Journal of NeuroEngineering and Rehabilitation最新文献

Background: A discrepancy between the level of impairment at the upper extremity (UE) and its use in activities of daily life is frequently observed in individuals who have experienced a stroke. Wrist-worn accelerometers allow an objective and valid measure of UE use in everyday life. Accelerometer studies have shown that a wide range of factors beyond UE impairment can influence UE use. This scoping review aims to identify factors associated with UE use and to investigate the influence of different types of accelerometry metrics on these associations.

Method: A search using CINHAL, Embase, MEDLINE, Compendex, and Web of Science Core Collection databases was performed. Studies that assessed the association between UE use quantified with accelerometers and factors related to the person or their environment in individuals with stroke were included. Data related to study design, participants characteristics, accelerometry methodology (absolute vs. relative UE use metrics), and associations with personal and environmental factors were extracted.

Results: Fifty-four studies were included. Multiple studies consistently reported associations between relative UE use and stroke severity, UE motor impairment, unimanual capacity, bimanual capacity, and mobility. In contrast, there were inconsistent associations with factors such as neglect and concordance between dominance and side of paresis and a consistent lack of association between relative UE use and time since stroke, sex, and age. Metrics of absolute paretic UE use yielded different results regarding their association with personal and environmental factors, as they were more influenced by factors related to physical activity and less associated with factors related to UE capacity.

Conclusion: Healthcare providers should recognize the complexity of the relationship between UE use and impairment and consider additional factors when selecting assessments during rehabilitation to identify patients at risk of underutilizing their paretic arm in daily life. Future research in this domain should preconize relative UE use metrics or multi-sensors method to control for the effect of physical activity.

Background: Acquired homonymous visual field defects (HVFDs) result in significant disability, reducing quality of life. Spontaneous recovery occurs within the first months, then the likelihood of vision recovery decreases, making rehabilitation necessary. HVFDs rehabilitation is typically lengthy and intensive, done on an outpatient basis, hardly compatible with the return to everyday life. Telerehabilitation represents an option for continuing the therapy in the chronic phase of the disease, offering long-term support after hospital discharge. It also allows individuals with HVFDs to exercise independently, intensively, and actively at home, in a familiar environment, under remote supervision. However, the efficacy of telerehabilitation for chronic HVFDs in adults still requires empirical support.

Methods: This single-arm clinical trial assesses the efficacy of a home-based, remote-supervised, compensatory audio-visual training (AVT) in 26 adults with chronic HVFDs following a brain lesion. Immediate and long-term (up to 6 months) effects on visual field scanning, reading, activities of daily living and mood were assessed. Predictors of treatment-induced gains were also investigated considering behavioral, neuro-ophthalmological (visual field perimetry and visual evoked potentials) and neuroradiological variables (structural imaging of grey- and white-matter damages). Finally, the efficacy of the home-based AVT was compared to that of its in-person version (16 new participants with chronic HVFDs).

Results: Home-based AVT improves accuracy and speed of visual search, reading, mood, and disability in the activities of daily living, with improvements persisting up to 6 months after the end of the training (baseline vs. post-training assessments, all ps < 0.04). Post-treatment gains correlate with the severity of visual search deficit and the efficiency of multisensory integration (rs = -0.7/-0.5, all ps < 0.04). Neuro-ophthalmological and neuroradiological (structural connectivity) parameters are unaffected by the AVT, in line with its compensatory nature, although being associated to its efficacy (all ps < 0.03). Finally, the telerehabilitation version of the AVT produces effects comparable to the in-person AVT.

Conclusion: Multisensory training delivered in telerehabilitation is feasible and effective for ameliorating oculomotor compensation of visual field loss, improving mood and reducing functional disabilities in adults with chronic HVFDs. Trial registration This study was retrospectively registered at clinicaltrials.gov (NCT06341777; 26/03/2024).

This paper analyses diversity and intersectionality aspects in the R&D of wearable assistive and rehabilitation technologies (WEARTechs). We advocate for inclusive, innovative research that we hope will help bridge the gap between laboratories and the real world and reduce disparities in healthcare and technology development. We performed a systematic literature review of the intersections between assistive technologies and diversity and conducted a thematic analysis of the diversity factors identified in the literature. In addition, we carried out a supplementary literature search on WEARTechs to discover which, if any, diversity aspects are currently being reported on. Our findings indicate that diversity has not been addressed in the field of WEARTechs. There is not sufficient knowledge to determine, which diversity-related aspects researchers must consider when evaluating the performance of any specific WEARTech device. Nor about how these can be properly addressed in the R&D process. We, therefore, provide actionable recommendations on how to integrate diversity-relevant aspects at different R&D stages. We hope that our review will help scientists rethink and reformulate approaches to the R&D of WEARTechs and build the way towards more inclusive solutions. It is our belief that this will spark innovation and enhance discovery potential in the field.

