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Archive for category Tele/Home Rehabilitation
[Abstract] User performance evaluation and real-time guidance in cloud-based physical therapy monitoring and guidance system
The effectiveness of traditional physical therapy may be limited by the sparsity of time a patient can spend with the physical therapist (PT) and the inherent difficulty of self-training given the paper/figure/video instructions provided to the patient with no way to monitor and ensure compliance with the instructions.
In this paper, we propose a cloud-based physical therapy monitoring and guidance system. It is able to record the actions of the PT as he/she demonstrates a task to the patient in an offline session, and render the PT as an avatar. The patient can later train himself by following the PT avatar and getting real-time guidance on his/her device.
Since the PT and user (patient) motion sequences may be misaligned due to human reaction and network delays, we propose a Gesture-Based Dynamic Time Warping algorithm that can segment the user motion sequence into gestures, and align and evaluate the gesture sub-sequences, all in real time. We develop an evaluation model to quantify user performance based on different criteria provided by the PT for a task, trained with offline subjective test data consisting of user performance and physical therapist scores. Moreover, we design three types of guidance which can be provided after each gesture based on user score, and conduct subjective tests to validate their effectiveness.
Experiments with multiple subjects show that the proposed system can effectively train patients, give accurate evaluation scores, and provide real-time guidance which helps the patients learn the tasks and reach the satisfactory score with less time.
[ARTICLE] Home-based neurologic music therapy for arm hemiparesis following stroke: results from a pilot, feasibility randomized controlled trial – Full Text
To assess the feasibility of a randomized controlled trial to evaluate music therapy as a home-based intervention for arm hemiparesis in stroke.
A pilot feasibility randomized controlled trial, with cross-over design. Randomization by statistician using computer-generated, random numbers concealed in opaque envelopes.
Eleven people with stroke and arm hemiparesis, 3–60 months post stroke, following discharge from community rehabilitation.
Each participant engaged in therapeutic instrumental music performance in 12 individual clinical contacts, twice weekly for six weeks.
Feasibility was estimated by recruitment from three community stroke teams over a 12-month period, attrition rates, completion of treatment and successful data collection. Structured interviews were conducted pre and post intervention to establish participant tolerance and preference. Action Research Arm Test and Nine-hole Peg Test data were collected at weeks 1, 6, 9, 15 and 18, pre and post intervention by a blinded assessor.
A total of 11 of 14 invited participants were recruited (intervention n = 6, waitlist n = 5). In total, 10 completed treatment and data collection.
It cannot be concluded whether a larger trial would be feasible due to unavailable data regarding a number of eligible patients screened. Adherence to treatment, retention and interview responses might suggest that the intervention was motivating for participants.
A total of 80% of stroke cases result in hemiparesis,1 and half this number experience persistent lack of arm function.2 Effective interventions are lacking, and evidence to support those that are accessible is insufficient.3 A clear need has been identified for long-term support in the community for people with stroke, but services are limited and few studies have examined home-based interventions and provided sufficient detail of the protocols used.4
Music interventions may be beneficial for improving arm function following stroke,5,6 and a strong rhythmic stimulus embedded within music may enhance motor performance more than the use of a rhythmic stimulus alone without music.7 More research is needed to establish the effects of music interventions on arm function, and with the majority of rehabilitation being delivered in patients’ homes it is useful to determine the feasibility of home-based treatment delivery and research. This article reports on the feasibility of conducting a randomized controlled trial where a music intervention, for which there was a clear protocol based on published guidelines,8,9 was delivered in a variety of home environments.
Continue —> Home-based neurologic music therapy for arm hemiparesis following stroke: results from a pilot, feasibility randomized controlled trialClinical Rehabilitation – Alexander J Street, Wendy L Magee, Andrew Bateman, Michael Parker, Helen Odell-Miller, Jorg Fachner, 2018
Cloud-based rehabilitation services for post-stroke hand disability.
Tensor-based pattern recognition technique to detect the real-time condition of patient.
The integration of cloud computing with AR-based rehabilitation system.
