Setting the Tone for Virtual Spasticity Assessment: Planning Development and Testing of the Telerehabilitation-Objective-Neuromuscular- Evaluation (TONE) Device

• Author / Creator

  Gillespie, Daniel C

• Background: Telehealth provides the ability to connect specialist healthcare providers with patients regardless of geographical location or other limitations restricting in-person care. Spasticity is a common complication affecting individuals with neurological conditions requiring specialist management. Challenges remain in objectively identifying the neural and non-neural components of spasticity, as no gold standard assessment exists. In telehealth spasticity assessment practices, the inability to use routine hands-on approaches is a significant barrier to care. Quantitative measures relating to range of motion, muscle activity, and force are essential for advancing in-person and telehealth spasticity assessment practices. The Telerehabilitation-Objective-Neuromuscular-Evaluation (TONE) device is a novel device and software application capable of measuring and transmitting quantitative spasticity assessment information, including range of motion, surface electromyography, and force data within telehealth contexts.
  Objectives: The main objective of this doctoral research was to develop, construct, and evaluate a device and software application for obtaining biomechanical and neurophysiological measurements of spasticity compatible with telehealth settings.
  Methods: Three complementary studies were conducted to achieve the primary objectives. Study 1 utilized an online survey and focus group interviews to gather information about how spasticity clinicians across Canada are currently performing telehealth spasticity assessments. This study also aimed to identify challenges and advantages associated with telehealth spasticity assessment delivery. Plan-Do-Study-Act methodology was used to guide development of the Telerehabilitation-Objective-Neuromuscular-Evaluation (TONE) device and software application as outlined in chapter 3. Study 2 involved validating the TONE device against reference standards in a population without neurological impairment. Proof of concept testing was completed in study 3, involving preliminary testing of the TONE device within a group of five participants with known post-stroke and traumatic brain injury-related spasticity of the upper extremity.
  Results: Survey findings from study 1 indicated that most respondents felt the ability to perform telehealth spasticity assessments would benefit their clinical practice. However, most respondents also reported not being satisfied with current telehealth spasticity assessment practices. Qualitative analysis revealed telehealth spasticity assessment success to be highly variable and dependent on several personal and environmental factors. Participants identified the inability to perform hands-on clinical assessments of spasticity in telehealth environments as a significant limitation. Another theme emerging from qualitative interviews was uncertainty among spasticity clinicians regarding adopting quantitative measures of spasticity within clinical practice. Development of the first iteration of the TONE device and software application commenced in January 2021 and was completed in December 2021. Successful wireless transmission and recording of range of motion, force, and muscle activity measures were achieved prior to validation testing.
  Study 2 demonstrated a moderate to strong relationship between elbow joint kinematic measures assessed between the TONE device and reference standard optical motion tracking measures. Good agreement was found between the TONE device’s surface electromyography (sEMG) sensor and Delsys’s sEMG reference standard measure for measures of muscle contraction duration time. Timing of the duration of muscle contraction and average force analysis demonstrated good agreement between the developed TONE device and the commercially available handheld dynamometer (KForce®) reference device. Results from proof-of-concept testing in study 3 demonstrated that the TONE device was successfully able to measure and transmit quantitative spasticity assessment data from patient to specialist within a simulated telehealth environment. In five individuals, differences between the spastic and non-spastic limbs were detected during passive elbow extension in the measures of range of motion, joint angular velocity, force, and EMG signal response.
  Conclusions: This thesis has outlined a collaboration between healthcare providers, biomedical engineers, researchers, and patients to develop a device and software application for obtaining biomechanical and neurophysiological measurements of spasticity compatible with telehealth settings. This thesis has also demonstrated that biomechanical and neurophysiological measures related to spasticity can be obtained within telehealth environments. Preliminary evidence has been presented that the TONE device is capable of differentiating between spastic and non-spastic upper limbs in individuals with post-stroke spasticity. Future work should aim to enhance the precision of the sEMG sensor data by preserving the raw signal, allowing for post-signal processing methods to determine if the catch angle can be visualized. Additionally, strategies for assessing spasticity in other body regions should be explored. Further investigation is needed into the feasibility and effectiveness of adopting quantitative measures of spasticity within clinical practice.

• Subjects / Keywords

  • Spasticity
  • Stroke
  • Telehealth
  • Assessment

• Graduation date

  Spring 2024

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/r3-q59t-vp67

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.