Archive for May, 2020

[Abstract] The Effect of Priming on Outcomes of Task-Oriented Training for the Upper Extremity in Chronic Stroke: A Systematic Review and Meta-analysis

Background. Priming results in a type of implicit memory that prepares the brain for a more plastic response, thereby changing behavior. New evidence in neurorehabilitation points to the use of priming interventions to optimize functional gains of the upper extremity in poststroke individuals. Objective. To determine the effects of priming on task-oriented training on upper extremity outcomes (body function and activity) in chronic stroke.

Methods. The PubMed, CINAHL, Web of Science, EMBASE, and PEDro databases were searched in October 2019. Outcome data were pooled into categories of measures considering the International Classification Functional (ICF) classifications of body function and activity. Means and standard deviations for each group were used to determine group effect sizes by calculating mean differences (MDs) and 95% confidence intervals via a fixed effects model. Heterogeneity among the included studies for each factor evaluated was measured using the I2 statistic.

Results. Thirty-six studies with 814 patients undergoing various types of task-oriented training were included in the analysis. Of these studies, 17 were associated with stimulation priming, 12 with sensory priming, 4 with movement priming, and 3 with action observation priming. Stimulation priming showed moderate-quality evidence of body function. Only the Wolf Motor Function Test (time) in the activity domain showed low-quality evidence. However, gains in motor function and in use of extremity members were measured by the Fugl-Meyer Assessment (UE-FMA). Regarding sensory priming, we found moderate-quality evidence and effect size for UE-FMA, corresponding to the body function domain (MD 4.77, 95% CI 3.25-6.29, Z = 6.15, P < .0001), and for the Action Research Arm Test, corresponding to the activity domain (MD 7.47, 95% CI 4.52-10.42, Z = 4.96, P < .0001). Despite the low-quality evidence, we found an effect size (MD 8.64, 95% CI 10.85-16.43, Z = 2.17, P = .003) in movement priming. Evidence for action observation priming was inconclusive.

Conclusion. Combining priming and task-oriented training for the upper extremities of chronic stroke patients can be a promising intervention strategy. Studies that identify which priming techniques combined with task-oriented training for upper extremity function in chronic stroke yield effective outcomes in each ICF domain are needed and may be beneficial for the recovery of upper extremities poststroke.

via The Effect of Priming on Outcomes of Task-Oriented Training for the Upper Extremity in Chronic Stroke: A Systematic Review and Meta-analysis – Erika Shirley Moreira da Silva, Gabriela Nagai Ocamoto, Gabriela Lopes dos Santos-Maia, Roberta de Fátima Carreira Moreira Padovez, Claudia Trevisan, Marcos Amaral de Noronha, Natalia Duarte Pereira, Alexandra Borstad, Thiago Luiz Russo,

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[Abstract] A Novel Wearable Device for Motor Recovery of Hand Function in Chronic Stroke Survivors

Background. In monkey, reticulospinal connections to hand and forearm muscles are spontaneously strengthened following corticospinal lesions, likely contributing to recovery of function. In healthy humans, pairing auditory clicks with electrical stimulation of a muscle induces plastic changes in motor pathways (probably including the reticulospinal tract), with features reminiscent of spike-timing dependent plasticity. In this study, we tested whether pairing clicks with muscle stimulation could improve hand function in chronic stroke survivors.

Methods. Clicks were delivered via a miniature earpiece; transcutaneous electrical stimuli at motor threshold targeted forearm extensor muscles. A wearable electronic device (WD) allowed patients to receive stimulation at home while performing normal daily activities. A total of 95 patients >6 months poststroke were randomized to 3 groups: WD with shock paired 12 ms before click; WD with clicks and shocks delivered independently; standard care. Those allocated to the device used it for at least 4 h/d, every day for 4 weeks. Upper-limb function was assessed at baseline and weeks 2, 4, and 8 using the Action Research Arm Test (ARAT), which has 4 subdomains (Grasp, Grip, Pinch, and Gross).

Results. Severity across the 3 groups was comparable at baseline. Only the paired stimulation group showed significant improvement in total ARAT (median baseline: 7.5; week 8: 11.5; P = .019) and the Grasp subscore (median baseline: 1; week 8: 4; P = .004).

