Measuring Health: A Guide to Rating Scales and Questionnaires

The existing shortage of therapists and caregivers assisting physically disabled individuals at home is expected to increase and become serious problem in the near future The patient population needing physical rehabilitation of the upper extremity is also constantly increasing Robotic devices have the potential to address this problem as noted by the results of recent research studies However, the availability of these devices in clinical settings is limited, leaving plenty of room for improvement The purpose of this paper is to document a review of robotic devices for upper limb rehabilitation including those in developing phase in order to provide a comprehensive reference about existing solutions and facilitate the development of new and improved devices In particular the following issues are discussed: application field, target group, type of assistance, mechanical design, control strategy and clinical evaluation This paper also includes a comprehensive, tabulated comparison of technical solutions implemented in various systems

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A survey on robotic devices for upper limb rehabilitation

The existing shortage of therapists and caregivers assisting physically disabled individuals at home is expected to increase and become serious problem in the near future. The patient population needing physical rehabilitation of the upper extremity is also constantly increasing. Robotic devices have the potential to address this problem as noted by the results of recent research studies. However, the availability of these devices in clinical settings is limited, leaving plenty of room for improvement. The purpose of this paper is to document a review of robotic devices for upper limb rehabilitation including those in developing phase in order to provide a comprehensive reference about existing solutions and facilitate the development of new and improved devices. In particular the following issues are discussed: application field, target group, type of assistance, mechanical design, control strategy and clinical evaluation. This paper also includes a comprehensive, tabulated comparison of technical solutions implemented in various systems.

A survey on robotic devices for upper limb

Impaired manual dexterity is a frequently reported disability in people with multiple sclerosis (MS) and is increasingly prevalent with worsening disease. While various tests and patient-reported outcome measures are available, the Nine-Hole Peg Test (NHPT) is considered as a gold standard measure of manual dexterity and most frequently used in MS research and clinical practice. The MS Outcome Assessments Consortium (MSOAC) includes representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with MS. Among the MSOAC goals are acceptance and qualification by regulators of performance outcomes that are highly reliable and valid, practical, cost-effective, and meaningful to persons with MS. A critical step for these neuroperformance metrics is elucidation of clinically relevant benchmarks, well-defined degrees of disabili...

https://journals.sagepub.com/doi/pdf/10.1177/1352458517690824

The Nine-Hole Peg Test as a manual dexterity performance measure for multiple sclerosis.

Background
Establishing which upper limb outcome measures are most commonly used in stroke studies may help in improving consensus among scientists and clinicians.

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Upper Limb Outcome Measures Used in Stroke Rehabilitation Studies: A Systematic Literature Review

Few research in multiple sclerosis (MS) has focused on physical rehabilitation of upper limb dysfunction, though the latter strongly influences independent performance of activities of daily living. Upper limb rehabilitation technology could hold promise for complementing traditional MS therapy. Consequently, this pilot study aimed to examine the feasibility of an 8-week mechanical-assisted training program for improving upper limb muscle strength and functional capacity in MS patients with evident paresis. A case series was applied, with provision of a training program (3×/week, 30 minutes/session), supplementary on the customary maintaining care, by employing a gravity-supporting exoskeleton apparatus (Armeo Spring). Ten high-level disability MS patients (Expanded Disability Status Scale 7.0-8.5) actively performed task-oriented movements in a virtual real-life-like learning environment with the affected upper limb. Tests were administered before and after training, and at 2-month follow-up. Muscle strength was determined through the Motricity Index and Jamar hand-held dynamometer. Functional capacity was assessed using the TEMPA, Action Research Arm Test (ARAT) and 9-Hole Peg Test (9HPT). Muscle strength did not change significantly. Significant gains were particularly found in functional capacity tests. After training completion, TEMPA scores improved (p = 0.02), while a trend towards significance was found for the 9HPT (p = 0.05). At follow-up, the TEMPA as well as ARAT showed greater improvement relative to baseline than after the 8-week intervention period (p = 0.01, p = 0.02 respectively). The results of present pilot study suggest that upper limb functionality of high-level disability MS patients can be positively influenced by means of a technology-enhanced physical rehabilitation program.

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The Armeo Spring as training tool to improve upper limb functionality in multiple sclerosis: a pilot study

