This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Restoring Warfighters with Neuromusculoskeletal Injuries Research Program (RESTORE) under Award No. W81XWH-21-1-0138. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense.

Experimental procedures were approved by the West Virginia University Institutional Review Board (IRB), protocol # 1311129283, and adhered to the principles of the Declaration of Helsinki. Risks from this protocol are minor but it is necessary to explain all procedures and potential risks to participants and written, informed consent was acquired with documentation approved by the institutional ethical review board.
1. System characteristics and design
NOTE: The setup for this protocol consists of the following elements: (1) EMG sensors and base, (2) EMG data acquisition (DAQ) software, (3) a motion capture system, and (4) a VR headset with corresponding software. These components are visualized in Figure 1.
<ol>
	<li>Setup of the system components
	<ol>
		<li>Connect the EMG system.
		<ol>
			<li>Plug in the EMG base station to power.</li>
			<li>Connect the EMG base station to a dedicated computer (Figure 1C) containing the DAQ scripts. 
			NOTE: Example scripts can be found at:&#160;https://www.dropbox.com/sh/7se5lih4noxj584/AACqFDZytpDm-L8jAULFwfTHa?dl=0. Some commercial products may come with licensed DAQ software, which may also be used.</li>
		</ol>
		</li>
		<li>Connect the motion capture system.
		<ol>
			<li>Connect a second dedicated computer (Figure 1A) to a network router.</li>
			<li>Connect the network router to a motion capture server.</li>
			<li>Connect the motion capture server to a computer monitor for visualization.</li>
			<li>Connect the cameras to the motion capture server.</li>
		</ol>
		</li>
		<li>Connect the VR system.
		<ol>
			<li>Connect the VR headset to a third dedicated computer with the corresponding DAQ scripts (Figure 1B). 
			NOTE: Example scripts can be found at: https://www.dropbox.com/sh/7se5lih4noxj584/AACqFDZytpDm-L8jAULFwfTHa?dl=0</li>
			<li>Load the VR gaming environment containing the intended tasks to the computer linked to the VR headset (Figure 1B).</li>
		</ol>
		</li>
		<li>Prepare the area where the subject will complete the task.
		<ol>
			<li>Use an arm-less, sturdy chair to ensure that there is no interference with the subject&#39;s normal reaching.</li>
			<li>For the safety and accuracy of the data collected, confirm that the testing area is clear of all obstacles.</li>
		</ol>
		</li>
		<li>Synchronize the systems.
		<ol>
			<li>Use a custom software function to synchronize systems in time to a one-time server.</li>
			<li>Alternatively, use one computer or a preferred message manager.</li>
		</ol>
		</li>
	</ol>
	</li>
</ol>
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/65736/65736fig01.jpg" /> 
Figure 1: Experimental equipment setup. (A) The marker motion capture cameras are positioned on the floor and in the ceiling around the experimental space, establishing an optimal space for tracking motion. A dedicated computer is used to run the motion capture software and save the data. (B) The headset used to display the modified BBT in VR is connected to a dedicated computer where the virtual assessment and task data are saved. (C) The EMG base is connected to a dedicated computer where muscle activity data is recorded and saved during the task execution. EMG sensors and LED markers for motion capture are both placed on the subject&#39;s arm during the session (see Figure 2). Abbreviations: VR = virtual reality; EMG = electromyography. <a href="https://www.jove.com/files/ftp_upload/65736/65736fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
2. Experimental procedures
NOTE: a visual representation of the experimental flow described in this protocol is shown in Figure 2.
<ol>
	<li>Setup EMG
	<ol>
		<li>To determine EMG sensor placement for best signal quality, palpate the muscle belly while the participant contracts the relevant muscle27. See Table 1 for the muscle selection used in this protocol.</li>
		<li>Using an alcohol wipe, carefully clean each electrode and the intended sensor placement site on the subject&#39;s arm. 
