Publications by authors named "Massimo Penta"

21 Publications

  • Page 1 of 1

Recognizing Manual Activities Using Wearable Inertial Measurement Units: Clinical Application for Outcome Measurement.

Sensors (Basel) 2021 May 7;21(9). Epub 2021 May 7.

Institue of Neurosciences (IoNS), Université catholique de Louvain, Avenue Mounier 53, 1200 Brussels, Belgium.

The ability to monitor activities of daily living in the natural environments of patients could become a valuable tool for various clinical applications. In this paper, we show that a simple algorithm is capable of classifying manual activities of daily living (ADL) into categories using data from wrist- and finger-worn sensors. Six participants without pathology of the upper limb performed 14 ADL. Gyroscope signals were used to analyze the angular velocity pattern for each activity. The elaboration of the algorithm was based on the examination of the activity at the different levels (hand, fingers and wrist) and the relationship between them for the duration of the activity. A leave-one-out cross-validation was used to validate our algorithm. The algorithm allowed the classification of manual activities into five different categories through three consecutive steps, based on hands ratio (i.e., activity of one or both hands) and fingers-to-wrist ratio (i.e., finger movement independently of the wrist). On average, the algorithm made the correct classification in 87.4% of cases. The proposed algorithm has a high overall accuracy, yet its computational complexity is very low as it involves only averages and ratios.
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http://dx.doi.org/10.3390/s21093245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8125825PMC
May 2021

ABILHAND-HS: a linear scale for outcome measurement in hand surgery.

J Hand Surg Eur Vol 2021 Feb 8:1753193421991485. Epub 2021 Feb 8.

Service d'orthopédie et traumatologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.

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http://dx.doi.org/10.1177/1753193421991485DOI Listing
February 2021

Manual ability in hand surgery patients: Validation of the ABILHAND scale in four diagnostic groups.

PLoS One 2020 3;15(12):e0242625. Epub 2020 Dec 3.

Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium.

Background: Patients treated in hand surgery (HS) belong to different demographic groups and have varying impairments related to different pathologies. HS outcomes are measured to assess treatment results, complication risks and intervention reliability. A one-dimensional and linear measure would allow for unbiased comparisons of manual ability between patients and different treatment effects.

Objective: To adapt the ABILHAND questionnaire through Rasch analysis for specific use in HS patients and to examine its validity.

Methods: A preliminary 90-item questionnaire was presented to 216 patients representing the diagnoses most frequently encountered in HS, including distal radius fracture (n = 74), basal thumb arthritis (n = 66), carpal tunnel syndrome (n = 53), and heavy wrist surgery (n = 23). Patients were assessed during the early recovery and in the late follow-up period (0-3 months, 3-6 months and >6 months), leading to a total of 305 assessments. They rated their perceived difficulty with queried activities as impossible, difficult, or easy. Responses were analyzed using the RUMM2030 software. Items were refined based on item-patient targeting, fit statistics, differential item functioning, local independence and item redundancy. Patients also completed the QuickDASH, 12-item Short Form Survey (SF-12) and a numerical pain scale.

Results: The rating scale Rasch model was used to select 23 mostly bimanual items on a 3-level scale, which constitute a unidimensional, linear measure of manual ability with good reliability across all included diagnostic groups (Person-Separation Index = 0.90). The resulting scale was found to be invariant across demographic and clinical subgroups and over time. ABILHAND-HS patient measures correlated significantly (p<0.001) with the QuickDASH (r = -0.77), SF-12 Physical Component Summary (r = 0.56), SF-12 Mental Component Summary (r = 0.31), and pain scale (r = -0.49).

Conclusion: ABILHAND-HS is a robust person-centered measure of manual ability in HS patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0242625PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714184PMC
January 2021

Lower Limb Kinematics Using Inertial Sensors during Locomotion: Accuracy and Reproducibility of Joint Angle Calculations with Different Sensor-to-Segment Calibrations.

Sensors (Basel) 2020 Jan 28;20(3). Epub 2020 Jan 28.

Institue of Neurosciences (IONS), Université Catholique de Louvain, Secteur des Sciences de la Santé, Place Pierre de Coubertin 1, B-1348 Louvain-la-Neuve, Belgium.

