Sensor Network for Analyzing Upper Body Strategies in Parkinson's Disease versus Normative Kinematic Patterns.

In rehabilitation, the upper limb function is generally assessed using clinical scales and functional motor tests. Although the Box and Block Test (BBT) is commonly used for its simplicity and ease of execution, it does not provide a quantitative measure of movement quality. This study proposes the integration of an ecological Inertial Measurement Units (IMUs) system for analysis of the upper body kinematics during the execution of a targeted version of BBT, by able-bodied persons with subjects with Parkinson's disease (PD). Joint angle parameters (mean angle and range of execution) and hand trajectory kinematic indices (mean velocity, mean acceleration, and dimensionless jerk) were calculated from the data acquired by a network of seven IMUs. The sensors were applied on the trunk, head, and upper limb in order to characterize the motor strategy used during the execution of BBT. Statistics revealed significant differences (p < 0.05) between the two groups, showing compensatory strategies in subjects with PD. The proposed IMU-based targeted BBT protocol allows to assess the upper limb function during manual dexterity tasks and could be used in the future for assessing the efficacy of rehabilitative treatments.

Functional Gait Recovery after a Combination of Conventional Therapy and Overground Robot-Assisted Gait Training Is Not Associated with Significant Changes in Muscle Activation Pattern: An EMG Preliminary Study on Subjects Subacute Post Stroke.

BACKGROUND: Overground Robot-Assisted Gait Training (o-RAGT) appears to be a promising stroke rehabilitation in terms of clinical outcomes. The literature on surface ElectroMyoGraphy (sEMG) assessment in o-RAGT is limited. This paper aimed to assess muscle activation patterns with sEMG in subjects subacute post stroke after training with o-RAGT and conventional therapy. METHODS: An observational preliminary study was carried out with subjects subacute post stroke who received 15 sessions of o-RAGT (5 sessions/week; 60 min) in combination with conventional therapy. The subjects were assessed with both clinical and instrumental evaluations. Gait kinematics and sEMG data were acquired before (T1) and after (T2) the period of treatment (during ecological gait), and during the first session of o-RAGT (o-RAGT1). An eight-channel wireless sEMG device acquired in sEMG signals. Significant differences in sEMG outcomes were found in the BS of TA between T1 and T2. There were no other significant correlations between the sEMG outcomes and the clinical results between T1 and T2. CONCLUSIONS: There were significant functional gains in gait after complex intensive clinical rehabilitation with o-RAGT and conventional therapy. In addition, there was a significant increase in bilateral symmetry of the Tibialis Anterior muscles. At this stage of the signals from the tibialis anterior (TA), gastrocnemius medialis (GM), rectus femoris (RF), and biceps femoris caput longus (BF) muscles of each lower extremity. sEMG data processing extracted the Bilateral Symmetry (BS), the Co-Contraction (CC), and the Root Mean Square (RMS) coefficients. RESULTS: Eight of 22 subjects in the subacute stage post stroke agreed to participate in this sEMG study. This subsample demonstrated a significant improvement in the motricity index of the affected lower limb and functional ambulation. The heterogeneity of the subjects' characteristics and the small number of subjects was associated with high variability research, functional gait recovery was associated with minimal change in muscle activation patterns.

Retrospective Robot-Measured Upper Limb Kinematic Data From Stroke Patients Are Novel Biomarkers.

Background: The efficacy of upper-limb Robot-assisted Therapy (ulRT) in stroke subjects is well-established. The robot-measured kinematic data can assess the biomechanical changes induced by ulRT and the progress of patient over time. However, literature on the analysis of pre-treatment kinematic parameters as predictive biomarkers of upper limb recovery is limited. Objective: The aim of this study was to calculate pre-treatment kinematic parameters from point-to-point reaching movements in different directions and to identify biomarkers of upper-limb motor recovery in subacute stroke subjects after ulRT. Methods: An observational retrospective study was conducted on 66 subacute stroke subjects who underwent ulRT with an end-effector robot. Kinematic parameters were calculated from the robot-measured trajectories during movements in different directions. A Generalized Linear Model (GLM) was applied considering the post-treatment Upper Limb Motricity Index and the kinematic parameters (from demanding directions of movement) as dependent variables, and the pre-treatment kinematic parameters as independent variables. Results: A subset of kinematic parameters significantly predicted the motor impairment after ulRT: the accuracy in adduction and internal rotation movements of the shoulder was the major predictor of post-treatment Upper Limb Motricity Index. The post-treatment kinematic parameters of the most demanding directions of movement significantly depended on the ability to execute elbow flexion-extension and abduction and external rotation movements of the shoulder at baseline. Conclusions: The multidirectional analysis of robot-measured kinematic data predicts motor recovery in subacute stroke survivors and paves the way in identifying subjects who may benefit more from ulRT.

