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Abstract
Bilateral training systems look to promote the paretic hand's use in individuals with hemiplegia. Although this is normally achieved using mechanical coupling (i.e., a physical connection between the hands), a virtual reality system relying on virtual coupling (i.e., through a shared virtual object) would be simpler to use and prevent slacking. However, it is not clear whether different coupling modes differently impact task performance and effort distribution between the hands. We explored how 18 healthy right-handed participants changed their motor behaviors in response to the uninstructed addition of mechanical coupling, and virtual coupling using a shared cursor mapped to the average hands' position. In a second experiment, we then studied the impact of connection stiffness on performance, perception, and effort imbalance. The results indicated that both coupling types can induce the hands to actively contribute to the task. However, the task asymmetry introduced by using a cursor mapped to either the left or right hand only modulated the hands' contribution when not mechanically coupled. The tracking performance was similar for all coupling types, independent of the connection stiffness, although the mechanical coupling was preferred and induced the hands to move with greater correlation. These findings suggest that virtual coupling can induce the hands to actively contribute to a task in healthy participants without hindering their performance. Further investigation on the coupling types' impact on the performance and hands' effort distribution in patients with hemiplegia could allow for the design of simpler training systems that promote the affected hand's use.NEW & NOTEWORTHY We showed that the uninstructed addition of a virtual and/or a mechanical coupling can induce both hands to actively contribute in a continuous redundant bimanual tracking task without impacting performance. In addition, we showed that the task asymmetry can only alter the effort distribution when the hands are not connected, independent of the connection stiffness. Our findings suggest that virtual coupling could be used in the development of simpler VR-based training devices.
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Affiliation(s)
- Nuria Peña-Pérez
- 1School of Electronic Engineering and Computer Science, Queen Mary University of London, London, United Kingdom,4Department of Bioengineering, Imperial College of Science Technology and Medicine, London, United Kingdom
| | - Jonathan Eden
- 2Mechanical Engineering Department, The University of Melbourne, Melbourne, Victoria, Australia,4Department of Bioengineering, Imperial College of Science Technology and Medicine, London, United Kingdom
| | - Ekaterina Ivanova
- 4Department of Bioengineering, Imperial College of Science Technology and Medicine, London, United Kingdom
| | - Ildar Farkhatdinov
- 3School of Engineering and Materials Science, Queen Mary University of London, London, United Kingdom,4Department of Bioengineering, Imperial College of Science Technology and Medicine, London, United Kingdom
| | - Etienne Burdet
- 4Department of Bioengineering, Imperial College of Science Technology and Medicine, London, United Kingdom
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Cornette R, Delapré A, Houssin C, Mulot B, Pouydebat E. Measuring the force of the tip of the elephants trunk. MethodsX 2022; 9:101896. [DOI: 10.1016/j.mex.2022.101896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
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Mace M, Mutalib SA, Ogrinc M, Goldsmith N, Burdet E. GripAble: An accurate, sensitive and robust digital device for measuring grip strength. J Rehabil Assist Technol Eng 2022; 9:20556683221078455. [PMID: 35251685 PMCID: PMC8891833 DOI: 10.1177/20556683221078455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/20/2022] [Indexed: 12/16/2022] Open
Abstract
Introduction Grip strength is a reliable biomarker of overall health and physiological well-being. It is widely used in clinical practice as an outcome measure. This paper demonstrates the measurement characteristics of GripAble, a wireless mobile handgrip device that measures grip force both isometrically and elastically-resisted for assessment and training of hand function. Methods A series of bench tests were performed to evaluate GripAble's grip force measurement accuracy and sensitivity. Measurement robustness was evaluated through repeated drop tests interwoven with error verification test phases. Results GripAble's absolute measurement error at the central position was under 0.81 and 1.67 kg (95th percentiles; N = 47) when measuring elastically and isometrically, respectively, providing similar or better accuracy than the industry-standard Jamar device. Sensitivity was measured as 0.062 ± 0.015 kg (mean ± std; 95th percentiles: [0.036, 0.089] kg; N = 47), independent of the applied force. There was no significant performance degradation following impact from 30 drops from a height >1.5 m. Conclusion GripAble is an accurate and reliable grip strength dynamometer. It is highly sensitive and robust, which in combination with other novel features (e.g. portability, telerehabilitation and digital data tracking) enable broad applicability in a range of clinical caseloads and environments.
