Procedure for the quantitative evaluation of motor disturbances in cerebellar ataxic patients (original) (raw)
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A Comprehensive Scheme for the Objective Upper Body Assessments of Subjects with Cerebellar Ataxia
2020
Background Cerebellar ataxia (CA) is a complex motor disorder that exhibits various symptoms such as lack of movement accuracy, delayed motion and ataxic movements associated with gait, extremity and eye. Accurate assessment of ataxic movements forms an integral part, not only in the process of diagnosis, but also to monitor the severity of the neurodegenerative progression, particularly in a rehabilitation context. However, the current assessment schemes are mostly based on the subjective observation of experienced clinicians. Capturing the movement during standard upper limb tests using readily available motion sensors, this paper is intended to amalgamate the sensory information to obtain a more accurate and objective form of assessment. Methods An assessment scheme involving an inertial measurement system and a Kinect system was considered to quantify the degree of ataxia in four instrumented version of upper extremities tests, i.e. Finger Chase (FCT), Finger Tapping (FTT), Fing...
European Journal of Neurology, 2009
Background and purpose: The design of useful and effective treatment strategies for movement disorders largely depends on the ability to objectively quantify changes in performances, providing reliable outcome measures. Evaluation of ataxia remains mainly assigned to different clinical scales, providing a semi-quantitative assessment. The aim of this study was to quantitatively characterize functional changes in upper limb movements in ataxic patients, using an optoelectronic system for objective measurements.Methods: Fourteen patients with cerebellar ataxia and 27 healthy subjects were analyzed using an optoelectronic system with passive markers during pointing task and hand-to-mouth movement. Quantitative parameters capable of characterizing ataxic movements were defined using recorded kinematics.Results: In both the considered functional movements, ataxic patients showed increased adjustment during the last phase of movement. The movement was less smooth than that in controls, with a fragmented trajectory presenting more direction changes than controls.Conclusions: The proposed protocol allows the quantitative characterization of the motion pattern of ataxic subjects in a non-invasive way. We believe that this analysis could represent a good tool for ataxia evaluation in a clinical context such as neurorehabilitation.
Outcome measures for the assessment of balance and posture control in cerebellar ataxia
Physical Therapy Reviews, 2013
Background: Discrepancies exist in the use of outcome measures for the assessment of balance and postural control among people with cerebellar ataxia. There is a need to explore the spectrum of tools used in order to determine their utility. Objectives: The aims of this narrative review were to identify, categorize, and discuss outcome measures used for the evaluation of balance and postural control in cerebellar assessment and intervention, and to identify outcome measures which might relate to the localization of cerebellar lesion. Major findings: Electronic search of the evaluation of cerebellar interventions and identification or illustration of clinical features of problems relating to balance and postural control identified 45 outcome measures. Using the international classification of functioning, the outcome measures were categorized as: health condition-specific (n57), body structure and function level (n513), activity level (n525), and none at a participatory level. Accessibility, time required to perform, and psychometric property testing determined the utility of outcome measures. Frequency and amplitude of postural sway, and measures obtained from force plate testing were used to localize the cerebellar lesion. Conclusion: A wide range of outcome measures were used to assess balance and postural control deficits; none of the clinical tools appeared to localize cerebellar lesion. Health condition-specific outcome measures were used for cerebellar intervention trials and psychometric properties of outcome measures at an activity level were not tested among pure cerebellar lesions. Further investigation is warranted to streamline the utility and selection of outcome measures for clinical practice.