Barriers to sEMG Assessment During Overground Robot-Assisted Gait Training in Subacute Stroke Patients.

Background: The limitation to the use of ElectroMyoGraphy (sEMG) in rehabilitation services is in contrast with its potential diagnostic capacity for rational planning and monitoring of the rehabilitation treatments, especially the overground Robot-Assisted Gait Training (o-RAGT). Objective: To assess the barriers to the implementation of a sEMG-based assessment protocol in a clinical context for evaluating the effects of o-RAGT in subacute stroke patients. Methods: An observational study was conducted in a rehabilitation hospital. The primary outcome was the success rate of the implementation of the sEMG-based assessment. The number of dropouts and the motivations have been registered. A detailed report on difficulties in implementing the sEMG protocol has been edited for each patient. The educational level and the working status of the staff have been registered. Each member of staff completed a brief survey indicating their level of knowledge of sEMG, using a five-point Likert scale. Results: The sEMG protocol was carried out by a multidisciplinary team composed of Physical Therapists (PTs) and Biomedical Engineers (BEs). Indeed, the educational level and the expertise of the members of staff influenced the fulfillment of the implementation of the study. The PTs involved in the study did not receive any formal education on sEMG during their course of study. The low success rate (22.7%) of the protocol was caused by several factors which could be grouped in: patient-related barriers; cultural barriers; technical barriers; and administrative barriers. Conclusions: Since a series of barriers limited the use of sEMG in the clinical rehabilitative environment, concrete actions are needed for disseminating sEMG in rehabilitation services. The sEMG assessment should be included in health systems regulations and specific education should be part of the rehabilitation professionals' curriculum. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03395717.

Kinematic Parameters for Tracking Patient Progress during Upper Limb Robot-Assisted Rehabilitation: An Observational Study on Subacute Stroke Subjects.

BACKGROUND: Upper limb robot-assisted therapy (RT) provides intensive, repetitive, and task-specific treatment, and its efficacy for stroke survivors is well established in literature. Biomechanical data from robotic devices has been widely employed for patient's assessment, but rarely it has been analysed for tracking patient progress during RT. The goal of this retrospective study is to analyse built-in kinematic data registered by a planar end-effector robot for assessing the time course of motor recovery and patient's workspace exploration skills. A comparison of subjects having mild and severe motor impairment has been also conducted. For that purpose, kinematic data recorded by a planar end-effector robot have been processed for investigating how motor performance in executing point-to-point trajectories with different directions changes during RT. METHODS: Observational retrospective study of 68 subacute stroke patients who conducted 20 daily sessions of upper limb RT with the InMotion 2.0 (Bionik Laboratories, USA): planar point-to-point reaching tasks with an "assist as needed" strategy. The following kinematic parameters (KPs) were computed for each subject and for each point-to-point trajectory executed during RT: movement accuracy, movement speed, number of peak speed, and task completion time. The Wilcoxon signed-rank tests were used with clinical outcomes. the Friedman test and post hoc Conover's test (Bonferroni's correction) were applied to KPs. A secondary data analysis has been conducted by comparing patients having different severities of motor impairment. The level of significance was set at p value < 0.05. RESULTS: At the RT onset, the movements were less accurate and smoothed, and showed higher times of execution than those executed at the end of treatment. The analysis of the time course of KPs highlighted that RT seems to improve the motor function mainly in the first sessions of treatment: most KPs show significant intersession differences during the first 5/10 sessions. Afterwards, no further significant variations occurred. The ability to perform movements away from the body and from the hemiparetic side remains more challenging. The results obtained from the data stratification show significant differences between subjects with mild and severe motor impairment. CONCLUSION: Significant improvements in motor performance were registered during the time course of upper limb RT in subacute stroke patients. The outcomes depend on movement direction and motor impairment and pave the way to optimize healthcare resources and to design patient-tailored rehabilitative protocols.

