The studies using this protocol were funded by the Heart and Stroke Foundation (G-18-0020952), the Craig H. Neilsen Foundation (542675), the Natural Sciences and Engineering Research Council of Canada (RGPIN-2014-05498), and Ministry of Research, Innovation and Science, Ontario (ER16-12-013).

The study was approved by the Research Ethics Board of the University Health Network. Signed informed consent was obtained from each participant before enrollment in the study. Signed informed consent was also obtained from any caregivers or household members appearing in video recordings.
1. Verification of the protocol applicability to the individual
NOTE: This protocol is intended to be applied to individuals with impaired but not completely absent hand function (specific criteria can be adapted to the population and/or question of interest).
<ol>
	<li>Ask participants whether their affected hands impact their ability to carry out ADLs. 
	NOTE: It is recommended to ask participants to give some examples of tasks that they can and cannot perform independently with their affected hands.</li>
	<li>Verify that the total score on the Montreal Cognitive Assessment (MoCA) is above 21, in order to avoid potential difficulties understanding and following protocol procedures.</li>
</ol>
2. Determination of the daily routine of participants
<ol>
	<li>Ask participants to recall their daily routines over the past two weeks. Document which daily tasks are performed, for how long, and at approximately what time.</li>
	<li>In collaboration with participants, select 3 timeslots of 1.5 h each during which to record videos. Select timeslots that are spread over different days of the week, and take place when ADLs involving the hands are typically carried out in sequence. 
	NOTE: The selected ADLs must be representative of each participant&#39;s typical activities, and be perceived by them as meaningful. Scheduling recording periods on different days is intended to increase the variety of recorded ADLs and to promote the capture of useful and meaningful data. 
	&#8203;NOTE: Recording timeslots are scheduled for recording efficiency, but participants should understand that they have full control of when to start and to stop recordings.</li>
</ol>
3. Agreement on recording schedules and target video content with participants
<ol>
	<li>Obtain agreement of each participant on the recording schedules, after discussing any concerns that they may have.</li>
	<li>Set a goal of 3 h of videos over two weeks. Inform participants that insufficient videos may lead to extending their recording periods.</li>
</ol>
4. Emphasis of the importance of performing ADLs naturally
<ol>
	<li>Instruct participants to focus on capturing realistic routines, instead of specifying particular activities to record. The intent of the instruction is to discourage participants from artificially recording specific activities in greater amounts than is typical for them.</li>
</ol>
5. Notification of potential privacy issues during recordings at home
<ol>
	<li>Ensure that participants understand that all recordings should take place inside their homes, not in public places to avoid privacy issues.</li>
	<li>Give some examples that may raise privacy concerns, such as bathing, dressing/undressing, and checking confidential information. Remind participants to be aware of mirrors, which may show their faces in the recordings.</li>
	<li>Suggest that participants avoid the presence of other people such as family members or caregivers as much as possible in the videos. 
	&#8203;NOTE: In the context of research studies, in cases where the presence of other people is unavoidable, informed consent should be obtained from those individuals.</li>
</ol>
6. Camera and tablet instruction
NOTE: If participants indicate during the initial contact that they require caregiver assistance for many of their daily needs, the caregiver is encouraged to also attend the study visit and be trained on the use of the equipment, so that they can later assist the participant.
<ol>
	<li>Demonstrate how to use an egocentric camera (Table of Materials) to participants.
	<ol>
		<li>Demonstrate how to turn the camera on and off.</li>
		<li>Demonstrate how to control recordings (start, pause, stop) using the camera.</li>
	</ol>
	</li>
	<li>Demonstrate how to use a tablet (Table of Materials) with the preinstalled camera app to control the recordings, if applicable. 
	&#8203;NOTE: The demonstration includes controlling the recordings from the camera app, as well as replaying and editing (e.g., trim or delete) the recorded videos. A camera remote was initially considered (Supplemental Files), but in practice was not used because participants were comfortable using the camera or tablet to start and stop recordings.
	<ol>
		<li>Demonstrate how to turn on and off the tablet.</li>
		<li>Demonstrate how to connect the tablet to the camera through the camera app.</li>
		<li>Demonstrate how to control the recordings from the camera app.</li>
		<li>Demonstrate how to review recorded videos from the camera app.</li>
		<li>Demonstrate how to trim or delete the videos from the camera app.</li>
	</ol>
	</li>
	<li>Demonstrate how to don and doff the camera using an elastic headband adjustable to the participant&#39;s head. 
	NOTE: See Figure 1. 
	<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/61898/61898fig01.jpg" /> 
	Figure 1. Wearable camera setup.&#160;(A) Positioning of the egocentric camera. (B) Viewing angle from the camera.&#160;<a href="https://www.jove.com/files/ftp_upload/61898/61898fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
	<ol>
		<li>Place the camera on the participant&#39;s forehead. Adjust the headband to wear the camera comfortably and steadily.</li>
		<li>Ensure an optimal angle of the camera with respect to the forehead.</li>
		<li>Ask participants to record a short segment of video while moving the hands in front of them and manipulating an object (e.g., the tablet).</li>
		<li>Review the recorded video and ensure the two hands were clearly visible in the central region of the scene while conducting manipulation tasks.</li>
		<li>Practice the use of the camera and tablet with participants and their caregivers, until they demonstrate proficiency.</li>
	</ol>
	</li>
</ol>
7. Giving the equipment
<ol>
	<li>Give the kit with all the equipment to participants to record their ADLs at home. In addition to the camera and tablet, the kit includes extra camera batteries, battery chargers for both camera and tablet, charging cables, headband for the camera, and a printed set of guidelines for using the camera (See the Supplemental Material).</li>
</ol>
8. Experimental troubleshooting and followup
<ol>
	<li>Provide contact information of the researchers to help solve obstacles during the actual recordings at home. After one week, researchers call the participants to document the recording progress and solve any potential technical issues.</li>
</ol>
9. Retrieval of equipment and videos
<ol>
	<li>Retreive all the equipment and videos from participants in person or through pre-paid mail parcels.</li>
	<li>Ensure that participants agree to share all the videos returned. Participants are encouraged to review all of the collected videos before returning them to the research team, and to delete any portions that they do not wish to share.</li>
	<li>For research studies, review the returned videos and check if anyone appears in the video without having given their consent. If so, send consent forms or call the individuals who appear in the videos to gain their consents for use of the videos. If the individuals are not reachable, the portions of the videos in which they appear are deleted by the researchers.</li>
</ol>