Conclusion. A wearable device delivering paired clicks and shocks over 4 weeks can produce a small but significant improvement in upper-limb function in stroke survivors.

via A Novel Wearable Device for Motor Recovery of Hand Function in Chronic Stroke Survivors – Supriyo Choudhury, Ravi Singh, A. Shobhana, Dwaipayan Sen, Sidharth Shankar Anand, Shantanu Shubham, Suparna Gangopadhyay, Mark R. Baker, Hrishikesh Kumar, Stuart N. Baker,

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[Abstract] Quantitative Assessment of Upper Limb Rehabilitation through Digital Motion Acquisition

Abstract

Motion capture (Mocap) systems are considered more and more interesting for the assessment of rehabilitation processes. In fact, medical personnel are increasingly demanding for technologies (possibly low-cost) to quantitatively measure and assess patients’ improvements during rehabilitation exercises. In this paper, we focus the attention on the assessment of rehabilitation process for injured shoulders. This is particularly challenging because the recognition and the measurement of compensatory movements are very difficult during visual assessment and the movements of a shoulder are complex and arduous to be captured. The proposed solution integrates a low-cost Mocap system with video processing techniques to allow a quantitative evaluation of abduction, which is one of the first post-surgery exercises required for shoulder rehabilitation. The procedure is based on a set of open-source software tools to measure abduction and evaluate the correctness of the movement by detecting and measuring compensatory movements according to the parameters commonly considered by the physicians. Finally, a preliminary results and future works are presented and discussed.

via (9) Quantitative Assessment of Upper Limb Rehabilitation through Digital Motion Acquisition | Request PDF

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[WEB PAGE] Caregiver Health – MedlinePlus

Caregiver Health

Also called: Caring for the caregiver

What is a caregiver?

caregiver gives care to someone who needs help taking care of themselves. The person who needs help may be a child, an adult, or an older adult. They may need help because of an injury, chronic illness, or disability.

Some caregivers are informal caregivers. They are usually family members or friends. Other caregivers are paid professionals. Caregivers may give care at home or in a hospital or other health care setting. Sometimes they are caregiving from a distance. The types of tasks that caregivers do may include

  • Helping with daily tasks like bathing, eating, or taking medicine
  • Arranging activities and medical care
  • Making health and financial decisions

How does caregiving affect the caregiver?

Caregiving can be rewarding. It may help to strengthen connections to a loved one. You may feel fulfillment from helping someone else. But caregiving may also be stressful and sometimes even overwhelming. Caregiving may involve meeting complex demands without any training or help. You may also be working and have children or others to care for. To meet all of the demands, you might be putting your own needs and feelings aside. But that’s not good for your long-term health. But you need to make sure that you are also taking care of yourself.

What is caregiver stress?

Many caregivers are affected by caregiver stress. This is the stress that comes from the emotional and physical strain of caregiving. The signs include

  • Feeling overwhelmed
  • Feeling alone, isolated, or deserted by others
  • Sleeping too much or too little
  • Gaining or losing a lot of weight
  • Feeling tired most of the time
  • Losing interest in activities you used to enjoy
  • Becoming easily irritated or angered
  • Feeling worried or sad often
  • Having headaches or body aches often
  • Turning to unhealthy behaviors like smoking or drinking too much alcohol

How can caregiver stress affect my health?

Long-term caregiver stress may put you at risk for many different health problems. Some of these problems can be serious. They include

What can I do to prevent or relieve caregiver stress?

Taking steps to prevent or relieve caregiver stress may help prevent health problems. Remember that if you feel better, you can take better care of your loved one. It will also be easier to focus on the rewards of caregiving. Some ways to help yourself include

  • Learning better ways to help your loved one. For examples, hospitals offer classes that can teach you how to care for someone with an injury or illness.
  • Finding caregiving resources in your community to help you. Many communities have adult daycare services or respite services. Using one of these can give you a break from your caregiving duties.
  • Asking for and accepting help. Make a list of ways others can help you. Let helpers choose what they would like to do. For instance, someone might sit with the person you care for while you do an errand. Someone else might pick up groceries for you.
  • Joining a support group for caregivers. A support group can allow you to share stories, pick up caregiving tips, and get support from others who face the same challenges as you do.
  • Being organized to make caregiving more manageable. Make to-do lists and set a daily routine.
  • Staying in touch with family and friends. It’s important for you to have emotional support.
  • Taking care of your own health. Try to find time to be physically active on most days of the week, choose healthy foods, and get enough sleep. Make sure that you keep up with your medical care such as regular checkups and screenings.
  • Considering taking a break from your job, if you also work and are feeling overwhelmed. Under the federal Family and Medical Leave Act, eligible employees can take up to 12 weeks of unpaid leave per year to care for relatives. Check with your human resources office about your options.

