Wearable sensors and machine learning in post-stroke rehabilitation assessment: A systematic review

A cerebrovascular accident or stroke is the second commonest cause of death in the world. If it is not fatal, it can result in paralysis, sensory impairment and significant disability. Rehabilitation plays an important role to help survivors relearn lost skills and assist them to regain independence and thus ameliorate their quality of life. With the development of technology, researchers have come up with new solutions to assist clinicians in monitoring and assessing their patients; as well as making physiotherapy available to all. The objective of this review is to assess the recent developments made in the field of post-stroke rehabilitation using wearable devices for data collection and machine learning algorithms for the exercises’ evaluation. To do so, PRISMA guidelines for systematic reviews were followed. Scopus, Lens, PubMed, ScienceDirect and Microsoft academic were electronically searched. Peer-reviewed papers using sensors in post-stroke rehabilitation were included, for the period between 2015 to August 2021. Thirty-three publications that used wearable sensors for patients’ assessment were included. Based on that, we have proposed a taxonomy that divided the assessment systems into three categories namely activity recognition, movement classification, and clinical assessment emulation. Moreover, The most commonly employed sensors as well as the most targeted body–limbs, outcome measures, and study designs are reviewed, in addition to the examination of the machine learning approaches starting from the feature engineering to the classification done. Finally, limitations and potential study directions in the field are presented.

[1]  Christian Poellabauer,et al.  Activity Recognition for Persons With Stroke Using Mobile Phone Technology: Toward Improved Performance in a Home Setting , 2017, Journal of medical Internet research.

[2]  A. U. Rickel,et al.  Guidelines for Prevention, I , 1998 .

[3]  Yuanyuan Wang,et al.  Towards an IoT-based upper limb rehabilitation assessment system , 2017, 2017 39th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[4]  S. Wolf,et al.  Pilot normative database for the Wolf Motor Function Test. , 2006, Archives of physical medicine and rehabilitation.

[5]  P. Alam ‘T’ , 2021, Composites Engineering: An A–Z Guide.

[6]  Eunjeong Park,et al.  Automatic Grading of Stroke Symptoms for Rapid Assessment Using Optimized Machine Learning and 4-Limb Kinematics: Clinical Validation Study , 2020, Journal of medical Internet research.

[7]  J. Fung,et al.  A Single Bout of High-Intensity Interval Training Improves Motor Skill Retention in Individuals With Stroke , 2017, Neurorehabilitation and neural repair.

[8]  M. Owolabi,et al.  Stroke: a global response is needed , 2016, Bulletin of the World Health Organization.

[9]  Mehdi Ammi,et al.  Smart Cup to Monitor Stroke Patients Activities During Everyday Life , 2018, 2018 IEEE International Conference on Internet of Things (iThings) and IEEE Green Computing and Communications (GreenCom) and IEEE Cyber, Physical and Social Computing (CPSCom) and IEEE Smart Data (SmartData).

[10]  Alexander W Dromerick,et al.  Measuring Functional Arm Movement after Stroke Using a Single Wrist-Worn Sensor and Machine Learning. , 2017, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[11]  Yu Zhou,et al.  A Multi-channel EMG-Driven FES Solution for Stroke Rehabilitation , 2018, ICIRA.

[12]  Tapas Mondal,et al.  Wearable Sensors for Remote Health Monitoring , 2017, Sensors.

[13]  J. Gomes,et al.  Types of Strokes , 2013 .

[14]  V. Chair,et al.  Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the , 2006, Circulation.

[15]  Daxi Xiong,et al.  A remote quantitative Fugl-Meyer assessment framework for stroke patients based on wearable sensor networks , 2016, Comput. Methods Programs Biomed..

[16]  Shyamal Patel,et al.  Using a Minimum Set of Wearable Sensors to Assess Quality of Movement in Stroke Survivors , 2017, 2017 IEEE/ACM International Conference on Connected Health: Applications, Systems and Engineering Technologies (CHASE).

[17]  K. Tanja-Dijkstra,et al.  The psychological effects of the physical healthcare environment on healthcare personnel. , 2011, The Cochrane database of systematic reviews.

[18]  O. Amft,et al.  Wearable motion sensors and digital biomarkers in stroke rehabilitation , 2020, Current Directions in Biomedical Engineering.

[19]  Geoffrey I. Webb,et al.  InceptionTime: Finding AlexNet for time series classification , 2019, Data Mining and Knowledge Discovery.

