[WEB SITE] Vivistim Therapy “Rewires” Brain to Help Move the Arms Post-Stroke

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Study participant Ken Meeks tests the use of Vivistim therapy to help him regain use of his arms after experiencing a stroke following a car accident. (Photo courtesy of Ohio State University Wexner Medical Center)

Study participant Ken Meeks tests the use of Vivistim therapy to help him regain use of his arms after experiencing a stroke following a car accident. (Photo courtesy of Ohio State University Wexner Medical Center)

An experimental treatment called Vivistim therapy is being tested for use with stroke patients to help them regain some function in their arms.

The therapy involves the use of a neurotransmitter implanted just below the skin on the chest during a minimally invasive outpatient surgery. The device is connected to the vagus nerve in the neck, which transmits signals to the brain.

A study being conducted at the Neurological Institute at Ohio State University’s Wexner Medical Center, as well as at other institutions across the United States and in the United Kingdom is investigating whether use of the device along with rehabilitative therapy may help improve patients’ upper limb movement after a stroke, according to a news story from Healthline.

Marcia Brockbrader, MD, PhD, one of the study’s principal investigators, notes that the device may be promising, but it won’t be a quick fix. It doesn’t work on its own, she adds.

“It’s a device that helps the brain get into a state where it can benefit more from therapy. There’s a button that the therapist presses to activate the device as participants do therapy. The intent of the pulse is much like a heart pacer — to pace the brain. It’s about half a second of stimulation. We think that this very brief pulse is like a ‘wake up and pay attention’ to the brain to use what happens next to help relearn how to use a paralyzed limb,” she explains.

Bockbrader states this trial is focusing on the upper limbs in part because people need their hands to take care of themselves.

“If you can use your hands, you can do a lot of what you need to do with a wheelchair. If you can’t use your hands, you need people around to help more,” she says.

According to the news story, 13 institutions in the United States and five institutions in the United Kingdom are participating in this trial, and they are still seeking participants.

“We’re looking at people in the chronic phase of stroke because it gives them the chance to recover naturally as much as possible,” Bockbrader states.

The typical participant is about 9 months out from a stroke and has done all the therapies they’re eligible for. In addition, per the news story, researchers are choosing a middle-of-the-road impaired population who can flex and extend the wrist and move the thumb, but can’t use their hands the way they should for daily living.

“This suggests to us that connections between the arm and the brain are still there but not working at 100 percent efficiency. There’s still room for improvement. If the device is found to be effective, we can start looking at whether it can be beneficial for those more severely affected by stroke. It’s early on in the evaluation process,” Bockbrader shares.

Recruitment will probably continue for the next 2 years.

Bockbrader says the study is a complicated three-phase design. The initial two phases can last up to a year and a half.

“But if people choose to, we will keep the stimulator in and follow them yearly after that. There’s no end in sight for people who want to keep the stimulator in place and feel it’s helping. If they don’t, removal is a short outpatient surgery,” she notes.

Patients interested in participating in the study should contact the recruitment office at their nearest participating institution, according to the news story.

[Source: Healthline]

via Vivistim Therapy “Rewires” Brain to Help Move the Arms Post-Stroke – Rehab Managment

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[BLOG POST] Substance Use and Disability – A Look at NIDILRR – Funded Research

 

Last week, NIDILRR released a Funding Opportunity Announcement for a Disability and Rehabilitation Research Projects (DRRP) Program: Research on Opioid Use Disorder Among People with Disabilities. The announcement followed several months of careful research to write an opportunity that answered the needs of the community in regard to opioid use and disability. Earlier in the year, NIDILRR released a Request for Information on the topic to generate comments, concerns, and ideas from the community on this issue. The result, summarized in a report released May 4th (PDF), provided information about “what is known and what are the most pressing research questions for the disability and rehabilitation research fields.” Among the responses, NIDILRR found that:

  • New evidence suggests that people with disabilities are more likely than the general population to misuse opioids and develop related disorders, but they may be less likely to receive treatment than their peers without disabilities.
  • Barriers to treatment included physical accessibility of treatment centers, limited insurance coverage, and policies that withheld opioid prescriptions without first offering pain management alternatives.
  • People with disabilities involving serious traumatic injury such as spinal cord or brain injuries may be at greater risk of opioid misuse and unintentional death due to opioid poisoning.

