Archive for November, 2019

[Abstract] Feature Evaluation of Upper Limb Exercise Rehabilitation Interactive System Based on Kinect – Full Text PDF

ABSTRACT

The virtual rehabilitation system combining virtual rehabilitation environment and upper limb rehabilitation technology is interactive and interesting, which can improve the enthusiasm and initiative of patients for rehabilitation training, improve the efficiency of rehabilitation training and improve the effect of rehabilitation treatment. This paper firstly conducts in-depth research and analysis on the research progress of the upper limb rehabilitation robot system, and deeply studies the principle and rehabilitation principle of the stroke caused by hemiplegic dyskinesia, and summarizes the goals and methods of the upper limb rehabilitation system design. Secondly, the hand motion tracking is realized by Kinect’s bone tracking, and the optimal tracking distance is determined experimentally, which verifies the stability and robustness of the tracking. Static gesture recognition adopts two gesture recognition schemes based on Kinect depth image and color space model respectively. Finally, using the rehabilitation robot and Kinect sensor as the hardware platform, the virtual rehabilitation training system experimental platform is constructed, and the horizontal rehabilitation exercise and the three-dimensional space rehabilitation exercise are respectively studied experimentally, and the exercise data obtained by using healthy subjects as the experimental object is analyzed. Based on this, the validity and feasibility of the Kinect-based upper limb exercise rehabilitation interactive system were verified.

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[Submissions from Readers] Stroke Recovery

How to improve stroke

by Sultan
(UK)

Question: How do you improve patient’s hand, fingers, and leg movement? Please tell me some exercises for my mother. Thanks.


Answer: If your mother already has some movement in her hand and fingers then I would recommend some of the exercises from this website’s hand exercises page at www.stroke-rehab.com/hand-exercises.html.

If she does not have any movement or only little movement in her hand, then I recommend trying to put weight through the arm to facilitate sensory input. This can be done by placing the hand on a firm surface and helping to support her elbow while she leans into the hand. When there is little movement in the upper extremity, it’s best to eliminate gravity as much as possible and provide assist as needed. I often place the hand on a ball and see if the patient can elicit movement. If approved by her MD, you could talk to a therapist about using electrical stimulation to facilitate movement.

Some simple hand and arm exercises I use after a stroke are as follows (stretch the hand prior to exercises):

1) Place patient’s open hand on ball and have them work on just keeping the hand on the ball without assistance

2) Once they can keep the hand on the ball, try rolling the ball gently side to side and forward and back

3) Once they can roll the ball, place both hands on the sides of the ball (soccer ball works well) and try to lift the ball off their lap using both hands and 

without the weak hand falling off

4) As they are able to lift the ball, work on lifting the ball higher or moving it side to side

5) Work on taking weak hand off the ball slowly and with controlled movement

6) Once they can move hand off/on ball with some control, work on placing hand on smaller objects such as a plastic cup and letting go. Progress to trying to lift the cup.

Some other options to help facilitate return of the hemiplegic arm include using e-stim with a therapist or tapping the muscles you are trying to stimulate. If trying to close the hand, turn the palm up and tap the forearm muscles. If trying to open the hand, turn the palm down and tap the back of the forearm.

Weight bearing is also good for the leg. If your mother is able to stand, have a therapist show her how to shift weight onto the weak leg and work on weight bearing on the affected side. A physical therapist can also show you tapping techniques to help facilitate movement. For example, to elicit straightening the knee, you would tap the top of the thigh.

If you are looking for therapy ideas, I suggest looking on You Tube for stroke rehab exercises. Many therapists and patients have recorded their therapy sessions which might give you ideas on what would work for your mother. You should always consult a therapist or physician that has worked with your mom to make sure any exercises would be appropriate for her.

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Gaining Strength After Stroke

by Jayesh Mehta
(Wellingborough in UK)

Question: I suffered a hemorrhagic stroke in April 2009 and subsequently got senses back in all of my body. As an effect of the stroke, my left side, even though movement feels OK, is a bit weak due to prolong time in bed (8 months in hospital+rehab). My body has lost its strength and hence I can’t get up from a sitting position. I have joined a gym to gain strength and am a full time worker post stroke. The reason for this note is to see what you can suggest to get some strength back – to be able to get up by myself and take a few steps, etc. (not looking for running down the street). Please share anything that you think might help.