<ol><li>Nichols-Larsen, D. S., Clark, P., Zeringue, A., Greenspan, A., Blanton, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Factors+influencing+stroke+survivors%27+quality+of+life+during+subacute+recovery%5BTitle%5D)+AND+%22Stroke%22%5BJournal%5D)">Factors influencing stroke survivors' quality of life during subacute recovery.</a> Stroke. 36 (7), 1480-1484 (2005).</li>
<li>Anderson, K. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Targeting+recovery%3A+priorities+of+the+spinal+cord-injured+population%5BTitle%5D)+AND+%22Journal+of+Neurotrauma%22%5BJournal%5D)">Targeting recovery: priorities of the spinal cord-injured population.</a> Journal of Neurotrauma. 21 (10), 1371-1383 (2004).</li>
<li>Gladstone, D. J., Danells, C. J., Black, S. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+Fugl-Meyer+assessment+of+motor+recovery+after+stroke%3A+a+critical+review+of+its+measurement+properties%5BTitle%5D)+AND+%22Neurorehabilitation+and+Neural+Repair%22%5BJournal%5D)">The Fugl-Meyer assessment of motor recovery after stroke: a critical review of its measurement properties.</a> Neurorehabilitation and Neural Repair. 16 (3), 232-240 (2002).</li>
<li>Barreca, S. R., Stratford, P. W., Lambert, C. L., Masters, L. M., Streiner, D. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Test-retest+reliability%2C+validity%2C+and+sensitivity+of+the+Chedoke+arm+and+hand+activity+inventory%3A+a+new+measure+of+upper-limb+function+for+survivors+of+stroke%5BTitle%5D)+AND+%22Archives+of+Physical+Medicine+and+Rehabilitation%22%5BJournal%5D)">Test-retest reliability, validity, and sensitivity of the Chedoke arm and hand activity inventory: a new measure of upper-limb function for survivors of stroke.</a> Archives of Physical Medicine and Rehabilitation. 86 (8), 1616-1622 (2005).</li>
<li>Uswatte, G., Taub, E., Morris, D., Vignolo, M., McCulloch, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Reliability+and+validity+of+the+upper-extremity+Motor+Activity+Log-14+for+measuring+real-world+arm+use%5BTitle%5D)+AND+%22Stroke%22%5BJournal%5D)">Reliability and validity of the upper-extremity Motor Activity Log-14 for measuring real-world arm use.</a> Stroke. 36 (11), 2493-2496 (2005).</li>
<li>Duncan, P. W., Bode, R. K., Lai, S. M., Perera, S., Antagonist, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Rasch+analysis+of+a+new+stroke-specific+outcome+scale%3A+the+Stroke+Impact+Scale%5BTitle%5D)+AND+%22Archives+of+Physical+Medicine+and+Rehabilitation%22%5BJournal%5D)">Rasch analysis of a new stroke-specific outcome scale: the Stroke Impact Scale.</a> Archives of Physical Medicine and Rehabilitation. 84 (7), 950-963 (2003).</li>
<li>Marino, R. J., Shea, J. A., Stineman, M. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+capabilities+of+upper+extremity+instrument%3A+reliability+and+validity+of+a+measure+of+functional+limitation+in+tetraplegia%5BTitle%5D)+AND+%22Archives+of+Physical+Medicine+and+Rehabilitation%22%5BJournal%5D)">The capabilities of upper extremity instrument: reliability and validity of a measure of functional limitation in tetraplegia.</a> Archives of Physical Medicine and Rehabilitation. 79 (12), 1512-1521 (1998).</li>
<li>Hayward, K. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Exploring+the+role+of+accelerometers+in+the+measurement+of+real+world+upper-limb+use+after+stroke%5BTitle%5D)+AND+%22Brain+Impairment%22%5BJournal%5D)">Exploring the role of accelerometers in the measurement of real world upper-limb use after stroke.</a> Brain Impairment. 17 (1), 16-33 (2016).</li>
<li>van der Pas, S. C., Verbunt, J. A., Breukelaar, D. E., van Woerden, R., Seelen, H. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Assessment+of+arm+activity+using+triaxial+accelerometry+in+patients+with+a+stroke%5BTitle%5D)+AND+%22Archives+of+Physical+Medicine+and+Rehabilitation%22%5BJournal%5D)">Assessment of arm activity using triaxial accelerometry in patients with a stroke.</a> Archives of Physical Medicine and Rehabilitation. 92 (9), 1437-1442 (2011).</li>
<li>Oess, N. P., Wanek, J., Curt, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Design+and+evaluation+of+a+low-cost+instrumented+glove+for+hand+function+assessment%5BTitle%5D)+AND+%22Journal+of+Neuroengineering+and+Rehabilitation%22%5BJournal%5D)">Design and evaluation of a low-cost instrumented glove for hand function assessment.</a> Journal of Neuroengineering and Rehabilitation. 9 (1), 2(2012).</li>
<li>Friedman, N., Rowe, J. B., Reinkensmeyer, D. J., Bachman, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+manumeter%3A+a+wearable+device+for+monitoring+daily+use+of+the+wrist+and+fingers%5BTitle%5D)+AND+%22IEEE+Journal+of+Biomedical+Health+Informatics%22%5BJournal%5D)">The manumeter: a wearable device for monitoring daily use of the wrist and fingers.</a> IEEE Journal of Biomedical Health Informatics. 18 (6), 1804-1812 (2014).</li>