Inertial measurement unit (IMU) records of human movement can be converted into joint angles using a sensor-to-segment calibration, also called functional calibration. This study aims to compare the accuracy and reproducibility of four functional calibration procedures for the 3D tracking of the lower limb joint angles of young healthy individuals in gait. Three methods based on segment rotations and one on segment accelerations were used to compare IMU records with an optical system for their accuracy and reproducibility. The squat functional calibration movement, offering a low range of motion of the shank, provided the least accurate measurements. A comparable accuracy was obtained in other methods with a root mean square error below 3.6° and an absolute difference in amplitude below 3.4°. The reproducibility was excellent in the sagittal plane (intra-class correlation coefficient (ICC) > 0.91, standard error of measurement (SEM) < 1.1°), good to excellent in the transverse plane (ICC > 0.87, SEM < 1.1°), and good in the frontal plane (ICC > 0.63, SEM < 1.2°). The better accuracy for proximal joints in calibration movements using segment rotations was traded to distal joints in calibration movements using segment accelerations. These results encourage further applications of IMU systems in unconstrained rehabilitative contexts.
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http://dx.doi.org/10.3390/s20030715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7039222PMC
January 2020

A robust machine learning enabled decomposition of shear ground reaction forces during the double contact phase of walking.

Gait Posture 2019 09 9;73:221-227. Epub 2019 Jul 9.

Institute of Neuroscience, Université catholique de Louvain, Louvain-la-Neuve, Belgium; Arsalis SPRL, Glabais, Belgium. Electronic address:

Background: Dynamic analyses of walking rely on the 3D ground reaction forces (GRF) under each foot, while only the resultant force of both limbs may be recorded on a single-belt instrumented treadmill or when both feet touch the same force platform.

Research Question: This study aims to develop a robust decomposition of the shear GRF to complete the most accurate decomposition of the vertical GRF [8].

Methods: A retrospective study of 374 healthy adults records (age: 22.8 ± 2.6 years, speed: 1.34 ± 0.28 m/s) and of 434 patient records (age: 21.3 ± 17.8 years, speed: 0.64 ± 0.19 m/s) were used in a machine learning process to develop a robust predictive model to decompose the fore-aft GRF. The lateral GRF was decomposed by resolving the equilibrium of transverse moments around the center of pressure.

Results: A predictive linear model of the fore-aft GRF under the back foot every 5% of the double contact phase was obtained from 2 predictors: the total fore-aft GRF and the vertical GRF under the back foot. Each predictor uses a time series of 31 samples before and during the double contact. The model performs accurately in healthy (median[IQR] error of 3.0[2.2-4.1]%) and in clinical gaits (7.7[4.7-13.4]%). The error in lateral GRF decomposition is of 5.7[3.9-10.2]% in healthy gaits and of 12.0[7.2-19.2]% in patients under the back foot and about half of that under the front foot.

Significance: The decomposition of shear GRFs achieved in this study supports the mechanics of walking. It provides outstanding accuracy in healthy gait and also applies to neurologic and orthopedic disorders. Together with the vertical GRF decomposition [8], this approach for the shear components paves the way for robust single limb GRF determination on a single-belt instrumented treadmill or when both feet touch the same force platform in normal and clinical gait analysis.
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http://dx.doi.org/10.1016/j.gaitpost.2019.07.190DOI Listing
September 2019

Determinants of Social Participation at 1, 3, and 6 Months Poststroke in Benin.

Arch Phys Med Rehabil 2019 11 25;100(11):2071-2078. Epub 2019 Apr 25.

Systems and Cognitive Neuroscience Division, Institute of Neuroscience, Catholic University of Louvain, Brussels, Belgium. Electronic address:

Objective: To build a model of prediction of social participation of community-dwelling stroke survivors in Benin at 1 month, 3 months, and 6 months.

Design: An observational study with evaluations at 1 month, 3 months, and 6 months poststroke. Correlational analyses and multivariate linear regressions were performed.

Setting: Outpatient rehabilitation centers in Benin.

Participants: A volunteer sample of 91 stroke patients was enrolled at baseline; 64 (70%) patients completed all the study (N=64): 70% male and 52% right hemiparesis.

Intervention: Not applicable.

