Posts Tagged Motivation

[ARTICLE] A multisession evaluation of an adaptive competitive arm rehabilitation game – Full Text

Background

People with neurological injuries such as stroke should exercise frequently and intensely to regain their motor abilities, but are generally hindered by lack of motivation. One way to increase motivation in rehabilitation is through competitive exercises, but such exercises have only been tested in single brief sessions and usually did not adapt difficulty to the patient’s abilities.

Methods

We designed a competitive arm rehabilitation game for two players that dynamically adapts its difficulty to both players’ abilities. This game was evaluated by two participant groups: 15 participants with chronic arm impairment who exercised at home with an unimpaired friend or relative, and 20 participants in the acute or subacute phase of stroke who exercised in pairs (10 pairs) at a rehabilitation clinic. All participants first played the game against their human opponent for 3 sessions, then played alone (against a computer opponent) in the final, fourth session. In all sessions, participants’ subjective experiences were assessed with the Intrinsic Motivation Inventory questionnaire while exercise intensity was measured using inertial sensors built into the rehabilitation device. After the fourth session, a final brief questionnaire was used to compare competition and exercising alone.

Results

Participants who played against an unimpaired friend or relative at home tended to prefer competition (only 1 preferred exercising alone), and exhibited higher enjoyment and exercise intensity when competing (first three sessions) than when exercising alone (last session).

Participants who played against each other in the clinic, however, did not exhibit significant differences between competition and exercising alone. For both groups, there was no difference in enjoyment or exercise intensity between the first three sessions, indicating no negative effects of habituation or novelty.

Conclusions

Competitive exercises have high potential for unsupervised home rehabilitation, as they improve enjoyment and exercise intensity compared to exercising alone. Such exercises could thus improve rehabilitation outcome, but this needs to be tested in long-term clinical trials. It is not clear why participants who competed against each other at the clinic did not exhibit any advantages of competition, and further studies are needed to determine how different factors (environment, nature of opponent etc.) influence patients’ experiences with competitive exercises.

Trial registration

The study is not a clinical trial. While human subjects are involved, they do not participate in a full rehabilitation intervention, and no health outcomes are examined.

Electronic supplementary material

The online version of this article (10.1186/s12984-017-0336-9) contains supplementary material, which is available to authorized users.

Background

Rehabilitation games

Stroke is a leading cause of disability, with 795,000 new or recurrent strokes per year in the United States alone [1]. 88% of survivors experience motor function impairment and thus require rehabilitation to regain their movement abilities [2]. However, even top hospitals devote only an hour per day to motor rehabilitation [3], and exercise intensity is usually too low for optimal rehabilitation outcome [4]. Patients are thus expected to exercise independently at home after leaving the clinic to fully regain their abilities, but frequently do not exercise frequently or intensely enough. For example, one study found that only 30% of unsupervised patients comply with prescribed home rehabilitation regimens [5]. Another home rehabilitation study found that patients average around 1.5 h of exercise per week [6], while clinical studies involve at least 3 h of exercise per week [78]. To improve home rehabilitation, it is therefore critical to increase the frequency and intensity of exercise.

One key reason for poor compliance in home rehabilitation is lack of motivation, which is an important predictor of rehabilitation outcome [910]. While the definition of motivation in rehabilitation is blurry, it is generally agreed to involve a willingness to actively engage in exercise [1112]. To improve engagement, researchers have thus developed numerous rehabilitation games that try to both ensure high enjoyment (using, e.g., meaningful goals, in-game rewards and entertaining graphics [1215]) and provide an appropriate exercise intensity via automated difficulty adaptation [121416]. The games are controlled using motion tracking hardware such as the Microsoft Kinect or even with rehabilitation robots that provide limb support in addition to motion tracking. However, recent reviews have emphasized that such games are not yet sufficiently engaging for all patients [1718]. Therefore, additional rehabilitation game development and validation is necessary to improve patient engagement.[…]

 

Continue —> A multisession evaluation of an adaptive competitive arm rehabilitation game

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Fig. 1
The Bimeo arm rehabilitation system in the wrist and forearm training configuration. Inertial sensors are attached to the upper arm, attached to the forearm, and integrated in the sphere that supports the hand

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[WEB SITE] 7 signs of executive dysfunction after brain injury

7 signs of executive dysfunction after brain injury Main Image

 ‘Executive dysfunction‘ is not, perhaps, a particularly well known term, but the effects of brain injury that it covers are very common indeed. It is used to collectively describe impairment in the ‘executive functions’ – the key cognitiveemotional and behavioural skills that are used to navigate through life, especially when undertaking activities and interacting with others.

