a joint Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, Berlin, Germany,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany,*Correspondence: Simone Spuler, ; Elisabetta Gazzerro,
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Koh ES, Kurillo G, Han JJ, Lim JY. Use of the Kinect sensor measured three-dimensional reachable workspace to assess the upper extremity function in older adults. Clin Biomech (Bristol, Avon) 2022; 99:105767. [PMID: 36150288 DOI: 10.1016/j.clinbiomech.2022.105767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 09/07/2022] [Accepted: 09/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND We explored the utility of Kinect sensor-based upper extremity reachable workspace measure in healthy adults aged over 65 years. METHODS Forty-three healthy older subjects (19 men and 24 women) aged over 65 years and 22 healthy young subjects (11 men and 11 women) were included. All participants were ambulatory and perform the activities of daily living independently. Three-dimensional reachable workspace data were acquired for both arms using the Kinect sensor. We evaluated hand grip strength, manual muscle shoulder strength, and the active shoulder ranges of motion of the dominant and non-dominant sides. We assessed upper limb function using the Disabilities of Arm, Shoulder, and Hand (DASH) instrument and the health-related quality of life employing the descriptive EQ-5D-5L system. FINDINGS The quadrant 3 relative surface area in older adults was significantly smaller than that of young adults (both dominant and non-dominant sides), while the total and quadrants 1, 2, and 4 relative surface areas did not differ between older and young adults. However, the quadrant 3 relative surface area did not correlate with the DASH or EQ5D scores. The total and quadrant 1, 2, and 4 relative surface areas of the dominant side significantly correlated with the DASH score. The quadrant 4 relative surface area of the dominant side significantly correlated with the EQ5D score. INTERPRETATION Kinect sensor-based, three-dimensional, reachable workspace analysis may be useful to evaluate upper limb function in older adults.
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Affiliation(s)
- Eun Sil Koh
- Department of Rehabilitation Medicine, National Medical Center, Seoul, Republic of Korea
| | - Gregorij Kurillo
- Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, CA, United States of America
| | - Jay J Han
- Department of Physical Medicine & Rehabilitation, University of California at Irvine School of Medicine, Irvine, CA, United States of America
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Institute on Aging, Seoul National University, Seoul, Republic of Korea.
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Chan V, Thai R, Vartanian R, Kim MS, Hatch MN, Koh J, Han JJ. Sensor acquired reachable workspace in the elderly population: A cross-sectional observational study. Medicine (Baltimore) 2022; 101:e29575. [PMID: 35905262 PMCID: PMC9333543 DOI: 10.1097/md.0000000000029575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The elderly population experiences a decline in upper extremity range of motion (ROM), impairing activities of daily living. The primary mode of quantification is by goniometer measurement. In this cross-sectional observation study, we investigate a sensor-acquired reachable workspace for assessing shoulder ROM decline in an elderly population in comparison to traditional measurements. Sixty-one healthy subjects aged ≥ 65 years were included and compared to a cohort of 39 younger subjects, aged 20 to 64. A sensor acquired reachable workspace using a Kinect motion capture camera measured the maximum reaching ability of both arms while in a seated position, measured in m2 and normalized to arm length to calculate a novel score defined as a relative surface area. This score approximates range of motion in the upper extremity. This measurement was compared to goniometer measurements, including active ROM in shoulder flexion and abduction. Total RSA shows moderate to strong correlation between goniometer in flexion and abduction in the dominant arm (R = 0.790 and R = 0.650, P < .001, respectively) and moderate correlations for the nondominant arm (R = 0.622 and R = 0.615, P < .001). Compared to the younger cohort, the elderly population demonstrated significantly reduced total RSA in the dominant arm (meanelderly = 0.774, SD = 0.09; meanyounger = 0.830, SD = 0.07, P < .001), with significant reductions in the upper lateral quadrant in both arms (dominant: meanelderly = 0.225, SD = 0.04; meanyounger = 0.241, SD = 0.01; P < .001; nondominant: meanelderly = 0.213, SD = 0.03; meanyounger = 0.228, SD = 0.01; P = .004). The test-retest reliability was strong for both dominant and nondominant total RSA (ICC > 0.762). The reachable workspace demonstrates promise as a simple and quick tool for clinicians to assess detailed and quantitative active shoulder ROM decline in the elderly population.
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Affiliation(s)
- Vicky Chan
- University of California at Irvine School of Medicine, Department of Physical Medicine and Rehabilitation, Irvine, CA, USA
- *Correspondence: Vicky Chan, Department of Physical Medicine and Rehabilitation, University of California at Irvine School of Medicine, 101 The City Drive South, Orange, CA 92868, USA (e-mail: )
| | - Richard Thai
- University of California at Irvine School of Medicine, Department of Physical Medicine and Rehabilitation, Irvine, CA, USA
| | - Revik Vartanian
- University of California at Irvine School of Medicine, Department of Physical Medicine and Rehabilitation, Irvine, CA, USA
| | - Min Su Kim
- University College of Medicine and Institute of Wonkwang Medical Science, Department of Rehabilitation Medicine, Iksan, Republic of Korea
| | - Maya N. Hatch
- University of California at Irvine School of Medicine, Department of Physical Medicine and Rehabilitation, Irvine, CA, USA
| | - Jason Koh
- University of California at Irvine School of Medicine, Department of Physical Medicine and Rehabilitation, Irvine, CA, USA
| | - Jay J. Han
- University of California at Irvine School of Medicine, Department of Physical Medicine and Rehabilitation, Irvine, CA, USA
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6
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Naarding KJ, Janssen MMHP, Boon RD, Bank PJM, Matthew RP, Kurillo G, Han JJ, Verschuuren JJGM, de Groot IJM, van der Holst M, Kan HE, Niks EH. The Black Box of Technological Outcome Measures: An Example in Duchenne Muscular Dystrophy. J Neuromuscul Dis 2022; 9:555-569. [PMID: 35723109 PMCID: PMC9398077 DOI: 10.3233/jnd-210767] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Outcome measures for non-ambulant Duchenne muscular dystrophy (DMD) patients are limited, with only the Performance of the Upper Limb (PUL) approved as endpoint for clinical trials. Objective: We assessed four outcome measures based on devices developed for the gaming industry, aiming to overcome disadvantages of observer-dependency and motivation. Methods: Twenty-two non-ambulant DMD patients (range 8.6–24.1 years) and 14 healthy controls (HC; range 9.5–25.4 years) were studied at baseline and 16 patients at 12 months using Leap Motion to quantify wrist/hand active range of motion (aROM) and a Kinect sensor for reached volume with Ability Captured Through Interactive Video Evaluation (ACTIVE), Functional Workspace (FWS) summed distance to seven upper extremity body points, and trunk compensation (KinectTC). PUL 2.0 was performed in patients only. A stepwise approach assessed quality control, construct validity, reliability, concurrent validity, longitudinal change and patient perception. Results: Leap Motion aROM distinguished patients and HCs for supination, radial deviation and wrist flexion (range p = 0.006 to <0.001). Reliability was low and the manufacturer’s hand model did not match the sensor’s depth images. ACTIVE differed between patients and HCs (p < 0.001), correlated with PUL (rho = 0.76), and decreased over time (p = 0.030) with a standardized response mean (SRM) of –0.61. It was appraised as fun on a 10-point numeric rating scale (median 9/10). PUL decreased over time (p < 0.001) with an SRM of –1.28, and was appraised as fun (median 7/10). FWS summed distance distinguished patients and HCs (p < 0.001), but reliability in patients was insufficient. KinectTC differed between patients and HCs (p < 0.01), but correlated insufficiently with PUL (rho = –0.69). Conclusions: Only ACTIVE qualified as potential outcome measure in non-ambulant DMD patients, although the SRM was below the commonly used threshold of 0.8. Lack of insight in technological constraints due to intellectual property and software updates made the technology behind these outcome measures a kind of black box that could jeopardize long-term use in clinical development.
