18
METHODS FOR 3D UPPER EXTREMITY MOTION ANALYSIS & CLINICALLY AVAILABLE DATA ANALYSIS TOOLS Ellen Jaspers, PT, PhD Cristina Simon6Martinez, MSc, PhD candidate GCMAS SYMPOSIUM 2017 1
METHODS FOR 3D UPPER EXTREMITYMOTION ANALYSIS
&CLINICALLY AVAILABLE DATA ANALYSIS
TOOLSEllen%Jaspers,%PT,%PhDCristina%Simon6Martinez,%MSc,%PhD%candidate
GCMAS&SYMPOSIUM&2017 1
Disclosure*InformationAACPDM*71st*Annual*Meeting*|*September*13=16,*2017
Speaker%Name:%%Ellen%Jaspers,%Cristina%Simon6Martinez
Disclosure%of%Relevant%Financial%RelationshipsWe&have&no&financial&relationships&to&disclose.&
Disclosure%of%Off6Label%and/or%investigative%uses:&We&will¬&discuss&off&label&use&and/or&investigational&use&in&any&of&our&presentations.
AACPDM&– GCMAS&SYMPOSIUM&2017 2
1. Data%acquisition
2. Data%analysis
3. Data%interpretation
4. Clinical%application
FLOWCHART
GCMAS&SYMPOSIUM&2017 3
GCMAS&SYMPOSIUM&2017 4
1.*Data*acquisitionSUBJECT%PREPARATION%6 MARKER%PLACEMENT
trunk
scapula
upper,arm
forearm
hand
Wu#et#al.,#ISB#recommendations#for#upper#extremity#motion#analysis,#J.#Biomech#2005Capazzo#et#al.,#CAST#procedure,#J.#Biomech#1995
• Minimum&3&markers&/&segment
NOT%JOINT%MOVEMENT
• Calibration&procedure&(CAST)
Link&anatomical&landmarks&to&segmentsMEASUREMENT%OF%JOINT%MOVEMENT
• Data&acquisition&(movement&protocol)
• Reach&tasks&(different&directions)• forwards• sideways• upwards
• Reach&to&grasp&tasks&(different&object&orientation)• little&ball&• vertical&cylinder
• Gross&motor&tasks&(ADL&related)• hand&to&mouth• hand&to&head• hand&to&contralateral&shoulder
GCMAS&SYMPOSIUM&2017 5
Protocol#as#currently#applied#in#the#Clinical#Motion#Analysis#Laboratory#of#the#University#Hospital#Pellenberg,#Leuven,#Belgium
Jaspers#et#al.#Gait#Posture#2011M33:279Q285Jaspers#et#al.#Gait#Posture#2011M33:568Q575
MOVEMENT%PROTOCOL
• Standardization&of&set&up
• Palpation&of&anatomical&landmarks&of&interest
• Marker&visibility&
GCMAS&SYMPOSIUM&2017 6
CHALLENGES
• None&provided&by&different&commercially&available&gait&analysis&tools&
• Upper&Limb&Evaluation&in&Motion&Analysis&(U.L.E.M.A.)&&
• Open&source&software&(GitHub)
• Matlab based&
• Windows&compatible&
GCMAS&SYMPOSIUM&2017 7
2.*Data*analysisCLINICAL%TOOLS
https://github.com/u0078867/ulemaQulQanalyzer
3.*Data*interpretationUPPER%LIMB%ANGLES
TRUNK SCAPULA
!"Elevation"="negative"angle
SHOULDER%
Pearl"et"al."1992
ELBOW WRIST
GCMAS&SYMPOSIUM&2017 8
9
TRUNK
SCAPULA
SHOULDER
ELBOW
WRIST
UPPER%LIMB%REPORTS
GCMAS&SYMPOSIUM&2017
0
20
40
60
80
100
120
Movement%cycle%(percentage)
Flexion
Extension
10
UPPER%LIMB%REPORTS
ROM50◦ flexion
ROM34◦ flexion
0%%%%% 20% 40% 60%%%%% 80%%%%%% 100
MAX97◦ flexion|
PTA%/%MIN47◦ flexion
|
|
MAX59◦ flexion
PTA%/%MIN25◦ flexion
|
uCP TDC
INFORMATION%ONDISCRETE%JOINT%ANGLES
NO%INFORMATION%ONAMOUNT%OF%MOVEMENT%PATHOLOGY
Fig.#3#from#“Mailleux#L,#SimonQMartinez#C,#Feys#H,#Jaspers#E.#Upper#Extremity#Movement#Pathology#in#Functional#Tasks.#Handbook#on#Human#Motion.#Springer#2017”
GCMAS&SYMPOSIUM&2017
11GCMAS&SYMPOSIUM&2017
UPPER%LIMB%SUMMARY%SCORE
0
10
20
30
40
50
60
70
