Posts Tagged motor rehabilitation

[Editorial] Introducing the thematic series on transcranial direct current stimulation (tDCS) for motor rehabilitation: on the way to optimal clinical use

Introduction

Transcranial direct current stimulation (tDCS) is a method of noninvasive brain stimulation that directs a constant low amplitude electric current through scalp electrodes. tDCS has been shown to modulate excitability in both cortical and subcortical brain areas [], with anodal tDCS leading to increased neuronal excitability and cathodal tDCS inversely leading to reduced neuronal excitability. tDCS can also modulate blood flow (i.e. oxygen supply to cortical and subcortical areas []) and neuronal synapsis strength [], triggering plasticity processes (i.e. long-term potentiation and long-term depression). There is growing interest in using tDCS as a low-cost, non-invasive brain stimulation option for a wide range of potential clinical applications. Advantages of tDCS over other methods of non-invasive brain stimulation include favorable safety and tolerability profiles and its portability and applicability.

The use of tDCS in motor rehabilitation for neurological diseases as well as in healthy ageing is a growing area of therapeutic use. Although the results of tDCS interventions for motor rehabilitation are still preliminary, they encourage further research to better understand its therapeutic utility and to inform optimal clinical use. Therefore, The Journal of NeuroEngineering and Rehabilitation (JNER. https://jneuroengrehab.biomedcentral.com/) is pleased to present the thematic series entitled “tDCS application for motor rehabilitation”.

The goal of this thematic series is to increase the awareness of academic and clinical communities to different potential applications of tDCS for motor rehabilitation. Experts in the field were invited to submit experimental or review studies. A call for papers was also announced to reach those interested in contributing to this thematic series. This collection of articles was thought to present the most recent advances in tDCS for motor rehabilitation, addressing topics such as theoretical, methodological, and practical approaches to be considered when designing tDCS-based rehabilitation. The targeted disorders include but are not limited to: stroke, Parkinson’s disease, Cerebral Palsy, cerebellar ataxia, trauma, Multiple Sclerosis.

tDCS – A promising clinical tool for motor rehabilitation

tDCS has been used in experimental and clinical neuroscience for the study of brain functions and treatment in a range of disorders of the central nervous system. Of particular interest to this thematic series, a growing body of evidence suggest that tDCS has potential to become a clinical tool for motor rehabilitation.

The existing tDCS protocols using well-defined montages, stimulus durations and intensities are safe and well tolerated by both healthy individuals and clinical populations. There are no reported indications of any serious adverse effects, such as damage of brain tissue or seizure induction, with the use of 1–2 mA protocols []. The most commonly reported adverse effects included redness, tingling and itching sensations under the electrodes, as well as headache []. Moreover, the overall adverse effect rates are similar between active and sham tDCS [], which suggests that the mild adverse effects are related to electrode positioning on the skin and not the stimulation itself.

As tDCS is portable, devices can easily be transported, which circumvents accessibility barriers to health care (i.e. tDCS can easily be moved into clinics or wards). It can be implemented in combination with other kinds of interventions, such as cognitive or physical training or exercise, with this pairing possibly leading to synergistic benefit []. Although accumulating evidence highlights potential benefits offered by tDCS for motor rehabilitation, further research is required for tDCS to become an approved clinical tool. The majority of existing clinical trials has involved a limited number of participants, which may imply underpowered analysis. Thus, large-scale studies are needed to overcome this major flaw.

Due to the potential for self- or caregiver-application, remotely supervised protocols have been developed and recently found feasible for those with motor impairment []. However, these studies employ highly structured protocols and rigorous criteria with real time supervision via teleconference, and do not support a “do-it-yourself” tDCS practice. Instead, the remotely supervised protocols can be used to facilitate the clinical trial designs that are necessary in order to advance tDCS towards therapeutic use.