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Affiliation(s)
- Karin J Naarding
- Department of Neurology, Leiden University Medical Center (LUMC), Leiden, Zuid-Holland, Netherlands.,Duchenne CenterNetherlands
| | - Mariska M H P Janssen
- Duchenne CenterNetherlands.,Donders Institute for Brain, Cognition and Behavior, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ruben D Boon
- C.J. Gorter Center for High Field MRI, Dept. of Radiology, LUMC, Leiden, Zuid-Holland, Netherlands
| | - Paulina J M Bank
- Department of Neurology, Leiden University Medical Center (LUMC), Leiden, Zuid-Holland, Netherlands
| | - Robert P Matthew
- Department of Physical Therapy and Rehabilitation Science, University of California at San Francisco, San Francisco, CA, USA
| | - Gregorij Kurillo
- Department of Orthopaedic Surgery, University of California at San Francisco, SanFrancisco, CA, USA
| | - Jay J Han
- Department of Physical Medicine & Rehabilitation, UC Irvine School of Medicine, Irvine, CA, USA
| | - Jan J G M Verschuuren
- Department of Neurology, Leiden University Medical Center (LUMC), Leiden, Zuid-Holland, Netherlands.,Duchenne CenterNetherlands
| | - Imelda J M de Groot
- Duchenne CenterNetherlands.,Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
| | - Menno van der Holst
- Duchenne CenterNetherlands.,Department of Orthopedics, Rehabilitation and Physiotherapy, Leiden University Medical Center, Leiden, Netherlands
| | - Hermien E Kan
- Duchenne CenterNetherlands.,C.J. Gorter Center for High Field MRI, Dept. of Radiology, LUMC, Leiden, Zuid-Holland, Netherlands
| | - Erik H Niks
- Department of Neurology, Leiden University Medical Center (LUMC), Leiden, Zuid-Holland, Netherlands.,Duchenne CenterNetherlands
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Scott B, Seyres M, Philp F, Chadwick EK, Blana D. Healthcare applications of single camera markerless motion capture: a scoping review. PeerJ 2022; 10:e13517. [PMID: 35642200 PMCID: PMC9148557 DOI: 10.7717/peerj.13517] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/09/2022] [Indexed: 01/17/2023] Open
Abstract
Background Single camera markerless motion capture has the potential to facilitate at home movement assessment due to the ease of setup, portability, and affordable cost of the technology. However, it is not clear what the current healthcare applications of single camera markerless motion capture are and what information is being collected that may be used to inform clinical decision making. This review aims to map the available literature to highlight potential use cases and identify the limitations of the technology for clinicians and researchers interested in the collection of movement data. Survey Methodology Studies were collected up to 14 January 2022 using Pubmed, CINAHL and SPORTDiscus using a systematic search. Data recorded included the description of the markerless system, clinical outcome measures, and biomechanical data mapped to the International Classification of Functioning, Disability and Health Framework (ICF). Studies were grouped by patient population. Results A total of 50 studies were included for data collection. Use cases for single camera markerless motion capture technology were identified for Neurological Injury in Children and Adults; Hereditary/Genetic Neuromuscular Disorders; Frailty; and Orthopaedic or Musculoskeletal groups. Single camera markerless systems were found to perform well in studies involving single plane measurements, such as in the analysis of infant general movements or spatiotemporal parameters of gait, when evaluated against 3D marker-based systems and a variety of clinical outcome measures. However, they were less capable than marker-based systems in studies requiring the tracking of detailed 3D kinematics or fine movements such as finger tracking. Conclusions Single camera markerless motion capture offers great potential for extending the scope of movement analysis outside of laboratory settings in a practical way, but currently suffers from a lack of accuracy where detailed 3D kinematics are required for clinical decision making. Future work should therefore focus on improving tracking accuracy of movements that are out of plane relative to the camera orientation or affected by occlusion, such as supination and pronation of the forearm.
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Affiliation(s)
- Bradley Scott
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Martin Seyres
- School of Engineering, University of Aberdeen, Aberdeen, United Kingdom
| | - Fraser Philp
- School of Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | - Dimitra Blana
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
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8
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Suslov V, Suslova G, Lytaev S. MRI Assessment of Motor Capabilities in Patients with Duchenne Muscular Dystrophy According to the Motor Function Measure Scale. Tomography 2022; 8:948-960. [PMID: 35448710 PMCID: PMC9025497 DOI: 10.3390/tomography8020076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/16/2022] Open
Abstract
The research was aimed on the study of motor capabilities on the Motor Function Measure (MFM) scale in ambulant and non-ambulant patients with Duchenne muscular dystrophy, and to conduct a correlation analysis between the results of the MFM scale and Magnetic Resonance Imaging (MRI) data. A total of 46 boys who had genetically confirmed Duchenne muscular dystrophy (age from 2.1 to 16.7 years) and were in clinical rehabilitation were investigated. An assessment was performed according to the Motor Function Measure scale (subsections D1, D2, D3, and the total score), an MRI obtaining T1-VI of the muscles of the pelvic girdle was conducted, and the thighs and lower legs were further assessed in terms of the severity of fibrous-fat degeneration according to the Mercuri scale. In ambulant patients, the ability to stand up and move (D1) was 74.4%, axial and proximal motor functions (D2)—97.6%, distal motor functions (D3)—96.2%, and total score was 87.9%. In non-ambulant patients, the ability to stand up and move (D1) was 1.7%, axial and proximal motor functions (D2)—47%, distal motor functions (D3)—67.5%, and the total score—33.1%. A high inverse correlation (r = −0.7, p < 0.05) of the MRI data of the pelvic girdle and thighs with tasks D1, as well as a noticeable inverse correlation with tasks D2 (r = −0.6, p < 0.05) of the scale MFM, were revealed in the ambulant group of patients. In the non-ambulant group of patients, the MRI data of the lower legs muscles were characterized by a high inverse correlation (r = −0.7, p < 0.05) with tasks D3 and a noticeable inverse correlation (r = −0.6, p < 0.05) with tasks D1 of the MFM scale. Conclusion: The Motor Function Measure scale allows effective assessment of the motor capabilities of patients with Duchenne muscular dystrophy at different stages of the disease, which is confirmed by visualization of fibro-fatty muscle replacement.
