Posts Tagged assistive technologies

[ARTICLE] BCI and FES Based Therapy for Stroke Rehabilitation Using VR Facilities – Full Text

Abstract

In recent years, the assistive technologies and stroke rehabilitation methods have been empowered by the use of virtual reality environments and the facilities offered by brain computer interface systems and functional electrical stimulators. In this paper, a therapy system for stroke rehabilitation based on these revolutionary techniques is presented. Using a virtual reality Oculus Rift device, the proposed system ushers the patient in a virtual scenario where a virtual therapist coordinates the exercises aimed at restoring brain function. The electrical stimulator helps the patient to perform rehabilitation exercises and the brain computer interface system and an electrooculography device are used to determine if the exercises are executed properly. Laboratory tests on healthy people led to system validation from technical point of view. The clinical tests are in progress, but the preliminary results of the clinical tests have highlighted the good satisfaction degree of patients, the quick accommodation with the proposed therapy, and rapid progress for each user rehabilitation.

1. Introduction

The worldwide statistics reported by World Health Organization highlight that stroke is the third leading cause of death and about 15 million people suffer stroke worldwide each year ‎[1]. Of these, 5 million are permanently disabled needing long time assistance and only 5 million are considered socially integrated after recovering. Recovering from a stroke is a difficult and long process that requires patience, commitment, and access to various assistive technologies and special devices. Rehabilitation is an important part of recovering and helps the patient to keep abilities or gain back lost abilities in order to become more independent. Taking into account the depression installed after stroke, it is very important for a patient to benefit from an efficient and fast rehabilitation program followed by a quick return to community living ‎[2]. In the last decade, many research groups are focused on motor, cognitive, or speech recovery after stroke like Stroke Centers from Johns Hopkins Institute ‎[3], ENIGMA-Stroke Recovery ‎[4], or StrokeBack Consortium funded by European Union’s Seventh Framework Programme ‎[5]. Important ICT companies bring a major contribution to the development of technologies and equipment that can be integrated into rehabilitation systems. For example, Stroke Recovery with Kinect is a research project to build an interactive and home-rehabilitation system for motor recovery after a stroke based on Microsoft Kinect technology ‎[6].

In the last years, the virtual reality (VR) applications received a boost in development due to VR headset prices that dropped below $1000, allowing them to become a mass-market product ‎[7]. The VR was and still is especially used for military training or video games to provide some sense of realism and interaction with the virtual environment to its users ‎[8]. Now it attracts more and more the interest of physicians and therapist which are exploring the potential of VR headset and augmented reality (AR) to improve the neuroplasticity of the brain, to be used in neurorehabilitation and treatment of motor/mental disorders ‎[9]. However, considering the diversity of interventions and methods used, there is no evidence that VR therapy alone can be efficacious compared with other traditional therapies for a particular type of impairment ‎[10]. This does not mean that the potential of VR was overestimated and the results are not the ones that were expected. The VR therapy must be complemented with other forms of rehabilitation technologies like robotic therapy, brain computer interface (BCI) and functional electrical stimulation (FES) therapy, and nevertheless traditional therapy to provide a more targeted approach ‎[11].

SaeboVR is a virtual rehabilitation system exclusively focusing on activities of daily living and uses a virtual assistant that appears on the screen to educate and facilitate performance by providing real-time feedback ‎[12]. The neurotechnology company MindMaze has introduced MindMotion PRO, a 3D virtual environment therapy for upper limb neurorehabilitation incorporating virtual reality-based physical and cognitive exercise games into stroke rehabilitation programs ‎[13]. At New York Dynamic Neuromuscular Rehabilitation, the CAREN (Computer Assisted Rehabilitation Environment) based on VR is currently used to treat patients poststroke and postbrains injuries ‎[14]. EVREST Multicentre has achieved remarkable results regarding the use of VR exercises in stroke rehabilitation ‎[15].