Data on optimal protocols and predictors of response to tDCS are currently lacking in the literature. Future studies in this field should focus on determining the optimal stimulation parameters and predictors of response to tDCS in different clinical populations. It seems that one size does not fit all in tDCS. However, previous studies may be limited, as standard clinical assessments may miss subtle motor improvements. Future outcomes for determining the effectiveness of tDCS for motor rehabilitation need to be robust. Therefore, combining tDCS protocols with other validated mobile technologies to monitor motor performance, such as wearable inertial sensors or innovative Internet of Things devices, may provide important insight into effectiveness within clinic and beyond.

Despite the positive progression of research to clinical practice, there are still questions to be answered before tDCS can be extensively recommended for motor rehabilitation.

• What is the ideal intensity and duration of the session?

• How many sessions are required?

• What is the ideal interval between sessions?

• What about patients’ characteristics?

• Who will benefit from tDCS?

• Do specific demographic characteristics lead to greater benefits?

Final considerations

We hope the accepted papers will contribute meaningfully to the body of knowledge in the field of tDCS for motor rehabilitation and that they will motivate the development of further research. Additionally, we hope this thematic series will assist both researchers and clinical professionals in making decisions for the achievement of optimal benefits throughout tDCS.

References

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    Bolzoni F, Pettersson L-G, Jankowska E. Evidence for long-lasting subcortical facilitation by transcranial direct current stimulation in the cat. J Physiol [Internet]. 2013 [cited 2018 Nov 10];591:3381–3399. Available from: http://doi.wiley.com/10.1113/jphysiol.2012.244764.
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    Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol [Internet]. 2000 [cited 2018 Nov 10];527 Pt 3:633–639. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10990547.
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    Zheng X, Alsop DC, Schlaug G. Effects of transcranial direct current stimulation (tDCS) on human regional cerebral blood flow. Neuroimage [Internet]. 2011 [cited 2019 Feb 14];58:26–33. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21703350.
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    Polanía R, Paulus W, Antal A, Nitsche MA. Introducing graph theory to track for neuroplastic alterations in the resting human brain: a transcranial direct current stimulation study. Neuroimage [Internet]. 2011 [cited 2019 Feb 14];54:2287–2296. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1053811910012875.
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    Woods AJ, Antal A, Bikson M, Boggio PS, Brunoni AR, Celnik P, et al. A technical guide to tDCS, and related non-invasive brain stimulation tools. Clin Neurophysiol [Internet] 2016 [cited 2018 Nov 10];127:1031–1048. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26652115.
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    Moffa AH, Brunoni AR, Fregni F, Palm U, Padberg F, Blumberger DM, et al. Safety and acceptability of transcranial direct current stimulation for the acute treatment of major depressive episodes: Analysis of individual patient data. J Affect Disord [Internet]. 2017 [cited 2018 Nov 10];221:1–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28623732.
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    Bikson M, Grossman P, Thomas C, Zannou AL, Jiang J, Adnan T, et al. Safety of transcranial direct current stimulation: evidence based update 2016. Brain Stimul [Internet] 2016 [cited 2018 Nov 10];9:641–661. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27372845.
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    Fertonani A, Ferrari C, Miniussi C. What do you feel if I apply transcranial electric stimulation? Safety, sensations and secondary induced effects. Clin Neurophysiol [Internet]. 2015 [cited 2018 Nov 10];126:2181–2188. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25922128.
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    Kaski D, Dominguez R, Allum J, Islam A, Bronstein A. Combining physical training with transcranial direct current stimulation to improve gait in Parkinson’s disease: a pilot randomized controlled study. Clin Rehabil [Internet]. 2014 [cited 2018 Nov 10];28:1115–24. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24849794.
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    Agarwal S, Pawlak N, Cucca A, Sharma K, Dobbs B, Shaw M, et al. Remotely-supervised transcranial direct current stimulation paired with cognitive training in Parkinson’s disease: An open-label study. J Clin Neurosci [Internet]. 2018 [cited 2018 Nov 10];57:51–57. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30193898.

