Archive for April, 2017

[ARTICLE] Movement visualisation in virtual reality rehabilitation of the lower limb: a systematic review – Full Text

Abstract

Background

Virtual reality (VR) based applications play an increasing role in motor rehabilitation. They provide an interactive and individualized environment in addition to increased motivation during motor tasks as well as facilitating motor learning through multimodal sensory information. Several previous studies have shown positive effect of VR-based treatments for lower extremity motor rehabilitation in neurological conditions, but the characteristics of these VR applications have not been systematically investigated. The visual information on the user’s movement in the virtual environment, also called movement visualisation (MV), is a key element of VR-based rehabilitation interventions. The present review proposes categorization of Movement Visualisations of VR-based rehabilitation therapy for neurological conditions and also summarises current research in lower limb application.

Methods

A systematic search of literature on VR-based intervention for gait and balance rehabilitation in neurological conditions was performed in the databases namely; MEDLINE (Ovid), AMED, EMBASE, CINAHL, and PsycInfo. Studies using non-virtual environments or applications to improve cognitive function, activities of daily living, or psychotherapy were excluded. The VR interventions of the included studies were analysed on their MV.

Results

In total 43 publications were selected based on the inclusion criteria. Seven distinct MV groups could be differentiated: indirect MV (N = 13), abstract MV (N = 11), augmented reality MV (N = 9), avatar MV (N = 5), tracking MV (N = 4), combined MV (N = 1), and no MV (N = 2). In two included articles the visualisation conditions included different MV groups within the same study. Additionally, differences in motor performance could not be analysed because of the differences in the study design. Three studies investigated different visualisations within the same MV group and hence limited information can be extracted from one study.

Conclusions

The review demonstrates that individuals’ movements during VR-based motor training can be displayed in different ways. Future studies are necessary to fundamentally explore the nature of this VR information and its effect on motor outcome.

Background

Virtual reality (VR) in neurorehabilitation has emerged as a fairly recent approach that shows great promise to enhance the integration of virtual limbs in one`s body scheme [1] and motor learning in general [2]. Virtual Rehabilitation is a “group [of] all forms of clinical intervention (physical, occupational, cognitive, or psychological) that are based on, or augmented by, the use of Virtual Reality, augmented reality and computing technology. The term applies equally to interventions done locally, or at a distance (tele-rehabilitation)” [3]. The main objectives of intervention for facilitating motor learning within this definition are to (1) provide repetitive and customized high intensity training, (2) relay back information on patients’ performance via multimodal feedback, and (3) improve motivation [24]. VR therapies or interventions are based on real-time motion tracking and computer graphic technologies displaying the patients’ behaviour during a task in a virtual environment.

The interaction of the user and Virtual environment can be described as a perception and action loop [5]. This motor performance is displayed in the virtual environment and subsequently, the system provides multimodal feedback related to movement execution. Through external (e.g. vision) and internal (proprioception) senses the on-line sensory feedback is integrated into the patient’s mental representation. If necessary, the motor plan is corrected in order to achieve the given goal [5].

A previous Cochrane Review from Laver, George, Thomas, Deutsch, and Crotty [2] on Virtual Reality for stroke rehabilitation showed positive effects of VR intervention for motor rehabilitation in people post-stroke. However, grouped analysis from this review on recommendation for VR intervention provides inconclusive evidence. The author further comments that “[…] virtual reality interventions may vary greatly […], it is unclear what characteristics of the intervention are most important” ([2], p. 14).

Virtual rehabilitation system provides three different types of information to the patient: movement visualisation, performance feedback and context information [6]. During a motor task the patient’s movements are captured and represented in the virtual environment (movement visualisation). According to the task success, information about the accomplished goal or a required movement alteration is transmitted through one or several sensory modalities (performance feedback). Finally, these two VR features are embedded in a virtual world (context information) that can vary from a very realistic to an abstract, unrealistic or reduced, technical environment.

Performance feedback often relies on theories of motor learning and is probably the most studied information type within VR-based motor rehabilitation. Moreover, context information is primarily not designed with a therapeutic purpose. Movement observation, however, plays an important role for central sensory stimulation therapies, such as mirror therapy or mental training. The observation or imagination of body movements facilitates motor recovery [789] and provides new possibilities for cortical reorganization and enhancement of functional mobility. Thus, it appears that movement visualisation may also play an important role in motor rehabilitation [101112], although this aspect is yet to be systematically investigated [13].

The main goal of the present review is to identify various movement visualisation groups in VR-based motor interventions for lower extremities, by means of a systematic literature search. Secondarily, the included studies are further analysed for their effect on motor learning. This will help guide future research in rehabilitation using VR.

