A Novel Setup and Protocol to Measure the Range of Motion of the Wrist and the Hand.
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ABSTRACT:
SUBMITTER: Nizamis K
PROVIDER: S-EPMC6210232 | biostudies-literature | 2018 Sep
REPOSITORIES: biostudies-literature
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A Novel Setup and Protocol to Measure the Range of Motion of the Wrist and the Hand.
Nizamis Kostas K Rijken Noortje H M NHM Mendes Ana A Janssen Mariska M H P MMHP Bergsma Arjen A Koopman Bart F J M BFJM
Sensors (Basel, Switzerland) 20180925 10
The human hand is important for the performance of activities of daily living which are directly related to quality of life. Various conditions, such as Duchenne muscular dystrophy (DMD) can affect the function of the human hand and wrist. The ability to assess the impairment in the hand and the wrist by measuring the range of motion (ROM), is essential for the development of effective rehabilitation protocols. Currently the clinical standard is the goniometer. In this study we explore the feasi ...[more]
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Project description:Study designCross-sectional reliability and validity study.Purpose1. To determine intrarater, interrater and inter instrument reliabilities and validity of two digital electro goniometry to measure active wrist/finger range of motions (ROMs) in patients with limited motion. 2. To determine intrarater and interrater reliabilities of digital goniometry to measure torques of PIP passive flexion of the index finger in patients with limited motion.MethodsThe study was designed in a randomized block plan on 44 patients (24 women, 20 men) with limited wrist or hand motions. Two experienced raters measured active wrist ROMs, and active and passive index PIP flexion using two digital goniometers. All measures were repeated by one rater 2-5 days after the initial measurements. The reliability measures were analyzed using Intraclass Correlation Coefficients (ICCs) and the construct validity was determined by correlation coefficients analysis between sub measures of scores; patient rated pain and function (PRWE) and quick Disabilities of the Arm, Shoulder and Hand (quick DASH) scores.ResultsThe intrarater, interrater and inter instrument reliabilities were high in most ROM measures (range 0.64-0.97) for both types of electro-goniometers. The 95% limit of agreements and Bland and Altman plots did not show progressive changes. There was a significant difference in force application between the raters when performing passive ROM measures for PIP index, but the same rater produced consistent force. Most of the NK and J-Tech ROM measures were moderately correlated with the patient rated pain and function scores (range 0.32-0.63).
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Project description:Neurorehabilitation research suggests that not only high training intensity, but also somatosensory information plays a fundamental role in the recovery of stroke patients. Yet, there is currently a lack of easy-to-use robotic solutions for sensorimotor hand rehabilitation. We addressed this shortcoming by developing a novel clinical-driven robotic hand rehabilitation device, which is capable of fine haptic rendering, and that supports physiological full flexion/extension of the fingers while offering an effortless setup. Our palmar design, based on a parallelogram coupled to a principal revolute joint, introduces the following novelties: (1) While allowing for an effortless installation of the user's hand, it offers large range of motion of the fingers (full extension to 180° flexion). (2) The kinematic design ensures that all fingers are supported through the full range of motion and that the little finger does not lose contact with the finger support in extension. (3) We took into consideration that a handle is usually comfortably grasped such that its longitudinal axis runs obliquely from the metacarpophalangeal joint of the index finger to the base of the hypothenar eminence. (4) The fingertip path was optimized to guarantee physiologically correct finger movements for a large variety of hand sizes. Moreover, the device possesses a high mechanical transparency, which was achieved using a backdrivable cable transmission. The transparency was further improved with the implementation of friction and gravity compensation. In a test with six healthy participants, the root mean square of the human-robot interaction force was found to remain as low as 1.37 N in a dynamic task. With its clinical-driven design and easy-to-use setup, our robotic device for hand sensorimotor rehabilitation has the potential for high clinical acceptance, applicability and effectiveness.
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Project description:Purpose To determine the reliability of wrist range of motion (WROM) measurements based on digital photographs taken by patients at home compared with traditional measurements done in the office with a goniometer. Methods Sixty-nine postoperative patients were enrolled in this study at least 3 months postoperatively. Active and passive wrist flexion/extension and radial/ulnar deviation were recorded by one of the two attending surgeons with a 1-degree resolution goniometer at the last postoperative office visit. Patients were provided an illustrated instruction sheet detailing how to take digital photographic images at home in six wrist positions (active and passive flexion/extension, and radial/ulnar deviation). Wrist position was measured from digital images by both the attending surgeons in a randomized, blinded fashion on two separate occasions greater than 2 weeks apart using the same goniometer. Reliability analysis was performed using the intraclass correlation coefficient to assess agreement between clinical and photography-based goniometry, as well as intra- and interobserver agreement. Results Out of 69 enrolled patients, 30 (43%) patients sent digital images. Of the 180 digital photographs, only 9 (5%) were missing or deemed inadequate for WROM measurements. Agreement between clinical and photography-based measurements was "almost perfect" for passive wrist flexion/extension and "substantial" for active wrist flexion/extension and radial/ulnar deviation. Inter- and intraobserver agreement for the attending surgeons was "almost perfect" for all measurements. Discussion This study validates a photography-based goniometry protocol allowing accurate and reliable WROM measurements without direct physician contact. Passive WROM was more accurately measured from photographs than active WROM. This study builds on previous photography-based goniometry literature by validating a protocol in which patients or their families take and submit their own photographs. Clinical Relevance Patient-performed photography-based goniometry represents an alternative to traditional clinical goniometry that could enable longer-term follow-up, overcome travel-related impediments to office visits, improve convenience, and reduce costs for patients.