Main Outcome Measures: Participants were evaluated with the Participation Measurement Scale, ACTIVLIM-Stroke (activities of daily living [ADL]), Stroke Impairment Assessment Set, 6-minute walk test, Hospital Anxiety and Depression Scale, and the modified Rankin Scale.

Results: The significant predictors of social participation after controlling the confounders were the following: at 1 month ADL (0.4 [0.3, 0.6]) and depression (‒0.6 [‒0.8, ‒0.2]) with total model R=0.44; at 3 months ADL (0.58 [0.4, 0.7]) and depression (‒0.58 [‒0.5, ‒0.7]) with total model R=0.65; and at 6 months ADL (0.31 [0.2, 0.5]), impairments (‒0.82 [‒0.5, ‒0.7]), and depression (‒0.94 [‒0.8, ‒0.2]) with total model R=0.78.

Conclusions: Using socioculturally tailored tools, the present study identified ADL performance (ACTIVLIM-Stroke), depression (Hospital Anxiety Depression Scale), and overall impairments (Stroke Impairment Assessment Set) as the significant determinants of social participation (Participation Measurement Scale) poststroke in Benin. These findings will be a valuable resource for rehabilitation stakeholders in evaluating interventions, programs, and policies designed to encourage social participation for stroke patients.
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http://dx.doi.org/10.1016/j.apmr.2019.03.020DOI Listing
November 2019

Measuring Participation After Stroke in Africa: Development of the Participation Measurement Scale.

Arch Phys Med Rehabil 2018 04 26;99(4):652-659. Epub 2017 Oct 26.

Institute of Neuroscience, Catholic University of Louvain, Brussels, Belgium; University Hospital Saint-Luc, Physical and Rehabilitation Medecine Department, Catholic University of Louvain, Brussels, Belgium. Electronic address:

Objective: To develop a valid stroke-specific tool, named the Participation Measurement Scale (PM-Scale), for the measurement of participation after stroke.

Design: Observational study and questionnaire development.

Setting: Outpatient rehabilitation centers.

Participants: Patients with stroke (N=276; mean age, 58.5±11.1y; 57% men).

Interventions: Not applicable.

Main Outcome Measures: Participants completed a 100-item experimental questionnaire of the PM-Scale. Items were scored as "not at all," "weakly," or "strongly." The Hospital Anxiety and Depression Scale was used to evaluate depression, and the modified Rankin Scale was used to categorize the severity of disability on the basis of observation.

Results: After successive Rasch analyses using unrestricted partial credit parameterization, a valid, unidimensional, and linear 22-item scale for the measurement of participation was constructed. All 22 items fulfilled the measurement requirements of overall and individual item and person fits, category discrimination, invariance, and local response independence. The PM-Scale showed good internal consistency (person separation index, .93). The test-retest reliability of item difficulty hierarchy (r=.96; P<.001) and patient location (r=.99; P<.001) were excellent. This patient-based scale covers all 9 International Classification of Functioning, Disability and Health domains of participation.

Conclusions: The PM-Scale has good psychometric qualities and provides accurate measures of participation in patients with stroke in Africa.
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http://dx.doi.org/10.1016/j.apmr.2017.10.004DOI Listing
April 2018

How robust is ACTIVLIM for the follow-up of activity limitations in patients with neuromuscular diseases?

Neuromuscul Disord 2016 Mar 21;26(3):211-20. Epub 2015 Dec 21.

Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium; Arsalis SPRL, Glabais, Belgium. Electronic address:

This study aims to investigate the clinimetric properties of ACTIVLIM, a measure of activity limitations, when it is used in daily practice in a large nationwide representative cohort of patients with neuromuscular diseases. A cohort of 2986 patients was assessed at least once over 2 years in 6 national neuromuscular diseases reference centers. Successive Rasch analyses were conducted in order to investigate the scale validity, reliability, consistency across demographic and clinical sub-groups and its sensitivity to change. ACTIVLIM confirmed excellent fit to a unidimensional scale, with stable but 3-times more accurate item calibrations compared to the original publication. It showed a good reliability (R = 0.95), an appropriate targeting for 87% of the sample and an excellent invariance across age, gender, language and time. Despite some variations in the item difficulty hierarchy across diagnoses, ACTIVLIM exhibited a good capability to quantify small but significant changes in activity for various diagnostic groups. Overall, ACTIVLIM demonstrated very good clinimetric properties, allowing accurate quantitative measurement of activity limitations in both children and adults with a variety of neuromuscular diseases.
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http://dx.doi.org/10.1016/j.nmd.2015.12.004DOI Listing
March 2016

Physical factors influencing pleasant touch during passive fingertip stimulation.