		NOTE: Thorough cleaning of both the EMG sensors and the subject&#39;s skin will ensure a low electrode-to-skin impedance. This ensures that recorded EMG data has a high signal-to-noise ratio. Excess hair at the sensor placement site may cause low-quality data even if properly cleaned. In this case, it may be necessary to shave the hair.</li>
		<li>After preparing the EMG electrodes and the subject&#39;s skin, place the EMG sensors on the subject, ensuring good contact between the electrodes and skin. Bipolar electrodes should be positioned so that the sensors are parallel to the direction of the muscle fibers.</li>
	</ol>
	</li>
	<li>Setup motion capture system 
	NOTE: This may not be necessary if only a VR headset is being used to track hand movements for kinematics.
	<ol>
		<li>Calibrate the motion tracking cameras using the manufacturer&#39;s instructions. Move the calibration wand throughout the experimental space to calibrate the motion tracking cameras and set the 3D axis of the space. 
		NOTE: The marker motion capture system used in this protocol includes a calibration wand with LED markers.</li>
		<li>Place the LED motion capture markers on the bony landmarks of the subject&#39;s upper extremity and trunk that are needed to construct the desired biomechanical models.</li>
		<li>Use the provided motion capture software to ensure that all markers are recognized and tracked by the motion capture cameras. Instruct the subject to perform several practice movements while study personnel visually monitor marker data in real time.</li>
	</ol>
	</li>
	<li>Setup VR skill assessment task
	<ol>
		<li>Position a chair in the center of the motion capture experimental space. Use a chair that is similar to that used for the traditional, real-world test.</li>
		<li>Calibrate the VR headset in the chair where the subject will perform the assessment task. Once calibrated, instruct the subject to sit in the chair and place the VR headset on their head.</li>
		<li>While the subject is seated, measure the distance between the subject&#39;s shoulder and the ground, as well as the length of the subject&#39;s arm. Use these distances to set the location where the table and assessment task will spawn in VR.</li>
		<li>In the VR task control script, input the subject&#39;s measurements and program the desired number of block spawn repetitions. 
		NOTE: In this Modified BBT, individual blocks will spawn one at a time to increase reproducibility.</li>
	</ol>
	</li>
	<li>Instruct the subject to perform the modified BBT assessment in VR.
	<ol>
		<li>Provide a brief explanation of the task to the subject.
		<ol>
			<li>The virtual block will spawn on the left or right side, as determined by the experimenter.</li>
			<li>Explain to the subject that they will need to pick up the virtual block, transport it over the partition, and place it onto the target in the opposing compartment (Figure 2). 
			NOTE: In the virtual modified BBT used here, the block will automatically disappear and re-spawn at the starting position as many times as determined by the experimenter.</li>
		</ol>
		</li>
		<li>Start collecting EMG data.</li>
		<li>Start collecting motion capture data.</li>
		<li>Start the VR skill assessment task.
		<ol>
			<li>Let the task run for the preset number of repetitions before automatically ending.</li>
		</ol>
		</li>
		<li>Save the EMG and kinematic data for post-hoc analysis.</li>
		<li>Determine a clinically relevant score for the Modified BBT post-hoc as the number of blocks successfully carried over the barrier or repetitions of the task in 60 s.</li>
	</ol>
	</li>
</ol>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/65736/65736fig02.jpg" /> 
Figure 2: Experimental protocol, VR task, and subject setup. (A) Flow diagram describing the experimental protocol used here. (B) Example view of modified BBT implemented in VR environment. Anatomical measurements are used to calibrate the VR task, ensuring that the virtual table spawns at the correct relative location. (C) Placement of LED motion capture markers and EMG sensors on the subject. EMG sensors are placed on the muscles of interest and LED motion capture markers are positioned over bony landmarks. Abbreviations: VR = virtual reality; EMG = electromyography; LED = light-emitting diode. <a href="https://www.jove.com/files/ftp_upload/65736/65736fig02large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>

