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[ARTICLE] Does motivation matter in upper-limb rehabilitation after stroke? ArmeoSenso-Reward: study protocol for a randomized controlled trial – Full Text
Fifty percent of all stroke survivors remain with functional impairments of their upper limb. While there is a need to improve the effectiveness of rehabilitative training, so far no new training approach has proven to be clearly superior to conventional therapy. As training with rewarding feedback has been shown to improve motor learning in humans, it is hypothesized that rehabilitative arm training could be enhanced by rewarding feedback. In this paper, we propose a trial protocol investigating rewards in the form of performance feedback and monetary gains as ways to improve effectiveness of rehabilitative training.
This multicentric, assessor-blinded, randomized controlled trial uses the ArmeoSenso virtual reality rehabilitation system to train 74 first-ever stroke patients (< 100 days post stroke) to lift their impaired upper limb against gravity and to improve the workspace of the paretic arm. Three sensors are attached to forearm, upper arm, and trunk to track arm movements in three-dimensional space while controlling for trunk compensation. Whole-arm movements serve as input for a therapy game. The reward group (n = 37) will train with performance feedback and contingent monetary reward. The control group (n = 37) uses the same system but without monetary reward and with reduced performance feedback. Primary outcome is the change in the hand workspace in the transversal plane. Standard clinical assessments are used as secondary outcome measures.
This randomized controlled trial will be the first to directly evaluate the effect of rewarding feedback, including monetary rewards, on the recovery process of the upper limb following stroke. This could pave the way for novel types of interventions with significantly improved treatment benefits, e.g., for conditions that impair reward processing (stroke, Parkinson’s disease).
After stroke, 50% of survivors are left with impairments in arm function [1, 2], which is associated with reduced health-related quality of life . While there is evidence for a positive correlation between therapy dose and functional recovery [4, 5, 6], a higher therapy dose is challenging to implement, as it usually leads to an increase in costs commonly not covered by health insurances. However, when dose is matched, most randomized controlled trials introducing new types of rehabilitative interventions (e.g., robot-assisted therapy ) failed to show a superior effect compared to standard therapy. Thus, the need for improving therapy effectiveness remains. In search for elements of effective therapy, we hypothesize that performance feedback and monetary rewards can improve effectiveness.
It has been shown that reward enhances procedural  and motor-skill learning [9, 10] and has a positive effect on motor adaptation . Rewards mainly improve retention of motor skills and motor adaptations [9, 10, 11]. This effect was not explained by training duration (dose) as rewarded and non-rewarded groups underwent similar training schedules [8, 9, 10, 11]. In a functional magnetic resonance imaging (fMRI) study, Widmer et al. reported that adding monetary rewards after good performance leads to better consolidation and higher ventral striatum activation than knowledge of performance alone . The striatum is a key locus of reward processing , and its activity was shown to be increased by both intrinsic and extrinsic reward . Being a brain structure that receives substantial dopaminergic input from the midbrain, ventral striatal activity can be seen as a surrogate marker for dopaminergic activity in the substantia nigra/ventral tegmental area . In rodents, Hosp et al. found that dopaminergic projections from the midbrain also terminate directly in the primary motor cortex (M1) . Dopamine in M1 is necessary for long-term potentiation of certain cortico-cortical connections and successful motor-skill learning . As mechanisms of motor learning are also thought to play a role in motor recovery , rehabilitative interventions may benefit from neuroplasticity enhanced by reward.
Here, we describe a trial protocol to test the effect of enhanced feedback and reward on arm rehabilitation after stroke at matched training dose (time and intensity). We use the ArmeoSenso, a standardized virtual reality (VR)-based training system  that is delivered in two versions for two different study groups, one version with and one without reward and enhanced performance feedback. […]
[ARTICLE] Effects of somatosensory electrical stimulation on motor function and cortical oscillations – Full Text
Few patients recover full hand dexterity after an acquired brain injury such as stroke. Repetitive somatosensory electrical stimulation (SES) is a promising method to promote recovery of hand function. However, studies using SES have largely focused on gross motor function; it remains unclear if it can modulate distal hand functions such as finger individuation.
