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[WEB SITE] New Anatomy VR App Lets You Look Inside Your Own Body

IN BRIEF

Curiscope, a startup, aims to blend VR and AR. Their Virtuali-Tee allows users to take a peek inside their own chest cavities.

TAKE A LOOK AT YOURSELF

Most people feel confident that they know a fair amount about their own body, in terms of general health and what they look like from the outside. However, most of us haven’t taken a look inside—literally speaking. Ed Barton and his UK-based startup Curiscope is hoping to change that with a unique blend of virtual reality (VR) and augmented reality (AR). Using an anatomy VR app and the company’s Virtuali-Tee, a t-shirt, they are allowing people to see inside of their own chest cavities.

Barton explained to Wired: “We use a mix of VR and AR to see inside the anatomy…With positionally tracked AR, you can position VR experiences physically within your environment.”

Barton and Curiscope co-founder Ben Kidd have so far raised almost $1 million in seed funding from LocalGlobe, and they’ve already sold almost 3,000 of the Virtuali-Tees.

HIGH TECH T-SHIRT

Barton told Wired that, using positional tracking, “we have a blurring of physical and digital items, and an experience more tightly connected to reality.” He continued, “With the Virtuali-Tee, AR is your interface and VR is used to transport you somewhere else. The technologies should be merging.”

This technology works using a highly-stylized QR code printed onto the front of the t-shirt. When you scan the code with the corresponding app, you can explore throughout the chest cavity, including the heart and lungs.

AR technology hit the mainstream with the release of Pokémon Go, but its applications have shown that it can reach far beyond games. From smartphone usage to vehicle blueprint design, AR is quickly developing. The combination of both AR and VR could not only make the Virtuali-Tee device fully immersive, but also lead to a whole host of other technologies that combine AR and VR.

This t-shirt, specifically, could be a fantastic tool for the curious. It can be used for educational purposes, allowing anatomy and biology to be a fun experience that students can really wrap their minds around. Even outside of a formal educational setting, this device could allow us to better connect with our own biology. Virtuali-Tee could help people to better understand their own inner workings, and how the things we do every day—from what we eat to how we exercise—might affect our health.

Source: New Anatomy VR App Lets You Look Inside Your Own Body

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[WEB SITE] The Relationship Between Epilepsy and Sleep

The Thomas Haydn Trust in an aid to understanding Epilepsy and Sleep has published this mobile article. This article is not extensive and should not be used as medical advice; it’s intended for information purposes only. This dictionary is also available for download from http://www.thomashaydntrust.com/publications.htm in .pdf format. [Please note that this is version 1 and further updates may be availalbe]

Written by

M C Walker, S M Sisodiya

Institute of Neurology, University College London, National Hospital for Neurology and Neurosurgery, Queen Square, London, and National Society for Epilepsy, Chalfont St Peter, Bucks. London, and National Society for Epilepsy, Chalfont St Peter, Bucks. September 2005. This article can be reproduced for educational purposes.

Introduction

Epilepsy has a complex association with sleep. Certain seizures are more common during sleep, and may show prominent diurnal variation. Rarely, nocturnal seizures are the only manifestation of an epileptic disorder and these can be confused with a parasomnia. Conversely, certain sleep disorders are not uncommonly misdiagnosed as epilepsy. Lastly, sleep disorders can exacerbate epilepsy and epilepsy can exacerbate certain sleep disorders. This chapter is thus divided into four sections: normal sleep physiology and the relationship to seizures; the interaction of sleep disorders and epilepsy; and the importance of sleep disorders in diagnosis.

Normal sleep physiology and the relationship to seizures

Adults require on average 7 – 8 hours sleep a night. This sleep is divided into two distinct states – rapid eye movement (REM) sleep and non-REM sleep. These two sleep states cycle over approximately 90 minutes throughout the night with the REM periods becoming progressively longer as sleep continues. Thus there is a greater proportion of REM sleep late on in the sleep cycles. REM sleep accounts for about a quarter of sleep time. During REM sleep, dreams occur; hypotonia or atonia of major muscles prevents dream enactment. REM sleep is also associated with irregular breathing and increased variability in blood pressure and heart rate. Non-REM sleep is divided into four stages (stages I – IV) defined by specific EEG criteria. Stages I/II represent light sleep, while stages III/IV represent deep, slow-wave sleep.

Gowers noted that in some patients, epileptic seizures occurred mainly in sleep. Sleep influences cortical excitability and neuronal synchrony. Surveys have suggested that 10 – 45% of patients have seizures that occur predominantly or exclusively during sleep or occur with sleep deprivation. EEG activation in epilepsy commonly occurs during sleep, so that sleep recordings are much more likely to demonstrate epileptiform abnormalities. These are usually most frequent during non-REM sleep and often have a propensity to spread so that the epileptiform discharges are frequently observed over a wider field than is seen during the wake state. Sleep deprivation (especially in generalised epilepsies) can also ‘activate’ the EEG, but can induce seizures in some patients. Thus many units perform sleep EEGs with only moderate sleep deprivation (late night, early morning), avoidance of stimulants (e.g. caffeine-containing drinks) and EEG recording in the afternoon. Sleep-induced EEGs in which the patient is given a mild sedative (e.g. chloral hydrate) are also useful.

Sleep and generalised seizures

Thalamocortical rhythms are activated during non-REM sleep giving rise to sleep spindles. Since similar circuits are involved in the generation of spike-wave discharges in primary generalised epilepsy, it is perhaps not surprising that non-REM sleep often promotes spike-wave discharges. Epileptiform discharges and seizures in primary generalised epilepsies are both commonly promoted by sleep deprivation. Furthermore, primary generalised seizures often occur within a couple of hours of waking, whether from overnight sleep or daytime naps. This is most notable with juvenile myoclonic epilepsy in which both myoclonus and tonic-clonic seizures occur shortly after waking, and the

Διαφήμιση

syndrome of tonic-clonic seizures on awakening described by Janz. Seizure onset in this syndrome is from 6 – 35 years and the prognosis for eventual remission is good.

