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[BOOK] Emerging Therapies in Neurorehabilitation II – [Chapter] Virtual Rehabilitation – Request PDF


This chapter addresses the current state of the art of virtual rehabilitation by summarizing recent research results that focus on the assessment and remediation of motor impairments using virtual rehabilitation technology. Moreover, strengths and weaknesses of the virtual rehabilitation approach and its technical and clinical implications will be discussed. This overview is an update and extension of a previous virtual rehabilitation chapter with a similar focus. Despite tremendous advancements in virtual reality hardware in the past few years, clinical evidence for the efficacy of virtual rehabilitation methods is still sparse. All recent meta-analyses agree that the potential of virtual reality systems for motor rehabilitation in stroke and traumatic brain injury populations is evident, but that larger clinical trials are needed that address the contribution of individual aspects of virtual rehabilitation systems on different patient populations in acute and chronic stages of neurorehabilitation.

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[BOOK Chapter] The “Arm” Line of Devices for Neurological Rehabilitation: Engineering Book Chapter – Abstract


In the modern scenario of neurological rehabilitation, which requires affordable solutions oriented toward promoting home training, the Institute of Industrial Technologies and Automation (ITIA) of the Italian National Research Council (CNR) developed a line of prototypal devices for the rehabilitation of the upper limb, called “Arm.” Arm devices were conceived to promote rehabilitation at affordable prices by capturing all the main features of the state-of-the-art devices. In fact, Arm devices focus on the main features requested by a robot therapist: mechanical adaptation to the patient, ranging from passive motion to high transparency, assist-as-needed and resistive modalities; proper use of sensors for performance monitoring; easy-to-use, modular, and adaptable design. These desirable features are combined with low-cost, additive manufacturing procedures, with the purpose of meeting the requirements coming from research on neuro-motor rehabilitation and motor control and coupling them with the recent breakthrough innovations in design and manufacturing.

The “Arm” Line of Devices for Neurological Rehabilitation

Copyright: © 2018 |Pages: 30

DOI: 10.4018/978-1-5225-2993-4.ch007




 The use of robotic devices for upper-limb neuro-motor rehabilitation is usual practice in clinical centers. In respect to conventional therapies, robots allow to increase training intensity and help patients to promote their active contribution. Furthermore, robots can act as measurers of patients’ performances and adapt their interaction modalities to the emerging needs during the rehabilitation course. Robots like ARMin, MIT Manus, Armeo Spring, Braccio di Ferro, represent the state of the art devices for rehabilitation of the upper-limb and for promoting motor recovery. According to the available assessments and studies in the literature, their efficacy is slightly/moderately higher than the one of conventional therapies. Furthermore, robots are used in research to learn more about physiological and pathological motor control and neuromuscular diseases. Unfortunately, while being the state of the art devices for neuro-motor stimulation and training, such robots are very expensive and not compliant to user-friendly requirements that are needed for semi-autonomous home use. Consequently, they can be used only in clinical environments, under the supervision of medical personnel. Furthermore, sanitary costs related to rehabilitation are increasing and clinical centers can hardly support their burden. The possibility of delocalizing rehabilitation from clinical centers opens the chance for training performed in home environment, with time and costs savings for both the sanitary system and patients. In this scenario, which requires affordable solutions oriented toward promoting home training, the Institute of Industrial Technologies and Automation (ITIA) of the Italian National Research Council (CNR) developed a line of prototypal devices for the rehabilitation of the upper-limb, called -ArmArm devices were conceived to test the possibility of promoting rehabilitation at affordable prices but capturing all the main features of the state of the art devices. In fact, Arm devices focus on the main features requested by a robot therapist: mechanical adaptation to the patient, ranging from passive motion to high transparency, assist-as-needed and resistive modalities; proper use of sensors for performance monitoring; easy-to-use, modular and adaptable design. These desirable features are combined with low-cost, additive manufacturing procedures, with the purpose of meeting the requirements coming from research on neuro-motor rehabilitation and motor control and coupling them with the recent breakthrough innovations in design and manufacturing. Arm devices cover both clinical and home-oriented training and are designed for adaptation to patients with different motor impairment.