Thanks
Jayesh

Answer: I like to use hi-lo mats to help patients improve their ability to stand from a sitting position. A hi-lo mat can be adjusted to a low or high position. I will have my patients sit on the mat and then raise the height. We will practice weight bearing through the legs with the mat elevated (with the buttocks still on the mat) and then will practice sit to stand from this position. I will block the knee on their weak side if necessary to prevent the leg from buckling. An air splint can also be used to help keep the leg from collapsing. Once a patient has gained confidence in standing then I work on the patient shifting weight side to side and learning to take more weight through the weak leg. I also vary the height of the hi-lo mat to work on sit to stand from different heights. As the legs and core get stronger, one will be able to get up from a lower height.

A physical therapist should be able to help you with the techniques described above. I don’t know about equipment in the UK but hi-lo mats are standard equipment in a US therapy clinic.

One might could use a hospital bed or lift chair to achieve the same effect as a hi-lo mat, however, I haven’t tried this out. You should always check with your medical provider before attempting any exercises and also have a therapist or trained caregiver with you when attempting such exercises as described above.

Below is an examples of a hi-lo mat. One can purchase these mats, however, they are expensive.

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[Abstract] Automated design of a custom-made hand rehabilitation robot – Full Text PDF

Abstract

A frequent consequence of stroke is a limited hand function. Numerous studies have shown, that repetitive passive training enhances the rehabilitation process. As there are high anthropometric variances in hand and finger anatomy, this contribution presents a custom-made hand rehabilitation robot. The individual design is proposed to ensure an ergonomic interface which allows long-time wearing. To provide a cost-effective production, we present an automated design process. The individual fingers are manufactured monolithically using the selective laser sintering of polyamide. The presented device is portable and can be used for training as well as for grasping things.

 

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[VIDEO] Flooding – Becoming Overwhelmed After Brain Injury – YouTube

Welcome to the Northern Brain Injury Association’s webcast on ‘flooding’, created to help you assist survivors of brain injury who are experiencing flooding by teaching them to identify their triggers, control their exposure and manage their anxiety. For more webcasts on issues faced by survivors of brain injury, visit http://www.nbia.ca

 

 

 

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[Abstract] Movement kinematics and proprioception in post-stroke spasticity: assessment using the Kinarm robotic exoskeleton – Full Text PDF

Headline

Background

Motor impairment after stroke interferes with performance of everyday activities. Upper limb spasticity may further disrupt the movement patterns that enable optimal function; however, the specific features of these altered movement patterns, which differentiate individuals with and without spasticity, have not been fully identified. This study aimed to characterize the kinematic and proprioceptive deficits of individuals with upper limb spasticity after stroke using the Kinarm robotic exoskeleton.

Methods

Upper limb function was characterized using two tasks: Visually Guided Reaching, in which participants moved the limb from a central target to 1 of 4 or 1 of 8 outer targets when cued (measuring reaching function) and Arm Position Matching, in which participants moved the less-affected arm to mirror match the position of the affected arm (measuring proprioception), which was passively moved to 1 of 4 or 1 of 9 different positions. Comparisons were made between individuals with (n = 35) and without (n = 35) upper limb post-stroke spasticity.

Results

Statistically significant differences in affected limb performance between groups were observed in reaching-specific measures characterizing movement time and movement speed, as well as an overall metric for the Visually Guided Reaching task. While both groups demonstrated deficits in proprioception compared to normative values, no differences were observed between groups. Modified Ashworth Scale score was significantly correlated with these same measures.

Conclusions

The findings indicate that individuals with spasticity experience greater deficits in temporal features of movement while reaching, but not in proprioception in comparison to individuals with post-stroke motor impairment without spasticity. Temporal features of movement can be potential targets for rehabilitation in individuals with upper limb spasticity after stroke.

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[WEB SITE] A Manifesto for being InCredible – ACNR | Online Neurology Journal ACNR | Online Neurology Journal

A Manifesto for being InCredible

Posted in Industry News,News Review on 25th Nov 2019

The British Neuroscience Association (BNA) is officially launching its ‘Credibility in Neuroscience Manifesto today, Monday 25th November, at an evening reception at the House of Commons.