Certain epileptic encephalopathies show marked diurnal variation in seizure manifestation and electrographic activity. An example is the generalised repetitive fast discharge during slow-wave sleep occurring in Lennox-Gastaut syndrome. Another example is electrical status epilepticus during sleep (ESES). This is characterised by spike and wave discharges in 85 – 100% of non-REM sleep. This phenomenon is associated with certain epilepsy syndromes, including Landau-Kleffner, Lennox-Gastaut syndrome, continuous spikes and waves during sleep and benign epilepsy of childhood with rolandic spikes. ESES can thus be a component of a number of different epilepsy syndromes with agedependent onset, many seizure types, and varying degrees of neuropsychological deterioration. Indeed, ESES has been described in the setting of an autistic syndrome alone with no other

manifestation of epilepsy.

Sleep and partial epilepsies

Inter-ictal epileptiform abnormalities on the EEG occur more frequently during sleep, especially stage III/IV sleep (slow-wave sleep). The discharges have a greater propensity to spread during sleep, and thus are often seen over a wider field than discharges occurring during wakefulness. Temporal lobe seizures are relatively uncommon during sleep, while frontal lobe seizures occur often predominantly (sometimes exclusively) during sleep. Nocturnal frontal lobe seizures can be manifest as: brief stereotypical, abrupt arousals; complex stereotypical, nocturnal movements; or episodic nocturnal wanderings with confusion. Inherited frontal lobe epilepsies can manifest with only nocturnal events that can be confused with parasomnias (see below). Autosomal dominant nocturnal frontal lobe epilepsy is such an epilepsy. This has been associated with mutations in alpha-4 and beta-2 subunits of the neuronal nicotinic acetylcholine receptor. Onset is usually in adolescence with seizures occurring frequently, sometimes every night. The seizures are provoked by stress, sleep deprivation and menstruation, and often respond well to carbamazepine.

The interaction of sleep disorders and epilepsy

Seizures can disrupt sleep architecture. Complex partial seizures at night disrupt normal sleep patterns, decrease REM sleep and increase daytime drowsiness. Daytime complex partial seizures can also decrease subsequent REM sleep, which may contribute to impaired function. Antiepileptic drugs (AEDs) can also disrupt normal sleep patterns, although there are conflicting data (this is partially due to drugs having different short-term and long-term effects). Carbamazepine, for example, given acutely reduces and fragments REM sleep, but these effects are reversed after a month of treatment. The GABAergic drugs can have a profound effect on sleep; phenobarbitone and benzodiazepines prolong non-REM sleep and shorten REM sleep, while tiagabine increases slow-wave sleep and sleep efficiency. Gabapentin and lamotrigine may both increase REM sleep.

Certain sleep disorders are more common in patients with epilepsy. This is particularly so with obstructive sleep apnoea which is more common in patients with epilepsy and can also exacerbate seizures. Indeed, sleep apnoea is approximately twice as common in those with refractory epilepsy than in the general population. The reasons why this is so are unknown, but may relate to increased body weight, use of AEDs, underlying seizure aetiology or the epilepsy syndrome itself.

Patients with obstructive sleep apnoea often find that seizure control improves with treatment of the sleep apnoea. Topiramate may also be a particularly useful drug in these cases.

The importance of sleep disorders in differential diagnosis

On occasions nocturnal seizures can be misdiagnosed as a primary sleep disorder (see above). Conversely, certain sleep disorders can be misdiagnosed as epilepsy and the more common of these will be discussed below. Sleep disorders tend to occur during specific sleep phases and thus usually occur at specific times during the night, while seizures usually occur at any time during the night. There may also be other clues in the history, including age of onset, association with other symptoms (see below) and the stereotypy of the episodes (seizures are usually stereotypical).

In cases where there is some uncertainty, video-EEG polysomnography is the investigation of choice. There are, however, instances in which the diagnosis can be difficult even after overnight video-EEG telemetry as frontal lobe seizures can be brief with any EEG change obscured by movement artefact, and it is often the stereotypy of the episodes that confirms the diagnosis.

Abnormalities of sleep are divided into three main categories: 1) dysomnias or disorders of the sleepwake cycle; 2) parasomnias or disordered behaviour that intrudes into sleep, and 3) sleep disorders associated with medical or psychiatric conditions. Although there is an extensive list of conditions within each of these categories, we will confine ourselves to the clinical features of the more common conditions that can be confused with epilepsy.

Narcolepsy

Narcolepsy is a specific, well-defined disorder with a prevalence of approximately one in 2000. It is a life-long condition usually presenting in late teens or early 20s. Narcolepsy is a disorder of REM sleep and has as its main symptom excessive daytime sleepiness. This is manifest as uncontrollable urges to sleep, not only at times of relaxation (e.g. reading a book, watching television), but also at inappropriate times (e.g. eating a meal or while talking). The sleep is itself usually refreshing. The other typical symptoms are cataplexy, sleep paralysis and hypnagogic/hypnopompic hallucinations. These represent REM sleep phenomena such as hypotonia/atonia, and dreams occurring at inappropriate times. Cataplexy is a sudden decrease in voluntary muscle tone (especially jaw, neck and limbs) that occurs with sudden emotion like laughter, elation, surprise or anger. This can manifest as jaw dropping, head nods or a feeling of weakness or, in more extreme cases, as falls with ‘paralysis’ lasting sometimes minutes. Consciousness is preserved. Cataplexy is a specific symptom of narcolepsy, although narcolepsy can occur without cataplexy. Sleep paralysis and hypnagogic hallucinations are not particularly specific and can occur in other sleep disorders and with sleep deprivation (especially in the young). Both these phenomena occur shortly after going to sleep or on waking.

