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Robot-assisted arm assessments in spinal cord injured patients: a consideration of concept study.

Keller U, Schölch S, Albisser U, Rudhe C, Curt A, Riener R, Klamroth-Marganska V - PLoS ONE (2015)

Bottom Line: We investigated whether a set of robot-based assessments that encompasses kinematic, kinetic and timing metrics is applicable, safe, reliable and comparable to clinical metrics for measurement of arm motor function.In conclusion, the therapy robot ARMin provides a comprehensive set of assessments that are applicable and safe.The methods applied and results can serve as a basis for the future development of end-effector and exoskeleton-based robotic assessments.

View Article: PubMed Central - PubMed

Affiliation: Sensory-Motor Systems Lab, Department of Health Sciences and Technology ETH Zurich, Zurich, Switzerland; Balgrist University Hospital, University of Zurich, Zurich, Switzerland.

ABSTRACT
Robotic assistance is increasingly used in neurological rehabilitation for enhanced training. Furthermore, therapy robots have the potential for accurate assessment of motor function in order to diagnose the patient status, to measure therapy progress or to feedback the movement performance to the patient and therapist in real time. We investigated whether a set of robot-based assessments that encompasses kinematic, kinetic and timing metrics is applicable, safe, reliable and comparable to clinical metrics for measurement of arm motor function. Twenty-four healthy subjects and five patients after spinal cord injury underwent robot-based assessments using the exoskeleton robot ARMin. Five different tasks were performed with aid of a visual display. Ten kinematic, kinetic and timing assessment parameters were extracted on joint- and end-effector level (active and passive range of motion, cubic reaching volume, movement time, distance-path ratio, precision, smoothness, reaction time, joint torques and joint stiffness). For cubic volume, joint torques and the range of motion for most joints, good inter- and intra-rater reliability were found whereas precision, movement time, distance-path ratio and smoothness showed weak to moderate reliability. A comparison with clinical scores revealed good correlations between robot-based joint torques and the Manual Muscle Test. Reaction time and distance-path ratio showed good correlation with the "Graded and Redefined Assessment of Strength, Sensibility and Prehension" (GRASSP) and the Van Lieshout Test (VLT) for movements towards a predefined position in the center of the frontal plane. In conclusion, the therapy robot ARMin provides a comprehensive set of assessments that are applicable and safe. The first results with spinal cord injured patients and healthy subjects suggest that the measurements are widely reliable and comparable to clinical scales for arm motor function. The methods applied and results can serve as a basis for the future development of end-effector and exoskeleton-based robotic assessments.

No MeSH data available.


Related in: MedlinePlus

Example of an aROM Bland-Altman plot regarding wrist flexion for the nine patient arms.The limits of agreement (dashed lines for lower -4.3° and upper 5.4° limit) and the mean difference (solid line at 0.5°) are shown. The x-axis shows the mean values of the two measurements of tester 1 and 2 (negative values indicate flexion, positive values stand for extension), while the y-axis shows the measurement difference between tester 1 and 2.
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pone.0126948.g004: Example of an aROM Bland-Altman plot regarding wrist flexion for the nine patient arms.The limits of agreement (dashed lines for lower -4.3° and upper 5.4° limit) and the mean difference (solid line at 0.5°) are shown. The x-axis shows the mean values of the two measurements of tester 1 and 2 (negative values indicate flexion, positive values stand for extension), while the y-axis shows the measurement difference between tester 1 and 2.

Mentions: The inter-rater reliability was analyzed using the Spearman’s rank correlation coefficient and the Bland-Altman plot. In Fig 4 an exemplary Bland-Altman plot for the wrist flexion is shown. The analysis of the WORKSPACE and QOM parameters is shown in more detail in S3 Table. The mean cubic volume was 107.5 dm3. Fig 5 is an example of a patient’s hand movements to the eight different targets in the QOM assessment package. The summarized results for the inter-rater reliability between testers 1 and 2 are summarized in Table 7.