PLoS One 2014 7;9(7):e101361. Epub 2014 Jul 7.

Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium; Cliniques Universitaires Saint-Luc, Physical and Rehabilitation Medicine Department, Université catholique de Louvain, Brussels, Belgium.

Objective: Tactile explorations with the fingertips provide information regarding the physical properties of surfaces and their relative pleasantness. Previously, we performed an investigation in the active touch domain and linked several surface properties (i.e. frictional force fluctuations and net friction) with their pleasantness levels. The aim of the present study was to investigate physical factors being important for pleasantness perception during passive fingertip stimulation. Specifically we were interested to see whether factors, such as surfaces' topographies or their frictional characteristics could influence pleasantness. Furthermore, we ascertained how the stimulus pleasantness level was impacted by (i) the normal force of stimulus application (FN) and (ii) the stimulus temperature (TS).

Methods And Results: The right index fingertips of 22 blindfolded participants were stimulated using 27 different stimuli, which varied in average roughness (Ra) and TS. A 4-axis robot moved the stimuli horizontally under participants' fingertips with three levels of FN. The robot was equipped with force sensors, which recorded the FN and friction force (FT) during stimulation. Participants rated each stimulus according to a three-level pleasantness scale, as very pleasant (scored 0), pleasant (scored 1), or unpleasant (scored 2). These ordinal pleasantness ratings were logarithmically transformed into linear and unidimensional pleasantness measures with the Rasch model. Statistical analyses were conducted to investigate a possible link between the stimulus properties (i.e. Ra, FN, FT, and TS) and their respective pleasantness levels. Only the mean Ra and FT values were negatively correlated with pleasantness. No significant correlation was detected between FN or TS and pleasantness.

Conclusion: Pleasantness perception, resulting from passive fingertip stimulation, seems to be influenced by the surfaces' average roughness levels and average FT occurring during fingertip stimulation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0101361PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4084823PMC
February 2015

Can manual ability be measured with a generic ABILHAND scale? A cross-sectional study conducted on six diagnostic groups.

BMJ Open 2012 31;2(6). Epub 2012 Oct 31.

Physical and Occupational Therapy Departments, Paramedical Category, Haute Ecole Louvain en Hainaut, Montignies-sur-Sambre, Belgium.

Objectives: Several ABILHAND Rasch-built manual ability scales were previously developed for chronic stroke (CS), cerebral palsy (CP), rheumatoid arthritis (RA), systemic sclerosis (SSc) and neuromuscular disorders (NMD). The present study aimed to explore the applicability of a generic manual ability scale unbiased by diagnosis and to study the nature of manual ability across diagnoses.

Design: Cross-sectional study.

Setting: Outpatient clinic homes (CS, CP, RA), specialised centres (CP), reference centres (CP, NMD) and university hospitals (SSc).

Participants: 762 patients from six diagnostic groups: 103 CS adults, 113 CP children, 112 RA adults, 156 SSc adults, 124 NMD children and 124 NMD adults.

Primary And Secondary Outcome Measures: Manual ability as measured by the ABILHAND disease-specific questionnaires, diagnosis and nature (ie, uni-manual or bi-manual involvement and proximal or distal joints involvement) of the ABILHAND manual activities.

Results: The difficulties of most manual activities were diagnosis dependent. A principal component analysis highlighted that 57% of the variance in the item difficulty between diagnoses was explained by the symmetric or asymmetric nature of the disorders. A generic scale was constructed, from a metric point of view, with 11 items sharing a common difficulty among diagnoses and 41 items displaying a category-specific location (asymmetric: CS, CP; and symmetric: RA, SSc, NMD). This generic scale showed that CP and NMD children had significantly less manual ability than RA patients, who had significantly less manual ability than CS, SSc and NMD adults. However, the generic scale was less discriminative and responsive to small deficits than disease-specific instruments.

