Functional Evaluation of Handgrip Signals for Parkinsonian Patients Gregorio Andria, Filippo Attivissimo, Nicola Giaquinto, Anna Maria Lucia Lanzolla, Livio Quagliarella, and Nicola Sasanell IEEE Transaction On Instrumentation And Measurement, Vol.55, No. 5, October 2006 Presenter: Lim Bee Yen
Outline Introduction of Parkinson’s disease Purposes Measurement System Factors Affecting Grip Strength: A review Experimental Tests Results Discussion and Conclusions
Introduction of Parkinson’s disease Degenerative Diseases of the Nervous System Chronic neurological conditions associated with progressive loss of neurons. No evidence of inflammation. No evidence of cellular necrosis. Examples: Alzheimer’s disease. Parkinson’s disease. Motor neuron disease (ALS). 神經系統變性疾病 與神經元逐漸喪失相關的慢性神經系統疾病。 沒有證據表明炎症。 沒有證據細胞壞死。 例如: 阿爾茨海默氏病。 帕金森氏病。 運動神經元病(ALS)。
Parkinson’s disease(1/3) 2nd most common neurodegenerative disease. Mean onset = 57 years of age. Affects 1-2% of population over 60 years of age. Etiology is unknown. Disease progression is highly variable. Can be early onset in some cases. 第二個最常見的神經變性疾病。 平均發病= 57歲。 影響1-2%人口超過60歲。 病因不明。 疾病進展是高度可變的。 可以是發病早期的情況。
Parkinson’s disease(2/3) Patient’s afflicted with Parkinson’s disease are described as exhibiting a ‘classic triad’: Resting tremor Muscle rigidity Bradykinesia Electroencephalograms (EEGs) record some aspects of brain electrical activity not effective in spotting Parkinson’s disease No diagnostic test that can confirm Parkinson’s disease 患者患有帕金森氏症被描述為表現出“經典三聯徵”: 靜止性震顫 肌強直 運動遲緩 沒有診斷測試,可以確認帕金森氏病
Parkinson’s disease(3/3) Many studies concern gait analysis in Parkinsonian patients high-cost equipment problematic test protocols experienced operators Simpler procedures have been used to analyze reach-to-grasp movements and ballistic movements with the upper limbs high degrees of freedom and the complexity of the analyzed movements 帕金森病的患者很多研究關注步態分析 高成本的設備 有問題的測試協議 經驗豐富的操作 更簡單的程序已經用來分析實現到把握運動和彈道運動與上肢 高自由度和所分析的運動的複雜性
Purposes Measurement System A very simple and versatile system Able to perform most of the tests indispensable to hand functionality analysis Two main parts: A handle An acquisition system
A handle Sensor based on traction Compression load cells TCLZ-100KA-Tokyo Sokki Kenkyujo Company, supply voltage: 5 V, full scale 100 kg in order to measure the grip strength Rendering of the realized prototype equipped with accessories for different grasp typologies Prototype realized by Sezione di Ingegneria Biomedica—Università di Bari, Bari, Italy, in collaboration with the Measurement Group, Polytechnic of Bari.