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Affiliation(s)
- Vasily Suslov
- Department of Rehabilitation, Saint Petersburg State Pediatric Medical University, 194100 Saint Petersburg, Russia;
- Correspondence: ; Tel.: +7-911-2297049
| | - Galina Suslova
- Department of Rehabilitation, Saint Petersburg State Pediatric Medical University, 194100 Saint Petersburg, Russia;
| | - Sergey Lytaev
- Department of Normal Physiology, Saint Petersburg State Pediatric Medical University, 194100 Saint Petersburg, Russia;
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Bortolani S, Brusa C, Rolle E, Monforte M, De Arcangelis V, Ricci E, Mongini TE, Tasca G. Technology-outcome measures in neuromuscular disorders: a systematic review. Eur J Neurol 2021; 29:1266-1278. [PMID: 34962693 DOI: 10.1111/ene.15235] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Portable and wearable devices can monitor a number of physical performances and have been lately applied to patients with neuromuscular disorders (NMD). METHODS We performed a systematic search of literature databases following PRISMA principles, including all studies reporting the use of technological devices for motor function assessment in NMDs from 2000 to 2021. We also summarized the evidence on measurement properties (validity, reliability, responsiveness) of the analyzed technological outcome measures. RESULTS One-hundred studies fulfilled the selection criteria, most of them published in the last ten years. We defined four categories that gathered similar technologies: gait analysis tools, for clinical assessment of pace and posture; continuous monitoring of physical activity with inertial sensors, that allow "unsupervised" activity assessment; upper limb evaluation tools, including Kinect-based outcome measures to assess the reachable workspace; and new muscle strength assessment tools, such as Myotools. Inertial sensors have the evident advantage of being applied in the "in-home" setting, which has become especially appealing with the Covid-19 pandemic, although poor evidence from psychometric property assessment and results of the analyzed studies may limit their research application. Both Kinect-based outcome measures and Myotools have been already validated in multicenter studies and different NMDs, showing excellent characteristics for application in clinical trials. CONCLUSION This overview is intended to raise awareness on the potential of the different TOMs in the neuromuscular field and be an informative source for the design of future clinical trials, particularly in the era of telemedicine.
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Affiliation(s)
- Sara Bortolani
- Department of Neuroscience, Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy.,Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Brusa
- Department of Neuroscience, Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Enrica Rolle
- Department of Neuroscience, Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Mauro Monforte
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valeria De Arcangelis
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enzo Ricci
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tiziana Enrica Mongini
- Department of Neuroscience, Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Giorgio Tasca
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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10
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Davoli GBDQ, Cardoso J, Silva GC, Moreira RDFC, Mattiello-Sverzut AC. Instruments to assess upper-limb function in children and adolescents with neuromuscular diseases: a systematic review. Dev Med Child Neurol 2021; 63:1030-1037. [PMID: 33834485 DOI: 10.1111/dmcn.14887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 11/29/2022]
Abstract
AIM To synthesize clinical and scientific evidence regarding the instruments available to assess upper-limb function in paediatric patients with neuromuscular disease (NMD). METHOD This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines (Prospective Registry of Systematic Reviews no. CRD42020140343). Two independent reviewers searched the PubMed/MEDLINE, LILACS, Embase, and Scopus databases. Inclusion criteria were cross-sectional or longitudinal studies or randomized controlled trials that used scales or questionnaires to assess upper-limb function in paediatric patients with NMDs. The COSMIN Risk of Bias checklist and criteria for good measurement properties were applied to assess the methodological quality of the instruments. RESULTS In total, 34 articles and 12 instruments were included. The Brooke Upper Extremity (n=16) and Performance of Upper Limb (PUL) (n=12) instruments were the most used tools. The PUL and Duchenne muscular dystrophy (DMD) Upper Limb patient-reported outcome measures (PROMs) tested more measurement properties and provided higher methodological quality scores for patients with DMD. Likewise, the Revised Upper Limb Module (RULM) was the most suitable instrument for patients with spinal muscular atrophy. No instrument has been devised to assess upper-limb function in patients with Charcot-Marie-Tooth disease and no other disease-specific instruments were found. INTERPRETATION The PUL, DMD Upper Limb PROM, and RULM are the most suitable instruments to assess upper-limb function in the two most prevalent paediatric NMDs. The identified gaps and methodological flaws of the available instruments indicate a need to develop high-quality instruments to assess other types of paediatric NMDs. What this paper adds The most suitable observer-rater instrument to assess upper-limb function in Duchenne muscular dystrophy (DMD) is the Performance of Upper Limb. The most suitable observer-rater instrument to assess upper-limb function in spinal muscular atrophy is the Revised Upper Limb Module. The DMD Upper Limb patient-reported outcome measure is recommended to assess the upper-limb performance of patients with DMD. Literature gaps and methodological flaws indicate the need to develop high-quality instruments to assess other types of paediatric neuromuscular disease.
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Affiliation(s)
| | - Juliana Cardoso
- Department of Health Science, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Giovanna Constantin Silva
- Department of Health Science, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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11
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Fukumoto Y, Miyama T. Alleviation of masticatory disturbance with an occlusal splint in a Duchenne muscular dystrophy patient. SPECIAL CARE IN DENTISTRY 2021; 41:572-578. [PMID: 33826161 PMCID: PMC8518792 DOI: 10.1111/scd.12594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/11/2021] [Accepted: 03/23/2021] [Indexed: 12/03/2022]
Abstract
Aim To present an occlusal splint effective for alleviating masticatory disturbance in Duchenne muscular dystrophy (DMD). Case report A 13‐year‐old male DMD patient with masticatory disturbance presented with an open bite, with occlusal contact only between the first and second molars bilaterally and reduced masticatory performance. We applied an occlusal splint that achieved occlusal contact for all teeth and monitored its effects on masticatory function over 6 years. The occlusal splint increased occlusal contact points from 11 to 60. Although occlusal force remained at 13.9‒16 kg, masticatory performance increased, and the number of mastication strokes increased from 124 to 169. Masseter muscle activity decreased from 76.8% to 33.4% maximum voluntary contraction (MVC) and digastric muscle activity increased from 8.7% to 18.0% MVC. Time from start of peanut mastication to swallowing decreased, and the vertical mastication cycle diameter and its width on the habitual side increased. Conclusions Masticatory disturbance in a DMD patient was alleviated using an occlusal splint. The number of mastication strokes and the digastric to masseter muscle activity ratio were increased. Furthermore, the mastication cycle was enlarged, which increased masticatory movement. As masseter muscle activity during mastication decreased, the occlusal splint likely reduced muscle fatigue during masticatory movement.