The specific goal of this study was to monitor the effects of SES on individuation as well as on cortical oscillations measured using EEG, with the additional goal of identifying neurophysiological biomarkers.
Eight participants with a history of acquired brain injury and distal upper limb motor impairments received a single two-hour session of SES using transcutaneous electrical nerve stimulation. Pre- and post-intervention assessments consisted of the Action Research Arm Test (ARAT), finger fractionation, pinch force, and the modified Ashworth scale (MAS), along with resting-state EEG monitoring.
SES was associated with significant improvements in ARAT, MAS and finger fractionation. Moreover, SES was associated with a decrease in low frequency (0.9-4 Hz delta) ipsilesional parietomotor EEG power. Interestingly, changes in ipsilesional motor theta (4.8–7.9 Hz) and alpha (8.8–11.7 Hz) power were significantly correlated with finger fractionation improvements when using a multivariate model.
We show the positive effects of SES on finger individuation and identify cortical oscillations that may be important electrophysiological biomarkers of individual responsiveness to SES. These biomarkers can be potential targets when customizing SES parameters to individuals with hand dexterity deficits. Trial registration: NCT03176550; retrospectively registered.
Despite recent advances in rehabilitation, a substantial fraction of stroke patients continue to experience persistent upper-limb deficits . At best, up to 1 out of 5 patients will recover full arm function, while 50% will not recover any functional use of the affected arm.  Improvement in upper limb function specifically depends on sensorimotor recovery of the paretic hand . Yet, there remains a lack of effective therapies readily available to the patient with acquired brain injury for recovery of hand and finger function; a systematic review found that conventional repetitive task training may not be consistently effective for the upper extremity . It is thus critical to explore inexpensive and scalable approaches to restore hand and finger dexterity, reduce disability and increase participation after stroke and other acquired brain injuries.
Sensory threshold somatosensory electrical stimulation (SES) is a promising therapeutic modality for targeting hand motor recovery . It is known to be a powerful tool to focally modulate sensorimotor cortices in both healthy and chronic stroke participants [5, 6, 7, 8]. Devices such as transcutaneous nerve stimulation (TENS) units can deliver SES and are commercially available, inexpensive, low risk, and easily applied in the home setting . Previous studies have demonstrated short-term and long-term improvements in hand function after SES [5, 10, 11, 12, 13, 14, 15]. However, the effect of SES on regaining the ability to selectively move a given digit independently from other digits (i.e. finger fractionation) has not been investigated. Poor finger individualization is an important therapeutic target because it is commonly present even after substantial recovery and may account for chronic hand dysfunction . Further, it is unclear if SES is associated with compensatory or restorative mechanisms. Prior studies have largely relied on relatively subjective clinical evaluations of impairment, such as the Fugl-Meyer Assessment, or timed and task-based assessments, such as the Jebson-Taylor Hand Function Test. Biomechanical analyses, on the other hand, can provide important objective and quantitative evidence of improvement in neurologic function and normative motor control [17, 18]. Therefore, we aimed to determine not only the functional effects, but also the kinematic effects, of SES on chronic hand dysfunction.
Simultaneously, it should be noted that although SES can potentially be an effective therapy, not all individuals who are administered SES experience positive effects. While improvement levels as high as 31–36% compared to baseline function have been reported, [11, 19] about half of one cohort demonstrated minimal or no motor performance improvement after a single session of SES . One method to shed more light on this discrepancy is to identify neurophysiological biomarkers associated with motor responses to SES. Neurophysiological biomarkers are increasingly used to predict treatment effects [20, 21]. Although some studies have examined biomarkers associated with treatment-induced motor recovery, to our knowledge none have been performed for SES [22, 23]. A recent study using electroencephalography (EEG) found that changes in patterns of connectivity predicted motor recovery after stroke . At present, little is known about the effect of peripheral neuromodulation on EEG activity, how existing neural dynamics interacts with peripheral stimulation, and whether this interaction is associated with improvements in motor function. Associating EEG activity with treatment response may also provide mechanistic insight regarding the effects of SES on neural plasticity. EEG activity can also potentially be used as a cost-effective real-time metric of the time-varying efficacy of SES. This novel application of EEG information may help tailor treatment efforts while reducing the variability in outcome.