Although executive dysfunction is a common problem among many brain injury survivors, it is most commonly experienced following an injury to the frontal lobe.

The importance of executive functions is shown by the difficulties caused when they don’t work properly and someone has problems with executive dysfunction. Since the executive functions are involved in even the most routine activities, frontal injuries leading to executive dysfunction can lead to problems in many aspects of life.

Here we list the most common effects of executive dysfunction, with some examples of common issues that brain injury survivors can face:

Difficulties with motivation and organisation

  • Loss of ‘get up and go’, which can be mistaken for laziness
  • Problems with thinking ahead and carrying out the sequence of steps needed to complete a task

Rigid thinking

  • Difficulty in evaluating the result of actions and reduced ability to change behaviour or switch between tasks if needed

Poor problem solving

  • Finding it hard to anticipate consequences
  • Decreased ability to make accurate judgements or find solutions if things are going wrong

Impulsivity

  • Acting too quickly and impulsively without fully thinking through the consequences, for example, spending more money than can be afforded

Mood disturbances

  • Difficulty in controlling emotions which may lead to outbursts of emotion such as anger or crying
  • Rapid mood changes may occur, for example, switching from happiness to sadness for no apparent reason

Difficulties in social situations

  • Reduced ability to engage in social interactions
  • Finding it hard to initiate, participate in, or pay attention to conversations
  • Poor judgement in social situations, which may lead to saying or doing inappropriate things

Memory/attention problems

  • Finding it harder to concentrate
  • Difficulty with learning new information
  • Decreased memory for past or current events, which may lead to disorientation

Find out more

If you or someone you care for is affected by executive dysfunction, it is important to seek support. Speak to your doctor about your symptoms, and ask about referral to specialist services such as counselling, neuropsychology and rehabilitation.

You can find out more and get tips and strategies to help manage your condition on our executive dysfunction after brain injury page.

Headway groups and branches can offer support in your area, and you can contact our helpline if you would like to talk things through.

via 7 signs of executive dysfunction after brain injury | Headway

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[Abstract+References] Influence awareness: considering motivation in computer-assisted rehabilitation

Abstract

The use of computers in the e-Health domain is becoming increasingly common, since technology is present in most aspects of our lives. In the rehabilitation field in particular, some additional issues requiring the use of computer-assisted therapies arise. On the one hand, there is a scarce availability of rehabilitation specialists and centers to satisfy the growing demand of their services. This problem gets even magnified because of the ageing population. On the other hand, the huge opportunities that the new interaction devices can bring to rehabilitation smooth the path towards novel therapies.

Nevertheless, even if a proper rehabilitation therapy is prescribed, it can fail because of the patient´s lack of motivation There are assorted motivation theories available in the literature to address this demotivation of patients. Unfortunately, there is no model or guide to put those theories into practice in computer-assisted rehabilitation. This paper is aimed at filling this gap by providing a model, namely Influence Awareness, to support the specification of motivation aspects in those applications used in computer-assisted rehabilitation.

Furthermore, some guidelines are also provided, so that the designer can get some extra guidance on some heuristics about how to design motivation. The integration of motivation design into a model-based development process is presented by showing how this motivation model is integrated into a task model. Finally, to better illustrate our approach a case study based on a collaborative e-Health system is also included.

References

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via Influence awareness: considering motivation in computer-assisted rehabilitation | SpringerLink

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[WEB SITE] Games, Gloves, and Grip: PTs Rehab Arms and Hands Post-Stroke With YouGrabber

Published on 

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Playing virtual reality games could be as effective as adding extra physical therapy sessions to a stroke patient’s rehab regimen, according to researchers.

“It is not a question of choosing one thing over the other, rather of having different training alternatives to provide variation,” says Iris Brunner, author of a study, published recently in Neurology, that explored a variety of medical uses for virtual reality.

“Virtual reality cannot replace physical therapy. But it can be experienced as a game, motivating patients to do an extra treatment session,” adds Brunner, associate professor with the University of Aarhus and Hammel Neurocenter, in Denmark.

Brunner and her team’s study included 120 stroke patients with mild to severe hand weakness, all of whom were randomly assigned to add 16 hour-long therapy sessions to their routine rehabilitation over a month. One group performed physical therapy, while the other group played a virtual reality game called YouGrabber, notes a media release from HealthDay.

