To rehabilitate individuals with impaired upper-limb function, we have designed and developed a robot guided rehabilitation scheme. A humanoid robot, NAO was used for this purpose. NAO has 25 degrees of freedom. With its sensors and actuators, it can walk forward and backward, can sit down and stand up, can wave his hand, can speak to the audience, can feel the touch sensation, and can recognize the person he is meeting. All these qualities have made NAO a perfect coach to guide the subjects to perform rehabilitation exercises. To demonstrate rehabilitation exercises with NAO, a library of recommended rehabilitation exercises involving shoulder (i.e., abduction/adduction, vertical flexion/extension, and internal/external rotation), and elbow (i.e., flexion/extension) joint movements was formed in Choregraphe (graphical programming interface). In experiments, NAO was maneuvered to instruct and demonstrate the exercises from the NRL. A complex ‘touch and play’ game was also developed where NAO plays with the subject that represents a multi-joint movement’s exercise. To develop the proposed tele-rehabilitation scheme, kinematic model of human upper-extremity was developed based modified Denavit-Hartenberg notations. A complete geometric solution was developed to find a unique inverse kinematic solution of human upper-extremity from the Kinect data. In tele-rehabilitation scheme, a therapist can remotely tele-operate the NAO in real-time to instruct and demonstrate subjects different arm movement exercises. Kinect sensor was used in this scheme to get tele-operator’s kinematics data. Experiments results reveals that NAO can be tele-operated successfully to instruct and demonstrate subjects to perform different arm movement exercises. A control algorithm was developed in MATLAB for the proposed robot guided supervised rehabilitation scheme. Experimental results show that the NAO and Kinect sensor can effectively be used to supervise and guide the subjects in performing active rehabilitation exercises for shoulder and elbow joint movements.
Assad-Uz-Zaman, Md, “Design and Development of a Robot Guided Rehabilitation Scheme for Upper Extremity Rehabilitation” (2017). Theses and Dissertations. 1578.
via “Design and Development of a Robot Guided Rehabilitation Scheme for Upp” by Md Assad-Uz-Zaman
Lack of motivation during physical rehabilitation is a very common problem that worsens the efficacy of rehabilitation, decreasing the recovery rates of the patient. We suggest a gamified upper-limb rehabilitation that incorporates adaptive gameplay and difficulty so as to overcome that issue, emerging as a support tool for physical therapy professionals. The presence of difficulty adjustment in the game allows a higher motivation level for the patients by preserving the trade off between keeping the difficulty low enough to avoid frustration, but high enough to promote motivation and engagement. This rehabilitation game is a home-based system that allows the patient to exercise at home, due to its Kinect-based portable setup. The game aims to increase the motivation of the patients and thus the speed of their recovery. To accomplish that goal, it is key to potentiate a full immersion into the therapeutic activity. Thus gamification elements, gameplay design and adaptive difficulty are explored and incorporated into the concept.
via Adaptive gameplay and difficulty adjustment in a gamified upper-limb rehabilitation – IEEE Conference Publication
We designed this study to prove the efficacy of the low-cost Kinect-based virtual rehabilitation (VR) system for upper limb recovery among patients with subacute stroke.
A double-blind, randomized, sham-controlled trial was performed. A total of 23 subjects with subacute stroke (<3 months) were allocated to sham (n = 11) and real VR group (n = 12). Both groups participated in a daily 30-minute occupational therapy for upper limb recovery for 10 consecutive weekdays. Subjects received an additional daily 30-minute Kinect-based or sham VR. Assessment was performed before the VR, immediately and 1 month after the last session of VR. Fugl-Meyer Assessment (FMA) (primary outcome) and other secondary functional outcomes were measured. Accelerometers were used to measure hemiparetic upper limb movements during the therapy.