The Arm prototypes are:

  • • LINarm: linear device, freely orientable in space, suitable for functional movements. It features a variable stiffness actuation, allowing to adapt the mechanical behavior of the device to patients’ needs. Functional Electrical Stimulation, simple Virtual Environments and a Patient Model, gathering data from integrated sensors and modulating the level of assistance, are integrated in the set-up. The LINarm++ Echord++ Project ended in October 2016 and guided the development of a second, more refined prototype, enhancing the original concept.
  • • PLANarm: planar device, freely orientable in space, suitable for planar functional movements. The state of the art planar robots used in literature for motor control and motor learning research inspired PLANarm. It features a variable stiffness actuation, allowing adapting the mechanical behavior of the device depending on patients’ needs.
  • • DUALarm: Low-Cost device for bimanual rehabilitation, exploiting the capability of the less affected limb to provide rehabilitation to the more affected limb. DUALarm is completely realized in 3D printing technology and aims at being an easy-to-use, low-cost, open-source project. Currently, reaching movements can be trained, but the device is conceived to be suitable for training of other functional gestures.
  • • LIGHTarm: Exoskeleton for the rehabilitation of the upper-limb, designed in two versions: LIGHTarm, not actuated, and conceived to support the weight of the impaired limb. The mechanical design includes high backdrivability, focusing on shoulder rhythm and elbow singular configurations.
  • • VIRTUALarm: Kinect One-based platform for motor monitoring, including body and limb tracking and a biomechanical evaluation of the performance in relation to databases of healthy subjects. Assessments include range of motion, motion dynamics, effort, motor control indexes, body segments barycenter tracking.

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[BOOK] Spasticity: Diagnosis and Management – Google Books

Front Cover
Allison Brashear, MD
Demos Medical PublishingAug 31, 2010 – Medical – 448 pages

A Doody’s Core Title 2012

Spasticity: Diagnosis and Management is the first book solely dedicated to the diagnosis and treatment of spasticity. This pioneering work defines spasticity in the broad context of Upper Motor Neuron Syndrome and focuses not on a single component, but on the entire constellation of conditions that make up the UMNS and often lead to disability.

Spasticity: Diagnosis and Management clearly defines the process for the diagnosis of spasticity, the basic science behind its pathophysiology, the measurement tools used for evaluation, and reviews the available treatment options. Divided into five sections, this comprehensive clinical resource provides a roadmap for assessing the complicated picture of spasticity and choosing the appropriate interventions. Therapies including oral medications, intrathecal baclofen, botulinum toxin and phenol, and surgical options are thoroughly discussed, as are non-medical therapies and the role of the emerging technologies. The full spectrum of diseases involving spasticity in adults and children and the unique diagnostic and management challenges they present is addressed by experienced clinicians. This text is a one-stop source for physicians, therapists and other members of the spasticity management team tasked with the goal of improving patient care and outcomes.

Special Features of Spasticity: Diagnosis and Management include

  • In-depth coverage of diagnoses, interventions, and outcomes across multiple pathologies
  • Tools and clinical measurements for patient assessment
  • Treatment-focused chapters outlining current medical and other therapeutic options
  • Illustrated review of limb anatomy
  • Hands-on guidance to chemodenervation techniques with botulinum toxin and phenol, and ITB management
  • Disease-based chapters devoted to the full range of clinical conditions involving spasticity in adults.and children
  • Multidisciplinary perspective supporting a team approach to care

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[BOOK Chapter] Hand Rehabilitation after Chronic Brain Damage: Effectiveness, Usability and Acceptance of Technological Devices: A Pilot Study – Full Text

By Marta Rodríguez-Hernández, Carmen Fernández-Panadero, Olga López-Martín and Begoña Polonio-López
DOI: 10.5772/67532


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[BOOK] Chapter 4: The Design Process and Usability Assessment of an Exergame System to Facilitate Strength for Task Training for Lower Limb Stroke Rehabilitation



