Technological Advances in Instrumental Assessment in Rehabilitation

Objectives . To assess the motor control during quiet stance in patients with established ankylosing spondylitis (AS) and to evaluate the effect of visual input on the maintenance of a quiet posture. Methods . 12 male AS patients (mean age 50.1 ± 13.2 years) and 12 matched healthy subjects performed 2 sessions of 3 trials in quiet stance, with eyes open (EO) and with eyes closed (EC) on a baropodometric platform. The oscillation of the centre of feet pressure (CoP) was acquired. Indices of stability and balance control wereassessedbytheswaypath(SP)oftheCoP,thefrequencybandwidth(FB1)thatincludesthe80%oftheareaundertheamplitudespectrum,themeanamplitudeofthepeaks(MP)oftheswaydensitycurve(SDC),andthemeandistance(MD)between2peaks of the SDC. Results . In severe AS patients, the MD between two peaks of the SDC and the SP of the center of feet pressure were significantly higher than controls during both EO and EC conditions. The MP was significantly reduced just on EC. Conclusions . Ankylosing spondylitis exerts negative effect on postural stability, not compensable by visual inputs. Our findings may be useful in the rehabilitative management of the increased risk of falling in AS. This pioneering observational study explored the interaction between subacute stroke inpatients and a rehabilitation robot during upper limb training. 25 stroke survivors (age 55 ± 17 years; time since stroke, 52 ± 21 days) with severe upper limb paresis carried out 16 sessions of robot-assisted shoulder/elbow training (InMotion 2.0, IMT, Inc., MA, USA) combined with standard therapy. The values of 3 patient/robot interaction parameters (a guidance parameter: Stiffness, a velocity-related parameter: Slottime, and RoboticPower)werecomparedbetweensessions1(S1),4(S4),8(S8),12(S12),and16(S16).Pre/postFugl-MeyerAssessment(FMA)scoreswerecomparedin18patients.Correlationsbetweeninteractionparametersandclinicalandkinematicoutcomemeasureswereevaluated.SlottimedecreasedatS8 (𝑃 = 0.003) , while Guidance decreased at S12 (𝑃 = 0.008) . Robotic Power tended to decrease until S16. FMA scores improved from S1 to S16 (+49%, 𝑃 = 0.002 ). Changes in FMA score were correlated with the Stiffness parameter ( 𝑅 = 0.4 , 𝑃 = 0.003 ). Slottime was correlated with movement velocity. This novel approach demonstrated that a robotic device is a useful and reliable tool for the quantification of interaction parameters. Moreover, changes in these parameters were correlated with clinical and kinematic changes. These results suggested that robot-based recordings can provide new insights into the motor recovery process. Brain injury such as traumatic brain injury (TBI) and stroke is the major cause of long-term disabilities in many countries. The increasingrateofbraindamagedvictimsandtheheterogeneityofimpairmentsdecreaserehabilitationeffectivenessandcompetenceresultinginhighercostofrehabilitationtreatment.Ontheotherhand,traditionalrehabilitationexercisesareboring,thusleadingpatientstoneglecttheprescribedexercisesrequiredforrecovery.Therefore,weproposegame-basedapproachtoaddresstheseproblems.Thispaperpresentsarehabilitationgamingsystem(RGS)forcognitiverehabilitation.TheRGSisdevelopedbasedonaproposedconceptualframeworkwhichhasalsobeenpresentedinthispaper. Stroke survivors often suffer impairments on their wrist and hand. Robot-mediated rehabilitation techniques have been proposed as a way to enhance conventional therapy, based on intensive repeated movements. Amongst the set of activities of daily living, grasping is one of the most recurrent. Our aim is to incorporate the detection of grasps in the machine-mediated rehabilitation framework so that they can be incorporated into interactive therapeutic games. In this study, we developed and tested a method based on support vector machines for recognizing various grasp postures wearing a passive exoskeleton for hand and wrist rehabilitation after stroke. The experiment was conducted with ten healthy subjects and eight stroke patients performing the grasping gestures. The method was tested in terms of accuracy and robustness with respect to intersubjects’ variability and differences between different grasps. Our results show reliable recognition while also indicating that the recognition accuracy can be used to assess the patients’ ability to consistently repeat the gestures. Additionally, a grasp quality measure was proposed to measure the capabilities of the stroke patients to perform grasp postures in a similar way than healthy people. These two measures can be potentially used as complementary measures to other upper limb motion tests. The assessment of waveform similarity is a crucial issue in gait analysis for the comparison of kinematic or kinetic patterns