<li>Liu, X., Rajan, S., Ramasarma, N., Bonato, P., Lee, S. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+use+of+a+finger-worn+accelerometer+for+monitoring+of+hand+use+in+ambulatory+settings%5BTitle%5D)+AND+%22IEEE+Journal+of+Biomedical+Health+Informatics%22%5BJournal%5D)">The use of a finger-worn accelerometer for monitoring of hand use in ambulatory settings.</a> IEEE Journal of Biomedical Health Informatics. 23 (2), 599-606 (2018).</li>
<li>Lee, S. I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+novel+upper-limb+function+measure+derived+from+finger-worn+sensor+data+collected+in+a+free-living+setting%5BTitle%5D)+AND+%22PloS+One%22%5BJournal%5D)">A novel upper-limb function measure derived from finger-worn sensor data collected in a free-living setting.</a> PloS One. 14 (3), (2019).</li>
<li>Rowe, J. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+variable+relationship+between+arm+and+hand+use%3A+a+rationale+for+using+finger+magnetometry+to+complement+wrist+accelerometry+when+measuring+daily+use+of+the+upper+extremity%5BTitle%5D)+AND+%222014+36th+Annual+International+Conference+of+the+IEEE+Engineering+in+Medicine+and+Biology+Society%22%5BJournal%5D)">The variable relationship between arm and hand use: a rationale for using finger magnetometry to complement wrist accelerometry when measuring daily use of the upper extremity.</a> 2014 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society. , 4087-4090 (2014).</li>
<li>Dousty, M., Zariffa, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Tenodesis+Grasp+Detection+in+Egocentric+Video%5BTitle%5D)+AND+%22IEEE+Journal+of+Biomedical+and+health%22%5BJournal%5D)">Tenodesis Grasp Detection in Egocentric Video.</a> IEEE Journal of Biomedical and health. , (2020).</li>
<li>Likitlersuang, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Egocentric+video%3A+a+new+tool+for+capturing+hand+use+of+individuals+with+spinal+cord+injury+at+home%5BTitle%5D)+AND+%22Journal+of+Neuroengineering+and+Rehabilitation%22%5BJournal%5D)">Egocentric video: a new tool for capturing hand use of individuals with spinal cord injury at home.</a> Journal of Neuroengineering and Rehabilitation. 16 (1), 83(2019).</li>
<li>Tsai, M. -F., Wang, R. H., Zariffa, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Generalizability+of+Hand-Object+Interaction+Detection+in+Egocentric+Video+across+Populations+with+Hand+Impairment%5BTitle%5D)+AND+%222020+42nd+Annual+International+Conference+of+the+IEEE+Engineering+in+Medicine+%26+Biology+Society+%28EMBC%29%22%5BJournal%5D)">Generalizability of Hand-Object Interaction Detection in Egocentric Video across Populations with Hand Impairment.</a> 2020 42nd Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC). , 3228-3231 (2020).</li>
<li>Bandini, A., Dousty, M., Zariffa, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+wearable+vision-based+system+for+detecting+hand-object+interactions+in+individuals+with+cervical+spinal+cord+injury%3A+First+results+in+the+home+environment%5BTitle%5D)+AND+%222020+42nd+Annual+International+Conference+of+the+IEEE+Engineering+in+Medicine+%26+Biology+Society+%28EMBC%29%22%5BJournal%5D)">A wearable vision-based system for detecting hand-object interactions in individuals with cervical spinal cord injury: First results in the home environment.</a> 2020 42nd Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC). , 2159-2162 (2020).</li>
<li>Dousty, M., Zariffa, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Towards+Clustering+Hand+Grasps+of+Individuals+with+Spinal+Cord+Injury+in+Egocentric+Video%5BTitle%5D)+AND+%222020+42nd+Annual+International+Conference+of+the+IEEE+Engineering+in+Medicine+%26+Biology+Society+%28EMBC%29%22%5BJournal%5D)">Towards Clustering Hand Grasps of Individuals with Spinal Cord Injury in Egocentric Video.</a> 2020 42nd Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC). , 2151-2154 (2020).</li>
<li>Bandini, A., Zariffa, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Analysis+of+the+hands+in+egocentric+vision%3A+A+survey%5BTitle%5D)+AND+%22IEEE+Transactions+on+Pattern+Analysis+and+Machine+Intelligence%22%5BJournal%5D)">Analysis of the hands in egocentric vision: A survey.</a> IEEE Transactions on Pattern Analysis and Machine Intelligence. , (2020).</li>
<li>Likitlersuang, J., Sumitro, E. R., Theventhiran, P., Kalsi-Ryan, S., Zariffa, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Views+of+individuals+with+spinal+cord+injury+on+the+use+of+wearable+cameras+to+monitor+upper+limb+function+in+the+home+and+community%5BTitle%5D)+AND+%22Journal+of+Spinal+Cord+Medicine%22%5BJournal%5D)">Views of individuals with spinal cord injury on the use of wearable cameras to monitor upper limb function in the home and community.</a> Journal of Spinal Cord Medicine. 40 (6), 706-714 (2017).</li>
</ol>

