Stroke is one of the leading causes of long-term disability and, resulting mainly in hemiparesis of the upper limb, impacts on the subjects' ability to carry out daily living activities. One of the most commonly functional outcome measures used in stroke population motor assessment is the Box and Block Test (BBT). Each subject is asked to move blocks from one to another side of a box. The number of blocks moved in one-minute defines the subject's performance. Despite its ease, speed of implementation and ability to evoke activities such as grasping and manipulation of objects, its outcome does not provide information about the subject's ability to produce either physiological movements or compensatory strategies.
Objectification of clinical and functional scales still remains a challenge in the field of the clinical assessment. In the last years the use of wearable systems equipped with kinematic and electromyographic (EMG) sensors gained significant interest in upper limb movement analysis. At the state of art, no instrumented measurements provide a detailed insight into the upper limb movement during the BBT.
This project aims at defining a physiology-evidence based global index to quantitative describe the movement during the BBT execution. To reach the aim, three tasks will be accomplished: 1) EMG and kinematic data collection during BBT from healthy subjects and stroke patients with motor impairment of the upper limb; 2) movement characterization based on the analysis of EMG and kinematic features in both whole task and individual task phases (reaching, manipulation with object, and transfer); 3) global index definition to quantitatively describe the movement pattern. The project will provide a better insight into the arm motor function during the BBT execution and strongly impact on the clinical assessment, since it will return more informative and quantitative assessment of patients' states and improvements during the process of regaining motor abilities.
The project takes place in the context of the objectification of clinical and functional outcome measures. The expected results might strongly impact on the medical field providing a quantitative feedback to the clinicians, useful in patient assessment process. EMG and kinematic features extracted during BBT execution will be used to define a physiology-evidence based global index, able to assess the quality of synergy used by the patient to perform the movement.
From a scientific perspective, the project will provide a better insight into the arm motor function during the execution of the BBT. For the first time an integrated approach based on EMG and kinematic features will be applied to define a physiology-evidence-based global index able to describe the BBT and to characterize stroke population. Moreover, it will return information about individual task phases (i.e. reaching, manipulation with object, and transfer) not yet investigated during the BBT execution.
From a technical perspective, in an exploratory manner the global index defined in the proposal might be integrated in a tool (device) potentially usable by patients at home, without any support from therapists or clinicians, for evaluating by themselves the quality of movement synergy. The intellectual property protection will be sought for this device, increasing the prestige of the proponent and the university. In addition, results from kinematic assessment reached by means more affordable and easy to use technology (i.e. IMU) might promote and corroborate the use and application of that technology in clinical context.
From a clinical perspective, the research activity will provide a quantitative feedback (the global index) to the clinicians about the task execution, more related to how patients move the blocks and not only how many blocks the patient is able to move. Results might also increase the widespread of the BBT in clinical contest because of the time required (one-minute) for the assessment: the same setup as well as the same index might be applied in all pathological condition assessment in which BBT is among the gold standard functional outcome measures.
In some ways, the project will strongly impact on the clinical assessment, since it will return more informative and quantitative assessment of patients' states and improvements during the process of regaining motor abilities.