Integrating VR and Biosensors for Quantitative Motion-Muscle Activity Assessment

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The authors have no conflicts of interest to declare.

EMG system 
The hardware of the EMG system consists of 15 EMG sensors used to obtain muscle activation data. A commercially available Application Programming Interface (API) was used to generate custom EMG recording software. The VR system hardware consists of a virtual reality headset used to display the immersive VR environment and a cable to link the headset to the dedicated computer where the virtual assessment task is stored. The software consists of 3D computer graphics software to create and ...

Movement is how we interact with the world. While everyday activities such as picking up a glass of water or walking to work may seem simple, even these movements rely on complex signaling between the central nervous system, muscles, and limbs1. As such, personal independence and quality of life are highly correlated to the level of an individual&#39;s limb function2,3. Neurological damage, as in spinal cord injury (SCI) or peripheral nerve injury, can result in permanent motor deficits, thereby diminishing one&#39;s ability to execute even simple activities of daily living4,5. According to the National Institute of Neurological Disorders and Stroke, over 100 million people in the United States experience motor deficits, with stroke as one of the leading causes6,7,8. Due to the nature of these injuries, patients often require prolonged care in which quantitative motor assessment and remote treatment may be beneficial.
Current practices for treating movement disorders often require both initial and ongoing clinical assessment of function through observation by trained experts such as physical or occupational therapists. Standard validated clinical tests often require trained professionals to administer them, with specific time constraints and subjective scoring of predefined movements or functional tasks. However, even in healthy individuals, identical movements can be accomplished with varying combinations of joint angles. This concept is termed musculoskeletal redundancy.
Functional clinical tests often do not account for the individual redundancy underlying inter-subject variability. For clinicians and researchers alike, distinguishing between normal variability caused by redundancy and pathological changes in movement remains a challenge. Standardized clinical assessments performed by well-trained raters utilize low-resolution scoring systems to reduce inter-rater variability and improve test validity. However, this introduces ceiling effects, thus lowering the sensitivity and predictive validity for subjects who may have mild movement deficits9,10. Furthermore, these clinical tests cannot differentiate if deficits are caused by passive body mechanics or active muscle coordination, which may be of importance during initial diagnosis and when designing a patient-specific rehabilitation plan. Randomized clinical trials have revealed inconsistent efficacy of treatment plans formulated based on evidence provided by these clinical tests11,12,13. Several studies have emphasized the need for quantitative, user-friendly clinical metrics that may be used to guide the design of future interventions14,15.
In previous studies, we demonstrated the implementation of automated movement assessment using readily available consumer motion capture devices in post-stroke arm impairment, as well as the evaluation of shoulder function after chest surgery in breast cancer patients16,17. Additionally, we have shown that using active joint moments to estimate muscle moments of specific active movements is a more sensitive measure of motor deficits after stroke compared to joint angles18. Motion capture and surface electromyography (EMG) may therefore be of critical importance in the assessment of patients who are diagnosed as asymptomatic by standard clinical tests, but who may still be experiencing movement difficulties, fatigue, or pain. This paper describes a system that may enable detailed and quantitative characterization of movement during standard clinical tests for the future development of methods for at-home evaluation and rehabilitation in movement-impaired patient populations.
Virtual reality (VR) can be used to construct an immersive user experience while modeling everyday tasks. Typically, VR systems track the hand movements of the user to allow for simulated interactions with the virtual environment. The protocol we describe here uses consumer VR products for motion capture to quantify the assessment of motor deficits, similar to other studies demonstrating the use of off-the-shelf video game controllers in quantitative evaluation of impairment after stroke or shoulder surgery16,17. In addition, EMG is a non-invasive measure of the neural activity underlying muscular contraction19. As such, EMG may be used to indirectly evaluate the quality of the neural control of movement and provide a detailed assessment of motor function. Muscle and nerve damage may be detected by EMG, and disorders such as muscular dystrophy and cerebral palsy are commonly monitored using this technique20,21. Furthermore, EMG may be used to track changes in muscle strength or spasticity, which may not be evident in kinematic assessments22,23, as well as fatigue and muscle coactivation. Metrics such as these are critical in considering rehabilitation progress23,24,25.
The experimental paradigm described here seeks to leverage a combination of VR and EMG to address the limitations of traditional clinical assessment tools. Here, participants were asked to perform a modified Box and Block task (BBT)26 using real objects and in VR. The standard BBT is a clinical tool used in the general assessment of gross upper extremity function, in which subjects are asked to move as many 2.5 cm blocks as possible from one compartment, over a partition, to an adjoining compartment within one minute. While often used to reliably assess deficits in patients with stroke or other neuromuscular conditions (e.g., upper extremity paresis, spastic hemiplegia), normative data have also been reported for healthy children and adults, ages 6-8926. A virtual movement assessment is used to simulate functional aspects of the validated clinical test performed in real life. VR is used here to decrease required hardware while allowing for the provision of standardized instructions and programmed, automated scoring. As such, constant supervision by trained professionals would no longer be necessary.
The BBT in this study has been simplified to focus on capturing the reaching and grasping of one block at a time that appears in the same location. This maximized the reproducibility of the movements and minimized the inter-subject variability in recorded data. Lastly, virtual reality headsets can be purchased for as little as $300 and have the potential to house multiple assessments. Once programmed, this would significantly decrease the cost associated with typical professional evaluation and allow for increased accessibility of these standard, validated clinical tests in both clinical and remote/at-home settings.