The main goal of this pilot study was to evaluate both changes in finger fractionation in response to SES and identify the associated neural biomarkers through analyses of EEG dynamics. Outcomes from this study have potential in designing targeted SES therapy based on neural biomarkers to modulate and improve hand function after acquired brain injury such as stroke (e.g. enrollment in long-term studies of the efficacy of SES).
[WEB SITE] Lobachevsky University scientists are studying nervous system adaptation to ischemic damage
Lobachevsky University researchers are working to explore the mechanisms of adaptation of the nervous system to ischemic damage. Scientists say that under certain conditions, the brain’s protective forces can be activated, even in some severe cases.
According to Maria Vedunova, Director of the Institute of Biology and Biomedicine at Lobachevsky University, a large number of stressors affect the body by depleting its internal reserves and, as a consequence, leading to a number of diseases.
“The effect of stress on the nervous system and the brain is especially damaging. Everything that we associate with the personality, self-consciousness, all our feelings and thoughts, decisions and experiences – all this is the result of the brain function. Therefore, scientists and medical practitioners face a global challenge – to find an effective way to protect nervous system cells and restore lost brain functions after damage. By solving this problem, it will be possible to change the quality of life of those who have suffered a stroke, severe trauma or surgery,” notes Maria Vedunova.
UNN scientists are currently involved in the study of the role of internal adaptation systems of the central nervous system.
“We are developing ways to repair brain damage. To understand the mechanisms of ischemia and effectively combat this disease, each of its key links has to be examined separately. For this purpose, scientists create special model conditions to study the primary cultures of the cells from different brain sections (the “brain in vitro”) rather than the whole brain. Thus, one can trace the processes taking place at the neural network level. Why is it so important? In fact, the brain functions are performed not by single neurons, but by their groups, neural networks. It is at the level of the neural network (the minimal structural and functional unit of the nervous system) that information is transferred, processed and stored, and complex cognitive reactions occur. In a cell culture, one can see how the neural network is formed, how an electrical impulse is generated, and how it is distributed and transmitted over the network, how the entire functional ensemble reacts to ischemic damage. Researchers around the world hope that the understanding of the way neural networks function in the normal state and under the effect of stressors will open up prospects for the development of effective therapeutic strategies.
It is practically impossible to study the operation of a neural network in the whole (intact) brain, because signals of a single network cannot be isolated. Besides, the brain is very well protected by the skull bones, and it is not so easy to get access to it: there are too many cells and signals. In culture, this can be done by using special techniques and complex mathematical calculations,” continues Maria Vedunova.
UNN scientists have developed some methods for modeling different phases of ischemia and studied the features of the neural network operation under such effects. When modeling ischemic damage, very large numbers of neurons die, but their death does not occur simultaneously. Ischemic factors trigger pathological reactions within active neurons that lead to cell death within 3-6 days after an episode of ischemia.
Something similar occurs in the brain: most neurons die within the first week after exposure rather than at the moment of actual damage. The signal that a cell receives when there is a lack of oxygen and glucose or when the free radical oxidation is activated leads to the activation – by the cell itself – of the processes of cell death. It means that there is a period of time during which one can change the neuron’s program and keep it alive.
These studies are of great fundamental importance. In the near future, the study of the nervous system’s adaptive and regenerative properties will allow the development of a new therapeutic strategy for protecting the brain from traumatic and ischemic damage, thus contributing to the improvement of life quality and reducing the risk of severe disability among the working-age population.
A collaborative research team from Shinshu University in Japan has designed a wearable robot to support a person’s hip joint while walking. Details of their prototype are published in Smart Materials and Structures.