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Affiliation(s)
| | - Sharah Abdul Mutalib
- GripAble Limited, London, UK
- Bioengineering Department, Imperial College of Science Technology and Medicine, London, UK
| | - Matjaz Ogrinc
- GripAble Limited, London, UK
- Bioengineering Department, Imperial College of Science Technology and Medicine, London, UK
| | - Nicola Goldsmith
- GripAble Limited, London, UK
- NES Hand Therapy Training, London, UK
| | - Etienne Burdet
- Bioengineering Department, Imperial College of Science Technology and Medicine, London, UK
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Mutalib SA, Mace M, Seager C, Burdet E, Mathiowetz V, Goldsmith N. Modernising grip dynamometry: Inter-instrument reliability between GripAble and Jamar. BMC Musculoskelet Disord 2022; 23:80. [PMID: 35073887 PMCID: PMC8785007 DOI: 10.1186/s12891-022-05026-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/13/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Maximum grip strength (MGS) is a reliable biomarker of overall health and physiological well-being. Therefore, an accurate and reliable measurement device is vital for ensuring the validity of the MGS assessment. This paper presents GripAble, a mobile hand grip device for the assessment of MGS. GripAble's performance was evaluated using an inter-instrument reliability test against the widely used Jamar PLUS+ dynamometer. METHODS MGS data from sixty-three participants (N = 63, median (IQR) age = 29.0 (29.5) years, 33 M/30 F) from both hands using GripAble and Jamar PLUS+ were collected and compared. Intraclass correlation (ICC), regression, and Bland and Altman analysis were performed to evaluate the inter-instrument reliability and relationship in MGS measurements between GripAble and Jamar PLUS+ . RESULTS GripAble demonstrates good-to-excellent inter-instrument reliability to the Jamar PLUS+ with ICC3,1 = 0.906 (95% CI [0.87-0.94]). GripAble's MGS measurement is equivalent to 69% (95% CI [0.67-0.71]%) of Jamar PLUS+'s measurement. There is a proportional difference in mean MGS between the two devices, with the difference in MGS between GripAble and Jamar PLUS+ increasing with MGS. CONCLUSION The GripAble is a reliable tool for measuring grip strength. However, the MGS readings from GripAble and Jamar PLUS+ should not be interchanged for serial measurements of the same patient, nor be translated directly from one device to the other. A new normative MGS data using GripAble will be collected and accessed through the software for immediate comparison to age and gender-matched subpopulations.
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Affiliation(s)
- Sharah Abdul Mutalib
- GripAble Limited, London, UK.
- Bioengineering Department Imperial College of Science, Technology and Medicine, London, UK.
| | | | | | - Etienne Burdet
- Bioengineering Department Imperial College of Science, Technology and Medicine, London, UK
| | - Virgil Mathiowetz
- Occupational Therapy Program, University of Minnesota, Minneapolis, MN, USA
| | - Nicola Goldsmith
- GripAble Limited, London, UK
- NES Hand Therapy Training, London, UK
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Atashzar SF, Carriere J, Tavakoli M. Review: How Can Intelligent Robots and Smart Mechatronic Modules Facilitate Remote Assessment, Assistance, and Rehabilitation for Isolated Adults With Neuro-Musculoskeletal Conditions? Front Robot AI 2021; 8:610529. [PMID: 33912593 PMCID: PMC8072151 DOI: 10.3389/frobt.2021.610529] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/08/2021] [Indexed: 12/12/2022] Open
Abstract
Worldwide, at the time this article was written, there are over 127 million cases of patients with a confirmed link to COVID-19 and about 2.78 million deaths reported. With limited access to vaccine or strong antiviral treatment for the novel coronavirus, actions in terms of prevention and containment of the virus transmission rely mostly on social distancing among susceptible and high-risk populations. Aside from the direct challenges posed by the novel coronavirus pandemic, there are serious and growing secondary consequences caused by the physical distancing and isolation guidelines, among vulnerable populations. Moreover, the healthcare system's resources and capacity have been focused on addressing the COVID-19 pandemic, causing less urgent care, such as physical neurorehabilitation and assessment, to be paused, canceled, or delayed. Overall, this has left elderly adults, in particular those with neuromusculoskeletal (NMSK) conditions, without the required service support. However, in many cases, such as stroke, the available time window of recovery through rehabilitation is limited since neural plasticity decays quickly with time. Given that future waves of the outbreak are expected in the coming months worldwide, it is important to discuss the possibility of using available technologies to address this issue, as societies have a duty to protect the most vulnerable populations. In this perspective review article, we argue that intelligent robotics and wearable technologies can help with remote delivery of assessment, assistance, and rehabilitation services while physical distancing and isolation measures are in place to curtail the spread of the virus. By supporting patients and medical professionals during this pandemic, robots, and smart digital mechatronic systems can reduce the non-COVID-19 burden on healthcare systems. Digital health and cloud telehealth solutions that can complement remote delivery of assessment and physical rehabilitation services will be the subject of discussion in this article due to their potential in enabling more effective and safer NMSDK rehabilitation, assistance, and assessment service delivery. This article will hopefully lead to an interdisciplinary dialogue between the medical and engineering sectors, stake holders, and policy makers for a better delivery of care for those with NMSK conditions during a global health crisis including future pandemics.