<table><tbody><tr><td>Armless Chair</td><td>N/A</td><td></td><td>A chair for subjects to sit in should be armless so that their arms are not interfered with.</td></tr><tr><td>Computer</td><td>Dell Technologies</td><td></td><td>Three computers were used to accompany the data acquisition equipment.</td></tr><tr><td>Leap Motion Controller</td><td>Ultraleap</td><td></td><td>Optical hand tracking module that captures the hand and finger movement. The controller has two 640 x 240-pixel near-infrared cameras (120 Hz), which are capable of tracking movement up to 60 cm from the device and in a 140 x 120&amp;deg; field of view. This device was attached to the VR headset or secured above the head during movement.</td></tr><tr><td>MATLAB</td><td>MathWorks, Inc.&amp;nbsp;</td><td></td><td>Programming platform used to develop custom data acquisition software</td></tr><tr><td>Oculus Quest 2</td><td>Meta</td><td></td><td>Immersive virtual reality headset equipped with hand tracking ability through 4 infrared build-in cameras (72-120 Hz). Can be substituted with other similar devices (ex. HTC Vive, HP Reverb, Playstation VR).</td></tr><tr><td>Oculus Quest 2 Link cable</td><td>Meta</td><td></td><td>Used to connect the headset to the computer where the VR game was stored</td></tr><tr><td>PhaseSpace Motion Capture</td><td>PhaseSpace, Inc.</td><td></td><td>Markered motion capture system, consisting of a server, cameras with 60&amp;deg; field of view, red light emitting diode (LED) as markers, and a calibration object</td></tr><tr><td>Trigno Wireless System</td><td>Delsys, Inc.</td><td></td><td>By Delsys Inc., includes EMG, accelerometer, force sensors, a base station, and collection software. The Trigno-MATLAB Application Programming Interface (API) was used to develop custom recording software.</td></tr><tr><td>UnReal Engine 4</td><td>Epic Games</td><td></td><td>Software used to create and run the modified Box and Block Task in VR</td></tr></tbody></table>

setup for the quantitative assessment of motion and muscle activity during a virtual modified box and block test

The ability to move allows us to interact with the world. When this ability is impaired, it can significantly reduce one's quality of life and independence and may lead to complications. The importance of remote patient evaluation and rehabilitation has recently grown due to limited access to in-person services. For example, the COVID-19 pandemic unexpectedly resulted in strict regulations, reducing access to non-emergent healthcare services. Additionally, remote care offers an opportunity to address healthcare disparities in rural, underserved, and low-income areas where access to services remains limited. 
Improving accessibility through remote care options would limit the number of hospital or specialist visits and render routine care more affordable. Finally, the use of readily available commercial consumer electronics for at-home care can enhance patient outcomes due to improved quantitative observation of symptoms, treatment efficacy, and therapy dosage. While remote care is a promising means to address these issues, there is a crucial need to quantitatively characterize motor impairment for such applications. The following protocol seeks to address this knowledge gap to enable clinicians and researchers to obtain high-resolution data on complex movement and underlying muscle activity. The ultimate goal is to develop a protocol for remote administration of functional clinical tests. 
Here, participants were instructed to perform a medically-inspired Box and Block task (BBT), which is frequently used to assess hand function. This task requires subjects to transport standardized cubes between two compartments separated by a barrier. We implemented a modified BBT in virtual reality to demonstrate the potential of developing remote assessment protocols. Muscle activation was captured for each subject using surface electromyography. This protocol allowed for the acquisition of high-quality data to better characterize movement impairment in a detailed and quantitative manner. Ultimately, these data have the potential to be used to develop protocols for virtual rehabilitation and remote patient monitoring.

