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Atzori M.,University of Applied Sciences and Arts Western Switzerland | Gijsberts A.,Institute Of Recherche Idiap | Heynen S.,University of Applied Sciences and Arts Western Switzerland | Hager A.-G.M.,University of Applied Sciences and Arts Western Switzerland | And 5 more authors.
Proceedings of the IEEE RAS and EMBS International Conference on Biomedical Robotics and Biomechatronics | Year: 2012

This paper is about (self-powered) advanced hand prosthetics and their control via surface electromyography (sEMG). We hereby introduce to the biorobotics community the first version of the Ninapro database, containing kinematic and sEMG data from the upper limbs of 27 intact subjects while performing 52 finger, hand and wrist movements of interest. The setup and experimental protocol are distilled from existing literature and thoroughly described; the data are then analysed and the results are discussed. In particular, it is clear that standard analysis techniques are no longer enough when so many subjects and movements are taken into account. The database is publicly available to download in standard ASCII format. The database is an ongoing work lasting several years, which is planned to contain data from more than 100 intact subjects and 50 trans-radial amputees; characteristics of the amputations, phantom limbs and prosthesis usage will be stored. We therefore hope that it will constitute a standard, widely accepted benchmark for all novel myoelectric hand prosthesis control methods, as well as a fundamental tool to deliver insight into the needs of trans-radial amputees. © 2012 IEEE.

Atzori M.,University of Applied Sciences and Arts Western Switzerland | Gijsberts A.,Institute Of Recherche Idiap | Kuzborskij I.,Institute Of Recherche Idiap | Elsig S.,University of Applied Sciences and Arts Western Switzerland | And 5 more authors.
IEEE Transactions on Neural Systems and Rehabilitation Engineering | Year: 2015

In this paper, we characterize the NINAPRO database and its use as a benchmark for hand prosthesis evaluation. The database is a publicly available resource that aims to support research on advanced myoelectric hand prostheses. The database is obtained by jointly recording surface electromyography signals from the forearm and kinematics of the hand and wrist while subjects perform a predefined set of actions and postures. Besides describing the acquisition protocol, overall features of the datasets and the processing procedures in detail, we present benchmark classification results using a variety of feature representations and classifiers. Our comparison shows that simple feature representations such as mean absolute value and waveform length can achieve similar performance to the computationally more demanding marginal discrete wavelet transform. With respect to classification methods, the nonlinear support vector machine was found to be the only method consistently achieving high performance regardless of the type of feature representation. Furthermore, statistical analysis of these results shows that classification accuracy is negatively correlated with the subject's Body Mass Index. The analysis and the results described in this paper aim to be a strong baseline for the NINAPRO database. Thanks to the NINAPRO database (and the characterization described in this paper), the scientific community has the opportunity to converge to a common position on hand movement recognition by surface electromyography, a field capable to strongly affect hand prosthesis capabilities. © 2014 IEEE.

PubMed | University of Lausanne, Rehaklinik Bellikon, Institute Of Recherche En Readaptation and Suva Swiss National Accident Insurance Fund
Type: | Journal: Swiss medical weekly | Year: 2015

Time to fitness for work (TFW) was measured as the number of days that were paid as compensation for work disability during the 4 years after discharge from the rehabilitation clinic in a population of patients hospitalised for rehabilitation after orthopaedic trauma. The aim of this study was to test whether some psychological variables can be used as potential early prognostic factors of TFW.A Cox proportional hazards model was used to estimate the associations between predictive variables and TFW. Predictors were global health, pain at hospitalisation and pain decrease during the stay (all continuous and standardised by subtracting the mean and dividing by two standard deviations), perceived severity of the trauma and expectation of a positive evolution (both binary variables).Full data were available for 807 inpatients (660 men, 147 women). TFW was positively associated with better perceived health (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.13-1.19), pain decrease (HR 1.46, 95% CI 1.30-1.64) and expectation of a positive evolution (HR 1.50, 95% CI 1.32-1.70) and negatively associated with pain at hospitalisation (HR 0.67, 95% CI 0.59-0.76) and high perceived severity (HR 0.72, 95% CI 0.61-0.85).The present results provide some evidence that work disability during a four-year period after rehabilitation may be predicted by prerehabilitation perceptions of general health, pain, injury severity, as well as positive expectation of evolution.

