Development and testing of virtual environments for rehabilitation is a lengthy process which involves conceptualization, design, validation, proof concept testing and ultimately, if appropriate, randomized controlled trials. Ironically, once vetted, many of these VEs are not available to clinicians or their patients. To address the challenge of transferring research grade technology from the lab to the clinic the authors have created the Open Rehabilitation Initiative. It is an international independent online portal that aims to help clinicians, scientists, engineers, game developers and end-users to interact with and share virtual rehabilitation tools. In this paper, the conceptualization, development and formative evaluation testing are described. Three groups of developers of VEs (n=3), roboticists who use VEs for robot interactivity (n=10) and physical therapists (n=6) who are the clinicians end-users participated in the study. Interviews, focus groups and administration of the System Usability Scale (SUS) were used to assess acceptability. Data were collected on three aspects: 1) discussion of what a resource might look like; 2) interaction with the site; and 3) reaction to the proposed site and completion of the SUS. Interviews and focus groups were recorded and transcribed. Data from the SUS was analyzed using a One-way ANOVA. There was no significant difference by groups. However, the clinicians’ mean score of 68 on the SUS was just at the acceptable level, while the developers and roboticists scored above 80. While all users agreed that the site was a tool that could promote collaboration and interaction between developers and users, each had different requirements for the design and use. Iterative development and discussion of scaling and sustaining the site is ongoing.
Development testing of virtual environments (VEs) for rehabilitation is a lengthy process, which involves conceptualization, design, validation, proof concept testing and ultimately, if appropriate, randomized controlled trials. Often, once the technology has been developed and tested for a specific application, it is discarded. This results in a lack of transfer of the technology to the clinician at the point of care. Several explanations exist for the lack of transfer. One explanation is that the technology was not developed with the end-user in mind and therefore uses hardware that may not be readily available to persons in clinical practice. Another explanation is that the route to commercialization is expensive and lengthy and many scientists are not interested in pursuing this avenue. In this paper we propose the development of an international community as a solution, the Open Rehab Initiative (ORI), whereby developers may share their technology with clinicians. As the virtual rehabilitation field evolves and technology becomes more accessible and available, the authors believe, it is increasingly important to find mechanisms to coordinate and bring together clinicians, scientists and engineers to interact with and share their efforts with virtual rehabilitation tools. Recent reviews support the use of virtual rehabilitation training in people with neurological diagnoses (Pietrzak et al., 2014; Laver et al., 2015). However, a large part of the implementation of VR in rehabilitation is limited to work developed in the context of research projects – which does not reach end users, in particular clinicians and patients. Currently what is available to clinicians are the results of efforts to repurpose commercial games available for game consoles by providing clinicians with tools to adapt the Wii™ (Deutsch et al., 2011) and online resources on how to use the Adventure Games for the Kinect™ (Levac et al., 2015). Resources are also made available by clinicians or researchers themselves through blogs or structured websites where hardware and software lists – mostly commercial Wii™ or Kinect™ games, and sometimes companies developing bespoke rehabilitation systems – are shared together with therapy game suggestions, ratings and tips (Leynse Harpold, 2016; Scott, 2016; TherapWii, 2016). In implementation sciences, researchers have studied transfer knowledge as well as support of clinical reasoning by using online resources (Deutsch et al., 2015). The use of these resources for knowledge translation has been associated with positive behavior change in healthcare workers including nurses, physicians, physical therapists, and occupational therapists (Magrabi et al., 2004; McKenna et al., 2005; Grimshaw et al., 2006; Honeybourne et al., 2006). Unfortunately, less work can be found in the systematic transfer of virtual environments and serious games technology from developers to users. Multiple efforts exist in the creation of indices of games specially designed for specific health purposes (Lieberman et al., 2013; Serious Games Association, 2016). Unfortunately, available indices do not refer to literature specific to the applications and, consequently, the use of such games and applications is mostly not validated. On the other hand, other initiatives such as Games for Health and Games for Health Europe (van Rijswijk et al., 2016) feature a limited number of research projects with detailed descriptions and information regarding