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via Caregiver Health: MedlinePlus

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[BLOG POST] Google Maps Will Now Show Wheelchair Accessible Places

There’s good news for wheelchair users. On May 21, Global Accessibility Awareness Day, Google announced that Google Maps will now show places that are wheelchair accessible, and users will be able to find such places effortlessly without taking any extra steps. All they have to do is turn on the “Accessible Places” feature in their settings.

With this setting turned on, Google Maps will show a wheelchair icon next to places and users will be able to get more details as well like whether the place has wheelchair accessible entrance, parking lot, elevator, restroom, and seating. Such information is typically added by other guests to these locations. Android users have been doing this for a long time and very soon iOS users will be able to add this information too.

Watch the short video below to learn more about this feature.

Source: Google

via Google Maps Will Now Show Wheelchair Accessible Places – Assistive Technology Blog

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[Abstract] Medical devices for self-help management: the case of stroke rehabilitation – Systematic Review

Abstract

Introduction: Self-help devices (SHD) have been used as an alternative to conventional treatment for post stroke rehabilitation. This review aims to look for evidence that a stroke survivor may have increased muscle strength with the use of SHD.

Methods: This article was conducted according to PRISMA, a statistical tool (state of the art by systematic review) and previously registered in PROSPERO (international prospective registry of systematic reviews) under number CRD42018091424. Studies addressing the use of SHD and its effect on muscle strength in stroke patients were included. The studies were read, selected and their metadata extracted. A Downs & Black scale was used to assess methodological quality.

Results: 41 publications were analyzed, of which only three met the proposed inclusion criteria. Two articles showed positive results in strength gain using SHD. One study presented a decrease in the mean reaching forces when compared to the intervention groups (subacute and chronic with assistance to grip) and controls but SHD assisted in performing the activity.

Conclusion: Studies using SHD suggest muscle strength improvement in stroke patients.

via Medical devices for self-help management: the case of stroke rehabilitation | International Journal of Advanced Engineering Research and Science

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[ARTICLE] Adaptive Treadmill-Assisted Virtual Reality-Based Gait Rehabilitation for Post-Stroke Physical Reconditioning—a Feasibility Study in Low-Resource Settings – Full Text

Abstract

Objectives: Individuals with chronic stroke suffer from heterogeneous functional limitations, including cardiovascular dysfunction and gait disorders (associated with increased energy expenditure) besides psychological factors, e.g., motivation. To recondition their cardiovascular endurance and gait, rehabilitation exercises with gradually increasing exercise intensity suiting their individualized capabilities need to be offered. In principal accordance, here we (i) implemented an adaptive Virtual Reality (VR)-based treadmill-assisted platform sensitive to energy expenditure, (ii) investigated its safety and feasibility of use and (iii) examined the implications of gait exercise with this platform on cardiac and gait performance along with energy expenditure, clinical measures (to estimate physical reconditioning of subjects with stroke) and their views on community ambulation capabilities. Methods: Ten able-bodied subjects volunteered in a study to ensure its safety and feasibility of use. Nine subjects with chronic stroke underwent physical reconditioning over multiple exposures using our platform. We investigated the patients’ cardiac and gait performance prior and post exposure to our platform along with studying the clinical relevance of gait parameters in estimating their physical reconditioning. We collected the patients’ feedback. Results: We found statistical improvement in the gait parameters and reduction in energy expenditure during overground walk following ~1 month of gait exercise with our platform. They reported that the VR-based tasks were motivating. Conclusion: Results show that this platform can pave the way towards implementing home-based individualized exercise platform that can monitor one’s cardiac and gait performance capabilities while offering an adaptive and progressive gait exercise environment within safety thresholds suiting one’s exercise capabilities.
Physiological Cost Index sensitive Adaptive Response Technology (PCI-ART) for post-stroke physical reconditioning. Note: PCI- Physiological Cost Index; SST-Single Support Time; AL- Affected limb; UAL- Unaffected limb.