via Introducing the thematic series on transcranial direct current stimulation (tDCS) for motor rehabilitation: on the way to optimal clinical use | SpringerLink

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[Abstract] Vision-Based Serious Games and Virtual Reality Systems for Motor Rehabilitation: A Review Geared Toward a Research Methodology

ABSTRACT

Background

Nowadays, information technologies are being widely adopted to promote healthcare and rehabilitation. Owing to their affordability and use of hand-free controllers, vision-based systems have gradually been integrated into motor rehabilitation programs and have greatly drawn the interest of healthcare practitioners and the research community. Many studies have illustrated the effectiveness of these systems in rehabilitation. However, the report and design aspects of the reported clinical trials were disregarded.

Objective

In this paper, we present a systematic literature review of the use of vision-based serious games and virtual reality systems in motor rehabilitation programs. We aim to propose a research methodology that engineers can use to improve the designing and reporting processes of their clinical trials.

Methods

We conducted a review of published studies that entail clinical experiments. Searches were performed using Web of Science and Medline (PubMed) electronic databases, and selected studies were assessed using the Downs and Black Checklist and then analyzed according to specific research questions.

Results

We identified 86 studies and our findings indicate that the number of studies in this field is increasing, with Korea and USA in the lead. We found that Kinect, EyeToy system, and GestureTek IREX are the most commonly used technologies in studying the effects of vision-based serious games and virtual reality systems on rehabilitation. Findings also suggest that cerebral palsy and stroke patients are the main target groups, with a particular interest on the elderly patients in this target population. The findings indicate that most of the studies focused on postural control and upper extremity exercises and used different measurements during assessment.

Conclusions

Although the research community’s interest in this area is growing, many clinical trials lack sufficient clarity in many aspects and are not standardized. Some recommendations have been made throughout the article.

via Vision-Based Serious Games and Virtual Reality Systems for Motor Rehabilitation: A Review Geared Toward a Research Methodology – ScienceDirect

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[WEB SITE] tDCS application for motor rehabilitation

Neuer Inhalt

An increasing number of studies highlight the potential application of transcranial direct current stimulation (tDCS) for motor rehabilitation in neurological diseases as well as in healthy aging. tDCS is a technique where a constant weak electric current is passed through scalp electrodes and has been shown to modulate excitability in both cortical and subcortical brain areas. Although the results of tDCS interventions for motor rehabilitation are still preliminary, they encourage further research to better understand its therapeutic potential and to inform optimal clinical use.

This collection of articles aims to present the most recent advances in tDCS for motor rehabilitation, addressing topics such as theoretical, methodological, and practical approaches to be considered when designing tDCS-based rehabilitation. Submissions of both experimental and review studies is encouraged.

This collection of articles has not been sponsored and articles have undergone the journal’s standard peer-review process overseen by the Editor-in-Chief and Associate Editors. The Editor-in-Chief and Associate Editors declare no competing interests.

  1. Content Type:Review

    Transcranial direct current stimulation for the treatment of motor impairment following traumatic brain injury

    After traumatic brain injury (TBI), motor impairment is less common than neurocognitive or behavioral problems. However, about 30% of TBI survivors have reported motor deficits limiting the activities of daily…

    Authors:Won-Seok Kim, Kiwon Lee, Seonghoon Kim, Sungmin Cho and Nam-Jong Paik

    Citation:Journal of NeuroEngineering and Rehabilitation 2019 16:14

    Published on: 25 January 2019

  2. Content Type:Review

    Transcranial direct current stimulation for promoting motor function in cerebral palsy: a review

    Transcranial direct current stimulation (tDCS) has the potential to improve motor function in a range of neurological conditions, including Cerebral Palsy (CP). Although there have been many studies assessing …

    Authors:Melanie K. Fleming, Tim Theologis, Rachel Buckingham and Heidi Johansen-Berg

    Citation:Journal of NeuroEngineering and Rehabilitation 2018 15:121

    Published on: 20 December 2018

  3. Content Type:Commentary

    Transcranial direct current stimulation (tDCS) for upper limb rehabilitation after stroke: future directions.