The authors have nothing to disclose.

We presented a protocol for recording videos of ADLs at home using wearable cameras in individuals with upper limb impairments, such as cSCI and stroke. The protocol is flexible and can be goal-directed to capture hand function performance in specific ADLs or to track the progress of rehabilitation remotely in people living at home. The egocentric vision paradigm has great potential for remote monitoring of hand function in individuals living in the community, and for optimizing rehabilitation once people are discharged ...

Hand function is a determinant of independence and quality of life across clinical populations with upper limb impairments1,2. Capturing the hand function of individuals with hand impairments at home is vital to evaluating the progress of their ability to carry out activities of daily living (ADLs) during and after rehabilitation. Most clinical hand function assessments are conducted in a clinical or laboratory environment, rather than at home3,4. Existing clinical hand function assessments that seek to capture the impact on ADLs at home are questionnaires and rely on subjective self-reported ratings5,6,7. An objective evaluation to assess the ultimate impact of rehabilitation on hand function at home is still unavailable.
In recent years, many wearable technologies have been developed and implemented to capture upper limb function in real-world environments. Wearable sensors such as accelerometers and inertial measurement units (IMUs) have been commonly used to measure upper limb movements in daily life. However, these devices typically do not distinguish whether the detected epochs belong to functional upper limb movements8,9, defined as purposeful movements intended to complete a desired task. For example, some wearable sensors are sensitive to the presence of upper limb swings during walking, which is not a functional movement of the upper limb. Furthermore, although wrist-worn accelerometers capture upper limb movements, they cannot capture the details of hand function in real-world environments. Sensorized gloves allow capturing more detailed information about hand manipulations10, but they may be cumbersome for people whose hand function and sensation are already impaired. Wearable approaches have also been proposed to capture finger movements through magnetometry or finger-worn accelerometers11,12,13, but the functional interpretation of those movements remains challenging14. Thus, although previously proposed wearable devices are small and convenient to use, they are insufficient to describe the details and functional context of hand use.
Wearable cameras have been proposed to fill these gaps and capture details of hand function during ADLs at home for neurorehabilitation applications15,16,17,18,19. Automated analysis of egocentric videos using computer vision has considerable potential to quantify hand function in context, by providing information both about the hands themselves and about the tasks carried out in real ADLs20. On the other hand, the duration of continuous recordings is typically limited to approximately 1 to 1.5 h by battery, storage, and comfort considerations. Here, within these constraints, we present an egocentric video collection protocol intended to obtain data that is both representative of an individual&#39;s daily life as well as informative for hand function evaluation.

<table><tbody><tr><td>Egocentric camera</td><td>GoPro Inc., CA, USA</td><td>GoPro Hero 4 and 5</td><td>A camera that records from a first-person angle.</td></tr><tr><td>Battery chager and batteries</td><td>GoPro Inc., CA, USA</td><td>MAX Dual Battery Charger + Battery</td><td>Extra batteries for the camera and battery charger</td></tr><tr><td>Camera charger</td><td>GoPro Inc., CA, USA</td><td>Supercharger</td><td>This charger is connected to the camera directly without disassembling the camera frame.</td></tr><tr><td>Camera frame</td><td>GoPro Inc., CA, USA</td><td>The Frame</td><td>The hinge of the camera frame can be used to adjust the angle of view of the camera.</td></tr><tr><td>Headband for the camera</td><td>GoPro Inc., CA, USA</td><td>Head Strap + QuickClip</td><td></td></tr><tr><td>SD card</td><td>SanDisk, CA, USA</td><td>32GB microSD</td><td></td></tr><tr><td>Tablet</td><td>ASUSTeK Computer Inc., Taiwan</td><td>ZenPad 8.0 Z380M</td><td>The tablet is installed with the GoPro App in order to connect with the camera.</td></tr></tbody></table>

capturing representative hand use at home using egocentric video in individuals with upper limb impairment