[20]  P. Alam ‘A’ , 2021, Composites Engineering: An A–Z Guide.

[21]  Aladdin Ayesh,et al.  IEEE 7010: A New Standard for Assessing the Well-being Implications of Artificial Intelligence , 2020, 2020 IEEE International Conference on Systems, Man, and Cybernetics (SMC).

[22]  James A. Young,et al.  Stroke Evaluation and Treatment , 2009, Topics in stroke rehabilitation.

[23]  Wei-Chun Hsu,et al.  Multiple-Wearable-Sensor-Based Gait Classification and Analysis in Patients with Neurological Disorders , 2018, Sensors.

[24]  Thomas de Quincey [C] , 2000, The Works of Thomas De Quincey, Vol. 1: Writings, 1799–1820.

[25]  Peter S. Lum,et al.  Robust Classification of Functional and Nonfunctional Arm Movement after Stroke Using a Single Wrist-Worn Sensor Device , 2018, 2018 IEEE International Conference on Big Data (Big Data).

[26]  Kamiar Aminian,et al.  Improving activity recognition using a wearable barometric pressure sensor in mobility-impaired stroke patients , 2015, Journal of NeuroEngineering and Rehabilitation.

[27]  Jeff Heaton,et al.  An empirical analysis of feature engineering for predictive modeling , 2016, SoutheastCon 2016.

[28]  Jan van Gijn,et al.  Acute Ischemic Stroke , 2007 .

[29]  Derek William Nicoll,et al.  Users as Currency: Technology and Marketing Trials as Naturalistic Environments , 2000, Inf. Soc..

[30]  Automatic Identification of Upper Extremity Rehabilitation Exercise Type and Dose Using Body-Worn Sensors and Machine Learning: A Pilot Study , 2021, Digital Biomarkers.

[31]  Tak-Chung Fu,et al.  A review on time series data mining , 2011, Eng. Appl. Artif. Intell..

[32]  C. Eskey,et al.  Hemorrhagic stroke. , 2011, Radiologic clinics of North America.

[33]  David E. Levy,et al.  Delayed postischemic hypoperfusion , 1979, Neurology.

[34]  Shyamal Patel,et al.  A review of wearable sensors and systems with application in rehabilitation , 2012, Journal of NeuroEngineering and Rehabilitation.

[35]  Yu-Wei Hsieh,et al.  Development and Validation of a Short Form of the Fugl-Meyer Motor Scale in Patients With Stroke , 2007, Stroke.

[36]  Miguel A. Labrador,et al.  Use of Wearable Sensor Technology in Gait, Balance, and Range of Motion Analysis , 2019, Applied Sciences.

[37]  G. G. Stokes "J." , 1890, The New Yale Book of Quotations.

[38]  Vikash Gilja,et al.  Use of Accelerometry for Long Term Monitoring of Stroke Patients , 2019, IEEE Journal of Translational Engineering in Health and Medicine.

[39]  M. Moskowitz,et al.  Exciting, radical, suicidal: how brain cells die after stroke. , 2005, Stroke.

[40]  P. Duncan,et al.  Stroke: who's counting what? , 2001, Journal of rehabilitation research and development.

[41]  Sunghoon Ivan Lee,et al.  Estimating Upper-Limb Impairment Level in Stroke Survivors Using Wearable Inertial Sensors and a Minimally-Burdensome Motor Task , 2020, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[42]  P. Duncan,et al.  Fugl-Meyer Assessment of Sensorimotor Function After Stroke: Standardized Training Procedure for Clinical Practice and Clinical Trials , 2011, Stroke.

[43]  G. V. van Heck,et al.  Psychometric qualities of a brief self-rated fatigue measure: The Fatigue Assessment Scale. , 2003, Journal of psychosomatic research.

[44]  Brett C Meyer,et al.  A Review of the Evidence for the Use of Telemedicine Within Stroke Systems of Care: A Scientific Statement From the American Heart Association/American Stroke Association , 2009, Stroke.

[45]  郭雅雯,et al.  巴氏量表(Barthel Index)知多少? , 2011 .

[46]  M. A. Jabbar,et al.  Machine Learning in Healthcare: A Review , 2018, 2018 Second International Conference on Electronics, Communication and Aerospace Technology (ICECA).

[47]  P. Alam,et al.  H , 1887, High Explosives, Propellants, Pyrotechnics.

[48]  E. Taub,et al.  Constraint-induced movement therapy: A new approach to treatment in physical rehabilitation. , 1998 .

