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      Upper Extremity Functional Evaluation by Fugl-Meyer Assessment Scoring Using Depth-Sensing Camera in Hemiplegic Stroke Patients

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          Abstract

          Virtual home-based rehabilitation is an emerging area in stroke rehabilitation. Functional assessment tools are essential to monitor recovery and provide current function-based rehabilitation. We developed the Fugl-Meyer Assessment (FMA) tool using Kinect (Microsoft, USA) and validated it for hemiplegic stroke patients. Forty-one patients with hemiplegic stroke were enrolled. Thirteen of 33 items were selected for upper extremity motor FMA. One occupational therapist assessed the motor FMA while recording upper extremity motion with Kinect. FMA score was calculated using principal component analysis and artificial neural network learning from the saved motion data. The degree of jerky motion was also transformed to jerky scores. Prediction accuracy for each of the 13 items and correlations between real FMA scores and scores using Kinect were analyzed. Prediction accuracies ranged from 65% to 87% in each item and exceeded 70% for 9 items. Correlations were high for the summed score for the 13 items between real FMA scores and scores obtained using Kinect (Pearson’s correlation coefficient = 0.873, P<0.0001) and those between total upper extremity scores (66 in full score) and scores using Kinect (26 in full score) (Pearson’s correlation coefficient = 0.799, P<0.0001). Log transformed jerky scores were significantly higher in the hemiplegic side (1.81 ± 0.76) compared to non-hemiplegic side (1.21 ± 0.43) and showed significant negative correlations with Brunnstrom stage (3 to 6; Spearman correlation coefficient = -0.387, P = 0.046). FMA using Kinect is a valid way to assess upper extremity function and can provide additional results for movement quality in stroke patients. This may be useful in the setting of unsupervised home-based rehabilitation.

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          Most cited references14

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          Factors influencing stroke survivors' quality of life during subacute recovery.

          Health-related quality of life (HRQOL) is an important index of outcome after stroke and may facilitate a broader description of stroke recovery. This study examined the relationship of individual and clinical characteristics to HRQOL in stroke survivors with mild to moderate stroke during subacute recovery. Two hundred twenty-nine participants 3 to 9 months poststroke were enrolled in a national multisite clinical trial (Extremity Constraint-Induced Therapy Evaluation). HRQOL was assessed using the Stroke Impact Scale (SIS), Version 3.0. The Wolf Motor Function Test documented functional recovery of the hemiplegic upper extremity. Multiple analysis of variance and regression models examined the influence of demographic and clinical variables across SIS domains. Age, gender, education level, stroke type, concordance (paretic arm=dominant hand), upper extremity motor function (Wolf Motor Function Test), and comorbidities were associated across SIS domains. Poorer HRQOL in the physical domain was associated with age, nonwhite race, more comorbidities, and reduced upper-extremity function. Stroke survivors with more comorbidities reported poorer HRQOL in the area of memory and thinking, and those with an ischemic stroke and concordance reported poorer communication. Although results may not generalize to lower functioning stroke survivors, individual characteristics of persons with mild to moderate stroke may be important to consider in developing comprehensive, targeted interventions designed to maximize recovery and improve HRQOL.
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            Movement smoothness changes during stroke recovery.

            Smoothness is characteristic of coordinated human movements, and stroke patients' movements seem to grow more smooth with recovery. We used a robotic therapy device to analyze five different measures of movement smoothness in the hemiparetic arm of 31 patients recovering from stroke. Four of the five metrics showed general increases in smoothness for the entire patient population. However, according to the fifth metric, the movements of patients with recent stroke grew less smooth over the course of therapy. This pattern was reproduced in a computer simulation of recovery based on submovement blending, suggesting that progressive blending of submovements underlies stroke recovery.
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              Parkinsonism reduces coordination of fingers, wrist, and arm in fine motor control.