Sleep paralysis is a feeling of being awake, but unable to move. This can last minutes and is often very frightening, so can be associated with a feeling of panic. Hypnagogic/hypnopompic hallucinations are visual or auditory hallucinations occurring while dozing/falling asleep or on waking; often the hallucinations are frightening, especially if associated with sleep paralysis.

Narcolepsy is associated with HLA type. Approximately 90% of all narcoleptic patients with definite cataplexy have the HLA allele HLA DQB1*0602 (often in combination with HLA DR2), compared with approximately 25% of the general population. The sensitivity of this test is decreased to 70% if cataplexy is not present. The strong association with HLA type has raised the possibility that narcolepsy is an autoimmune disorder. Recently loss of hypocretin-containing neurons in the hypothalamus has been associated with narcolepsy, and it is likely that narcolepsy is due to deficiency in hypocretin (orexin).

Since narcolepsy is a life-long condition with possibly addictive treatment, the diagnosis should always be confirmed with multiple sleep latency tests (MSLT). During this test five episodes of sleep are permitted during a day; rapid onset of sleep and REM sleep within 15 minutes in the absence of sleep deprivation are indicative of narcolepsy.

The excessive sleepiness of narcolepsy can be treated with modafinil, methylphenidate or dexamphetamine and regulated daytime naps. The cataplexy, sleep paralysis and hypnagogic/hypnopompic hallucinations respond to antidepressants (fluoxetine or clomipramine are the most frequently prescribed). People with narcolepsy often have fragmented, poor sleep at night, and good sleep hygiene can be helpful.

Sleep apnoea

Sleep apnoea can be divided into the relatively common obstructive sleep apnoea and the rarer central sleep apnoea. Obstructive sleep apnoea is more common in men than women and is associated with obesity, micrognathia and large neck size. The prevalence may be as high as 4% in men, and 2% in women. The symptoms suggestive of obstructive sleep apnoea are loud snoring, observed nocturnal apnoeic spells, waking at night fighting for breath or with a feeling of choking, morning headache, daytime somnolence, personality change and decreased libido. Although the daytime somnolence can be as severe as narcolepsy, the naps are not usually refreshing and are longer. Obstructive sleep apnoea and central sleep apnoea can be associated with neurological disease, but central sleep apnoea can also occur as an idiopathic syndrome. The correct diagnosis requires polysomnography with measures of oxygen saturations and nasal airflow or chest movements. To be pathological a sleep apnoea or hypopnoea (a 50% reduction in airflow) has to last ten seconds and there need to be more than five apnoeas/hypopnoeas per hour (the precise number to make a diagnosis varies from sleep laboratory to sleep laboratory).

Uncontrolled sleep apnoea can lead to hypertension, cardiac failure, pulmonary hypertension and stroke. In addition, sleep apnoea has been reported to worsen other sleep conditions, such as narcolepsy, and to worsen seizure control.

Treatment of sleep apnoea should include avoidance of alcohol and sedatives and weight reduction. Pharmacological treatment is not particularly effective, although REM suppressants such as protriptyline can be helpful. The mainstays of treatment are surgical and include tonsillectomies, adenoidectomy and procedures to widen the airway, and the use of mechanical devices. Dental appliances to pull the bottom jaw forward can be effective in mild cases, but continuous positive airway pressure administered by a nasal mask has become largely the treatment of choice for moderate/severe obstructive sleep apnoea. In cases associated with neuromuscular weakness intermittent positive pressure ventilation is often necessary.

Restless legs syndrome/periodic limb movements in sleep

Restless legs syndrome (RLS) and periodic limb movements in sleep (PLMS) can occur in association or separately. Most people with RLS also have PLMS, but the converse is not true and most people with PLMS do not have RLS. RLS is characterised by an unpleasant sensation in the legs, often described as tingling, cramping or crawling, and an associated overwhelming urge to move the legs. These sensations are usually worse in the evening, and movement only provides temporary relief. RLS affects about 5% of the population. Periodic limb movements in sleep are brief, repetitive jerking of usually the legs that occur every 20 – 40 seconds. These occur in non-REM sleep and can cause frequent arousals. PLMS occurs in about 50% of people over 65 years. These conditions can also be associated with daytime jerks. Both RLS and PLMS can be familial, but can be secondary to peripheral neuropathy (especially diabetic, uraemic and alcoholic neuropathies), iron deficiency, pregnancy and rarely spinal cord lesions.

Symptomatic relief can be achieved with benzodiazepines, gabapentin and opioids, but L-DOPA and dopamine agonists are the mainstay of treatment.

Sleep-wake transition disorders

The most common of these are hypnic jerks or myoclonic jerks that occur on going to sleep or on waking. They are entirely benign in nature, and require no treatment. They can occur in association with other sleep disorders. Rhythmic movement disorder is a collection of conditions occurring in infancy and childhood characterised by repetitive movements occurring immediately prior to sleep onset that can continue into light sleep. One of the most dramatic is headbanging or jactatio capitis nocturna. Persistence of these rhythmic movements beyond the age of ten years is often associated with learning difficulties, autism or emotional disturbance. Sleep-talking can occur during non-REM and REM sleep, but is often seen with wake-sleep transition and is a common and entirely benign phenomenon.

Nocturnal enuresis

Nocturnal enuresis is a common disorder that can occur throughout the night. Although diagnosis is straightforward, it can recur in childhood, and also occurs in the elderly, with approximately 3% of women and 1% of men over the age of 65 years having the disorder. Thus, on occasions, it can be misdiagnosed as nocturnal epilepsy.