their target population and scientific outcome. However, in most cases content is unavailable to the clinician and end user. Consequently, there is still a large body of work on validated and research-driven technology that remains unavailable to clinicians and patient populations. There is therefore the need to facilitate the translation from research into daily clinical practice and to create new communication channels and a common framework to share and improve interventions in this area. The ORI is an international independent initiative that aims to help clinicians, scientists, engineers, game developers and end-users to interact with and share virtual rehabilitation tools. The ORI portal is planned as a hub where the community who build and use software tools for virtual rehabilitation can easily communicate, interact with and share these tools. The webpage currently offers software, drivers, and documentation of evidence and application, with support for discussion boards, and blogs. Although ORI originates from academic institutions, it is designed to grow through community driven content, incorporating inputs from all the relevant communities. This sentiment is reflected in the ORI mission statement: ORI’s mission is to become “the go-to community for clinicians, scientists, engineers, game developers and end-users to interact with and share virtual rehabilitation tools”. As such, we aim to attract both developers and virtual rehabilitation users, for research as well as for clinical practice. The scope of the simulations encompasses sensorimotor and cognitive rehabilitation. The objective of this study was twofold: first, to describe the conceptualization and preliminary rendering of the ORI site; and second, to report on the formative evaluations conducted on three groups of users: clinicians in a rehabilitation setting, developers (clinician scientists and engineers) of VEs for rehabilitation and an engineering group that develops robotic devices that have serious game interfaces. As developers and roboticits have a certain degree of technical expertise and would be both contributors and users to the site, we anticipated that their assessment of the site capability as well as the usability ratings would differ from those of the clinicians.
What is CIMT?
Constraint Induced Movement Therapy (“CIMT” or “CI Therapy”) is a form of rehabilitation of the arm and hand following a neurological event such as a stroke.
Constraint induced movement therapy is suitable for adults with hemiplegia, where one arm is weaker than the other. CIMT involves rehabilitation of the weaker arm while restraining the stronger arm. CIMT can make significant and lasting improvements to the amount and quality of use of the affected arm, which can have a major impact on your quality of life and function.
Constraint induced movement therapy has a large body of scientific research behind it and the effects of the treatment have been shown not only on the hand and arm, but on the brain itself.
A constraint induced movement therapy programme is short but intensive. Treatment is provided daily over a period of 2 to 3 weeks and led by a specialist physiotherapist or occupational therapist. You will wear a restraint “mitt” on your stronger hand for 90% of your waking hours throughout the programme, and take part in intensive therapy sessions as well as home practice.
Explore our website for more information, or contact us to speak directly with one of our CIMT therapists.
[ARTICLE] Smart control for functional electrical stimulation with optimal pulse intensity – Full Text
Transcutaneous electrical stimulation is a common treatment option for patients suffering from spinal cord injury or stroke. Two major difficulties arise when employing electrical stimulation in patients: Accurate stimulation electrode placement and configuration of optimal stimulation parameters. Optimizing the stimulation parameters has the advantage to reduce muscle fatigue after repetitive stimulation. Here we present a newly developed system which is able to automatically find the optimal individual stimulation intensity by varying the pulse length. The effectiveness is measured with flex sensors. By adapting the stimulation parameters, the effect of muscle fatigue can be compensated, allowing for a more stable movement upon stimulation over time.
Functional electrical stimulation (FES) has been used to help patients who suffer from stroke or spinal chord injury for many years now . FES is able to support patients in activities of daily living, like walking or grasping . Performing electrical stimulation in most cases arises two core questions: Where the optimal placement of the stimulation electrodes is and which stimulation intensity should be applied . Addressing the former question, prior studies have investigated the optimal electrode placement by using electrode arrays . Addressing the latter is an equivalently complex question, as parameters vary from patient to patient. Providing neither too strong, nor too weak stimulation intensity is crucial, as too weak stimulation leads to an insufficiently opened hand or incorrect step while walking. Too strong stimulation exhaust the muscles quickly without any further benefit, leading to muscle fatigue .