An interim analysis of the review published in 2013 showed six MV groups for upper and lower extremity training and additional two MV groups directed only towards lower extremity training. In this paper, we analysed only studies involving lower limb training, leading to a revision and expansion of the previously published MV groups findings [131415].

Continue —> Movement visualisation in virtual reality rehabilitation of the lower limb: a systematic review | BioMedical Engineering OnLine | Full Text

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[WEB SITE] ISVR Newsletter – International Society for Virtual Rehabilitation

ISVR Newsletter

Welcome to the newsletter of the International Society for Virtual Rehabilitation! The aim of this newsletter is to help fulfill the mission of the Society by providing regular information on activities and topics of interest in Virtual Rehabilitation relevant to current and potential future members.

The newsletter consists of four regular sections: a technological and a clinical profile of experienced virtual rehabilitation researchers, a feature article and the latest news from the society. We welcome your suggestions for future topics. Please let us know your feedback on newsletter@isvr.org, and join our mailing list!

Date Issue
April 2017 ISVR Newsletter Issue 10
December 2016 ISVR Newsletter Issue 9
September 2016 ISVR Newsletter Issue 8
April 2016 ISVR Newsletter Issue 7
November 2015 ISVR Newsletter Issue 6
August 2015 ISVR Newsletter Issue 5
April 2015 ISVR Newsletter Issue 4
December 2014 ISVR Newsletter Issue 3
August 2014 ISVR Newsletter Issue 2
March 2014 ISVR Newsletter Issue 1

Source: ISVR Newsletter | International Society for Virtual Rehabilitation

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[Conference paper] 3D Virtual System Using a Haptic Device for Fine Motor Rehabilitation -Abstract+References

Abstract

It is presented a 3D Virtual system with a haptic device that allows the interaction between a user and a virtual environment developed in Unity3D. This System was designed for rehabilitation of paretic hands in adult people with Stroke; the virtual environment was developed considering a daily life’s activity (watering plants in pots). The system was used by five people with mild and moderate Stroke according to ASWRTH 1+ scale, which completed the exercise showed in the virtual application. Patients performed a usability test SUS with outcomes (79, 5 ± 3, 67) this allows to define that the system has a good acceptance for rehabilitation.

Source: 3D Virtual System Using a Haptic Device for Fine Motor Rehabilitation | SpringerLink

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[WEB SITE] How It All Works – Brainworks

eRehabilitation™: The future of rehab!


One thing we know for certain is that the future of rehab is inseparable from the Internet. To be client–centred, we have to go where our clients are … and our clients are everywhere, throughout the community and all over the Internet. The growth and complexity of knowledge, research and evidence for best practices in health mirrors the growth of the Internet and its tools to disseminate information, to provide forums for eclectic interactions and informative discussions. Our clients are aptly at this intersection – they are at the centre and we need to meet them there. This intersection is a magical place; it‘s on fire with prolific activity.

We are the benefactors of a modern revolution: the intersection of advances in technology, creative interfaces and evidence-based therapies are taking healthcare to levels only dreamed of. “The motive behind the use of this technology is to maintain the essential qualities of the health-care interaction, while improving access by overcoming barriers such as economics, culture, climate, and geography,” (Rees, 2004).

Telehealth has been touted as the most significant contribution to health-care delivery systems of the future (Bashshur, 1997). eRehabilitation™, a component of telehealth, is a cutting-edge, yet flourishing means of delivering rehabilitation, psychological & mental health services.

At Brainworks, we have developed eRehabilitation™ as a comprehensive treatment platform that uses interactive audio, video, or data communications to provide rehabilitation services at a distance.

 

Does eRehabilitation™ work?

Absolutely – eRehabilitation™ is Evidence-Based: there is a growing literature base that demonstrates the efficacy of these interactive, online modalities.

There are several areas for which online guided therapy based on CBT could be regarded as empirically-supported (Andersson, 2009), including panic disorder, social anxiety disorder, posttraumatic stress disorder (PTSD), and mild to moderate depression. progress. Carlbring et al. (2005) found equivalent outcomes of individual face-to-face CBT and Internet CBT for panic disorder. In a trial on depression (Spek, Nyklıcek, et al., 2007) found no differences between live group treatment and Internet CBT.

A recent study by Matsura et al. (2002) investigated the interrater reliability of videoconferencing compared with face-to-face assessment interviews. Perfect agreement was obtained between both interviewing conditions. Glueckauf et al. (2002) assessed the effects of videoconferencing-based counselling compared with counselling using a speakerphone, and conventional, face-to-face counselling. The counselling was provided to 22 rural teenagers with epilepsy. All treatment conditions were associated with similar outcomes, including significant reductions in problem severity and frequency.