Robot-assisted arm assessments in spinal cord injured patients: a consideration of concept study.

Keller U, Schölch S, Albisser U, Rudhe C, Curt A, Riener R, Klamroth-Marganska V - PLoS ONE (2015)

Example of an aROM Bland-Altman plot regarding wrist flexion for the nine patient arms.The limits of agreement (dashed lines for lower -4.3° and upper 5.4° limit) and the mean difference (solid line at 0.5°) are shown. The x-axis shows the mean values of the two measurements of tester 1 and 2 (negative values indicate flexion, positive values stand for extension), while the y-axis shows the measurement difference between tester 1 and 2.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4440615&req=5

pone.0126948.g004: Example of an aROM Bland-Altman plot regarding wrist flexion for the nine patient arms.The limits of agreement (dashed lines for lower -4.3° and upper 5.4° limit) and the mean difference (solid line at 0.5°) are shown. The x-axis shows the mean values of the two measurements of tester 1 and 2 (negative values indicate flexion, positive values stand for extension), while the y-axis shows the measurement difference between tester 1 and 2.
Mentions: The inter-rater reliability was analyzed using the Spearman’s rank correlation coefficient and the Bland-Altman plot. In Fig 4 an exemplary Bland-Altman plot for the wrist flexion is shown. The analysis of the WORKSPACE and QOM parameters is shown in more detail in S3 Table. The mean cubic volume was 107.5 dm3. Fig 5 is an example of a patient’s hand movements to the eight different targets in the QOM assessment package. The summarized results for the inter-rater reliability between testers 1 and 2 are summarized in Table 7.

Bottom Line: We investigated whether a set of robot-based assessments that encompasses kinematic, kinetic and timing metrics is applicable, safe, reliable and comparable to clinical metrics for measurement of arm motor function.In conclusion, the therapy robot ARMin provides a comprehensive set of assessments that are applicable and safe.The methods applied and results can serve as a basis for the future development of end-effector and exoskeleton-based robotic assessments.

View Article: PubMed Central - PubMed

Affiliation: Sensory-Motor Systems Lab, Department of Health Sciences and Technology ETH Zurich, Zurich, Switzerland; Balgrist University Hospital, University of Zurich, Zurich, Switzerland.

ABSTRACT
Robotic assistance is increasingly used in neurological rehabilitation for enhanced training. Furthermore, therapy robots have the potential for accurate assessment of motor function in order to diagnose the patient status, to measure therapy progress or to feedback the movement performance to the patient and therapist in real time. We investigated whether a set of robot-based assessments that encompasses kinematic, kinetic and timing metrics is applicable, safe, reliable and comparable to clinical metrics for measurement of arm motor function. Twenty-four healthy subjects and five patients after spinal cord injury underwent robot-based assessments using the exoskeleton robot ARMin. Five different tasks were performed with aid of a visual display. Ten kinematic, kinetic and timing assessment parameters were extracted on joint- and end-effector level (active and passive range of motion, cubic reaching volume, movement time, distance-path ratio, precision, smoothness, reaction time, joint torques and joint stiffness). For cubic volume, joint torques and the range of motion for most joints, good inter- and intra-rater reliability were found whereas precision, movement time, distance-path ratio and smoothness showed weak to moderate reliability. A comparison with clinical scores revealed good correlations between robot-based joint torques and the Manual Muscle Test. Reaction time and distance-path ratio showed good correlation with the "Graded and Redefined Assessment of Strength, Sensibility and Prehension" (GRASSP) and the Van Lieshout Test (VLT) for movements towards a predefined position in the center of the frontal plane. In conclusion, the therapy robot ARMin provides a comprehensive set of assessments that are applicable and safe. The first results with spinal cord injured patients and healthy subjects suggest that the measurements are widely reliable and comparable to clinical scales for arm motor function. The methods applied and results can serve as a basis for the future development of end-effector and exoskeleton-based robotic assessments.

No MeSH data available.


Related in: MedlinePlus