Archive for category REHABILITATION

[WEB PAGE] Neuropsychologist: Definition and Patient Education

What is a neuropsychologist?

A neuropsychologist is a psychologist who specializes in understanding the relationship between the physical brain and behavior. The brain is complex. Disorders within the brain and nervous system can alter behavior and cognitive function.

According to the University of Rochester Medical Center, the role of a neuropsychologist is to understand how brain structures and systems relate to behavior and thinking.

Neuropsychologists have a doctorate in psychology and training in neuropsychology. They often work in research or clinical settings.

What does a neuropsychologist do?

Neuropsychologists evaluate and treat people with various types of nervous system disorders. They work closely with doctors, including neurologists.

Illnesses, injuries, and diseases of the brain and nervous system can affect the way a person feels, thinks, and behaves. Symptoms that may call for a neuropsychologist include:

  • memory difficulties
  • mood disturbances
  • learning difficulties
  • nervous system dysfunction

If other doctors can’t identify the cause of a symptom, a neuropsychologist can help determine a diagnosis. If a diagnosis is already known, an assessment can still be helpful.

A neuropsychologist can help determine what impairments you might have and how severe they are. The following are examples of conditions they evaluate and treat:

  • A stroke can affect behavior, thinking, memory, and other brain functions in obvious or subtle ways. They can perform an evaluation to help determine the degree of stroke impairment.
  • Parkinson’s disease, a progressive disorder, can cause several neurological problems. A neuropsychologist’s exam can provide a baseline to help them determine disease progression and decreased function.
  • Alzheimer’s disease and other types of dementia can interfere with memory, personality, and cognitive abilities. A neuropsychologist can perform an exam to help them identify it in its early stage.
  • Traumatic brain injuries can cause a wide variety of symptoms. A neuropsychologist can help determine how an injury affects functions like reasoning or problem-solving skills.
  • A neuropsychologist can help determine which of the many types of learning disabilities someone has and develop a treatment plan.

Typical neuropsychological procedures

The nervous system is complex. Neuropsychologists use different types of procedures to identify problems and treatment plans. Typical procedures they perform include:

Neuropsychological evaluation

This evaluation is an assessment of how your brain functions. The evaluation will include an interview and questions that will help outline your performance of daily tasks, as well as identify memory issues and mental health concerns. The interview will also cover information on symptoms, medical history, and medications you take.

An evaluation includes different types of standardized tests to measure many areas of brain function, including:

  • memory
  • cognitive ability
  • personality
  • problem-solving
  • reasoning
  • emotions
  • personality

Brain scans, such as CT or MRI scans, can also help a neuropsychologist make a diagnosis.

Understanding results

Your neuropsychologist will compare your test results with those of other people with a similar education and age.

Evaluation and test results may help determine the cause of an issue when other methods don’t work. Tests can even help identify mild thinking and memory issues, which may be subtle.

Neuropsychologists help develop a treatment plan by understanding how the brain functions and how that functioning relates to behavior. Treatment plans may include medication, rehabilitation therapy, or surgery.


A neuropsychologist can help diagnose a cognitive, behavioral, or neurological condition. Seeing a neuropsychologist and completing their tests can lead to a deeper understanding of your condition. When other doctors might not be able to diagnose an issue, consider seeing a neuropsychologist.


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[Abstract] An Analysis of Wrist and Forearm Range of Motion using the Dartfish Motion Analysis System



Wrist range of motion (ROM) is considered the universal measurement of success for both surgical and non-surgical treatments. A goniometer can be challenging for an individual; to use by themselves, whereas the Dartfish app can analyze and provide immediate feedback to monitor and evaluate patients’ kinematic changes during recovery.


of Study: To establish the validity and reliability of the Dartfish app measuring ROM in order for it to be used in clinical applications.


Twelve healthy participants, ages 18 to 25, with no previous history of wrist injuries were recruited for this study. The ROM measurements collected were flexion/extension, radial/ulnar deviation, and supination/pronation for both goniometer and Dartfish measurements.Goniometer measurements were performed using a plastic universal two-arm goniometer. Dartfish measurements were performed by two observers on an iPad Pro for three trials. Statistical analyses such as t-tests, and the Pearson correlation coefficient, as well as reliability analyses, such as intraclass correlation coefficient (ICC), and Bland-Altman plots were performed.


There was no significant difference between the goniometer and Dartfish ROM measurements except for the ulnar deviation measurement. The concurrent validity showed nearly; perfect correlations between examiners using Dartfish with r-values that ranged from 0.904 to 0.997, and between ADK and the goniometer showed medium, large, and very large correlations since the values ranged from 0.418 to 0.829. The ICC for test-retest reliability had excellent agreement which ranged from 0.993 to 0.999 and the ICC values for inter-observer reliability had good and excellent agreement which ranged from 0.893 to 0.997.


Overall, the results demonstrated that the Dartfish app was a reliable and valid method to measure wrist and forearm ROM. A patient would be able to easily record their own ROM measurements videos and track their progress during their recovery without the need to visit their physician.