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Affiliation(s)
- S. Farokh Atashzar
- Department of Electrical and Computer Engineering, Department of Mechanical and Aerospace Engineering, New York University, New York, NY, United States
| | - Jay Carriere
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Mahdi Tavakoli
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
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Mutalib SA, Mace M, Ong HT, Burdet E. Influence of visual-coupling on bimanual coordination in unilateral spastic cerebral palsy. IEEE Int Conf Rehabil Robot 2019; 2019:1013-1018. [PMID: 31374762 DOI: 10.1109/icorr.2019.8779390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Controlling two objects simultaneously during a bimanual task is a cognitively demanding process; both hands need to be temporally and spatially coordinated to achieve the shared task goal. Children with unilateral spastic cerebral palsy (USCP) exhibit severe sensory and motor impairments to one side of their body that make the process of coordinating bimanual movements particularly exhausting. Prior studies have shown that performing visually-coupled task could reduce cognitive interference associated with performing 'two tasks at once' in an uncoupled bimanual task. For children with USCP, who also present with cognitive delay, performing this type of task may allow them to process and plan their movement faster. We tested this hypothesis by examining the grip force control of 7 children with USCP during unimanual and visually-coupled bimanual tasks. Results demonstrated that despite the visual coupling, the bimanual coordination of these children remained impaired. However, there may be a potential benefit of visually-coupled task in encouraging both hands to initiate in concert. The implication of the study for children with USCP is discussed.
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Lotay R, Mace M, Rinne P, Burdet E, Bentley P. optimizing self-exercise scheduling in motor stroke using Challenge Point Framework theory. IEEE Int Conf Rehabil Robot 2019; 2019:435-440. [PMID: 31374668 DOI: 10.1109/icorr.2019.8779497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An important challenge for technology-assisted self-led rehabilitation is how to automate appropriate schedules of exercise that are responsive to patients' needs, and optimal for learning. While random scheduling has been found to be superior for long-term learning relative to fixed scheduling (Contextual Interference), this method is limited by not adequately accounting for task difficulty, or skill acquisition during training. One method that combines contextual interference with adaptation of the challenge to the skill-level of the player is Challenge Point Framework (CPF) theory. In this pilot study we test whether self-led motor training based upon CPF scheduling achieves faster learning than deterministic, fixed scheduling. Training was implemented in a mobile gaming device adapted for arm disability, allowing for grip and wrist exercises. We tested 11 healthy volunteers and 12 hemiplegic stroke patients in a single-blinded no crossover controlled randomized trial. Results suggest that patients training with CPF-based adaption performed better than those training with fixed conditions. This was not seen for healthy volunteers whose performance was close to ceiling. Further data collection is required to determine the significance of the results.
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Sebastian F, Fu Q, Santello M, Polygerinos P. Soft Robotic Haptic Interface with Variable Stiffness for Rehabilitation of Neurologically Impaired Hand Function. Front Robot AI 2017. [DOI: 10.3389/frobt.2017.00069] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mace M, Kinany N, Rinne P, Rayner A, Bentley P, Burdet E. Balancing the playing field: collaborative gaming for physical training. J Neuroeng Rehabil 2017; 14:116. [PMID: 29151360 PMCID: PMC5694911 DOI: 10.1186/s12984-017-0319-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 10/16/2017] [Indexed: 11/30/2022] Open
Abstract
Background Multiplayer video games promoting exercise-based rehabilitation may facilitate motor learning, by increasing motivation through social interaction. However, a major design challenge is to enable meaningful inter-subject interaction, whilst allowing for significant skill differences between players. We present a novel motor-training paradigm that allows real-time collaboration and performance enhancement, across a wide range of inter-subject skill mismatches, including disabled vs. able-bodied partnerships. Methods A virtual task consisting of a dynamic ball on a beam, is controlled at each end using independent digital force-sensing handgrips. Interaction is mediated through simulated physical coupling and locally-redundant control. Game performance was measured in 16 healthy-healthy and 16 patient-expert dyads, where patients were hemiparetic stroke survivors using their impaired arm. Dual-player was compared to single-player performance, in terms of score, target tracking, stability, effort and smoothness; and questionnaires probing user-experience and engagement. Results Performance of less-able subjects (as ranked from single-player ability) was enhanced by dual-player mode, by an amount proportionate to the partnership’s mismatch. The more abled partners’ performances decreased by a similar amount. Such zero-sum interactions were observed for both healthy-healthy and patient-expert interactions. Dual-player was preferred by the majority of players independent of baseline ability and subject group; healthy subjects also felt more challenged, and patients more skilled. Conclusion This is the first demonstration of implicit skill balancing in a truly collaborative virtual training task leading to heightened engagement, across both healthy subjects and stroke patients. Electronic supplementary material The online version of this article (doi:10.1186/s12984-017-0319-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael Mace
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK.
| | - Nawal Kinany
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK.,Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Paul Rinne
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK.,Division of Brain Sciences, Imperial College of Science, Technology and Medicine, London, UK
| | - Anthony Rayner
- Division of Brain Sciences, Imperial College of Science, Technology and Medicine, London, UK
| | - Paul Bentley
- Division of Brain Sciences, Imperial College of Science, Technology and Medicine, London, UK
| | - Etienne Burdet
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, UK.,School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
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