Motor imagery (MI) is a technique used in poststroke rehabilitation for a long time ago. One of its major problems was that there was not an objective method to determine whether the user is performing the expected movement imagination. MI-based BCIs can quantify the motor imagery and output signals that can be used for controlling an external device such as a wheelchair, neuroprosthesis, or computer. The FES therapy combined with MI-based BCI became a promising technique for stroke rehabilitation. Instead of providing communication, in this case, MI is used to induce closed-loop feedback within conventional poststroke rehabilitation therapy. This approach is called paired stimulation (PS) due to the fact that it pairs each user’s motor imagery with stimulation and feedback, such as activation of a functional electrical stimulator (FES), avatar movement, and/or auditory feedback ‎[16]. Recent research from many groups showed that MI can be recorded in the clinical environment from patients and used to control real-time feedback and at the same time, they support the hypothesis that PS could improve the rehabilitation therapy outcome ‎[1721].

In a recent study, Irimia et al. ‎[22] have proved the efficacy of combining motor imagery, bar feedback, and real hand movements by testing a system combining a MI-based BCI and a neurostimulator on three stroke patients. In every session, the patients had to imagine 120 left-hand and 120 right-hand movements. The visual feedback was provided in form of an extending bar on the screen. During the trials where the correct imagination was classified, the FES was activated in order to induce the opening of the corresponding hand. All patients achieved high control accuracies and exhibited improvements in motor function. In a later study, Cho et al. ‎[23] present the results of two patients who performed the BCI training with first-person avatar feedback. After the study, both patients reported improvements in motor functions and both have improved their scores on Upper Extremity Fugl-Meyer Assessment scale. Even if the number of patients presented in these two studies is low, they support the idea that this kind of systems may bring additional benefits to the rehabilitation process outcome in stroke patients.

2. General System Architecture

The BCI-FES technique presented in this paper is part of a much more complex system designed for stroke rehabilitation called TRAVEE ‎[24], presented in Figure 1. The stimulation devices, the monitoring devices, the VR headset, and a computer running the software are the main modules of the TRAVEE system. The stimulation devices help the patient to perform the exercises and the monitoring devices are used to determine if the exercises are executed properly, according to the proposed scenarios. Actually, the TRAVEE system must be seen as a software kernel that allows defining a series of rehabilitation exercises using a series of USB connectable devices. This approach is very useful because it offers the patient the options to buy, borrow, or rent the abovementioned devices according to his needs and after connection, the therapist may choose the suitable set of exercises.[…]

 

Continue —> BCI and FES Based Therapy for Stroke Rehabilitation Using VR Facilities

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[Abstract] Upper limb motor training using a Saebo™ orthosis is feasible for increasing task-specific practice in hospital after stroke

Abstract

Background/aim

Assistive technologies have the potential to increase the amount of movement practice provided during inpatient stroke rehabilitation. The primary aim of this study was to investigate the feasibility of using the Saebo-Flex device in a subacute stroke setting to increase task-specific practice for people with little or no active hand movement. The secondary aim was to collect preliminary data comparing hand/upper limb function between a control group that received usual rehabilitation and an intervention group that used, in addition, the Saebo-Flex device.

Methods

Nine inpatients (mean three months (median six weeks) post-stroke) participated in this feasibility study conducted in an Australian rehabilitation setting, using a randomised pre-test and post-test design with concealed allocation and blinded outcome assessment. In addition to usual rehabilitation, the intervention group received eight weeks of daily motor training using the Saebo-Flex device. The control group received usual rehabilitation (task-specific motor training) only. Participants were assessed at baseline (pre-randomisation) and at the end of the eight-week study period. Feasibility was assessed with respect to ease of recruitment, application of the device, compliance with the treatment programme and safety. Secondary outcome measures included the Motor Assessment Scale (upper limb items), Box and Block Test, grip strength and the Stroke Impact Scale.

Results

Recruitment to the study was very slow because of the low number of patients with little or no active hand movement. Otherwise, the study was feasible in terms of being able to apply the Saebo-Flex device and compliance with the treatment programme. There were no adverse events, and a greater amount of upper limb rehabilitation was provided to the intervention group. While there were trends in favour of the intervention group, particularly for dexterity, no between-group differences were seen for any of the secondary outcomes.