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Affiliation(s)
- Yutaka Fukumoto
- Department of Dentistry, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Takeshi Miyama
- Department of Surgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
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12
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Matthew RP, Seko S, Kurillo G, Bajcsy R, Cheng L, Han JJ, Lotz J. Reachable Workspace and Proximal Function Measures for Quantifying Upper Limb Motion. IEEE J Biomed Health Inform 2020; 24:3285-3294. [PMID: 32340969 DOI: 10.1109/jbhi.2020.2989722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There are a lack of quantitative measures for clinically assessing upper limb function. Conventional biomechanical performance measures are restricted to specialist labs due to hardware cost and complexity, while the resulting measurements require specialists for analysis. Depth cameras are low cost and portable systems that can track surrogate joint positions. However, these motions may not be biologically consistent, which can result in noisy, inaccurate movements. This paper introduces a rigid body modelling method to enforce biological feasibility of the recovered motions. This method is evaluated on an existing depth camera assessment: the reachable workspace (RW) measure for assessing gross shoulder function. As a rigid body model is used, position estimates of new proximal targets can be added, resulting in a proximal function (PF) measure for assessing a subject's ability to touch specific body landmarks. The accuracy, and repeatability of these measures is assessed on ten asymptomatic subjects, with and without rigid body constraints. This analysis is performed both on a low-cost depth camera system and a gold-standard active motion capture system. The addition of rigid body constraints was found to improve accuracy and concordance of the depth camera system, particularly in lateral reaching movements. Both RW and PF measures were found to be feasible candidates for clinical assessment, with future analysis needed to determine their ability to detect changes within specific patient populations.
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13
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Gandolla M, Antonietti A, Longatelli V, Biffi E, Diella E, Delle Fave M, Rossini M, Molteni F, D’Angelo G, Bocciolone M, Pedrocchi A. Test-retest reliability of the Performance of Upper Limb (PUL) module for muscular dystrophy patients. PLoS One 2020; 15:e0239064. [PMID: 32986757 PMCID: PMC7521751 DOI: 10.1371/journal.pone.0239064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 09/18/2020] [Indexed: 11/18/2022] Open
Abstract
The Performance of the Upper Limb (PUL) module is an externally-assessed clinical scale, initially designed for the Duchenne muscular dystrophy population. It provides an upper extremity functional score suitable for both weaker ambulatory and non-ambulatory phases up to the severely impaired patients. It is capable of characterizing overall progression and severity of disease and of tracking the stereotypical proximal-to-distal progressive loss of upper limb function in muscular dystrophy. Since the PUL module has been validated only with Duchenne patients, its use also for Becker and Limb-Girdle muscular dystrophy patients has been here evaluated, to verify its reliability and extend its use. In particular, two different assessors performed this scale on 32 dystrophic subjects in two consecutive days. The results showed that the PUL module has high reliability, both absolute and relative, based on the calculation of Pearson's r (0.9942), Intraclass Correlation Coefficient (0.9943), Standard Error of Measurement (1.36), Minimum Detectable Change (3.77), and Coefficient of Variation (3%). The Minimum Detectable Change, in particular, can be used in clinical trials to perform a comprehensive longitudinal evaluation of the effects of interventions with the lapse of time. According to this analysis, an intervention is effective if the difference in the PUL score between subsequent evaluation points is equal or higher than 4 points; otherwise, the observed effect is not relevant. Inter-rater reliability with ten different assessors was evaluated, and it has been demonstrated that deviation from the mean is lower than calculated Minimum Detectable Change. The present work provides evidence that the PUL module is a reliable and valid instrument for measuring upper limb ability in people with different forms of muscular dystrophy. Therefore, the PUL module might be extended to other pathologies and reliably used in multicenter settings.
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Affiliation(s)
- Marta Gandolla
- Nearlab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
- * E-mail:
| | - Alberto Antonietti
- Nearlab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Valeria Longatelli
- Nearlab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Emilia Biffi
- Scientific Institute IRCCS E. Medea, Bosisio Parini, Italy
| | | | | | - Mauro Rossini
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Italy
| | | | - Marco Bocciolone
- Department of Mechanical Engineering, Politecnico di Milano, Milano, Italy
| | - Alessandra Pedrocchi
- Nearlab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
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14
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Okuyama K, Kawakami M, Tsuchimoto S, Ogura M, Okada K, Mizuno K, Ushiba J, Liu M. Depth Sensor-Based Assessment of Reachable Work Space for Visualizing and Quantifying Paretic Upper Extremity Motor Function in People With Stroke. Phys Ther 2020; 100:870-879. [PMID: 32048724 DOI: 10.1093/ptj/pzaa025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/14/2019] [Accepted: 10/22/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND Quantitative evaluation of upper extremity (UE) motor function is important in people with hemiparetic stroke. A depth sensor-based assessment of reachable work space (RWS) was applied to visualize and quantify paretic UE motor function. OBJECTIVE The objectives of this study were to examine the characteristics of RWS and to assess its validity, reliability, measurement error, and responsiveness in people with hemiparetic stroke. DESIGN This was a descriptive, repeated-measures, observational study. METHODS Fifty-eight people with stroke participated. RWS was assessed on both paretic and nonparetic UEs, and the RWS ratio was determined by dividing the RWS of the paretic UE by that of the nonparetic UE. The concurrent validity of the RWS was determined by examining the relationship with the Fugl-Meyer Assessment UE motor score. Test-retest reproducibility was examined in 40 participants. Responsiveness was determined by examining the RWS results before and after 3 weeks of intensive training of the paretic UE in 32 participants. RESULTS The lower area of RWS bordering shoulder was significantly larger than the upper area, and the medial-lower area of RWS bordering shoulder was significantly larger than the lateral-lower area. The RWS ratio was highly correlated with the Fugl-Meyer Assessment UE motor score (r = 0.81). The RWS ratio showed good intrarater relative reliability (intraclass correlation coefficient = 0.94) and no fixed or proportional bias. The minimal detectable change of the RWS ratio was 16.6. The responsiveness of the RWS ratio was large (standardized response mean = 0.83). LIMITATIONS Interexaminer reliability was not assessed. CONCLUSIONS The RWS assessment showed sufficient validity, reliability, and responsiveness in people with hemiparetic stroke. A depth sensor-based RWS evaluation is useful for visualizing and quantifying paretic UE motor function in the clinical setting.
