Kinematic Analysis Using 3D Motion Capture of Drinking Task in People With and Without Upper-extremity Impairments
Summary
This protocol describes an objective method to evaluate the movement performance and sensorimotor function of the upper extremity applied to individuals with stroke and healthy controls. A standardized test procedure, kinematic analysis and outcome variables for three-dimensional motion capture of drinking task are provided.
Abstract
Kinematic analysis is a powerful method for objective assessment of upper extremity movements in a three-dimensional (3D) space. Three-dimensional motion capture with an optoelectronic camera system is considered as golden standard for kinematic movement analysis and is increasingly used as outcome measure to evaluate the movement performance and quality after an injury or disease involving upper extremity movements. This article describes a standardized protocol for kinematic analysis of drinking task applied in individuals with upper extremity impairments after stroke. The drinking task incorporates reaching, grasping and lifting a cup from a table to take a drink, placing the cup back, and moving the hand back to the edge of the table. The sitting position is standardized to the individual's body size and the task is performed in a comfortable self-paced speed and compensatory movements are not constrained. The intention is to keep the task natural and close to a real-life situation to improve the ecological validity of the protocol. A 5-camera motion capture system is used to gather 3D coordinate positions from 9 retroreflective markers positioned on anatomical landmarks of the arm, trunk, and face. A simple single marker placement is used to ensure the feasibility of the protocol in clinical settings. Custom-made Matlab software provides automated and fast analyses of movement data. Temporal kinematics of movement time, velocity, peak velocity, time of peak velocity, and smoothness (number of movement units) along with spatial angular kinematics of shoulder and elbow joint as well as trunk movements are calculated. The drinking task is a valid assessment for individuals with moderate and mild upper extremity impairment. The construct, discriminative and concurrent validity along with responsiveness (sensitivity to change) of the kinematic variables obtained from the drinking task have been established.
Introduction
Kinematic analysis describes the movements of the body through space and time, including linear and angular displacements, velocities, and accelerations. The optoelectronic motion capture systems use multiple high-speed cameras that either send out infra-red light signals to capture the reflections from passive markers placed on the body or transmit the movement data from active markers containing infrared emitting diodes. These systems are considered as 'gold standard' for the acquisition of kinematic data1. These systems are valued for their high accuracy and flexibility in measurements of diverse tasks. Kinematic measures have shown to be effective in capturing smaller changes in movement performance and quality that may be undetected with traditional clinical scales2,3. It has been suggested that kinematics should be used for distinction between true recovery (restoration of premorbid movement characteristics) and the use of compensatory (alternative) movement patterns during the accomplishment of a task4,5.
Upper extremity movements can be quantified using end-point kinematics, generally obtained from a hand marker, and angular kinematics from joints and segments (i.e., trunk). End-point kinematics provide information about trajectories, speed, temporal movement strategies, precision, straightness, and smoothness, while angular kinematics characterize movement patterns in terms of temporal and spatial joint and segment angles, angular velocities, and interjoint coordination. End-point kinematics, such as, movement time, speed, and smoothness are effective to capture the deficits and improvements in movement performance after stroke6,7,8 and angular kinematics show whether the movements of joints and body segments are optimal for a specific task. Kinematics from people with impairments are often compared with movement performance in individuals without impairments8,9. End-point and angular kinematics are correlated in a way that a movement performed with effective speed, smoothness, and precision will require good movement control, coordination, and use of effective and optimal movement patterns. For example, a patient with stroke who moves slowly usually also shows decreased smoothness (increased number of movement units), lower maximum velocity, and increased trunk displacement8. On the other hand, improvements in endpoint kinematics, such as movement speed and smoothness might occur independently from the changes of compensatory movement strategies of trunk and arm10. It has been established that kinematic analysis may provide additional and more precise information about how the task is accomplished after an injury or disease, which in turn is essential for individualized effective treatment to reach optimal motor recovery11. Kinematic analysis is increasingly used in clinical studies to describe the movements in people with upper extremity impairments after stroke8,9, to evaluate motor recovery7,12,13 or to determine the effectiveness of therapeutic interventions10,14.
Movement tasks often studied in stroke are pointing and reaching, although the use of functional tasks that incorporate manipulation of real everyday objects is increasing1. Since kinematics of reaching depend on the experimental constraints such as the selection of objects and the goal of the task15, it is essential to assess movements during purposeful and functional tasks in which the real difficulties in individual's daily life will be reflected more closely.
Thus, the aim of this paper is to provide a detailed description of a simple standardized protocol used for kinematic analysis of a purposeful and functional task, drinking task, applied to individuals with upper extremity impairments in acute and chronic stages after stroke. Results from the validation of this protocol for individuals with moderate and mild stroke impairment will be summarized.
Protocol
Representative Results
Discussion
The protocol can successfully be used to quantify the movement performance and quality in individuals with moderate and mild upper extremity sensorimotor impairments at all stages after stroke. The feasibility of this protocol has been proved in a clinical setting as early as 3 days post stroke, and showed that the system can be used by trained health professional without specific technical qualifications. Technical expertise is, however, needed to create and develop a program for data analysis. From this aspect, the upp…
Disclosures
The authors have nothing to disclose.
Acknowledgements
Special thanks to Bo Johnels, Nasser Hosseini, Roy Tranberg and Patrik Almström for help with the initiation of this project. The research data presented in this protocol was gathered at the Sahlgrenska University Hospital.
Materials
| 5 camera optoelectronic ProReflex Motion capture system (MCU 240 Hz) | Qualisys AB, Gthenburg, Sweden | N/A | Movement analysis system with passive retroreflective markers |
| Markers | Qualisys AB, Gthenburg, Sweden | N/A | Retroleflective passive circular markers, diameter of 12 mm |
| Calibration frame and wand | Qualisys AB, Gthenburg, Sweden | N/A | L-shape calibration frame (defines the origin and orientation of the coordinate system); T-shape wand (300 mm) |
| Qualisys Track Manager | Qualisys AB, Gthenburg, Sweden | N/A | 3D Tracking software |
| Matlab | Mathworks, Inc, Natick, Ca | N/A | Data analysis software |
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