Many people with disabilities experience pain on a daily basis and may use opioids as part of their physician-directed pain management. Research is needed in this area to understand how these individuals and their care teams can balance the need to manage pain and the risk of substance abuse. This opportunity is not NIDILRR’s first foray into exploring the connection between disability and substance use disorders. NIDILRR-funded research in this area has included:

2010-2018

(Click the project title to view an abstract and links to any related publications in NARIC’s REHABDATA database)

Integrated Program to Improve Competitive Employment in Dually Diagnosed Clients(Field Initiated 2014-2017)

Treatment Development for Alcohol Craving and Rehabilitation Among Individuals with Co-Occurring Mild Traumatic Brain Injury, Post-Traumatic Stress Disorder, and Alcohol Use Disorder. (Fellowship 2013-2014

Deaf Off Drugs and Alcohol: Evaluating a Technology-Assisted E-Therapy Program for Substance Use Disorder Treatment (Field Initiated 2011-2013)

A National Assessment of the Rates and Correlates of Alcohol and Other Drug Use by College Students with Disabilities (Field Initiated 2008-2011)

2000-2010

The Impact of Alcohol Use on Outcome and Recovery after Traumatic Brain Injury.(Fellowship 2006-2007)

Rehabilitation Research and Training Center on Substance Abuse, Disability, and Employment. (Rehabilitation Research and Training Center 2004-2010)

1990-2000

Rehabilitation Research and Training Center on Drugs and Disability (RRTC 1997-2001) and the RRTC on Substance Abuse and Disability (1993-1997)

Substance Abuse Treatment for Adults with Chronic Mental Illness (Fellowship 1994-1995)

Substance Abuse as a Barrier to Employment for Persons with Traumatic Brain Injury.(Disability and Rehabilitation Research Project 1991-1995)

Pre 1990

Innovation Grant to Develop a Unique Rehabilitation Curriculum to Train Rehabilitation Counseling Masters Students in Alcoholism Counseling to Work with Multidisabled Alcoholics. (Innovative Research Projects, 1987-1988)

Medication Effects on Attention and Behavior in Head Injured Patients. (Field Initiated 1986-1987)

Relation of Substance Use to Rehabilitation Outcome in Persons with Spinal Cord Injury.(Field Initiated 1986-1987)

Publications

Explore publications from these projects and other members of the NIDILRR community in the area of substance use disorders:

If you are a person with a disability who is concerned about substance use disorder, please visit the Behavioral Health Treatment Services Locator at https://findtreatment.samhsa.gov/ or call your local 211 to speak with a community-level information specialist who can help you find treatment in your area.

 

via Substance Use and Disability – A Look at NIDILRR-Funded Research | Collection Spotlight from the National Rehabilitation Information Center

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[ARTICLE] FES-UPP: A Flexible Functional Electrical Stimulation System to Support Upper Limb Functional Activity Practice – Full Text

There is good evidence supporting highly intensive, repetitive, activity-focused, voluntary-initiated practice as a key to driving recovery of upper limb function following stroke. Functional electrical stimulation (FES) offers a potential mechanism to efficiently deliver this type of therapy, but current commercial devices are too inflexible and/or insufficiently automated, in some cases requiring engineering support. In this paper, we report a new, flexible upper limb FES system, FES-UPP, which addresses the issues above. The FES-UPP system consists of a 5-channel stimulator running a flexible FES finite state machine (FSM) controller, the associated setup software that guides therapists through the setup of FSM controllers via five setup stages, and finally the Session Manager used to guide the patient in repeated attempts at the activities(s) and provide feedback on their performance. The FSM controller represents a functional activity as a sequence of movement phases. The output for each phase implements the stimulations to one or more muscles. Progression between movement phases is governed by user-defined rules. As part of a clinical investigation of the system, nine therapists used the FES-UPP system to set up FES-supported activities with twenty two patient participants with impaired upper-limbs. Therapists with little or no FES experience and without any programming skills could use the system in their usual clinical settings, without engineering support. Different functional activities, tailored to suit the upper limb impairment levels of each participant were used, in up to 8 sessions of FES-supported therapy per participant. The efficiency of delivery of the therapy using FES-UPP was promising when compared with published data on traditional face-face therapy. The FES-UPP system described in this paper has been shown to allow therapists with little or no FES experience and without any programming skills to set up state-machine FES controllers bespoke to the patient’s impairment patterns and activity requirements, without engineering support. The clinical results demonstrated that the system can be used to efficiently deliver high intensity, activity-focused therapy. Nevertheless, further work to reduce setup time is still required.