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Affiliation(s)
- Kohei Okuyama
- Department of Rehabilitation Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Shohei Tsuchimoto
- School of Fundamental Science and Technology, Graduate School of Keio University, Kanagawa, Japan
| | - Miho Ogura
- Department of Rehabilitation Medicine, School of Medicine, Keio University
| | - Kohsuke Okada
- Department of Rehabilitation Medicine, School of Medicine, Keio University
| | - Katsuhiro Mizuno
- Department of Rehabilitation Medicine, School of Medicine, Keio University
| | - Junichi Ushiba
- Department of Biosciences and Informatics, Faculty of Science and Technology, Keio University; and Keio Institute of Pure and Applied Sciences, Kanagawa, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, School of Medicine, Keio University
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15
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Bulut N, Alemdaroğlu-Gürbüz I, Topaloğlu H, Yılmaz Ö, Karaduman A. The association between trunk control and upper limb functions of children with Duchenne muscular dystrophy. Physiother Theory Pract 2020; 38:46-54. [DOI: 10.1080/09593985.2020.1723151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Numan Bulut
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altındağ, Ankara, Turkey
| | - Ipek Alemdaroğlu-Gürbüz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altındağ, Ankara, Turkey
| | - Haluk Topaloğlu
- Faculty of Medicine, İhsan Doğramacı Children Hospital, Pediatric Neurology Department, Hacettepe University, Altındağ, Ankara, Turkey
| | - Öznur Yılmaz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altındağ, Ankara, Turkey
| | - Ayşe Karaduman
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altındağ, Ankara, Turkey
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16
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Upper Limb Three-Dimensional Reachable Workspace Analysis Using the Kinect Sensor in Hemiplegic Stroke Patients: A Cross-Sectional Observational Study. Am J Phys Med Rehabil 2019; 99:397-403. [PMID: 31725017 DOI: 10.1097/phm.0000000000001350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE A reachable workspace evaluation using the Kinect sensor was previously introduced as a novel upper limb outcome measure in neuromuscular and musculoskeletal conditions. This study investigated its usefulness in hemiplegic stroke patients. DESIGN Forty-one patients with hemiplegic stroke were included. Kinect-based reachable workspace analysis was performed on both paretic and nonparetic sides. Upper limb impairment was measured using the Fugl-Meyer Assessment and the Motricity Index on the paretic side. Disability was assessed using the shortened Disabilities of the Arm, Shoulder, and Hand questionnaire. Correlations between the relative surface areas, impairment scores, and disability were analyzed. RESULTS Quadrants 1, 3, and 4 as well as the total relative surface area of the paretic side were significantly reduced compared with the nonparetic side. The total relative surface area of the paretic side correlated with the Fugl-Meyer Assessment scores, the Motricity Index for Upper Extremity, and the Disabilities of the Arm, Shoulder, and Hand questionnaire score. Furthermore, quadrant 3 was the most important determinant of upper limb impairment and disability. CONCLUSIONS A reachable workspace (a sensor-based measure that can be obtained relatively quickly and unobtrusively) could be a useful and alternative outcome measure for upper limb in hemiplegic stroke patients.
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17
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Varsanik JS, Kimmel ZM, Laforet GA, Ricotti V, Sajeev G, Signorovitch J, Quiroz JA, Chevalier TW. Validation of an ambient measurement system (AMS) for physical activities in a paediatric population. J Med Eng Technol 2019; 43:182-189. [PMID: 31305192 DOI: 10.1080/03091902.2019.1640308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Ambient measurement systems (AMSs) can enable continuous assessment of functional performance at home, increasing the availability of data for monitoring of neuromuscular disease. An AMS passively measures movement whenever someone is in range of the sensor, without the need for any wearable sensors. The current study evaluates the performance of an AMS for three metrics associated with functional assessments in Duchenne muscular dystrophy (DMD): ambulation speed, rise-to-stand speed and arm-raise speed. Healthy paediatric subjects performed a series of functional tasks and were graded by both a human rater and an AMS. Linear mixed-effect models were fit to calculate agreement between the two measurement methods. For all activities, the AMS and human rater supplied similar measurements of average speed, with correlation coefficients of 0.76-0.92 and systematic differences ranging in magnitude from 0 to 0.48 m per second. The largest systematic difference was for the 10-m run, which was likely due to human rater reaction time. Systematic differences in arm-raise measurements were due to incomplete execution of movements by test participants. These results are consistent with previous studies comparing automated and manual measurements of movement. This study demonstrates that an AMS device is able to measure ambulation speed, rise-to-stand speed and arm-raise speed in a paediatric population in a controlled setting without the need for complicated installation, calibration or worn sensors.
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18
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Essers JMN, Peters A, Meijer K, Peters K, Murgia A. Superficial Shoulder Muscle Synergy Analysis in Facioscapulohumeral Dystrophy During Humeral Elevation Tasks. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1556-1565. [PMID: 31295115 DOI: 10.1109/tnsre.2019.2927765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Facioscapulohumeral dystrophy (FSHD) is a progressive muscle-wasting disease which leads to a decline in upper extremity functionality. Although the scapulohumeral joint's stability and functionality are affected, evidence on the synergetic control of the shoulder muscles in FSHD individuals is still lacking. The aim of this paper is to understand the neuromuscular changes in shoulder muscle control in people with FSHD. Upper arm kinematics and electromyograms (EMG) of eight upper extremity muscles were recorded during shoulder abduction-adduction and flexion-extension tasks in eleven participants with FSHD and 11 healthy participants. Normalized muscle activities were extracted from EMG signals. Non-negative matrix factorization was used to compute muscle synergies. Maximum muscle activities were compared using non-parametric analysis of variance. Similarities between synergies were also calculated using correlation. The Biceps Brachii was significantly more active in the FSHD group (25±2%) while Trapezius Ascendens and Serratus Anterior were less active (32±7% and 39±4%, respectively). Muscle synergy weights were altered in FSHD individuals and showed greater diversity while controls mostly used one synergy for both tasks. The decreased activity by selected scapula rotator muscles and muscle synergy weight alterations show that neuromuscular control of the scapulohumeral joint is less consistent in people with FSHD compared to healthy participants. Assessments of muscle coordination strategies can be used to evaluate motor output variability and assist in management of the disease.
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19
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Uhm KE, Lee S, Kurillo G, Han JJ, Yang JH, Yoo YB, Lee J. Usefulness of Kinect sensor-based reachable workspace system for assessing upper extremity dysfunction in breast cancer patients. Support Care Cancer 2019; 28:779-786. [PMID: 31144172 DOI: 10.1007/s00520-019-04874-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/14/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Recently, the utility of the Kinect sensor-based reachable workspace analysis system for measuring upper extremity outcomes of neuromuscular and musculoskeletal diseases has been demonstrated. Here, we investigated its usefulness for assessing upper extremity dysfunction in breast cancer patients. METHODS Twenty unilateral breast cancer patients were enrolled. Upper extremity active range of motion was captured by the Kinect sensor, and reachable workspace relative surface areas (RSAs) were obtained. The QuickDASH was completed to assess upper extremity disability. General and breast cancer-specific quality of life (QOL) were assessed by the EORTC QLQ-C30 and EORTC QLQ-BR23. RESULTS The total RSA ratio of the affected and unaffected sides ranges from 0.64 to 1.11. Total RSA was significantly reduced on the affected versus unaffected side (0.659 ± 0.105 vs. 0.762 ± 0.065; p = 0.001). Quadrant 1 and 3 RSAs were significantly reduced (0.135 ± 0.039 vs. 0.183 ± 0.040, p < 0.001; 0.172 ± 0.058 vs. 0.217 ± 0.031, p = 0.006). Total RSA of the affected side was strongly correlated with the numeric pain rating scale during movement (r = - 0.812, p < 0.001) and moderately with the QuickDASH (r = - 0.494, p = 0.027). Further, quadrant 3 RSA was correlated with EORTC QLQ-C30 role functioning (r = 0.576, p = 0.008) and EORTC QLQ-BR23 arm symptoms (r = - 0.588, p = 0.006) scales. CONCLUSIONS The Kinect sensor-based reachable workspace analysis system was effectively applied to assess upper extremity dysfunction in breast cancer patients. This system could potentially serve as a quick and simple outcome measure that provides quantitative data for breast cancer patients.
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Affiliation(s)
- Kyeong Eun Uhm
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Seunghwan Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Gregorij Kurillo
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jay J Han
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of California at Irvine, Orange, CA, USA
| | - Jung-Hyun Yang
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Young Bum Yoo
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, South Korea. .,Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, South Korea.
