Benefits of observing pointlight displays in postoperative rehabilitation of the total knee prosthesis (original) (raw)
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Medicina
Background and Objectives: The present study aimed to assess the potential benefit of the observation of rehabilitation-related point-light display in addition to a conventional 3-week rehabilitation program, the objective being to improve functional capacity in patients having undergone total knee arthroplasty. Materials and Methods: Patients randomized in the control group had conventional rehabilitation treatment with two sessions per day 5 days a week of physical therapy (90 min), whereas patients in the experimental group had a program of conventional rehabilitation combined with a point-light display observation two times per day (5 min) and 3 days a week. Results: The patients of both groups had improved their performances by the end of the program, and the pre- and post-test improvement were superior for the experimental group over the control group concerning the total WOMAC score (p = 0.04), the functional WOMAC score (p = 0.03), and correct recognition of point-light disp...
Knee implant kinematics are task-dependent
Journal of The Royal Society Interface
Although total knee arthroplasty (TKA) has become a standard surgical procedure for relieving pain, knowledge of the in vivo knee joint kinematics throughout common functional activities of daily living is still missing. The goal of this study was to analyse knee joint motion throughout complete cycles of daily activities in TKA subjects to establish whether a significant difference in joint kinematics occurs between different activities. Using dynamic videofluoroscopy, we assessed tibio-femoral kinematics in six subjects throughout complete cycles of walking, stair descent, sit-to-stand and stand-to-sit. The mean range of condylar anterior-posterior translation exhibited clear task dependency across all subjects. A significantly larger anterior-posterior translation was observed during stair descent compared to level walking and stand-to-sit. Local minima were observed at approximately 308 flexion for different tasks, which were more prominent during loaded task phases. This characteristic is likely to correspond to the specific design of the implant. From the data presented in this study, it is clear that the flexion angle alone cannot fully explain tibio-femoral implant kinematics. As a result, it seems that the assessment of complete cycles of the most frequent functional activities is imperative when evaluating the behaviour of a TKA design in vivo.
Human Movement Science, 2020
Following total knee replacement (TKR), patients often persist in maladaptive motor behavior which they developed before surgery to cope with symptoms of osteoarthritis. An important challenge in physical therapy is to detect, recognize and change such undesired movement behavior. The goal of this study was to measure the differences in clinical status of patients pre-TKR and post-TKR and to investigate if differences in clinical status were accompanied by differences in the patients'' motor flexibility. Eleven TKR participants were measured twice: pre-TKR and post-TKR (twenty weeks after TKR). In order to infer maladaptation, the pre-TKR and post-TKR measurements of the patient group were separately compared to one measurement in a control group of fourteen healthy individuals. Clinical status was measured with the Visual Analogue Scale (VAS) for pain and knee stiffness and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Furthermore, Lower-limb motor flexibility was assessed by means of a treadmill walking task and a leg-amplitude differentiation task (LAD-task) supported by haptic or visual feedback. Motor flexibility was measured by coordination variability (standard deviation (SD) of relative phase between the legs) and temporal variability (sample entropy) of both leg movements. In the TKR-group, the VAS-pain and VAS-stiffness and the subscales of the KOOS significantly decreased after TKR. In treadmill walking, lower-limb motor flexibility did not significantly change after TKR. Between-leg coordination variability was significantly lower post-TKR compared to controls. In the LAD-task, a significant decrease of between-leg coordination variability between pre-TKR and post-TKR was accompanied by a significant increase in temporal variability. Post-TKR-values of lower-limb flexibility approached the values of the control group. The results demonstrate that a clinically relevant change in clinical status, twenty weeks after TKR, is not accompanied by alterations in lower-limb motor flexibility during treadmill walking but is accompanied by changes in motor flexibility towards the level of healthy controls during a LADtask with visual and haptic feedback. Challenging patients with non-preferred movements such as
arXiv (Cornell University), 2021
Due to the redundancy of our motor system, movements can be performed in many ways. While multiple motor control strategies can all lead to the desired behavior, they result in different joint and muscle forces. This creates opportunities to explore this redundancy, e.g., for pain avoidance or reducing the risk of further injury. To assess the effect of different motor control optimization strategies, a direct measurement of muscle and joint forces is desirable, but problematic for medical and ethical reasons. Computational modeling might provide a solution by calculating approximations of these forces. In this study, we used a full-body computational musculoskeletal model to (1) predict forces measured in knee prostheses during walking and squatting and (2) to study the effect of different motor control strategies (i.e., minimizing joint force vs. muscle activation) on the joint load and prediction error. We found that musculoskeletal models can accurately predict knee joint forces with an RMSE of <0.5 BW in the superior direction and about 0.1 BW in the medial and anterior directions. Generally, minimization of joint forces produced the best predictions. Furthermore, minimizing muscle activation resulted in maximum knee forces of about 4 BW for walking and 2.5 BW for squatting. Minimizing joint forces resulted in maximum knee forces of 2.25 BW and 2.12 BW, i.e., a reduction of 44% and 15%, respectively. Thus, changing the muscular coordination strategy can strongly affect knee joint forces. Patients with a knee prosthesis may adapt their neuromuscular activation to reduce joint forces during locomotion.