Conclusions: Our finding that most of the manual item difficulties were disease-dependent emphasises the danger of using generic scales without prior investigation of item invariance across diagnostic groups. Nevertheless, a generic manual ability scale could be developed by adjusting and accounting for activities perceived differently in various disorders.
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http://dx.doi.org/10.1136/bmjopen-2012-001807DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3533037PMC
November 2012

Rasch-Built Measure of Pleasant Touch through Active Fingertip Exploration.

Front Neurorobot 2012 21;6. Epub 2012 Jun 21.

Institute of Neuroscience, Université Catholique de Louvain Brussels, Belgium.

Background: Evidence suggests that somatic sensation has a modality for pleasant touch.

Objective: To investigate pleasant touch at the fingertip level (i.e., glabrous skin site) through the elaboration of a linear unidimensional scale that measures (i) various materials according to the level of pleasantness they elicit through active fingertip explorations and (ii) subjects according to their pleasantness leniency levels.

Subjects: We enrolled 198 healthy subjects without any neurological disease.

Methods: Blindfolded subjects actively explored 48 materials with their index fingertips and reported the perceived pleasantness of each on a 4-level scale. The fingertip moisture levels on each subject were measured before the experimental session. Data were analyzed using the Rasch model.

Results: We elaborated unidimensional linear scale that included 37 materials according to their pleasantness of touch. The pleasantness level of 21 materials was perceived differently, depending on the fingertip moisture levels of the subjects.

Conclusion: Based on our findings, we formulated a Pleasant Touch Scale. Fingertip moisture levels appeared to be a major factor for (un)pleasant feelings during active exploration.
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http://dx.doi.org/10.3389/fnbot.2012.00005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3380275PMC
October 2012

Validation of the ABILHAND questionnaire to measure manual ability in children and adults with neuromuscular disorders.

J Neurol Neurosurg Psychiatry 2010 May 2;81(5):506-12. Epub 2009 Sep 2.

Rehabilitation and Physical Medicine Unit, Université catholique de Louvain, Brussels 1200, Belgium.

Background: Neuromuscular disorders (NMDs) can lead to specific manual disabilities due to hand muscle weakness and atrophy, myotonia or loss of sensory function. The aim of this study was to adapt and validate the ABILHAND questionnaire in children and adults with NMDs using the Rasch model.

Methods: This questionnaire contained specific manual activities for children and for adults, as well as common manual activities. 124 adult patients and the parents of 124 paediatric patients were asked to provide their perceived difficulty in performing each manual activity on a three level scale: impossible (0), difficult (1) or easy (2). Items were selected from well established psychometric criteria (ordered categories, equal item discrimination, adequate fit to the Rasch model, lack of redundancy) using the Rasch Unidimensional Measurement Models (RUMM2020) computer programme.

Results: The 22 selected items contain four children specific items, four adult specific items and 14 items commonly applicable to both children and adults. They define a unidimensional and linear measure of manual ability and demonstrate continuous progression in their difficulty. The item hierarchy of difficulty was invariant across six patient related factors. The scale exhibited good precision (r=0.95) and the 22 items were well targeted to the patients' locations. The ABILHAND measures were strongly related to the ACTIVLIM measures (r=0.76) and poorly related to grip strength (r=0.36 for the right hand and r=0.40 for the left hand).

Conclusion: This scale can be used for adults and children, allowing manual ability to be assessed from childhood to adulthood.
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http://dx.doi.org/10.1136/jnnp.2009.177055DOI Listing
May 2010

Hand impairments and their relationship with manual ability in children with cerebral palsy.

J Rehabil Med 2007 Nov;39(9):708-14

Laboratory of Rehabilitation and Physical Medicine, Universite catholique de Louvain, Bruxelles, Belgium.

Objective: To study hand impairments and their relationship with manual ability in children with cerebral palsy.

Design: Cross-sectional survey.

Patients: A total of 101 children with cerebral palsy (mean age 10 years, age range 6-15 years) were assessed.

Methods: Three motor and 3 sensory impairments were measured on both hands. Motor impairments included grip strength (Jamar dynamometer), gross manual dexterity(Box and Block Test) and fine finger dexterity (Purdue Peg-board Test). Sensory impairments included tactile pressure detection (Semmes-Weinstein aesthesiometer), stereognosis(Manual Form Perception Test) and proprioception (passive mobilization of the metacarpophalangeal joints). Manual ability was measured with the ABILHAND-Kids questionnaire. The relationship between hand impairments and manual ability was studied through correlation coefficients and a multiple linear forward stepwise regression analysis.