The manifesto has been published in response to current threats and challenges to credible research across life sciences. Currently, there is a huge pressure to publish as many papers as possible, with an emphasis on dramatic, novel findings. This in turn has led to increasing levels of non-reproducible research[i], which can skew scientific understanding, contribute to hyped expectations, and jeopardise the translation of research to real-world applications.[…]

Continue —-> A Manifesto for being InCredible – ACNR | Online Neurology Journal ACNR | Online Neurology Journal

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[Abstract] Exploratory Randomized Double-Blind Placebo-Controlled Trial of Botulinum Therapy on Grasp Release After Stroke (PrOMBiS)

Background. OnabotulinumtoxinA injections improve upper-limb spasticity after stroke, but their effect on arm function remains uncertain.

Objective. To determine whether a single treatment with onabotulinumtoxinA injections combined with upper-limb physiotherapy improves grasp release compared with physiotherapy alone after stroke.

Methods. A total of 28 patients, at least 1 month poststroke, were randomized to receive either onabotulinumtoxinA or placebo injections to the affected upper limb followed by standardized upper-limb physiotherapy (10 sessions over 4 weeks). The primary outcome was time to release grasp during a functionally relevant standardized task. Secondary outcomes included measures of wrist and finger spasticity and strength using a customized servomotor, clinical assessments of stiffness (modified Ashworth Scale), arm function (Action Research Arm Test [ARAT], Nine Hole Peg Test), arm use (Arm Measure of Activity), Goal Attainment Scale, and quality of life (EQ5D).

Results. There was no significant difference between treatment groups in grasp release time 5 weeks post injection (placebo median = 3.0 s, treatment median = 2.0 s; t(24) = 1.20; P = .24; treatment effect = −0.44, 95% CI = −1.19 to 0.31). None of the secondary measures passed significance after correcting for multiple comparisons. Both groups achieved their treatment goals (placebo = 65%; treatment = 71%), and made improvements on the ARAT (placebo +3, treatment +5) and in active wrist extension (placebo +9°, treatment +11°).

Conclusions. In this group of stroke patients with mild to moderate spastic hemiparesis, a single treatment with onabotulinumtoxinA did not augment the improvements seen in grasp release time after a standardized upper-limb physiotherapy program.

 

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[Abstract + References] Epileptic and Nonepileptic Seizures after Traumatic Brain Injury

Abstract

Representing approximately 5% of epilepsy in the civilian population and up to 50% in certain military populations, posttraumatic epilepsy warrants both increased clinical attention and research considerations. In this chapter, we will discuss the important definitions when considering posttraumatic epilepsy including the timing of posttraumatic seizures and the severity of head injuries. We will also review the epidemiology and risk factors for posttraumatic epilepsy in both the civilian population and the military and will describe the association of head trauma and psychogenic nonepileptic seizures. Our clinical discussion focuses on the timing of posttraumatic seizures, the utility of diagnostic testing, treatment of posttraumatic epilepsy, and outcomes of these patients. In addition, we elucidate potential pathophysiologic mechanisms underlying posttraumatic epilepsy and consider its role as a model for epileptogenesis in current and future research. We highlight the relevant studies in each section and underscore the theme that more research is certainly needed in most areas of posttraumatic epilepsy.

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[ARTICLE] A portable assist-as-need upper-extremity hybrid exoskeleton for FES-induced muscle fatigue reduction in stroke rehabilitation – Full Text

Abstract

Background

Hybrid exoskeletons are a recent development which combine Functional Electrical Stimulation with actuators to improve both the mental and physical rehabilitation of stroke patients. Hybrid exoskeletons have been shown capable of reducing the weight of the actuator and improving movement precision compared to Functional Electrical Stimulation alone. However little attention has been given towards the ability of hybrid exoskeletons to reduce and manage Functional Electrical Stimulation induced fatigue or towards adapting to user ability. This work details the construction and testing of a novel assist-as-need upper-extremity hybrid exoskeleton which uses model-based Functional Electrical Stimulation control to delay Functional Electrical Stimulation induced muscle fatigue. The hybrid control is compared with Functional Electrical Stimulation only control on a healthy subject.

