A novel parametric scale for determining rehabilitation progress in the upper limb

Abstract

The process of sensorimotor rehabilitation depends upon the clinical condition, age and circumstances of the patient and is unlikely to be continuous or predictable in nature. Mapping progress in conditions such as stroke, cerebral palsy and traumatic brain injury relies upon a variety of qualitative assessments, each resulting in different scales of measurement. Most current assessments are elaborate, specific to certain participants and/or stages of a condition, and subject to inter-rater and intra-rater variability. A simple and reliable measuring system is required that can capture rehabilitation progress from an initial state through to complete rehabilitation. It must be believable, flexible, understandable and accessible if the patient is to benefit from its use. Two-dimensional reaching tasks reflect movements made in typical therapies and activities of daily living. This thesis hypothesises that valuable parameters exist within positional and temporal data gathered from simple reaching tasks. Such parameters should be able to identify movement quality and hence measure state and progress during rehabilitation. They should correlate well with a variety of clinical scales to be meaningful and, as quantifiable measurands, they should be extendable beyond the range of established clinical scales. This thesis proposes a novel solution for the assessment of upper limb rehabilitation. An affordable desktop computer assessment system was developed and used with juvenile patient participants (N=11) to compare simple desktop reaching parameters with a clinical scale. A control group of normal juvenile participants (N=10) provided baseline data. The results indicated good correlation with the clinical scale based upon a weighted combination of pre-selected movement parameters. The methodology developed permits assessment against further clinical scales and additional participant groups allowing rapid, accurate, reliable and extendable assessments. The potential for mass data acquisition from clinical and domestic settings is identified to support the development of further assessments and, potentially, new therapies to address limited therapist availability and innovative treatments.