EMG, kinematic, and force data obtained from subjects using this protocol can be used to characterize movements across repetitions of the same task, as well as during different tasks. Data shown here represent results from healthy control participants to demonstrate the feasibility of this setup. Representative EMG profiles recorded from a healthy subject performing the modified BBT in VR are shown in Figure 3. High muscle activation of the anterior deltoid (DELT_A) can be seen, suggesting t...

Read this Scientific Article Protocol about Author Spotlight: Enhancing Remote Rehabilitation with Virtual Reality and Electromyography at JoVE.com

Author Spotlight: Enhancing Remote Rehabilitation with Virtual Reality and Electromyography

The protocol described here aims to enhance the quantitative evaluation of upper limb deficits, with the goal of developing additional technology for remote assessment both in the clinic and at home. Virtual reality and biosensor technologies are combined with standard clinical techniques to provide insights into the functioning of the neuromuscular system.

Setup for the Quantitative Assessment of Motion and Muscle Activity During a Virtual Modified Box and Block Test

The ability to move allows us to interact with the world. When this ability is impaired, it can significantly reduce one's quality of life and ...

setup-for-quantitative-assessment-motion-muscle-activity-during

Research

JoVE Journal

Engineering

548 Views.  West Virginia University. Hier in het Neuroengineering and Rehabilitation Laboratory van de West Virginia University bestuderen we functionele mechanismen van sensorische motorische controle en ontwikkelen we objectieve beoordelingsinstrumenten voor de beoordeling van motorische vaardigheden en bewegingsstoornissen. Zorg op afstand of virtuele zorg is een veelbelovend middel geworden om ongelijkheden in de gezondheidszorg aan te pakken. Er is echter een kritieke behoefte om motorische vaardigheden kwantitatief te kara...

Video: Auteur in de schijnwerpers: revalidatie op afstand verbeteren met virtual reality en elektromyografie

Methods to Quantify Pharmacologically Induced Alterations in Motor Function in Human Incomplete SCI

Spinal cord injury (SCI) is a debilitating disorder, which produces profound deficits in volitional motor control. Following medical stabilization, recovery from SCI typically involves long term rehabilitation. While recovery of walking ability is a primary goal in many patients early after injury, those with a motor incomplete SCI, indicating partial preservation of volitional control, may have the sufficient residual descending pathways necessary to attain this goal. However, despite physical interventions, motor impairments including weakness, and the manifestation of abnormal involuntary reflex activity, called spasticity or spasms, are thought to contribute to reduced walking recovery. Doctrinaire thought suggests that remediation of this abnormal motor reflexes associated with SCI will produce functional benefits to the patient. For example, physicians and therapists will provide specific pharmacological or physical interventions directed towards reducing spasticity or spasms, although there continues to be little empirical data suggesting that these strategies improve walking ability.
In the past few decades, accumulating data has suggested that specific neuromodulatory agents, including agents which mimic or facilitate the actions of the monoamines, including serotonin (5HT) and norepinephrine (NE), can initiate or augment walking behaviors in animal models of SCI. Interestingly, many of these agents, particularly 5HTergic agonists, can markedly increase spinal excitability, which in turn also increases reflex activity in these animals. Counterintuitive to traditional theories of recovery following human SCI, the empirical evidence from basic science experiments suggest that this reflex hyper excitability and generation of locomotor behaviors are driven in parallel by neuromodulatory inputs (5HT) and may be necessary for functional recovery following SCI. 
The application of this novel concept derived from basic scientific studies to promote recovery following human SCI would appear to be seamless, although the direct translation of the findings can be extremely challenging. Specifically, in the animal models, an implanted catheter facilitates delivery of very specific 5HT agonist compounds directly onto the spinal circuitry. The translation of this technique to humans is hindered by the lack of specific surgical techniques or available pharmacological agents directed towards 5HT receptor subtypes that are safe and effective for human clinical trials. However, oral administration of commonly available 5HTergic agents, such as selective serotonin reuptake inhibitors (SSRIs), may be a viable option to increase central 5HT concentrations in order to facilitate walking recovery in humans. Systematic quantification of how these SSRIs modulate human motor behaviors following SCI, with a specific focus on strength, reflexes, and the recovery of walking ability, are missing.
This video demonstration is a progressive attempt to systematically and quantitatively assess the modulation of reflex activity, volitional strength and ambulation following the acute oral administration of an SSRI in human SCI. Agents are applied on single days to assess the immediate effects on motor function in this patient population, with long-term studies involving repeated drug administration combined with intensive physical interventions.