Physiological Cost Index sensitive Adaptive Response Technology (PCI-ART) for post-stroke physical reconditioning. Note: PCI- Physiological Cost Index; SST-Single Support Time; AL- Affected limb; UAL- Unaffected limb. 

SECTION I.

Introduction

Neurological disorders, such as stroke is a leading cause of disability with a prevalence rate of 424 in 100,000 individuals in India [1]. Often, these patients suffer from functional disabilities, heterogeneous physical deconditioning along with deteriorated cardiac functioning [2], [3] and a sedentary lifestyle immediately following stroke [4]. A deconditioned patient requires reconditioning of his/her cardiac capacity and ambulation capabilities that can be achieved through individualized rehabilitation [5]. This needs to be done under the supervision of a clinician who can monitor one’s functional capability, cardiac capacity and gait performance thereby recommending an appropriate dosage of the gait rehabilitation exercise intensity to the patient along with feedback. Such gait rehabilitation is crucial since about 80% of these patients have been reported to suffer from gait-related disorders [6] along with more energy expenditure than able-bodied individuals [7] often accompanied with reduced cardiac capacity [2], [4]. However, given the low doctor-to-patient ratio [8], lack of rehabilitation facilities and patients being released early from rehabilitation clinics followed by home-based exercise [9], particularly in developing countries like India, availing individualized rehabilitation services becomes difficult. Again, undergoing home-based exercises under clinician’s one-on-one supervision becomes difficult given the restricted healthcare resources, thereby limiting the rehabilitation outcomes [10]. Again, given the restricted healthcare resources, getting a clinician visiting the homes for delivering therapy sessions to patients is often costly causing the patients to miss the expert inputs on the exercise intensity suiting his/her exercise capability along with motivational feedback from the clinician [11]. This necessitates the use of a complementary technology-assisted rehabilitation platform that can be availed by the patient at his/her home [12] following a short stay at the rehabilitation clinic [13]. Again, it is preferred that this platform be capable of offering individualized gait exercise while varying the dosage of exercise intensity (based on the patient’s exercise capability) along with motivational feedback [14]. Additionally, exercise administered by this platform can be complemented with intermediate clinician-mediated assessments of rehabilitation outcomes, thereby reducing continuous demands on the restricted clinical resources. Thus, it is important to investigate the use of such technology-assisted gait exercise platforms that are capable of offering exercise based on one’s individualized capability along with motivational feedback.

Researchers have explored the use of technology-assisted solutions to offer rehabilitative gait exercises to these patients, along with presenting motivational feedback [15]–[16][17][18][19][20][21][22][23][24]. Specifically, investigators have used Virtual Reality (VR) coupled with a treadmill (having a limited footprint and making it suitable for home-based settings) while delivering individualized feedback [15] to the patient during exercise. Again, VR can help to project scenarios that can make the exercise engaging and interactive for a user [16]–[17][18][19]. In fact, Finley et al. have shown that the visual feedback offered by VR provides an optical flow that can induce changes in the gait performance (quantified in terms of gait parameters, e.g., Step Length, Step Symmetry, etc.) of such patients during treadmill-assisted walk [20]. Further, Jaffe et al. have reported positive implications of VR-based treadmill-assisted walking exercise on the gait performance of individuals with stroke [23], leading to improvement in their community ambulation [24]. These studies have shown the efficacy of the VR-based treadmill-assisted gait exercise platform to contribute towards gait rehabilitation of individuals suffering from stroke. Though promising, none of these platforms are sensitive to one’s individualized exercise capability and thus, in turn, could not decide an optimum dosage of exercise intensity suiting one’s capability, e.g., cardiac capacity and ambulation capability. This is particularly critical for individuals with stroke since they possess diminished exercise ability along with deteriorated cardiac functioning [2], [4].