Results

The hybrid system produced 24° less average angle error and 13.2° less Root Mean Square Error, than Functional Electrical Stimulation on its own and showed a reduction in Functional Electrical Stimulation induced fatigue.

Conclusion

As far as the authors are aware, this is the study which provides evidence of the advantages of hybrid exoskeletons compared to use of Functional Electrical Stimulation on its own with regards to the delay of Functional Electrical Stimulation induced muscle fatigue.

Background

Stroke is the second largest cause of disability worldwide after dementia [1]. Temporary hemiparesis is common among stroke survivors. Regaining strength and movement in the affected side takes time and can be improved with the use of rehabilitation therapy involving repetitive and function-specific tasks [2]. Muscle atrophy is another common issue that occurs after a stroke due to lack of use of the muscle. For each day a patient is in hospital lying in bed with minimal activity approximately 13% of muscular strength is lost (Ellis. Liam, Jackson. Samuel, Liu. Cheng-Yueh, Molloy. Peter, Paterson. Kelsey, Lower Limb Exoskeleton Final Report, unpublished). Electromechanically actuated exoskeletons offer huge advantages in their ability to repetitively and precisely provide assistance/resistance to a user. However electromechanical actuators which provide the required forces are often heavy in weight and have high power requirements which limits portability. Furthermore, muscle atrophy can only be prevented by physically working the muscles either through the patient’s own volition or the use of Functional Electrical Stimulation (FES).

FES is the application of high frequency electrical pulses to the nerves or directly to the muscle belly in order to elicit contractions in the muscle. FES devices are typically lightweight and FES is well suited to reducing muscle atrophy in patients with no or extremely limited movement. The trade off to this is that precise control of FES is extremely difficult and controlling specific, repetitive, and functional movement is not easily accomplished. Furthermore, extended use of FES is limited by the introduction of muscle fatigue caused by the unnatural motor unit recruitment order [3]. The forces required for large movements, such as shoulder abduction, are too great to be provided by the use of FES which is much better suited to smaller movements such as finger extension [45]. Some patients also find the use of FES painful.

Combining the use of FES and an electromechanical actuator within an exoskeleton can potentially overcome the limitations of each individual system. Despite the potential advantages of hybrid exoskeletons, so far only limited studies have been done on their effectiveness. A recent review was conducted into upper-extremity hybrid exoskeletons [6] which highlighted the advantages hybrid exoskeletons (exoskeletons which combine FES with an actuator) have with regards to improving the precision of FES induced movements. However, little attention has been given towards reduction and management of FES-induced fatigue. FES control systems used for upper-extremity hybrid exoskeletons simply manually ramp up stimulation intensity when fatigue is observed.

This work describes the design and testing of an assist-as-need upper-extremity hybrid exoskeleton which uses model-based control of FES with a focus on reducing FES-induced muscle fatigue. The control system is described in Section “Theory”, and the results are presented in Section “Results”. A discussion of the results is given in Section “Discussion”. Conclusions are summarised in Section “Conclusion”. Methods, physical structure of the exoskeleton, and the sensing system is described in Section “Material and methods”.[…]

 

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Fig. 10 The Powered Exoskeleton (Right Arm)

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[Abstract + References] Using a Collaborative Robot to the Upper Limb Rehabilitation – Conference paper

Abstract

Rehabilitation is a relevant process for the recovery from dysfunctions and improves the realization of patient’s Activities of Daily Living (ADLs). Robotic systems are considered an important field within the development of physical rehabilitation, thus allowing the collection of several data, besides performing exercises with intensity and repeatedly. This paper addresses the use of a collaborative robot applied in the rehabilitation field to help the physiotherapy of upper limb of patients, specifically shoulder. To perform the movements with any patient the system must learn to behave to each of them. In this sense, the Reinforcement Learning (RL) algorithm makes the system robust and independent of the path of motion. To test this approach, it is proposed a simulation with a UR3 robot implemented in V-REP platform. The main control variable is the resistance force that the robot is able to do against the movement performed by the human arm.

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