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[ARTICLE] Automatic Control of Wrist Rehabilitation Therapy (WRist-T) device for Post-Ischemic Stroke Patient – Full Text PDF

Abstract

Since a decade, the wrist rehabilitation services in Malaysia has been operated by the physiotherapist (PT). Throughout the rehabilitative procedure, PT commonly used a conventional method which later triggered some problems related to the effectiveness of the rehab services. Timeconsuming, long-waiting time, lack of human power and all those leading to exhaustion, both for the patient and the provider. Patients could not commit to the therapy session due to logistic and domestic problems. This problem can be greatly solved with rehabilitation robot, but the current product in the market is expensive and not affordable especially for lowincome earners family. In this paper, an automatic control of wrist rehabilitation therapy; called WRist-T device has been developed. There are based on three different modes of exercises that can be carried out by the device which is the flexion/extension, radial/ulnar deviation and pronation/supination. By using this device, the patient can easily receive physiotherapy session with minor supervision from the physiotherapist at the hospital or rehabilitation centre and also can be conducted at patient home.

Full Text: PDF

 

References

N. Bayona,“The role of task-specific training in rehabilitation therapies,”Topics in Stroke Rehabilitation, vol. 12, 2005,pp. 58–65.

R. Bonita, R. Beaglehole, “Recovery of motor function after stroke,”Stroke, 1988,pp. 19.

S. Cramer, J. Riley, “Neuroplasticity and brain repair after stroke,”Current Opinion in Neurology,vol. 21, 2008,pp. 76–82.

D.J. Reinkensmeyer, J. Emken, S. Cramer, “Robotics, motor learning, and neurologic recovery,”Annual Review of Biomedical Engineering, vol. 6, 2004, pp. 497-525.

M. Takaiwa, “Wrist rehabilitation training simulator for P.T. using pneumatic parallel manipulator,”IEEE International Conference on Advanced Intelligent Mechatronics (AIM), 2016, pp. 276-281.

H. Al-Fahaam, S. Davis, S. Nefti-Meziani, “Wrist Rehabilitation exoskeleton robot based on pneumatic soft actuators,”International Conference for Students of Applied Engineering (ICSAE), 2016, pp. 491-496.

D. Dauria, F. Persia, B. Siciliano,“Human-Computer Interaction in Healthcare: How to Support Patients during their Wrist Rehabilitation,”IEEE Tenth International Conference on Semantic Computing (ICSC), 2016, pp. 325-328.

W.M. Hsieh, Y.S. Hwang, S.C. Chen, S.Y. Tan,C.C. Chen, and Y.L. Chen, “Application of the Blobo Bluetooth ball in wrist rehabilitation training,”Journal of Physical Therapy Science, vol. 28, 2016, pp. 27- 32.

A. Hacıoğlu, O.F. Özdemir, A,K, Şahin, Y.S. Akgül, “Augmented reality based wrist rehabilitation system,”Signal Processing and Communication Application Conference (SIU), 2016. pp. 1869-1872.

Z.J. Lu, L.C.B. Wang, L.H. Duan, Q.Q. Lui, H.Q. Sun, Z.I. Chen, “Development of a robot MKW-II for hand and Wrist Rehabilitation Training,”The Annual IEEE International Conference on Cyber Technology in Automation, Control and Intelligent Systems, 2016, pp. 302-307.

 

via Automatic Control of Wrist Rehabilitation Therapy (WRist-T) device for Post-Ischemic Stroke Patient | Mohd Adib | Journal of Telecommunication, Electronic and Computer Engineering (JTEC)

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[Study] Home Is a Better Bet Than Hospitals for Achieving More PA Poststroke

There’s no place like home for engaging in the levels of physical activity (PA) that can aid in recovery poststroke—at least compared with the current hospital setting—according to a small study from Australia.

For the study, researchers used accelerometers and self-reports to track the PA and sitting time of 32 participants (mean age of 68, 53% male) who had experienced a stroke, comparing data gathered during their last week in the hospital with data gathered during their first week home. Participants were also assessed in a number of areas during their final week in the hospital, including physical function, functional independence, pain, anxiety, and depression.

The researchers were interested in finding out if an individual’s environment plays a role in PA poststroke—something they describe as “pivotal” to recovery—and whether other factors, such as depression, have an effect on any changes in PA levels. Results were e-published ahead of print in theArchives of Physical Medicine and Rehabilitation (abstract only available for free).