Non-REM parasomnias

Non-REM parasomnias usually occur in slow-wave (stage III/IV) sleep. These conditions are often termed arousal disorders and indeed can be induced by forced arousal from slow-wave sleep. There are three main non-REM parasomnias – sleepwalking, night terrors and confusional arousal. These disorders often have a familial basis, but can be brought on by sleep deprivation, alcohol and some drugs. They can also be triggered by other sleep disorders such as sleep apnoea, medical and psychiatric illness. Patients are invariably confused during the event, and are also amnesic for the event. These conditions are most common in children, but do occur in adults.

Sleepwalking may occur in up to 25% of children, with the peak incidence occurring from age 11 – 12 years. The condition is characterised by wanderings often with associated complex behaviours such as carrying objects, and eating. Although speech does occur, communication is usually impossible. The episode usually lasts a matter of minutes. Aggressive and injurious behaviour is uncommon, and should it occur then polysomnography may be indicated to exclude an REM sleep parasomnia (see below), and to confirm the diagnosis. Night terrors are less common and are characterised by screaming, and prominent sympathetic nervous system activity – tachycardia, mydriasis and excessive sweating. Both these conditions are usually benign and rarely need treatment. If dangerous behaviour occurs, then treatment may be indicated. Benzodiazepines, especially clonazepam, are usually very effective.

REM parasomnias

Nightmares are REM phenomena that can occur following sleep deprivation, with certain drugs (e.g. L-DOPA) and in association with psychological and neurological disease. Sleep paralysis (see narcolepsy) is also an REM parasomnia, and may be familial.

Of more concern are REM sleep behaviour disorders. These consist of dream enactment. They are often violent, and tend to occur later in sleep when there is more REM sleep. These are rare and tend to occur in the elderly. In over one-third of cases, REM sleep behaviour disorders are symptomatic of an underlying neurological disease such as dementia, multisystem atrophy, Parkinson’s disease, brainstem tumours, multiple sclerosis, subarachnoid haemorrhage and cerebrovascular disease. In view of this, a history of possible REM sleep behaviour disorder needs to be investigated by polysomnography, and if confirmed, then possible aetiologies need to be investigated. REM sleep behaviour disorders respond very well to clonazepam.

Further reading

• BAZIL CW (2002) Sleep and epilepsy. Semin Neurol 22(3) , 321-327.

• FOLDVARY-SCHAEFER NJ (2002) Sleep complaints and epilepsy: the role of seizures,

antiepileptic drugs and sleep disorders. Clin Neurophysiol 19(6) , 514-521.

• MALOW BA (2002) Paroxysmal events in sleep. J Clin Neurophysiol 19(6) , 522-534.

• SCHNEERSON J. Handbook of Sleep Medicine . Blackwell Science, Oxford.

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Source: The Relationship Between Epilepsy and Sleep – Wattpad

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[BLOG POST] Gist reasoning – The most invisible loss of mild TBI

Broken Brain - Brilliant Mind

catching-up-6I am thinking a lot about losses, these days. Loss of friends, loss of doctors, loss of family, loss of jobs, loss of money, loss of hope.

I’ve been actively working on my brain injury recovery since 2007 — nearly 10 years. I got hurt at the end of 2004, so it’s been over 11 years since my last TBI. And my expectations and hopes have varied, during that time.

I always expected to be able to build back my abilities to at least some extent. I expected to be able to be able to retrain my brain to build back my memory, to address my distractability, to handle my fatigue, and basically all-round get myself back to where I wanted to be.

But that hasn’t happened. The one area where I have significantly improved, is in my gist reasoning, which is really the biggest “functional” deficit I had. Not…

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[WEB SITE] SMARTmove – FES

Summary

SMARTmove is a £1.1 million Medical Research Council research project running for 30 months from September 2016 to February 2019, funded under the Development Pathway Funding Scheme (DPFS). The project brings together a multidisciplinary team with expertise in functional materials, direct printing fabrication, control algorithms, wireless electronics, sensors, and end user engagement to address stroke rehabilitation. Working together with the advisory board members from six institutions, we will deliver a personalised wearable device for home-based stroke upper limb rehabilitation.

     

The Need

Stroke is one of the largest causes of disability: 17 million strokes occur every year worldwide, meaning one stroke every two seconds. Half of stroke survivors lose the ability to perform everyday tasks with their upper limb, which affects their independence. The cost to society in the UK is nine billion pounds per year due to health and social care, informal care, productivity loss and benefit payments. As stroke is an age-related disease, these numbers are set to increase as the population ages.

Novelty

Current commercial devices using functional electrical stimulation (FES) have large electrodes that only stimulate a limited number of muscles, resulting in simple, imprecise movements and the rapid onset of fatigue. In addition, current commercial devices do not employ feedback control to account for the movement of patients, only reducing the level of precision in the resulting movements. In addition, devices are either bulky and expensive, or difficult to set-up due to trailing wires.

Our project uses bespoke screen printable pastes to print electrode arrays directly onto everyday fabrics, such as those used in clothing. The resulting garments will have cutting-edge sensor technologies integrated into them. Advanced control algorithms will then adjust the stimulation based on the patients’ limb motion to enable precise functional movements, such as eating, washing or dressing.