Purpose: Virtual reality (VR) has emerged as a pivotal tool for studying balance and postural control mechanisms, leveraging unpredictable visual disturbances that dynamically challenge visuomotor processing. However, the quantity and quality of information available in the visual field may differ between VR systems, potentially introducing conflict with the intended perturbation inputs. Consequently, the extent to which a VR system used in a visual perturbation paradigm influences its ability to elicit compensatory gait behaviors remains unclear. Here we investigate the impact of (1) VR display modality and (2) the direction of visual perturbations on spatiotemporal gait parameters and measures of stability in VR.

Methods: Participants were tasked with maintaining steady-state walking on a self-paced treadmill while viewing a VR scene presented in either a rear-projection curved screen immersive room (IR) or a head-mounted display (HMD). During trials with augmented visual perturbations, pseudorandom oscillations were combined with forward walking speed either in the anterior-posterior (AP), or medio-lateral (ML) direction. Linear mixed-effects models were used to analyze the impact of VR display type and visual perturbations on spatiotemporal gait parameters, stability measures, and joint kinematics.

Results: For self-paced walking in matched VR optic flow, we found that the HMD increased the variability of several parameters related to walking speed control, but did not significantly impact any gait parameter average values. Superimposing visual perturbations along the ML axis increased gait variability and decreased walking stability in both VR systems, but the perturbations had stronger effects if presented in the HMD.

Conclusion: Together, these findings suggest that portable light-weight HMD systems can provide affordable, reliable tools for studying and training balance control and locomotion.

Background: Motor imagery based brain-computer interfaces (MI-BCIs) are systems that detect the mental rehearsal of movement from brain activity signals (EEG) for controlling devices that can potentiate motor neurorehabilitation. Considering the problem that MI proficiency requires training and it is not always achieved, EEG desirable features should be investigated to propose indicators of successful MI training.

Methods: Nine healthy right-handed subjects trained with a MI-BCI for four sessions. In each session, EEG was recorded for 30 trials that consisted of a rest and a dominant-hand MI sequence, which were used for calibrating the system. Then, the subject participated in 160 trials in which a cursor was displaced on a screen by performing MI or relaxing to hit a target. The session's accuracy was calculated. For each trial from the calibration phase of the first session, the power spectral density (PSD) and the partial directed coherence (PDC) of the rest and MI EEG segments were obtained to estimate the event-related synchronization changes (ERS) and the connectivity patterns of the $\theta$ , $\alpha$ , $\beta$ and $\gamma$ bands that are associated with high BCI control (accuracy above 70% in at least one session). Finally, t-tests and rank-sum tests ( $p<0.05$ , with Benjamini-Hochberg correction) were used to compare the ERS/ERD and PDC values of subjects with high and low accuracy, respectively.

Results: Proficient users showed greater $\alpha$ ERD on the right-hand motor cortex (left hemisphere). Furthermore, the $\beta$ PDC related to the ipsilateral motor cortex is commonly weakened during motor imagery, while the contralateral motor cortex $\gamma$ PDC is enhanced.

Conclusions: Motor imagery proficiency is related to the focused and lateralized event-related $\alpha$ desynchronization patterns and the lateralization of $\beta$ and $\gamma$ PDC. Future analysis of these features could allow complimenting the information for assessment of subject-specific BCI control and the prediction of the effectiveness of motor-imagery training.

Background: Postural instability greatly reduces quality of life in people with Parkinson's disease (PD). Early and objective detection of postural impairments is crucial to facilitate interventions. Our aim was to use a convolutional neural network (CNN) to differentiate people with early to mid-stage PD from healthy age-matched individuals based on spectrogram images obtained from their body sway. We hypothesized the time-frequency content of body sway to be predictive of PD, even when impairments are not yet clinically apparent.

Methods: 18 people with idiopathic PD and 15 healthy controls (HC) participated in the study. We tracked participants' center of pressure (COP) using a Wii Balance Board and their full-body motion using a Microsoft Kinect, out of which we calculated the trajectory of their center of mass (COM). We used 30 s-snippets of motion data from which we acquired wavelet-based time-frequency spectrograms that were fed into a custom-built CNN as labeled images. We used binary classification to have the network differentiate between individuals with PD and controls (n = 15, respectively).