“With a rapidly aging society, an increasing number of elderly people require care after suffering from stroke, and other-age related disabilities. Various technologies, devices, and robots are emerging to aid caretakers,” writes team leader Minoru Hashimoto, a professor of textile science and technology at Shinshu University, noting that several technologies meant to assist a person with walking are often cumbersome to the user.
“[In our] current study, [we] sought to develop a lightweight, soft, wearable assist wear for supporting activities of daily life for older people with weakened muscles and those with mobility issues,” he adds, in a media release from Shinshu University.
The wearable system consists of plasticized polyvinyl chloride (PVC) gel, mesh electrodes, and applied voltage. The mesh electrodes sandwich the gel, and when voltage is applied, the gel flexes and contracts, like a muscle. It’s a wearable actuator, the mechanism that causes movement.
“We thought that the electrical mechanical properties of the PVC gel could be used for robotic artificial muscles, so we started researching the PVC gel,” Hashimoto notes. “The ability to add voltage to PVC gel is especially attractive for high speed movement, and the gel moves with high speed with just a few hundred volts.”
In a preliminary evaluation, a stroke patient with some paralysis on one side of his body walked with and without the wearable system.
“We found that the assist wear enabled natural movement, increasing step length and decreasing muscular activity during straight line walking,” Hashimoto states. The researchers also found that adjusting the charge could change the level of assistance the actuator provides.
The robotic system earned first place in demonstrations with their multilayer PVC gel artificial muscle at the, “24th International Symposium on Smart Structures and Materials & Nondestructive Evaluation and Health Monitoring” for SPIE the international society for optics and photonics.
Next, the researchers plan to create a string actuator using the PVC gel, which could potentially lead to the development of fabric capable of providing more manageable external muscular support with ease, the release continues.
[Source(s): Shinshu University, Science Daily]
[Abstract] Efficacy of the Regent Suit-based rehabilitation on gait EMG patterns in hemiparetic subjects: a pilot study
Background: The recovery of the functional limb mobility of patients with cerebral damages can take great benefit of the role offered by proprioceptive rehabilitation. Recently have been developed a special Regent Suit (RS) for rehabilitative applications. Actually, there are preliminary studies which describes the effects of RS on gait recovery of stroke patients in acute stage, but none in chronic stage. Moreover, it is known that motor recovery does not always reflect improvements of the muscle activity and coactivity.
AIM: To investigate the effects of proprioceptive stimulation induced by the Regent Suit (RS) on the EMG patterns during gait in post-stroke chronic patients.
Design: Randomized controlled trial.
Setting: S. Maugeri Foundation, Telese Terme (BN), Italy.
Population: Patients have been randomly assigned into two equal groups of 20 patients: experimental group and traditional group. Further, a control group of 20 healthy subjects have been enrolled.
Settings: The traditional group attended a rehabilitation program composed by neuro-motor exercises without the RS, the experimental group performed the same rehabilitation program while wearing the RS. the NIH Stroke Scale (NIHSS), the Barthel Index (BI), the Functional Independent Measure (FIM) and the Berg Balance Scale (BBS) have been evaluated. EMG analysis has been performed considering the muscle activation timing over the gait of the Soleus, Tibialis Anterior, Semitendinosus and Vastus Lateralis muscles by decomposing the EMG signals into Gaussian pulses. Then, the symmetry of muscle activation and the muscle synergy patterns over the gait cycle have been assessed.
Results: The proprioceptive stimulation of the RS-based treatment induces higher and remarkable restoration of the normal muscle activation timing, also increasing the muscle symmetry and reducing the pathological muscle coactivation on both affected and non-affected sides.
Conclusions: These results suggest confirm that a RS-based treatment is more effective than usual care in improving the EMG patterns during locomotion and daily living activities in chronic post-stroke subjects.
Clinical Rehabilitation Impact: The proprioceptive rehabilitation Regent Suit based has an impact on motor function in stroke patients during gait.
