Can kinematic parameters of 3D reach-to-target movements be used as a proxy for clinical outcome measures in chronic stroke rehabilitation? An exploratory study

Catherine Adans-Dester, Susan E Fasoli, Eric Fabara, Nicolas Menard, Annie B Fox, Giacomo Severini, Paolo Bonato, Catherine Adans-Dester, Susan E Fasoli, Eric Fabara, Nicolas Menard, Annie B Fox, Giacomo Severini, Paolo Bonato

Abstract

Background: Despite numerous trials investigating robot-assisted therapy (RT) effects on upper-extremity (UE) function after stroke, few have explored the relationship between three-dimensional (3D) reach-to-target kinematics and clinical outcomes. The objectives of this study were to 1) investigate the correlation between kinematic parameters of 3D reach-to-target movements and UE clinical outcome measures, and 2) examine the degree to which differences in kinematic parameters across individuals can account for differences in clinical outcomes in response to RT.

Methods: Ten chronic stroke survivors participated in a pilot RT intervention (eighteen 1-h sessions) integrating cognitive skills training and a home-action program. Clinical outcome measures and kinematic parameters of 3D reach-to-target movements were collected pre- and post-intervention. The correlation between clinical outcomes and kinematic parameters was investigated both cross-sectionally and longitudinally (i.e., changes in response to the intervention). Changes in clinical outcomes and kinematic parameters were tested for significance in both group and subject-by-subject analyses. Potential associations between individual differences in kinematic parameters and differences in clinical outcomes were examined.

Results: Moderate-to-strong correlation was found between clinical measures and specific kinematic parameters when examined cross-sectionally. Weaker correlation coefficients were found longitudinally. Group analyses revealed significant changes in clinical outcome measures in response to the intervention; no significant group changes were observed in kinematic parameters. Subject-by-subject analyses revealed changes with moderate-to-large effect size in the kinematics of 3D reach-to-target movements pre- vs. post-intervention. Changes in clinical outcomes and kinematic parameters varied widely across participants.

Conclusions: Large variability was observed across subjects in response to the intervention. The correlation between changes in kinematic parameters and clinical outcomes in response to the intervention was variable and not strong across parameters, suggesting no consistent change in UE motor strategies across participants. These results highlight the need to investigate the response to interventions at the individual level. This would enable the identification of clusters of individuals with common patterns of change in response to an intervention, providing an opportunity to use cluster-specific kinematic parameters as a proxy of clinical outcomes.

Trial registration: ClinicalTrials.gov, NCT02747433 . Registered on April 21st, 2016.

Keywords: Clinical outcomes; Kinematics; Reach-to-target; Rehabilitation; Robot-assisted therapy; Stroke; Upper extremity.

Conflict of interest statement

The authors have no financial interests related to the content of this manuscript.

Additional disclosures: GS has received grant support (as Principal Investigator) from the EU (H2020) and Enterprise Ireland. SF received funding support from the MGH Institute of Health Professions, Faculty Research Fellowship and would like to acknowledge a research loan of the Amadeo™ robot from Tyromotion (Graz, AT) for this pilot study. PB has received grant support from the American Heart Association, the Department of Defense, the Michael J Fox Foundation, the National Institutes of Health (NIH), the National Science Foundation (NSF), and the Peabody Foundation including sub-awards on NIH and NSF SBIR grants from Barrett Technology (Newton MA), BioSensics (Watertown MA) and Veristride (Salt Lake City UT). He has also received grant support from Emerge Diagnostics (Carlsbad CA), MC10 (Lexington MA), Mitsui Chemicals (Tokyo Japan), Pfizer (New York City NY), Shimmer Research (Dublin Ireland), and SynPhNe (Singapore). He serves in an advisory role the Michael J Fox Foundation, the NIH-funded Center for Translation of Rehabilitation Engineering Advances and Technology, and the NIH-funded New England Pediatric Device Consortium. He also serves on the Scientific Advisory Boards of Hocoma AG (Zurich Switzerland), Trexo (Toronto Canada), and ABLE Human Motion (Barcelona, Spain) in an uncompensated role. The other authors have no disclosures relevant to the study.

Figures

Fig. 1
Fig. 1
Experimental Set-up. a. Subject set-up: Twenty reflective markers were placed on the following body landmarks: 7th cervical vertebra spinous process, 10th thoracic vertebra spinous process, suprasternal notch and xiphoid process. Markers were also placed bilaterally on the acromion, upper-arm, lateral epicondyle of the humerus, forearm, radial styloid process, ulnar styloid process, first metacarpal head and second metacarpal head. b. Biomechanical model of subject in 1a and the target panel: Biomechanical model (Plug-in-gait) applied to reconstruct UE segments and derive kinematic parameters
Fig. 2
Fig. 2
Changes in kinematic parameters pre- vs. post-intervention (subject-by-subject analyses). Improvements are represented above the horizontal line. Circles filled in grey and black represent statistically significant changes after Holm-Adjustment at p<0.05 and p<0.005, respectively. Unfilled circles represent changes that did not reach statistical significance.

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