From literature review, we find that after stroke, treadmill-assisted cardiac exercise programs can lead to one’s improved fitness and exercise capability [25]. For example, researchers have presented studies on Moderate-Intensity Continuous Exercise and High-Intensity Interval Training in which exercise protocols are individualized by a clinician based on one’s cardiac capacity while contributing to effective gait rehabilitation [26]–[27][28][29]. Though promising, these have not offered a progressive and adaptive exercise environment in which the dosage of exercise intensity is varied based on one’s cardiac capacity in real-time. Thus, the choice of optimum dosage of exercise intensity that can be individualized in real-time for a patient, still remains as inadequately explored [4]. For deciding the optimal dosage of rehabilitative exercise intensity, clinicians often refer to the guidelines recommended by the American College of Sports Medicine (ACSM) [30]. These guidelines suggest thresholds to decide the intensity of the exercise based on one’s metabolic energy consumption in terms of oxygen intake, heart rate, etc. Deciding the dosage of exercise intensity is crucial, particularly for individuals with stroke since their energy requirements have been reported to be 55-100% higher than that of their able-bodied counterparts [7]. Specifically, higher energy requirement often limits the capabilities of these patients and challenges their rehabilitation outcomes. This can be addressed if the technology-assisted gait exercise platform can offer individualized exercise (maintaining the safe exercise thresholds) based on the energy expenditure of the patients acquired in real-time during the exercise.

The energy expenditure can be defined as the cost of physical activity [4] and it is often expressed in terms of oxygen consumption or heart rate [31]. Thus, investigators have monitored the oxygen consumption and heart rate to estimate the energy expenditure of individuals with stroke during their walk [31], [32]. However, monitoring oxygen consumption during exercise requires a cumbersome setup [31], making it unsuitable for home-based rehabilitation. On the other hand, one’s heart rate (HR) can be monitored using portable solutions [33] that can be integrated with a treadmill in home-based settings. Researchers have explored treadmill-assisted gait exercise platforms that are sensitive to the user’s heart rate. For example, researchers have offered treadmill training to subjects with stroke in which some of them varied treadmill speed to achieve 45%-50% [34], while others varied speed to achieve 85% to 95% [35], [36] of one’s age-related maximum heart rate. Again, Pohl et al. have offered treadmill-assisted exercise to subjects with stroke while ensuring that the user’s heart rate settled to the respective resting-state heart rate [37]. Again of late, there had been advanced treadmills, available off-the-shelf, that can monitor one’s heart rate and vary the treadmill speed to maintain the user’s heart rate at a predefined level [38], [39]. Though one’s heart rate is an important indicator that needs to be considered during treadmill-assisted exercise, one’s walking speed while using the treadmill also offers important information on one’s exercise capability. This is because gait rehabilitation aims to improve one’s community ambulation that is related to one’s walking speed [40]. Thus, it would be interesting to explore the composite effect of one’s walking speed along with working and resting-state heart rates during treadmill-assisted gait exercise to study one’s energy expenditure, quantified in terms of a proxy index, namely Physiological Cost Index (PCI) [31].

Given that there are no existing studies that have used a treadmill-assisted gait exercise platform deciding the dosage of exercise intensity based on one’s PCI estimated in real-time during exercise, it might be interesting to explore the use of such an individualized gait exercise platform for individuals with stroke. Thus, we wanted to extend a treadmill-assisted gait exercise platform by making it adaptive to one’s individualized PCI. Additionally, we wanted to augment this platform with VR-based user interface to offer visual feedback to the user undergoing gait exercise. We hypothesized that such a gait exercise platform can recondition a patient’s exercise capability in terms of cardiac and gait performance to achieve improved community ambulation. The objectives of our research were three-fold, namely to (i) implement a novel PCI-sensitive Adaptive Response Technology (PCI-ART) offering VR-based treadmill-assisted gait exercise, (ii) investigate the safety and feasibility of use of this platform among able-bodied individuals before applying it to subjects with stroke and (iii) examine implications of undergoing gait exercise with this platform on the patients’ (a) cardiac and gait performance along with energy expenditure, (b) clinical measures estimating the physical reconditioning and (c) views on their community ambulation capabilities.