They found that environment does seem to make a difference—and a fairly big one at that. While the amount of time spent awake didn’t change much from hospital to home (13.1 hours a day in the hospital vs 13.5 hours per day at home), the amount of PA achieved—and time spent in sedentary behaviors—varied significantly. Participants sat for an average of 45 fewer minutes a day at home than they did in their last week in the hospital, were upright for 45 more minutes a day, spent 12 more minutes a day walking, and completed an average of 724 additional daily steps.

The results were similar when adjusted for demographic variables and didn’t seem to be significantly affected by any of the secondary factors assessed in the hospital, save one—depression, which when present was associated with no gains in PA at home.

The researchers don’t pin the improvement to any single factor but speculate that “the home environment may provide greater opportunity for activities of daily living such as cooking, cleaning, social and community activities, and there may be fewer external restrictions such as hospital routines and safety concerns around mobilization.”

Authors of the study also believe the gap between home and hospital PA poststroke could be closed if hospitals were to take more cues from the home environment.

“Physically, cognitively, and socially enriched stroke rehabilitation environments appear to increase activity by 20%,” they write. “Wards [that] include communal areas to promote more time spent upright, and the need to transport patients further for personal care may create opportunities for activity. The low activity levels in [the] hospital and at home found in our study, and in prior reports…indicate that there is clearly more work to be done in promoting activity after stroke.”

via Study: Home Is a Better Bet Than Hospitals for Achieving More PA Poststroke

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[ARTICLE] A customized home-based computerized cognitive rehabilitation platform for patients with chronic-stage stroke: study protocol for a randomized controlled trial – Full Text

Abstract

Background

Stroke patients usually suffer primary cognitive impairment related to attention, memory, and executive functions. This impairment causes a negative impact on the quality of life of patients and their families, and may be long term. Cognitive rehabilitation has been shown to be an effective way to treat cognitive impairment and should be continued after hospital discharge. Computerized cognitive rehabilitation can be performed at home using exercise programs that advance with predetermined course content, interval, and pace. We hypothesize that computerized rehabilitation might be improved if a program could customize course content and pace in response to patient-specific progress. The present pilot study is a randomized controlled double-blind crossover clinical trial aiming to study if chronic stroke patients with cognitive impairment could benefit from cognitive training through a customized tele-rehabilitation platform (“Guttmann, NeuroPersonalTrainer”®, GNPT®).

Methods/design

Individuals with chronic-stage stroke will be recruited. Participants will be randomized to receive experimental intervention (customized tele-rehabilitation platform, GNPT®) or sham intervention (ictus.online), both with the same frequency and duration (five sessions per week over 6 weeks). After a washout period of 3 months, crossover will occur and participants from the GNPT® condition will receive sham intervention, while participants originally from the sham intervention will receive GNPT®. Patients will be assessed before and after receiving each treatment regimen with an exhaustive neuropsychological battery. Primary outcomes will include rating measures that assess attention difficulties, memory failures, and executive dysfunction for daily activities, as well as performance-based measures of attention, memory, and executive functions.

Discussion

Customized cognitive training could lead to better cognitive function in patients with chronic-stage stroke and improve their quality of life.

Background

Stroke, the most common cerebrovascular disease, is a focal neurological disorder of abrupt development due to a pathological process in blood vessels [1]. There are three main types of stroke, namely transient ischemic attack, characterized by a loss of blood flow in the brain and which reverts in less than 24 h without associated acute infarction [2]; ischemic stroke, characterized by a lack of blood reaching part of the brain due to the obstruction of blood vessels and causing tissue damage (infarction), wherein cells die in the immediate area and those surrounding the infarction area are at risk; and a hemorrhagic stroke, where either a brain aneurysm bursts or a weakened blood vessel leaks, resulting in blood spillage into or around the brain, creating swelling and pressure, and damaging cells and tissue in the brain [3].

In 2013, according to the World Health Organization (WHO) and the Global Burden of Disease study, worldwide, there were 11–15 million people affected by stroke and almost 1.5 million deaths from this cerebrovascular disease [45]. Moreover, in 2013, the total Disability-Adjusted Life Years (years of healthy life lost while living with a poor health condition) from all strokes was 51,429,440. In Spain, in 2011, the National Institute of Statistics reported 116,017 cases of stroke, corresponding to an incidence of 252 episodes per 100,000 inhabitants [6]. Although stroke incidence increases with advancing age, adults aged 20–64 years comprise 31% of the total global incidence.