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[Abstract] Virtual reality and neuropsychological assessment: The reliability of a virtual kitchen to assess daily-life activities in victims of traumatic brain injury
Traumatic brain injury (TBI) causes impairments affecting instrumental activities of daily living (IADL). However, few studies have considered virtual reality as an ecologically valid tool for the assessment of IADL in patients who have sustained a TBI. The main objective of the present study was to examine the use of the Nonimmersive Virtual Coffee Task (NI-VCT) for IADL assessment in patients with TBI. We analyzed the performance of 19 adults suffering from TBI and 19 healthy controls (HCs) in the real and virtual tasks of making coffee with a coffee machine, as well as in global IQ and executive functions. Patients performed worse than HCs on both real and virtual tasks and on all tests of executive functions. Correlation analyses revealed that NI-VCT scores were related to scores on the real task. Moreover, regression analyses demonstrated that performance on NI-VCT matched real-task performance. Our results support the idea that the virtual kitchen is a valid tool for IADL assessment in patients who have sustained a TBI.
via Virtual reality and neuropsychological assessment: The reliability of a virtual kitchen to assess daily-life activities in victims of traumatic brain injury: Applied Neuropsychology: Adult: Vol 23, No 3
[ARTICLE] A Cloud-Based Virtual Reality App for a Novel Telemindfulness Service: Rationale, Design and Feasibility Evaluation – Full Text
Background: Worldwide, there has been a marked increase in stress and anxiety, also among patients with traumatic brain injury (TBI). Access to psychology services is limited, with some estimates suggesting that over 50% of sufferers are not accessing the existing services available to them for reasons such as inconvenience, embarrassment, or stigmatization concerns around mental health. Health service providers have increasingly been turning to drug-free therapies, such as mindfulness programs, as complementary treatments.
Objective: Virtual reality (VR) as a new delivery method for meditation-based stress and anxiety reduction therapy offers configurable environments and privacy protection. Our objective was to design a serious learning-meditation environment and to test the feasibility of the developed telemindfulness approach based on cloud technologies.
Methods: We developed a cloud-based system, which consisted of a Web interface for the mindfulness instructor and remote clients, who had 3D VR headsets. The mindfulness instructor could communicate over the Web interface with the participants using the headset. Additionally, the Web app enabled group sessions in virtual rooms, 360-degree videos, and real interactions or standalone meditation. The mindfulness program was designed as an 8-week Mindfulness-Based Stress Reduction course specifically for the developed virtual environments. The program was tested with four employees and four patients with TBI. The effects were measured with psychometric tests, the Mindful Attention Awareness Scale (MAAS) and the Satisfaction With Life Scale (SWLS). Patients also carried out the Mini-Mental State Examination (MMSE). An additional objective evaluation has also been carried out by tracking head motion. Additionally, the power spectrum analyses of similar tasks between sessions were tested.
Results: The patients achieved a higher level of life satisfaction during the study (SWLS: mean 23.0, SD 1.8 vs mean 18.3, SD 3.9) and a slight increase of the MAAS score (mean 3.4, SD 0.6 vs mean 3.3, SD 0.4). Particular insight into the MAAS items revealed that one patient had a lower MAAS score (mean 2.3). Employees showed high MAAS scores (mean 4.3, SD 0.7) and although their SWLS dropped to mean 26, their SWLS was still high (mean 27.3, SD 2.8). The power spectrum showed that the employees had a considerable reduction in high-frequency movements less than 0.34 Hz, particularly with the 360-degree video. As expected, the patients demonstrated a gradual decrease of high-frequency movements while sitting during the mindfulness practices in the virtual environment.
Conclusions: With such a small sample size, it is too early to make any specific conclusions, but the presented results may accelerate the use of innovative technologies and challenge new ideas in research and development in the field of mindfulness/telemindfulness.
