Quantifying Abnormal Muscle Tone Due to Neurological Impairment - - PowerPoint PPT Presentation

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Quantifying Abnormal Muscle Tone Due to Neurological Impairment - - PowerPoint PPT Presentation

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Quantifying Abnormal Muscle Tone Due to Neurological Impairment Thursday March 20 th , 2014 Starts at 12:00 PM EST Presented by Elizabeth Brokaw, PhD Kinesia HomeView TM Kinesia ProView TM 2 MyoSense 3 Outline Impact of Neurological

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Quantifying Abnormal Muscle Tone Due to Neurological Impairment

Thursday March 20th, 2014 Starts at 12:00 PM EST Presented by Elizabeth Brokaw, PhD

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Kinesia HomeViewTM Kinesia ProViewTM

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MyoSense

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  • Impact of Neurological Impairment

– Abnormal Muscle Tone

  • MyoSense

– Development – Bench Testing – Clinical Evaluation

Outline

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  • High incidence of

neurological disorders

– Abnormal muscle tone – Reduced independence

Individuals With Neurological Impairment

Stroke 795,000

Center for Disease Control; Jan 2006 Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths, 2002-2006

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  • Resistance force to passive movement
  • Abnormal muscle tone presents in many

different forms.

– Rigidity – Dystonia – Spasticity – Hypertonia

Abnormal Muscle Tone

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Rigidity

  • Parkinson’s Disease

– Stiffness or heaviness

  • Lead pipe
  • Cog wheel

Rigidity

UCD Medicine https://www.youtube.com/watch?v=sJqKvajUC3k

Lead Pipe

Speed/Position Force

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Cog wheel

Position Force

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  • Cerebral Palsy

– Rigid/Posturing – Unintentional movement

Dystonia

http://www.localmatters.co.nz/ http://www.ndta.org/clinicians-corner.php?id=4

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Rigid Dystonia

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Spasticity

  • Stroke and Traumatic Brain Injury

– Speed based – Catch

Spasticity

www.strokeassociation.org

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Hypertonia

  • Stroke and Traumatic Brain Injury

– Range of motion

Hypertonia

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Treatments

  • Various types of treatment

– Botox – Baclofen – Phenol injections – Surgical intervention – Deep brain stimulation

Treatments

http://jarrettwilsontbi.wordpress.com/ 2013/08/05/tbi-is-truly-stunning-botox-images/

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Tone Management

  • Abnormal tone types respond differently
  • Difficult to distinguish different types of tone

– Cerebral palsy

  • Research limited by current clinical outcome

measures Issues with Abnormal Tone Management

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DBS Baclofen Dystonia Dystonia Spasticity Spasticity ? ?

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Clinical Scales

  • Specific aspects of abnormal tone
  • Modified Ashworth, Tardieu (spasticity)
  • Fahn Marsden Burke (dystonia)
  • Low resolution
  • Subjective interpretation

Clinical Scales

FMB Arm Evaluation No dystonia present 1 Slight dystonia. Clinically insignificant 2

  • Mild. Obvious dystonia but not disabling

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  • Moderate. Able to grasp, with some manual function

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  • Severe. No useful grasp

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MyoSense Development

MyoSense Development

  • Quantitative assessment of abnormal tone
  • Integrate with conventional practice

– Clinician worn

  • Reduce patient burden

– Typical Assessment

  • Speed
  • Position
  • Force

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Myosense

  • Prototype Hardware

– Flexiforce FSR sensors and XBee – GLNT Movement Sensor (bluetooth)

MyoSense

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  • Information

about

  • rientation and

speed

  • Correlate with

force data MyoSense Data

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MyoSense Bench Testing

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Simulated Abnormal Elbow Tone

Threshold set at 45 deg/s

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Distinguishing Profiles

  • Hypertonia Evaluation

– Move the simulated elbow at 5 deg/s

  • Position bins and

average force

  • Correlation to

theoretical = 0.93

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Distinguishing Profiles

  • Mod-Ashworth Evaluation

– Move the simulated elbow at 90 deg/s

  • Speed bins and average

force

  • Correlation to theoretical

= 0.80

  • High speed effects of

device mechanics

– Belts and filtering

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  • Issue

– High speed mechanical effects – Acceleration – Change in direction

  • Solution

– Track specific speeds – Examine the change across speed

Comparing Different Abnormal Tone Profiles

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  • Tracking specific speeds

– 5, 25, 45, 65, 85 deg/s

  • At each 20s trial

– Average speed and average force

Comparing Different Abnormal Tone Profiles

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  • Correlation of 0.99
  • Distinguish Profiles and Changes in magnitude

Comparing Different Abnormal Tone Profiles

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  • Successful pilot evaluation of MyoSense
  • Clinical evaluation with individuals with

spasticity, dystonia, and cerebral palsy Bench Testing Conclusion

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MyoSense Clinical Evaluation

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Clinical Evaluation Protocol

  • Subjects

– 10 Pure dystonia – 10 Pure spasticity – 10 Mixed dystonia and spasticity (Cerebral Palsy) – 30 Age matched controls

  • Clinician manipulates limb

– 5, 45, 90, 135, 180 – wrist, elbow, knee, ankle – Mod Ashworth and Fahn Marsden Burke

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Individual with Dystonia

Preliminary Results

FMB = 1 FMB = 0

Unimpaired Control

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Clinical Evaluation Goals

  • Goal from Clinical Evaluation

– Differentiate types of abnormal muscle tone – Examine correlation to clinical measures

  • Commercialization

– Effects of spasticity and dystonia – Effects of treatments

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Acknowledgements

  • Dr. Erwin Montgomery
  • Dr. Ilia Itin
  • Alexandria Wyant
  • Funding from NIH

National Institute of Neurological Disorders and Stroke (1R43NS076052-01A1)

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GLNT Movement Sensor

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http://glneurotech.com/motion-sensor

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Questions?

For more information contact: Elizabeth Brokaw Ebrokaw@glneurotech.com