Luthi F.,Clinique Romande de Readaptation Suvacare | Luthi F.,Institute Of Recherche En Readaptation | Luthi F.,University of Lausanne | Deriaz O.,Institute Of Recherche En Readaptation | And 6 more authors.
PLoS ONE | Year: 2014

Background: Workers with persistent disabilities after orthopaedic trauma may need occupational rehabilitation. Despite various risk profiles for non-return-to-work (non-RTW), there is no available predictive model. Moreover, injured workers may have various origins (immigrant workers), which may either affect their return to work or their eligibility for research purposes. The aim of this study was to develop and validate a predictive model that estimates the likelihood of non-RTW after occupational rehabilitation using predictors which do not rely on the worker's background. Methods: Prospective cohort study (3177 participants, native (51%) and immigrant workers (49%)) with two samples: a) Development sample with patients from 2004 to 2007 with Full and Reduced Models, b) External validation of the Reduced Model with patients from 2008 to March 2010. We collected patients' data and biopsychosocial complexity with an observer rated interview (INTERMED). Non-RTW was assessed two years after discharge from the rehabilitation. Discrimination was assessed by the area under the receiver operating curve (AUC) and calibration was evaluated with a calibration plot. The model was reduced with random forests. Results: At 2 years, the non-RTW status was known for 2462 patients (77.5% of the total sample). The prevalence of non-RTW was 50%. The full model (36 items) and the reduced model (19 items) had acceptable discrimination performance (AUC 0.75, 95% CI 0.72 to 0.78 and 0.74, 95% CI 0.71 to 0.76, respectively) and good calibration. For the validation model, the discrimination performance was acceptable (AUC 0.73; 95% CI 0.70 to 0.77) and calibration was also adequate. Conclusions: Non-RTW may be predicted with a simple model constructed with variables independent of the patient's education and language fluency. This model is useful for all kinds of trauma in order to adjust for case mix and it is applicable to vulnerable populations like immigrant workers. © 2014 Luthi et al.

PubMed | Clinique romande de readaptation suvacare and Institute Of Recherche En Readaptation
Type: | Journal: Journal of occupational rehabilitation | Year: 2016

Purpose Updating the Wallis Occupational Rehabilitation Risk (WORRK)model formula, predicting non-return to work (nRTW) at different time points (3 and 12months) than in the validation study (2years). Methods Secondary analysis of two samples was carried out (following orthopaedic trauma), including work status, the first at 3months (428 patients) and the second at 12months (431 patients) after discharge from rehabilitation. We used calibration (agreement between predicted probabilities and observed frequencies) and discrimination (area under the receiver operating characteristics curve) to assess performance of the model after fitting it in the new sample, then calculated the probabilities of nRTW based on the coefficients from the 2-year prediction. Finally, the intercepts were updated for both 3- and 12-month prediction models (re-calibration was necessary for the adjustment of these probabilities) and performance re-evaluated. Results Patient characteristics were similar in all samples (mean age 43 in both groups; 86% male at 3months, 84% male at 12months). The proportion of nRTW at 3months was 63.8% and 53.4% at 12months (50.36% at 2years). Performance of the original WORRK for both 3- and 12-month prediction showed an AUC of 0.73, while statistically significant miscalibration was found for both time points (p<0.001). After the updating of the intercept, calibration was improved and did not show significant miscalibration (p=0.458 and 0.341). The AUC stayed at 0.73. Conclusion The WORRK model was successfully adapted by changing the intercept for 3- and 12-month prediction of nRTW, now available for use in clinical practice.

Terrier P.,Institute Of Recherche En Readaptation | Deriaz O.,Institute Of Recherche En Readaptation
Journal of NeuroEngineering and Rehabilitation | Year: 2011