RehabGesture: An Alternative Tool for Measuring Human Movement
Telemedicine and e-Health, 2016
Background: Systems for range of motion (ROM) measurement such as OptoTrak, Motion Capture, Motion Analysis, Vicon, and Visual 3D are so expensive that they become impracticable in public health systems and even in private rehabilitation clinics. Telerehabilitation is a branch within telemedicine intended to offer ways to increase motor and/or cognitive stimuli, aimed at faster and more effective recovery of given disabilities, and to measure kinematic data such as the improvement in ROM. Materials and Methods: In the development of the RehabGesture tool, we used the gesture recognition sensor Kinect Ò (Microsoft, Redmond, WA) and the concepts of Natural User Interface and Open Natural Interaction. Results: RehabGesture can measure and record the ROM during rehabilitation sessions while the user interacts with the virtual reality environment. The software allows the measurement of the ROM (in the coronal plane) from 0°extension to 145°flexion of the elbow joint, as well as from 0°a dduction to 180°abduction of the glenohumeral (shoulder) joint, leaving the standing position. The proposed tool has application in the fields of training and physical evaluation of professional and amateur athletes in clubs and gyms and may have application in rehabilitation and physiotherapy clinics for patients with compromised motor abilities. Conclusions: RehabGesture represents a low-cost solution to measure the movement of the upper limbs, as well as to stimulate the process of teaching and learning in disciplines related to the study of human movement, such as kinesiology.
A Novel Framework to Facilitate User Preferred Tuning for a Robotic Knee Prosthesis
IEEE Transactions on Neural Systems and Rehabilitation Engineering
The tuning of robotic prosthesis control is essential to provide personalized assistance to individual prosthesis users. Emerging automatic tuning algorithms have shown promise to ease the device personalization procedure. However, very few automatic tuning algorithms consider the user preference as the tuning goal, which may limit the adoptability of the robotic prosthesis. In this study, we propose and evaluate a novel prosthesis control tuning framework for a robotic knee prosthesis, which could enable user preferred robot behavior in the device tuning process. The framework consists of 1) a User-Controlled Interface that allows the user to select their preferred knee kinematics in gait and 2) a reinforcement learning-based algorithm for tuning high-dimension prosthesis control parameters to meet the desired knee kinematics. We evaluated the performance of the framework along with usability of the developed user interface. In addition, we used the developed framework to investigate whether amputee users can exhibit a preference between different profiles during walking and whether they can differentiate between their preferred profile and other profiles when blinded. The results showed effectiveness of our developed framework in tuning 12 robotic knee prosthesis control parameters while meeting the user-selected knee kinematics. A blinded comparative study showed that users can accurately and consistently identify their preferred prosthetic control knee profile. Further, we preliminarily examined gait biomechanics of the prosthesis users when walking with different prosthesis control and did not find clear difference between walking with preferred prosthesis control and when walking with normative gait control parameters. This study may inform future translation of this novel prosthesis tuning framework for home or clinical use.
Interactive Technologies and Games conference 2012 (ITAG 2012), 2012
Stroke is a major cause of physical disability for those that survive it. Traditionally, treatment of disability involves interaction with professional trained in the movement therapies. However, there is a growing body of research into interactive systems that are intended to provide support for rehabilitation, many of which draw on game-like elements to motivate engagement. A promising tactic to consider when designing such systems is the integration of knowledge from the movement therapies, and this paper is intended to provide support for this tactic. It contributes a detailed consideration of the structure of this knowledge within this domain, considers the challenges inherent in incorporating it into effective designs, and describes a conceptual framework which is intended to support this process. These contributions are illustrated in relation to two influential approaches to movement therapy, namely “Bobath” and the “Motor Re-Learning Program”.
In this paper, we propose a general framework for tuning component-level kinematic features using therapists' overall impressions of movement quality, in the context of a Home-based Adaptive Mixed Reality Rehabilitation (HAMRR) system. We propose a linear combination of non-linear kinematic features to model wrist movement, and propose an approach to learn feature thresholds and weights using high-level labels of overall movement quality provided by a therapist. The kinematic features are chosen such that they correlate with the quality of wrist movements to clinical assessment scores. Further, the proposed features are designed to be reliably extracted from an inexpensive and portable motion capture system using a single reflective marker on the wrist. Using a dataset collected from ten stroke survivors, we demonstrate that the framework can be reliably used for movement quality assessment in HAMRR systems. The system is currently being deployed for largescale evaluations, and will represent an increasingly important application area of motion capture and activity analysis.