School of Clinical Sciences - Te Kura Mātai Haumanu

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https://hdl.handle.net/10292/1241
The School of Clinical Sciences plays an important role in specialist teaching and research conducted by its academic staff and postgraduate students. This places AUT students at the forefront of much of the ground-breaking research undertaken in New Zealand, especially in the fields of Midwifery, Nursing, Occupational Therapy, Oral Health, Paramedicine, Physiotherapy, Podiatry.

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Browsing School of Clinical Sciences - Te Kura Mātai Haumanu by Subject "0805 Distributed Computing"

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    Assessing Gait & Balance in Adults with Mild Balance Impairment: G&B App Reliability and Validity
    (MDPI, 2023-12-09) Shafi, Hina; Awan, Waqar Ahmed; Olsen, Sharon; Siddiqi, Furqan Ahmed; Tassadaq, Naureen; Rashid, Usman; Niazi, Imran Khan
    Smartphone applications (apps) that utilize embedded inertial sensors have the potential to provide valid and reliable estimations of different balance and gait parameters in older adults with mild balance impairment. This study aimed to assess the reliability, validity, and sensitivity of the Gait&Balance smartphone application (G&B App) for measuring gait and balance in a sample of middle- to older-aged adults with mild balance impairment in Pakistan. Community-dwelling adults over 50 years of age (N = 83, 50 female, range 50–75 years) with a Berg Balance Scale (BBS) score between 46/56 and 54/56 were included in the study. Data collection involved securing a smartphone to the participant’s lumbosacral spine. Participants performed six standardized balance tasks, including four quiet stance tasks and two gait tasks (walking looking straight ahead and walking with head turns). The G&B App collected accelerometry data during these tasks, and the tasks were repeated twice to assess test-retest reliability. The tasks in quiet stance were also recorded with a force plate, a gold-standard technology for measuring postural sway. Additionally, participants completed three clinical measures, the BBS, the Functional Reach Test (FRT), and the Timed Up and Go Test (TUG). Test-retest reliability within the same session was determined using intraclass correlation coefficients (ICCs) and the standard error of measurement (SEM). Validity was evaluated by correlating the G&B App outcomes against both the force plate data and the clinical measures using Pearson’s product-moment correlation coefficients. To assess the G&B App’s sensitivity to differences in balance across tasks and repetitions, one-way repeated measures analyses of variance (ANOVAs) were conducted. During quiet stance, the app demonstrated moderate reliability for steadiness on firm (ICC = 0.72) and compliant surfaces (ICC = 0.75) with eyes closed. For gait tasks, the G&B App indicated moderate to excellent reliability when walking looking straight ahead for gait symmetry (ICC = 0.65), walking speed (ICC = 0.93), step length (ICC = 0.94), and step time (ICC = 0.84). The TUG correlated with app measures under both gait conditions for walking speed (r −0.70 and 0.67), step length (r −0.56 and −0.58), and step time (r 0.58 and 0.50). The BBS correlated with app measures of walking speed under both gait conditions (r 0.55 and 0.51) and step length when walking with head turns (r = 0.53). Force plate measures of total distance wandered showed adequate to excellent correlations with G&B App measures of steadiness. Notably, G&B App measures of walking speed, gait symmetry, step length, and step time, were sensitive to detecting differences in performance between standard walking and the more difficult task of walking with head turns. This study demonstrates the G&B App’s potential as a reliable and valid tool for assessing some gait and balance parameters in middle-to-older age adults, with promise for application in low-income countries like Pakistan. The app’s accessibility and accuracy could enhance healthcare services and support preventive measures related to fall risk.
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    Decoding Attempted Hand Movements in Stroke Patients Using Surface Electromyography
    (MDPI AG, 2020-11-26) Jochumsen, M; Niazi, IK; Rehman, MZU; Amjad, I; Shafique, M; Gilani, SO; Waris, A
    Brain‐ and muscle‐triggered exoskeletons have been proposed as a means for motor training after a stroke. With the possibility of performing different movement types with an exoskeleton, it is possible to introduce task variability in training. It is difficult to decode different movement types simultaneously from brain activity, but it may be possible from residual muscle activity that many patients have or quickly regain. This study investigates whether nine different motion classes of the hand and forearm could be decoded from forearm EMG in 15 stroke patients. This study also evaluates the test‐retest reliability of a classical, but simple, classifier (linear discriminant analysis) and advanced, but more computationally intensive, classifiers (autoencoders and convolutional neural networks). Moreover, the association between the level of motor impairment and classification accuracy was tested. Three channels of surface EMG were recorded during the following motion classes: Hand Close, Hand Open, Wrist Extension, Wrist Flexion, Supination, Pronation, Lateral Grasp, Pinch Grasp, and Rest. Six repetitions of each motion class were performed on two different days. Hudgins time‐domain features were extracted and classified using linear discriminant analysis and autoencoders, and raw EMG was classified with convolutional neural networks. On average, 79 ± 12% and 80 ± 12% (autoencoders) of the movements were correctly classified for days 1 and 2, respectively, with an intraclass correlation coefficient of 0.88. No association was found between the level of motor impairment and classification accuracy (Spearman correlation: 0.24). It was shown that nine motion classes could be decoded from residual EMG, with autoencoders being the best classification approach, and that the results were reliable across days; this may have implications for the development of EMG‐controlled exoskeletons for training in the patient’s home.
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    Decoding of Ankle Joint Movements in Stroke Patients Using Surface Electromyography