Impact

This project will deliver a fabric-based wearable FES for home based stroke rehabilitation. The beneficiaries include:

  1. Persons with stroke (PwS) and other neurological conditions. Stroke survivors are the direct beneficiaries of our research. The FES clothing can be adapted to also treat hand/arm disabilities resulting from other neurological conditions such as cerebral palsy, head injury, spinal cord injury, and multiple sclerosis. The use of the wearable training system increases the intensity of rehabilitation without an increase in clinical contact time. This leads to better outcomes such as reduced impairment, greater restoration of function, improved quality of life and increased social activity.
  2. The NHS. FES-integrated clothing is comfortable to wear and convenient to use for rehabilitation, enabling impaired people to benefit from FES at home. It will transfer hospital based professional care to home based self-care, and therefore will reduce NHS costs by saving healthcare professionals’ time and other hospital resources.
  3. Industry. Benefits include: bringing business to the whole supply chain; increasing the FES market demand by improving performance; benefiting other industry sectors such as rehabilitation for other neurological conditions.
  4. Research communities in related fields. Specifically, the fields of novel fabrication, control systems, design of medical devices, rehabilitation, smart fabrics, and remote healthcare will benefit from the highly transformative platform technology (e.g. direct write printing, fabric electrodes, iterative learning control systems) developed in this work.

What is FES?

Functional electrical stimulation (FES) is a technique used to facilitate the practice of therapeutic exercises and tasks. Intensive movement practice can restore the upper limb function lost following stroke. However, stroke patients often have little or no movement, so are unable to practice. FES activates muscles artificially to facilitate task practise and improve patients’ movement.

More…..

Source: SMARTmove

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[Abstract] Proposition of a classification of adult patients with hemiparesis in chronic phase

Objective

Patients who have developed hemiparesis after central nervous system lesion often experience reduced walking capacity. Related gaitabnormalities at hip, knee, and ankle joints during swing induce decreased foot clearance and increased risk of falls, and thus need a meticulous management. This study aimed to (1) propose a classification focusing on these abnormalities for adult patients with hemiparesis, (2) evaluate its discriminatory capacity using clinical gait analysis (CGA).

Material/patients and methods

Twenty-six patients (10 women, 16 men) with hemiparesis (13 left, 13 right) in chronic phase (i.e. hemiparesis more than 6 months old) were included in this study. Clinical examination (i.e. passive range of motion, muscle weakness, and spasticity) and video records were conducted on each patient. The following classification was then applied: group I (GI) was mainly characterized by a decreased ankle dorsiflexion during swing, group II (GII) and group III (GIII) by a decreased knee flexion during swing, completed by a reduced range of hip motion and a hip flexors weakness in GIII. Subdivisions were also applied on each group to describe (a) absence or (b) presence of genu recurvatum during stance. The discriminatory capacity of the classification was then evaluated. For that, all patients were instrumented with cutaneous reflective markers and at least 5 gait cycles were recorded using optoelectronic cameras (OQUS, Qualisys, Sweden). A statistical analysis (ANOVA) was then performed between each group and subgroup on 24 kinematic parameters and walking speed.

Results

Only one patient could not be classified, 5 were classified in GI (1 GIa, 4 GIb), 15 in GII (7 GIIa, 8 GIIb), and 5 in GIII (1 GIIIa, 4 GIIIb). When subgroups (a) and (b) were combined, 16 of the 25 assessed parameters revealed a statistically significant difference (P-level < 0.05) between at least two groups. In particular, the maximum knee flexion in swing and the total amplitude of hip flexion-extension were significantly different between groups.

Discussion – conclusion

This classification can be performed in regular clinical practice (using clinical evaluation and video records). It should thus ease the development of clinical management algorithms and the efficiency assessment of related therapies.

Source: Proposition of a classification of adult patients with hemiparesis in chronic phase – ScienceDirect

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[BLOG POST] You Probably Didn’t Aware Of These Surprising Epileptic Seizure Causes

Epileptic Seizure Causes

Epileptic Seizure has no known cause in about half of those with the condition. In the other, the condition may be traced to various factors.

Genetic influence. Some types of epilepsy, which are categorized by the type of seizure you experience or the part of the brain that is affected, run in families. In these cases, it’s likely that there’s a genetic effect.

Researchers have associated some types of this disorder to specific genes that Epileptic Seizure Causes, also include genes though it’s estimated that up to 500 genes could be tied to the condition. For most people, genes are only part of the cause of this disorder. Certain genes may make a person more sensitive to environmental conditions that provoke seizures.

Head trauma. Epileptic Seizure Causes by Head trauma as a result of a car accident or other traumatic injury.

Brain conditions. Brain conditions that cause damage to the brain, such as brain tumors or strokes, can cause Epileptic Seizure. Stroke is a leading cause of epilepsy in adults older than age 35.

Infectious diseases. Infectious diseases, such as meningitis, AIDS and viral encephalitis, can cause epilepsy.

Prenatal injury. Before birth, babies are sensitive to brain damage that could be caused by several factors, such as an infection in the mother, poor nutrition or oxygen deficiencies. This brain damage can result in epilepsy or cerebral palsy.

  • Different epilepsies are due to many different underlying Epileptic Seizure Causes.Epileptic Seizure Causes can be complex, and sometimes hard to identify. A person might start having seizures because they have one or more of the following.
  • A genetic tendency that is not inherited, but is a new change in the person’s genes.
  • A structural (sometimes called ‘symptomatic’) change in the brain, such as the brain not developing properly, or damage caused by a brain injury, infections like meningitis, a stroke or a tumour. A brain scan, such as Magnetic Resonance Imaging (MRI), may show this.
  • Structural changes due to genetic conditions such as tuberous sclerosis, or neurofibromatosis, which can cause growths affecting the brain.Developmental disorders. Epilepsy can sometimes be associated with developmental disorders, such as autism and neurofibromatosis
  • A genetic tendency, passed down from one or both parents (inherited). source

Source:  You Probably Didn’t Aware Of These Surprising Epileptic Seizure Causes

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[ARTICLE] Adaptive hybrid robotic system for rehabilitation of reaching movement after a brain injury: a usability study – Full Text

Abstract

Background

Brain injury survivors often present upper-limb motor impairment affecting the execution of functional activities such as reaching. A currently active research line seeking to maximize upper-limb motor recovery after a brain injury, deals with the combined use of functional electrical stimulation (FES) and mechanical supporting devices, in what has been previously termed hybrid robotic systems. This study evaluates from the technical and clinical perspectives the usability of an integrated hybrid robotic system for the rehabilitation of upper-limb reaching movements after a brain lesion affecting the motor function.