Multi-sensory big data oriented tensor approach to handle patient’s collected data.
Given the flexibility and potential of cloud technologies, cloud-based rehabilitation frameworks have shown encouraging results as assistive tools for post-stroke disability rehabilitation exercises and treatment. To treat post-stroke disability, cloud-based rehabilitation offers great advantages over conventional, clinic-based rehabilitation, providing ubiquitous flexible rehabilitation services and storage while offering therapeutic feedback from a therapist in real-time during patients’ rehabilitative movements. With the development of sensory technologies, cloud computing technology integrated with Augmented Reality (AR) may make therapeutic exercises more enjoyable.
To achieve these objectives, this paper proposes a framework for cloud-based rehabilitation services, which uses AR technology along with other sensory technologies. We have designed a prototype of the framework that uses the mechanism of sensor gloves to recognize gestures, detecting the real-time condition of a patient doing rehabilitative exercises. This prototype framework is tested on twelve patients not using sensor gloves and on four patients wearing sensor gloves over six weeks. We found statistically significant differences between the forces exerted by patients’ fingers at week one compared to week six. Significant improvements in finger strength were found after six weeks of therapeutic rehabilitative exercises.
Exergames provide a challenging opportunity for home-based training and evaluation of postural control in the elderly population, but affordable sensor technology and algorithms for assessment of whole body movement patterns in the home environment are yet to be developed.
The aim of the present study was to evaluate the use of Kinect, a commonly available video game sensor, for capturing and analyzing whole body movement patterns.
Healthy adults (n=20) played a weight shifting exergame under five different conditions with varying amplitudes and speed of sway movement, while 3D positions of ten body segments were recorded in the frontal plane using Kinect and a Vicon 3D camera system. Principal Component Analysis (PCA) was used to extract and compare movement patterns and the variance in individual body segment positions explained by these patterns. Using the identified patterns, balance outcome measures based on spatiotemporal sway characteristics were computed.
The results showed that both Vicon and Kinect capture >90% variance of all body segment movements within three PCs. Kinect-derived movement patterns were found to explain variance in trunk movements accurately, yet explained variance in hand and foot segments was underestimated and overestimated respectively by as much as 30%. Differences between both systems with respect to balance outcome measures range 0.3–64.3%.
The results imply that Kinect provides the unique possibility of quantifying balance ability while performing complex tasks in an exergame environment.
The functional connectivity and structural proximity of elements of the language and motor systems result in frequent co-morbidity post brain injury. Although rehabilitation services are becoming increasingly multidisciplinary and “integrated”, treatment for language and motor functions often occurs in isolation. Thus, behavioural therapies which promote neural reorganisation do not reflect the high intersystem connectivity of the neurologically intact brain. As such, there is a pressing need for rehabilitation tools which better reflect and target the impaired cognitive networks.
The objective of this research is to develop a combined high dosage therapy tool for language and motor rehabilitation. The rehabilitation therapy tool developed, MaLT (Motor and Language Therapy), comprises a suite of computer games targeting both language and motor therapy that use the Kinect sensor as an interaction device. The games developed are intended for use in the home environment over prolonged periods of time. In order to track patients’ engagement with the games and their rehabilitation progress, the game records patient performance data for the therapist to interrogate.
MaLT incorporates Kinect-based games, a database of objects and language parameters, and a reporting tool for therapists. Games have been developed that target four major language therapy tasks involving single word comprehension, initial phoneme identification, rhyme identification and a naming task. These tasks have 8 levels each increasing in difficulty. A database of 750 objects is used to programmatically generate appropriate questions for the game, providing both targeted therapy and unique gameplay every time. The design of the games has been informed by therapists and by discussions with a Public Patient Involvement (PPI) group.
Pilot MaLT trials have been conducted with three stroke survivors for the duration of 6 to 8 weeks. Patients’ performance is monitored through MaLT’s reporting facility presented as graphs plotted from patient game data. Performance indicators include reaction time, accuracy, number of incorrect responses and hand use. The resultant games have also been tested by the PPI with a positive response and further suggestions for future modifications made.