Stroke often results in cognitive dysfunction, and medical treatment may cause great expense on a personal, family, economic, and social level. Depending on the area of the brain affected and the severity of lesions, stroke patients may suffer cognitive impairment, and alteration in emotional and behavioral regulation [7]. Generally, cognitive impairment derived from stroke includes alterations in attention, memory, and executive function [8].

Recent reports have begun to show positive results from the use of computerized cognitive rehabilitation systems (CCRS) for stroke patients to improve attention, memory, and executive functions. Nevertheless, more research is needed to better control variables and improve training designs in order to reduce heterogeneity and increase control of the intensity and level of performance during treatments [9101112].

CCRS allow adjustment of the type of exercises administered to the specific cognitive impairment profile of each patient, but within a fixed set of possible exercises such that heterogeneity of therapy choice is minimized. This can improve studies by allowing better categorization of patient groups that execute similar training sessions in a similar range of responses [13]. Further, CCRS offers the possibility of applying cognitive rehabilitation at home, while patient adherence and performance can be monitored online, so that patients do not need to live near, lodge near, or travel to a rehabilitation center to receive therapy. Because CCRS therapy is entirely digitized, it generates objective data that can be analyzed to determine the relative effectiveness of these interventions. We hypothesize that by allowing a trained professional to oversee an automated customization program that stratifies the level of difficulty, duration, and stimulus speed of presentation, we will reduce the heterogeneity of traditional cognitive training and improve the efficacy of intervention in chronic stroke patients.

The first objective of this pilot study is to assess if chronic stroke patients with cognitive impairment could benefit from cognitive training through a customized tele-rehabilitation platform (“Guttmann, NeuroPersonalTrainer”®, GNPT ® ) [14] intended to increase the control of experimental variables (cognitive impairment profile, adherence, and performance) traditionally identified as a source of experimental heterogeneity. The study aims to assess if this benefit could translate into an improvement of the trained cognitive domains (attention, memory, and executive functions).

The second objective is focused on generalization, namely the ability to use what has been learned in rehabilitation contexts and apply it in different environments [15]. Transfer of learning is included within the concept of generalization when specifically referring to the ability to apply specific strategies to related tasks [16]. Two types of transfer have been proposed – near transfer and far transfer [17]. By near transfer we mean that, through the training of a task within a given cognitive domain, improved function in other similar, untrained tasks may be observed in the same cognitive domain. For instance, a patient who performs selective attention exercises and improves execution through the training might improve their performance in other selective attention exercises too. By far transfer we mean that training in a given cognitive domain may improve performance of tasks in other cognitive domains. Such improvement will be observable in tasks that are structurally dissimilar from the ones used in the training. For instance, if a patient performs selective attention exercises, they may also improve their performance in memory tasks.

It has been demonstrated that computerized cognitive training can lead to the phenomenon of transfer, as previously studied in stroke patients [18]. Thus, our research aims to note whether the application of patient-customized tele-rehabilitation can give rise to an improvement in other functions that are based on cognitive domains related to those that have been trained (near transfer) as well as in different ones (far transfer).

Finally, the third objective is to assess the variables of demography (age, sex, years of education) and etiology (ischemic stroke or hemorrhage) and their impact on rehabilitation outcome, given the need to understand the patient characteristics that may influence treatment effectiveness [19].[…]

 

Continue —> A customized home-based computerized cognitive rehabilitation platform for patients with chronic-stage stroke: study protocol for a randomized controlled trial | Trials | Full Text

 

Fig. 4Sham intervention (ictus.online) screenshots. a To access to the platform, the user must enter their username and password. b Each exercise begins with an instruction screen. c The user watches a 10-min video. d When finished, the user accesses a three-question quiz with four response options. e When the quiz is finished, a results screen is displayed. In each session, three videos with their corresponding quiz are presented

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[Abstract] Application of Commercial Games for Home-Based Rehabilitation for People with Hemiparesis: Challenges and Lessons Learned

Objective: To identify the factors that influence the use of an at-home virtual rehabilitation gaming system from the perspective of therapists, engineers, and adults and adolescents with hemiparesis secondary to stroke, brain injury, and cerebral palsy.

