Enabling precision rehabilitation interventions using wearable sensors and machine learning to track motor recovery

The need to develop patient-specific interventions is apparent when one considers that clinical studies often report satisfactory motor gains only in a portion of participants. This observation provides the foundation for “precision rehabilitation”. Tracking and predicting outcomes defining the recovery trajectory is key in this context. Data collected using wearable sensors provide clinicians with the opportunity to do so with little burden on clinicians and patients. The approach proposed in this paper relies on machine learning-based algorithms to derive clinical score estimates from wearable sensor data collected during functional motor tasks. Sensor-based score estimates showed strong agreement with those generated by clinicians. Score estimates of upper-limb impairment severity and movement quality were marked by a coefficient of determination of 0.86 and 0.79, respectively. The application of the proposed approach to monitoring patients’ responsiveness to rehabilitation is expected to contribute to the development of patient-specific interventions, aiming to maximize motor gains.

[1]  Paolo Bonato,et al.  Enabling Stroke Rehabilitation in Home and Community Settings: A Wearable Sensor-Based Approach for Upper-Limb Motor Training , 2018, IEEE Journal of Translational Engineering in Health and Medicine.

[2]  A. Fugl-Meyer,et al.  The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. , 1975, Scandinavian journal of rehabilitation medicine.

[3]  E. Taub,et al.  The reliability of the wolf motor function test for assessing upper extremity function after stroke. , 2001, Archives of physical medicine and rehabilitation.

[4]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[5]  J. Pons,et al.  Combining Dopaminergic Facilitation with Robot-Assisted Upper Limb Therapy in Stroke Survivors , 2016, American journal of physical medicine & rehabilitation.

[6]  Fran Brander,et al.  Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme , 2019, Journal of Neurology, Neurosurgery, and Psychiatry.

[7]  Carl E. Rasmussen,et al.  Gaussian processes for machine learning , 2005, Adaptive computation and machine learning.

[8]  S. Jaglal,et al.  Cognitive and Motor Recovery and Predictors of Long-Term Outcome in Patients With Traumatic Brain Injury. , 2019, Archives of physical medicine and rehabilitation.

[9]  S. Sawamura,et al.  Prediction of Functional Outcome After Stroke Rehabilitation , 2000, American journal of physical medicine & rehabilitation.

[10]  T. Miller,et al.  Prevalence of Long‐Term Disability From Traumatic Brain Injury in the Civilian Population of the United States, 2005 , 2008, The Journal of head trauma rehabilitation.

[11]  S. Holm A Simple Sequentially Rejective Multiple Test Procedure , 1979 .

[12]  Steven A Kautz,et al.  Corticospinal tract lesion load: An imaging biomarker for stroke motor outcomes , 2015, Annals of neurology.

[13]  A. Huk,et al.  Temporal Dynamics Underlying Perceptual Decision Making: Insights from the Interplay between an Attractor Model and Parietal Neurophysiology , 2008, Front. Neurosci..

[14]  E. Bizzi,et al.  Muscle synergy patterns as physiological markers of motor cortical damage , 2012, Proceedings of the National Academy of Sciences.

[15]  P. Langhorne,et al.  Motor recovery after stroke: a systematic review , 2009, The Lancet Neurology.

[16]  Paolo Bonato,et al.  Complex Upper-Limb Movements Are Generated by Combining Motor Primitives that Scale with the Movement Size , 2018, Scientific Reports.

[17]  Amanda McIntyre,et al.  Rethinking the continuum of stroke rehabilitation. , 2014, Archives of physical medicine and rehabilitation.

[18]  Alan D. Lopez,et al.  The Global Burden of Disease Study , 2003 .

[19]  Shyamal Patel,et al.  Estimating fugl-meyer clinical scores in stroke survivors using wearable sensors , 2011, 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[20]  B. Shahbaba,et al.  Genetic Variation in the Human Brain Dopamine System Influences Motor Learning and Its Modulation by L-Dopa , 2013, PloS one.

[21]  P Piot,et al.  The global epidemic. , 1998, AIDS care.

[22]  Kendra M. Cherry-Allen,et al.  Dose response of task‐specific upper limb training in people at least 6 months poststroke: A phase II, single‐blind, randomized, controlled trial , 2016, Annals of neurology.

[23]  J. Schaechter,et al.  Corticospinal Tract Diffusion Abnormalities Early After Stroke Predict Motor Outcome , 2014, Neurorehabilitation and neural repair.

[24]  Alan D. Lopez,et al.  Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study , 1997, The Lancet.