MaLT provides a tool that innovatively combines motor and language therapy for high dosage rehabilitation in the home. It has demonstrated that motion sensor technology can be successfully combined with a language therapy task to target both upper limb and linguistic impairment in patients following brain injury. The initial studies on stroke survivors have demonstrated that the combined therapy approach is viable and the outputs of this study will inform planned larger scale future trials.
Available from: https://www.researchgate.net/publication/321478935_EMG_based_FES_for_post-stroke_rehabilitation [accessed Dec 09 2017].
ePHoRt is a project that aims to develop a web-based system for the remote monitoring of rehabilitation exercises in patients after hip replacement surgery. The tool intends to facilitate and enhance the motor recovery, due to the fact that the patients will be able to perform the therapeutic movements at home and at any time. As in any case of rehabilitation program, the time required to recover is significantly diminished when the individual has the opportunity to practice the exercises regularly and frequently. However, the condition of such patients prohibits transportations to and from medical centers and many of them cannot afford a private physiotherapist. Thus, low-cost technologies will be used to develop the platform, with the aim to democratize its access. By taking into account such a limitation, a relevant option to record the patient’s movements is the Kinect motion capture device. The paper describes an experiment that evaluates the validity and accuracy of this visual capture by a comparison to an accelerometer sensor. The results show a significant correlation between both systems and demonstrate that the Kinect is an appropriate tool for the therapeutic purpose of the project.
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[Abstract] Feasibility study of a serious game based on Kinect system for functional rehabilitation of the lower limbs
Conventional functional rehabilitation costs time, money and effort for the patients and for the medical staff. Serious games have been used as a new approach to improve the performance as well as to possibly reduce medical cost in the future for cognitive rehabilitation and body balance control. The objective of this present work was to perform a feasibility study on the use of a new real-time serious game system for improving the musculoskeletal rehabilitation of the lower limbs.
Materials and methods
A basic functional rehabilitation exercise database was established with different levels of difficulties. A 3D virtual avatar was created and scaled to represent each subject-specific body. A portable and affordable Kinect sensor was used to capture real-time kinematics during each exercise. A specific data coupling process was developed. An evaluation campaign was established to assess the developed system.
The squats exercise was the hardest challenge. Moreover, the performance of each functional rehabilitation exercise depended on the physiological profile of each participant. Our game system was clear and attractive for all functional rehabilitation exercises. All testing subjects felt motivated and secure when playing the rehabilitation game.
The comparison with other systems showed that our system was the first one focusing on the functional rehabilitation exercises of the lower limbs.
Our system showed useful functionalities for a large range of applications (rehabilitation at home, sports training). Looking forward, new in-situation exercises will be investigated for specific musculoskeletal disorders.
[ARTICLE] Development and Implementation of a New Telerehabilitation System for Audiovisual Stimulation Training in Hemianopia – Full Text
Telerehabilitation, defined as the method by which communication technologies are used to provide remote rehabilitation, although still underused, could be as efficient and effective as the conventional clinical rehabilitation practices. In the literature, there are descriptions of the use of telerehabilitation in adult patients with various diseases, whereas it is seldom used in clinical practice with child and adolescent patients. We have developed a new audiovisual telerehabilitation (AVT) system, based on the multisensory capabilities of the human brain, to provide a new tool for adults and children with visual field defects in order to improve ocular movements toward the blind hemifield. The apparatus consists of a semicircular structure in which visual and acoustic stimuli are positioned. A camera is integrated into the mechanical structure in the center of the panel to control eye and head movements. Patients can use this training system with a customized software on a tablet. From hospital, the therapist has complete control over the training process, and the results of the training sessions are automatically available within a few minutes on the hospital website. In this paper, we report the AVT system protocol and the preliminary results on its use by three adult patients. All three showed improvements in visual detection abilities with long-term effects. In the future, we will test this apparatus with children and their families. Since interventions for impairments in the visual field have a substantial cost for individuals and for the welfare system, we expect that our research could have a profound socio-economic impact avoiding prolonged and intensive hospital stays.