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20
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Design and Analysis of Cloud Upper Limb Rehabilitation System Based on Motion Tracking for Post-Stroke Patients. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9081620] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In order to improve the convenience and practicability of home rehabilitation training for post-stroke patients, this paper presents a cloud-based upper limb rehabilitation system based on motion tracking. A 3-dimensional reachable workspace virtual game (3D-RWVG) was developed to achieve meaningful home rehabilitation training. Five movements were selected as the criteria for rehabilitation assessment. Analysis was undertaken of the upper limb performance parameters: relative surface area (RSA), mean velocity (MV), logarithm of dimensionless jerk (LJ) and logarithm of curvature (LC). A two-headed convolutional neural network (TCNN) model was established for the assessment. The experiment was carried out in the hospital. The results show that the RSA, MV, LC and LJ could reflect the upper limb motor function intuitively from the graphs. The accuracy of the TCNN models is 92.6%, 80%, 89.5%, 85.1% and 87.5%, respectively. A therapist could check patient training and assessment information through the cloud database and make a diagnosis. The system can realize home rehabilitation training and assessment without the supervision of a therapist, and has the potential to become an effective home rehabilitation system.
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21
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Ricotti V, Selby V, Ridout D, Domingos J, Decostre V, Mayhew A, Eagle M, Butler J, Guglieri M, Van der Holst M, Jansen M, Verschuuren JJGM, de Groot IJM, Niks EH, Servais L, Straub V, Voit T, Hogrel JY, Muntoni F. Respiratory and upper limb function as outcome measures in ambulant and non-ambulant subjects with Duchenne muscular dystrophy: A prospective multicentre study. Neuromuscul Disord 2019; 29:261-268. [PMID: 30852071 DOI: 10.1016/j.nmd.2019.02.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/05/2019] [Accepted: 02/08/2019] [Indexed: 11/19/2022]
Abstract
The field of translational research in Duchenne muscular dystrophy (DMD) has been transformed in the last decade by a number of therapeutic targets, mostly studied in ambulant patients. A paucity of studies focus on measures that capture the non-ambulant stage of the disease, and the transition between the ambulant and non-ambulant phase. In this prospective natural history study, we report the results of a comprehensive assessment of respiratory, upper limb function and upper limb muscle strength in a group of 89 DMD boys followed in 3 European countries, 81 receiving corticosteroids, spanning a wide age range (5-18 years) and functional abilities, from ambulant (n = 60) to non-ambulant (n = 29). Respiratory decline could be detected in the early ambulatory phase using Peak Expiratory Flow percentage predicted (PEF%), despite glucocorticoid use (mean annual decline: 4.08, 95% CI [-7.44,-0.72], p = 0.02 in ambulant; 4.81, 95% CI [-6.79,-2.82], p < 0.001 in non-ambulant). FVC% captured disease progression in non-ambulant DMD subjects, with an annual loss of 5.47% (95% CI [-6.48,-4.45], p < 0.001). Upper limb function measured with the Performance of Upper Limb (PUL 1.2) showed an annual loss of 4.13 points (95% CI [-4.79,3.47], p < 0.001) in the non-ambulant cohort. Measures of upper limb strength (MyoGrip and MyoPinch) showed a continuous decline independent of the ambulatory status, when reported as percentage predicted (grip force -5.51%, 95% CI [-6.54,-4.48], p < 0.001 in ambulant and a slower decline -2.86%; 95% CI -3.29,-2.43, p < 0.001, in non-ambulant; pinch force: -2.66%, 95% CI [-3.82,-1.51], p < 0.001 in ambulant and -2.23%, 95% CI [-2.92,-1.53], p < 0.001 in non-ambulant). Furthermore, we also explored the novel concept of a composite endpoint by combining respiratory, upper limb function and force domains: we were able to identify clear clinical progression in patients in whom an isolated measurement of only one of these domains failed to appreciate the yearly change. Our study contributes to the field of natural history of DMD, linking the ambulant and non-ambulant phases of the disease, and suggests that composite scores should be explored further.
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Affiliation(s)
- V Ricotti
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, University College London, London, UK; Solid Biosciences, London, UK.
| | - V Selby
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, University College London, London, UK; Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, London, UK
| | - D Ridout
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, University College London, London, UK; Population, Policy and Practice Program, UCL Great Ormond Street Institute of Child Health, London, UK
| | - J Domingos
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, London, UK
| | - V Decostre
- Groupe Hospitalier Pitié Salpêtrière, Institut de Myologie, Paris, France
| | - A Mayhew
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle, UK
| | - M Eagle
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle, UK
| | - J Butler
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, London, UK
| | - M Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle, UK
| | | | - M Jansen
- Department of Rehabilitation, Donders Centre of Neuroscience, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | | | - I J M de Groot
- Department of Rehabilitation, Donders Centre of Neuroscience, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - E H Niks
- Leiden University Medical Centre, Leiden, The Netherlands
| | - L Servais
- Groupe Hospitalier Pitié Salpêtrière, Institut de Myologie, Paris, France
| | - V Straub
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle, UK
| | - T Voit
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, University College London, London, UK; Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, London, UK
| | - J Y Hogrel
- Groupe Hospitalier Pitié Salpêtrière, Institut de Myologie, Paris, France
| | - F Muntoni
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, University College London, London, UK; Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, London, UK.
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22
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Bakhti KKA, Laffont I, Muthalib M, Froger J, Mottet D. Kinect-based assessment of proximal arm non-use after a stroke. J Neuroeng Rehabil 2018; 15:104. [PMID: 30428896 PMCID: PMC6236999 DOI: 10.1186/s12984-018-0451-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/30/2018] [Indexed: 01/25/2023] Open
Abstract
Background After a stroke, during seated reaching with their paretic upper limb, many patients spontaneously replace the use of their arm by trunk compensation movements, even though they are able to use their arm when forced to do so. We previously quantified this proximal arm non-use (PANU) with a motion capture system (Zebris, CMS20s). The aim of this study was to validate a low-cost Microsoft Kinect-based system against the CMS20s reference system to diagnose PANU. Methods In 19 hemiparetic stroke individuals, the PANU score, reach length, trunk length, and proximal arm use (PAU) were measured during seated reaching simultaneously by the Kinect (v2) and the CMS20s over two testing sessions separated by two hours. Results Intraclass correlation coefficients (ICC) and linear regression analysis showed that the PANU score (ICC = 0.96, r2 = 0.92), reach length (ICC = 0.81, r2 = 0.68), trunk length (ICC = 0.97, r2 = 0.94) and PAU (ICC = 0.97, r2 = 0.94) measured using the Kinect were strongly related to those measured using the CMS20s. The PANU scores showed good test-retest reliability for both the Kinect (ICC = 0.76) and CMS20s (ICC = 0.72). Bland and Altman plots showed slightly reduced PANU scores in the re-test session for both systems (Kinect: − 4.25 ± 6.76; CMS20s: − 4.71 ± 7.88), which suggests a practice effect. Conclusion We showed that the Kinect could accurately and reliably assess PANU, reach length, trunk length and PAU during seated reaching in post stroke individuals. We conclude that the Kinect can offer a low-cost and widely available solution to clinically assess PANU for individualised rehabilitation and to monitor the progress of paretic arm recovery. Trial registration The study was approved by The Ethics Committee of Montpellier, France (N°ID-RCB: 2014-A00395–42) and registered in Clinical Trial (N° NCT02326688, Registered on 15 December 2014, https://clinicaltrials.gov/ct2/show/results/NCT02326688).