Comparison of three scales to evaluate personality traits in Parkinson's disease: which one to use?

BACKGROUND: Personality traits have gained interest in the field of disability and stress, because they may either prompt or deny compliance. They can also foster motivation and influence outcome. Parkinson disease (PD) is a disabling and stressful condition that requires coping strategies and rehabilitation plans. Three constructs and their relative scales have been a matter of investigation, namely dispositional optimism (DO), locus-of-control (LOC), and sense-of-coherence (SOC). AIM: The present study compared the psychometric properties of three constructs in Parkinson's disease (PD). The health-related variables were: emotional distress (ED), quality of life (HR-QoL) and activities of daily living (ADL). The final objective was to provide guidance on scale selection to be implemented in clinical protocols. DESIGN: A cross sectional study. SETTING: Community-based general physicians. POPULATION: Participants with PD (N.=84) from community-based general physicians. METHODS: PD patients completed 3 self-report scales, namely Life Orientation Test-Revised (LOT-R, measuring Dispositional Optimism), Internal and External Locus Of Control (LOC-int. LOC-ext) and Sense of Coherence (SOC). All participants had magnetic resonance imaging. The MDS-UPDRS and the Barthel Scale were compiled by the investigator with the assistance of a caregiver. RESULTS: LOC-ext was the only scale to be associated with PD severity and disability (P<0.05). A higher level of LOC-ext was also associated with a higher level of ED (P<0.005). LOT-R was inversely associated with ED. Subjects in the highest tertile had a 41% lower ED (P<0.001). SOC was also inversely associated with degree of ED. Subjects in the highest tertile have a 44% lower ED (P<0.01). Moreover, HR-QoL is associated with several parameters, but LOT-R is the one with the strongest association (P<0.001). CONCLUSIONS: DO and SOC are predictive of important end-points, namely HR-QoL and ED. DO is even better under this respect. Conversely, those clinicians who are more interested in motor problems may find LOC more suitable. DO may be the most efficient construct to use in PD because of its favorable psychometric properties. CLINICAL REHABILITATION IMPACT: DO, LOC and SOC are constructs to be implemented in both research and clinical PD protocols. It is recommended to implement these, because they have predictive value especially when HR-QoL and ED are studied.

'Locus of control', health-related quality of life, emotional distress and disability in Parkinson's disease.

This cross-sectional study evaluated locus of control and its subscales in Parkinson's disease. A total of 50 consecutive Parkinson's disease participants and 50 healthy volunteers (control group) were enrolled. External locus of control was significantly higher in Parkinson's disease participants, whereas internal locus of control had no significant differences. External locus of control and internal locus of control were correlated in control group, but not in Parkinson's disease. In Parkinson's disease participants, external locus of control was negatively associated with health-related quality of life as well as positively associated with emotional distress and disease severity (but not with disability). After adjusting to confound variables, the associations remained. On the other hand, internal locus of control was negatively associated with depression.

Effects of dispositional optimism on quality of life, emotional distress and disability in Parkinson's disease outpatients under rehabilitation.

This study was performed with the aim of assessing dispositional optimism (DO) in a sample of Parkinson's disease (PD) patients, in order to evaluate its association with clinical outcomes and its impact on rehabilitation. Before entering an outpatient rehabilitation program, 58 participants suffering from idiopathic PD completed the Life Orientation Test-Revised (LOT-R) to evaluate their level of DO, the WHO-5 scale to evaluate their health-related quality of life (HR-QoL), the Hospital Anxiety and Depression Scale (HADS) to identify emotional distress, and the Barthel Index to evaluate their level of disability. All the measures were repeated four months later, at their discharge from the program. Disease stage and severity measures (Unified Parkinson's Disease Rating Scale) were also taken into consideration. Correlations and multivariate regression analyses compared DO with the health-related variables. On admission a high level of DO was found to be associated with less severe disease, a better quality of life (QoL) and lower emotional distress, but not with level of disability (Barthel Index). Consistent results were found at discharge. The level of DO di not change after rehabilitation, while anxiety was significantly reduced, especially in subjects with low LOT-R and high HADS scores. The Barthel Index values significantly improved. At discharge, participants with high DO showed the best improvements in disability and in QoL. Effects of dispositional optimism on quality of life, emotional distress and disability in Parkinson's disease outpatients under rehabilitation In conclusion, a high level of DO was associated with QoL, HADS and UPDRS both on admission and at discharge. The level of DO remained stable after rehabilitation, while disability and anxiety were reduced. Participants with high DO generally had better QoL, and better clinical and psychological performances.