Telerehabilitation, defined as the method by which communication technologies are used to provide remote rehabilitation, although still underused, could be as efficient and effective as the conventional clinical rehabilitation practices (1). In the literature, we can find some descriptions of the use of telerehabilitation in adult patients for various types of disorder, whereas it is seldom used in clinical practice with children and adolescents (2).
The development and use of telerehabilitation program are slow because they are affected by many logistical factors, such as regional economic resources, medical technical support systems, and population quality, but their potential is very high, as they are conceived and studied to improve patients’ ability to perform activities from daily life, thereby increasing their independence (3). For example, for adult post-stroke patients, telerehabilitation is widely used with the main goal of giving disabled people the same quality of motor, cognitive, and neuropsychological rehabilitation at home as they would have in-home visit and day-care rehabilitation (4, 5–7).
So far, the application of telerehabilitation during childhood has been primarily limited to preterm babies (8) and children with hemiplegia (9, 10), with autism spectrum disorders (11), with speech and language disorders (12, 13), and with learning difficulties (14–16). Despite the well-known impact of visual defects on cognitive functioning and neurological recovery (17), no study has yet investigated the application of telerehabilitation with children with visual impairments.
Here, we describe an innovative telerehabilitation platform, which consists in an audiovisual telerehabilitation (AVT) system, developed for children and adults with visual field defects caused by post-chiasmatic brain lesions. The AVT system allows patients to exercise independently, in an intensive, active, and functional way and in a familiar environment, under remote supervision; it consists of a mobile device platform with remote control, which is accessible directly from home and suitable both for adults, adolescents, and children from the age of 8.
The AVT system is based on a very promising multisensory audiovisual therapy, originally developed for the treatment of adults and children with visual field defects caused by brain lesions (18, 19). Basically, this training aims to stimulate multisensory integration mechanisms in order to reinforce visual and spatial compensatory functions (i.e., implementation of oculomotor strategies). In this first phase of the study, we tested the feasibility and efficacy of AVT in three adult patients with chronic visual field defects, in order to explore how the apparatus can be implemented at home.[…]
Background. Although rehabilitation therapy is commonly provided after stroke, many patients do not derive maximal benefit because of access, cost, and compliance. A telerehabilitation-based program may overcome these barriers. We designed, then evaluated a home-based telerehabilitation system in patients with chronic hemiparetic stroke. Methods. Patients were 3 to 24 months poststroke with stable arm motor deficits. Each received 28 days of telerehabilitation using a system delivered to their home. Each day consisted of 1 structured hour focused on individualized exercises and games, stroke education, and an hour of free play. Results. Enrollees (n = 12) had baseline Fugl-Meyer (FM) scores of 39 ± 12 (mean ± SD). Compliance was excellent: participants engaged in therapy on 329/336 (97.9%) assigned days. Arm repetitions across the 28 days averaged 24,607 ± 9934 per participant. Arm motor status showed significant gains (FM change 4.8 ± 3.8 points, P = .0015), with half of the participants exceeding the minimal clinically important difference. Although scores on tests of computer literacy declined with age (r = −0.92; P < .0001), neither the motor gains nor the amount of system use varied with computer literacy. Daily stroke education via the telerehabilitation system was associated with a 39% increase in stroke prevention knowledge (P = .0007). Depression scores obtained in person correlated with scores obtained via the telerehabilitation system 16 days later (r = 0.88; P = .0001). In-person blood pressure values closely matched those obtained via this system (r = 0.99; P < .0001). Conclusions. This home-based system was effective in providing telerehabilitation, education, and secondary stroke prevention to participants. Use of a computer-based interface offers many opportunities to monitor and improve the health of patients after stroke.
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Source: A Home-Based Telerehabilitation Program for Patients With StrokeNeurorehabilitation and Neural Repair – Lucy Dodakian, Alison L. McKenzie, Vu Le, Jill See, Kristin Pearson-Fuhrhop, Erin Burke Quinlan, Robert J. Zhou, Renee Augsberger, Xuan A. Tran, Nizan Friedman, David J. Reinkensmeyer, Steven C. Cramer, 2017