Kinect-based assessment of proximal arm non-use after a stroke

K K A Bakhti, I Laffont, M Muthalib, J Froger, D Mottet, K K A Bakhti, I Laffont, M Muthalib, J Froger, D Mottet

Abstract

Background: After a stroke, during seated reaching with their paretic upper limb, many patients spontaneously replace the use of their arm by trunk compensation movements, even though they are able to use their arm when forced to do so. We previously quantified this proximal arm non-use (PANU) with a motion capture system (Zebris, CMS20s). The aim of this study was to validate a low-cost Microsoft Kinect-based system against the CMS20s reference system to diagnose PANU.

Methods: In 19 hemiparetic stroke individuals, the PANU score, reach length, trunk length, and proximal arm use (PAU) were measured during seated reaching simultaneously by the Kinect (v2) and the CMS20s over two testing sessions separated by two hours.

Results: Intraclass correlation coefficients (ICC) and linear regression analysis showed that the PANU score (ICC = 0.96, r2 = 0.92), reach length (ICC = 0.81, r2 = 0.68), trunk length (ICC = 0.97, r2 = 0.94) and PAU (ICC = 0.97, r2 = 0.94) measured using the Kinect were strongly related to those measured using the CMS20s. The PANU scores showed good test-retest reliability for both the Kinect (ICC = 0.76) and CMS20s (ICC = 0.72). Bland and Altman plots showed slightly reduced PANU scores in the re-test session for both systems (Kinect: - 4.25 ± 6.76; CMS20s: - 4.71 ± 7.88), which suggests a practice effect.

Conclusion: We showed that the Kinect could accurately and reliably assess PANU, reach length, trunk length and PAU during seated reaching in post stroke individuals. We conclude that the Kinect can offer a low-cost and widely available solution to clinically assess PANU for individualised rehabilitation and to monitor the progress of paretic arm recovery.

Trial registration: The study was approved by The Ethics Committee of Montpellier, France (N°ID-RCB: 2014-A00395-42) and registered in Clinical Trial (N° NCT02326688, Registered on 15 December 2014, https://ichgcp.net/clinical-trials-registry/NCT02326688 ).

Keywords: Arm non-use; Kinect v2; Movement analysis; Rehabilitation; Stroke.

Conflict of interest statement

Ethics approval and consent to participate

The Ethics Committee of Montpellier, France, approved the study protocol (N°ID-RCB: 2014-A00395–42). Clinical trial registration number: NCT02326688.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Experimental setup. The quantification of the proximal arm non-use (PANU) score was simultaneously determined by the Kinect (blue encircled) and CMS20s (red encircled) movement recording systems. The CMS20s recorded the position of 3 markers placed on the manubrium, right dorsal hand, left dorsal hand (blue spots). The Kinect provided a skeleton of the person (orange) out of which we retained 3 “joints” corresponding best to the position of CMS20s markers on the body: Spine-Shoulder, WristRight, WristLeft
Fig. 2
Fig. 2
Comparison of PANU scores obtained with the Kinect and CMS20s systems. The left panel presents the Bland and Altman plot and the right panel presents the linear regression plot. PANU scores obtained with the Kinect and CMS20s were strongly correlated, yet with a small underestimate with the Kinect
Fig. 3
Fig. 3
Comparison of PANU components obtained with the Kinect and CMS20s systems. Panels in the first row illustrate proximal arm-use (PAU). Panels in the second row illustrate trunk movement amplitude (∆Trunk). Panels in the third row illustrate reach length (∆Hand). For each row, the left panel represents the Bland and Altman plot and the right panel represents the linear regression plot. The three components are adequately determined by the Kinect, yet with a small underestimate for ∆Hand (11 mm)
Fig. 4
Fig. 4
Comparison of movement kinematics obtained with the Kinect and CMS20s. Panels in the first row illustrate the movement time (MT). Panels in the second row illustrate the number of velocity peaks (NVP). For each row, the left panel represents the Bland and Altman plot and the right panel represents the linear regression plot. The movement time is adequately determined by the Kinect, but not the number of velocity peaks
Fig. 5
Fig. 5
Test-retest of PANU scores with the Kinect and CMS20s. Each panel compares the PANU scores in the test (R1) and retest (R2) sessions. Panels in the first row illustrate repeatability with the Kinect. Panels in the second row illustrate repeatability with the CMS20s. For each row, the left panel represents the Bland and Altman plot and the right panel represents the linear regression plot. The constant bias in the Bland and Altman plots (− 4.25 for Kinect; − 4.71 for CMS20s) indicates that the PANU scores decrease over repetitions, which was accurately determined by the Kinect and the CMS20s

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