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[ARTICLE] A reward–punishment feedback control strategy based on energy information for wrist rehabilitation – Full Text


Based on evidence from the previous research in rehabilitation robot control strategies, we found that the common feature of the effective control strategies to promote subjects’ engagement is creating a reward–punishment feedback mechanism. This article proposes a reward–punishment feedback control strategy based on energy information. Firstly, an engagement estimated approach based on energy information is developed to evaluate subjects’ performance. Secondly, the estimated result forms a reward–punishment term, which is introduced into a standard model-based adaptive controller. This modified adaptive controller is capable of giving the reward–punishment feedback to subjects according to their engagement. Finally, several experiments are implemented using a wrist rehabilitation robot to evaluate the proposed control strategy with 10 healthy subjects who have not cardiovascular and cerebrovascular diseases. The results of these experiments show that the mean coefficient of determination (R 2) of the data obtained by the proposed approach and the classical approach is 0.7988, which illustrate the reliability of the engagement estimated approach based on energy information. And the results also demonstrate that the proposed controller has great potential to promote patients’ engagement for wrist rehabilitation.


Stroke has become one of the major diseases that threaten people’s physical and mental health in the world.1 Loss of control of upper limbs is a common impairment underlying disability after stroke for patients, which seriously affects their daily activities.2 Traditional physical therapy is labor intensive and requires great energy of therapists.3 With the development of robotics, the emergence of rehabilitation robots provides a new way for rehabilitation.4 Rehabilitation robots are able to assist patients to complete training tasks without therapists. In addition, rehabilitation robots are capable of estimating patients’ rehabilitation status accurately through a variety of sensors, which helps therapists to develop a follow-up treatment plan for patients.

Control of rehabilitation robots, however, remains an open-ended research area. Control strategies, which target subjects ranging from the mildly impaired and severely impaired, are the most extensively investigated controller paradigm in the rehabilitation robotics community and have been proved to be the most promising techniques for promoting recovery after stroke.5,6 There is strong evidence that high engagement in rehabilitation training induces neural plasticity.7 Therefore, great attention is paid on investigating how to use robot control strategies to promote patients’ active engagement in robotic therapy.

Assist-as-needed (AAN) control strategy is one of the most popular research topics in the field of rehabilitation robots control strategies and is considered promising to promote patients’ engagement. As the name suggested, AAN control strategy emphasizes that robots only supply as much effort as a patient needs to accomplish training tasks by estimating his/her performance in real time.8 Impedance control first proposed by Hogon was applied in AAN control strategy primitively.9 Representatively, Krebs et al. proposed an AAN controller based on impedance control with MIT-Manus,10,11 which can update impedance parameters according to patients’ performance. In this case of robotic therapy, the robot provides assistance based on specific impedance parameters when the subject is not able to track the desired trajectory and does not provide assistance when the subject is able to track or exceed the desired trajectory so as to allow the subject to move voluntarily. This kind of mechanism encourages subjects to get rid of the limitations of the desired trajectory, which can be regarded as a reward and make them more active. But some subjects showed signs of slack behavior that they rely too much on the robot’s assistance to complete the task without any punishments.12 In other words, giving only rewards without punishments will cause subjects’ slackness in rehabilitation training. Therefore, it is necessary to develop control strategies exhibiting the reward–punishment feedback.

Wolbrecht et al. proposed an adaptive controller including a forgetting term to create the reward–punishment feedback mechanism.13 The adaptive law is made up of an error-based adaptive law and a forgetting law. The standard adaptive law dominates when there is a major tracking error so as to assist the subject to complete the task, while the forgetting law dominates when there is a minor tracking error so as to decay the assistance force to promote the subject’s active engagement, which forms a mechanism that gives a reward feedback to subjects by exhibiting a minor tracking error when they are highly engaged and gives a punishment feedback by exhibiting a major tracking error when they are slack. But the adaptive controller is model-based, it does not perform well when it is applied to wrist or finger rehabilitation because minor modeling deviations affect the wrist or finger much more than the upper limb. The tracking error will not change significantly regardless of the degree of the subject’s engagement.

Another improvement to the AAN control strategy was proposed by Pehilivan et al., who introduced a minimum AAN control strategy, which relied on Kalman filter to estimate subjects’ capability.14,15 According to the estimated results, the controller updates the derivative feedback gain to modify the bounds of allowable error on the desired trajectory, which also reflects the idea of reward–punishment feedback. Subsequently, Kalman filter was replaced by nonlinear disturbance observer, and the electromyography (EMG) sensors were used to estimate the subjects’ engagement.16

To sum up, in order to promote the engagement of subjects, the common feature of the above control strategies is that they can create a reward–punishment feedback mechanism according to the subjects’ current engagement or performance. To the best of our knowledge, previous researchers have not specifically identified this mechanism. More control strategies for rehabilitation robots support this point of view.1725

In this article, we proposed a reward–punishment feedback control strategy to promote subjects’ engagement for wrist rehabilitation. Firstly, we utilize the energy contributed by the subject to estimate his/her engagement. The energy can be obtained by calculating the integral of the torque contributed by the subject against the position. Secondly, an adaptive controller including a reward–punishment term was proposed. Unlike the adaptive controller above,13 the included term is not constant. Instead, it updates based on the estimated results so that the controller can give reward or punishment feedback to subjects by reflecting different tracking error, which is suitable for wrist rehabilitation. Finally, the control strategy was demonstrated through experiments on healthy subjects without cardiovascular and cerebrovascular diseases operating a wrist rehabilitation robot. The contributions of this work include the development of an engagement estimated approach without any extra sensors, which greatly reduces development costs. This work also proposed an improved adaptive controller including a reward–punishment term for wrist rehabilitation, which has great potential to promote subjects’ engagement.