Introduction

In the United Kingdom there are more than 100,000 new stroke cases each year and approximately 1.2 million people living with the consequences of stroke (Stroke Association, 2017). In the United Kingdom, during their entire in-patient stay, a typical patient will receive around 5 h of physiotherapy (McHugh and Swain, 2014), with much of that time focused on the rehabilitation of posture, balance and walking (Wit et al., 2005). The consequences of this are that patients do not receive anything approaching the intensity of upper limb therapy that research suggests is needed to drive functional recovery (Clarke et al., 2015). Possibly as a result, long term recovery of the upper limb remains very poor. Almost three quarters of stroke survivors are left with upper limb motor problems (Lawrence et al., 2001), which seriously impact on their quality of life.

There is strong evidence supporting intensive (Lohse et al., 2014), repetitive, activity-focused (Winstein et al., 2004Alon et al., 2007Langhorne et al., 2009), voluntary-initiated (Peckham and Knutson, 2005Knutson et al., 2009) practice for upper limb functional recovery. However, to enable such an approach, without significantly increasing the number of therapists, we need to look to rehabilitation technologies.

A number of rehabilitation technologies have been developed to encourage the recovery of upper limb motor function after stroke, including robotic devices, virtual reality and functional electrical stimulation (FES) systems (Howlett et al., 2015). Studies have shown positive results for FES in the rehabilitation of reaching and grasping function (Thrasher et al., 2008Knutson et al., 2009), elbow extension (Thrasher et al., 2008Hughes et al., 2010), shoulder motion (Hara et al., 2009), and stabilization of wrist joints (Malešević et al., 2012). In addition, FES offers the potential to increase therapy dose at a reasonable cost (Kitago and Krakauer, 2013), in a way that does not need the dedicated attention of a therapist.

Current upper limb FES systems can be categorized according to the methods of control over stimulation. The first group of systems use a push button operated by the patient’s unaffected hand, and/or are pre-programmed to repeat a fixed sequence of timed stimulations (Mann et al., 2005). Commercial systems of this type, which tend to be used largely for passive exercising, include Odstock Medical’s Microstim 2 and 4 Channel Stimulator Kit, and the Bioness H200. The Odstock 2 and 4 channel stimulators offer flexibility over which muscles are stimulated; the H200 (Snoek et al., 2000) offers 5 channels of stimulation, but is limited to stimulation of hand and wrist. Previous studies have suggested that cyclical stimulation is less clinically effective than voluntary triggered stimulation (de Kroon et al., 2005), although debate on this issue continues (Wilson et al., 2016). A recent report identified that the carryover, or therapeutic effect, in drop foot patients was only observed in patients who showed brain activation patterns consistent with movement planning (Gandolla et al., 2016). This supports Rushton’s hypothesis (Rushton, 2003) which proposed that when the F wave resulting from stimulation coincides with voluntary intention to move, connectivity between the intact upper motor and lower motor neurons is strengthened at the spinal cord level. These studies suggest that stimulation delivered without the active involvement of the patient may not be the most effective approach.