Results: Motor impairments were markedly more prevalent than sensory ones. Gross manual dexterity on the dominant hand and grip strength on the non-dominant hand were the best independent predictors of the children's manual ability,predicting 58% of its variance.

Conclusion: Hand impairments and manual ability are not related in a predictable straightforward relationship. It is important that, besides hand impairments, manual ability is also measured and treated, as it is not simply the integration of hand functions in daily activities.
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http://dx.doi.org/10.2340/16151977-0111DOI Listing
November 2007

Validation of the ABILHAND questionnaire as a measure of manual ability in patients with rheumatoid arthritis.

Ann Rheum Dis 2007 Aug 14;66(8):1098-105. Epub 2006 Dec 14.

Department of Rheumatology, Cliniques Universitaires St-Luc, Université Catholique de Louvain, 10, B-1200 Bruxelles, Belgium.

Objective: Hand and upper limb involvement is common in patients with rheumatoid arthritis (RA). However, its impact on manual activities of daily life has not been fully evaluated. A measure of manual ability was developed, through the Rasch measurement model, by adapting and validating the ABILHAND questionnaire, which measures the patient's perceived difficulty in performing everyday manual activities.

Methods: 112 patients with RA were evaluated. The following tests were performed: the ABILHAND questionnaire, the Health Assessment Questionnaire (HAQ), the Jamar grip and key pinch strength tests, the Box and Block dexterity test and the Purdue pegboard dexterity test. In total, 35 patients were reassessed to determine the test-retest reliability of the ABILHAND, and 6 patients were studied before and after therapy with tumour necrosis factor (TNF) blockers to address sensitivity to change.

Results: The Rasch refinement of the ABILHAND led to a selection of 27 items rated on a 3-point scale. The resulting ability scale was targeted to the ability of the patients. The item-difficulty hierarchy was stable across demographic and clinical subgroups and over time. Grip and key pinch strength and manual and digital dexterity on both hands were significantly, though moderately, correlated with the ABILHAND measures. Manual ability was also significantly related to the number of affected hands, disease duration, tender and swollen joint counts on upper limbs, disease activity and the HAQ. Sensitivity to change was demonstrated in patients treated with TNF blockers, commensurate with their clinical improvement.

Conclusion: The ABILHAND questionnaire is a clinically valid person-centred measure of manual ability that could be useful in longitudinal RA studies.
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http://dx.doi.org/10.1136/ard.2006.056150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1954701PMC
August 2007

Cross-cultural validity of functional independence measure items in stroke: a study using Rasch analysis.

J Rehabil Med 2005 Jan;37(1):23-31

Rehabilitation medicine, Sahlgrenska Academy at Göteborg University, Sahlgrenska University Hospital, Bruna Stråket 30, SE-413 45 Göteborg, Sweden.

Objective: To analyse cross-cultural validity of the Functional Independence Measure (FIM) in patients with stroke using the Rasch model.

Settings: Thirty-one rehabilitation facilities within 6 different countries in Europe.

Participants: A total of 2546 in-patients at admission, median age 63 years.

Methods: Data from the FIM were evaluated with the Rasch model, using the Rasch analysis package RUMM2020. A detailed analysis of scoring functions of the 7 categories of the FIM items was undertaken prior to testing fit to the model. Categories were re-scored where necessary. Analysis of Differential Item Functioning was undertaken in pooled data for each of the FIM motor and social-cognitive scales, respectively.

Results: Disordered thresholds were found on most items when using 7 categories. Fit to the Rasch model varied between countries. Differential Item Functioning was found by country for most items. Adequate fit to the Rasch model was achieved when items were treated as unique for each country and after a few country-specific items were removed.

Conclusion: Clinical collected data from FIM for patients with stroke cannot be pooled in its raw form, or compared across countries. Comparisons can be made after adjusting for country-specific Differential Item Functioning, though the adjustments for Differential Item Functioning and rating scales may not generalize to other samples.
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http://dx.doi.org/10.1080/16501970410032696DOI Listing
January 2005

A force measuring treadmill in clinical gait analysis.