This article is organized as follows. The second section presents an engagement estimated approach based on energy information and a human robot coupled system modeling. The third section proposes an adaptive controller including a reward–punishment term and details the Lyapunov stability analysis. The fourth section introduces the specific implementation methods of three experiments. The fifth section presents and analyzes experimental results. Eventually, the discussion and conclusion are presented in the sixth section.

Engagement estimated based on energy information

We have developed a wrist rehabilitation robot, a three degree-of-freedom (DOF) device, as shown in Figure 1(a). The device is capable of independently actuating all three DOFs of subject’s forearm and wrist. Relatively, the device has three joints: flexion/extension joint, radial/ulnar deviation joint, and pronation/supination joint can all be controlled. Each joint of the device employs both a brushless DC motor with a conveyor belt to drive. Therefore, the control methods of the three joints are similar, and this article only describes the control strategy of the flexion/extension joint.

Figure 1. The mechanical structure of the wrist rehabilitation robot. (a) The directional view of the human robot coupled system. (b) The side view of the wrist rehabilitation robot.



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[ARTICLE] Functional electrical stimulation therapy for restoration of motor function after spinal cord injury and stroke: a review – Full Text


Functional electrical stimulation is a technique to produce functional movements after paralysis. Electrical discharges are applied to a person’s muscles making them contract in a sequence that allows performing tasks such as grasping a key, holding a toothbrush, standing, and walking. The technology was developed in the sixties, during which initial clinical use started, emphasizing its potential as an assistive device. Since then, functional electrical stimulation has evolved into an important therapeutic intervention that clinicians can use to help individuals who have had a stroke or a spinal cord injury regain their ability to stand, walk, reach, and grasp. With an expected growth in the aging population, it is likely that this technology will undergo important changes to increase its efficacy as well as its widespread adoption. We present here a series of functional electrical stimulation systems to illustrate the fundamentals of the technology and its applications. Most of the concepts continue to be in use today by modern day devices. A brief description of the potential future of the technology is presented, including its integration with brain–computer interfaces and wearable (garment) technology.


Losing the ability to move voluntarily can have devastating consequences for the independence and quality of life of a person. Stroke and spinal cord injury (SCI) are two important causes of paralysis which affect thousands of individuals around the world. Extraordinary efforts have been made in an attempt to mitigate the effects of paralysis. In recent years, rehabilitation of voluntary movement has been enriched by the constant integration of new neurophysiological knowledge about the mechanisms behind motor function recovery. One central concept that has improved neurorehabilitation significantly is neuroplasticity, the ability of the central nervous system to reorganize itself during the acquisition, retention, and consolidation of motor skills [1]. In this document, we present one of the interventions that has flourished as a consequence of our increased understanding of the plasticity of the nervous system: functional electrical stimulation therapy or FEST. The document, which is not a systematic review, is intended to describe early work that played an important historical role in the development of this field, while providing a general understanding of the technology and applications that continue to be used today. Readers interested in systematic reviews of functional electrical simulation (FES) are directed to other sources (e.g., [2,3,4]).[…]


Textile-based neuroprostheses. a Finger extension produced using a shirt designed for implementing a neuroprosthesis for reaching and grasping. The garment includes rectangular areas (dark grey patches) made of conductive yarn that function as electrodes. b Forward reaching. Details can be found in [65]

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[WEB PAGE] Net Health Study Pits Telehealth Against In-Clinic Rehab

Posted by Debbie Overman | Sep 25, 2020       

Net Health Study Pits Telehealth Against In-Clinic Rehab

Rehabilitation patients receiving therapy via telehealth methods (videoconference, phone and email) do as well on average, and are just as satisfied, as those getting in-person care, according to a new study from Focus on Therapeutic Outcomes (FOTO), a Net Health company that provides outcomes management software for rehab therapists.

Utilizing telehealth may provide additional benefits, including cost-savings and the ability to reach more patients, the study suggests, according to a media release from Net Health Systems Inc.

FOTO will share the study results and discuss the implications in two upcoming webinars for outpatient rehab therapists and skilled nursing facilities.

FOTO Telehealth Pilot Study

The FOTO Telehealth Pilot Study analyzed over 40,000 episodes-of-care and determined that nearly 4,000 were conducted using telehealth. The degree of telehealth used for each episode was examined across four levels of intensity: 1) any level, 2) less than half of visits, 3) most visits, or 4) all visits. All four levels of telehealth were compared to care delivered by traditional face-to-face interactions.

