System identification: a feasible, reliable and valid way to quantify upper limb motor impairments

Journal of NeuroEngineering and Rehabilitation

Research

Mark van de Ruit¹  Claudia J. W. Haarman²  Joyce L. Benner³  Ruud W. Selles³  Gerard M. Ribbers³  Levinia L. van der Velden³  Bram Onneweer⁴ 

[1] Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628CD, Delft, The Netherlands;Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands;Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands;Hankamp Rehab, Enschede, The Netherlands;Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands;Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands;Rijndam Rehabilitation, Westersingel 300, 3015 LJ, Rotterdam, The Netherlands;

关键词: Viscoelasticity;    Biomechanics;    Upper limb;    Diagnostics;    Motor impairments;   

DOI  :  10.1186/s12984-023-01192-x

 received in 2022-07-22, accepted in 2023-05-10,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundUpper limb impairments in a hemiparetic arm are clinically quantified by well-established clinical scales, known to suffer poor validity, reliability, and sensitivity. Alternatively, robotics can assess motor impairments by characterizing joint dynamics through system identification. In this study, we establish the merits of quantifying abnormal synergy, spasticity, and changes in joint viscoelasticity using system identification, evaluating (1) feasibility and quality of parametric estimates, (2) test–retest reliability, (3) differences between healthy controls and patients with upper limb impairments, and (4) construct validity.MethodsForty-five healthy controls, twenty-nine stroke patients, and twenty cerebral palsy patients participated. Participants were seated with the affected arm immobilized in the Shoulder-Elbow-Perturbator (SEP). The SEP is a one-degree-of-freedom perturbator that enables applying torque perturbations to the elbow while providing varying amounts of weight support to the human arm. Participants performed either a ‘do not intervene’ or a resist task. Elbow joint admittance was quantified and used to extract elbow viscosity and stiffness. Fifty-four of the participants performed two sessions to establish the test–retest reliability of the parameters. Construct validity was assessed by correlating system identification parameters to parameters extracted using a SEP protocol that objectifies current clinical scales (Re-Arm protocol).ResultsFeasibility was confirmed by all participants successfully completing the study protocol within ~ 25 min without reporting pain or burden. The parametric estimates were good with a variance-accounted-for of ~ 80%. A fair to excellent test–retest reliability was found (ICC=0.46-0.98\documentclass[12pt]{minimal}\usepackage{amsmath}\usepackage{wasysym}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{amsbsy}\usepackage{mathrsfs}\usepackage{upgreek}\setlength{\oddsidemargin}{-69pt}\begin{document}$$ICC = 0.46-0.98$$\end{document}) for patients, except for elbow stiffness with full weight support (ICC=0.35\documentclass[12pt]{minimal}\usepackage{amsmath}\usepackage{wasysym}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{amsbsy}\usepackage{mathrsfs}\usepackage{upgreek}\setlength{\oddsidemargin}{-69pt}\begin{document}$$ICC = 0.35$$\end{document}). Compared to healthy controls, patients had a higher elbow viscosity and stiffness during the ‘do not intervene’ task and lower viscosity and stiffness during the resist task. Construct validity was confirmed by a significant (all p<0.03\documentclass[12pt]{minimal}\usepackage{amsmath}\usepackage{wasysym}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{amsbsy}\usepackage{mathrsfs}\usepackage{upgreek}\setlength{\oddsidemargin}{-69pt}\begin{document}$$p<0.03$$\end{document}) but weak to moderate (r=0.36-0.50\documentclass[12pt]{minimal}\usepackage{amsmath}\usepackage{wasysym}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{amsbsy}\usepackage{mathrsfs}\usepackage{upgreek}\setlength{\oddsidemargin}{-69pt}\begin{document}$$r = 0.36-0.50$$\end{document}) correlation with parameters from the Re-Arm protocol.ConclusionsThis work demonstrates that system identification is feasible and reliable for quantifying upper limb motor impairments. Validity was confirmed by differences between patients and controls and correlations with other measurements, but further work is required to optimize the experimental protocol and establish clinical value.

【 授权许可】

CC BY   
© The Author(s) 2023

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