Impaired hand function after neurological injuries can have a major impact on independence and quality of life. Most existing upper limb assessments are carried out in person, which is not always indicative of hand use in the community. Novel approaches to capture hand function in daily life are required to measure the true impact of rehabilitation interventions. Egocentric video combined with computer vision for automated analysis has been proposed to evaluate hand use at home. However, there are limitations to the duration of continuous recordings. We present a protocol designed to ensure that the videos obtained are representative of daily routines while respecting participant privacy. 
A representative recording schedule is selected through a collaborative process between the researchers and participants, to ensure that the videos capture natural tasks and performance, while being useful for hand assessment. Use of the equipment and procedures is demonstrated to the participants. A total of 3 h of video recordings are scheduled over two weeks. To reduce privacy concerns, participants have full control to start and stop recordings, and the opportunity to edit the videos before returning them to the research team. Reminders are provided, as well as help calls and home visits if necessary. 
The protocol was tested with 9 stroke survivors and 14 individuals with cervical spinal cord injury. The videos obtained contained a variety of activities, such as meal preparation, dishwashing, and knitting. An average of 3.11 &plusmn; 0.98 h of video were obtained. The recording periods varied from 12-69 d, due to illness or unexpected events in some cases. Data was successfully obtained from twenty-two out of 23 participants, with 6 participants requiring assistance from the investigators during the home recording period. The protocol was effective for collecting videos that contained valuable information about hand function at home after neurological injuries.

Participant demographics and inclusion criteria 
A sample of 23 participants was recruited for these studies: 9 stroke survivors (6 men, 3 women) and 14 individuals with cSCI (12 men, 2 women). Summary demographic and clinical information for the recruited sample are reported in Table 1.
<table border="1" fo:keep-together.within-page="always">
	<tbody>
		<tr>
			<td rowspan="2"></td>
			<td rowspan="2">Age (years)</td>
			<...

Watch this Scientific Journal Video about Capturing Representative Hand Use at Home Using Egocentric Video in Individuals with Upper Limb Impairment at JoVE.com

Capturing Representative Hand Use at Home Using Egocentric Video in Individuals with Upper Limb Impairment

A protocol is proposed to capture natural hand function of individuals with hand impairments during their daily routines using an egocentric camera. The goal of the protocol is to ensure that the recordings are representative of an individual&#39;s typical hand use during activities of daily living at home.

Impaired hand function after neurological injuries can have a major impact on independence and quality of life. Most existing upper limb assessments are ...

capturing-representative-hand-use-at-home-using-egocentric-video

Research

JoVE Journal

Bioengineering

2.5K Views.  University of Toronto. Er wordt een protocol voorgesteld om de natuurlijke handfunctie van personen met handbeperkingen tijdens hun dagelijkse routines vast te leggen met behulp van een egocentrische camera. Het doel van het protocol is om ervoor te zorgen dat de opnames representatief zijn voor het typische handgebruik van een persoon tijdens activiteiten van het dagelijks leven thuis.

Video: Capturing Representative Hand Use at Home Using Egocentric Video in Individuals with Upper Limb Impairment

Corticospinal Excitability Modulation During Action Observation

This study used the transcranial magnetic stimulation/motor evoked potential (TMS/MEP) technique to pinpoint when the automatic tendency to mirror someone else's action becomes anticipatory simulation of a complementary act. TMS was delivered to the left primary motor cortex corresponding to the hand to induce the highest level of MEP activity from the abductor digiti minimi (ADM; the muscle serving little finger abduction) as well as the first dorsal interosseus (FDI; the muscle serving index finger flexion/extension) muscles. A neuronavigation system was used to maintain the position of the TMS coil, and electromyographic (EMG) activity was recorded from the right ADM and FDI muscles. Producing original data with regard to motor resonance, the combined TMS/MEP technique has taken research on the perception-action coupling mechanism a step further. Specifically, it has answered the questions of how and when observing another person's actions produces motor facilitation in an onlooker's corresponding muscles and in what way corticospinal excitability is modulated in social contexts.

Single-pulse transcranial magnetic stimulation over the primary motor cortex, neuronavigation, and registration of electromyographic activity of hand muscles were used in this study to explore corticospinal excitability while participants were observing action sequences.

This study used the transcranial magnetic stimulation/motor evoked potential (TMS/MEP) technique to pinpoint when the automatic tendency to mirror someone ...