This video demonstrates modulation of reflex activity, volitional strength and ambulation through clinical and quantitative assessments in individuals with motor incomplete SCI as a result of acute oral administration of a serotonin reuptake inhibitor (SSRI).

Spinal cord injury (SCI) is a debilitating disorder, which produces profound deficits in volitional motor control. Following medical stabilization, ...

Medicine

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

Multifunctional Setup for Studying Human Motor Control Using Transcranial Magnetic Stimulation, Electromyography, Motion Capture, and Virtual Reality

The study of neuromuscular control of movement in humans is accomplished with numerous technologies. Non-invasive methods for investigating neuromuscular function include transcranial magnetic stimulation, electromyography, and three-dimensional motion capture. The advent of readily available and cost-effective virtual reality solutions has expanded the capabilities of researchers in recreating &#8220;real-world&#8221; environments and movements in a laboratory setting. Naturalistic movement analysis will not only garner a greater understanding of motor control in healthy individuals, but also permit the design of experiments and rehabilitation strategies that target specific motor impairments (e.g. stroke). The combined use of these tools will lead to increasingly deeper understanding of neural mechanisms of motor control. A key requirement when combining these data acquisition systems is fine temporal correspondence between the various data streams. This protocol describes a multifunctional system&#8217;s overall connectivity, intersystem signaling, and the temporal synchronization of recorded data. Synchronization of the component systems is primarily accomplished through the use of a customizable circuit, readily made with off the shelf components and minimal electronics assembly skills.

Transcranial magnetic stimulation, electromyography, and 3D motion capture are commonly used non-invasive techniques for investigating neuromuscular function in humans. In this paper, we describe a protocol that synchronously samples data generated by all three of these tools along with the unique addition of virtual reality stimulus presentation and feedback.

The study of neuromuscular control of movement in humans is accomplished with numerous technologies. Non-invasive methods for investigating neuromuscular ...

An Objective and Child-friendly Assessment of Arm Function by Using a 3-D Sensor

Progressive and irreversible muscle atrophy characterizes Spinal Muscular Atrophy (SMA) and other similar muscle disorder diseases. Objective assessment of muscle functions is an essential and important, although challenging, prerequisite for successful clinical trials. Current clinical rating scales restrain the movement abnormalities to certain predefined coarse-grained individual items. The Kinect 3-D sensor has emerged as a low-cost and portable motion sensing technology used to capture and track people&#39;s movement in many medical and research fields. A novel approach using this 3-D sensor was developed and a game-like test was designed to objectively measure the upper limb function of patients with SMA. The prototype test targeted joint movement capability. While sitting in a virtual scene, the patient was instructed to extend, flex, and lift the whole arm in order to reach and place some objects. Both kinematic and spatiotemporal characteristics of upper limb movement were extracted and analyzed, e.g., elbow extension and flexion angles, hand velocity, and acceleration. The first study included a small cohort of 18 ambulant SMA patients and 19 age- and gender-matched healthy controls. A comprehensive analysis of arm movement was achieved; however, no significant difference between the groups were found due to the mismatch of patient&#39;s capability and the test difficulty. Based on this experience, a second version of the test consisting of a modified version of the first game with increased difficulties and a second game targeting muscle endurance were designed and implemented. The new test has not been conducted in any patient groups yet. Our work has demonstrated the potential capability of the 3-D sensor in assessing such muscle function and suggested an objective approach to complement the clinical rating scales.

An objective measure of muscle functions is challenging especially in children. Based on a commercially available digital 3-D sensor, a child-friendly gaming test was developed to assess upper limb function for clinical trials.