Results: Classification performance was best when the medio-lateral motion of the COM was considered. Here, our network reached a predictive accuracy, sensitivity, specificity, precision and F1-score of 100%, respectively, with a receiver operating characteristic area under the curve of 1.0. Moreover, an explainable AI approach revealed high frequencies in the postural sway data to be most distinct between both groups.

Conclusion: Heeding our small and heterogeneous sample, our findings suggest a CNN classifier based on cost-effective and conveniently obtainable posturographic data to be a promising approach to detect postural impairments in early to mid-stage PD and to gain novel insight into the subtle characteristics of impairments at this stage of the disease.

Background: Disorders in the recovery of gait strategies in individuals with incomplete spinal cord injury (SCI) suggest difficulties in controlling lower limb intersegmental dynamics, which could relate to proprioceptive impairments. To probe discrete aspects of lower limb interjoint coordination, we present here a novel protocol to assess lower limb motor strategies and evaluate the influence of proprioceptive impairments following SCI.

Methods: Twelve able-bodied controls and 16 participants with SCI performed lower limb pointing to three targets that involved combined hip and knee flexion, or hip or knee flexion only while standing, with either full or obstructed visual feedback. We quantified lower limb proprioceptive sense in individuals with SCI using a robotic gait device. We used motion analysis to determine lower limb joint angles and foot trajectory, computed inverse dynamics to quantify joint and intersegmental dynamics, and derived muscle torque as an indicator of the motor strategies produced to control the motion to each target. We used linear mixed-effects models to assess differences between the control and SCI groups on end-point performance and muscle torque, and to assess the relationship of muscle torque with end-point performance and proprioceptive sense.

Results: Groups differed in motor strategies, but not end-point performance, when pointing to all three targets. Compared to controls, the SCI group had difficulty controlling knee muscle torque when performing the hip-flexion-only target (p = 0.008) or when flexing the hip and knee simultaneously (p = 0.0004). To complete the knee-flexion-only target, the SCI group had difficulties generating the required hip extensor muscle torque to maintain the thigh in neutral (p = 0.0001). These altered motor strategies in individuals with SCI were associated with proprioceptive impairments and end-point performance.

Conclusion: This novel lower limb pointing task can identify disordered motor strategies in individuals with SCI, especially at the knee, and are associated with proprioceptive impairment. Variations of this paradigm can be employed to further understand differences in motor strategies between controls and individuals with SCI, and the impact of proprioceptive deficits.

Background: Conventional clinical tools for assessing upper limb motor function often lack the sensitivity and specificity needed to detect subtle changes in motor performance and may be subject to bias. Kinematic assessment offers a potential solution by providing objective, precise, and detailed data on movement quality. However, it is typically associated with high costs, complex equipment, time-consuming procedures, and the need for controlled environments, all of which limit its accessibility and practicality in clinical settings. This study aimed to evaluate the reliability, validity, and sensitivity of a low-cost, touchscreen-based kinematic assessment tool for measuring upper limb function in individuals post-stroke.

Methods: Sixty-four individuals with stroke participated in this study. Participants performed a visually guided reaching task on a large touch screen that consisted in reaching from a central target to five outer targets arranged in a circular pattern, each at a time, and then returning to the central target. Their motor function was assessed using the Fugl-Meyer Assessment for Upper Extremity, the Box and Block Test, and the Nine Hole Peg Test. Kinematic measures of the trajectories performed during the reaching task were extracted and analyzed for reliability, convergent validity with clinical assessments, and sensitivity to impairment severity.

Results: The kinematic measures demonstrated good to excellent test-retest reliability, with intraclass correlation coefficients ranging from moderate to excellent. The convergent validity analysis revealed multiple significant correlations between the kinematic parameters and clinical assessments, particularly in tests requiring higher skill and precision, such as the Coordination and Speed subscale of the Fugl-Meyer Assessment for Upper Extremity and the Nine Hole Peg Test. Additionally, the touchscreen-based assessment was sensitive to the severity of motor impairment, as reflected by notable differences in the kinematic measures among participants with varying levels of upper limb function.

Conclusions: The touchscreen-based kinematic assessment offered an affordable yet reliable, valid, and sensitive alternative for evaluating upper limb kinematics in individuals with stroke, which could complement clinical assessments by offering additional insights into motor performance. Furthermore, its low cost, high speed, and ease of use make it a practical option for widespread clinical adoption.