Here we present a newly developed system which is able to increase the intensity of stimulation in a stepwise manner until the optimal point is reached. We demonstrate it’s use in a chronic stroke patient with hand paresis, focusing the opening of the hand. In order to cancel out fatigue, we regulate the intensity, allowing a stable opening of the affected hand.
[ARTICLE] Wristband Accelerometers to motiVate arm Exercise after Stroke (WAVES): study protocol for a pilot randomized controlled trial – Full Text
Loss of upper limb function affects up to 85 % of acute stroke patients. Recovery of upper limb function requires regular intensive practise of specific upper limb tasks. To enhance intensity of practice interventions are being developed to encourage patients to undertake self-directed exercise practice. Most interventions do not translate well into everyday activities and stroke patients continue to find it difficult remembering integration of upper limb movements into daily activities. A wrist-worn device has been developed that monitors and provides ‘live’ upper limb activity feedback to remind patients to use their stroke arm in daily activities (The CueS wristband). The aim of this trial is to assess the feasibility of a multi-centre, observer blind, pilot randomised controlled trial of the CueS wristband in clinical stroke services.
This pilot randomised controlled feasibility trial aims to recruit 60 participants over 15 months from North East England. Participants will be within 3 months of stroke which has caused new reduced upper limb function and will still be receiving therapy. Each participant will be randomised to an intervention or control group. Intervention participants will wear a CueS wristband (between 8 am and 8 pm) providing “live” feedback towards pre-set movement goals through a simple visual display and vibration prompts whilst undertaking a 4-week upper limb therapy programme (reviewed twice weekly by an occupational/physiotherapist). Control participants will also complete the 4-week upper limb therapy programme but will wear a ‘sham’ CueS wristband that monitors upper limb activity but provides no feedback. Outcomes will determine study feasibility in terms of recruitment, retention, adverse events, adherence and collection of descriptive clinical and accelerometer motor performance data at baseline, 4 weeks and 8 weeks.
The WAVES study will address an important gap in the evidence base by reporting the feasibility of undertaking an evaluation of emerging and affordable technology to encourage impaired upper limb activity after stroke. The study will establish whether the study protocol can be supported by clinical stroke services, thereby informing the design of a future multi-centre randomised controlled trial of clinical and cost-effectiveness.
5 reasons why my sex drive changed after a traumatic brain injury
“Sexual energy is the primal and creative energy of the universe.” — Deepak Chopra
As someone who had a fairly healthy sex drive before falling on the ice and suffering a traumatic brain injury (TBI), I was confused as to what was going on with my libido.
It’s a story I hear far too often among TBI survivors — they want to be intimate with their partner, yet just don’t have the bandwidth to even consider it. The partner feels neglected and/or frustrated, and the survivor feels helpless and misunderstood. This cycle can continue for years, and I felt it was time to speak out on a topic that affects 2.5 million Americans each year, yet is rarely talked about: Sex After Brain Injury.
For the past few years I have had a “friends-with-benefits” situation with Tim (not his real name.) We enjoy each other’s company, and have a great sexual chemistry together. He lives about an hour west of the Twin Cities, so I see him only every few months, which works out perfectly for both of us.
I saw Tim several times in the first few months after my fall and it was, well, interesting. In addition to a TBI, I had also sustained whiplash, torn muscles, and a dislocated sternum. Finding a position for me to get comfortable in was challenging, to say the least. Tim was patient with me, and very gentle and kind. He understood my situation and wanted to do whatever he could to make it easier for me.
It was almost comical, the amount of work it took—propping me up on pillows so that I wouldn’t be dizzy, repositioning me every few minutes so that I wouldn’t be in pain, and let’s not forget that I couldn’t “jiggle” my head around or it would cause an instant headache.