Behavior

A Structured Rehabilitation Protocol for Improved Multifunctional Prosthetic Control: A Case Study

Advances in robotic systems have resulted in prostheses for the upper limb that can produce multifunctional movements. However, these sophisticated systems require upper limb amputees to learn complex control schemes. Humans have the ability to learn new movements through imitation and other learning strategies. This protocol describes a structured rehabilitation method, which includes imitation, repetition, and reinforcement learning, and aims to assess if this method can improve multifunctional prosthetic control. A left below elbow amputee, with 4 years of experience in prosthetic use, took part in this case study. The prosthesis used was a Michelangelo hand with wrist rotation, and the added features of wrist flexion and extension, which allowed more combinations of hand movements. The participant&#8217;s Southampton Hand Assessment Procedure score improved from 58 to 71 following structured training. This suggests that a structured training protocol of imitation, repetition and reinforcement may have a role in learning to control a new prosthetic hand. A larger clinical study is however required to support these findings.

As prosthetic development moves towards the goal of natural control, harnessing amputees&#8217; inherent ability to learn new motor skills may enable proficiency. This manuscript describes a structured rehabilitation protocol, which includes imitation, repetition, and reinforcement learning strategies, for improved multifunctional prosthetic control.

Advances in robotic systems have resulted in prostheses for the upper limb that can produce multifunctional movements. However, these sophisticated ...

Frame-by-Frame Video Analysis of Idiosyncratic Reach-to-Grasp Movements in Humans

Prehension, the act of reaching to grasp an object, is central to the human experience. We use it to feed ourselves, groom ourselves, and manipulate objects and tools in our environment. Such behaviors are impaired by many sensorimotor disorders, yet our current understanding of their neural control is far from complete. Current technologies for investigating human reach-to-grasp movements often utilize motion tracking systems that can be expensive, require the attachment of markers or sensors to the hands, impede natural movement and sensory feedback, and provide kinematic output that can be difficult to interpret. While generally effective for studying the stereotypical reach-to-grasp movements of healthy sighted adults, many of these technologies face additional limitations when attempting to study the unpredictable and idiosyncratic reach-to-grasp movements of young infants, unsighted adults, and patients with neurological disorders. Thus, we present a novel, inexpensive, and highly reliable yet flexible protocol for quantifying the temporal and kinematic structure of idiosyncratic reach-to-grasp movements in humans. High speed video cameras capture multiple views of the reach-to-grasp movement. Frame-by-frame video analysis is then used to document the timing and magnitude of pre-defined behavioral events such as movement start, collection, maximum height, peak aperture, first contact, and final grasp. The temporal structure of the movement is reconstructed by documenting the relative frame number of each event while the kinematic structure of the hand is quantified using the ruler or measure function in photo editing software to calibrate 2 dimensional linear distances between two body parts or between a body part and the target. Frame-by-frame video analysis can provide a quantitative and comprehensive description of idiosyncratic reach-to-grasp movements and will enable researchers to expand their area of investigation to include a greater range of naturalistic prehensile behaviors, guided by a wider variety of sensory modalities, in both healthy and clinical populations.

This protocol describes how to use frame-by-frame video analysis to quantify idiosyncratic reach-to-grasp movements in humans. A comparative analysis of reaching in sighted versus unsighted healthy adults is used to demonstrate the technique, but the method can also be applied to the study of developmental and clinical populations.

Prehension, the act of reaching to grasp an object, is central to the human experience. We use it to feed ourselves, groom ourselves, and manipulate ...

Measuring the Kinematics of Daily Living Movements with Motion Capture Systems in Virtual Reality

The inability to complete instrumental activities of daily living (IADL) is a precursor to various neuropsychological diseases. Questionnaire-based assessments of IADL are easy to use but prone to subjective bias. Here, we describe a novel virtual reality (VR) test to assess two complex IADL tasks: handling financial transactions and using public transportation. While a participant performs the tasks in a VR setting, a motion capture system traces the position and orientation of the dominant hand and head in a three-dimensional Cartesian coordinate system. Kinematic raw data are collected and converted into &#39;kinematic performance measures,&#39; i.e., motion trajectory, moving distance, and time to completion. Motion trajectory is the path of a particular body part (e.g., dominant hand or head) in space. Moving distance refers to the total distance of the trajectory, and time to completion is how long it took to complete an IADL task. These kinematic measures could discriminate patients with cognitive impairment from healthy controls. The development of this kinematic measuring protocol allows detection of early IADL-related cognitive impairments.

We designed a virtual reality test to assess instrumental activities of daily living (IADL) with a motion capture system. We propose a detailed kinematic analysis to interpret the participant&#39;s various movements, including trajectory, moving distance, and time to completion to evaluate IADL capabilities.

The inability to complete instrumental activities of daily living (IADL) is a precursor to various neuropsychological diseases. Questionnaire-based ...