Day and Schneider (2002) conducted a comprehensive and methodologically sound study evaluating the delivery of brief CBT via videoconferencing. A sample of 80 clients with concerns ranging from weight concerns to personality disorders were randomly assigned to one of three treatment groups (face-to-face, two-way audio, or two-way video) or a waiting list control group. No significant differences were found between treatment groups across outcome measures and all three groups were significantly superior to the no-treatment group.

A number of studies have demonstrated the benefits of conducting assessments via the Internet. These include: ease of administration, collecting data, communicating findings to clients, cost efficiency, reaching disabled persons and those that live in the rural areas (EmmelKamp, 2005; Fischer & Freid, 2001; Naus, Phillip, & Samsi 2009;).


References:

References available upon request. Please contact us for more information and literature to support your referral!

Source: How It All Works – Brainworks

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[Conference paper] VRAndroid System Based on Cognitive Therapeutic Exercises for Stroke Patients – Abstract+References

Abstract

It is presented VRAndroid System designed in Android and implemented on an Android Tablet, the system consists in a set of nine shapes based on cognitive therapeutic exercises for the motor rehabilitation in upper limbs, this tools provides perceptive feedback (vibration) to the patient as he follows the correct shape with his finger. There are two performed rehabilitation phases: (1) Through the Perffeti Technique (15 sessions), (2) Through VRAndroid System (15 sessions), the evolution and results of the rehabilitation are evaluated by the BOX AND BLOCK test, which shows that, the rehabilitation through this techniques help in the motor recovery of the upper limbs, moreover, the VRAndroid System is a useful tool to be used as a traditional rehabilitation supplement.

Source: VRAndroid System Based on Cognitive Therapeutic Exercises for Stroke Patients | SpringerLink

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[WEB SITE] What Is Spasticity – Saebo

What is Spasticity?

Spasticity is a neuromuscular condition usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement. The damage causes a change in the balance of signals between the nervous system and the muscles. It is typically found in people with cerebral palsy, traumatic brain injury, stroke, multiple sclerosis, and spinal cord injury.

Charley horse is an understatement.

Spasticity is often described as tight, stiff muscles or spasms that may make movement, posture, and balance difficult. It negatively affects muscles and joints of the extremities, and is particularly harmful to growing children. Individuals with mild spasticity may experience muscle tightness whereas severe spasticity may produce painful, uncontrollable spasms of the extremities; most commonly the legs and arms. This can interfere with functional recovery and curtail rehabilitation efforts.

Unintended consequences.

Spasticity can be disabling and if left untreated, or sub-optimally managed, it may lead to adverse effects such as:

  • Contractures
  • Muscle and joint deformitiesv
  • Urinary tract infections
  • Chronic constipation
  • Fever or other systemic illnesses
  • Pressure sores
  • Overactive reflexes
  • Pain
  • Decreased functional abilities and delayed motor development
  • Difficulty with care and hygiene
  • Abnormal posture
  • Bone and joint deformities

Loosening the grip.

Common treatment interventions for spasticity vary from conservative (therapy) to more aggressive (surgery). Typically, a variety of treatment options are used simultaneously to maximize results. Current spasticity treatment options may include the following:

  • Oral medications
  • Injectable medications
  • Stretching
  • Orthoses
  • Casting
  • Electrotherapeutics
  • Cryotherapy
  • Surgery

Source: What Is Spasticity | Saebo

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[WEB SITE] Caregiving Issues and Strategies

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Whether you’re trying to work out a care plan for your aging parents with  your siblings, or searching online for the latest app to assist you with your ill spouse’s medication reminders, FCA’s resources on Caregiving Issues and Strategies offer a wealth of information. This section provides you with practical care strategies, stress relief, available community resources, how to handle family issues, as well as hands-on care.

Source: Family Caregiver Alliance

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[ARTICLE] Quantification of task-dependent cortical activation evoked by robotic continuous wrist joint manipulation in chronic hemiparetic stroke – Full Text

Abstract

Background

Cortical damage after stroke can drastically impair sensory and motor function of the upper limb, affecting the execution of activities of daily living and quality of life. Motor impairment after stroke has been thoroughly studied, however sensory impairment and its relation to movement control has received less attention. Integrity of the somatosensory system is essential for feedback control of human movement, and compromised integrity due to stroke has been linked to sensory impairment.