Gait Posture 2004 Dec;20(3):299-303

Rehabilitation and Physical Medicine Unit, Université Catholique de Louvain, Tour Pasteur 5375, Avenue Mounier 53, 1200 Brussels, Belgium.

This preliminary study presents the development and testing of an instrumented treadmill device measuring the ground reaction forces (GRFs) and the feasibility of using this force measuring treadmill (FMT) in clinical gait analysis. A commercially available treadmill was modified and fitted out with three-dimensional strain-gauge force transducers. Tests of linearity, centre of pressure position (CoP), cross talk, natural frequency, background noises, and belt speed were undertaken in order to assess the performance of the FMT. In addition, the GRFs and segmental kinematics were recorded while healthy subjects and patients walked on the FMT, in order to compute the net ankle joint moments and the body centre of mass (CMb) kinematics and mechanics. The preliminary results of technical tests were satisfactory with an error less than 10% and dynamic tests in healthy subjects corresponded to the literature. The results of patients were clearly disturbed, demonstrating the ability of the FMT to discriminate pathological gaits from normal ones. We concluded that the GRFs measurements obtained from the FMT seem valid and the clinical assessment of net joint moments and CMb kinematics and mechanics seem feasible. The FMT could be useful device for clinical research and routine gait analysis since it allows gaining some extra room and quickly collecting the GRFs during a large number of successive gait cycles and over a wide range of steady-state gait speeds. However, more work is needed in this area in order to confirm the present results, collect reference data and validate the methodology across pathologies.
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http://dx.doi.org/10.1016/j.gaitpost.2003.11.001DOI Listing
December 2004

ABILHAND-Kids: a measure of manual ability in children with cerebral palsy.

Neurology 2004 Sep;63(6):1045-52

Laboratory of Rehabilitation and Physical Medicine, Université catholique de Louvain, Brussels, Belgium.

Objective: To develop a clinical tool for measuring manual ability (ABILHAND-Kids) in children with cerebral palsy (CP) using the Rasch measurement model.

Methods: The authors developed a 74-item questionnaire based on existing scales and experts' advice. The questionnaire was submitted to 113 children with CP (59% boys; mean age, 10 years) without major intellectual deficits (IQ > 60) and to their parents, and resubmitted to both groups after 1 month. The children's and parents' responses were analyzed separately with the WINSTEPS Rasch software to select items presenting an ordered rating scale, sharing the same discrimination, and fitting a unidimensional scale.

Results: The final ABILHAND-Kids scale consisted of 21 mostly bimanual items rated by the parents. The parents reported a finer perception of their children's ability than the children themselves, leading to a wider range of measurement, a higher reliability (R = 0.94), and a good reproducibility over time (R = 0.91). The item difficulty hierarchy was consistent between the parents and the experts. The ABILHAND-kids measures are significantly related to school education, type of CP, and gross motor function.

Conclusions: ABILHAND-Kids is a functional scale specifically developed to measure manual ability in children with CP providing guidelines for goal setting in treatment planning. Its range and measurement precision are appropriate for clinical practice.
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http://dx.doi.org/10.1212/01.wnl.0000138423.77640.37DOI Listing
September 2004

Assessing and adjusting for cross-cultural validity of impairment and activity limitation scales through differential item functioning within the framework of the Rasch model: the PRO-ESOR project.

Med Care 2004 Jan;42(1 Suppl):I37-48

Academic Unit of Musculoskeletal and Rehabilitation Medicine, University of Leeds, 36 Clarendon Road, Leeds, LS2 9NZ, United Kingdom.

Introduction: In Europe it is common for outcome measures to be translated for use in other languages. This adaptation may be complicated by culturally specific approaches to certain tasks; for example, bathing. In this context the issue of cross-cultural validity becomes paramount.

Objective: To facilitate the pooling of data in international studies, a project set out to evaluate the cross-cultural validity of impairment and activity limitation measures used in rehabilitation from the perspective of the Rasch measurement model.

Methods: Cross-cultural validity is assessed through an analysis of Differential Item Functioning (DIF) within the context of additive conjoint measurement expressed through the Rasch model. Data from patients undergoing rehabilitation for stroke was provided from 62 centers across Europe. Two commonly used outcome measures, the Mini-Mental State Examination (MMSE) and the Functional Independence Measure (FIM) motor scale are used to illustrate the approach.