The rest of the paper is organized as follows: Section II presents our system design. Section III explains the experiments and procedures of this study. Section IV discusses the results. In Section V, we summarize our findings, limitations, and scope of future research.[…]

Continue —-> Adaptive Treadmill-Assisted Virtual Reality-Based Gait Rehabilitation for Post-Stroke Physical Reconditioning—a Feasibility Study in Low-Resource Settings – IEEE Journals & Magazine

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[WEB PAGE] All in the Wrist: Wearables Help Treat Disease, Disability

Suffering a stroke can change how your body works in odd ways. Maybe you suddenly can’t lift your leg the way you did a few weeks before, or your arm doesn’t seem to extend properly. It’s different for every case.

Recovering from these disabilities can be an arduous process. A patient must not only struggle with his or her impairments, but also the conviction to overcome them. At the hospital, therapists coach rehabbing patients through intense exercise schedules, but after being sent home, patients won’t be monitored as closely and often stop using disabled limbs, favoring healthier body parts instead. This often results in more lost functionality.

Doctors have long been perplexed about how to effectively help patients who aren’t in the exam room or rehab clinic. Researchers and programmers are now developing a new generation of wearables that can monitor, encourage, and even treat people suffering from chronic neurological disorders like stroke, cerebral palsy, and epilepsy, as well as the essential tremors that come with Parkinson’s Disease.

Practice makes perfect

Around 2015, Belén Rubio Ballester, a researcher at Spain’s IBEC Institute for Bioengineering of Catalonia (IBEC), fixated on a specific challenge faced by patients recovering from stroke: Use it or lose it.

“You practice, you learn — if you quit practicing, you lose your skills,” says Ballester. “We see this everywhere, whether you’re playing an instrument or in sports. Stroke patients may similarly lose some motor function.”

It’s common for rehab patients to favor their stronger muscles, usually to the detriment of debilitated fingers, hands, and legs. To remedy this, Ballester launched a pilot experiment to see if a watch-like wearable connected to a smartphone could influence patient behavior. Subjects were fitted with a bracelet-like prototype that buzzed once an hour to remind stroke sufferers to use their arms, and an app installed on a paired phone checked for movement that confirmed the patient actually followed the advice. It was a small study, monitoring just four trainees over five days, but the results were consistent: The techno nudge helped.

rehab session
BSIP / Getty

In March, the same team launched a follow-up study that promises to be one of the largest experiments of its kind, training and tracking 100 recovering stroke patients with a combination of smartphones and Android Wear watches.

Similar to the original homegrown bracelets, the Android watches will buzz once an hour to remind patients not to forget they need to exercise their impaired limbs. Study participants will also be able to see their usage quantified on paired smartphones. The Android Wear gyroscope makes it easier for the researchers to track the type of movements. Each patient will be asked to regularly draw circles to check the fluidity of the gesture.

Employing Android Wear is more of a practical choice than tech preference. Android watches tend to be cheaper than Apple ones or other comparable gear, and since the researchers aren’t providing phones, they’re banking on patients owning compatible gear.

Ballester projects initial data for the study will be available by December 2020. The IBEC team also plans to track the patients after they’ve stopped wearing the watches to check if the habits developed by the recurring buzzes will stick. The full results should be completed by the middle of 2021.

Wearables to monitor neurological disorders

On the other side of the Atlantic, Rutgers University professor Jean-Francois Daneault is using wearables, phones, and robotics to monitor and treat patients with a range of neurological disorders, including stroke, cerebral palsy and essential tremor. In 2019, he won a $400,000 grant from the National Institutes of Health to develop a platform that will track patients over long periods to help diagnose those impairments.

“A lot of those ailments have overlapping symptoms,” said Daneault. “Doctors who aren’t specialists can have a hard time identifying the differences between the diseases.” A well-attuned wearable, in combination with a smartphone app, can capture those often imperceptible symptoms that give a doctor the necessary stats to make an informed diagnosis.

The platform will also potentially be used to measure how symptoms may change over months and years. “People may only see their neurologists or doctors once or twice a year, for a limited amount of time, so it can be difficult to know how they’re doing,” says Daneault. A well-done app can tell a doctor if a medication is working or if the treatment needs to be adjusted.

AliveCor

“There are very few specialists, and they’re always booked,” he says, underscoring the need for more monitoring of patient ailments.