[49]  Neelesh Kumar,et al.  Role of machine learning in gait analysis: a review , 2020, Journal of medical engineering & technology.

[50]  Raja Ariffin Raja Ghazilla,et al.  Reviews on Various Inertial Measurement Unit (IMU) Sensor Applications , 2013, SiPS 2013.

[51]  Bart Vanrumste,et al.  Exploration of Human Activity Recognition Using a Single Sensor for Stroke Survivors and Able-Bodied People , 2021, Sensors.

[52]  Michelle McDonnell,et al.  Action research arm test. , 2008, The Australian journal of physiotherapy.

[53]  Edward D. Lemaire,et al.  Feature Selection for Wearable Smartphone-Based Human Activity Recognition with Able bodied, Elderly, and Stroke Patients , 2015, PloS one.

[54]  L. Molnar,et al.  Transportation and aging: a research agenda for advancing safe mobility. , 2007, The Gerontologist.

[55]  R. Hicks,et al.  Balance and mobility following stroke: effects of physical therapy interventions with and without biofeedback/forceplate training. , 2001, Physical therapy.

[56]  Paolo Bonato,et al.  Using wearable sensors to measure motor abilities following stroke , 2006, International Workshop on Wearable and Implantable Body Sensor Networks (BSN'06).

[57]  Paolo Bonato,et al.  The Use of a Finger-Worn Accelerometer for Monitoring of Hand Use in Ambulatory Settings , 2019, IEEE Journal of Biomedical and Health Informatics.

[58]  Tim Oates,et al.  Imaging Time-Series to Improve Classification and Imputation , 2015, IJCAI.

[59]  P. Langhorne,et al.  Stroke rehabilitation , 2011, The Lancet.

[60]  Richard K. G. Do,et al.  Convolutional neural networks: an overview and application in radiology , 2018, Insights into Imaging.

[61]  Aaron Miller,et al.  Comparison of Machine Learning approaches for Classifying Upper Extremity Tasks in Individuals Post-Stroke , 2020, 2020 42nd Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC).

[62]  S. Johnston,et al.  Transient Ischemic Attack , 2002 .

[63]  Saeid Sanei,et al.  Triaxial rehabilitative data analysis incorporating matching pursuit , 2017, 2017 25th European Signal Processing Conference (EUSIPCO).

[64]  M. Fisher,et al.  An overview of acute stroke therapy: past, present, and future. , 2000, Archives of internal medicine.

[65]  장윤희,et al.  Y. , 2003, Industrial and Labor Relations Terms.

[66]  Hyung‐Soon Park,et al.  Development and Clinical Evaluation of a Web-Based Upper Limb Home Rehabilitation System Using a Smartwatch and Machine Learning Model for Chronic Stroke Survivors: Prospective Comparative Study , 2020, JMIR mHealth and uHealth.

[67]  Heikki Mannila,et al.  Time series segmentation for context recognition in mobile devices , 2001, Proceedings 2001 IEEE International Conference on Data Mining.

[68]  Filippo Cavallo,et al.  Assessment of Purposeful Movements for Post-Stroke Patients in Activites of Daily Living with Wearable Sensor Device , 2019, 2019 IEEE Conference on Computational Intelligence in Bioinformatics and Computational Biology (CIBCB).

[69]  R. Jorge,et al.  Oxford Grading Scale vs manometer for assessment of pelvic floor strength in nulliparous sports students. , 2013, Physiotherapy.

[70]  Hwee Pink Tan,et al.  Machine Learning in Wireless Sensor Networks: Algorithms, Strategies, and Applications , 2014, IEEE Communications Surveys & Tutorials.

[71]  P. Alam,et al.  R , 1823, The Herodotus Encyclopedia.

[72]  P. Alam ‘E’ , 2021, Composites Engineering: An A–Z Guide.

[73]  Peter Langhorne,et al.  Barthel Index for Stroke Trials: Development, Properties, and Application , 2011, Stroke.

[74]  Haipeng Shen,et al.  Artificial intelligence in healthcare: past, present and future , 2017, Stroke and Vascular Neurology.

[75]  Marc Fisher,et al.  Acute Ischemic Stroke Therapy Overview. , 2017, Circulation research.

[76]  R W Bohannon,et al.  Sit-to-Stand Test for Measuring Performance of Lower Extremity Muscles , 1995, Perceptual and motor skills.

[77]  Vincent M. Vacca,et al.  Acute ischemic stroke. , 2006, Nursing.