Progressive and irreversible muscle atrophy characterizes Spinal Muscular Atrophy (SMA) and other similar muscle disorder diseases. Objective assessment ...

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 ...

Isokinetic Robotic Device to Improve Test-Retest and Inter-Rater Reliability for Stretch Reflex Measurements in Stroke Patients with Spasticity

Measuring spasticity is important in treatment planning and determining efficacy after treatment. However, the current tool used in clinical settings has been shown to be limited in inter-rater reliability. One factor in this poor inter-rater reliability is the variability of passive motion while measuring the angle of catch (AoC) measurements. Therefore, an isokinetic device has been proposed to standardize the manual joint motion; however, the benefits of isokinetic motion for AoC measurements has not been tested in a standardized manner. This protocol investigates whether isokinetic motion itself can improve inter-rater reliability for AoC measurements. For this purpose, a robotic isokinetic device was developed that is combined with surface electromyography (EMG). Two conditions, manual and isokinetic motions, are compared with the standardized method to measure the angle and subjective feeling of catch. It is shown that in 17 stroke patients with mild elbow flexor spasticity, isokinetic motion improved the intraclass correlation coefficient (ICC) for inter-rater reliability of AoC measurements to 0.890 [95% confidence interval (CI): 0.685&#8211;0.961] by the EMG criteria, and 0.931 (95% CI: 0.791&#8211;0.978) by the torque criteria, from 0.788 (95% CI: 0.493&#8211;0.920) by manual motion. In conclusion, isokinetic motion itself can improve inter-rater reliability of AoC measurements in stroke patients with mild spasticity. Given that this system may provide greater standardized angle measurements and catch of feeling, it may be a good option for the evaluation of spasticity in a clinical setting.

Using a robotic isokinetic device with electromyography (EMG) measurements, this protocol illustrates that isokinetic motion itself can improve inter-rater reliability for the angle of catch measurements in stroke patients with mild elbow flexor spasticity.

Measuring spasticity is important in treatment planning and determining efficacy after treatment. However, the current tool used in clinical settings has ...

Bioengineering

Video Movement Analysis Using Smartphones (ViMAS): A Pilot Study

The use of smartphones in clinical practice is steadily increasing with the availability of low cost/freely available &#34;apps&#34; that could be used to assess human gait. The primary aim of this manuscript is to test the concurrent validity of kinematic measures recorded by a smartphone application in comparison to a 3D motion capture system in the sagittal plane. The secondary aim was to develop a protocol for clinicians on the set up of the smartphone camera for video movement analysis.
The sagittal plane knee angle was measured during heel strike and toe off events using the smart phone app and a 3D motion-capture system in 32 healthy subjects. Three trials were performed at near (2-m) and far (4-m) smartphone camera distances. The order of the distances was randomized. Regression analysis was performed to estimate the height of the camera based on either the subject&#39;s height or leg length.
Absolute measurement errors were least during toe off (3.12 &#177; 5.44 degrees) compared to heel strike (5.81 &#177; 5.26 degrees). There were significant (p &#60; 0.05) but moderate agreements between the application and 3D motion capture measures of knee angles. There were also no significant (p &#62; 0.05) differences between the absolute measurement errors between the two camera positions. The measurement errors averaged between 3 - 5 degrees during toe off and heel strike events of the gait cycle.
The use of smartphone apps can be a useful tool in the clinic for performing gait or human movement analysis. Further studies are needed to establish the accuracy in measuring movements of the upper extremity and trunk.

Video Movement Analysis Using Smartphones ViMAS: A Pilot Study

This manuscript describes the method to test the concurrent validity of kinematic measures recorded by the smartphone application in comparison to a 3D motion capture system in the sagittal plane. This protocol will enable clinicians to set up smartphones for video capture of human movement.

The use of smartphones in clinical practice is steadily increasing with the availability of low cost/freely available &#34;apps&#34; that could be used to ...