After the first two visits, I simply wasn’t even interested in sex any more. Not because it took too much work, but because I just didn’t have the energy. I didn’t even have the desire to “make out,” and even just giving him a hug took everything I had. When Tim would stop by for a visit, I would basically sit on the couch in a zombie-like state while we talked about the weather. It was awkward, but he never made me feel bad, although I am sure he was disappointed.
His visits became less frequent, but we still talked often on the phone. Fortunately we had a good friendship, and the “benefits” were only part of the deal.
About two years after my fall, I was expecting a visit from Tim and was actually looking forward to it. I felt I was ready to give an afternoon romp another try. Alas, I had a killer headache when he showed up. He could tell just by looking at me — and hearing the difficulty I had speaking — that a romp just wasn’t going to happen.
I was so frustrated because I had actually psyched myself up enough to want to have sex again. It was the first time in almost two years that I had felt the need inside of me. I knew how good we were together in the bedroom, and wanted to experience that feeling of intimacy with him again.
He recently came to town again, and this time I was determined to make it happen. Finally, after two and a half years, Amy was ready for “sexy time” again. I still struggled with a bit of dizziness, but I powered through it and didn’t let it distract me. I reassured Tim that I was ready to try this or that, and we had a fun afternoon together. I had missed the feeling of intimacy, almost as much as I missed my memory and spunky personality.
While most of my physical injuries have healed, every inch of my body hurt the following day. It took me a few days to recover physically and restore my energy levels, but it was completely worth it — Amy got her groove back! Tim commented on the fact that he could tell my personality was returning to “normal” and was happy to see me feeling more energetic and lively.
While I am fortunate that my “friend with benefits” was compassionate and understanding, I completely get how relationships are turned upside by TBI. Not only is the person and his or her partner dealing with an invisible injury, the partner is also getting frustrated with what is and isn’t happening in the bedroom. While the person may be physically back to normal, she or he is still dealing with a lot of the invisible symptoms of TBI.
From my experience, I’ve learned that five main areas of my TBI were holding my body back from having a sex drive:
- Neuro Fatigue. Our energy levels are severely limited after a brain injury. Every single thing we do throughout the day requires energy. Whether it’s brushing our teeth, reading emails, going for a walk, or washing the dishes, we are taking energy from our reserves. We are easily tired, and I know that I sleep 10 hours at night, and still require a 2-hour nap during the afternoon. The thought of trying to add sex into my daily routine was daunting, and I’m sure if I had a spouse or partner, he would have been frustrated. However, it is important for the partner to understand that it’s not him (or her)—it has absolutely nothing to do with him—and it could take a long time to get our energy levels and stamina back. It took me two and a half years to be ready to participate in a single afternoon of lovemaking.
- Dizzy and Balance Issues. Many brain injury survivors suffer from being dizzy and having balance disorders. In the early days after my TBI, I couldn’t lie flat on my back, nor could I bend over without practically passing out. While one can try a lot of positions in the bedroom, almost all of them caused some degree of dizziness. Circle back to my first point about neuro fatigue, and combine the already-tired brain with some dizziness, and that’s a recipe for disaster.
- Chronic Pain. Not all brain injury survivors will have physical injuries, but I did. Even two and a half years later, I still deal with a lot of chronic pain. In the bedroom it hurt my chest, neck, and shoulders to be on the top, bottom, or anywhere in between. Again, think of neuro fatigue, coupled with chronic pain… are you starting to get the picture?
- Apathy. Having a total lack of interest in anything—not just sex—is one of the most common side effects of a brain injury. I remember my personality being “flat” for the first two years, and wondering if I would ever laugh again, or want to do any of my hobbies again. I can’t say it too often: every single thing we do takes energy. I think our brains instinctively try to preserve as much energy as possible, and having an interest in something is a low priority. I remember not wanting to do pretty much anything. Laundry and cooking were horrific tasks, as was driving myself to my favorite store.