In the game, Brunner explains, “the patients wear gloves with sensors, and their movements are tracked by an infrared camera and transferred to a virtual arm on screen.”

“In different scenarios, they can grasp objects that come toward them or pick carrots. In other games, patients steer a plane or a car with their movement. The therapist chooses the movements to be trained and the level of difficulty.”

Fifty patients in the physical therapy group and 52 in the virtual reality group completed the study and were evaluated after 3 months.

The researchers found no difference between the two groups with regard to the improvement in their hand and arm function.

“Patients who started out with moderately to mildly impaired arm and hand motor function achieved, on average, a level of good motor function,” Brunner states, while those with severe weakness were able to use their arms to make movements.

Patients with severe hand weakness appreciated how even small movements translated to the virtual arms on screen, she adds. And even the older patients liked the virtual reality game, she notes, possibly because the graphics are simpler than those in commercial video games.

Brunner concludes by noting that larger studies are needed to understand the potential value of virtual reality as a stroke recovery treatment.

[Source: HealthDay]

 

via Games, Gloves, and Grip: PTs Rehab Arms and Hands Post-Stroke With YouGrabber – Rehab Managment

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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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[Thesis] Serious Games for Health Rehabilitation

FACULDADE DE ENGENHARIA DA UNIVERSIDADE DO PORTO
Serious Games for Health Rehabilitation
Paula Alexandra Carvalho de Sousa Rego

Abstract
Serious Games are growing into a significant area spurred by the growth in the use of video games and of new methods for their development. They have important applications in several distinct areas such as: military, health, government, and education. As such, their purpose is to be used for other purposes than pure entertainment, which is normally associated with the concept of game. The interest for Serious Games arises from the fact that games have a set of features that makes them very effective to engage users and keep their motivation at higher levels.

From the above discussion, the design of computer games can offer valuable contributions to develop effective games in the rehabilitation area. In rehabilitation programs, one of the major problems reported are related to the motivation and engagement of patients in the exercises training sessions using traditional therapy approaches. Patients rapidly lose their interest and get bored doing the, usually repetitive, rehabilitation tasks.

This thesis addresses Serious Games for Health Rehabilitation (SGHR), and provides an indepth study and survey of the existent games and features. With this study we were able to devise a taxonomy that enables researchers and practitioners to use a systematic approach to study, classify and compare SGHR. This taxonomy is validated by a set of experts in the interrelated domain of knowledge. The research led us to identify and propose several important features and guidelines to include in SGHR. As a result, we propose, discuss and describe a framework for the development of serious games. The framework integrates a set of features of natural and multimodal interaction, social interaction (collaboration and competitiveness) and progress monitoring, which can be used to increase the motivation of the patients during the rehabilitation process.

To validate the proposed framework and features, a set of serious games were developed. These games are intended to be used in rehabilitation sessions, and their main goal is to increase the users’ motivation during the rehabilitation process. The developed games were designed based on well established rehabilitation systems and rehabilitation tasks. We describe the design and implementation of the games with respect to our proposed framework. The resulting game platform includes a set of features, such as competitiveness, collaboration and handicap mechanisms, with the aim of promoting the engagement and motivation of the patients involved in the rehabilitation process. The resulting system is a Web platform that enables games to be played online, making it more accessible to all users, including patients in rehabilitation. Besides that, the web platform provides a low cost solution to patients training and enables home rehabilitation, in addition to traditional therapy.

Final experiments were performed in order to validate the proposed framework and provide scientific evidence that it is possible to use serious games for health rehabilitation to increase the motivation of users. Experiments were conducted with healthy people and elderly users. The scores achieved in all the tests used were quite good with emphasis for the very good SUS and IMI scores achieved.

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[BLOG POST] Conquer motivation after brain injury- tips from a survivor

Why it’s so difficult to conquer motivation after brain injury?

One of the most commonly reported symptoms of brain injury is fatigue. And I don’t mean tiredness.  Fatigue is something much worse. For me I can be willing, but my brain has other ideas. Sometimes I think my conscious mind and sub-conscious don’t like each other and are always having an argument.  The result might make me appear lazy to the casual observer, but that isn’t the whole story. The ongoing battle is within me, as I try to conquer motivation.

When I tried to return to work (and failed) my bosses tried to tell me I needed to take some responsibility for my recovery. My left leg and arm were very weak, and they were surprised that I hadn’t joined a gym to rebuild my strength. At that stage I had never been a gym goer. But the idea of trying to do something like that without being ordered to was unfathomable.  When I was suffering with so much fatigue, how was I supposed to find the motivation?

