Computational models for improved diagnosis and prognosis of stroke using robot-based biomarkers

Stroke is a leading cause of death and permanent disability worldwide, affecting millions of individuals. Traditional clinical scores for assessment of stroke-related impairments are inherently subjective and limited by inter-rater and intra-rater reliability, as well as floor and ceiling effects. In contrast, robotic technologies provide objective, highly repeatable tools for quantification of neurological impairments following stroke. KINARM is an exoskeleton robotic device that provides objective, reliable tools for assessment of sensorimotor, proprioceptive and cognitive brain function by means of a battery of behavioral tasks. As such, KINARM is particularly useful for assessment of neurological impairments following stroke. This thesis introduces a computational framework for assessment of neurological impairments using the data provided by KINARM. This is done by achieving two main objectives. First, to investigate how robotic measurements can be used to estimate current and future abilities to perform daily activities for subjects with stroke. We are able to predict clinical scores related to activities of daily living at present and future time points using a set of robotic biomarkers. The findings of this analysis provide a proof of principle that robotic evaluation can be an effective tool for clinical decision support and target-based rehabilitation therapy. The second main objective of this thesis is to address the emerging problem of long assessment time, which can potentially lead to fatigue when assessing subjects with stroke. To address this issue, we examine two time reduction strategies. The first strategy focuses on task selection, whereby KINARM tasks are arranged in a hierarchical structure so that an earlier task in the assessment procedure can be used to decide whether or not subsequent tasks should be performed. The second strategy focuses on time reduction on the longest two individual KINARM tasks. Both reduction strategies are shown to provide significant time savings, ranging from 30% to 90% using task selection and 50% using individual task reductions, thereby establishing a framework for reduction of assessment time on a broader set of KINARM tasks. All in all, findings of this thesis establish an improved platform for diagnosis and prognosis of stroke using robot-based biomarkers.

Stress Inversion Using LiDAR Tunnel Deformation Measurements

Far-field stresses are those present in a volume of rock prior to excavations being created. Estimates of the orientation and magnitude of far-field stresses, often used in mine design, are generally obtained by single-point measurements of stress, or large-scale, regional trends. Point measurements can be a poor representation of far-field stresses as a result of excavation-induced stresses and geological structures. For these reasons, far-field stress estimates can be associated with high levels of uncertainty. The purpose of this thesis is to investigate the practical feasibility, applications, and limitations of calibrating far-field stress estimates through tunnel deformation measurements captured using LiDAR imaging. A method that estimates the orientation and magnitude of excavation-induced principal stress changes through back-analysis of deformation measurements from LiDAR imaged tunnels was developed and tested using synthetic data. If excavation-induced stress change orientations and magnitudes can be accurately estimated, they can be used in the calibration of far-field stress input to numerical models. LiDAR point clouds have been proven to have a number of underground applications, thus it is desired to explore their use in numerical model calibration. The back-analysis method is founded on the superposition of stresses and requires a two-dimensional numerical model of the deforming tunnel. Principal stress changes of known orientation and magnitude are applied to the model to create calibration curves. Estimation can then be performed by minimizing squared differences between the measured tunnel and sets of calibration curve deformations. In addition to the back-analysis estimation method, a procedure consisting of previously existing techniques to measure tunnel deformation using LiDAR imaging was documented. Under ideal conditions, the back-analysis method estimated principal stress change orientations within ±5° and magnitudes within ±2 MPa. Results were comparable for four different tunnel profile shapes. Preliminary testing using plastic deformation, a rough tunnel profile, and profile occlusions suggests that the method can work under more realistic conditions. The results from this thesis set the groundwork for the continued development of a new, inexpensive, and efficient far-field stress estimate calibration method.

Improved Accuracy in Optical Motion Capture Measurements Leads to Increased Sensitivity to Kinematic Changes

Clinical optical motion capture allows us to obtain kinematic and kinetic outcome measures that aid clinicians in diagnosing and treating different pathologies affecting healthy gait. The long term aim for gait centres is for subject-specific analyses that can predict, prevent, or reverse the effects of pathologies through gait retraining. To track the body, anatomical segment coordinate systems are commonly created by applying markers to the surface of the skin over specific, bony anatomy that is manually palpated. The location and placement of these markers is subjective and precision errors of up to 25mm have been reported [1]. Additionally, the selection of which anatomical landmarks to use in segment models can result in large angular differences; for example angular differences in the trunk can range up to 53o for the same motion depending on marker placement [2]. These errors can result in erroneous kinematic outcomes that either diminish or increase the apparent effects of a treatment or pathology compared to healthy data. Our goal was to improve the accuracy and precision of optical motion capture outcome measures. This thesis describes two separate studies. In the first study we aimed to establish an approach that would allow us to independently quantify the error among trunk models. Using this approach we determined if there was a best model to accurately track trunk motion. In the second study we designed a device to improve precision for test, re-test protocols that would also reduce the set-up time for motion capture experiments. Our method to compare a kinematically derived centre of mass velocity to one that was derived kinetically was successful in quantifying error among trunk models. Our findings indicate that models that use lateral shoulder markers as well as limit the translational degrees of freedom of the trunk through shared pelvic markers result in the least amount of error for the tasks we studied. We also successfully reduced intra- and inter-operator anatomical marker placement errors using a marker alignment device. The improved accuracy and precision resulting from the methods established in this thesis may lead to increased sensitivity to changes in kinematics, and ultimately result in more consistent treatment outcomes.