The sense-of-coherence predicts health-related quality of life and emotional distress but not disability in Parkinson's disease.

BACKGROUND: Personality traits are deemed important in many fields of Medicine. The present study aimed at evaluating i) the presence of Sense-of-Coherence (SOC) in patients suffering from Parkinson's Disease (PD) in comparison with an age-matched general control population, ii) the influence of SOC on health-related variables, such as depression and anxiety, quality of life (Qol), and activities of daily living (ADL). METHODS: SOC was measured in 50 PD patients and in 50 matched controls enrolled in cross-sectional study. The other clinical measures included: Mini Mental State Examination (MMSE), Movement Disorder Society revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Well-being Index (WHO-5), Hospital Anxiety and Depression Scale (HADS) and the Barthel Index of ADL (BI). Data were analysed with univariate statistics and loglinear adjusted regression models. RESULTS: No difference emerged between PD and controls on socio-demographic and SOC. A statistically significant positive correlation was found between SOC and Qol (0.40, p < 0.004) and a negative significant correlation between SOC and emotional distress (-0.37, p < 0.008). The multivariate regression analysis confirmed the negative effect of SOC on total emotional distress (-3%, p = 0.01) and positive effect on Qol (2%, p = 0.01). SOC and BI were uncorrelated. CONCLUSIONS: SOC is predictive of QoL and emotional distress in PD, whereas no evidence of a predictive effect for disability could be found. These results support only partially, the Salutogenic Theory in PD, i.e. a strong SOC positively influences psychosocial health, but does not influence physical health.

Dispositional optimism, depression, disability and quality of life in Parkinson's disease.

Very little research on dispositional optimism (DO) has been carried out in the field of Parkinson's disease (PD). The present cross-sectional study, focusing on this personality trait, was performed with two main aims: i) to compare DO between patients with PD and a control group (CG); ii) to perform, in the PD group, a regression analysis including health-related variables, such as depression, anxiety, quality of life (QoL) and activities of daily living. Seventy PD participants and 70 healthy volunteers were enrolled in the study. The Mann-Whitney test was used to compare life orientation between the PD and CG groups. In the PD group, Pearson's correlation analysis was used to investigate the relationship between the measures of DO and the other variables. Means of log-linear regression were also used. Mean ratios adjusted for sex, age, education, and severity of disease were estimated, with relative 95% confidence intervals and p-values. The main results were as follows: i) no significant difference in DO was found between the PD participants and the CG; ii) DO was positively associated with QoL and emotional distress and inversely correlated with the Unified Parkinson's Disease Rating Scale; iii) DO was not correlated with disability. In conclusion, high DO predicts a satisfactory quality of life, low emotional distress and reduced disease severity in PD.

A bio-psycho-social approach for treating sub-acute low back pain.

PURPOSE: This article examines the distinctive opportunities and challenges involved in treating sub-acute low back pain (LBP). Several risk factors have been identified. Thus, a multi-disciplinary design and a comprehensive bio-psycho-social approach seem to be the best modality of intervention to improve outcome. METHOD: The relevant literature on various factors that are supposed to improve outcome is summarised and discussed. RESULTS: A controversial on the rehabilitation benefits still exists. From one side, meta-analytic studies provide a small evidence of effectiveness. Most treatments for chronic LBP provide weak results and the benefits can be just transient. From the other side, comprehensive bio-psycho-social approaches seem to be the best modality of intervention to facilitate physical outcome and return to work. CONCLUSION: This article reflects the conviction that clinicians with a special knowledge on LBP problems and researchers with a special knowledge on health policy will better work together. Their targets are outcome and cost-benefit ratio by taking into account the economical and political milieu of the country where the research is carried out.