FMA immediately after last VR session was not different between the sham (46.8 ± 16.0) and the real VR group (49.4 ± 14.2) (P = .937 in intention to treat analysis). Significant differences of total activity counts (TAC) were found in hemiparetic upper limb during the therapy between groups (F2,26 = 4.43; P = .22). Real VR group (107,926 ± 68,874) showed significantly more TACs compared with the sham VR group (46,686 ± 25,814) but there was no statistical significance between real VR and control (64,575 ± 27,533).
Low-cost Kinect-based upper limb rehabilitation system was not more efficacious compared with sham VR. However, the compliance in VR was good and VR system induced more arm motion than control and similar activity compared with the conventional therapy, which suggests its utility as an adjuvant additional therapy during inpatient stroke rehabilitation.
via A low cost kinect-based virtual rehabilitation system for inpatient rehabilitation of the upper limb in patients with subacute stroke: A randomized… – PubMed – NCBI
Therapeutic benefits of Kinect-based virtual reality (VR) game training in rehabilitation encourage its use to improve motor function.
To assess the effects of Kinect-based VR training on motor recovery of the upper extremity and functional outcomes in patients with chronic stroke.
In this randomized controlled trial, group A received 20 sessions of physical therapy (PT) + 20 sessions of Kinect-based VR training and group B received only 20 sessions of PT. Clinical outcome measures were assessed at baseline and at the end of the treatments. Primary outcome measures that assess stroke patients’ motor function included upper extremity (UE) Fugl-Meyer Assessment (FMA). Secondary outcome measures were Brunnstrom Recovery Stages (BRS), Modified Ashworth Scale (MAS), Box and Block test (BBT), Motricity index (MI), and active range of motion (AROM) measurement.
Statistically significant improvements in game scores (p < 0.05) were observed in group A. In within-group analysis, there were statistically significant improvements in all clinical outcome measures except for the BRS-hand, MAS-distal, and MAS-hand in group A; MAS-(proximal, distal, hand) and BRS-(UE, hand) in group B compared with baseline values. Differences from baseline of FMA, MI, and AROM (except adduction of shoulder and extension of elbow) were greater in group A (p < 0.05).
To conclude, our results suggest that the adjunct use of Kinect-based VR training may contribute to the improvement of UE motor function and AROM in chronic stroke patients. Further studies with a larger number of subjects with longer follow-up periods are needed to establish its effectiveness in neurorehabilitation.
via Effects of Kinect-based virtual reality game training on upper extremity motor recovery in chronic stroke. – PubMed – NCBI
The proportion of rehabilitation doctors and patients mismatch is very grim in the context of social aging. The Family Rehabilitation System captures the profound information of the trainer’s movements through the kinect bone tracing technique, allowing the doctor to remotely master the patient’s training progress. With the help of computers and the Internet, the patient can consult a physician, while the physician can remotely guide and launch the training “prescription” through the Internet according to the training effect. Patients can have rehabilitated training at home. The results of the test showed that the system has a positive effect on the rehabilitation of the patient.
The number of patients with motor dysfunction caused by hemiplegia and stroke increased. In order to promote better recovery of their body muscles, patients are still required to perform rehabilitation exercises in the community or family after the treatment of discharge. However, there are still some difficulties in community rehabilitation for patients with motor dysfunction:
- (1) The number of therapists on-site services is scarce and expensive;
- (2) In the absence of standard and systematic action guidance, the patients ‘ own training is not only the science is not high and the effect is limited.
- (3) Patients need to be trained in special environments such as rehabilitation centers, and wearing complex training equipment is inconvenient for them.
The family rehabilitation system collects the depth information of the trainer’s movements through the Kinect skeletal tracking technique; With the help of computers and the Internet, patients can consult physicians, and the doctor through the Internet remote guidance and open training action “prescription” according to the training effect so that patients at home can be rehabilitation training. This liberated the physician’s labour force and formed a network community that was closely linked to the hospital and regularly received “training prescriptions” to improve patient rehabilitation. […]
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via Design and Implementation study of Remote Home Rehabilitation Training Operating System based on Internet – IOPscience
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.