The second group of systems attempt to ensure that stimulation coincides with voluntary intention to move; thus increasing the likelihood of effective motor relearning. Examples of systems which use voluntary initiated neural signals to control FES include the EMG-based MeCFES (Thorsen et al., 2001) and STIWELL med4 (Rakos et al., 2007) systems and a small number of demonstrator projects which use brain-computer interface approaches (Müller-Putz et al., 2005Ajiboye et al., 2017). However, reliable surface EMG signal(s) from appropriate muscles are frequently either difficult to measure or absent in people with paretic upper limbs (Bolton et al., 2004Gazzoni, 2010), making EMG-controlled FES difficult to use with certain patients. Additionally, the voluntary effort in producing an EMG signal can increase spasticity, opposing the movement that is intended. Although systems using brain-implanted electrodes have been reported, most of the current EEG controlled systems use non-invasive electrodes, which provide limited information transfer rate, require patients to complete a significant amount of training prior to first use (Scherberger, 2009Bouton et al., 2016), and need frequent re-calibration (Ajiboye et al., 2017).

Motion-controlled FES systems offer an attractive alternative (Mann et al., 2011Sun et al., 2016a,b). An example of a motion controlled system is the Bionic Glove (Prochazka et al., 1997) which uses data from a wrist position sensor to control stimulation of hand and wrist muscles in C6/7 spinal cord injury (SCI) patients. More recently, the Southampton group have reported on a system based on iterative learning control (Meadmore et al., 2014) in which stimulation is applied to the triceps, anterior deltoid and wrist/finger extensors muscles to support specified reaching activities. Stimulation levels are adjusted cycle-to-cycle based on kinematic data collected from previous attempts in such a way that the patient is always challenged. These motion controlled FES systems have the potential to deliver appropriately timed neural inputs to promote re-learning and hence recovery (Rushton, 2003Sheffler and Chae, 2007) and recent studies have reported positive results (Knutson et al., 2012Meadmore et al., 2014), including sustained improvements in function (Persch et al., 2012), and improvements even in patients with severe hand arm paralysis (Popovic et al., 2005Thrasher et al., 2008). However, these systems are generally inflexible in terms of the number and location of muscles to be stimulated (Snoek et al., 2000Alon and McBride, 2003Mann et al., 2011) and/or require engineering support to accommodate a wide range of upper limb activities (Tresadern et al., 2008). Relatively little attention has been paid to the development of easy to use, flexible systems able to support a range of patients in practicing varied, yet challenging functional activities (Rakos et al., 2007Tresadern et al., 2008). In particular, if such systems are to be widely adopted, they must be sufficiently user-friendly to remove the need for routine engineering support.

In this paper, we report on a new, flexible upper limb FES system, FES-UPP, which address the issues discussed above. Below we report on the design of the upper limb FES controller and the setup software. Finally, we show data from a clinical investigation study of the system carried out without on-site engineering support to illustrate the potential for the system to be used in the delivery of intensive FES-supported practice.[…]

 

Continue —-> Frontiers | FES-UPP: A Flexible Functional Electrical Stimulation System to Support Upper Limb Functional Activity Practice | Neuroscience

FIGURE 1. Example set-up of the FES-UPP system for the “Sweeping coins” activity. (A) Anterior view; and (B) Lateral view (informed consent was obtained from all participants).

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[VIDEO] NAO performs physical rehabilitation with CP and OBPP patients (P2) – YouTube

The patient is a male of 9 years old with Brachial Plexus Palsy and a degree of dystonia where muscle contractions cause him twisting and unintentional movements.

This video belongs to a set of evaluations of our autonomous robotic system in the Hospital Virgen del Rocio (Sevilla, Spain) while performing rehabilitation sessions with Cerebral Palsy (CP) and Obstetric Brachial Plexus Palsy (OBPP) patients.