[78]  Paul W. Stratford,et al.  Validation of Three Shortened Versions of the Chedoke Arm and Hand Activity Inventory , 2006 .

[79]  B. Dobkin Strategies for stroke rehabilitation , 2004, The Lancet Neurology.

[80]  Igor Bisio,et al.  When eHealth Meets IoT: A Smart Wireless System for Post-Stroke Home Rehabilitation , 2019, IEEE Wireless Communications.

[81]  W. Byblow,et al.  Advances and challenges in stroke rehabilitation , 2020, The Lancet Neurology.

[82]  P. Alam ‘W’ , 2021, Composites Engineering.

[83]  E. Roth,et al.  Physical Activity and Exercise Recommendations for Stroke Survivors: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association , 2014, Stroke.

[84]  Angelo M. Sabatini,et al.  A Machine Learning Framework for Gait Classification Using Inertial Sensors: Application to Elderly, Post-Stroke and Huntington’s Disease Patients , 2016, Sensors.

[85]  Sydney Katz Assessing Self‐maintenance: Activities of Daily Living, Mobility, and Instrumental Activities of Daily Living , 1983, Journal of the American Geriatrics Society.

[86]  Diane Podsiadlo,et al.  The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons , 1991, Journal of the American Geriatrics Society.

[87]  S. Ebrahim,et al.  Illness in the context of older age: the case of stroke. , 1998 .

[88]  Koushik Maharatna,et al.  Rehab-Net: Deep Learning Framework for Arm Movement Classification Using Wearable Sensors for Stroke Rehabilitation , 2019, IEEE Transactions on Biomedical Engineering.

[89]  James H. Cauraugh,et al.  Chronic stroke motor recovery: duration of active neuromuscular stimulation , 2003, Journal of the Neurological Sciences.

[90]  Gorjan Alagic,et al.  #p , 2019, Quantum information & computation.

[91]  Mingzhe Jiang,et al.  An IoT-Enabled Stroke Rehabilitation System Based on Smart Wearable Armband and Machine Learning , 2018, IEEE Journal of Translational Engineering in Health and Medicine.

[92]  Gabriel Rilling,et al.  On empirical mode decomposition and its algorithms , 2003 .

[93]  K. Mcdonald-Maier,et al.  Improving the activity recognition using GMAF and transfer learning in post-stroke rehabilitation assessment , 2021, 2021 IEEE 19th World Symposium on Applied Machine Intelligence and Informatics (SAMI).

[94]  Nathan A. Baune,et al.  Measuring Activities of Daily Living in Stroke Patients with Motion Machine Learning Algorithms: A Pilot Study , 2021, International journal of environmental research and public health.

[95]  M. Gohari,et al.  The Effect of Early Passive Range of Motion Exercise on Motor Function of People with Stroke: a Randomized Controlled Trial , 2019, Journal of caring sciences.

[96]  D. Choi,et al.  Stroke therapy. , 1991, Scientific American.

[97]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement , 2009, BMJ : British Medical Journal.

[98]  J. Gladman,et al.  The scope for rehabilitation in severely disabled stroke patients. , 1998, Disability and rehabilitation.

[99]  S. Wolf,et al.  Assessing Wolf Motor Function Test as Outcome Measure for Research in Patients After Stroke , 2001, Stroke.

[100]  Eric Wade,et al.  Upper extremity post-stroke motion quality estimation with decision trees and bagging forests , 2016, 2016 38th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[101]  Yu Guan,et al.  Automated Stroke Rehabilitation Assessment using Wearable Accelerometers in Free-Living Environments , 2020, ArXiv.

[102]  Se Jin Park,et al.  Evaluation of ECG Features for the Classification of Post-Stroke Survivors with a Diagnostic Approach , 2020, Applied Sciences.

[103]  Jon Chamberlain,et al.  A Visual Approach to Query Formulation for Systematic Search , 2019, CHIIR.

[104]  Fei Wang,et al.  Deep learning for healthcare: review, opportunities and challenges , 2018, Briefings Bioinform..

[105]  Fu-Cheng Wang,et al.  Detection and Classification of Stroke Gaits by Deep Neural Networks Employing Inertial Measurement Units , 2021, Sensors.

[106]  Tsuyoshi Murata,et al.  {m , 1934, ACML.

[107]  Francesca N. Delling,et al.  Heart Disease and Stroke Statistics—2018 Update: A Report From the American Heart Association , 2018, Circulation.

[108]  Irene Katzan,et al.  Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the , 2006, Stroke.