Despite the functional impact of upper limb dysfunction in multiple sclerosis (MS), effects of intensive exercise programs and specifically robot-supported training have been rarely investigated in persons with advanced MS. To investigate the effects of additional robot-supported upper limb training in persons with MS compared to conventional treatment only. Seventeen persons with MS (pwMS) (median Expanded Disability Status Scale of 8, range 3.5–8.5) were included in a pilot RCT comparing the effects of additional robot-supported training to conventional treatment only. Additional training consisted of 3 weekly sessions of 30 min interacting with the HapticMaster robot within an individualised virtual learning environment (I-TRAVLE). Clinical measures at body function (Hand grip strength, Motricity Index, Fugl-Meyer) and activity (Action Research Arm test, Motor Activity Log) level were administered before and after an intervention period of 8 weeks. The intervention group were also evaluated on robot-mediated movement tasks in three dimensions, providing active range of motion, movement duration and speed and hand-path ratio as indication of movement efficiency in the spatial domain. Non-parametric statistics were applied. PwMS commented favourably on the robot-supported virtual learning environment and reported functional training effects in daily life. Movement tasks in three dimensions, measured with the robot, were performed in less time and for the transporting and reaching movement tasks more efficiently. There were however no significant changes for any clinical measure in neither intervention nor control group although observational analyses of the included cases indicated large improvements on the Fugl-Meyer in persons with more marked upper limb dysfunction. Robot-supported training lead to more efficient movement execution which was however, on group level, not reflected by significant changes on standard clinical tests. Persons with more marked upper limb dysfunction may benefit most from additional robot-supported training, but larger studies are needed. This trial is registered within the registry Clinical Trials GOV (
 NCT02257606
 ).

https://link.springer.com/content/pdf/10.1186%2Fs12984-015-0043-3.pdf

Robot-supported upper limb training in a virtual learning environment : a pilot randomized controlled trial in persons with MS

Background:The real-life relevance of frequently applied clinical arm tests is not well known in multiple sclerosis (MS).Objective:This study aimed to determine the relation between real-life arm p...

Perceived and actual arm performance in multiple sclerosis: relationship with clinical tests according to hand dominance:

Background: Hand grip strength in both the dominant and non-dominant hands is often used to assess upper limb impairment. Excessive hand grip fatigability is another important measure, as fatigability may also influence activities of daily living. Objective: To investigate to what extent hand grip fatigability in multiple sclerosis is dependent on hand dominance, muscle strength and disease progression. Methods: Thirty persons with multiple sclerosis and 16 healthy controls performed 15 repeated maximal hand grip contractions and a 30 s sustained contraction in order to determine dynamic and static fatigue indices. Fatigability was compared between the dominant and non-dominant hands and between the more and less affected hands in a subgroup of persons with multiple sclerosis with asymmetrical hand grip strength impairment. Furthermore, fatigability was compared between controls and subgroups of persons with multiple sclerosis with different disease progression. Results: There was no difference in fatigability between dominant and non-dominant hands in healthy controls or in persons with multiple sclerosis. Similarly, there was no difference between the more and less affected hands in the subgroup of persons with multiple sclerosis with asymmetrical hand grip impairment. The dynamic fatigue index did not discriminate persons with multiple sclerosis from controls. While the static fatigue index was not different between healthy controls and persons with multiple sclerosis with low to moderate (< 6) Expanded Disability Status Scale (EDSS), it was significantly higher in persons with multiple sclerosis with high (≥ 6) EDSS scores. The static fatigue index was related to the EDSS score, but not to maximal grip strength. Conclusion: Fatigability of hand grip strength in persons with multiple sclerosis is not influenced by hand dominance or muscle strength, but there is a correlation with disease progression. Differences in fatigability between healthy controls and, in particular, persons with multiple sclerosis with high EDSS, were found during sustained, but not during dynamic, contractions.

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Hand grip fatigability in persons with multiple sclerosis according to hand dominance and disease progression.

Quantifying and tracking upper limb impairment is of key importance to the understanding of disease progress, establishing patient-tailored therapy protocols and for optimal care provision. This paper presents the results of a pilot study on the assessment of upper limb motor function in patients with multiple sclerosis (MS) with the Virtual Peg Insertion Test (VPIT). The test consists in a goal-directed reaching task using a commercial haptic display combined with an instrumented handle and virtual environment, and allows for the extraction of objective kinematic and dynamic parameters. Ten MS patients and eight age-matched healthy subjects performed five repetitions of the VPIT with their dominant and non-dominant hand. Upper limb movements were found to be significantly slower, less smooth and less straight compared to healthy controls, and the time to complete the VPIT was well correlated with the conventional Nine Hole Peg Test (r=0.658, p<;0.01). Tremor in the range of 3-5 Hz could be detected and quantified using a frequency analysis in patients featuring intention tremor. These preliminary results illustrate the feasibility of using the VPIT with MS patients, and underline the potential of this test to evaluate upper limb motor function and discriminate characteristic MS related impairments.

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Lore Kerkhofs

Papers

The Armeo Spring as training tool to improve upper limb functionality in multiple sclerosis: a pilot study

Robot-supported upper limb training in a virtual learning environment : a pilot randomized controlled trial in persons with MS

Perceived and actual arm performance in multiple sclerosis: relationship with clinical tests according to hand dominance:

Hand grip fatigability in persons with multiple sclerosis according to hand dominance and disease progression.

Assessment of upper limb motor function in patients with multiple sclerosis using the Virtual Peg Insertion Test: A pilot study