Materials and Methods: This study reports on qualitative findings from a study, involving seven adults (two female; mean age: 65 ± 8 years) and three adolescents (one female; mean age: 15 ± 2 years) with hemiparesis, evaluating the feasibility and clinical effectiveness of a home-based custom-designed virtual rehabilitation system over 2 months. Thematic analysis was used to analyze qualitative data from therapists’ weekly telephone interview notes, research team documentation regarding issues raised during technical support interactions, and the transcript of a poststudy debriefing session involving research team members and collaborators.

Results: Qualitative themes that emerged suggested that system use was associated with three key factors as follows: (1) the technology itself (e.g., characteristics of the games and their clinical implications, system accessibility, and hardware and software design); (2) communication processes (e.g., preferences and effectiveness of methods used during the study); and (3) knowledge and training of participants and therapists on the technology’s use (e.g., familiarity with Facebook, time required to gain competence with the system, and need for clinical observations during remote therapy). Strategies to address these factors are proposed.

Conclusion: Lessons learned from this study can inform future clinical and implementation research using commercial videogames and social media platforms. The capacity to track compensatory movements, clinical considerations in game selection, the provision of kinematic and treatment progress reports to participants, and effective communication and training for therapists and participants may enhance research success, system usability, and adoption.

 

via Application of Commercial Games for Home-Based Rehabilitation for People with Hemiparesis: Challenges and Lessons Learned | Games for Health Journal

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[Abstract] MaLT – Combined Motor and Language Therapy Tool for Brain Injury Patients Using Kinect.

Abstract

BACKGROUND:

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.

OBJECTIVES:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

KEYWORDS:

 

via MaLT – Combined Motor and Language Therapy Tool for Brain Injury Patients Using Kinect. – PubMed – NCBI

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[Abstract] Providing Sources of Self-Efficacy Through Technology Enhanced Post-Stroke Rehabilitation in the Home.

Abstract

This research explores the impact of receiving feedback through a Personalised Self-Managed Rehabilitation System (PSMrS) for home-based post-stroke rehabilitation on the users’ self-efficacy; more specifically, mastery experiences and the interpretation of biomechanical data. Embedded within a realistic evaluation methodological approach, exploring the promotion of self-efficacy from the utilisation of computer-based technology to facilitate post-stroke upper-limb rehabilitation in the home included; semi-structured interviews, quantitative user data (activity and usage), observations and field notes. Data revealed that self-efficacy was linked with obtaining positive knowledge of results feedback. Encouragingly, this also transferred to functional activities such as, confidence to carry out kitchen tasks and bathroom personal activities. Findings suggest the PSMrS was able to provide key sources of self-efficacy by providing feedback which translated key biomechanical data to the users. Users could interpret and understand their performance, gain a sense of mastery and build their confidence which in some instances led to increased confidence to carry out functional activities. However, outcome expectations and socio-structural factors impacted on the self-efficacy associated with the use of the system. Increasing the understanding of how these factors promote or inhibit self-management and self-efficacy is therefore crucial to the successful adoption of technology solutions and promotion of self-efficacy.

Source: Providing Sources of Self-Efficacy Through Technology Enhanced Post-Stroke Rehabilitation in the Home. – PubMed – NCBI

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[Abstract] Autonomous rehabilitation at stroke patients home for balance and gait: safety, usability and compliance of a virtual reality system.

Abstract

Background: New technologies, such as telerehabilitation and gaming devices offer the possibility for patients to train at home. This opens the challenge of safety for the patient as he is called to exercise neither with a therapist on the patients’ side nor with a therapist linked remotely to supervise the sessions.

Aim: To study the safety, usability and patient acceptance of an autonomous telerehabilitation system for balance and gait (the REWIRE platform) in the patients home.

Design: Cohort study.

Setting: Community, in the stroke patients’ home.

Population: 15 participants with first-ever stroke, with a mild to moderate residual deficit of the lower extremities.

Method: Autonomous rehabilitation based on virtual rehabilitation was provided at the participants’ home for twelve weeks. The primary outcome was compliance (the ratio between days of actual and scheduled training), analysed with the two-tailed Wilcoxon Mann- Whitney test. Furthermore safety is defined by adverse events. The secondary endpoint was the acceptance of the system measured with the Technology Acceptance Model. Additionally, the cumulative duration of weekly training was analysed.