Methods

The presented system is comprised of four main components. The hybrid assistance is given by a passive exoskeleton to support the arm weight against gravity and a functional electrical stimulation device to assist the execution of the reaching task. The feedback error learning (FEL) controller was implemented to adjust the intensity of the electrical stimuli delivered on target muscles according to the performance of the users. This control strategy is based on a proportional-integral-derivative feedback controller and an artificial neural network as the feedforward controller. Two experiments were carried out in this evaluation. First, the technical viability and the performance of the implemented FEL controller was evaluated in healthy subjects (N = 12). Second, a small cohort of patients with a brain injury (N = 4) participated in two experimental session to evaluate the system performance. Also, the overall satisfaction and emotional response of the users after they used the system was assessed.

Results

In the experiment with healthy subjects, a significant reduction of the tracking error was found during the execution of reaching movements. In the experiment with patients, a decreasing trend of the error trajectory was found together with an increasing trend in the task performance as the movement was repeated. Brain injury patients expressed a great acceptance in using the system as a rehabilitation tool.

Conclusions

The study demonstrates the technical feasibility of using the hybrid robotic system for reaching rehabilitation. Patients’ reports on the received intervention reveal a great satisfaction and acceptance of the hybrid robotic system.

Background

Upper limb hemiparesis is one of the most common consequences after a brain injury accident [1]. This motor impairment has an adverse impact on the quality of life of survivors since it hinders the execution of activities of daily living. From the rehabilitation perspective, it is widely accepted that high-intensity and repetitive task-specific practice is the most effective principle to promote motor recovery after a brain injury [12]. However, traditional rehabilitation treatment offers a dose of movement repetition that is in most cases insufficient to facilitate neural reorganization [3]. In response to these current clinical shortcomings, there is a clear interest in alternative rehabilitation methods that improve the arm motor functionality of brain injury survivors.

Hybrid robotic systems for motor rehabilitation are a promising approach that combine the advantages of robotic support or assistive devices and functional electrical stimulation (FES) technologies to overcome their individual limitations and to offer more robust rehabilitation interventions [4]. Despite the potential benefits of using hybrid robotic systems for arm rehabilitation, a recent published review shows that only a few hybrid systems presented in the literature were tested with stroke patients [4]. Possible reasons could be the difficulties arising from the integration of both assistive technologies or the lack of integrated platforms that can be easily setup and used.

End-effector robotic devices combined with FES represent the most typical hybrid systems used to train reaching tasks under constrained conditions [567]. With these systems, patients’ forearms are typically restricted to the horizontal plane to isolate the training of the elbow extension movement. The main advantage of this approach is the simplicity of the setup, with only 1 Degree of Freedom (DoF). However, to maximize the treatment’s outcomes and achieve functional improvement it is necessary to train actions with higher range of motion (> 1 DoF) and functional connotations [89]. Yet, the complexity for driving a successful movement execution in such scenarios requires the implementation of a robust and reliable FES controller.

The appropriate design and implementation of FES controllers play a key role to achieve stable and robust motion control in hybrid robotic systems. The control strategy must be able to drive all the necessary joints to realize the desired movement, and compensate any disturbances to the motion, i.e. muscle fatigue onset as well as the strong nonlinear and time-varying response of the musculoskeletal system to FES [1011]. Consequently, open-loop and simple feedback controllers (e.g. proportional-integral-derivative -PID-) are not robust enough to cope with these disturbances [812]. Meadmore et al. presented a more suitable hybrid robotic system for functional rehabilitation scenarios [13]. They implemented a model-based iterative learning controller (ILC) that adjusts the FES intensity based on the tracking error of the previously executed movement (see [1314] for a detail description of the system). This iterative adjustment allows compensating for disturbances caused by FES. Although this approach addresses some of the issues regarding motion control with FES, it requires a detailed mathematical description of the musculoskeletal system to work properly. In this context, unmodeled dynamics and the linearization of the model can reduce the robustness of the controller performance. Also, the identification of the model’s parameters is complex and time consuming, which limits its applicability in clinical settings [1112].

The Feedback Error Learning (FEL) scheme proposed by Kawato [15] can be considered as an alternative to ILC. This scheme was developed to describe how the central nervous system acquires an internal model of the body to improve the motor control. Under this scheme, the motor control command of a feedback controller is used to train a feedforward controller to learn implicitly the inverse dynamics of the controlled system on-line (i.e. the arm). Complementary, this on-line learning procedure also allows the controller to adapt and compensate for disturbances. In contrast with the ILC, the main advantage of this strategy is that the controller does not require an explicit model of the controlled system to work correctly and that it can directly learn the non-linear characteristic of the controlled system. Therefore, using the FEL control strategy to control a hybrid robotic system can simplify the setup of the system considerably, which makes easier to deploy it in clinical settings as well as personalize its response according to each patient’s musculoskeletal characteristics and movement capabilities. The FEL has been used previously to control the wrist [16] and the lower limb [17] motion with FES in healthy subjects; but it has not been tested on brain injury patients. In a previous pilot study, we partially showed the suitability of the FEL scheme in hybrid robotic systems for reaching rehabilitation with healthy subjects [18]. However, a rigorous and robust analysis has not been presented neither this concept has not been tested with motor impaired patients.