Background: Motorized treadmills are widely used in research or in clinical therapy. Small kinematics, kinetics and energetics changes induced by Treadmill Walking (TW) as compared to Overground Walking (OW) have been reported in literature. The purpose of the present study was to characterize the differences between OW and TW in terms of stride-to-stride variability. Classical (Standard Deviation, SD) and non-linear (fractal dynamics, local dynamic stability) methods were used. In addition, the correlations between the different variability indexes were analyzed. Methods. Twenty healthy subjects performed 10 min TW and OW in a random sequence. A triaxial accelerometer recorded trunk accelerations. Kinematic variability was computed as the average SD (MeanSD) of acceleration patterns among standardized strides. Fractal dynamics (scaling exponent ) was assessed by Detrended Fluctuation Analysis (DFA) of stride intervals. Short-term and long-term dynamic stability were estimated by computing the maximal Lyapunov exponents of acceleration signals. Results: TW did not modify kinematic gait variability as compared to OW (multivariate T 2, p = 0.87). Conversely, TW significantly modified fractal dynamics (t-test, p = 0.01), and both short and long term local dynamic stability (T 2 p = 0.0002). No relationship was observed between variability indexes with the exception of significant negative correlation between MeanSD and dynamic stability in TW (3 × 6 canonical correlation, r = 0.94). Conclusions: Treadmill induced a less correlated pattern in the stride intervals and increased gait stability, but did not modify kinematic variability in healthy subjects. This could be due to changes in perceptual information induced by treadmill walking that would affect locomotor control of the gait and hence specifically alter non-linear dependencies among consecutive strides. Consequently, the type of walking (i.e. treadmill or overground) is important to consider in each protocol design. © 2011 Terrier and Dériaz; licensee BioMed Central Ltd.

Terrier P.,Institute Of Recherche En Readaptation | Luthi F.,Institute Of Recherche En Readaptation | Deriaz O.,Institute Of Recherche En Readaptation
BMC Musculoskeletal Disorders | Year: 2013

Background: Complex foot and ankle fractures, such as calcaneum fractures or Lisfranc dislocations, are often associated with a poor outcome, especially in terms of gait capacity. Indeed, degenerative changes often lead to chronic pain and chronic functional limitations. Prescription footwear represents an important therapeutic tool during the rehabilitation process. Local Dynamic Stability (LDS) is the ability of locomotor system to maintain continuous walking by accommodating small perturbations that occur naturally during walking. Because it reflects the degree of control over the gait, LDS has been advocated as a relevant indicator for evaluating different conditions and pathologies. The aim of this study was to analyze changes in LDS induced by orthopaedic shoes in patients with persistent foot and ankle injuries. We hypothesised that footwear adaptation might help patients to improve gait control, which could lead to higher LDS:. Methods. Twenty-five middle-aged inpatients (5 females, 20 males) participated in the study. They were treated for chronic post-traumatic disabilities following ankle and/or foot fractures in a Swiss rehabilitation clinic. During their stay, included inpatients received orthopaedic shoes with custom-made orthoses (insoles). They performed two 30s walking trials with standard shoes and two 30s trials with orthopaedic shoes. A triaxial motion sensor recorded 3D accelerations at the lower back level. LDS was assessed by computing divergence exponents in the acceleration signals (maximal Lyapunov exponents). Pain was evaluated with Visual Analogue Scale (VAS). LDS and pain differences between the trials with standard shoes and the trials with orthopaedic shoes were assessed. Results: Orthopaedic shoes significantly improved LDS in the three axes (medio-lateral: 10% relative change, paired t-test p < 0.001; vertical: 9%, p = 0.03; antero-posterior: 7%, p = 0.04). A significant decrease in pain level (VAS score -29%) was observed. Conclusions: Footwear adaptation led to pain relief and to improved foot & ankle proprioception. It is likely that that enhancement allows patients to better control foot placement. As a result, higher dynamic stability has been observed. LDS seems therefore a valuable index that could be used in early evaluation of footwear outcome in clinical settings. © 2013 Terrier et al.; licensee BioMed Central Ltd.

Terrier P.,Institute Of Recherche En Readaptation
PLoS ONE | Year: 2012

While walking, human beings continuously adjust step length (SpL), step time (SpT), step speed (SpS = SpL/SpT) and step width (SpW) by integrating both feedforward and feedback mechanisms. These motor control processes result in correlations of gait parameters between consecutive strides (statistical persistence). Constraining gait with a speed cue (treadmill) and/or a rhythmic auditory cue (metronome), modifies the statistical persistence to anti-persistence. The objective was to analyze whether the combined effect of treadmill and rhythmic auditory cueing (RAC) modified not only statistical persistence, but also fluctuation magnitude (standard deviation, SD), and stationarity of SpL, SpT, SpS and SpW. Twenty healthy subjects performed 6×5 min. walking tests at various imposed speeds on a treadmill instrumented with foot-pressure sensors. Freely-chosen walking cadences were assessed during the first three trials, and then imposed accordingly in the last trials with a metronome. Fluctuation magnitude (SD) of SpT, SpL, SpS and SpW was assessed, as well as NonStationarity Index (NSI), which estimates the dispersion of local means in the times series (SD of 20 local means over 10 steps). No effect of RAC on fluctuation magnitude (SD) was observed. SpW was not modified by RAC, what is likely the evidence that lateral foot placement is separately regulated. Stationarity (NSI) was modified by RAC in the same manner as persistent pattern: Treadmill induced low NSI in the time series of SpS, and high NSI in SpT and SpL. On the contrary, SpT, SpL and SpS exhibited low NSI under RAC condition. We used relatively short sample of consecutive strides (100) as compared to the usual number of strides required to analyze fluctuation dynamics (200 to 1000 strides). Therefore, the responsiveness of stationarity measure (NSI) to cued walking opens the perspective to perform short walking tests that would be adapted to patients with a reduced gait perimeter. © 2012 Philippe Terrier.