The researchers found that:

  • Telehealth and non-telehealth care episodes were equally effective for improving patients’ functional status.
  • Episodes of care involving telehealth had an average of two to three fewer visits, suggesting telehealth may promote greater efficiency of care for the same amount of functional improvement. 
  • Patients were equally satisfied with their therapy care regardless of whether any care visits were administered using telehealth.

“The research will give rehab therapists peace of mind because they can be confident the care they provide via telehealth is, on average, just as effective as in-person care in improving functional status and achieving high patient satisfaction. They also can promote this information to reach new patients.”

— Net Health CEO Josh Pickus

Improved Access to Care

In addition to helping therapy practices adapt to the pandemic, telehealth expands their reach, enabling therapists to care for elderly and sick people who find in-person visits difficult or impossible, the Net Health release continues.

“Older patients and those with chronic conditions are the largest and fastest-growing patient population being treated by FOTO clinicians. Finding safe and effective alternatives to provide care for older adults is becoming increasingly important.”

— Deanna Hayes, PT, DPT, MS, FOTO Director of Research

Telehealth also helps improve rehab therapy care for people who have reduced access to healthcare, such as those living in remote areas or having limited access to transportation.

Moving Forward with Telehealth

In the release, Net Health suggests that practitioners interested in telehealth begin by incorporating it with traditional on-site clinic care. A telehealth startup playbook could include:

  • Phasing in a few telehealth visits for appropriate patient conditions
  • Offering telehealth “booster” visits between in-person visits for patients needing more care
  • Integrating telehealth with the EHR system to facilitate recordkeeping, efficient billing, HIPAA compliance and reimbursement

Learn more about the FOTO Telehealth Study.

Webinar Information

FOTO experts will discuss these and other strategies in two upcoming webinars.

The first webinar, “Groundbreaking Telehealth Research Effectiveness Data and its Application to SNFs,” will provide an overview of the study results and impact on skilled nursing facilities on Tuesday, Sept. 29 at 2 p.m. ET.

The second webinar, “Telehealth Effectiveness and Outcomes for Outpatient Rehab Therapy,” will provide an overview of study results for rehab therapists on Thursday, Oct. 1 at 2 p.m. ET.

[Source(s): Net Health Systems Inc, PR Newswire]


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[WEB PAGE] Living With PTSD? How to Manage Anxiety and Flashbacks

How to take steps toward healing

The human brain

If you have post-traumatic stress disorder (PTSD), you know how much it can mess with your day-to-day life. But help is available. You can take steps to live well even with this challenging disorder.

PTSD symptoms: Difficult, but totally normal

Maybe you experience nightmares or flashbacks. The anxiety they bring can show up without warning, like the worst kind of surprise houseguest. And you might find yourself sucked into quicksand-like swamps of anger or guilt.

The good news: All of those symptoms are normal. You might be thinking, “That’s supposed to be good news?” But understanding where your symptoms are coming from is the first step toward healing. And you can heal and recover from PTSD – it will just take some time, says psychiatrist Molly Wimbiscus, MD.

What exactly is PTSD anyway?

First, the basics. PTSD is a type of anxiety disorder. It occurs in people who’ve experienced or witnessed a traumatic event.

Sometimes, that event is big and obvious: combat, a life-threatening accident, sexual assault. Other times, it develops after a series of smaller, less obvious, stressful events — like repeated bullying or an unstable childhood.

How is PTSD treated (and is it worth the effort)?

Professional treatment can help you feel better, says Dr. Wimbiscus. And while medications can play a role in treating the disorder, she says the gold-standard treatment is cognitive-behavioral therapy, or CBT.

This type of therapy helps you reframe your memories of the trauma and learn new ways to manage those thoughts and feelings. “A big part of managing PTSD is having a skilled mental health professional working alongside you,” Dr. Wimbiscus says.

Here’s the ugly truth: That treatment isn’t easy — it might dig up memories or emotions you’d rather keep buried. And for all that effort, you may not feel like you’re making much progress.

You might have to meet with your therapist a few times before you can get into the real work of treating PTSD.

Having patience for that process is easier said than done. But your hard work will be worth it when you come out on the other side, with fewer symptoms and better tools to manage your anxiety.

Some people with PTSD will notice their symptoms fade in a matter of months. For others, healing takes longer. You may feel frustrated that you can’t speed up the process.

Can you live a normal life with PTSD?