Successful stroke rehabilitation relies on early, long-term, repetitive and intensive treatment, which is rarely adhered to by patients. Exergames can increase patients’ engagement with their therapy. Marketed exergaming systems for lower limb rehabilitation are hard to find and, none yet, facilitate Strength for Task Training (STT), a novel physiotherapeutic method for stroke rehabilitation. STT involves performing brief but intensive strength training (priming) prior to task-specific training to promote neural plasticity and maximize the gains in locomotor ability. This research investigates how the design of an exergame system (game and game controller) for lower limb stroke rehabilitation can facilitate unsupervised STT and therefore allow stroke patients to care for their own health. The findings suggest that specific elements of STT can be incorporated in an exergame system. Barriers to use can be reduced through considering the diverse physiological and cognitive abilities of patients and aesthetic consideration can help create a meaningful system than promotes its use in the home. The semantics of form and movement play an essential role for stroke patients to be able to carry out their exercises.

1. Background

With over 15 million cases worldwide every year [1], strokes are a leading cause of serious long-term disability [23]. Up to 75% of people affected by stroke have lower limb mobility limitations [34], including hemiplegia (muscle paralysis) or hemiparesis (muscle weakness) down one side of the body [5]. The World Health Organization (WHO) has highlighted the need for home health care that calls for rehabilitative devices, self-monitoring tools and self-management skills [6].

Success for stroke rehabilitation relies on early, intensive, long term repetitive treatment to regain motor control [57] by learning to use existing redundant neural pathways [8]. However, although abundantly prescribed by clinicians, as little as 31% of patients perform these exercises correctly and consistently, often due to their monotonous nature [9].

Recent studies show that systems of rehabilitative devices with incorporated digital games for exercising (exergames) improve patient engagement with their home-based therapies. This has promoted beneficial patient outcomes for different long-term conditions, including upper limb stroke rehabilitation [51011], and more effective recovery [12]. While there exist systems designed for upper-limb stroke rehabilitation [51314] and for improving gait and balance [1517], only one was found targeted specifically towards lower limb stroke rehabilitation [18].[…]

Continue —> The Design Process and Usability Assessment of an Exergame System to Facilitate Strength for Task Training for Lower Limb Stroke Rehabilitation | InTechOpen

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[BOOK] Virtual Reality Enhanced Robotic Systems for Disability Rehabilitation – Google Books

Virtual Reality Enhanced Robotic Systems for Disability Rehabilitation

Front Cover
Hu, Fei
IGI GlobalJan 7, 2016 – Technology & Engineering – 383 pages

The study of technology and its implications in the medical field has become an increasingly crucial area of research. By integrating technological innovations into clinical practices, patients can receive improved diagnoses and treatments, as well as faster and safer recoveries.

Virtual Reality Enhanced Robotic Systems for Disability Rehabilitation is an authoritative reference source for the latest scholarly research on the use of computer-assisted rehabilitation methods for disabled patients. Highlighting the application of robots, sensors, and virtual environments, this book is ideally designed for graduate students, engineers, technicians, and company administrators interested in the incorporation of auto-training methods in patient recovery.

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[BOOK] Virtual Reality for Physical and Motor Rehabilitation – Google Books

Virtual Reality for Physical and Motor Rehabilitation

Front Cover

Patrice L. Tamar WeissEmily A. KeshnerMindy F. Levin
SpringerJul 24, 2014 – Medical – 232 pages

While virtual reality (VR) has influenced fields as varied as gaming, archaeology, and the visual arts, some of its most promising applications come from the health sector. Particularly encouraging are the many uses of VR in supporting the recovery of motor skills following accident or illness.