Upper Body Kinematics in Patients with Cerebellar Ataxia
The Cerebellum, 2014
Although abnormal oscillations of the trunk are a common clinical feature in patients with cerebellar ataxia, the kinematic behaviour of the upper body in ataxic patients has yet to be investigated in quantitative studies. In this study, an optoelectronic motion analysis system was used to measure the ranges of motion (ROMs) of the head and trunk segments in the sagittal, frontal and yaw planes in 16 patients with degenerative cerebellar ataxia during gait at self-selected speed. The data obtained were compared with those collected in a gender-, age-and gait speed-matched sample of healthy subjects and correlated with gait variables (time-distance means and coefficients of variation) and clinical variables (disease onset, duration and severity). The results showed significantly larger head and/or trunk ROMs in ataxic patients compared with controls in all three spatial planes, and significant correlations between trunk ROMs and disease duration and severity (in sagittal and frontal planes) and time-distance parameters (in the yaw plane), and between both head and trunk ROMs and swing phase duration variability (in the sagittal plane). Furthermore, the ataxic patients showed a flexed posture of both the head and the trunk during walking. In conclusion, our study revealed abnormal motor behaviour of the upper body in ataxic patients, mainly resulting in a flexed posture and larger oscillations of the head and trunk. The results of the correlation analyses suggest that the longer and more severe the disease, the larger the upper body oscillations and that large trunk oscillations may explain some aspects of gait variability. These results suggest the need of specific rehabilitation treatments or the use of elastic orthoses that may be particularly useful to reduce trunk oscillations and improve dynamic stability.
Cerebellar ataxia: Quantitative assessment and cybernetic interpretation
Human Movement Science, 2003
To assess neuromotor disorders clinicians often rely on rating scales. Unfortunately, these scales lack the sensitivity and accuracy needed to detect the small changes in motor coordination that reflect the clinical progression of the disease on the basis of which treatment programmes can be adjusted. As a contribution to this topic, the present paper proposes a straightforward kinematic and kinetic analysis of reaching movements of patients with cerebellar ataxia in conjunction with a cybernetic interpretation of the data. The aim of the approach is to capture key deficits in the underlying motor control processes. We suggest that cerebellar ataxia may be characterized by defective feedforward control.
Gait in patients with cerebellar ataxia
Movement Disorders, 1998
The gait pattern in 10 patients with cerebellar degenerations was studied and the results were compared with 10 matched normal subjects, seeking the principal patterns in this disorder. Gait at natural speed was studied in a biomechanics laboratory using a video-based kinematic data acquisition system for measuring body movements. Patients showed a reduced step and stride length with a trend to reduced cadence. Heel off time, toe off time, and time of peak flexion of the knee in swing were all delayed. Range of motion of ankle, knee, and hip were all reduced, but only ankle range of motion reached significance. Multijoint coordination was impaired, as indicated by a relatively greater delay of plantar flexion of the ankle compared with flexion of the knee and a relatively late knee flexion compared with hip flexion at the onset of swing. The patients also showed increased variability of almost all measures. Although some of the deviations from normal were simply the result of slowness of walking, the gait pattern of patients with cerebellar degeneration shows incoordination similar to that previously described for their multijoint limb motion.
Kinematic abnormalities of fast multijoint movements in cerebellar ataxia include abnormally increased curvature of hand trajectories and an increased hand path and are thought to originate from an impairment in generating appropriate levels of muscle torques to support normal coordination between shoulder and elbow joints. Such a mechanism predicts that kinematic abnormalities are pronounced when fast movements are performed and large muscular torques are required. Experimental evidence that systematically explores the effects of increasing movement velocities on movement kinematics in cerebellar multijoint movements is limited and to some extent contradictory. We, therefore, investigated angular and hand kinematics of natural multijoint pointing movements in patients with cerebellar degenerative disorders and healthy controls. Subjects performed self-paced vertical pointing movements with their right arms at three different target velocities. Limb movements were recorded in three-dimensional space using a two-camera infra- red tracking system. Differences between patients and healthy subjects were most prominent when the subjects performed fast movements. Peak hand acceleration and deceleration were similar to normals during slow and moderate velocity movements but were smaller for fast movements. While altering movement velocities had little or no effect on the length of the hand path and angular motion of elbow and shoulder joints in normal subjects, the patients exhibited overshooting motions (hypermetria) of the hand and at both joints as movement velocity increased. Hypermetria at one joint always accompanied hypermetria at the neighboring joint. Peak elbow angular deceleration was markedly delayed in patients compared with normals. Other temporal movement variables such as the relative timing of shoulder and elbow joint motion onsets were normal in patients. Kinematic abnormalities of multijoint arm movements in cerebellar ataxia include hypermetria at both the elbow and the shoulder joint and, as a consequence, irregular and enlarged paths of the hand, and they are marked with fast but not with slow movements. Our findings suggest that kinematic movement abnormalities that characterize cerebellar limb ataxia are related to an impairment in scaling movement variables such as joint acceleration and deceleration normally with movement speed. Most likely, increased hand paths and decomposition of movement during slow movements, as described earlier, result from compensatory mechanisms the patients may employ if maximum movement accuracy is required.