While you’re being treated for PTSD, you can do several things to make getting through each day a bit easier:

  • Embrace daily (often mundane) routines. It can be tempting to hole up and avoid situations that could trigger anxiety. But avoiding life only makes symptoms worse. “Get up, take a shower, go to work or school every day — even if you don’t feel like it,” advises Dr. Wimbiscus.
  • Ask for help. Often, there are workarounds to help you manage symptoms. If you need some adjustments to help you succeed at school or work, don’t be afraid to ask.
    If you’re having trouble concentrating, for instance, ask to take tests in a quieter room, or ask to move to a quieter cubicle in the office. (By the way, you may even be eligible for medical leave while you undergo treatment.)
  • Get support. If you have supportive friends and family members, that’s terrific. They probably want to help, so let them know what you need — whether it’s driving you to appointments, weekly coffee dates to get you out of the house or just a sympathetic ear.
    Unfortunately, not everyone can lean on family members. If your inner circle can’t offer you the help you need, try looking for a support group (in person or online) to connect with others facing similar challenges. It’s good to have friends who get it. NAMI, the National Alliance on Mental Illness, can help connect you to support groups and resources in your area.
  • Avoid drugs and alcohol. You probably know that drowning your feelings in a bottle of whiskey isn’t a long-term solution. Yes, it can be tempting to use substances to escape the hard parts of PTSD. But substance use can be dangerous and will make your recovery harder in the long run.

Don’t be too hard on yourself

One more thing you should definitely do if you have PTSD: Be kind to yourself. That advice probably makes you roll your eyes — but sometimes, cheesy advice rings true. PTSD can cause feelings of guilt, shame and anger. When you’re feeling down, it can help to remember that it’s not you. It’s the disorder.

PTSD changes the structure of your brain, Dr. Wimbiscus points out. Think about that: Your brain is physically different than it used to be. PTSD is not caused by weakness, and you can’t just make yourself get over it.

So what should you do when you’re feeling hopeless? Remember that hopelessness, too, can be a symptom of the disorder.

And try to follow Dr. Wimbiscus’ advice: “Focus on getting through your daily tasks, and know that it gets better. Allow time to do its work. It may be a struggle right now, but time is one of our greatest healers. There is hope.”


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[ARTICLE] Non-Immersive Virtual Reality for Post-Stroke Upper Extremity Rehabilitation: A Small Cohort Randomized Trial – Full Text


Immersive and non-immersive virtual reality (NIVR) technology can supplement and improve standard physiotherapy and neurorehabilitation in post-stroke patients. We aimed to use MIRA software to investigate the efficiency of specific NIVR therapy as a standalone intervention, versus standardized physiotherapy for upper extremity rehabilitation in patients post-stroke. Fifty-five inpatients were randomized to control groups (applying standard physiotherapy and dexterity exercises) and experimental groups (applying NIVR and dexterity exercises). The two groups were subdivided into subacute (<six months post-stroke) and chronic (>six months to four years post-stroke survival patients). The following standardized tests were applied at baseline and after two weeks post-therapy: Fugl–Meyer Assessment for Upper Extremity (FMUE), the Modified Rankin Scale (MRS), Functional Independence Measure (FIM), Active Range of Motion (AROM), Manual Muscle Testing (MMT), Modified Ashworth Scale (MAS), and Functional Reach Test (FRT). The Kruskal–Wallis test was used to determine if there were significant differences between the groups, followed with pairwise comparisons. The Wilcoxon Signed-Rank test was used to determine the significance of pre to post-therapy changes. The Wilcoxon Signed-Rank test showed significant differences in all four groups regarding MMT, FMUE, and FIM assessments pre- and post-therapy, while for AROM, only experimental groups registered significant differences. Independent Kruskal–Wallis results showed that the subacute experimental group outcomes were statistically significant regarding the assessments, especially in comparison with the control groups. The results suggest that NIVR rehabilitation is efficient to be administered to post-stroke patients, and the study design can be used for a further trial, in the perspective that NIVR therapy can be more efficient than standard physiotherapy within the first six months post-stroke.