Attention impairment has often been considered a hallmark of mental illness. Attention training is an important part of meditation, and has proven to augment the ability to sustain attention . Mindfulness as a meditation tool has an important role in psychology, self-awareness, and well-being. The authors Brown and Ryan [ ] reported that mindfulness over time was related to a reduction in variable mood and stress in patients with cancer. Mindfulness is an internationally recognized therapy that teaches self-awareness, maintaining own thoughts, sensations, feelings, emotions, and appreciation of your living environment [ ]. The mindfulness meditation technique may help patients manage potentially negative outcomes and improve well-being by controlling unselfconsciousness (thoughts on failure). Avoiding problems associated with the future, focusing on the present, being “now,” and controlling the tracking of time may, in addition to well-being, lead to mindfulness. A person who can achieve such an active and open attention state can control thoughts from a distance, free to judge whether they are good or not [ ]. In this context, mindfulness can also be considered an important tool for managing anxiety and stress in patients [ ]. Kabat-Zinn [ ] designed an 8-week meditation course, Mindfulness-Based Stress Reduction, which provides 2 hours of meditation in a group with additional homework. Mindfulness-Based Stress Reduction has demonstrated that awareness of the mind, unconscious thoughts, feelings, and other emotions positively affect major physiological processes and thus decreases the level of stress-related disorders [ – ].
Anxiety and stress disorders can be related to pressure at work, incurable diseases, or neuromuscular disorders, such as Parkinson disease, light traumatic brain injury (TBI), multiple sclerosis, or other diseases of the muscular or central nervous system. Deficits in executive functions, memory, and learning are often documented after TBI. In addition, at least half of those suffering from TBI experience chronic pain and/or sleep disorders, depression, and substance abuse .
A review of the literature shows that neural systems are modifiable networks and changes in the neural structure can occur in adults as a result of training . The study reported on anatomical magnetic resonance imaging (MRI) images from 16 healthy meditation-naïve participants who underwent the 8-week mindfulness program [ ]. The results obtained before and after the program suggested that participation in a Mindfulness-Based Stress Reduction course was associated with changes in gray matter concentration in the regions of the brain involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking.
Early rehabilitation in the acute and subacute phase may be a critical period and a key to effective rehabilitation, especially in TBI . A significant drawback is that patients often stay in hospital for a limited time and are soon discharged for recovery at home. Afterward they can visit an outpatients’ clinic. Patients residing close may find the outpatient service convenient, but it could be very inconvenient for those who are in need of ongoing care, are dependent on public transport, or in the worst case do not have access to transport at all. Consequently, external factors such as travel fatigue may hinder the effectiveness of the therapy and, in some, may even increase anxiety and stress. In addition, modern diseases caused by stress and anxiety in the workplace are on the increase, but access to treatment and therapy is usually not possible during working hours [ ].
Innovative technologies can ensure real-time communication and data recording/sharing over long distances, even within larger groups of participants . Nowadays, privacy, data security, shyness, and pride are among the most frequent reasons to avoid therapy if a mental disease or neuromuscular disorder is related to work or social status [ ].
Some patients prefer to remain anonymous and do not want to reveal their problems, even to colleagues. The sense of “total immersion” created by virtual reality (VR) is an emerging technology that may entirely replace mainstream videoconferencing techniques . These technologies may fulfill patient expectations [ ] regarding anonymity and enhance presence [ ]. Patients can hide their identify using an avatar and their voices can be disguised. Psychologists and other experts may observe the kinematic changes in motion patterns, gestures, face mimics, and other measurable features [ ]. If there is a group, the VR avatars can be synchronized and controlled in real time, using cloud-based technologies. The operator can form groups, deliver individual or group tasks, or lead a private conversation with selected participants. We have developed a technology that is available for home and workplace use, called Realizing Collaborative Virtual Reality for Well-being and Self-Healing (ReCoVR), for which the VR headset is coupled with a mobile phone. The only requirement is a connection to Wi-Fi/4G Internet, plus communication with the cloud server allows remote interaction with other users residing thousands of miles away.