Terrier P.,Institute Of Recherche En Readaptation | Deriaz O.,Institute Of Recherche En Readaptation
Human Movement Science | Year: 2012

It has been observed that long time series of Stride Time (ST), Stride Length (SL) and Stride Speed (SS = SL/ST) exhibited statistical persistence (long-range auto-correlation) in overground walking. Rhythmic auditory cueing induced anti-persistent (or anti-correlated) patterns in ST series, while SL and SS remained persistent. On the other hand, it has been shown that SS became anti-persistent in treadmill walking, while ST and SL remained persistent. The aim of this study was to analyze the effect of the combination of treadmill walking (imposed speed) and auditory cueing (imposed cadence) on gait dynamics. Twenty middle-aged subjects performed 6 × 5. min walking trials at various imposed speeds on an instrumented treadmill. Freely chosen walking cadences were measured during the first three trials, and then imposed accordingly in the last three trials by using a metronome. Detrended fluctuation analysis (DFA) was performed on the times series of ST, SL, and SS. Treadmill induced anti-persistent dynamics in the time series of SS, but preserved the persistence of ST and SL. On the contrary, all the three parameters were anti-persistent under dual-constraints condition. Anti-persistent dynamics may be related to a tighter control: deviations are followed by a rapid over-correction, which produces oscillations around target values. Under single constraint condition, while SS is tightly regulated in order to follow the treadmill speed, redundancy between ST and SL would likely allow persistent pattern to occur. Conversely, under dual constraint conditions, the absence of redundancy among SL, ST and SS would explain the generalized anti-persistent pattern. © 2012 Elsevier B.V.

PubMed | Institute Of Recherche En Readaptation
Type: | Journal: Annals of physical and rehabilitation medicine | Year: 2016

To measure if a decision-supportive tool based on the WORRK model, developed to predict non-return to work (nRTW) after orthopaedic trauma, improves the allocation to various vocational pathways according to patients nRTW risk, for use in clinical practice.Randomized-controlled trial using vocational inpatients after orthopaedic trauma (n=280). In the intervention group, the nRTW risk estimated using the WORRK tool was given to the clinician team before allocation of the vocational pathway, while in the control group it was not. Three pathways are available: simple (SP) and coaching (CP) (patients with low to intermediate nRTW risk, average of 5 week hospitalization and 17hrs of therapy/week) and evaluation (EP) (high risk of nRTW, average of 3 week hospitalization and 14hrs of therapy/week, less individual therapies, evaluation without training in the vocational workshop). The following indications were given: the higher the percentage of the WORRK score, the lower the predicted chance of RTW; a score<50% indicates that probably the SP or CP is most adapted to the patient; a score of 50-69% indicates that the EP can/should be considered; a score>70% indicates that probably the EP is most adapted to the patient. The primary outcome was the proportion of patients allocated to the EP.Four hundred and fifty patients were assessed for eligibility, 280 included, 139 randomized to the control group (mean age 42.3 years) and 141 to the intervention group (mean age 43.2 years). The two groups were similar regarding risk profile, age, education, native language, pain and quality of life. The patients in the intervention group were more often referred to the EP compared to the control group, having a 31% higher chance, but this difference was not statistically significant (risk ratio 1.31 [95% CI 0.70-2.46]). The NNT was 30.The effect of the WORRK tool was smaller than expected, possibly because: clinicians did not have confidence in the score provided, being given inadequate guidelines for when to refer patients to which pathway, clinicians avoid using the EP by fear of disadvantaging patients or because the EP is not adapted to our patients.

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