1. Introduction

Stroke Alliance for Europe states that “every 20 s, someone in Europe has a stroke”, while in the United States, “someone has a stroke every 40 s” a leading cause of significant long-term disabilities [1,2]. According to a European Union (EU) report, Romania has the lowest annual healthcare expenditure per capita (€1029 in 2015, compared to the EU average of €2884). The highest risk factors of a stroke are smoking and alcohol drinking, with males accounting for more than 50% of those impacted. Additionally, the level of education influences both lifestyle and life expectancy, with the Romanian life expectancy being among the lowest in the EU (75.3 years in Romania versus 80.9 years in the EU, in 2015). Moreover, there were 61,552 stroke cases in Romania in 2015 and forecasts state that this number will increase by 24% until 2035 [3,4].Worldwide, the population faces high incidence rates of stroke and post-stroke sequelae with an increased need for neurorehabilitation services. In Europe, it is estimated that the number of annual stroke events will increase from 613,148 registered in 2015 to 819,771 in 2035, an increase of 34%. Considering that post-stroke survival rates have improved; estimations predict that the number of people living with strokes in Europe will grow from 3,718,785 in 2015 to 4,631,050 in 2035 [1].Stroke complications can be long-lasting; thus, at 15-years post-stroke, two-thirds of survivors live with a disability, nearly two of five suffer from depression, and more than a quarter have cognitive impairment [5]. Post-stroke disability significantly contributes to the increasing use of long-term medical care resources, thus highlighting that efficient rehabilitation can cut costs in the healthcare system [6] whereas telerehabilitation is still in the early phase of utilization in developing countries.Furthermore, international guidelines for stroke rehabilitation include physiotherapy techniques and methods for the recovery of the swallowing function and the urinary and bowel continence. These techniques and methods are also recommended for the improvement/prevention of shoulder pain, joint misalignments, and limb deviations caused by post-stroke spasticity, also used for secondary prevention of falling, as well as for enhancing the ability to perform self-care and daily living activities. Recovery from post-stroke impairments is facilitated, on the one hand, by increasing the motor function and, on the other hand, by improving the functionality of the limbs and body as a whole functional unit. In order to retrieve functional capacity, the existing guidelines recommend the use of intensive, repetitive training, improvement of functional mobility, use of orthoses, performing specific activities of daily living (ADLs) practiced repeatedly, progressive and bilateral training of the upper limb, the use of virtual reality and assisted robotic therapy, and the use of strength training exercises [7,8,9].The use of virtual reality technology as an adjunct or substitute for traditional physiotherapy has been studied and proved to be effective in improving patients’ functional rehabilitation. However, as regards strokes, some systematic reviews suggest that virtual reality (VR) has not brought more benefits to patients compared to standard physiotherapy alone, while other research advocates for specific VR training as a therapy with a better outcome compared to conventional physiotherapy in the rehabilitation of stroke survivors [10,11,12,13,14].Research on neuroplasticity and learning or relearning abilities shows that there are several principles of motor learning, including multisensory stimulation, explicit feedback, knowledge of results, and motor imagery. These principles, notably explicit feedback and multisensory stimulation, are found in the VR technology used for neuromotor rehabilitation. Accordingly, VR therapy becomes an alternative to classical physiotherapy, as it develops neuroplasticity. So, novel enriched environments are preferred in the context of current rehabilitation methods since guidelines do not provide an accurate record of evidence inferred from the specialized literature about motor skill learning. This evidence is essential in identifying practical methods and applications that could shape future approaches to neuromotor relearning. Furthermore, in animal research, it has been shown that aerobic exercise and environmental enrichment have pleiotropic actions that influence the occurrence of molecular changes associated with stroke and subsequent spontaneous recovery. These aspects may argue in favor of the efficient use of VR in motor and functional recovery after a stroke, by stimulating neuroplasticity [15,16].Over the past ten years, research and literature reviews regarding the use of VR in post-stroke recovery have been homogeneous. Many approaches have focused on the use of VR as adjunct therapy alongside standard physiotherapy, and in some studies, non-dedicated VR technologies have been used, for medical purposes, in the motor rehabilitation of post-stroke patients [17,18]. Previous research on NIVR and immersive VR-based activities suggests that these interventions improve upper extremity rehabilitation after a stroke by providing motivating environments, stimulating extrinsic feedback, or simulating gameplay to facilitate recovery. Besides non-immersive VR therapy use in post-stroke patient’s rehabilitation, immersive VR therapy is used but requires more space and is more expensive, compared to NVIR. Robotic therapy is gaining more ground in neuro-motor rehabilitation, but the costs are very high, and in the case of exoskeletons, complex technology requires a long period of time for physiotherapists to acquire skills in the use of equipment. Currently, research has shown that VR positively influences the recovery of the upper extremity in post-stroke patients, as an adjunct therapy, by using dedicated and non-dedicated technologies [19,20]. The VR action on upper extremity post-stroke rehabilitation, using dedicated NVIR technology as a standalone therapy has not yet been determined at a staged level according to the post-stroke phases. The present study aims to investigate the efficiency of a dedicated NIVR system used in the rehabilitation of patients with subacute and chronic stroke, on upper extremity functionality and motor function. The research was done through specific VR training that incorporates real-time 3D motion capture and built-in visual feedback which provide functional exercises designed to train and regain the neuromotor functions of the upper extremity.Our main goal was to evaluate the efficiency of the proposed protocol, by using staged, specific, and customized NIVR therapy on three levels of difficulty and by using specific exergames according to patient’s capacity, and adjusted by the level of difficulty, compared to standard physiotherapy. Besides, we were looking for differences in post-stroke clinical and functional status in the use of VR that improve or negatively influence the functional outcomes of the upper extremity when exposed to VR-based therapy compared to standard physiotherapy. […]

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[Abstract + References] A Virtual Reality Serious Game for Hand Rehabilitation Therapy – IEEE Conference Publication


The human hand is the body part most frequently injured in occupational accidents, accounting for one out of five emergency cases and often requiring surgery with subsequently long periods of rehabilitation. This paper proposes a Virtual Reality game to improve conventional physiotherapy in hand rehabilitation, focusing on resolving recurring limitations reported in most technological solutions to the problem, namely the limited diversity support of movements and exercises, complicated calibrations and exclusion of patients with open wounds or other disfigurements of the hand. The system was assessed by seven able-bodied participants using a semistructured interview targeting three evaluation categories: hardware usability, software usability and suggestions for improvement. A System Usability Score (SUS) of 84.3 and participants’ disposition to play the game confirm the potential of both the conceptual and technological approaches taken for the improvement of hand rehabilitation therapy.