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Affiliation(s)
- K K A Bakhti
- Euromov, University of Montpellier, Montpellier, France. .,Physical Medicine and Rehabilitation, Montpellier University Hospital, Montpellier, France. .,Federative Institute for Research on Handicap, Paris, France.
| | - I Laffont
- Euromov, University of Montpellier, Montpellier, France.,Physical Medicine and Rehabilitation, Montpellier University Hospital, Montpellier, France.,Federative Institute for Research on Handicap, Paris, France
| | - M Muthalib
- Euromov, University of Montpellier, Montpellier, France.,Silverline Research, Brisbane, Australia
| | - J Froger
- Euromov, University of Montpellier, Montpellier, France.,Physical Medicine and Rehabilitation, Nîmes University Hospital, Le Grau du Roi, France.,Federative Institute for Research on Handicap, Paris, France
| | - D Mottet
- Euromov, University of Montpellier, Montpellier, France.,Federative Institute for Research on Handicap, Paris, France
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23
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Bonnechère B, Sholukha V, Omelina L, Van Sint Jan S, Jansen B. 3D Analysis of Upper Limbs Motion during Rehabilitation Exercises Using the Kinect TM Sensor: Development, Laboratory Validation and Clinical Application. SENSORS 2018; 18:s18072216. [PMID: 29996533 PMCID: PMC6069223 DOI: 10.3390/s18072216] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/29/2018] [Accepted: 07/06/2018] [Indexed: 01/05/2023]
Abstract
Optoelectronic devices are the gold standard for 3D evaluation in clinics, but due to the complexity of this kind of hardware and the lack of access for patients, affordable, transportable, and easy-to-use systems must be developed to be largely used in daily clinics. The KinectTM sensor has various advantages compared to optoelectronic devices, such as its price and transportability. However, it also has some limitations: (in)accuracy of the skeleton detection and tracking as well as the limited amount of available points, which makes 3D evaluation impossible. To overcome these limitations, a novel method has been developed to perform 3D evaluation of the upper limbs. This system is coupled to rehabilitation exercises, allowing functional evaluation while performing physical rehabilitation. To validate this new approach, a two-step method was used. The first step was a laboratory validation where the results obtained with the KinectTM were compared with the results obtained with an optoelectronic device; 40 healthy young adults participated in this first part. The second step was to determine the clinical relevance of this kind of measurement. Results of the healthy subjects were compared with a group of 22 elderly adults and a group of 10 chronic stroke patients to determine if different patterns could be observed. The new methodology and the different steps of the validations are presented in this paper.
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Affiliation(s)
- Bruno Bonnechère
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Université Libre de Bruxelles, 1050 Brussels, Belgium.
- Department of Electronics and Informatics-ETRO, Vrije Universiteit Brussel, 1050 Brussels, Belgium.
- International Medical Equipment Collaborative (IMEC), Kapeldreef 75, B-3001 Leuven, Belgium.
| | - Victor Sholukha
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Université Libre de Bruxelles, 1050 Brussels, Belgium.
- Department of Applied Mathematics, Peter the Great St. Petersburg Polytechnic University (SPbPU), 195251 Sankt-Peterburg, Russia.
| | - Lubos Omelina
- Department of Electronics and Informatics-ETRO, Vrije Universiteit Brussel, 1050 Brussels, Belgium.
- International Medical Equipment Collaborative (IMEC), Kapeldreef 75, B-3001 Leuven, Belgium.
- Institute of Computer Science and Mathematics, Slovak University of Technology, 81237 Bratislava, Slovakia.
| | - Serge Van Sint Jan
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Université Libre de Bruxelles, 1050 Brussels, Belgium.
| | - Bart Jansen
- Department of Electronics and Informatics-ETRO, Vrije Universiteit Brussel, 1050 Brussels, Belgium.
- International Medical Equipment Collaborative (IMEC), Kapeldreef 75, B-3001 Leuven, Belgium.
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24
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Straub V, Mercuri E. Report on the workshop: Meaningful outcome measures for Duchenne muscular dystrophy, London, UK, 30-31 January 2017. Neuromuscul Disord 2018; 28:690-701. [PMID: 30033203 DOI: 10.1016/j.nmd.2018.05.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Volker Straub
- Institute of Genetic Medicine, Newcastle University John Walton Muscular Dystrophy Research Centre, Newcastle, UK
| | - Eugenio Mercuri
- Pediatric Neurology Unit, Fondazione Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
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25
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Howard IM, Kaufman MS. Telehealth applications for outpatients with neuromuscular or musculoskeletal disorders. Muscle Nerve 2018; 58:475-485. [PMID: 29510449 DOI: 10.1002/mus.26115] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2018] [Indexed: 12/14/2022]
Abstract
Telehealth describes the provision of medical services remotely through technology, and may enhance patient access to specialty care services. Although teleneurology has expanded widely since the introduction of telestroke in 1999, telehealth services for outpatients with neuromuscular or musculoskeletal disorders are less widespread. In this narrative review, we will describe the current technology, applications, outcomes, and limitations of this dynamically growing field. Evidence for telehealth applications related to neuromuscular diseases, palliative care, specialized multidisciplinary services, and musculoskeletal care are reviewed. With growing demand for specialized services and finite resources, telehealth provides a promising avenue to promote access to high-quality care, decrease the cost and burden of travel for patients, and with the expansion of software to personal computing and mobile devices, offer flexible, low-overhead practice opportunities for clinicians. Providers embarking on careers in telehealth should be aware of current legal restrictions impacting care to minimize risk and avoid liability. Muscle Nerve 58: 475-485, 2018.
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Affiliation(s)
- Ileana M Howard
- Rehabilitation Care Services, S-117 RCS, 1660 South Columbian Way, VA Puget Sound Seattle, Washington, USA.,Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Marla S Kaufman
- Rehabilitation Care Services, S-117 RCS, 1660 South Columbian Way, VA Puget Sound Seattle, Washington, USA.,Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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26
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Birnkrant DJ, Bushby K, Bann CM, Apkon SD, Blackwell A, Brumbaugh D, Case LE, Clemens PR, Hadjiyannakis S, Pandya S, Street N, Tomezsko J, Wagner KR, Ward LM, Weber DR. Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and neuromuscular, rehabilitation, endocrine, and gastrointestinal and nutritional management. Lancet Neurol 2018; 17:251-267. [PMID: 29395989 PMCID: PMC5869704 DOI: 10.1016/s1474-4422(18)30024-3] [Citation(s) in RCA: 637] [Impact Index Per Article: 106.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 10/03/2017] [Accepted: 11/20/2017] [Indexed: 12/12/2022]
Abstract
Since the publication of the Duchenne muscular dystrophy (DMD) care considerations in 2010, multidisciplinary care of this severe, progressive neuromuscular disease has evolved. In conjunction with improved patient survival, a shift to more anticipatory diagnostic and therapeutic strategies has occurred, with a renewed focus on patient quality of life. In 2014, a steering committee of experts from a wide range of disciplines was established to update the 2010 DMD care considerations, with the goal of improving patient care. The new care considerations aim to address the needs of patients with prolonged survival, to provide guidance on advances in assessments and interventions, and to consider the implications of emerging genetic and molecular therapies for DMD. The committee identified 11 topics to be included in the update, eight of which were addressed in the original care considerations. The three new topics are primary care and emergency management, endocrine management, and transitions of care across the lifespan. In part 1 of this three-part update, we present care considerations for diagnosis of DMD and neuromuscular, rehabilitation, endocrine (growth, puberty, and adrenal insufficiency), and gastrointestinal (including nutrition and dysphagia) management.