Though Denault is attempting to build a platform that can work with Android Wear, Apple watches, and Fitbits, the wrist-worn tech can measure more than just arm and hand actions. Gait can also be tracked with a wearable or a smartphone placed in a pocket.

One of the big challenges of making a platform that works with multiple wearables is understanding the slight differences between the gyroscopes and accelerometers embedded into each. Daneault realizes the practical challenges such a platform must overcome: The app will need to pick through a wealth of data and parse out the most relevant information, and also find ways to integrate what is learned into numerous digital health systems.

Researchers are developing parallel tech and functionality at numerous schools, hospitals, and institutions. Doctors at the Cleveland Clinic are using iPads to measure the balance of multiple sclerosis (MS) patients. An A.I. expert at the Massachusetts Institute of Technology developed a smartwatch that can look for the signs of epilepsy seizures and predict their onset before they occur. There’s even a Google X project that uses Fitbits to help track the progression of MS symptoms.

Not all of these projects are ready for prime time, but the U.S. Food and Drug Administration (FDA) has already approved a few wearables that can monitor and treat neurological issues, and they are now commercially available. The Embrace wearable, for example, is a bracelet that monitors wearers for stress and potential seizures. A device called Trio, on the other hand, delivers peripheral nerve stimulation to ameliorate the symptoms of essential tremor. A clinical study of the device showed that using it decreases the amount of hand shaking, often caused by Parkinson’s disease, within three months.

Such products are just the early signs of how the treatment of neurological disorders is about to radically change.

“The future of motor rehab is not at the hospital,” says IBEC researcher Ballester. “You want patients to go home as soon as they feel safe and want to, and things are prepared at home. But you don’t want to lose track of them. You want rehab embedded in life. If it isn’t, it won’t be maintained … That’s why I see rehab in the life of the patient. Not at the hospital.”

Editors’ Recommendations

via All in the Wrist: Wearables Help Treat Disease, Disability | Digital Trends

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[BLOG POST] Global Accessibility Awareness Day – Building an Inclusive Digital World | Collection Spotlight from the National Rehabilitation Information Center

Global Accessibility Awareness Day – Building an Inclusive Digital World

 

May 21st is the ninth annual Global Accessibility Awareness Day, a day to get everyone talking, thinking, and learning about digital access, inclusion, and people with disabilities. More than 1 billion people are living with disabilities worldwide and digital inclusion is more important than ever. In addition, due to the current pandemic, much of our learning, working, socializing, and even healthcare are happening online. Even before the pandemic, access to government programs and financial services like banking had transitioned to online in many communities. If these websites, platforms, and portals are inaccessible, it means that 1 billion students, clients, patients, or customers will be left out.

Building an inclusive digital world starts with understanding how people with disabilities use information and communication technologies, from email to the Internet of Things, how these technologies support their independence and community participation, and what barriers or challenges they encounter in using technology every day. Several NIDILRR-funded Rehabilitation Engineering Research Centers (RERCs) are focusing on these very issues:

RERC on Universal Interface and Information Technology Access.

This RERC addresses access to inclusive information and communication technologies (ICT) for people with disabilities. ICTs are an integral part of life, impacting education, employment, health, transportation, and social communication; however, as ICTs continue to evolve (e.g., digital technologies) access for individuals with disabilities may become prohibitive. Among their current projects are:
EZ Access – a simple set of interface enhancements (tactile and software) which can be applied in the design of electronic products and devices such as touchscreen kiosks so that they can be used by more people including those with disabilities.
Morphic – an extension to the operating system that makes computers easier to use, particularly for those who have trouble using the computer. This includes people who need to adjust the computer (font size, contrast, etc.), those who have trouble finding and using features in the computer, those who find the computer too complex or confusing, and those who need special software of any kind.

RERC on Wireless Inclusive Technologies

The mission of the Wireless RERC is to integrate established wireless technologies with emerging wirelessly connected devices and services for a transformative future where individuals with disabilities achieve independence, improved quality of life, and enhanced community participation. Project goals include: (1) creating and promoting inclusive wireless technologies that improve the ability of individuals with disabilities to independently perform activities of their choice now, and in a fully-engaged and all-inclusive future; and (2) working with industry, government, and disability stakeholders to raise awareness and champion adoption of accessible solutions for wirelessly connected technologies. Visit the Wireless RERC to learn about:
Annual survey of user needs. How people with disabilities use wireless technologies, what they use it for, and the benefits and challenges.
Wireless connected devices including wearables and auditory assistive device development.