1. A. Elnaggar and D. Reichardt, “Digitizing the Hand Rehabilitation Using Serious Games Methodology with User-Centered Design Approach”, 2016 International Conference on Computational Science and Computational Intelligence (CSCI), pp. 13-22, 2016. Show Context View Article Full Text: PDF (1150KB) Google Scholar 

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[WEB PAGE] The Ultimate Guide to Stroke Exercises

Functional recovery is possible, even years after a stroke. Learn how to harness neuroplasticity through repetitive exercise, and the all-around health benefits of staying active after stroke or brain injury.

By JUNE LEE, 21 SEP 2020 

The Ultimate Guide to Stroke Exercises

Having a stroke is a mentally and physically taxing experience. According to the World Health Organization (WHO), 15 million people suffer from stroke worldwide each year. Of these, 5 million people die, and many survivors are left permanently disabled.

Stroke survivors may lose physical abilities and cognitive skills or undergo behavioral changes because strokes cause temporary or permanent damage to the brain areas that control those functions.

But here is the good news: the brain is able to recover after stroke, whether initially or months to years later. While short-term recovery after stroke (called spontaneous recovery) is limited to the first six months, long-term functional recovery can occur at any point thereafter. Stroke survivors who continue to engage their affected side in daily activity and exercise can capitalize on functional recovery potential throughout their stroke journey.

The Importance of Stroke Exercise for Rehabilitation and Recovery

The brain is capable of rewiring and repairing itself even if its cells are damaged. The undamaged parts step in to perform the tasks that the damaged parts were performing. This phenomenon (called neuroplasticity) allows stroke survivors to regain lost movement and function. The key to neuroplasticity is the consistent performance of repetitive tasks so that the brain can relearn how to perform these tasks through different neural pathways.

In simpler words, stroke exercise is one of the most effective means by which stroke patients can heal themselves, get stronger, improve the quality of their lives, and maximize their recovery from stroke. Because lifestyle factors like being overweight and having high blood pressure are a common cause of stroke, daily exercise becomes even more important in reducing the risk for recurrent stroke and other complications.

No matter the severity of the stroke, survivors can improve their quality of life through healthy lifestyle changes and engagement in restorative activities. Whether implementing big changes or small ones, the key to meaningful functional recovery is engaging in your post-stroke routine changes consistently.

The Physical and Mental Health Benefits of Stroke Recovery Exercises

Let’s look at some of the important physical and mental health benefits of engaging in stroke rehabilitation exercises. Post-stroke exercise is shown to produce many positive outcomes, which may include:

Physical benefits

  1. Speeds up all-round stroke recovery
  2. Recovers strength
  3. Improves endurance
  4. Increases walking speed
  5. Improves balance
  6. Boosts the ability to perform daily routine activities
  7. Prevents the recurrence of strokes.

Mental benefits

  1. Reduces depression and enhances mood
  2. Boosts brain health
  3. Relieves stress
  4. Helps in increasing a sense of self-worth and self-reliance that can decrease after a stroke
  5. Gives patients a sense of purpose and a goal to work towards.

Exercises to help Patients in Stroke Recovery at Home

The positive effects of post-stroke exercise are undeniable. However, when setting up an exercise routine as a stroke survivor, it is important to incorporate both cardiovascular fitness and muscle strengthening to ensure the most effective outcomes.

Stroke exercises are always safer to do with a loved one or caregiver around. However, if that is not possible, patients can modify an exercise program to ensure safe performance. For instance, completing exercises from sitting as opposed to standing to avoid loss of balance. It is also wise to consult a doctor or a therapist should any uncertainties about any of the stroke exercises arise or if you have any other underlying health condition.

Cardiovascular Fitness

Aerobic exercise is fundamental to building a healthy heart, improving endurance, and maintaining healthy lungs. Cardiovascular exercise can also improve the sensory perception and motor skills of stroke survivors. Walking outside or on a treadmill, stationary cycling, recumbent cross training and many other forms of exercise that get your heart pumping are extremely beneficial for stroke recovery.

Stroke survivors must get at least 20-60 minutes of light to moderate aerobic exercise (50 to 80% of your maximum heart rate) 3 to 7 days a week to improve the chances of stroke recovery. Patients can choose to do aerobic exercise at one go or in smaller sessions during the day.

Resistance Exercises for Strengthening Muscles

Resistance training or muscle strength training plays a crucial role in post-stroke recovery, as it helps to recover physical strength, stamina, stability, and improve range of motion.

Here are some commonly prescribed exercises for stroke recovery at home:

1. Wrist Curls

Equipment: A stable chair with armrests (preferably padded), light weights, or any household object which can provide some resistance and is easy to grip.

How To Do It: Sit up straight on the chair. Place your arms on the rests with your palms facing upward. Let your wrists dangle over the edge of the armrests. Grasp the weights firmly and comfortably, and with slow controlled movements, bend your wrist up towards your forearm and back down again (only your wrists should be moving).

Benefits: Wrist curls are isolated movements that build forearm strength, improve range of motion, and enhance gripping ability.

2. Wrist and Hand Stretch

Equipment: Stable chair with armrests.