80
Trunk%FlExt
Trunk%LatFl
Trunk%Rot
Scap%ProRetr
Scap%MedLat
Scap%%%%Tilt
Sh%Elev%Plane
Sh%Elev% Sh%Rot Elb%FlExt Elb%ProSup
Wr%FlExt Wr%Dev APS
RMS%diffe
rences%(d
egrees)
Reference%dataChild%with%uCP INFORMATION%ON%
AMOUNT%OF%MOVEMENT%PATHOLOGY
NO%INFORMATION%ONDIRECTION%OF%MOVEMENT%PATHOLOGY
NO%INFORMATION%WHEN%IN%CYCLE%THE%PATHOLOGY%IS%MOST%PRONOUNCED
Jaspers#et#al.#Gait#Posture#2011M34:227Q33
• Multiple&tasks
• Multiple&joint&angles
• Dependency&of&joint&angles
GCMAS&SYMPOSIUM&2017 12
CHALLENGES
GCMAS&SYMPOSIUM&2017 13
NEW%TOOLS%6 SPM
Statistical%Parametric%Mapping%1d
• Open&source&software&(GitHub)
• Matlab based&
• Windows&compatible&
Pataky#J#Biomech#2010M43:#1976Q82
1. Allows%hypothesis%testing%over%the%entire%spectrum%
2. Reduces%chances%of%incorrectly%rejecting%the%null6hypothesis
GCMAS&SYMPOSIUM&2017 14
4.*Clinical*application
Patient%information
• Boy,&14y7m&
• Left&hemiplegia
• MACS&II
• MAS&score&elbow&pronators&2,&elbow&flexors&1
PRE6POST%BTX%COMPARISON
BTX%intervention
• 160&U&Pronator&Teres• 40&U&Pronator&Quadratus
• No&adverse&events
EVALUATION%PRE%(4m) AND%POST%(60d)%BTX
Clinical&evaluation
• ROM,&spasticity&(MAS),&muscle&strength&
(MRC,&grip&strength)
ULa3DMA• Reach&to&grasp&a&vertically&oriented&object&
• Spatiotemporal¶meters
• Movement&pathology&(AaMAP)
GCMAS&SYMPOSIUM&2017 15
SPASTICITY%(MAS%scores)
PRE POST
Elbo
w
Flexors 1 0
Extensors 0 0
Pronators 2 1
Wrist Flexors 1 0
Extensors 0 0
FINGE
RS
Flexors 1 1
Extensors 0 0
Thumb 1 1.5
PRE6POST%BTX%COMPARISON
PASSIVE%RANGE%OF%MOTION%(degrees)
PRE POST
Elbo
w
Flexion 160 160
Extension a5 0
Supination 45 75
Pronation 95 95
Wrist Flexion 90 100
Extension 90 90
Wilcoxon"Signed"Rank"test;"*"Significant"(p<0.05),"£trend"(p"0.06)MUSCLE%(MRC)%&%GRIP%STRENGTH%(ratio,%)
Elbo
w
Flexors 4 4
Extensors 4 4
Supinators 1.5 1.5
Pronators 2.5 1.5
Wrist Flexors 2.5 2.5
Extensors 1 1
Grip strength 15 10
• ↑%ROM%elbow%supination• ↓%spasticity%elbow%&%wrist%flexors,%
elbow%pronators• ↓%strength%elbow%supinators• ↓%grip%strength
GCMAS&SYMPOSIUM&2017 16
PRE6POST%BTX%COMPARISON
SPATIOTEMPORAL%PARAMETERS
PRE POST
Duration%(sec) 1.6 2.2
Speed%(cm/sec) 815 778
Index of%curvature 1.2 1.6
Time at%Vmax%(%%cycle) 29 18
Slower%and%less%straight%movement%trajectory%post%BTX
17
0
10
20
30
40
50
60
70
80
90
Trunk,FlExt
Trunk,LatFl
Trunk,Rot
Scap,ProRetr
Scap,MedLat
Scap,Tilt Sh,Elev,Plane
Sh,Elev Sh,Rot Elb,FlExt
Elb,ProSup
Wr,FlExt Wr,Dev APS
RMS,difference,(degr)
PRE6POST%BTX%COMPARISON
MOVEMENT%PATHOLOGY%(A6MAP)PREPOSTTDC
↓% MOVEMENT%PATHOLOGY• TOTAL&movement&pathology&
(APS)
• Elbow&flexionaextension• Elbow&proasupination
• Shoulder&elevation&plane• Shoulder&rotation
GCMAS&SYMPOSIUM&2017
GCMAS&SYMPOSIUM&2017 18
PRE6POST%BTX%COMPARISON
SUMMARY%– BTX6A%TREATMENT%IN%ELBOW%PRONATORS
• ↑&ROM&elbow&supination• ↓&spasticity&elbow&&&wrist&flexors,&
elbow&pronators
• ↓&strength&elbow&supinators• ↓&grip&strength
↓%total%movement%pathology• Improved&elbow&movement&pattern• Improved&shoulder&movement&pattern
Slower%and%less%straight%movement%trajectory%
