ANALYSES OF KINEMATIC QUANTITIES OF PEOPLE AFTER STROKE DURING DIFFERENT FORMS OF
LOCOMOTION
1
Jacek Jurkojć, 1Robert Michnik, 1Agata Guzik-Kopyto, 2 Wiesław Rycerski and 2Agnieszka Szewczyk Nowak
Department of Applied Mechanics, Silesian University of Technology, Gliwice, Poland [email protected],
[email protected], [email protected], [email protected],
2
Upper Silesian Rehabilitation Center „Repty”, Poland, [email protected], [email protected]
1
SUMMARY
Within the confines of cooperation between scientists from the
Department of Applied Mechanics from Silesian University of
Technology and doctors from the Rehabilitation Centre
“Repty”, the project concerning elaboration of the system
which enables monitoring of rehabilitation progress of patients
after stroke is working out. The system is based on medical
tests and analyses of kinematic and dynamic quantities
measured and determined for different tasks performed by
patients. Exemplary kinematic results are presented in this
paper.
INTRODUCTION
Stroke is one of the main reason of people death or disability
[5]. Rehabilitation of survivors is very complex and longlasting. That is why the appropriate rehabilitation and its
assessment is so crucial. Nowadays the most popular way of
this assessment is subjective examination carried out by
doctors, which is based on some medical tests [1,2]. The aim
of the presented project is to elaborate the system enabling:
objective estimation of condition of patients locomotion
system and assessment how the rehabilitation progress run.
This project is conducted within the confines of cooperation
between the Department of Applied Mechanics from Silesian
University of Technology and the Rehabilitation Centre
“Repty”.
The elaborated system makes possible an objective analysis of
rehabilitation progress and gives some hints how to make this
process more dedicated for individual patients. The system is
composed of three groups of analyses of the patient’s
locomotion system. The first one is the typical examination
carried out by doctors. It is based on such tests as: Beck
Depression Inventory, Barthel Index, Ashworth Scale,
Brunnstrom Scale or Mini-Mental State Examination. The
second analysis bases on measurements of kinematic
quantities, ground reactions and calculations of kinematic
quantities which are conducted for such tasks as: walking,
going up the stairs and standing up. Simultaneously the
balance measurements are performed. The third analysis
consists in estimation of muscle forces and joint reactions
which occurs during mentioned tasks. This is performed by
means of dedicated mathematical models of human lower leg
motion. Both kinematic quantities, muscle forces and joint
reactions are determined in 3D space.
This paper concerns mainly the kinematic and ground
reactions analyses and it will be described precisely in the next
parts of the article.
METHODS
All measurements are carried out for patients who are already
able to walk. These examinations are conducted at the
beginning of the rehabilitation process and after every three
weeks of patient treatment (generally there are three
measurements because six week treatment is the most
common one in the Rehabilitation Centre). Every patient who
is qualified to examinations has to perform three tasks: walk
along a measurement path, stand up from a chair and go up the
step. If a patient is unable to do one or more of these tasks, it
is written down. Examined person has 17 markers attached to
the characteristic points of lower limb and pelvis. Execution of
tasks is recorded by a set of camcorders and ground reactions
are measured by means of dynamometric platforms. Then
obtained movies are processed with the use of APAS system
and computer program prepared by scientists from the
Department of Applied Mechanics [3,4]. In this way such
results are obtained as: courses of joint angles, velocity of gait,
cadence, stride length, range of motion in individual joints etc.
Then these quantities are analyzed, compared with each other
and with standard courses. During measurements it turned out
that pelvic markers are invisible for standing up and it is
impossible to carry out 3D kinematic analysis.
Besides measurements of kinematic quantities and ground
reactions, assessment of balance is carried out for every
patient.
RESULTS AND DISCUSSION
All measurements were performed in the Rehabilitation Centre
“Repty” in Tarnowskie Gory, Poland. There were 19 patients
who were examined. Quantitative and qualitative analyses
were carried out for each patient.