Results: Pooled data from 3 countries for the MMSE were shown to fit the Rasch model with only 1 item displaying DIF by country. In contrast, many items from the FIM expressed DIF and misfit to the model. Consequently they were allowed to be unique across countries, so resolving the lack of fit to the model.

Conclusions: Where data are to be pooled for international studies, analysis of DIF by culture is essential. Where DIF is observed, adjustments can be made to allow for cultural differences in outcome measurement.
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http://dx.doi.org/10.1097/01.mlr.0000103529.63132.77DOI Listing
January 2004

The effects of a change in gravity on the dynamics of prehension.

J Gravit Physiol 2002 Jul;9(1):P51-3

Unite de Readaptation et de Medecine Physique, Universite catholique de Louvain, Brussels, Belgium.

The objective of this study was to measure the forces applied on an object manipulated in different gravitational fields attained during parabolic flights. Eight subjects participated flights (ES) and four were inexperienced (NES). They had to move continuously an instrumented object up and down in three different gravitational conditions (1 g, 1.8 g, 0 g). In 1 g, the grip force precisely anticipated the fluctuations of load force which was maximum and minimum at the bottom and at the top of the arm trajectory respectively. When the gravity changed (0 g and 1.8 g), the grip-load force coupling persisted for all the subjects from the first parabola. While the ES immediately exerted a grip force appropriate to the gravity, the NES dramatically increased their grip when faced with hyper and microgravity for the first time. Then, they progressively released their grip until a continuous grip-load force relationship with regard to 1 g was established after the fifth parabola. We suggest that each new gravitational field is rapidly incorporated into an internal model within the CNS which can then be reused as required by the occasion.
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July 2002

Outcome evaluation of the hand and wrist according to the International Classification of Functioning, Disability, and Health.

Hand Clin 2003 Aug;19(3):371-8, vii

Department of Orthopaedic Surgery, University of Louvain and St-Luc Hospital, Avenue Hippocrate, 10, 1200 Brussels, Belgium.

This article is a brief review of the outcome evaluation of the hand and wrist according to the International Classification of Functioning, Disability, and Health. Several tools currently exist to quantify outcome in hand surgery at the impairment level (eg, mobility, hand strength, cutaneous sensation, dexterity). According to the World Health Organization's paradigm, however, activity limitations and participation restrictions are also clinically relevant. The authors have recently built a measure of an upper limb-impaired individual's ability to manage manual activities in daily life. Participation and quality of life are difficult outcomes to measure because they are multidimensional and depend on such factors as functional abilities, general physical health, financial security, and stability of the social and familial environment.
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http://dx.doi.org/10.1016/s0749-0712(02)00150-6DOI Listing
August 2003

The effects of a change in gravity on the dynamics of prehension.

Exp Brain Res 2003 Feb 15;148(4):533-40. Epub 2002 Nov 15.

Unité de Réadaptation, Université Catholique de Louvain, Tour Pasteur (5375), Avenue Mounier, 53, 1200 Brussels, Belgium.

Investigating cyclic vertical arm movements with an instrumented hand-held load in an airplane undergoing parabolic flight profiles allowed us to determine how humans modulate their grip force when the gravitational and the inertial components of the load force are varied independently. Eight subjects participated in this study; four had already experienced parabolic flights and four had not. The subjects were asked to move the load up and down continuously at three different gravitational conditions (1 g, 1.8 g, and 0 g). At 1 g, the grip force precisely anticipated the fluctuations in the load force, which was maximum at the bottom of the object trajectory and minimum at the top. When gravity changed, the temporal coupling between grip force and load force persisted for all subjects from the first parabola. At 0 g, the grip force was accurately adjusted to the two load force peaks occurring at the two opposite extremes of the trajectory due to the absence of weight. While the experienced subjects exerted a grip force appropriate to a new combination of weight and inertia since their first trial, the inexperienced subjects dramatically increased their grip when faced with either high or low force levels for the first time. Then they progressively released their grip until a continuous grip-load force relationship with regard to 1 g was established after the fifth parabola. We suggest that a central representation of the new gravitational field was rapidly acquired through the incoming vestibular and somatic sensory information.
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http://dx.doi.org/10.1007/s00221-002-1322-3DOI Listing
February 2003
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