Efficiently Recording the Eye-Hand Coordination to Incoordination Spectrum

The objective analysis of eye movements has a significant history and has been long proven to be an important research tool in the setting of brain injury. Quantitative recordings have a strong capacity to screen diagnostically. Concurrent examinations of the eye and upper limb movements directed toward shared functional goals (e.g., eye-hand coordination) serve as an additional robust biomarker-laden path to capture and interrogate neural injury, including acquired brain injury (ABI). While quantitative dual-effector recordings in 3-D afford ample opportunities within ocular-manual motor investigations in the setting of ABI, the feasibility of such dual recordings for both eye and hand is challenging in pathological settings, particularly when approached with research-grade rigor. Here we describe the integration of an eye tracking system with a motion tracking system intended primarily for limb control research to study a natural behavior. The protocol enables the investigation of unrestricted, three-dimensional (3D) eye-hand coordination tasks. More specifically, we review a method to assess eye-hand coordination in visually guided saccade-to-reach tasks in subjects with chronic middle cerebral artery (MCA) stroke and compare them to healthy controls. Special attention is paid to the specific eye- and limb-tracking system properties in order to obtain high fidelity data from participants post-injury. Sampling rate, accuracy, permissible head movement range given anticipated tolerance and the feasibility of use were several of the critical properties considered when selecting an eye tracker and an approach. The limb tracker was selected based on a similar rubric but included the need for 3-D recording, dynamic interaction and a miniaturized physical footprint. The quantitative data provided by this method and the overall approach when executed correctly has tremendous potential to further refine our mechanistic understanding of eye-hand control and help inform feasible diagnostic and pragmatic interventions within the neurological and rehabilitative practice.&#160;

Cerebral injury can damage both ocular and somatic motor systems. Characterization of motor control post-injury affords biomarkers that assist in disease detection, monitoring, and prognosis. We review a method to measure eye-hand movement control in health and in pathologic incoordination, with look-and-reach paradigms to assess coordination between eye and hand.

The objective analysis of eye movements has a significant history and has been long proven to be an important research tool in the setting of brain ...

Virtual Hand with Ambiguous Movement between the Self and Other Origin: Sense of Ownership and 'Other-Produced' Agency

The feeling that a body part is one&#8217;s own body (sense of ownership; SoO) and the feeling based on the causal relationship between one&#8217;s will and action (sense of agency; SoA) have been recognized as the basis of our bodily self-consciousness. Previously, the illusory SoO over a fake body part (e.g., rubber hand) was introduced as the rubber hand illusion (RHI). Furthermore, it was determined that one could also evoke a SoA over an object with movements linked to the one&#8217;s prior intention. On the other hand, the postdictivity of our spontaneity implies that it is essentially inseparable whether actions originate from self or others. In other words, our SoA or daily experiences are obtained in such as inseparable scenario. Previous research, however, has maintained the premise that self- and other-origin movements are perceptually distinguishable. Here, we implement a protocol to make these aspects ambiguous for the participants and to estimate whether they can feel SoO and/or SoA and how. To this end, we employ an experiment using virtual reality, under which participants observe virtual fingers moving very slowly (or quickly or not moving) while their own fingers do not move. For evaluation of the illusory SoO, measurements of skin conductance responses against a knife threat are adopted. Additionally, we introduce face-to-face interviews to determine whether the feelings regarding the slow movement match the conventional SoA definition. Our representative results suggest that the SoO is evoked over the hand, and various attitudes to accept its movement as the participant&#8217;s own with awareness that they did not originate it are reported by the majority. As the results show, the novelty of this protocol is discovering that in such a situation, the SoO cooperates with an externally produced SoA to establish one&#8217;s own bodily experience rather than the independence of the SoO and SoA.

While previous research on bodily self-consciousness assumed that self- and other-origin movements were perceptually distinguishable, this protocol allows them to be ambiguous on a virtual hand with unintentional slight movements. This enables us to observe one&#8217;s experience formed by SoO and other-produced SoA, rather than the absence of SoA.

The feeling that a body part is one&#8217;s own body (sense of ownership; SoO) and the feeling based on the causal relationship between one&#8217;s will ...

Kinematic Analysis Using 3D Motion Capture of Drinking Task in People With and Without Upper-extremity Impairments

Kinematic analysis is a powerful method for objective assessment of upper extremity movements in a three-dimensional (3D) space. Three-dimensional motion capture with an optoelectronic camera system is considered as golden standard for kinematic movement analysis and is increasingly used as outcome measure to evaluate the movement performance and quality after an injury or disease involving upper extremity movements. This article describes a standardized protocol for kinematic analysis of drinking task applied in individuals with upper extremity impairments after stroke. The drinking task incorporates reaching, grasping and lifting a cup from a table to take a drink, placing the cup back, and moving the hand back to the edge of the table. The sitting position is standardized to the individual&#39;s body size and the task is performed in a comfortable self-paced speed and compensatory movements are not constrained. The intention is to keep the task natural and close to a real-life situation to improve the ecological validity of the protocol. A 5-camera motion capture system is used to gather 3D coordinate positions from 9 retroreflective markers positioned on anatomical landmarks of the arm, trunk, and face. A simple single marker placement is used to ensure the feasibility of the protocol in clinical settings. Custom-made Matlab software provides automated and fast analyses of movement data. Temporal kinematics of movement time, velocity, peak velocity, time of peak velocity, and smoothness (number of movement units) along with spatial angular kinematics of shoulder and elbow joint as well as trunk movements are calculated. The drinking task is a valid assessment for individuals with moderate and mild upper extremity impairment. The construct, discriminative and concurrent validity along with responsiveness (sensitivity to change) of the kinematic variables obtained from the drinking task have been established.

This protocol describes an objective method to evaluate the movement performance and sensorimotor function of the upper extremity applied to individuals with stroke and healthy controls. A standardized test procedure, kinematic analysis and outcome variables for three-dimensional motion capture of drinking task are provided.