The main objective of this study is to verify the usability of a fully integrated hybrid robotic system based on an FEL scheme for rehabilitation of reaching movement in brain injury patients. To attain such objective two-step experimentation was followed. The first part consists of demonstrating the technical viability and learning capability of the developed FEL controller to drive the execution of a coordinated shoulder-elbow joint movement. The second part consists of testing the usability of the platform with brain injury patients in a more realistic rehabilitation scenario. For this purpose, we assessed the patients’ performance and overall satisfaction and emotional response after using the system.

Methods

In this section, we present the hybrid robotic system for the rehabilitation of reaching movement in patients with a brain injury. The system focuses on aiding users to move their paretic arm towards specific distal directions in the space. During the execution of the reaching task, the FEL controller adjusts the intensities of the electrical stimuli delivered to target muscles in order to aid the subjects in tracking accurately the target paths.

Description of the hybrid rehabilitation platform for reaching rehabilitation

Figure 1 shows the general overview of the developed platform. This rehabilitation platform is composed of four main components: the hybrid assistive device (upper limb exoskeleton + FES device); the high-level controller (HLC); the visual feedback and; the user interface. […]

Fig. 1 a General overview of the presented hybrid robotic platform for reaching rehabilitation. bVisual feedback provided to the users. The green ball represents the actual arm position, the blue cross is the reference trajectory, the initial and final position are represented by the gray ball and red square respectively. c Interface for system configuration

Source: Adaptive hybrid robotic system for rehabilitation of reaching movement after a brain injury: a usability study | Journal of NeuroEngineering and Rehabilitation | Full Text

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[WEB SITE] Brain Injury News – September 2017 – CNS

09/29/2017 Early predictors of outcome after mild traumatic brain injury
09/29/2017 Scientists say fluids study could aid traumatic brain injury research
09/28/2017 Risk of hospitalization with neurodegenerative disease after moderate-to-severe traumatic brain injury in the working-age population
09/28/2017 Girl soccer players are five times more likely to return to the game after a concussion than boys
09/27/2017 Neuropsychological predictors of outcome following traumatic brain injury in adults
09/27/2017 Many people thought to be in ‘vegetative’ conditions may still be conscious
09/26/2017 Accelerated cognitive aging following severe traumatic brain injury
09/26/2017 Study shows modified blood thinner reduces the impact of traumatic brain injury
09/25/2017 Expression of masculine identity in individuals with a traumatic brain injury
09/25/2017 Memory decline after head injury may be prevented by slowing brain cell growth
09/21/2017 Risk factors and outcomes associated with post-traumatic headache after mild traumatic brain injury
09/21/2017 Seaweed may help heal injured brain tissue
09/20/2017 Provider perceptions of the assessment and rehabilitation of sexual functioning after traumatic brain injury
09/20/2017 New treatment option discovered for brain injury patients suffering from aggression
09/19/2017 Risk factors for myocardial dysfunction after traumatic brain injury
09/19/2017 Concussion drug could reverse brain damage by ‘releasing’ damaged cells
09/18/2017 Who among patients with acquired brain injury returned to work after occupational rehabilitation?
09/15/2017 Home environment as a predictor of long-term executive functioning following early childhood traumatic brain injury
09/15/2017 Concussion in teenagers increases the risk of multiple sclerosis in later life
09/14/2017 ndividual- and population-level impacts of traumatic brain injury and maternal characteristics on subsequent offending behavior
09/14/2017 Concussions in women: Rates, symptoms and recovery are different than men
09/13/2017 The association of cognitive reserve in chronic-phase functional and neuropsychological outcomes following traumatic brain injury
09/13/2017 Science Says: How repeated head blows affect the brain
09/12/2017 Online family problem solving for pediatric traumatic brain injury
09/12/2017 Smartphones could someday assess brain injuries
09/11/2017 Resilience after traumatic brain injury
09/08/2017 Brain biomarkers and pre-injury cognition are associated with long-term cognitive outcome in children with traumatic brain injury
09/07/2017 Remediation of social communication impairments following traumatic brain injury using metacognitive strategy intervention
09/07/2017 Lab-grown brain balls are starting to look more lifelike
09/06/2017 Citicoline in severe traumatic brain injury: indications for improved outcome
09/06/2017 Researchers testing theory that you can diagnose a concussion through saliva
09/05/2017 Work productivity loss after mild traumatic brain injury
09/01/2017 Non-invasive vagal nerve stimulation effects on hyperarousal and autonomic state in patients with posttraumatic stress disorder and history of mild traumatic brain injury
09/01/2017 Brain Glue’ repairs traumatic brain injuries

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[Proceedings] Proceedings of the Third Neurological Disorders Summit (NDS-2017) – Journal of Neurology & Experimental Neuroscience – PDF file

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[ARTICLE] A wearable somatosensory teaching device with adjustable operating force for gait rehabilitation training robot – Full Text

A novel wearable multi-joint teaching device for lower-limb gait rehabilitation is presented, intended to facilitate the adjustment of training modes in unique requirements of patients. A physiotherapist manipulates this active teaching device to plan the personalized gait trajectory and to construct the individual training mode. A haptic interaction joint module that stems from the friction braking principle is outlined here, with an adjustable operating force exerted by pneumatic film cylinders. With dual functions of somatosensory perception and teaching, it provides physiotherapist with a smooth and comfortable operation and a kind of force telepresence. The main contents are elaborated including the structural design and pneumatic proportional servo system of the teaching device and the joint module, operating force control principle, and gravity compensation method. Through performance tests of the prototype, the adjustable operating force has been demonstrated with the characteristics of good linearity and response speed. The results of master–slave control experiments preliminarily verified the effectiveness of the control approach. The research on the novel somatosensory teaching device with master–slave teaching mode has provided a concise, convenient, and efficient means for the clinical application of lower-limb rehabilitation robots, presumably as a new idea and technical supports for the future design.