[25]  C. Winstein,et al.  Been there, done that, so what's next for arm and hand rehabilitation in stroke? , 2018, NeuroRehabilitation.

[26]  Alan R. Moody,et al.  From Big Data to Precision Medicine , 2019, Front. Med..

[27]  M. Alexander,et al.  Traumatic brain injury. Predicting course of recovery and outcome for patients admitted to rehabilitation. , 1994, Archives of neurology.

[28]  Leo Breiman,et al.  Random Forests , 2001, Machine Learning.

[29]  J. Langlois,et al.  Traumatic brain injury in the United States; emergency department visits, hospitalizations, and deaths , 2006 .

[30]  J. Krakauer,et al.  Computational neurorehabilitation: modeling plasticity and learning to predict recovery , 2016, Journal of NeuroEngineering and Rehabilitation.

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

[32]  Trends in aging--United States and worldwide. , 2003, MMWR. Morbidity and mortality weekly report.

[33]  Pablo Maceira-Elvira,et al.  Wearable technology in stroke rehabilitation: towards improved diagnosis and treatment of upper-limb motor impairment , 2019, Journal of NeuroEngineering and Rehabilitation.

[34]  M. Reuter,et al.  Genetically Determined Differences in Learning from Errors , 2007, Science.

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

[36]  A. Wing,et al.  Boosting robot-assisted rehabilitation of stroke hemiparesis by individualized selection of upper limb movements – a pilot study , 2019, Journal of NeuroEngineering and Rehabilitation.

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

[38]  Matthew A Petoe,et al.  Proportional recovery after stroke depends on corticomotor integrity , 2015, Annals of neurology.

[39]  M. Parnham,et al.  4 Ds in health research—working together toward rapid precision medicine , 2019, EMBO molecular medicine.

[40]  Jennifer M. Hootman,et al.  Prevalence and most common causes of disability among adults--United States, 2005. , 2009, MMWR. Morbidity and mortality weekly report.

[41]  M. Wald,et al.  Traumatic brain injury in the United States; emergency department visits, hospitalizations, and deaths, 2002-2006 , 2010 .

[42]  Sue Ann Sisto,et al.  Wolf Motor Function Test , 2017 .

[43]  Shyamal Patel,et al.  Using Wearable Motion Sensors to Estimate Longitudinal Changes in Movement Quality in Stroke and Traumatic Brain Injury Survivors Undergoing Rehabilitation , 2016 .

[44]  Mark A. Hall,et al.  Correlation-based Feature Selection for Machine Learning , 2003 .

[45]  D. Silberberg,et al.  Nervous system disorders: a global epidemic. , 2002, Archives of neurology.

[46]  N. Lannin,et al.  A Systematic Review of Upper Limb Rehabilitation for Adults With Traumatic Brain Injury , 2008 .

[47]  F. Collins,et al.  A new initiative on precision medicine. , 2015, The New England journal of medicine.

[48]  E. Mohammadi,et al.  Barriers and facilitators related to the implementation of a physiological track and trigger system: A systematic review of the qualitative evidence , 2017, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[49]  Shyamal Patel,et al.  A Novel Approach to Monitor Rehabilitation Outcomes in Stroke Survivors Using Wearable Technology , 2010, Proceedings of the IEEE.

[50]  S. Black,et al.  The Fugl-Meyer Assessment of Motor Recovery after Stroke: A Critical Review of Its Measurement Properties , 2002, Neurorehabilitation and neural repair.

[51]  S. G. Nelson,et al.  Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. , 1983, Physical therapy.

[52]  C. Lang,et al.  Upper Limb Performance in Daily Life Improves Over the First 12 Weeks Poststroke , 2019, Neurorehabilitation and neural repair.

[53]  Francesca N. Delling,et al.  Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association , 2019, Circulation.

[54]  Paolo Bonato,et al.  A novel upper-limb function measure derived from finger-worn sensor data collected in a free-living setting , 2019, PloS one.

[55]  W. Walker,et al.  Motor impairment after severe traumatic brain injury: A longitudinal multicenter study. , 2007, Journal of rehabilitation research and development.

[56]  M. Biddle,et al.  A report from the American Heart Association Council on Cardiovascular and Stroke Nursing. , 2015, The Journal of cardiovascular nursing.

[57]  P. Stratford,et al.  Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke. , 1993, Physical therapy.

[58]  Paolo Bonato,et al.  Advances in wearable technology and applications in physical medicine and rehabilitation , 2005, Journal of NeuroEngineering and Rehabilitation.