with reference data. A typical scenario is in fact the comparison of a patient’s gait pattern with a relevant physiological pattern. This study aims to propose and validate a simple method for the assessment of waveform similarity in terms of shape, amplitude, and offset. The method relies on the interpretation of these three parameters, obtained through a linear fit applied to the two data sets under comparison plotted one against the other after time normalization. The validity of this linear fit method was tested in terms of appropriateness (comparing real gait data of 34 patients with cerebrovascular accident with those of 15 healthy subjects), reliability, sensitivity, and specificity (applying a cluster analysis on the real data). Results showed for this method good appropriateness, 94.1% of sensitivity, 93.3% of specificity, and good reliability. The LFM resulted in a simple method suitable for analysing the waveform similarity in clinical gait analysis. Objective . The reliability of lateral scapular slide test (LSST) at 90 degrees of abduction is controversial; therefore, in order to achieve more reliability it may be necessary to make changes in this particular position. Methods . Modified lateral scapular slide test (MLSST) was done on thirty male basketball players with two examiners in one session and for the retest with one examiner in the next week. The test was done in 7 positions: arm relaxed at the side (P1), 90 degrees of abduction (P2), 90 degrees of scaption without having a weight in hands (P3), 90 degrees of scaption with having 3 different weights (1, 2, and 4 kg) in hands (P4, P5, and P6, resp.), and 180 degrees of scaption without having a weight in hands (P7). Results . In P1 and P6, the ICC scores indicated the highest level of intrarater reliability. In P2, the ICC scores showed a fair level of intrarater reliability, as the minimum reliability. The maximum and minimum interrater reliability were P1 and P4, respectively. Conclusion . Scaption with loading, as a functional position in the overhead athletes, is a reliable positioning and may be replaced with the third position of the traditional LSST. Background . Plantarflexion results from the combined action of the soleus and gastrocnemius muscles in the calf. The heel rise test is commonly used to test calf muscle endurance, function, and performance by a wide variety of professionals; however, no uniform description of the test is available. This paper aims to document the construction and reliability of a novel heel rise test device and measurement protocol that is suitable for the needs of most individuals. Methods . This device was constructed from compact and lightweight materials and is fully adjustable, enabling the testing of a wide variety of individuals. It is easy to assemble and disassemble, ensuring that it is portable for use in different settings. Findings . We tested reliability on 40 participants, finding excellent interrater reliability (ICC 2,1 0.97, 95% CI: 0.94 to 0.98). Limits of agreement were less than two repetitions in 90% of cases and the Bland-Altman plot showed no bias. Interpretation . We have designed a novel, standardized, simple, and reliable device and measurement protocol for the heel rise test which can be used by researchers and clinicians in a variety of settings. Background .Posturalinstabilityisoneofthemajorcomplicationsfoundinstrokesurvivors.Parameterisingthefunctionalreachtest (FRT) could be useful in clinical practice and basic research. Objectives . To analyse the reliability, sensitivity, and specificity in the FRT parameterisation using inertial sensors for recording kinematic variables in patients who have suffered a stroke. Design . Cross-sectional study. While performing FRT, two inertial sensors were placed on the patient’s back (lumbar and trunk). Participants . Five subjects over 65 who suffer from a stroke. Measurements . FRT measures, lumbosacral/thoracic maximum angular displacement, maximum time of lumbosacral/thoracic angular displacement, time return initial position, and total time. Speed and acceleration of the movements were calculated indirectly. Results . FRT measure is 12.75 ± 2.06 cm. Intrasubject reliability values range from 0.829 (time to initial position (lumbar sensor)) to 0.891 (lumbosacral maximum angular displacement). Intersubject reliability values range from 0.821 (time to return initial position (lumbar sensor)) to 0.883 (lumbosacral maximum angular displacement). FRT’s reliability was 0.987 (0.983–0.992) and 0.983 (0.979–0.989) intersubject and intrasubject, respectively. Conclusion . The main conclusion could be that the inertial sensors are a tool with excellent reliability and validity in the parameterization of the FRT in people who have had a stroke.