Virtual Reality for Physical and Motor Rehabilitation reviews two decades of progress and anticipates advances to come. It offers current research on the capacity of VR to evaluate, address, and reduce motor skill limitations, and the use of VR to support motor and sensorimotor function, from the most basic to the most sophisticated skill levels. Expert scientists and clinicians explain how the brain organizes motor behavior, relate therapeutic objectives to client goals, and differentiate among VR platforms in engaging the production of movement and balance. On the practical side, contributors demonstrate that VR complements existing therapies across various conditions such as neurodegenerative diseases, traumatic brain injury, and stroke. Included among the topics:

  • Neuroplasticity and virtual reality.
  • Vision and perception in virtual reality.
  • Sensorimotor recalibration in virtual environments.
  • Rehabilitative applications using VR for residual impairments following stroke.
  • VR reveals mechanisms of balance and locomotor impairments.
  • Applications of VR technologies for childhood disabilities.

A resource of great immediate and future utility, Virtual Reality for Physical and Motor Rehabilitation distills a dynamic field to aid the work of neuropsychologists, rehabilitation specialists (including physical, speech, vocational, and occupational therapists), and neurologists.

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[BOOK] New Trends in Medical and Service Robots: Design, Analysis and Control – Google Books


New Trends in Medical and Service Robots: Design, Analysis and Control

Manfred Husty, Michael Hofbaur

Springer, 7 Σεπ 2017330 σελίδες

These are selected papers presented at the 5th International Workshop on Medical and Service Robots (MESROB 2016).

The main topics of the workshop included: Exoskeleton and prostheses; Therapeutic robots and rehabilitation; Cognitive robots; Humanoid & Service robots; Assistive robots and elderly assistance; Surgical robots; Human-robot interfaces; Kinematic and mechatronic design for medical and assistive robotics; and Legal issues in medical robotics.

The workshop brought together researchers and practitioners to discuss new and emerging topics of Medical and Service Robotics. The meeting took place at castle St. Martin in Graz, Austria, from 4-6 July, 2016.

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[BOOK] Chapter 9: Neuroscience-Based Rehabilitation for Stroke Patients

The Book: Neuroscience-Based Rehabilitation for Stroke Patients | InTechOpen, Published on: 2017-05-10. Authors: Takayuki Kodama and Hideki Nakano

Chapter 9: Neuroscience-Based Rehabilitation for Stroke Patients


Hitherto, physical therapy for rehabilitating patients with cerebral dysfunction has focused on acquiring and improving compensatory strategies by using the remaining functions; it has been presumed that once neural functions have been lost, they cannot be restored. However, neuroscience-based animal research and neuroimaging research since the 1980s have demonstrated that recovery arises from plastic changes in the central nervous system and reconstruction of neural networks; this research is ushering in a new age of neuroscience-based rehabilitation as a treatment for cerebral dysfunction (such as stroke). In this paper, in regard to mental practices using motor imagery and kinaesthetic illusion, we summarize basic discoveries and theories relating to motor function therapy based on neuroscientific theory; in particular, we outline a novel rehabilitation method using kinaesthetic illusion induced by vibrational stimulus, which the authors are currently attempting in stroke patients.

1. Introduction

Conventional physical therapy (PT) for the rehabilitation of patients with brain dysfunction focuses on the acquisition of function through alternative means by using and improving the patients’ existing functions, and it is based on the assumption that once a neutral function is lost, it can never be recovered [1]. However, animal neuroscience studies [24] that were conducted after the 1980s and neuroimaging studies [5, 6] have shown that recovery can occur as a result of plastic changes in the nervous system or reorganization of the neural network, and rehabilitation (neuroscience-based rehabilitation, NBR) after cerebral dysfunction (e.g. stroke) has reached a new era in treatment. These observations suggest that the plasticity that is observed in patients is related to the characteristic that the more the patient receives therapy in specific parts of their body, the more that the brain areas that control these parts will be functionally as well as anatomically extended.