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Affiliation(s)
- David J Birnkrant
- Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Katharine Bushby
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Carla M Bann
- RTI International, Research Triangle Park, NC, USA
| | - Susan D Apkon
- Department of Rehabilitation Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | | | - David Brumbaugh
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital Colorado, Aurora, CO, USA
| | - Laura E Case
- Doctor of Physical Therapy Division, Department of Orthopaedics, Duke University School of Medicine, Durham, NC, USA
| | - Paula R Clemens
- Department of Neurology, University of Pittsburgh School of Medicine, and Neurology Service, Department of Veterans Affairs Medical Center, Pittsburgh, PA, USA
| | - Stasia Hadjiyannakis
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, and University of Ottawa, Ottawa, ON, Canada
| | - Shree Pandya
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Natalie Street
- Rare Disorders and Health Outcomes Team, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jean Tomezsko
- Medical Nutrition Consulting of Media LLC, and Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kathryn R Wagner
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, and Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Leanne M Ward
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, and University of Ottawa, Ottawa, ON, Canada
| | - David R Weber
- Division of Endocrinology and Diabetes, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
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27
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Clément J, Raison M, Rouleau DM. Reproducibility analysis of upper limbs reachable workspace, and effects of acquisition protocol, sex and hand dominancy. J Biomech 2018; 68:58-64. [DOI: 10.1016/j.jbiomech.2017.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 11/12/2017] [Accepted: 12/10/2017] [Indexed: 11/26/2022]
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28
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Aslani N, Noroozi S, Davenport P, Hartley R, Dupac M, Sewell P. Development of a 3D workspace shoulder assessment tool incorporating electromyography and an inertial measurement unit-a preliminary study. Med Biol Eng Comput 2017; 56:1003-1011. [PMID: 29127653 PMCID: PMC5978833 DOI: 10.1007/s11517-017-1745-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 10/25/2017] [Indexed: 12/02/2022]
Abstract
Traditional shoulder range of movement (ROM) measurement tools suffer from inaccuracy or from long experimental setup times. Recently, it has been demonstrated that relatively low-cost wearable inertial measurement unit (IMU) sensors can overcome many of the limitations of traditional motion tracking systems. The aim of this study is to develop and evaluate a single IMU combined with an electromyography (EMG) sensor to monitor the 3D reachable workspace with simultaneous measurement of deltoid muscle activity across the shoulder ROM. Six volunteer subjects with healthy shoulders and one participant with a ‘frozen’ shoulder were recruited to the study. Arm movement in 3D space was plotted in spherical coordinates while the relative EMG intensity of any arm position is presented graphically. The results showed that there was an average ROM surface area of 27291 ± 538 deg2 among all six healthy individuals and a ROM surface area of 13571 ± 308 deg2 for the subject with frozen shoulder. All three sections of the deltoid show greater EMG activity at higher elevation angles. Using such tools enables individuals, surgeons and physiotherapists to measure the maximum envelope of motion in conjunction with muscle activity in order to provide an objective assessment of shoulder performance in the voluntary 3D workspace. The aim of this study is to develop and evaluate a single IMU combined with an electromyography (EMG) sensor to monitor the 3D reachable workspace with simultaneous measurement of deltoid muscle activity across the shoulder ROM. The assessment tool consists of an IMU sensor, an EMG sensor, a microcontroller and a Bluetooth module. The assessment tool was attached to subjects arm. Individuals were instructed to move their arms with the elbow fully extended. They were then asked to provide the maximal voluntary elevation envelope of the arm in 3D space in multiple attempts starting from a small movement envelope going to the biggest possible in four consecutive circuits. The results showed that there was an average ROM surface area of 27291 ± 538 deg2 among all six healthy individuals and a ROM surface area of 13571 ± 308 deg2 for the subject with frozen shoulder. All three sections of the deltoid show greater EMG activity at higher elevation angles. Using such tools enables individuals, surgeons and physiotherapists to measure the maximum envelope of motion in conjunction with muscle activity in order to provide an objective assessment of shoulder performance in the voluntary 3D workspace. ![]()
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Affiliation(s)
- Navid Aslani
- Department of Design and Engineering, Faculty of Science and Technology, Bournemouth University, Talbot Campus, Fern Barrow, Poole, Dorset BH12 5BB UK
| | - Siamak Noroozi
- Department of Design and Engineering, Faculty of Science and Technology, Bournemouth University, Talbot Campus, Fern Barrow, Poole, Dorset BH12 5BB UK
| | - Philip Davenport
- Department of Design and Engineering, Faculty of Science and Technology, Bournemouth University, Talbot Campus, Fern Barrow, Poole, Dorset BH12 5BB UK
| | | | - Mihai Dupac
- Department of Design and Engineering, Faculty of Science and Technology, Bournemouth University, Talbot Campus, Fern Barrow, Poole, Dorset BH12 5BB UK
| | - Philip Sewell
- Department of Design and Engineering, Faculty of Science and Technology, Bournemouth University, Talbot Campus, Fern Barrow, Poole, Dorset BH12 5BB UK
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29
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de Bie E, Oskarsson B, Joyce NC, Nicorici A, Kurillo G, Han JJ. Longitudinal evaluation of upper extremity reachable workspace in ALS by Kinect sensor. Amyotroph Lateral Scler Frontotemporal Degener 2016; 18:17-23. [DOI: 10.1080/21678421.2016.1241278] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Evan de Bie
- University of California at Davis, School of Medicine, Department of Public Health Sciences, Division of Biostatistics, Davis, California,
| | - Bjorn Oskarsson
- University of California at Davis, School of Medicine, Department of Neurology, Sacramento, California,
- Mayo Clinic, Jacksonville, Florida,
| | - Nanette C. Joyce
- University of California at Davis, School of Medicine, Department of Physical Medicine and Rehabilitation, Sacramento, California,
| | - Alina Nicorici
- University of California at Davis, School of Medicine, Department of Physical Medicine and Rehabilitation, Sacramento, California,
| | - Gregorij Kurillo
- University of California at Berkeley, College of Engineering, Department of Electrical Engineering and Computer Science, Berkeley, California, and
| | - Jay J. Han
- University of California at Irvine, School of Medicine, Department of Physical Medicine and Rehabilitation, Orange, California, USA
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