Gait and going up the step analyses were carried out on the
basis of such quantities as: courses of joint angles, ground
reactions, time of gait cycle, duration of stance phase. Gait
Gilette Index (GGI) parameters were used to conduct
quantitative analyses. Figures 1 - 6 presents exemplary results
obtained for 39 years old woman after subarachnoid
hemorrhage with dexter hemiparesis. Figures 1 - 5 present
courses of knee and hip angles and two GGI parameters (max.
knee flexion and range of hip flexion) obtained before and
after rehabilitation. One can notice that courses of hip and
knee flexion angles, especially in the affected limb, are more
correct in the last measurement. Maximal angle of knee
flexion as well as range of hip flexion-extension movement
are lager also at the end of the rehabilitation.
a)
b)
Figure 1: Flexion/extension angle in the hip joint during one
gait cycle obtained for one patient a) before and b) after
rehabilitation. Shaded region corresponds to standard course,
red line – left limb, green line – right limb (affected side)
reactions obtained for one leg for healthy person with
characteristic points marked as P1, P2, P3.
a)
b)
Figure 5: Maximal knee flexion (a) and maximal range of hip
flexion/extension movement (b) during one cycle going up the
step obtained before and after rehabilitation
Figure 6: Ground reactions obtained during standing up
a)
b)
Figure 2: Flexion/extension angle in the knee joint during one
gait cycle obtained for one patient a) before and b) after
rehabilitation Shaded region corresponds to standard course,
red line – left limb, green line – right limb (affected side)
CONCLUSIONS
Applied methodology enables objective analysis based on
kinematic quantities and ground reactions. Such approach to
the problem of estimation of rehabilitation progress broaden
doctors knowledge and enables more individual patient
treatment.
ACKNOWLEDGEMENTS
The study was supported by research grant no. NN504083438
of the Ministry of Science and Higher Education in Poland.
b)
a)
Figure 3: Maximal knee flexion (a) and range of hip
flexion/extension movement (b) during one gait cycle obtained
before and after rehabilitation
a)
b)
Figure 4: Flexion/extension angle in the hip joint during one
cycle of going up the step obtained for one patient a) before
and b) after rehabilitation. Shaded region corresponds to
standard course, red line – left limb, green line – right limb
(affected side)
Analysis of standing up exercise was based only on ground
reactions courses. Three characteristic points on these courses
were determined. These points correspond to the following
phases of standing up process. Figure 6 presents standard
REFERENCES
1. Dębiec-Bąk A., Mraz M., Mraz M., Skrzek A.:
Jakościowa i ilościowa ocena chodu osób po udarze
mózgu, Acta Bio-Optica et Informatica Medica. 2/2007,
13, ss. 97-100
2. Drużbicki M., Prześniak-Jost A., Kwolek A.: Metody
klinimetryczne stosowane w rehabilitacji neurologicznej,
Przegląd Medyczny Uniwersytetu Rzeszowskiego,
Rzeszów 2007, 3, ss. 268-274
3. Michnik R., Jurkojć J., Guzik A., Tejszerska D.: Analysis
of loads of the lower limb during gait, carried out with the
use of the mathematical model, made for patients during
rehabilitation progress, Eccomas Conference “Multibody
Dynamics 2007” Conference Information Booklet &
Book of Abstracts, Milano 2007
4. Michnik Robert, Jurkojć Jacek, Jureczko Paweł, Guzik
Agata, Tejszerska Dagmara: Analysis of gait kinematics
of patients after total hip or knee replacement, Journal of
Vibroengineering, Vilnius 2006, 8, No. 3, pp. 15-18
5. Stephenson J. L., Lamontagne A., De Serres S.J.: The
coordination of upper and lower limb movement during
gait in healthy and stroke individuals, Gait and Posture,
29, 2009, ss. 11-