An acquisition system Multichannel strain gauge conditioner and amplifier system: Vishay M-M 2100 and 12-bit DAQ Board: PCL-718 Advantech for IBM Equipped with management and elaboration software to permit the complete characterization of hand motor activities. Both the young and the elderly, and the healthy and pathological people can easily use it. 採集系統 多通道應變調節器和放大器系統: 威世 MM2100和12位數據採集卡:PCL-718研華公司的IBM 配備了管理並擬訂軟件允許的手運動活動的完整的特徵。 無論是年輕人和老年人,以及健康和病態的人可以方便地使用它。
A standard calibration procedure A progression of known weights Varying in the range of 5–55 kg A step of 5 kg and applied in ascending and descending orders Suspended from the handle device, maintaining it in the vertical side The calibration cycle has been repeated three times For each applied weight, the handle extension has been measured
A standard calibration procedure Relationship between the applied weights and the recorded strain of the handle of the developed measurement instrument
Factors affecting grip strength: A review(1/3) Effects of Body Position A standardized testing body position is important to compare different test results “The patient seated with his shoulder adducted and neutrally rotated, the elbow flexed at 90◦, and the forearm and wrist in neutral position.” -ASHT Effects of Multiple Trials Motor performances and the greatest grip strength usually occur in the earlier trials Fatigue does not affect the hand strength measurements
Factors affecting grip strength: A review (2/3) Effects of Duration of Contraction Time Isometric contraction can cause potentially dangerous increases in blood pressure and pulse rate A duration of contraction phase equal to or less than 3 s is recommended Effects of Age Age is an important variable in the measurement of grip strength Grip strength has a nonlinear relationship to age(6~19, 20~50) Effects of Sex The hand strength of males is stronger than females In the range of 14–20 years, the differences between males and females increase rapidly 收縮持續時間的影響 等長收縮可引起潛在的危險的增加血壓和脈搏率 收縮相位等於或小於3秒的持續時間,建議 年齡的影響。 年齡是握力測量的一個重要變量 握力具有非線性關係,以年齡(6〜19,20〜50) 性別的影響。 男性的手的力量比女性強 在14-20歲的範圍內,男性和女性之間的差異增加迅速
Factors affecting grip strength: A review(3/3) Effects of Hand Dominance Some have found that the grip strength of a dominant hand is approximately 10% greater than that of the nondominant Effects of Body Weight and Height There is a positive relationship between hand strength and the variables of weight and height Grip strength has a nonlinear relationship to age(6~19, 20~50)
Experimental Tests (1/5) 44 people: 20 are healthy(11 men and nine women, averaging in age of 61 ± 4 years) 24 are pathological (15 men and nine women, averaging in age of 68 ± 6 years) Standard body position: Modified the standard body position described because for some Parkinsonian patients were not able to maintain the elbow flexed at 90∘ The proposed protocol is simple to understand, not requiring complicated adjustments of the subject position.
Experimental Tests (2/5) Analysis: Using the Stokes suggestions to eliminate the trials that are suspected as fictitious loss of grip. Five successive trials: For each patient and for both hands, five successive trials have been carried out, recoding the relevant score every time. The procedure of test requests an initial contraction, which takes about 3 s , and a successive release phase. The global time duration of each trial is 6 s.
Experimental Tests (3/5) Beginning and end of the test: Two different sounds identified the beginning and end of the test. When the patient heard the first sound, he should exercise the maximum strength on the handle, keeping the grasp until the perception of the second sound. A suitable acquisition system: IBM PLC-718 with an accuracy of 0.01% reading ± 1 bit) that uses a sampling frequency = 110 Hz. The obtained signal can be divided into five main phases [4]: reaction, contraction, maintenance, release, and relaxation
Experimental Tests (4/5) Signal relevant to the healthy patient test Signal relevant to the Parkinsonian patient test
Experimental Tests (5/5) Signal relevant to Parkinsonian patients (continuous line) and the relative filtered signal (circle marker). Filtered signal relevant to Parkinsonian patients (continuous line), the relative derivative signal (dotted line), and the relative area signal (dashed line).
Results (1/3) No differences of sex and age were considered because our sample of patients was characterized by individuals aged over 50 years old. The parameters that high-light in a clear way meaningful differences between healthy and Parkinsonian patients were “fall speed” and “area signal.” The release phase is less fatiguing and less difficult with respect to the contraction one.
Results (2/3) The area parameter takes into account all the main char- acteristics of grip strength behavior (contraction phase, maximum strength, and release phase). The velocities (in the rise and fall phase) represent the ratio between strength variation and time variation, giving information about the dynamics of the analyzed phenomena.
Results (3/3) Fall speed values relevant to the Parkinsonian (continuous line) and healthy (line with the plus marker) patients with relative average values and standard uncertainty. Area signal values relevant to the Parkinsonian (continuous line) and healthy (line with plus marker) patients with relative average values and standard uncertainty.
Conclusions The applicability of a new analysis method for characterization of the motor activities of limbs has been investigated. Objective evaluation relevant to Parkinson’s disease and represents the first attempt to identify some criteria for estimating the impairment produced by Parkinson’s disease. The analysis concerns patients under treatment ON-state so that a confirmation of the results must be given by the tests made on the Parkinsonian patients in OFF-state.
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