Based on the neuroplasticity principle,1 a lower-limb rehabilitation training robot is a kind of automatic equipment that can recover or rebuild neural pathways2,3 for patients with motor dysfunction. The clinical presentation of a spinal cord injury (SCI) or a stroke comprises motor weakness or complete paresis, complete or partial loss of sensory function. The Swedish therapist Brunnstrom proposed the famous six-recovery-stage theory. Based on this theory, the training has different aims in the early stage of rehabilitation (flaccid paralysis stage), middle stage of rehabilitation (spasm stage), and later stage of rehabilitation (recovery stage). One major principle of neurological rehabilitation is that of motor learning. According to the principle of neural plasticity, repetitive and specific training tasks, which make the cerebral cortex learn and store the correct movement patterns, are important and effective. During rehabilitation, patients have to relearn motor tasks in order to overcome disability and limitations in the completion of daily activities. This is the theoretical basis of rehabilitation treatment. For a robot, the control strategy is provided diversely in different stages of rehabilitation to eliminate abnormal movement patterns. In the early rehabilitation, the passive training mode is usually adopted to help patients according to the predetermined trajectory and improve exercise capacity and reduce muscle atrophy. Then the active assist training mode begins for the patients of the middle recovery stage with moderate strength and relieving muscle spasm. In the later rehabilitation stage, the active resist training mode can be used to encourage patients to participate initiatively. The effect and importance of rehabilitation robots have been internationally recognized.48

Giving different state of an illness exhibited by hemiparetic individuals and the different training modes as mentioned above, the gait rehabilitation training robot primarily entails customized designing the parameters including movement trajectory, training speed and strength, and real-time perceiving, adjusting, and controlling. Lower-limb exoskeleton mechanism features of many degrees of freedom, together with the individual and condition differences of patients, so the problems are highlighted about how to accurately plan the correct gait trajectory and how to adjust training modes on time according to the progression. These issues become one of the research foci and technical difficulties of rehabilitation robot.

Most of the typical lower-limb rehabilitation robots in the world are autonomously controlled. The gait training mode planning for them is summarized in two methods, that is, preselected by a physiotherapist and dynamically adjusted by the algorithm. For some representative examples, the horizontal rehabilitation training robot Motion Maker9 can automatically guide patients along a preselected trajectory to perform passive flexion movement training on hip, knee, and ankle joints. The Lokomat1012 is a kind of body-weight-supported treadmill training (BWSTT) robot that adjusts the assisted power or reference trajectory by the impedance algorithm according to the patient interaction force. Patients can be made available to active and passive training mode. In the case of the lower extremity powered exoskeleton (LOPES) gait rehabilitation robot,13,14 limb reference trajectory is generated by instantaneous mapping with the healthy limb movement. The feasibility and functional improvements achieved in response to the emergence of such self-control rehabilitation robot; however, the existing technological bottleneck is obvious, that is, the limited adaptability of training mode.

The objective of this research is to develop a gait trajectory teaching device, with which the physiotherapist can directly and professionally teach to the robot and therefore present complex actions and adjust training modes as needed. Through master–slave teaching method, such system may provide the adaptability of the robot-mediated training and improve the treatment quality and efficiency, and decrease the difficulties in control algorithm study and the contradiction between the complex algorithms and real-time control.

Because of the more elaborate actions of the upper extremity and hand, teaching and playback technology is first applied to upper-limb rehabilitation training robot, for example, the flexible force feedback master–slave exoskeleton manipulator developed by America General Electric Company,15 the wearable master–slave training equipment of upper limbs driven by pneumatic artificial muscles in Okayama University in Japan,16 and the remotely operated upper-limb training robot of Southeast University in China.17 But there are fewer applications for lower-limb rehabilitation training. A single-joint ankle-foot orthoses designed by Canada, the Centre for Interdisciplinary Research in Rehabilitation and Social Integration is introduced in the literature.18The main cylinder driven by a motor controlled the slave cylinder to drive the orthoses. As described in a literature,19 a wearable master–slave lower-limb training robot driven by pneumatic artificial muscle achieves the teaching and training for the knee and ankle rehabilitation by sensors feeding back the trainer joint torque to the main control mechanism. In most of the studies mentioned above, the limitations existing in master–slave teaching for the lower-limb rehabilitation training robot can be summarized as follows: (1) the teaching device has the characteristics of complex structure, large quality and high inertia, so the physiotherapist is laborious and feels fatigue quickly, (2) the coordinate of the multi joints is demanded highly which may lead to the insufficient operating smoothness of the device, and (3) the feedback joint torque cannot be directly perceived by the physiotherapist but only as the control signal for the device.

In light of the above limitations, a novel multi-joint wearable teaching device is developed with adjustable operating force, which is exerted by light film cylinders. Based on the gravity compensation control method, a physiotherapist operates the teaching device to plan training trajectory smoothly and comfortably while also perceive the scene interaction force came from patients. In this manner, our research solved the existing problems, namely, the weight, the difficult manipulation of the teaching and the less force feedback to the physiotherapist. He operates the teaching device with the master–slave mode may provide various training modes fast and intuitively. The force telepresence from patients makes physiotherapist better controlling the training intensity and realizing the individual rehabilitation training consultation.

In this article, we elaborate five major contents that have been derived from this research as follows: master–slave teaching system solution, structural design of the multi-joint wearable master teaching device, operating force regulation principle and gravity compensation method, operating force regulation performance experiments, and master–slave control experiments.

Figure 1. System overall scheme.

Continue —> A wearable somatosensory teaching device with adjustable operating force for gait rehabilitation training robotAdvances in Mechanical Engineering – Bingjing Guo, Jianhai Han, Xiangpan Li, Peng Wu, Yanbin Zhang, Aimin You, 2017

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