Kinematic analysis is a powerful method for objective assessment of upper extremity movements in a three-dimensional (3D) space. Three-dimensional motion ...

Neuroscience

Development of a Novel Task-oriented Rehabilitation Program using a Bimanual Exoskeleton Robotic Hand

A robot-assisted hand is used for the rehabilitation of patients with impaired upper limb function, particularly for stroke patients with a loss of motor control. However, it is unclear how conventional occupational training strategies can be applied to the use of rehabilitation robots. Novel robotic technologies and occupational therapy concepts are used to develop a protocol that allows patients with impaired upper limb function to grasp objects using their affected hand through a variety of pinching and grasping functions. To conduct this appropriately, we used five types of objects: a peg, a rectangular cube, a cube, a ball, and a cylindrical bar. We also equipped the patients with a robotic hand, the Mirror Hand, an exoskeleton&#160;hand that is fitted to the subject&#8217;s affected hand and follows the movement of the sensor glove fitted to their unaffected hand (bimanual movement training (BMT)). This study had two stages. Three healthy subjects were first recruited to test the feasibility and acceptability of the training program. Three patients with hand dysfunction caused by stroke were then recruited to confirm the feasibility and acceptability of the training program, which was conducted on 3 consecutive days. On each day, the patient was monitored during 5 min of movement in a passive range of motion, 5 min of robot-assisted bimanual movement, and task-oriented training using the five objects. The results showed that both healthy subjects and subjects who had suffered a stroke in conjunction with the robotic hand could successfully grasp the objects. Both healthy subjects and those who had suffered a stroke performed well with the robot-assisted task-oriented training program in terms of feasibility and acceptability.

This study reports the development of a novel robot-assisted task-oriented program for hand rehabilitation. The developmental process consists of experiments using both healthy subjects and subjects who have had a stroke and suffered from subsequent motor control dysfunction.

A robot-assisted hand is used for the rehabilitation of patients with impaired upper limb function, particularly for stroke patients with a loss of motor ...

Medicine

Capturing Dynamic Finger Gesturing with High-resolution Surface Electromyography and Computer Vision

Finger gestures are a critical element in human communication, and as such, finger gesture recognition is widely studied as a human-computer interface for state-of-the-art prosthetics and optimized rehabilitation. Surface electromyography (sEMG), in conjunction with deep learning methods, is considered a promising method in this domain. However, current methods often rely on cumbersome recording setups and the identification of static hand positions, limiting their effectiveness in real-world applications. The protocol we report here presents an advanced approach combining a wearable surface EMG and finger&#160;tracking system to capture comprehensive data during dynamic hand movements. The method records muscle activity from soft printed electrode arrays (16 electrodes) placed on the forearm as subjects perform gestures in different hand positions and during movement. Visual instructions prompt subjects to perform specific gestures while EMG and finger positions are recorded. The integration of synchronized EMG recordings and finger tracking data enables comprehensive analysis of muscle activity patterns and corresponding gestures. The reported approach demonstrates the potential of combining EMG and visual tracking technologies as an important resource for developing intuitive and responsive gesture recognition systems with applications in prosthetics, rehabilitation, and interactive technologies. This protocol aims to guide researchers and practitioners, fostering further innovation and application of gesture recognition in dynamic and real-world scenarios.

The paper presents a comprehensive protocol for simultaneously recording hand-electromyography (EMG) and visual finger tracking during natural finger gesturing. The visual data is designed to serve as the ground truth for the development of accurate EMG-based computational models for finger gesture recognition.

Finger gestures are a critical element in human communication, and as such, finger gesture recognition is widely studied as a human-computer interface for ...

Brain-Computer Interface-controlled Upper Limb Robotic System for Enhancing Daily Activities in Stroke Patients

This study introduces a Brain-Computer Interface (BCI)-controlled upper limb assistive robot for post-stroke rehabilitation. The system utilizes electroencephalogram (EEG) and electrooculogram (EOG) signals to help users assist upper limb function in everyday tasks while interacting with a robotic hand. We evaluated the effectiveness of this BCI-robot system using the Berlin Bimanual Test for Stroke (BeBiTS), a set of 10 daily living tasks involving both hands. Eight stroke patients participated in this study, but only four participants could adapt to the BCI robot system training and perform the postBeBiTS. Notably, when the preBeBiTS score for each item was four or less, the BCI robot system showed greater assistive effectiveness in the postBeBiTS assessment. Furthermore, our current robotic hand does not assist with arm and wrist functions, limiting its use in tasks requiring complex hand movements. More participants are required to confirm the training effectiveness of the BCI-robot system, and future research should consider using robots that can assist with a broader range of upper limb functions. This study aimed to determine the BCI-robot system's ability to assist patients in performing daily living activities.

This study introduces a brain-computer interface (BCI) system for stroke patients, which combines electroencephalography and electrooculography signals to control an upper limb robotic hand, enhancing daily activities. The evaluation used the Berlin Bimanual Test for Stroke (BeBiTS).

Capturing Representative Hand Use at Home Using Egocentric Video in Individuals with Upper Limb Impairment

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