- Overstimulation. Let’s be real: sex involves a LOT of stimulation. Even a healthy, active person without a brain injury can readily admit that sex engages pretty much every one of our senses to an extreme. Our brains are already running on conserved energy. I remember worrying that I was going to stroke-out the first time I had sex after my TBI. My heart was racing out of control, my head was pounding, I was dizzy, my entire body hurt, and all the while I was trying to make sure my partner wasn’t aware of the hell going on inside my head. Even going out to eat at a loud and people-filled restaurant is a major undertaking with all the background noise and lights and people talking. Is there any wonder that having sex is just too much for our brains?
I hope that having read this far, you are gaining a better understanding into the struggle of living with a brain injury. I hope…
- – If you are the survivor, you give yourself grace and know that you’re not alone in the journey.
- – If you’re the partner, you can have a better understanding of what the other person is going through. While I can’t even imagine how frustrating this has to be for you, it’s 10 times more frustrating for the survivor.
While I know I got my sexual groove back, it’s going to be different for every single person. It’s important for both of you to be patient and understanding, and for the partner to be compassionate and empathetic. And most importantly for both of you…just enjoy being there with your loved one.
Amy Zellmer is an award-winning author, speaker, and advocate of traumatic brain injury (TBI). She is a frequent contributor to the Huffington Post, and has created a privateFacebook groupfor survivors and also produces a podcast series. She sits on the Brain Injury Association of America’sAdvisory Council (BIAAAC) and is involved with theMinnesota Brain Injury Alliance. She travels the country with her Yorkie, Pixxie, to help raise awareness about this silent and invisible injury that affects over 2.5 million Americans each year.
In November, 2015 she released her first book,“Life With a Traumatic Brain Injury: Finding the Road Back to Normal” which received a silver award at the Midwest Book Awards in May, 2016. Her second book, “Surviving Brain Injury: Stories of Strength and Inspiration” is a collection of stories written by brain injury survivors and caregivers and will be released November 2016. for more information: www.facesoftbi.com
This talk was given at the BCI Meeting 2016 at Asilomar Conference Grounds on May 31st, 2016.
[WEB SITE] Restorative Therapies, Inc., Today Announced CE Mark and Canadian Approval for the new Xcite Functional Electrical Stimulation (FES) system
Restorative Therapies, Inc., advances its new era in physical therapy systems for neurological injury and paralysis with CE mark and Canadian medical device licensing of the company’s new Xcite Functional Electrical Stimulation (FES) rehabilitation system.
Baltimore, MD (PRWEB) October 26, 2016
Restorative Therapies, Inc., advances its new era in physical and occupational therapy systems for neurological injury and paralysis with CE mark and Canadian medical device licensing of the company’s new Xcite Functional Electrical Stimulation (FES) rehabilitation system.
Restorative Therapies is the designer of medical devices providing clinic and in-home restoration therapy. Xcite is the next in the series of FES powered therapy systems that started with the company’s hugely successful RT300 FES cycle.
FES is a physical and occupational therapy rehabilitation modality used to evoke functional movements and exercise not otherwise possible for individuals with a neurological impairment such as a spinal cord injury, stroke, multiple sclerosis or cerebral palsy.
The CE mark demonstrates that Xcite meets all the requirements of the European Medical Device Directive and facilitates its sale in numerous markets outside the USA. The Canadian medical device license provides approval to market Xcite in Canada.
The new Xcite FES system delivers up to 12 channels of electrical stimulation to nerves which activate core, leg and arm muscles. Easy to use sequenced stimulation evokes functional movement enabling a patient’s paralyzed or weak muscles to move through dynamic movement patterns and specific functional tasks.
“Xcite is a physical and occupational therapy system which provides a library of coordinated multichannel FES therapies for people with neurological impairments» said Prof. David Ditor of Brock University, in Ontario, Canada, “After being involved in the development trials we are excited to see the system obtain the CE mark and Canadian approval making the system more widely available”.