This cloud-based app is used for interaction and communication between a mindfulness expert and participants. Each participant uses a commercially available mobile phone and a simple head-mounted VR headset to join the mindfulness session in the virtual environment (VE). Our main objectives were to design a suitable mindfulness protocol based on Mindfulness-Based Stress Reduction, with tasks in the VE with 360-degree videos, and to test the feasibility of the developed mindfulness/telemindfulness app in a real environment. Additionally, we analyzed head movements during mindfulness sessions to stimulate further initiatives in this research space. […]
[Abstract] User performance evaluation and real-time guidance in cloud-based physical therapy monitoring and guidance system
The effectiveness of traditional physical therapy may be limited by the sparsity of time a patient can spend with the physical therapist (PT) and the inherent difficulty of self-training given the paper/figure/video instructions provided to the patient with no way to monitor and ensure compliance with the instructions.
In this paper, we propose a cloud-based physical therapy monitoring and guidance system. It is able to record the actions of the PT as he/she demonstrates a task to the patient in an offline session, and render the PT as an avatar. The patient can later train himself by following the PT avatar and getting real-time guidance on his/her device.
Since the PT and user (patient) motion sequences may be misaligned due to human reaction and network delays, we propose a Gesture-Based Dynamic Time Warping algorithm that can segment the user motion sequence into gestures, and align and evaluate the gesture sub-sequences, all in real time. We develop an evaluation model to quantify user performance based on different criteria provided by the PT for a task, trained with offline subjective test data consisting of user performance and physical therapist scores. Moreover, we design three types of guidance which can be provided after each gesture based on user score, and conduct subjective tests to validate their effectiveness.
Experiments with multiple subjects show that the proposed system can effectively train patients, give accurate evaluation scores, and provide real-time guidance which helps the patients learn the tasks and reach the satisfactory score with less time.
[Abstract] Evaluation of a self-administered transcutaneous electrical stimulation concept for the treatment of spasticity: a randomised placebo-controlled trial
BACKGROUND: Spasticity is a common consequence of injury to the central nervous system negatively affecting patient’s everyday activities. Treatment mainly consists of training and different drugs, often with side effects. There is a need for treatment options that can be performed by the patient in their home environment.
AIM: The objective of this study was to assess the effectiveness of an assistive technology (AT), Mollii®, a garment with integrated electrodes for multifocal transcutaneous electrical stimulation intended for self-treatment of spasticity, in study participants with spasticity due to stroke or CP.
DESIGN: The study was a randomised, controlled, double-blind study with a cross-over design.
SETTING: Participants were recruited from two rehabilitation clinics. Treatments were performed in participants’ homes and all follow-ups were performed in the two rehabilitation clinics.
POPULATION: Thirty-one participants were included in the study and 27 completed the study. Four participants discontinued the study. Two declined participation before baseline and two withdrew due to problems handling the garment.
METHODS: Participants used the AT with and without electrical stimulation (active/non-active period) for six weeks each, followed by six weeks without treatment. Goal Attainment Scaling (GAS), change in mobility, arm-hand ability, spasticity and pain were measured at baseline and after six, 12 and 18 weeks.
RESULTS: Fifteen of the 27 participants fulfilled the treatment protocol in terms of recommended use. Deviations were frequent. No statistically significant differences in outcome were found between the active and the non-active treatment periods. During the active period, an improvement was seen in the 10-metre comfortable gait test, time and steps. An improvement was seen in both the active and non-active periods for the GAS.
CONCLUSIONS: Compliance was low, partly due to deviations related to the garment, complicating the interpretation of the results. Further research should focus on identifying the target population and concomitant rehabilitation strategies.
CLINICAL REHABILITATION IMPACT: The evaluated concept of multifocal transcutaneous electrical stimulation (TES) represents an interesting addition to the existing repertoire of treatments to alleviate muscle spasticity. The evaluated concept allows TES to be self-administered by the patient in the home environment. A more elaborate design of training activities directly related to patient´s own rehabilitation goals is recommended and may increase the value of the evaluated concept.
via Evaluation of a self-administered transcutaneous electrical stimulation concept for the treatment of spasticity: a randomised placebo-controlled trial – European Journal of Physical and Rehabilitation Medicine 2017 Oct 25 – Minerva Medica – Journals