Planning and Learning Group

http://www.plg.inf.uc3m.es

More info Therapist: http://www.therapist.uma.es

via NAO performs physical rehabilitation with CP and OBPP patients (P2) – YouTube

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[VIDEO] MOTORE++ – A new Rehabilitation Robot for the upper limb – YouTube

ECHORD Plus PlusΔημοσιεύτηκε στις 12 Μαΐ 2017
The goal of this experiment was to continue the development of a rehabilitation robot named MOTORE to restore upper limb functionality. MOTORE++ improved the existing MOTORE rehabilitation device by improving the system to the level which is required for commercialization: it works without any links or wire and it is the first robot small enough to be easily carried and as such suitable for in-home rehabilitation. A proprietary software was developed with several exercises and a wide range of exercise parameters. Moreover, a patient database permits the customization of the therapy. The commercial application of this technological development will allow building smaller and lighter robotic systems which are able to interact with patients in hospitals, in retirement homes or are even suitable for in-home therapy. The improved prototype was tested in home-based rehabilitation sessions.

via MOTORE++ – A new Rehabilitation Robot for the upper limb – YouTube

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[Abstract] Design and Development of a Robot Guided Rehabilitation Scheme for Upper Extremity Rehabilitation

Abstract

To rehabilitate individuals with impaired upper-limb function, we have designed and developed a robot guided rehabilitation scheme. A humanoid robot, NAO was used for this purpose. NAO has 25 degrees of freedom. With its sensors and actuators, it can walk forward and backward, can sit down and stand up, can wave his hand, can speak to the audience, can feel the touch sensation, and can recognize the person he is meeting. All these qualities have made NAO a perfect coach to guide the subjects to perform rehabilitation exercises. To demonstrate rehabilitation exercises with NAO, a library of recommended rehabilitation exercises involving shoulder (i.e., abduction/adduction, vertical flexion/extension, and internal/external rotation), and elbow (i.e., flexion/extension) joint movements was formed in Choregraphe (graphical programming interface). In experiments, NAO was maneuvered to instruct and demonstrate the exercises from the NRL. A complex ‘touch and play’ game was also developed where NAO plays with the subject that represents a multi-joint movement’s exercise. To develop the proposed tele-rehabilitation scheme, kinematic model of human upper-extremity was developed based modified Denavit-Hartenberg notations. A complete geometric solution was developed to find a unique inverse kinematic solution of human upper-extremity from the Kinect data. In tele-rehabilitation scheme, a therapist can remotely tele-operate the NAO in real-time to instruct and demonstrate subjects different arm movement exercises. Kinect sensor was used in this scheme to get tele-operator’s kinematics data. Experiments results reveals that NAO can be tele-operated successfully to instruct and demonstrate subjects to perform different arm movement exercises. A control algorithm was developed in MATLAB for the proposed robot guided supervised rehabilitation scheme. Experimental results show that the NAO and Kinect sensor can effectively be used to supervise and guide the subjects in performing active rehabilitation exercises for shoulder and elbow joint movements.

Recommended Citation
Assad-Uz-Zaman, Md, “Design and Development of a Robot Guided Rehabilitation Scheme for Upper Extremity Rehabilitation” (2017). Theses and Dissertations. 1578.
https://dc.uwm.edu/etd/1578

via “Design and Development of a Robot Guided Rehabilitation Scheme for Upp” by Md Assad-Uz-Zaman

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[Abstract + References] Virtual Rehabilitation System for Fine Motor Skills Using a Functional Hand Orthosis –

Abstract

This article describes a virtual rehabilitation system with work and entertainment environments to treat fine motor injuries through an active orthosis. The system was developed in the Unity 3D graphic engine, which allows the patient greater immersion in the rehabilitation process through proposed activities; to identify the movement performed, the Myo armband is used, a device capable of receiving and sending the signals obtained to a mathematical algorithm which will classify these signals and activate the physical hand orthosis completing the desired movement. The benefits of the system is the optimization of resources, infrastructure and personnel, since the therapy will be assisted by the same virtual environment, in addition it allows selecting the virtual environment and the activity to be carried out according to the disability present in the patient. The results show the correct functioning of the system performed.