Even things like tidying the house took so much building up to. But over time I have noticed something about myself. I knew it before, but I hadn’t appreciated it’s power over me previously.

The impact on others gives me more motivation than the impact on me.

9 months after my accident I adopted my Dads cat Murphy, who he was struggling to care for. I knew Murphy was ill, and it turned out to be mouth cancer. I had known Murphy his whole life as I lived at my parents when Murphy first arrived. We were best mates, and so I moved him to the other side of the country with me so I could look after him.

He was skinny and very underweight. As he had no appetite so I spent all day, everyday chasing him with food, trying to make him eat. Murphy became one of my priorities. I knew he didn’t have time on his side, but I needed to make him as comfortable as possible. And it worked, I soon got him back to a healthy weight. He found new energy and found the motivation to explore outside several times a day. That made me so happy. He was my reason to get out of bed in the mornings, because he needed me more now than he had ever in his life. Earlier this year he lost his battle, but he knew he was loved.

Others well-being is my motivation

How I motivate myself now.

So if I need to tidy the house, I tell myself how it’s not fair on my partner James if I don’t. He works long hard days, so I can’t expect him to do it after work. Nor should I expect him to have to live in a pig sty. So I tell myself off and get on with it. (Followed by a impromptu nap.)

I did eventually join a gym and was doing really well. But that has fallen by the wayside, as it only helps  me. I don’t think this is about confidence or self esteem, just having a purpose. I was always a dedicated worker, but now I don’t work I’ve had to explore other ways  to motivate myself.

When I started this blog, it wasn’t as therapy for myself, it was to raise awareness. I felt people needed to better understand brain injury. Now I know there are other survivors who read this and in some small way find it helpful. So my responsibility is to you, and therefore you are my motivation to continue my ramblings. So my advice is if you struggling to get going think who really needs you to complete that task. It could be as simple as the birds in your garden need you to put some food out for them to ensure their survival. We make a difference to somebodies life every day, that is a most profound motivation for me.

If you need more ideas on motivation I found this article which is suitable for most people.

https://www.psychologytoday.com/blog/friendship-20/201605/5-ways-stop-sabotaging-yourself

Other related articles:

Source: Conquer motivation after brain injury- tips from a survivor

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[ARTICLE] Robotic-assisted serious game for motor and cognitive post-stroke rehabilitation – Full Text PDF

 

Abstract

Stroke is a major cause of long-term disability that can cause motor and cognitive impairments. New technologies such as robotic devices and serious games are increasingly being developed to improve post-stroke rehabilitation. The aim of the present project was to develop a ROBiGAME serious game to simultaneously improve motor and cognitive deficits (in particular hemiparesis and hemineglect). In this context, the difficulty level of the game was adapted to each patient’s performance, and this individualized adaptation was addressed as the main challenge of the game development. The game was implemented on the REAplan end-effector rehabilitation robot, which was used in continuous interaction with the game. A preliminary feasibility study of a target pointing game was run in order to validate the game features and parameters. Results showed that the game was perceived as enjoyable, and that patients reported a desire to play the game again. Most of the targets included in the game design were realistic, and they were well perceived by the patients. Results also suggested that the cognitive help strategy could include one visual prompting cue, possibly combined with an auditory cue. It was observed that the motor assistance provided by the robot was well adapted for each patient’s impairments, but the study results led to a suggestion that the triggering conditions should be reviewed. Patients and therapists reported the desire to receive more feedback on the patient’s performances. Nevertheless, more patients and therapists are needed to play the game in order to give further and more comprehensive feedback that will allow for improvements of the serious game. Future steps also include the validation of the motivation assessment module that is currently under development.

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[ARTICLE] Affordable stroke therapy in high-, low- and middle-income countries: From Theradrive to Rehab CARES, a compact robot gym – Full Text

 

Affordable technology-assisted stroke rehabilitation approaches can improve access to rehabilitation for low-resource environments characterized by the limited availability of rehabilitation experts and poor rehabilitation infrastructure. This paper describes the evolution of an approach to the implementation of affordable, technology-assisted stroke rehabilitation which relies on low-cost mechatronic/robot devices integrated with off-the-shelf or custom games. Important lessons learned from the evolution and use of Theradrive in the USA and in Mexico are briefly described. We present how a stronger and more compact version of the Theradrive is leveraged in the development of a new low-cost, all-in-one robot gym with four exercise stations for upper and lower limb therapy called Rehab Community-based Affordable Robot Exercise System (Rehab C.A.R.E.S). Three of the exercise stations are designed to accommodate versions of the 1 DOF haptic Theradrive with different custom handles or off-the-shelf commercial motion machine. The fourth station leverages a unique configuration of Wii-boards. Overall, results from testing versions of Theradrive in USA and Mexico in a robot gym suggest that the resulting presentation of the Rehab C.A.R.E.S robot gym can be deployed as an affordable computer/robot-assisted solution for stroke rehabilitation in developed and developing countries.