In rehabilitation research, interest in instrumental assessment is rapidly growing, particularly in the last decade. A large number of tools for instrumental assessment are now available, evaluating different aspects of the single patient or patient groups. Most of these assessment tools are diseasespecific and common to other medical disciplines, for example, goniometers, and clinical tests or scales that monitor patient impairment [1]. Technological advances now make it possible to perform an in-depth evaluation of patients, analyzing their abilities across a wide range of performances. In rehabilitation, high-technology assessment tools mainly concern diagnostic devices-used to obtain outcome measurements of variables of interest-or specific equipment that is necessary to apply the tests.
In fact, in a period of increasing application of measures in clinical practice, quality control, and audit procedures, assessment has become a key process in the drive to replace the empirical approach with a scientific methodology, fundamental both to the practice of evidence-based medicine and to the strengthening of the quality of research [1]. Assessment is mainly based on a measurement process characterized by the assignment of numerical values or categories to show (according to predefined rules) the quantity of certain characteristics, functions, or behaviors.
The possibility of having an objective measurement represents a fundamental advantage in several ways; for example, it provides a scientific basis for interprofessional communication, it documents the effectiveness of treatments, and it attests their scientific credibility. Therefore, researchers are motivated to develop new instrumental assessment tools or improve old ones, demonstrating their good psychometric properties and limits. On the other hand, clinicians, who are going to use a measuring instrument, are invited to base their choice on the presence of the psychometric characteristics necessary for the specific purpose and context (preferring instruments for which the application has already been tested under conditions similar to those of interest).
Numerous scientific studies have described the main criteria for selecting an outcome measure [2,3] and/or evaluating in detail its main psychometric properties and practices [4]. In general, the basic criterion for the choice of an instrumental assessment tool is the presence (as demonstrated through scientific publications) of adequate levels of reliability (the degree to which a measurement is free from error and, hence, the observed score gives a "true" picture), validity (degree of accuracy with which a tool measures what it is intended to measure), and responsiveness (the ability of an instrument to identify modifications or significant differences from the clinical point of view). The first two criteria are necessary for discriminative purposes (differences between subjects or groups) and predictive purposes (classification of subjects in predefined classes for prognostic purposes), while for evaluation purposes (i.e., to detect changes over time within subjects, as in the case of analysis of effectiveness of therapeutic interventions) a good level of responsiveness is also needed. Other requirements that are extremely important to consider when selecting an outcome measure are the appropriateness (degree to which the instrument responds to the questions that the specific evaluation intends to study) and accuracy (the degree to which the measuring instrument is able to capture real differences) [2,5].
In this special issue, we invited researchers to contribute with original research articles as well as reviews investigating the benefits of instrumental assessment or to propose new technological modalities for instrumental assessment in rehabilitation.
Our aim is to stimulate researchers to publish their research in the field of technological assessment in PMR. A wide array of topics is discussed in this special issue, related to areas such as strength assessment, posture, balance and gait analysis, functional assessment tools, and cognitive and robotic assessment. Robotic devices and passive instrumented orthoses have been proposed to assess upper limb patients affected by stroke. New software for computers has been shown to improve the cognitive assessment of neurological patients, facilitating the creation of large databases and opening up new opportunities for home-based rehabilitation. Novel technological devices and assessment protocols have been demonstrated to be reliable in the evaluation of basic motor performances, in postural control, and in gait analysis.
We are edified by the large number of papers submitted and by their high scientific level.
Finally, we wish to thank not only the authors but also the expert reviewers who, with their valuable work, have made possible the publication of this special issue.