Conclusions

This pilot feasibility study showed that the use of assistive technology, specifically the Saebo-Flex device, could be successfully used in a sample of stroke patients with little or no active hand movement. However, recruitment to the trial was very slow. The use of the Saebo-FlexTM device had variable results on outcomes, with some positive trends seen in hand function, particularly dexterity.

Source: Upper limb motor training using a Saebo™ orthosis is feasible for increasing task-specific practice in hospital after stroke – Lannin – 2016 – Australian Occupational Therapy Journal – Wiley Online Library

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[Abstract] Upper limb motor training using a Saebo™ orthosis is feasible for increasing task-specific practice in hospital after stroke. – Australian Occupational Therapy Journal

Abstract

Background/aim

Assistive technologies have the potential to increase the amount of movement practice provided during inpatient stroke rehabilitation. The primary aim of this study was to investigate the feasibility of using the Saebo-Flex device in a subacute stroke setting to increase task-specific practice for people with little or no active hand movement. The secondary aim was to collect preliminary data comparing hand/upper limb function between a control group that received usual rehabilitation and an intervention group that used, in addition, the Saebo-Flex device.

Methods

Nine inpatients (mean three months (median six weeks) post-stroke) participated in this feasibility study conducted in an Australian rehabilitation setting, using a randomised pre-test and post-test design with concealed allocation and blinded outcome assessment. In addition to usual rehabilitation, the intervention group received eight weeks of daily motor training using the Saebo-Flex device. The control group received usual rehabilitation (task-specific motor training) only. Participants were assessed at baseline (pre-randomisation) and at the end of the eight-week study period. Feasibility was assessed with respect to ease of recruitment, application of the device, compliance with the treatment programme and safety. Secondary outcome measures included the Motor Assessment Scale (upper limb items), Box and Block Test, grip strength and the Stroke Impact Scale.

Results

Recruitment to the study was very slow because of the low number of patients with little or no active hand movement. Otherwise, the study was feasible in terms of being able to apply the Saebo-Flex device and compliance with the treatment programme. There were no adverse events, and a greater amount of upper limb rehabilitation was provided to the intervention group. While there were trends in favour of the intervention group, particularly for dexterity, no between-group differences were seen for any of the secondary outcomes.

Conclusions

This pilot feasibility study showed that the use of assistive technology, specifically the Saebo-Flexdevice, could be successfully used in a sample of stroke patients with little or no active hand movement. However, recruitment to the trial was very slow. The use of the Saebo-FlexTM device had variable results on outcomes, with some positive trends seen in hand function, particularly dexterity.

Source: Upper limb motor training using a Saebo™ orthosis is feasible for increasing task-specific practice in hospital after stroke – Lannin – 2016 – Australian Occupational Therapy Journal – Wiley Online Library

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[REVIEW ARTICLE] Recent Development of Rehabilitation Robots – Full Text HTML

Abstract:

We have conducted a critical review on the development of rehabilitation robots to identify the limitations of existing studies and clarify some promising research directions in this field. This paper is presented to summarize our findings and understanding. The demands for assistive technologies for elderly and disabled population have been discussed, the advantages and disadvantages of rehabilitation robots as assistive technologies have been explored, the issues involved in the development of rehabilitation robots are investigated, some representative robots in this field by leading research institutes have been introduced, and a few of critical challenges in developing advanced rehabilitation robots have been identified. Finally to meet the challenges of developing practical rehabilitation robots, reconfigurable and modular systems have been proposed to meet the identified challenges, and a few of critical areas leading to the potential success of rehabilitation robots have been discussed.

1. Introduction

The progress on the studies of rehabilitating robots has been significantly lagged in contrast to the emerging society needs. On the one hand, the population who needs assistance and rehabilitation is consistently increasing; on the other hand, the existing rehabilitation robots have the limited capabilities of personalization and yet they are too expensive for the majority of patients. The performances of existing robots have been proven unsatisfactory [1, 2]. The innovations in the development of the next-generation rehabilitation robots can lead to significant benefits to human beings. In this paper, a critical literature review is conducted to identify the limitations of existing works and clarify the prosperous research directions in the development of assistive robots. In the next sections, the needs of assistive technologies in the healthcare industry are introduced…

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via Recent Development of Rehabilitation Robots.

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