              This experiment investigates movement coordination in Parkinson's disease (PD) subjects. Seventeen PD patients and 12 elderly control subjects performed several handwriting-like tasks on a digitizing writing tablet resting on top of a table in front of the subject. The writing patterns, in increasing order of coordination complexity, were repetitive back-and-forth movements in various orientations, circles and loops in clockwise and counterclockwise directions, and a complex writing pattern. The patterns were analyzed in terms of jerk normalized for duration and size per stroke. In the PD subjects, back-and-forth strokes, involving coordination of fingers and wrist, showed larger normalized jerk than strokes performed using either the wrist or the fingers alone. In the PD patients, wrist flexion (plus radial deviation) showed greater normalized jerk in comparison to wrist extension (plus ulnar deviation). The elderly control subjects showed no such effects as a function of coordination complexity. For both PD and elderly control subjects, looping patterns consisting of circles with a left-to-right forearm movement, did not show a systematic increase of normalized jerk. The same handwriting patterns were then simulated using a biologically inspired neural network model of the basal ganglia thalamocortical relations for a control and a mild PD subject. The network simulation was consistent with the observed experimental results, providing additional support that a reduced capability to coordinate wrist and finger movements may be caused by suboptimal functioning of the basal ganglia in PD. The results suggest that in PD patients fine motor control problems may be caused by a reduced capability to coordinate the fingers and wrist and by reduced control of wrist flexion.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                1 July 2016
                2016
                : 11
                : 7
                : e0158640
                Affiliations
                [1 ]Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
                [2 ]Department of Mechanical and Aerospace Engineering, Seoul National University, Seoul, South Korea
                INSERM U894, FRANCE
                Author notes

                Competing Interests: This work was supported by the MSIP (The Ministry of Science, ICT and Future Planning), Korea and Microsoft Research, under ICT/SW Creative research program supervised by the NIPA (National ICT Industry Promotion Agency). Nam-Jong Paik, Won-Seok Kim, Hyunwoo Bang and Sungmin Cho have a patent pending entitled 'virtual impatient rehabilitation system and method', the number is “10-2016-0002873”, which is focused on hand motion recognition and is not directly but broadly relevant to this work. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. Authors have also no competing interests relating to employment, consultancy, patents, products in development or modified products along with this patent. Finally, none of the authors have to disclose any additional financial interest regarding this work.

                Conceived and designed the experiments: WSK HB NJP. Performed the experiments: WSK SC DB. Analyzed the data: WSK SC NJP. Contributed reagents/materials/analysis tools: WSK SC. Wrote the paper: WSK SC DB HB NJP. Supervision of technical issues during the study: HB. Review the manuscript and suggest some corrections: HB NJP.

                Article
                PONE-D-16-09834
                10.1371/journal.pone.0158640
                4930182
                27367518
                20b2643d-fcaa-4131-9273-d65bbc98d1fc
                © 2016 Kim et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 8 March 2016
                : 20 June 2016
                Page count
                Figures: 5, Tables: 1, Pages: 13
                Funding
                Funded by: MSIP(The Ministry of Science, ICT and Future Planning), Korea and Microsoft Research, under ICT/SW Creative research program supervised by the NIPA(National ICT Industry Promotion Agency)
                Award ID: NIPA-2014-(H0510-14-1014)
                Award Recipient :
                Funded by: MSIP(The Ministry of Science, ICT and Future Planning), Korea and Microsoft Research, under ICT/SW Creative research program supervised by the NIPA(National ICT Industry Promotion Agency)
                Award ID: NIPA-2013-(H0503-13-1018)
                Award Recipient :
                This research was supported by the The Ministry of Science, ICT and Future Planning (MSIP), Korea and Microsoft Research, under ICT/SW Creative research program supervised by the National ICT Industry Promotion Agency (NIPA)[NIPA-2014-(H0510-14-1014)] and [NIPA-2013-(H0503-13-1018)], which were received by N-J.P. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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