Functional recovery originally referred to a patient’s recovery from limitations in their behavior, movements, and/or activity [7]. Therefore, the purpose of NBR is not only to induce the reorganization of brain functions through neural plasticity mechanisms but also recover comprehensive bodily motor functions and brain functions for autonomous and active social behavior. What type of treatment strategy is required so that patients feel positively engaged by it, gradually understand its effects, and work toward a goal? Previous studies have revealed important factors in the effects of NBR treatment, such as the amount of therapy [8, 9], rehabilitation implementation environment [10], and performance of neurocognitive rehabilitation [11] through mental practice techniques, such as motor imagery (MI) [12]. Among these factors, treatments involving MI are strongly recommended because MI contributes to the reorganization of neural functions. MI, which is an approach that is based on neuroscientific data and the motor learning theory, is defined as the capacity to internally mimic physical movements without any associated motor output [13]. The cognitive process that occurs during the imagination of movements involves various components, such as mutual understandings between oneself and others (environment), observations of movements, mental manipulations of objects, and psychological time and movement planning. Instead of repeating simple physical movements to receive feedback on outcome in the actual therapy, the practice of voluntary and skill-requiring movements that are geared toward task completion induces the functional recovery [14]. Thus, an important element of the patients’ engagement in the therapy is that it occurs in an active and top-down fashion through the use of MI. However, because MI has a task-specific nature, cognitive functions and memories of motor experiences that equip the patients to perform the task are required. Patients with neurofunctional states that make motor execution (ME) difficulty may suffer not only from impairments in motor-related brain areas but also from modifications in their intracerebral body representations (e.g. somatoparaphrenia) [15, 16]. In such cases, the exploitation of kinaesthetic illusions [1720], which can be induced in the brain by extraneous stimuli, such as vibratory stimulations, becomes important for inputting appropriate motor-sensory information into the brain in a passive and bottom-up fashion. Therefore, the implementation of a mental practice to determine the criteria for adequate treatment according to the states of the patient’s cognitive functions and motor functions is important in order to select and implement the best therapy. Thus, this paper summarizes the basic understanding and theories of mental practices that use MI or kinaesthetic illusion and discusses, in particular, research results concerning kinaesthetic illusions that are induced by vibratory stimulations, which we are currently attempting on stroke patients.

2. What is neuroscience-based rehabilitation?

NBR involves a series of processes that are selected for the intervention according to the current brain function theories that have been revealed by neuroscience and other similar studies and verification of its outcomes. For example, the selection of a NBR strategy for a stroke patient requires a combination of deep clinical reasoning, the experience of the therapist, and a vast understanding of the evidence obtained by studies from wide-ranging academic fields on the factors that support recovery mechanisms and produce particular outcomes. First, the neural basis of brain cell reorganization will be presented.

2.1. Neural basis of brain cell reorganization

The current understanding of neural reorganization after dysfunction is not that the neurons themselves recover after their axons are damaged but rather that damaged functional networks recover due to several processes that induce the recovery of motor and cognitive functions. Cajal [1], who was a proponent of neuron theory, stated that the central nervous system (brain and spinal cord) of adult mammals would not recover once it is damaged. However, studies that have been conducted since the 1980s and that have shown that alterations in the peripheral nervous system, such as denervation and amputation, change somatic sensations and the representations of body parts while they are in motion have revealed that the brain has plasticity. In 1998, Eriksson et al. [21] reported the new formation of neurons in the central nervous system of human beings. These findings raised the question of whether the plastic changes and functional reorganization that occur in subjects with cranial nerve disorders originate from an ischemic state, such as a cerebrovascular disturbance. The underlying mechanisms of the plasticity that occurs after a cortical deficit are thought to involve (i) the redundancy of neuronal connections in the central nervous system, (ii) morphological changes in the neurons, and (iii) changes in synaptic information transmission [22]. If neurons are damaged, astrocytes begin to divide due to the activity of microglia. These glial cells then reinforce the areas that have been damaged by brain lesions and release neurotrophic factors, such as nerve growth factor, to promote neuronal sprouting (it takes around two weeks for synapses to grow after nerve damage [23]). The sprouted neurons are then connected to an existing neural network, which forms a new network. In other words, if neurons are damaged, new neurons begin to reorganize themselves in order to compensate for it. Adequate NBR stimulates the neural network with the neurofunction that is most similar to the predamaged functional state of the neural network, even though the new network is not located in the damaged region. If strong inputs enter the network multiple times, the synaptic connections will be reinforced. However, plasticity will not be induced in synapses with little information (input specificity), and the synapses will be excluded from the network formation [24, 25].