    (MDPI AG, 2021-02-24) Noor, A; Waris, A; Gilani, SO; Kashif, AS; Jochumsen, M; Iqbal, J; Niazi, IK
    Stroke is a cerebrovascular disease (CVD), which results in hemiplegia, paralysis, or death. Conventionally, a stroke patient requires prolonged sessions with physical therapists for the recovery of motor function. Various home-based rehabilitative devices are also available for upper limbs and require minimal or no assistance from a physiotherapist. However, there is no clinically proven device available for functional recovery of a lower limb. In this study, we explored the potential use of surface electromyography (sEMG) as a controlling mechanism for the development of a home-based lower limb rehabilitative device for stroke patients. In this experiment, three channels of sEMG were used to record data from 11 stroke patients while performing ankle joint movements. The movements were then decoded from the sEMG data and their correlation with the level of motor impairment was investigated. The impairment level was quantified using the Fugl-Meyer Assessment (FMA) scale. During the analysis, Hudgins time-domain features were extracted and classified using linear discriminant analysis (LDA) and artificial neural network (ANN). On average, 63.86% ± 4.3% and 67.1% ± 7.9% of the movements were accurately classified in an offline analysis by LDA and ANN, respectively. We found that in both classifiers, some motions outperformed oth-ers (p < 0.001 for LDA and p = 0.014 for ANN). The Spearman correlation (ρ) was calculated between the FMA scores and classification accuracies. The results indicate that there is a moderately positive correlation (ρ = 0.75 for LDA and ρ = 0.55 for ANN) between the two of them. The findings of this study suggest that a home-based EMG system can be developed to provide customized therapy for the improvement of functional lower limb motion in stroke patients.
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    Detection of Error-Related Potentials in Stroke Patients from EEG Using an Artificial Neural Network
    (MDPI AG, 2021-09-18) Usama, N; Niazi, IK; Dremstrup, K; Jochumsen, M
    Error-related potentials (ErrPs) have been proposed as a means for improving brain– computer interface (BCI) performance by either correcting an incorrect action performed by the BCI or label data for continuous adaptation of the BCI to improve the performance. The latter approach could be relevant within stroke rehabilitation where BCI calibration time could be minimized by using a generalized classifier that is continuously being individualized throughout the rehabilitation session. This may be achieved if data are correctly labelled. Therefore, the aims of this study were: (1) classify single-trial ErrPs produced by individuals with stroke, (2) investigate test–retest reliability, and (3) compare different classifier calibration schemes with different classification methods (artificial neural network, ANN, and linear discriminant analysis, LDA) with waveform features as input for meaningful physiological interpretability. Twenty-five individuals with stroke operated a sham BCI on two separate days where they attempted to perform a movement after which they received feedback (error/correct) while continuous EEG was recorded. The EEG was divided into epochs: ErrPs and NonErrPs. The epochs were classified with a multi-layer perceptron ANN based on temporal features or the entire epoch. Additionally, the features were classified with shrinkage LDA. The features were waveforms of the ErrPs and NonErrPs from the sensorimotor cortex to improve the explainability and interpretation of the output of the classifiers. Three calibration schemes were tested: within-day, between-day, and across-participant. Using within-day calibration, 90% of the data were correctly classified with the entire epoch as input to the ANN; it decreased to 86% and 69% when using temporal features as input to ANN and LDA, respectively. There was poor test–retest reliability between the two days, and the other calibration schemes led to accuracies in the range of 63–72% with LDA performing the best. There was no association between the individuals’ impairment level and classification accuracies. The results show that ErrPs can be classified in individuals with stroke, but that user-and session-specific calibration is needed for optimal ErrP decoding with this approach. The use of ErrP/NonErrP waveform features makes it possible to have a physiological meaningful interpretation of the output of the classifiers. The results may have implications for labelling data continuously in BCIs for stroke rehabilitation and thus potentially improve the BCI performance.
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    Single-Trial Classification of Error-Related Potentials in People with Motor Disabilities: A Study in Cerebral Palsy, Stroke, and Amputees
    (MDPI AG, 2022-02-21) Usama, N; Niazi, IK; Dremstrup, K; Jochumsen, M
    Brain-computer interface performance may be reduced over time, but adapting the classifier could reduce this problem. Error-related potentials (ErrPs) could label data for continuous adaptation. However, this has scarcely been investigated in populations with severe motor impairments. The aim of this study was to detect ErrPs from single-trial EEG in offline analysis in participants with cerebral palsy, an amputation, or stroke, and determine how much discriminative information different brain regions hold. Ten participants with cerebral palsy, eight with an amputation, and 25 with a stroke attempted to perform 300–400 wrist and ankle movements while a sham BCI provided feedback on their performance for eliciting ErrPs. Pre-processed EEG epochs were inputted in a multi-layer perceptron artificial neural network. Each brain region was used as input individually (Frontal, Central, Temporal Right, Temporal Left, Parietal, and Occipital), the combination of the Central region with each of the adjacent regions, and all regions combined. The Frontal and Central regions were most important, and adding additional regions only improved performance slightly. The average classification accuracies were 84 ± 4%, 87± 4%, and 85 ± 3% for cerebral palsy, amputation, and stroke participants. In conclusion, ErrPs can be detected in participants with motor impairments; this may have implications for developing adaptive BCIs or automatic error correction.
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