Evaluating Postural Control and Lower-extremity Muscle Activation in Individuals with Chronic Ankle Instability

Computerized dynamic posturography (CDP) is an objective technique for the evaluation of postural stability under static and dynamic conditions and perturbation. CDP is based on the inverted pendulum model that traces the interrelationship between the center of pressure and the center of gravity. CDP can be used to analyze the proportions of vision, proprioception, and vestibular sensation to maintain postural stability. The following characters define chronic ankle instability (CAI): persistent ankle pain, swelling, the feeling of &#8220;giving way,&#8221; and self-reported disability. Postural stability and fibular muscle activation level in individuals with CAI decreased due to lateral ankle ligament complex injuries. Few studies have used CDP to explore the postural stability of individuals with CAI. Studies that investigate postural stability and related muscle activation by using synchronized CDP with surface electromyography are lacking. This CDP protocol includes a sensory organization test (SOT), a motor control test (MCT), and an adaption test (ADT), as well as tests that measure unilateral stance (US) and limit of stability (LOS). The surface electromyography system is synchronized with CDP to collect data on lower limb muscle activation during measurement. This protocol presents a novel approach for evaluating the coordination of the visual, somatosensory, and vestibular systems and related muscle activation to maintain postural stability. Moreover, it provides new insights into the neuromuscular control of individuals with CAI when coping with real complex environments.

Individuals with chronic ankle instability (CAI) exhibit postural control deficiency and delayed muscle activation of lower extremities. Computerized dynamic posturography combined with surface electromyography provides insights into the coordination of the visual, somatosensory, and vestibular systems with muscle activation regulation to maintain postural stability in individuals with CAI.

Computerized dynamic posturography (CDP) is an objective technique for the evaluation of postural stability under static and dynamic conditions and ...

Neuroscience

Lower Limb Biomechanical Analysis of Healthy Participants

Biomechanical analysis techniques are useful in the study of human movement. The aim of this study was to introduce a technique for the lower limb biomechanical assessment in healthy participants using commercially available systems. Separate protocols were introduced for the gait analysis and muscle strength testing systems. To ensure maximum accuracy for gait assessment, attention should be given to the marker placements and self-paced treadmill acclimatization time. Similarly, participant positioning, a practice trial, and verbal encouragement are three critical stages in muscle strength testing. The current evidence suggests that the methodology outlined in this article may be effective for the assessment of lower limb biomechanics.

This article introduces a comprehensive experimental methodology on two of the latest technologies available to measure the lower limb biomechanics of individuals.

Biomechanical analysis techniques are useful in the study of human movement. The aim of this study was to introduce a technique for the lower limb ...

Innovative Video-Based Tool for Precision Assessment and Rehabilitation of LBP

Biomechanical Changes Related to Low Back Pain: An Innovative Tool for Movement Pattern Assessment and Treatment Evaluation in Rehabilitation

Low back pain (LBP) is a highly prevalent disorder frequently related to biomechanical alterations. Movement pattern assessments have a role in the rehabilitation management of patients with LBP; however, a precise assessment is challenging in routine clinical settings. Thus, this study aims to assess the biomechanical alterations related to LBP through the development and application of an innovative assessment tool named CameraLab. Patients with LBP were assessed through a video analysis system. The movement pattern assessment tool includes a touchscreen interface and four high-velocity cameras, enabling real-time data acquisition during movement assessments. The cameras capture dynamic movements, facilitating a thorough examination of motor function. A video analysis software application is employed for precise angle assessments and joint tracking. Three patients with LBP were assessed, demonstrating positive results in pain intensity, functional independence, and overall well-being. The integration of advanced technology highlighted the movement pattern alterations and contributed to tailored rehabilitation strategies. The study offers a paradigm shift toward precision rehabilitation. This innovative approach provides valuable insights into the biomechanical changes related to LBP, fostering a deeper understanding for clinicians and paving the way for effective personalized interventions in the management of LBP.

This study shows the role of an innovative tool for assessing and treating biomechanical alterations in low back pain (LBP) patients. Three LBP patients demonstrated improved pain intensity and functional independence post-assessment. The technology aids in tailored rehabilitation strategies, offering insights into LBP biomechanics for personalized interventions.

Low back pain (LBP) is a highly prevalent disorder frequently related to biomechanical alterations. Movement pattern assessments have a role in the ...

Setup for the Quantitative Assessment of Motion and Muscle Activity During a Virtual Modified Box and Block Test

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