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Quantifying pathological synergies in the upper extremity of stroke patients with the use of a multisensory system

Bhagubai, Miguel M. C. (2019) Quantifying pathological synergies in the upper extremity of stroke patients with the use of a multisensory system.

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Abstract:Stroke is the third most common cause of disability in the world, where 5 million patients become permanently disabled. Stroke is caused by a disruption of blood flow in the brain, causing neuronal cell death. Depending on the size and location of the tissue damage, different types of disabilities can be experienced by stroke survivors. Around 80% of stroke patients suffer from motor deficits in the upper extremity, which limits the limbs’ functionality. In order to recover motor function, stroke patients resort to rehabilitation. The rehabilitation process is an extensive and complex procedure due to the diverse and varied types of impairment. In order to increase the efficiency and to evaluate the patients’ progress, a proper assessment of motor function is required. The rehabilitation procedure is adapted based on the reassessment of patients through time. Stroke patients are usually assessed by therapists in a laboratory environment. Several assessment protocols and scales are used to identify and qualify the severity of motor impairments, as well as the level of functional performance of the upper extremity. With the use of assessment scales, therapists are able to score the level of impairment of patients. However, stroke assessment scales are exclusively observer-based, either by a clinician or by self-report. High inter-rater reliability and well defined protocols are required. Inconsistencies in the assessment of the level of impairment can lead to less efficient rehabilitation programs. Sensor-based technologies have been developed in order to objectively quantify the presence and severity of motor impairments in stroke patients. Kinematic measures of the patient’s movement during the assessment procedures provides a detailed and objective measure of motor function and performance. The present thesis focuses on the usability of a multisensory distributed system in measuring abnormal movement patterns in the upper extremity of stroke patients. The main objective of this thesis is the evaluation of a sensor based system that can objectively measure stroke patient’s kinematics and identify irregular pathological upper extremity movements. The multisensory system developed is composed of several Inertial Measurement Units distributed along the trunk, arm and hand. Additionally, force sensors are included in the fingertips of the thumb, index and middle fingers. An electromyographic measuring system is used in parallel in order to measure muscle activity of key muscles of the upper extremity. In this thesis, measurements with the system were performed in stroke patients and a kinematic analysis is presented to extract relevant features for assessing the upper extremity. The system was used in two different scenarios: 1) while stroke patients perform predefined movements of the Fugl-Meyer Assessment scale (a motor function evaluation scale) and 2) while patients perform reach-grasp-displace tasks of several blocks (with different sizes and weight). The extracted features were used to evaluate the patient’s performance and to identify pathological synergistic movements during the movements. The system’s ability of identifying abnormal movements and in characterizing the patient’s performance was evaluated. It was found that stereotypical movements related to motor impairments can be measured in both the affected and non-affected upper extremities of stroke patients. The severity of these pathological movements reflected in the kinematic features was also related to the level of impairment of patients according to the severity score given by a therapist (Fugl-Meyer Assessment Score). It was found that the system can measure a higher coupled activity of the shoulder and elbow joints when the tasks are performed with the affected arm (directly related to the level of pathological muscle coupling). In the functional reach-grasp-displace tasks, the more affected patients showed to adopt more compensation strategies in order to successfully displace the different objects. The size of the object was shown to affect the posture of the hand and the way patients grasp it. The weight of the object had an effect on the level of compensation that patients use. The use of the multisensory system has made it possible to analyse detailed movement patterns and arm postures during the clinical assessment evaluation of the upper extremity of stroke patients. The usage of this system in the clinic can provide a better and objective evaluation of the severity of motor impairments. However, the presented methods need to be further tested in a larger population. The presented kinematic features can also be extended to fully characterize the patient’s motor function and performance. Nevertheless, the system has great potential to complement the clinical evaluation of stroke patients.
Item Type:Essay (Master)
Faculty:EEMCS: Electrical Engineering, Mathematics and Computer Science
Subject:02 science and culture in general, 44 medicine, 50 technical science in general
Programme:Biomedical Engineering MSc (66226)
Link to this item:http://purl.utwente.nl/essays/80294
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