Non-communicable diseases, especially cardiovascular diseases, are the leading cause of death and disability in the world. An increase in their prevalence often leads to higher incidences of stroke and consequently, an increase in the number of persons living with permanent disability due to stroke.1,2 Stroke is the leading cause of disability worldwide. Over 6.8 million adults live in the USA with disabilities due to a stroke, and by 2030, this number will grow by 4 million.3,4Seventy-five percent of adults recovering from stroke have residual impairment in their limbs, with only about 25% achieving recovery with minor impairments, and only 10% achieving full recovery.57 Greater than 30% are unable to walk without some assistance and 26% remain dependent in activities of daily living.8

The issues influencing rehabilitation outcomes are complex; some examples of these issues are poverty, increase in health costs, short length of stays, insurance limitations, and physical constraints on rehabilitation services (e.g. time).3,6 In low- and middle-income countries (LMIC), rehabilitation outcomes are worse since a disproportionate number of the population is without easy access to rehabilitation technologies, services and skilled clinicians.1,3,9,10 Improved stroke rehabilitation approaches can maximize the functional independence of stroke survivors discharged after inpatient and outpatient services and improve access to rehabilitation for low-resource environments in USA or other LMICs.

Our long-term goal is to develop and use affordable robot technologies to improve access to rehabilitation and ultimately improve the health and function of persons with persistent motor deficits due to a stroke in the USA and worldwide, especially in LMICs where more than 80% of those living with a stroke reside. Specifically, we desire to target stroke survivors who are diagnosed with hemiparesis, are living with severe to moderate motor function impairment, and are without easy access to rehabilitation. Research efforts are needed to develop cost-effective robot devices that can do the above and function in harsher environments characterized by extreme economic hardship (per country), intermittent energy and limited expert supervisors.

Our main approach to delivering rehabilitation has always promoted robot/computer-assisted motivating rehabilitation systems for stroke therapy.31 We have proposed the use and development of mechatronic devices alone or within a suite of devices for upper limb stroke therapy. This paper summarizes lessons learned regarding the delivery of affordable and accessible stroke therapy in HICs and LMICs. We illustrate these lessons via the use of Theradrive, alone (TD-1),2832 its development into a 1DOF Haptic Robot called Haptic Theradrive,3638 a therapy gym in Mexico (TD-2),3335 where Theradrive was one of six devices aimed at improving motor function after stroke. The paper then presents how a stronger and more compact version of the Theradrive is re-designed and leveraged in the development of a new low-cost, all-in-one robot gym called Rehab Community-based Affordable Robot Exercise System (Rehab C.A.R.E.S) with four exercise stations for upper and lower limb therapy. The prototype of the system is described along with strategies for control and new results from testing on exercise station 2. Finally, we discuss implications for deploying such a system in LMICs. […]

Continue —> Affordable stroke therapy in high-, low- and middle-income countries: From Theradrive to Rehab CARES, a compact robot gymJournal of Rehabilitation and Assistive Technologies Engineering – Michelle Jillian Johnson, Roshan Rai, Sarath Barathi, Rochelle Mendonca, Karla Bustamante-Valles, 2017

figure

Figure 1. Theradrive (TD-1), Mexico Theradrive (TD-2), and Haptic Theradrive (TD-3). The Mexico Theradrive has a similar platform to TD-1. Note: Figure 1 used with permission from reference 37.

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[Abstract+References] Ubiquitous gamification framework for stroke rehabilitation treatment based on the web service

Abstract

Every year a large number of people survives from the stroke. To overcome the muscular rigidity, the survivors should participate the rehabilitation program regularly. Above all things, the motivation of the survivors easily collapses and hinder the participating the rehabilitation program. As a consequence, finding a good motivator for individual survivors is an important task for the caregivers and the therapists. This paper utilizes an individualized game for a motivator and proposes a ubiquitous gamification framework for stroke rehabilitation using web-services. The framework provides a formal interface to embrace individualized games and devices and motivates the survivors to participate the rehabilitation process in daily life.

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