RESUMEN

Background: The human upper extremity is characterized by inherent motor abundance, allowing a diverse array of tasks with agility and adaptability. Upper extremity functional limitations are a common sequela to Stroke, resulting in pronounced motor and sensory impairments in the contralesional arm. While many therapeutic interventions focus on rehabilitating the weaker arm, it is increasingly evident that it is necessary to consider bimanual coordination and motor control. Methods: Participants were recruited to two groups differing in age (Group 1 (n = 10): 23.4 ± 2.9 years, Group 2 (n = 10): 55.9 ± 10.6 years) for an exploratory study on the use of accelerometry to quantify bilateral coordination. Three tasks featuring coordinated reaching were selected to investigate the acceleration of the upper arm, forearm, and hand during activities of daily living (ADLs). Subjects were equipped with acceleration and inclination sensors on each upper arm, each forearm, and each hand. Data was segmented in MATLAB to assess inter-limb and intra-limb coordination. Inter-limb coordination was indicated through dissimilarity indices and temporal locations of congruous movement between upper arm, forearm, or hand segments of the right and left limbs. Intra-limb coordination was likewise assessed between upper arm-forearm, upper arm-hand, and forearm-hand segment pairs of the dominant limb. Findings: Acceleration data revealed task-specific movement features during the three distinct tasks. Groups demonstrated diminished similarity as task complexity increased. Groups differed significantly in the hand segments during the buttoning task, with Group 1 showing no coordination in the hand segments during buttoning, and strong coordination in reaching each button with the upper arm and forearm guiding extension. Group 2's dissimilarity scores and percentages of similarity indicated longer periods of inter-limb coordination, particularly towards movement completion. Group 1's dissimilarity scores and percentages of similarity indicated longer periods of intra-limb coordination, particularly in the coordination of the upper arm and forearm segments. Interpretation: The Expanding Procrustes methodology can be applied to compute objective coordination scores using accessible and highly accurate wearable acceleration sensors. The findings of task duration, angular velocity, and peak roll angle are supported by previous studies finding older individuals to present with slower movements, reduced movement stability, and a reduction of laterality between the limbs. The theory of a shift towards ambidexterity with age is supported by the finding of greater inter-limb coordination in the group of subjects above the age of thirty-five. The group below the age of thirty was found to demonstrate longer periods of intra-limb coordination, with upper arm and forearm coordination emerging as a possible explanation for the demonstrated greater stability.

Asunto(s)

Acelerometría , Actividades Cotidianas , Extremidad Superior , Dispositivos Electrónicos Vestibles , Humanos , Persona de Mediana Edad , Masculino , Femenino , Acelerometría/instrumentación , Acelerometría/métodos , Adulto , Extremidad Superior/fisiología , Adulto Joven , Anciano , Desempeño Psicomotor/fisiología , Movimiento/fisiología , Antebrazo/fisiología

RESUMEN

Upper extremity motor impairment affects about 80% of persons after strokes. For stroke rehabilitation, upper limb kinematic assessments have increasingly been used as primary or secondary outcome measures. There is currently no universal standardized scale for categorizing multi-joint upper extremity movement. We propose a modified Procrustes statistical shape method as a quantitative analysis that can recognize segments of movement where multiple limb segments are coordinating movement. Rather than rely solely on discrete kinematic values to contrast movement, this method allows evaluation of how movement progresses. The Procrustes analysis of able-bodied movement showed that the hand and forearm segments moved in a more coordinated manner during initiation. The shoulder and elbow become more coordinated during movement completion. In impaired movement, this coordination between the hand and forearm is disrupted as the arm decelerates. The utilization of Procrustes analysis may be a step towards developing a comprehensive and universal quantitative tool that does not require changes to existing treatments or increase patient burden.Clinical relevance- This modified Procrustes Shape Analysis method can be applied by clinicians to motion capture data from patients suffering upper extremity movement deficits to objectively identify multi-joint coordination and recovery.

Asunto(s)

Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Extremidad Superior , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico , Hombro , Codo , Rehabilitación de Accidente Cerebrovascular/métodos

RESUMEN

Background: Strokes are a leading cause of disability worldwide, with many survivors experiencing difficulty in recovering upper extremity movement, particularly hand function and grasping ability. There is currently no objective measure of movement quality, and without it, rehabilitative interventions remain at best informed estimations of the underlying neural structures' response to produce movement. In this article, we utilize a novel modification to Procrustean distance to quantify curve dissimilarity and propose the Reach Severity and Dissimilarity Index (RSDI) as an objective measure of motor deficits. Methods: All experiments took place at the Medstar National Rehabilitation Hospital; persons with stroke were recruited from the hospital patient population. Using Fugl-Meyer (FM) scores and reach capacities, stroke survivors were placed in either mild or severe impairment groups. Individuals completed sets of reach-to-target tasks to extrapolate kinematic metrics describing motor performance. The Procrustes method of statistical shape analysis was modified to identify reaching sub-movements that were congruous to able-bodied sub-movements. Findings: Movement initiation proceeds comparably to the reference curve in both two- and three-dimensional representations of mild impairment movement. There were significant effects of the location of congruent segments between subject and reference curves, mean velocities, peak roll angle, and target error. These metrics were used to calculate a preliminary RSDI score with severity and dissimilarity sub-scores, and subjects were reclassified in terms of rehabilitation goals as Speed Emphasis, Strength Emphasis, and Combined Emphasis. Interpretation: The modified Procrustes method shows promise in identifying disruptions in movement and monitoring recovery without adding to patient or clinician burden. The proposed RSDI score can be adapted and expanded to other functional movements and used as an objective clinical tool. By reducing the impact of stroke on disability, there is a significant potential to improve quality of life through individualized rehabilitation.

Asunto(s)

Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Fenómenos Biomecánicos , Calidad de Vida , Recuperación de la Función/fisiología , Extremidad Superior , Accidente Cerebrovascular/diagnóstico

RESUMEN

Cells exhibit biologically heterogeneous phenotypes, particularly in pathogenic states. To study cell behavior at the single cell level, a variety of micropatterning techniques have been proposed that allow the spatial organization of cells with great control over cell volume, morphology, and intercellular interactions. Among these strategies, microstencil patterning has traditionally been eschewed due to fragility of membranes and lack of control over cell configurations within patterns. Here, we present a simple and reproducible strategy to create robust microstencils and achieve consistent and efficient cell patterns requiring less than 4 µl of cell solution. Polydimethylsiloxane microstencils fabricated with this technique can be used dozens of times over the course of several months with minimal wear or degradation. Characterization of pattern size, cell suspension density, and droplet volume allows on-demand configurations of singlets, doublets, triplets, or multiple cells per individual space. In addition, a novel technique to suppress evaporative convection provides precise and repeatable results, with a twofold increase in patterning efficacy. Selective dual surface modification to create hydrophilic islands on a hydrophobic substrate facilitates a significantly longer and healthier lifespan of cells without crossover of pattern boundaries. The ability to pattern individual cells with or without an extracellular matrix substrate and to control the magnitude of cell-cell contact as well as spread area provides a powerful approach to monitoring cell functions such as proliferation and intercellular signaling.