RERC on Information and Communication Technology (ICT) Access for Community Living, Health, and Function

This center promotes ICT access to existing and emerging technologies for all people regardless of ability and develops and validates ICT applications to improve the capacity for independent living and community participation. Among its activities, this center supports software and hardware developers in developing and releasing their proposals for assistive devices and accessibility apps as well as apps that support the health and function of people with disabilities.
Learn more about the App Factory and the host of apps and tech in production or soon to be available.

RERC: Develop and Evaluate Rehabilitation Technology and Methods for Individuals with Low Vision, Blindness, and Multiple Disabilities

The goal of this center is to impact numerous current barriers to opportunity faced by individuals who are blind, have low vision, and have multiple disabilities. Among its projects, the Center develops new tools for accessing graphics such as a tactile graphics helper and sonification cues for computer screen readers, new tools for accessing devices and appliances with digital displays, and tools and techniques to access careers and interests in science, technology, engineering, and mathematics (STEM) by consumers who are blind.
Check out this center’s Accessible Pandemic Data Bulletin which uses sonified data displays and the t-Scratch Tangible Programming Environment targeted for students who are blind or visually impaired.

RERC on Technologies to Support Aging-in-Place for People with Long-Term Disabilities (TechSAge RERC II)

This center aims to advance knowledge and accelerate the development, modification, and testing of technology-based interventions and strategies for use in the home and community to promote aging-in-place and reduce secondary conditions among people with long-term disabilities. Learn how digital assistantssmart bathroomstelewellness, and other technologies can help people maintain their independence, stay engaged in their communities, and stay safe at home.

These are just a few projects working to build an inclusive digital world. Learn more about the research and development projects funded each year by NIDILRR by searching the Program Database and reading summaries of recent studies in our Research In Focus series. You can also explore peer reviewed literature, original research reports, and more in our REHABDATA index of disability and rehabilitation research. Contact our information specialists if we can help you explore this topic!

via Global Accessibility Awareness Day – Building an Inclusive Digital World | Collection Spotlight from the National Rehabilitation Information Center

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[Abstract] Evaluating the effects of tDCS in stroke patients using functional outcomes: a systematic review

Background and purpose: Transcranial direct current stimulation (tDCS) has been extensively studied over the past 20 years to promote functional motor recovery after stroke. However, tDCS clinical relevance still needs to be determined. The present systematic review aims to determine whether tDCS applied to the primary motor cortex (M1) in stroke patients can have a positive effect on functional motor outcomes.

Materials and methods: Two databases (Medline & Scopus) were searched for randomized, double-blinded, sham-controlled trials pertaining to the use of M1 tDCS on cerebral stroke patients, and its effects on validated functional motor outcomes. When data were provided, effect sizes were calculated. PROSPERO registration number: CRD42018108157

Results: 46 studies (n = 1291 patients) met inclusion criteria. Overall study quality was good (7.69/10 on the PEDro scale). Over half (56.5%) the studies were on chronic stroke patients. There seemed to be a certain pattern of recurring parameters, but tDCS protocols still remain heterogeneous. Overall results were positive (71.7% of studies found that tDCS has positive results on functional motor outcomes). Effect-sizes ranged from 0 to 1.33. No severe adverse events were reported.

Conclusion: Despite heterogeneous stimulation parameters, outcomes and patient demographics, tDCS seems to be complementary to classical and novel rehabilitation approaches. With minimal adverse effects (if screening parameters are respected), none of which were serious, and a high potential to improve recovery when using optimal parameters (i.e.: 20 min of stimulation, at 2 mA with 25 or 35cm2 electrodes that are regularly humidified), tDCS could potentially be ready for clinical applications.

  • Implications for Rehabilitation
  • tDCS could potentially be ready for clinical application.

  • Evidence of very low to very high quality is available on the effectiveness of tDCS to improve motor control following stroke.

  • This should with caution be focused on the primary motor cortex.

via Evaluating the effects of tDCS in stroke patients using functional outcomes: a systematic review: Disability and Rehabilitation: Vol 0, No 0

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