Methods

The goal of this study is to assess the integrity of the somatosensory system in individuals with chronic hemiparetic stroke with different levels of sensory impairment, through a combination of robotic joint manipulation and high-density electroencephalogram (EEG). A robotic wrist manipulator applied continuous periodic disturbances to the affected limb, providing somatosensory (proprioceptive and tactile) stimulation while challenging task execution. The integrity of the somatosensory system was evaluated during passive and active tasks, defined as ‘relaxed wrist’ and ‘maintaining 20% maximum wrist flexion’, respectively. The evoked cortical responses in the EEG were quantified using the power in the averaged responses and their signal-to-noise ratio.

Results

Thirty individuals with chronic hemiparetic stroke and ten unimpaired individuals without stroke participated in this study. Participants with stroke were classified as having severe, mild, or no sensory impairment, based on the Erasmus modification of the Nottingham Sensory Assessment. Under passive conditions, wrist manipulation resulted in contralateral cortical responses in unimpaired and chronic stroke participants with mild and no sensory impairment. In participants with severe sensory impairment the cortical responses were strongly reduced in amplitude, which related to anatomical damage. Under active conditions, participants with mild sensory impairment showed reduced responses compared to the passive condition, whereas unimpaired and chronic stroke participants without sensory impairment did not show this reduction.

Conclusions

Robotic continuous joint manipulation allows studying somatosensory cortical evoked responses during the execution of meaningful upper limb control tasks. Using such an approach it is possible to quantitatively assess the integrity of sensory pathways; in the context of movement control this provides additional information required to develop more effective neurorehabilitation therapies.

Background

The cerebral cortex plays an important role in feedforward (i.e. voluntary motor drive) and feedback control (i.e. reflexes and modulation of spinal reflexes) of human movement [1]. Cortical damage after stroke impairs both feedforward and feedback control. Altered feedforward control after stroke has been thoroughly studied and may lead to motor impairments such as weakness and abnormal synergy-dependent motor control [23].

Cortical involvement in feedback control (including sensorimotor integration and spinal reflex modulation) requires connectivity between somatosensory receptors in the periphery and the sensorimotor cortex, yet compromised integrity of this somatosensory system after stroke has received little attention in the literature. Understanding the impact of sensory impairment, as well as motor impairment, is highly relevant for the development and selection of neurorehabilitation therapies aimed to enhance and normalize motor control [4567] and for evaluating their effectiveness.

Proprioceptive and tactile information are required for feedback control of a joint, and can be studied in an experimental setting by disturbing the joint via a robotic manipulator during motor control tasks. This robotic joint manipulation results in activation of spinal reflex loops [8910] as well as in activation of the somatosensory cortex via high-resolution sensory pathways [11]. However, the cortical activity evoked by joint manipulation and consequently the cortical involvement in feedback control have received less attention.

In able-bodied individuals, evoked cortical responses to robotic joint manipulation have been studied with transient [1213] and continuous disturbances [141516]. Continuous disturbances uninterruptedly provide input to the sensory system, allowing for studying movement control and somatosensory cortical activity during meaningful motor tasks. This study determines the cortical representation of afferent (proprioceptive and tactile) information in individuals with chronic hemiparetic stroke under different upper limb control conditions, relying on objective metrics derived from the electroencephalogram (EEG). Here, the goal is to quantify evoked cortical activation in individuals with chronic hemiparetic stroke, through a combination of robotic continuous joint manipulation of the paretic limb and high-density EEG. The evoked cortical activation reveals the integrity of the connections between sensory receptors in the periphery and the sensorimotor cortices.

It is hypothesized that, due to stroke-induced damage to the somatosensory system, individuals with clinically assessed proprioceptive and tactile impairment will show decreased cortical evoked responses to continuous joint manipulation in the absence of voluntary motor activity of the affected upper limb, as compared to unimpaired persons. In general, when voluntary motor activity of the affected upper limb is required, individuals with hemiparesis have been shown to recruit their contralesional brain hemisphere, i.e. ipsilateral to the movement [17181920]. It is unclear, however, what this recruitment means with regard to somatosensory (i.e. afferent) evoked cortical activity, as the anatomical pathways conducting proprioceptive and tactile information mainly connect to the contralateral hemisphere [21]; thus, increased evoked cortical activation of the ipsilateral hemisphere is not expected.