References

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via Virtual Rehabilitation System for Fine Motor Skills Using a Functional Hand Orthosis | SpringerLink

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[Abstract + References] Virtual Rehabilitation System for Fine Motor Skills Using a Functional Hand Orthosis – Conference paper

Abstract

This article describes a virtual rehabilitation system with work and entertainment environments to treat fine motor injuries through an active orthosis. The system was developed in the Unity 3D graphic engine, which allows the patient greater immersion in the rehabilitation process through proposed activities; to identify the movement performed, the Myo armband is used, a device capable of receiving and sending the signals obtained to a mathematical algorithm which will classify these signals and activate the physical hand orthosis completing the desired movement. The benefits of the system is the optimization of resources, infrastructure and personnel, since the therapy will be assisted by the same virtual environment, in addition it allows selecting the virtual environment and the activity to be carried out according to the disability present in the patient. The results show the correct functioning of the system performed.

References

  1. 1.
    Sanchez, J.S., et al.: Virtual Rehabilitation System for Carpal Tunnel Syndrome Through Spherical Robots. Accepted 2014Google Scholar
  2. 2.
    Naiker, A.: Repetitive Strain Injuries (RSI) – an ayurvedic approach. J. Ayurveda Integr. Med. Sci. 2(2), 170–173 (2017). ISSN 2456-3110Google Scholar
  3. 3.
    Rosales, R.S., Martin-Hidalgo, Y., Reboso-Morales, L., Atroshi, I.: Reliability and construct validity of the Spanish version of the 6-item CTS symptoms scale for outcomes assessment in carpal tunnel syndrome. BMC Musculoskelet. Disord. 17, 115 (2016)CrossRefGoogle Scholar
  4. 4.
    Uehli, K., et al.: Sleep problems and work injuries: a systematic review and meta-analysis. Sleep Med. Rev. 18(1), 61–73 (2014)CrossRefGoogle Scholar
  5. 5.
    Patti, F., et al.: The impact of outpatient rehabilitation on quality of life in multiple sclerosis. J. Neurol. 249(8), 1027–1033 (2002)CrossRefGoogle Scholar
  6. 6.
    Ueki, S., et al.: Development of a hand-assist robot with multi-degrees-of-freedom for rehabilitation therapy. IEEEASME Trans. Mechatron. 17(1), 136–146 (2012)CrossRefGoogle Scholar
  7. 7.
    Chang, W.H., Kim, Y.-H.: Robot-assisted therapy in stroke rehabilitation. J. Stroke 15(3), 174–181 (2013)CrossRefGoogle Scholar
  8. 8.
    Laver, K., George, S., Thomas, S., Deutsch, J.E., Crotty, M.: Virtual reality for stroke rehabilitation. Stroke 43(2), e20–e21 (2012)CrossRefGoogle Scholar
  9. 9.
    Lohse, K.R., Hilderman, C.G.E., Cheung, K.L., Tatla, S., der Loos, H.F.M.V.: Virtual reality therapy for adults post-stroke: a systematic review and meta-analysis exploring virtual environments and commercial games in therapy. PLoS ONE 9(3), e93318 (2014)CrossRefGoogle Scholar
  10. 10.
    North, M.M., North, S.M., Coble, J.R.: Virtual reality therapy: an effective treatment for the fear of public speaking. Int. J. Virtual Real. IJVR 03(3), 1–6 (2015)Google Scholar
  11. 11.
    Turolla, A., et al.: Virtual reality for the rehabilitation of the upper limb motor function after stroke: a prospective controlled trial. J. Neuroeng. Rehabil. 10, 85 (2013)CrossRefGoogle Scholar
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    Romero, P., León, A., Arteaga, O., Andaluz, V.H., Cruz, M.: Composite materials for the construction of functional orthoses. Accepted 2017Google Scholar
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    Benalcázar, M.E., Jaramillo, A.G., Jonathan, A., Zea, A., Páez, V.H.: Andaluz: hand gesture recognition using machine learning and the Myo armband. In: 2017 25th European Signal Processing Conference (EUSIPCO), pp. 1040–1044 (2017)Google Scholar
  14. 14.
    Maroukis, B.L., Chung, K.C., MacEachern, M., Mahmoudi, E.: Hand trauma care in the united states: a literature review. Plast. Reconstr. Surg. 137(1), 100e–111e (2016)CrossRefGoogle Scholar
  15. 15.
    Feron, L.O., Boniatti, C.M., Arruda, F.Z., Butze, J., Conde, A.: lesões por esforço repetitivo em cirurgiões-dentistas: uma revisão da literatura. Rev. Ciênc. Saúde 16(2), 79–86 (2014)Google Scholar
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    Putz-Anderson, V.: Cumulative Trauma Disorders. CRC Press, Boca Raton (2017)Google Scholar
  17. 17.
    Oktayoglu, P., Nas, K., Kilinç, F., Tasdemir, N., Bozkurt, M., Yildiz, I.: Assessment of the presence of carpal tunnel syndrome in patients with diabetes mellitus, hypothyroidism and acromegaly. J. Clin. Diagn. Res. JCDR 9(6), OC14–OC18 (2015)Google Scholar
  18. 18.
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[Abstract + References] Virtual System Using Haptic Device for Real-Time Tele-Rehabilitation of Upper Limbs – Conference paper