Coordination of multi-joint arm movements in cerebellar ataxia
Experimental Brain Research, 1998
Kinematic abnormalities of fast multijoint movements in cerebellar ataxia include abnormally increased curvature of hand trajectories and an increased hand path and are thought to originate from an impairment in generating appropriate levels of muscle torques to support normal coordination between shoulder and elbow joints. Such a mechanism predicts that kinematic abnormalities are pronounced when fast movements are performed and large muscular torques are required. Experimental evidence that systematically explores the effects of increasing movement velocities on movement kinematics in cerebellar multijoint movements is limited and to some extent contradictory. We, therefore, investigated angular and hand kinematics of natural multijoint pointing movements in patients with cerebellar degenerative disorders and healthy controls. Subjects performed self-paced vertical pointing movements with their right arms at three different target velocities. Limb movements were recorded in three-dimensional space using a two-camera infrared tracking system. Differences between patients and healthy subjects were most prominent when the subjects performed fast movements. Peak hand acceleration and deceleration were similar to normals during slow and moderate velocity movements but were smaller for fast movements. While altering movement velocities had little or no effect on the length of the hand path and angular motion of elbow and shoulder joints in normal subjects, the patients exhibited overshooting motions (hypermetria) of the hand and at both joints as movement velocity increased. Hypermetria at one joint always accompanied hypermetria at the neighboring joint. Peak elbow angular deceleration was markedly delayed in patients compared with normals. Other temporal movement variables such as the relative timing of shoulder and elbow joint motion onsets were normal in patients. Kinematic abnormalities of multijoint arm movements in cerebellar ataxia include hypermetria at both the elbow and the shoulder joint and, as a consequence, irregular and enlarged paths of the hand, and they are marked with fast but not with slow movements. Our findings suggest that kinematic movement abnormalities that characterize cerebellar limb ataxia are related to an impairment in scaling movement variables such as joint acceleration and deceleration normally with movement speed. Most likely, increased hand paths and decomposition of movement during slow movements, as described earlier, result from compensatory mechanisms the patients may employ if maximum movement accuracy is required.
Objective Assessment of Cerebellar Ataxia: A Comprehensive and Refined Approach
Scientific Reports
Parametric analysis of Cerebellar Ataxia (CA) could be of immense value compared to its subjective clinical assessments. This study focuses on a comprehensive scheme for objective assessment of CA through the instrumented versions of 9 commonly used neurological tests in 5 domains- speech, upper limb, lower limb, gait and balance. Twenty-three individuals diagnosed with CA to varying degrees and eleven age-matched healthy controls were recruited. Wearable inertial sensors and Kinect camera were utilised for data acquisition. Binary and multilabel discrimination power and intra-domain relationships of the features extracted from the sensor measures and the clinical scores were compared using Graph Theory, Centrality Measures, Random Forest binary and multilabel classification approaches. An optimal subset of 13 most important Principal Component (PC) features were selected for CA-control classification. This classification model resulted in an impressive performance accuracy of 97% (...
Gait & posture, 2018
Cerebellar ataxia often results in impairment in ambulation secondary to gait pattern dysfunction and compensatory gait adjustments. Pharmaceutical and therapy-based interventions with potential benefit for gait in ataxia are starting to emerge, however evaluation of such interventions is hampered by the lack of outcome measures that are responsive, valid and reliable for measurement of gait decline in cerebellar ataxia. This systematic review aimed for the first time to evaluate the psychometric properties of gait and walking outcomes applicable to individuals with cerebellar ataxia. Only studies evaluating straight walking were included. A comprehensive search of three databases (MEDLINE, CINAHL and EMBASE) identified 53 studies meeting inclusion criteria. Forty-nine were rated as 'poor' as assessed by the COnsensus-based Standards for the selection of health Measurement INstruments checklist. The primary objective of most studies was to explore changes in gait related to ...