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      Feasibility of Using Microsoft Kinect to Assess Upper Limb Movement in Type III Spinal Muscular Atrophy Patients

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          Abstract

          Although functional rating scales are being used increasingly as primary outcome measures in spinal muscular atrophy (SMA), sensitive and objective assessment of early-stage disease progression and drug efficacy remains challenging. We have developed a game based on the Microsoft Kinect sensor, specifically designed to measure active upper limb movement. An explorative study was conducted to determine the feasibility of this new tool in 18 ambulant SMA type III patients and 19 age- and gender-matched healthy controls. Upper limb movement was analysed elaborately through derived features such as elbow flexion and extension angles, arm lifting angle, velocity and acceleration. No significant differences were found in the active range of motion between ambulant SMA type III patients and controls. Hand velocity was found to be different but further validation is necessary. This study presents an important step in the process of designing and handling digital biomarkers as complementary outcome measures for clinical trials.

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          Most cited references23

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          Accuracy of the Microsoft Kinect sensor for measuring movement in people with Parkinson's disease.

          The Microsoft Kinect sensor (Kinect) is potentially a low-cost solution for clinical and home-based assessment of movement symptoms in people with Parkinson's disease (PD). The purpose of this study was to establish the accuracy of the Kinect in measuring clinically relevant movements in people with PD. Nine people with PD and 10 controls performed a series of movements which were measured concurrently with a Vicon three-dimensional motion analysis system (gold-standard) and the Kinect. The movements included quiet standing, multidirectional reaching and stepping and walking on the spot, and the following items from the Unified Parkinson's Disease Rating Scale: hand clasping, finger tapping, foot, leg agility, chair rising and hand pronation. Outcomes included mean timing and range of motion across movement repetitions. The Kinect measured timing of movement repetitions very accurately (low bias, 95% limits of agreement 0.9 and Pearson's r>0.9). However, the Kinect had varied success measuring spatial characteristics, ranging from excellent for gross movements such as sit-to-stand (ICC=.989) to very poor for fine movement such as hand clasping (ICC=.012). Despite this, results from the Kinect related strongly to those obtained with the Vicon system (Pearson's r>0.8) for most movements. The Kinect can accurately measure timing and gross spatial characteristics of clinically relevant movements but not with the same spatial accuracy for smaller movements, such as hand clasping. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.
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            An expanded version of the Hammersmith Functional Motor Scale for SMA II and III patients.

            To develop and evaluate an expanded version of the Hammersmith Functional Motor Scale allowing for evaluation of ambulatory SMA patients.
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              A motor function measure for neuromuscular diseases. Construction and validation study.

              A new scale for motor function measurement has been developed for neuromuscular diseases. The validation study included 303 patients, aged 6-62 years. Seventy-two patients had Duchenne muscular dystrophy, 32 Becker muscular dystrophy, 30 limb-girdle muscular dystrophy, 39 facio-scapulo-humeral dystrophy, 29 myotonic dystrophy, 21 congenital myopathy, 10 congenital muscular dystrophy, 35 spinal muscular atrophy and 35 hereditary neuropathy. The scale comprised 32 items, in three dimensions: standing position and transfers, axial and proximal motor function, distal motor function. Agreement coefficients for inter-rater reliability were excellent (kappa=0.81-0.94) for nine items, good (kappa=0.61-0.80) for 20 items and moderate (kappa=0.51-0.60) for three items. High correlations were found between the total score and other scores: Vignos (r=0.91) and Brooke (r=0.85) grades, Functional Independence Measure (r=0.91), the global severity of disability evaluated with visual analog scales by physicians (r=0.88) and physiotherapists (r=0.91). This scale is reliable, does not require any special equipment and is well-accepted by patients. Its sensitivity to change is being assessed to permit its use in clinical trials of neuromuscular diseases.
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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
                25 January 2017
                2017
                : 12
                : 1
                : e0170472
                Affiliations
                [1 ]Data Science, Roche Pharmaceutical Research and Early Development Informatics, Roche Innovation Center Basel, F. Hoffmann-La Roche, Ltd., Basel, Switzerland
                [2 ]Translational Technologies and Bioinformatics, Pharmaceutical Sciences, Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche, Ltd., Basel, Switzerland
                [3 ]Biomarker Experimental Medicine, Neuroscience, Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche, Ltd., Basel, Switzerland
                [4 ]Division of Neuropediatrics, University of Basel Children’s Hospital, Basel, Switzerland
                [5 ]Department of Neurology, University of Basel Hospital, Basel, Switzerland
                [6 ]Translational Medicine, Neuroscience and Rare Diseases, Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche, Ltd., Basel, Switzerland
                University of Edinburgh, UNITED KINGDOM
                Author notes

                Competing Interests: XC, JS, DW, CC, OK and MS are employees of F. Hoffmann-La Roche. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

                • Conceptualization: XC CC UB DF OK MS.

                • Data curation: XC JS.

                • Formal analysis: XC JS DW.

                • Investigation: UB DF.

                • Methodology: XC CC UB DF MS.

                • Project administration: CC DF.

                • Resources: XC UB DF MS.

                • Software: XC DW.

                • Supervision: OK CC MS DF.

                • Validation: XC JS DW.

                • Visualization: XC JS.

                • Writing – original draft: XC JS DW.

                • Writing – review & editing: XC JS DW CC.

                Author information
                http://orcid.org/0000-0002-0891-3002
                Article
                PONE-D-16-20912
                10.1371/journal.pone.0170472
                5266257
                28122039
                7b3c74e6-a5c4-40be-b9a6-3dfe8a45a9f0
                © 2017 Chen 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
                : 26 May 2016
                : 5 January 2017
                Page count
                Figures: 5, Tables: 2, Pages: 12
                Funding
                The study was entirely funded by F. Hoffmann–La Roche. The funder provided support in the form of salaries for authors XC, JS, DW, CC, OK and MS, but did not have any additional role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.
                Categories
                Research Article
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Limbs (Anatomy)
                Arms
                Elbow
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Limbs (Anatomy)
                Arms
                Elbow
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Limbs (Anatomy)
                Arms
                Hands
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Limbs (Anatomy)
                Arms
                Hands
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Joints (Anatomy)
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Joints (Anatomy)
                Medicine and Health Sciences
                Clinical Genetics
                Genetic Diseases
                Autosomal Recessive Diseases
                Spinal Muscular Atrophy
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Limbs (Anatomy)
                Arms
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Limbs (Anatomy)
                Arms
                Physical Sciences
                Physics
                Classical Mechanics
                Motion
                Velocity
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Joints (Anatomy)
                Knee Joints
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Joints (Anatomy)
                Knee Joints
                Custom metadata
                All data including extracted feature files and raw data files, all code including prototype game in Java, analysis code in R and data extraction code in Python as well as additional supplemental results are uploaded as supplemental materials and thus publically available.

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