Copyright: © 2018 |Pages: 30
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.
via The “Arm” Line of Devices for Neurological Rehabilitation: Engineering Book Chapter | IGI Global
Purpose: To investigate the effectiveness and feasibility of Kinect-based upper
extremity rehabilitation on functional performance in chronic stroke survivors.
Methods: This was a single cohort pre-post test study. Participants (N=10; mean age =
62.5 ± 9.06) engaged in Kinect-based training three times a week for four to five weeks
in a university laboratory. To simulate a clinic to home transfer condition,
individualized guidance was given to participants at the initial three sessions followed
by independent usage. Outcomes included Fugl-Meyer assessment of upper extremity,
Wolf Motor Function Test, Stroke Impact Scale, Confidence of Arm and Hand
Movement and Active Range of Motion. Participant experience was assessed using a
structured questionnaire and a semi-structured interview.
Results. Improvement was found in Fugl-Meyer assessment scores (p=0.001), Wolf
Motor Function Test, (p=0.008), Active Range of Motion (p<0.05) and Stroke Impact
Scale-Hand function (p=0.016). Clinically important differences were found in FuglMeyer
assessment scores (Δ= 5.70 ± 3.47) and Wolf Motor Function Test (Δ Time= –
4.45 ± 6.02; ∆ Functional Ability Scores= 0.29 ± 0.31). All participants could use the
system independently and recognized the importance of exercise individualization by
Conclusions. The Kinect-based UE rehabilitation provided clinically important
functional improvements to our study participants.
Stroke is the leading cause of long-term adult disability in the United States .
More than a half of survivors continue suffering from upper-limb hemiparesis poststroke with only 5% of people recovering their full arm function . The persistent
upper-limb dysfunction significantly impairs motor performance, and results in a
serious decline in functional ability as well as quality of life . Intensive and repeated
practice with the paretic arm appears necessary to enhance arm recovery and facilitate
neural reorganization [4-7]. Nevertheless, the healthcare system provides limited
amounts and duration of therapy, making it difficult for stroke survivors to achieve
maximal arm recovery before discharge from outpatient rehabilitation or home care
[8,9]. Therefore, identifying novel modalities that are accessible and affordable to the
general public while allowing continued practice of the arm is imperative for improving
long-term upper-limb outcomes after stroke.
One potential approach is the use of low-cost virtual reality (VR)-based systems,
for example, the Microsoft Kinect system. The Kinect is a vision-based motion
capturing system that can detect gesture and movements of the body through its RGA
camera and depth sensors. It allows users to interact with the VR-based system without
holding or wearing specialized equipment or markers for tracking. Users can play
games or practice exercises using natural movements while observing the performance of their virtual avatars shown in real-time on the computer screen. Through this interactive observation and feedback, stroke survivors can correct their movements towards more normal patterns. Furthermore, the Kinect is small and portable, thus enabling stroke survivors to practice exercises in a familiar and private environment. […]
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Exercise-based rehabilitation for chronic conditions such as cardiovascular disease, diabetes, and chronic obstructive pulmonary disease, constitutes a key element in reducing patient symptoms and improving health status and quality of life. However, group exercise in rehabilitation programmes faces several challenges imposed by the diversified needs of their participants. In this direction, we propose a novel computer-assisted system enhanced with sensors such as Kinect cameras and wristband heart rate monitors, aiming to support the trainer in adapting the exercise programme on-the-fly, according to identified requirements. The proposed system design facilitates maximal tailoring of the exercise programme towards the most beneficial and enjoyable execution of exercises for patient groups. This work contributes in the design of the next-generation of computerised systems in exercise-based rehabilitation.
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via A Computer-Assisted System with Kinect Sensors and Wristband Heart Rate Monitors for Group Classes of Exercise-Based Rehabilitation | SpringerLink
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.
via Suitability of Kinect for measuring whole body movement patterns during exergaming – ScienceDirect
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.
via MaLT – Combined Motor and Language Therapy Tool for Brain Injury Patients Using Kinect. – PubMed – NCBI