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Project description:Introduction: Duchenne muscular dystrophy (DMD) is a genetic disorder that induces progressive muscular degeneration. Currently, the increase in DMD individuals' life expectancy is not being matched by an increase in quality of life. The functioning of the hand and wrist is central for performing daily activities and for providing a higher degree of independence. Active exoskeletons can assist this functioning but require the accurate decoding of the users' motor intention. These methods have, however, never been systematically analyzed in the context of DMD. Methods: This case study evaluated direct control (DC) and pattern recognition (PR), combined with an admittance model. This enabled customization of myoelectric controllers to one DMD individual and to a control population of ten healthy participants during a target-reaching task in 1- and 2- degrees of freedom (DOF). We quantified real-time myocontrol performance using target reaching times and compared the differences between the healthy individuals and the DMD individual. Results and Discussion: Our findings suggest that despite the muscle tissue degeneration, the myocontrol performance of the DMD individual was comparable to that of the healthy individuals in both DOFs and with both control approaches. It was also evident that PR control performed better for the 2-DOF tasks for both DMD and healthy participants, while DC performed better for the 1-DOF tasks. The insights gained from this study can lead to further developments for the intuitive multi-DOF myoelectric control of active hand exoskeletons for individuals with DMD.
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Project description:Background. Hand function is essential to a person's self-efficacy and greatly affects quality of life. Adapted utensils with handles of increased diameters have historically been used to assist individuals with arthritis or other hand disabilities for feeding, and other related activities of daily living. To date, minimal research has examined the biomechanical effects of modified handles, or quantified the differences in ranges of motion (ROM) when using a standard versus a modified handle. The aim of this study was to quantify the ranges of motion (ROM) required for a healthy hand to use different adaptive spoons with electrogoniometry for the purpose of understanding the physiologic advantages that adapted spoons may provide patients with limited ROM. Methods. Hand measurements included the distal interphalangeal joint (DIP), proximal interphalangeal joint (PIP), and metacarpophalangeal joint (MCP) for each finger and the interphalangeal (IP) and MCP joint for the thumb. Participants were 34 females age 18-30 (mean age 20.38 ± 1.67) with no previous hand injuries or abnormalities. Participants grasped spoons with standard handles, and spoons with handle diameters of 3.18 cm (1.25 inch), and 4.45 cm (1.75 inch). ROM measurements were obtained with an electrogoniometer to record the angle at each joint for each of the spoon handle sizes. Results. A 3 × 3 × 4 repeated measures ANOVA (Spoon handle size by Joint by Finger) found main effects on ROM of Joint (F(2, 33) = 318.68, Partial η (2) = .95, p < .001), Spoon handle size (F(2, 33) = 598.73, Partial η (2) = .97, p < .001), and Finger (F(3, 32) = 163.83, Partial η (2) = .94, p < .001). As the spoon handle diameter size increased, the range of motion utilized to grasp the spoon handle decreased in all joints and all fingers (p < 0.01). Discussion. This study confirms the hypothesis that less range of motion is required to grip utensils with larger diameter handles, which in turn may reduce challenges for patients with limited ROM of the hand.
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Project description:BackgroundNo goniometric technique is both maximally convenient and completely accurate, although photogoniometry (ie, picture taking to facilitate digital angle measurement) shows promise in this regard. Our purpose was to test the feasibility and reliability of a photogoniometric protocol designed to measure wrist and digit range of motion in general.MethodsTwo independent observers examined a sample of joints in both normal and abnormal hands according to a photogoniometric protocol. Interrater and intrarater correlation were calculated, and these measurements were compared with measurements made by a third independent examiner with a manual goniometer.ResultsThe photo-based measurements were reliable within and between observers; however, only a minority of these measurements were in agreement with manually collected values.ConclusionsAt present, photogoniometry is not an acceptable alternative to manual goniometry for determining wrist and digit range of motion in general. Joint-specific photogoniometry should be the subject of future study, as should relevant imaging and software technology.
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