How To Do It: With your arms facing downward and your wrists dangling over the edge of the armrest, drop your hand down and use your other hand to gently lift your wrist up and down and side to side.

Benefits: This simple movement stretches the ligaments in the wrist and forearms to maintain range of motion.

Modification: If you add a weight while completing this exercise, you are completing a reverse wrist curl, strengthening the muscles on the opposite side of your forearm.

3. Shoulder Openers

Equipment: Light weights or any light object that can be gripped easily and will provide some resistance.

How To Do It: Grasping your weights (make fists with your fingers facing inwards), hold your arms at your sides, and bend your elbows 90 degrees. With slow controlled movements, move your fists outwards while keeping your arms in position at your sides (like you are opening a door). Bring your arms back to your starting stance. (Can be performed both sitting or standing).

Benefits: This exercise improves range of motion and strength in the shoulders.

4. Table Towel Slide

Equipment: Folded Towel and table.

How To Do It: Place the towel in front of you. With your weaker hand on the towel and your stronger hand on top of it, slide the towel away and towards you (using your stronger hand to guide and push). Apart from going back and forth, you could also go clock and counter-clockwise, forming circles on the table.

Benefits: Stretches and strengthens shoulder and arm muscles and promotes neuroplasticity through improved arm coordination.

5. Trunk Bends

Equipment: A stable chair.

How To Do It: Sit on the edge of your chair with your feet planted slightly apart but firmly on the ground. Bend forward as far as you can, and try to reach your ankles or the floor between your legs. Then use your core muscles for sitting back up as straight as you can.

Benefits: Improves core strength and helps with weight shifting.

6. Knee Rotations

Equipment: Firm, flat surfaces such as a bed or a mat.

How To Do It: Lie on your back and rest your hands by your sides. Bend your knees with your feet flat on the floor. Keeping your knees together, drop them, slowly, to the left then, bring them back to the center. Then drop them to the right and back to the center.

Benefits: Improves core, back strength, coordination, and balance.

7. Hip Abduction

Equipment: Stable chair.

How To Do It: Sit up straight on the edge of your chair. Gently tighten your abs and straighten one knee. With your toes pointed to the ceiling, slowly move your foot out to the side. Return to the starting stance, then repeat on the other side. You can decrease the intensity by lying down and performing this exercise or make it more difficult by attempting this from standing, if you are capable.

Benefits: Strengthens hips, core, leg, back, and improves coordination and stability.

8. Standing Knee Raises

Equipment: A firm surface to hold on to.

How To Do it: Stand with your back straight and hold on to a firm surface. Shifting your weight to one leg, bring the other leg up in front of you while bending your knee to a 90-degree angle. Hold for a few seconds and resume the starting position. Then switch legs.

Benefits: Strengthens upper and lower abs, hips, and back. It also helps with posture, balance, and coordination.

9. Sit to Stands

Equipment: Stable chair.

How To Do it: Sit up tall in your chair with your knees bent (90 degrees). Place your feet firmly on the floor shoulder-width apart. Slowly rise to a standing position while ensuring that your knees never cross the tips of your toes. Sit back down slowly and in a controlled manner. To make it less intense, use your arms for support, and to make it more difficult, cross your arms on your chest.

Benefits: Strengthens core and upper thigh muscles, improves weight shifting and balance.

10. Hip Thrusts

Equipment: A flat, firm surface like a bed or a mat.

How To Do it: Lie on your back with your feet flat on the ground and knees bent. Place your arms by your sides, palms down. Gently contract your abs and squeeze your glutes (backside muscles) to lift your hips and make a bridge. Hold on this position for a few seconds and lower to the starting stance. You can make it easier by straightening your legs and placing a rolled-up towel under your knees, then squeezing and lifting your hips. You could also make it more intense by lifting one foot at a time while holding the bridge.

Benefits: It boosts the strength of the core, glutes, lower back muscles, and muscles that support the spine.

Frequency and Intensity of Stroke Exercises

Stroke exercise is most beneficial if done consistently and repetitively. It is always best to consult your medical team about the type and frequency of exercises that are optimal for your unique situation. Do not risk your safety by attempting things that you are unsure about.

As a guideline, resistance exercises should be done 3-5 times a week. 2-3 sets of 12-15 repetitions (of each exercise) should be completed to achieve noticeable results. A survivor who is new to exercise post-stroke exercises may have to work up to the ideal frequency of exercise over time.

Stroke exercise should never cause pain. Pain may indicate that you are causing new or lasting damage to your muscles and joints. If your exercises produce a burning, shooting, or otherwise uncomfortable sensation, stop immediately and modify the activity (ex. reduce weight, perform the exercise within a smaller range of motion). If it is not possible to perform the activity without pain, remove it from your program and ask your doctor.


A stroke results in drastic and sudden changes in life that can leave survivors struggling physically, socially, and emotionally. However, proper stroke exercise is the path to reclaiming the body, mind, and quality of life. With determination and hard work, there is light at the end of the tunnel and a more promising future ahead.

For more information, support, or to know more about the latest developments in stroke recovery, give us a call at (888) 623-8984 or email at


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