Results: During the study there were no adverse events related to the therapy. Patients performed on average 71% (range 39 to 92%) of the scheduled sessions. The Technology Acceptance Model Questionnaire showed excellent values for stroke patients after the training. The average training duration per week was 99 ±53min.

Conclusion: Autonomous telerehabilitation for balance and gait training with the REWIRE-system is safe, feasible and can help to intensive rehabilitative therapy at home.

Clinical Rehabilitation Impact: Telerehabilitation enables safe training in home environment and supports of the standard rehabilitation therapy.

Read Article at publisher’s site

Source: Autonomous rehabilitation at stroke patients home for balance and gait: safety, usability and… – Abstract – Europe PMC

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[BLOG POST] Rehabilitation in the Home – Transitions Physiotherapy

Physiotherapy Rehabilitation in the Home

There are two main reasons why physiotherapy rehabilitation in the home has become so popular. The first, is the simple convenience of mobile physiotherapy delivered in the comfort of your own home without having to tackle traffic and parking.The second is because home-based rehabilitation really works!

Rehabilitation takes hard work and requires a lot of practice. The environment around us can affect how easy or difficult it is to practice, practice, practice! Clinic based physiotherapy is important when extra space or specialised equipment is required, and some people prefer to attend a consultation room.

Home-based physiotherapy allows you to take what you have learnt in hospital or clinic and gain real life experience with guidance from an experienced physiotherapist. There are many therapeutic benefits to rehabilitation in the home for people with neurological conditions:

  • Feeling more comfortable in a familiar environment will enhance performance
  • Gain confidence to practice tasks that are the ‘just right challenge’ in your home environment
  • Completing tasks in your own home will have greater meaning so will provide greater motivation
  • Learning tasks in the same place that you will need to practice them will lead to greater practice and repetition
  • Functional tasks such as how to get out of bed or negotiate steps can be tailoredto the exact environment where you need to perform them

Tailoring neurological physiotherapy to real-life is the focus of home visiting physiotherapy.  Rehabilitation in your own home harnesses the principles of neuroplasticity because it can fuel the motivation to continue with the practice of meaningful tasks that are the ‘just right challenge’.

Source: Rehabilitation in the Home – Transitions Physiotherapy Perth

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[Conference paper] Hand Robotic Rehabilitation: From Hospital to Home – Abstract+References

Abstract

Stroke patients are often affected by hemiparesis. In the rehabilitation of these patients the function of the hand is often neglected. Thus in this work we propose a robotic approach to the rehabilitation of the hand of a stroke patient in hospital and also at home. Some experimental results can be presented here especially for inpatients. Further experimental results on home-patients must be acquired through a telemedicine platform, designed for this application. 

References

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Source: Hand Robotic Rehabilitation: From Hospital to Home | SpringerLink

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[Abstract+References] High-Intensity Chronic Stroke Motor Imagery Neurofeedback Training at Home: Three Case Reports 

Motor imagery (MI) with neurofeedback has been suggested as promising for motor recovery after stroke. Evidence suggests that regular training facilitates compensatory plasticity, but frequent training is difficult to integrate into everyday life. Using a wireless electroencephalogram (EEG) system, we implemented a frequent and efficient neurofeedback training at the patients’ home. Aiming to overcome maladaptive changes in cortical lateralization patterns we presented a visual feedback, representing the degree of contralateral sensorimotor cortical activity and the degree of sensorimotor cortex lateralization. Three stroke patients practiced every other day, over a period of 4 weeks. Training-related changes were evaluated on behavioral, functional, and structural levels. All 3 patients indicated that they enjoyed the training and were highly motivated throughout the entire training regime. EEG activity induced by MI of the affected hand became more lateralized over the course of training in all three patients. The patient with a significant functional change also showed increased white matter integrity as revealed by diffusion tensor imaging, and a substantial clinical improvement of upper limb motor functions. Our study provides evidence that regular, home-based practice of MI neurofeedback has the potential to facilitate cortical reorganization and may also increase associated improvements of upper limb motor function in chronic stroke patients.

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Source: High-Intensity Chronic Stroke Motor Imagery Neurofeedback Training at Home: Three Case ReportsClinical EEG and Neuroscience – Catharina Zich, Stefan Debener, Clara Schweinitz, Annette Sterr, Joost Meekes, Cornelia Kranczioch, 2017

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