Abstract

This paper proposes a tool to support the rehabilitation of upper limbs assisted remotely, which makes it possible for the physiotherapist to be able to assist and supervise the therapy to patients who can not go to rehabilitation centers. This virtual system for real-time tele-rehabilitation is non-invasive and focuses on involving the patient with mild or moderate mobility alterations within a dynamic therapy based on virtual games; Haptics Devices are used to reeducate and stimulate the movement of the upper extremities, at the same time that both motor skills and Visual-Motor Integration skills are developed. The system contains a virtual interface that emulates real-world environments and activities. The functionality of the Novint Falcon device is exploited to send a feedback response that corrects and stimulates the patient to perform the therapy session correctly. In addition, the therapy session can vary in intensity through the levels presented by the application, and the amount of time, successes and mistakes made by the patient are registered in a database. The first results show the acceptance of the virtual system designed for real-time tele-rehabilitation.

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[Abstract] Home-based tele-rehabilitation presents comparable and positive impact on self-reported functional outcomes as center-based rehabilitation: Singapore tele-technology aided rehabilitation in stroke (STARS) trial

Introduction/Background
Stroke is a leading cause of disability worldwide. Functional, financial and social barriers commonly prevent individuals with acute stroke and disabilities from receiving rehabilitation following their hospital discharge. Home-based rehabilitation is an alternative to center-based rehabilitation but it is often costlier. Tele-rehabilitation is a promising solution for optimizing rehabilitation utilization, as it can enable clinicians to supervise patients and conversely, patients to receive the recommended care remotely. Our team therefore developed a novel tele-rehabilitation, with the primary aim to estimate the extent to which the proposed tele-rehabilitation resulted in an improvement in function during the first three-months after stroke in comparison to usual rehabilitation.

Material and method
This was a randomized controlled trial. We used the Late-Life Function and Disability Instrument (FDI) to assess our primary outcome (with adjustment made for baseline covariate).

Results
We recruited 124 participants and randomized them to receive either 12-week home-based tele-rehabilitation or usual rehabilitation.

Rehabilitation
Over the 12-week rehabilitation period, the intervention group spent 2246-minutes on their rehabilitation whereas the control group spent 2565-minutes. The median difference between the two groups was not statistically significant (P = 0.649).

Primary Outcome (FDI)
The mean FDI frequency score post-rehabilitation for the intervention and control groups were 39.7 (SD 11.7) and 43.0 (SD 10.6) respectively. The mean FDI limitation score post-rehabilitation for the intervention group was 78.5 (SD 20.6) and that for the control group was 85.4 (SD 19.6). The unadjusted and adjusted differences in both FDI scores between the two groups were not statistically significant (Models 1 and 2).

Conclusion
Both groups reported comparable amount of time spent on rehabilitation and similarly positive impact on the primary outcome. Home-based tele-rehabilitation can be an effective strategy for minimizing or eliminating rehabilitation utilization barriers while achieving the same functional outcome as center-based rehabilitation.

via Home-based tele-rehabilitation presents comparable and positive impact on self-reported functional outcomes as center-based rehabilitation: Singapore tele-technology aided rehabilitation in stroke (STARS) trial – ScienceDirect

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