These findings have been confirmed by several famous studies. Nudo et al. [8] caused artificial cerebral infarcts in monkeys in the region of the primary motor cortex (M1) that corresponds to fingers and then forced the monkeys to use fingers with motor deficits. Thus, they reported that the brain region that previously controlled the shoulders and elbows prior to the therapy then controlled the fingers and more distal body parts (Figure 1). Merzenich et al. [26] surgically sutured the fingers of monkeys and then compared the pre- and post-surgical somatotopies of Brodmann area (BA) 3b, which corresponds to the sensorimotor area (SMA). Microelectrodes were used to record the responses in BA3b to finger stimuli. The third and fourth fingers were then surgically sutured, and the responses were recorded again a month later. Thus, the boundary between the third and fourth fingers became unclear. In addition, the results of a study that was conducted in human beings suggested that the plasticity of brain cells depends on sensory input. The results of a magnetoencephalography study that compared the somatotopies of the first and fifth fingers of string players to normal controls showed that a broader cerebral cortical area was activated for string players compared to the controls [6].


Figure 1. Representation of the distal forelimb in cortical area 4 derived from pre- and post-training mapping procedures [8].

These findings suggest that the size of the intracerebral somatotopic representation, which is vital to ME, is determined by the degree of use of the region. If you try to induce plasticity in specific parts of the bodies of stroke patients, as mentioned above, the induction of neural plasticity in a pathway that allows highly efficient information processing by repeating movements in a pattern like the normal pattern should be possible, provided the patient has retained their motor functions to a certain degree. However, if a patient has the functional level of almost not able to perform movement or is only able to perform the movement in an abnormal pattern, the stimulation of the plasticity for the formation of a neural network that is required to be able to regain normal motor function may not be possible. Ward et al. [27] chronologically examined the relationships between motor function recovery scores and task-related brain activities for approximately 12 months after the onset of stroke with functional magnetic resonance imaging. They found a negative correlation between motor function recovery scores and a decline in the hyperactivity of brain areas in the damaged and undamaged hemispheres (M1, premotor cortex; PMC, supplementary motor cortex; SMC, cerebellum). These findings suggest that a better recovery of motor function is associated with better connectivity between the functional systems of multiple brain regions and that a continuous and long-term approach is required to study the changes in the morphologies and networks of neurons. Thus, a qualitative and continuous approach [28] is required in studies of the recovery of the entire neural system (e.g. transcortical network, M1-PMC neural network [29]) in order to be able to perform movement rather than merely establishing quantitative interventions of movement. Thus, next, we will discuss the current understanding of what is required in interventions for stroke patients.[…]

Continue —> Neuroscience-Based Rehabilitation for Stroke Patients | InTechOpen

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[BOOK] Technology in Physical Activity and Health Promotion – Google Books

Front CoverAs technology becomes an ever more prevalent part of everyday life and population-based physical activity programmes seek new ways to increase lifelong engagement with physical activity, so the two have become increasingly linked. This book offers a thorough, critical examination of emerging technologies in physical activity and health, considering technological interventions within the dominant theoretical frameworks, exploring the challenges of integrating technology into physical activity promotion and offering solutions for its implementation.

Technology in Physical Activity and Health Promotion occupies a broadly positive stance toward interactive technology initiatives and, while discussing some negative implications of an increased use of technology, offers practical recommendations for promoting physical activity through a range of media, including:

  • social media
  • mobile apps
  • global positioning and geographic information systems
  • wearables
  • active videogames (exergaming)
  • virtual reality settings.

Offering a logical and clear critique of technology in physical activity and health promotion, this book will serve as an essential reference for upper-level undergraduates, postgraduate students and scholars working in public health, physical activity and health and kinesiology, and healthcare professionals.

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