Continue —> Quantification of task-dependent cortical activation evoked by robotic continuous wrist joint manipulation in chronic hemiparetic stroke | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 1 Experimental setup. a The forearm of the participant is strapped into an armrest and the hand is strapped to the handle of the robotic manipulator, requiring no hand force to hold the handle. b Visual feedback as presented to the participant. The circle and crosshairs are always visible. The yellow arrow is only visible during the active task and points up if the target torque is applied. c Close-up of the arm in the robotic manipulator. The wrist joint is aligned with the axis of the motor and is placed in the neutral angle, defined as 20° wrist flexion. d One period of the disturbance signal applied to the wrist (root-mean-square of 0.02 rad). Zero radians corresponds to the neutral angle of the wrist

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[Executive Summary] Rehabilitation Research at the National Institutes of Health: Moving the Field Forward – Full Text

Article Outline

  1. Rehabilitation across the lifespan
  2. Technology in rehabilitation: From cutaneous to implanted
  3. Mechanisms and markers of activity and function
    1. Exercise, plasticity, and mechanism: “How is rehabilitation happening?”
  4. Access to the lived environment
  5. Individuals, families, and community
  6. Understanding the context: Environmental impacts in rehabilitation
  7. Effective pathways to evidence for rehabilitation
  8. Central and peripheral mechanisms of rehabilitation
  9. Bending the arc of technology toward rehabilitation and health
  10. Transitions across the lifespan
  11. Novel outcomes in rehabilitation and integration into clinical care
  12. Using data to drive discovery
  13. Preventing secondary disability
  14. Development of an NIH rehabilitation research plan
  15. Acknowledgments

Approximately 53 million Americans live with a disability. For decades, the National Institutes of Health (NIH) has been conducting and supporting research to discover new ways to minimize disability and enhance the quality of life of people with disabilities. After the passage of the American With Disabilities Act, the NIH established the National Center for Medical Rehabilitation Research with the goal of developing and implementing a rehabilitation research agenda. Currently, a total of 17 institutes and centers at NIH invest more than $500 million per year in rehabilitation research. Recently, the director of NIH, Dr Francis Collins, appointed a Blue Ribbon Panel to evaluate the status of rehabilitation research across institutes and centers. As a follow-up to the work of that panel, NIH recently organized a conference under the title “Rehabilitation Research at NIH: Moving the Field Forward.” This report is a summary of the discussions and proposals that will help guide rehabilitation research at NIH in the near future.

The conference took place at the NIH Campus on May 25 and 26, 2016. It was cosponsored by The Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Biomedical Imaging and Bioengineering, the National Institute of Neurological Diseases and Stroke, the National Institute of Nursing Research, the National Institute on Deafness and other Communication Disorders, the National Center for Complementary and Integrative Health, and the Office of Disease Prevention. The main objectives of the Conference were to (1) discuss the current NIH portfolio in rehabilitation research, (2) highlight advances in rehabilitation research supported by NIH, and (3) provide an opportunity for scientists and the general public to comment on gaps in knowledge, opportunities for training, and infrastructure needs. The program included a total of 13 expert panels, four remarks by NIH leaders, a consumer keynote, a town hall, a poster session, and the use of social media to disseminate information in real time. The following is a summary of the discussion and the subheadings correspond to the title of the expert panels.

Continue —> Rehabilitation Research at the National Institutes of Health: Moving the Field Forward (Executive Summary) – Archives of Physical Medicine and Rehabilitation

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[Abstract] “A CLINICAL FRAMEWORK FOR FUNCTIONAL RECOVERY IN A PERSON WITH CHRONIC TRAUMATIC BRAIN INJURY: A CASE REPORT” |

Provisional Abstract:
Background and Purpose: This case report describes a task-specific program for gait and functional recovery in a young man with severe chronic traumatic brain injury (TBI).

Case Description: The individual was a 26-year-old man 4 years post TBI with severe motor impairments who had not walked outside of therapy since his injury. He had received extensive gait training prior to initiation of services. His goal was to recover the ability to walk.

Intervention: The primary focus of the interventions was the restoration of gait. A variety of interventions were used, including locomotor treadmill training, electrical stimulation, orthoses and specialized assistive devices. A total of 79 treatments were delivered over a period of 62 weeks.

Outcomes: At the conclusion of therapy, the client was able to walk independently with a gait trainer for over 3000 feet and walked in the community with the assistance of his mother using a rocker bottom crutch for distances of up to 350 feet.

Discussion: Given the chronicity of this individual’s injury, the magnitude of his functional improvements were unexpected. However, very intentional interventions were selected in the development of his treatment plan. His potential was realized by structuring practice of the salient task, i.e. walking, with adequate intensity and frequency.

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Source: JUST ACCEPTED: “A CLINICAL FRAMEWORK FOR FUNCTIONAL RECOVERY IN A PERSON WITH CHRONIC TRAUMATIC BRAIN INJURY: A CASE REPORT” |

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