«It is the first truly practical FES rehabilitation system of this kind that I have seen. In addition to combining several valuable neuro-rehabilitation interventions, functional electrical stimulation, mass practice and neuromuscular re-education, Xcite is portable and easy enough to use that it could be used in the patient’s home,” said Prof. Susan Harkema of the Kentucky Spinal Cord Injury Research Center, University of Louisville. “In the context of rehabilitation influencing neural plasticity as a means for neural restoration, training in the home setting is an essential component of progress and I see Xcite as a great tool in achieving this,” concludes Harkema.
“Xcite system inherits many of the popular RT300 FES cycle’s great features including personalized muscle selection, secure Internet connectivity and physical therapy clinic ease of use.” says Andrew Barriskill, CEO of Restorative Therapies. “We are excited to have obtained CE marking and Canadian approval for this product which will allow us to market the system in Canada and many other international markets.”
Xcite is the latest result of Restorative Therapies commitment to ongoing development of FES powered therapy systems designed to help people with neurological impairments maximize their recovery potential.
About Restorative Therapies
Restorative Therapies mission is to help people with a neurological impairment or in critical care achieve their full recovery potential. Restorative Therapies combines activity-based physical therapy and Functional Electrical Stimulation as a rehabilitation therapy for immobility associated with paralysis such as stroke, multiple sclerosis and spinal cord injury or for patients in critical care
Restorative Therapies is a privately held company headquartered in Baltimore.
To learn more about Restorative Therapies please visit us at http://www.restorative-therapies.com
Judy Kline, Director of Sales and Marketing
Phone: 800 6099166 x301
For the original version on PRWeb visit: http://www.prweb.com/releases/2016/10/prweb13789606.htm
[ARTICLE] Self-Paced Reaching after Stroke: A Quantitative Assessment of Longitudinal and Directional Sensitivity Using the H-Man Planar Robot for Upper Limb Neurorehabilitation
Technology aided measures offer a sensitive, accurate and time-efficient approach for the assessment of sensorimotor function after neurological insult compared to standard clinical assessments. This study investigated the sensitivity of robotic measures to capture differences in planar reaching movements as a function of neurological status (stroke, healthy), direction (front, ipsilateral, contralateral), movement segment (outbound, inbound), and time (baseline, post-training, 2-week follow-up) using a planar, two-degrees of freedom, robotic-manipulator (H-Man). Twelve chronic stroke (age: 55±10.0 years, 5 female, 7 male, time since stroke: 11.2±6.0 months) and nine aged-matched healthy participants (age: 53±4.3 years, 5 female, 4 male) participated in this study. Both healthy and stroke participants performed planar reaching movements in contralateral, ipsilateral and front directions with the H-Man, and the robotic measures, spectral arc length (SAL), normalized time to peak velocities 〖(T〗_peakN), and root-mean square error (RMSE) were evaluated. Healthy participants went through a one-off session of assessment to investigate the baseline. Stroke participants completed a 2-week intensive robotic training plus standard arm therapy (8 x 90 minute sessions). Motor function for stroke participants was evaluated prior to training (baseline, week-0), immediately following training (post-training, week-2), and 2-weeks after training (follow-up, week-4) using robotic assessment and the clinical measures Fugl-Meyer Assessment (FMA), Activity-Research-Arm Test (ARAT), and grip-strength. Robotic assessments were able to capture differences due to neurological status, movement direction, and movement segment. Movements performed by stroke participants were less-smooth, featured longer T_peakN, and larger RMSE values, compared to healthy controls. Significant movement direction differences were observed, with improved reaching performance for the front, compared to ipsilateral and contralateral movement directions. There were group differences depending on movement segment. Outbound reaching movements were smoother and featured longer T_peakN values than inbound movements for control participants, whereas SAL, T_peakN, and RMSE values were similar regardless of movement segment for stroke patients. Significant change in performance was observed between initial and post assessments using H-Man in stroke participants, compared to conventional scales which showed no significant difference. Results of the study indicate the potential of H-Man as a sensitive tool for tracking changes in performance compared to ordinal scales (i.e. FM, ARAT).
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