    Transcranial Direct Current Stimulation (tDCS) is a potentially useful tool to improve upper limb rehabilitation outcomes after stroke, although its effects in this regard have shown to be limited so far. Addi…

    Authors:Bernhard Elsner, Joachim Kugler and Jan Mehrholz

    Citation:Journal of NeuroEngineering and Rehabilitation 2018 15:106

    Published on: 15 November 2018

  4. Content Type:Research

    Home-based transcranial direct current stimulation plus tracking training therapy in people with stroke: an open-label feasibility study

    Transcranial direct current stimulation (tDCS) is an effective neuromodulation adjunct to repetitive motor training in promoting motor recovery post-stroke. Finger tracking training is motor training whereby p…

    Authors:Ann Van de Winckel, James R. Carey, Teresa A. Bisson, Elsa C. Hauschildt, Christopher D. Streib and William K. Durfee

    Citation:Journal of NeuroEngineering and Rehabilitation 2018 15:83

    Published on: 18 September 2018

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[Conference Proceedings] Rhythmic Entrainment for Hand Rehabilitation Using the Leap Motion Controller – Full Text PDF

Abstract

Millions of individuals around the world suffer from motor impairment or disability, yet effective, engaging, and cost-effective therapeutic solutions are still lacking. In this work, we propose a game for hand rehabilitation that leverages the therapeutic aspects of music for motor rehabilitation, incorporates the power of gamification to improve adherence to medical treatment, and uses the versatility of devices such as the Leap Motion Controller to track users’ movements. The main characteristics of the game as well as future research directions are outlined.

Full Text PDF

via Rhythmic Entrainment for Hand Rehabilitation Using the Leap Motion Controller | Kat Agres

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[ARTICLE] Combined Cognitive-Motor Rehabilitation in Virtual Reality Improves Motor Outcomes in Chronic Stroke – A Pilot Study – Full Text

Stroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patients’ capability to live independently. Virtual Reality (VR) based methods for stroke rehabilitation have mainly focused on motor rehabilitation but there is increasing interest toward the integration of cognitive training for providing more effective solutions. Here we investigate the feasibility for stroke recovery of a virtual cognitive-motor task, the Reh@Task, which combines adapted arm reaching, and attention and memory training. 24 participants in the chronic stage of stroke, with cognitive and motor deficits, were allocated to one of two groups (VR, Control). Both groups were enrolled in conventional occupational therapy, which mostly involves motor training. Additionally, the VR group underwent training with the Reh@Task and the control group performed time-matched conventional occupational therapy. Motor and cognitive competences were assessed at baseline, end of treatment (1 month) and at a 1-month follow-up through the Montreal Cognitive Assessment, Single Letter Cancelation, Digit Cancelation, Bells Test, Fugl-Meyer Assessment Test, Chedoke Arm and Hand Activity Inventory, Modified Ashworth Scale, and Barthel Index. Our results show that both groups improved in motor function over time, but the Reh@Task group displayed significantly higher between-group outcomes in the arm subpart of the Fugl-Meyer Assessment Test. Improvements in cognitive function were significant and similar in both groups. Overall, these results are supportive of the viability of VR tools that combine motor and cognitive training, such as the Reh@Task. Trial Registration:This trial was not registered because it is a small clinical study that addresses the feasibility of a prototype device.

Introduction

Stroke is one of the most common causes of adult disability and its prevalence is likely to increase with an aging population (WHO, 2015). It is estimated that 33–42% of stroke survivors require assistance for daily living activities 3–6 months post-stroke and 36% continue to be disabled 5 years later (Teasell et al., 2012). Loss of motor control and muscle strength of the upper extremity are the most prevalent deficits and are those that have a greater impact on functional capacity (Saposnik, 2016). Hence, its recovery is fundamental for minimizing long-term disability and improving quality of life. In fact, most rehabilitation interventions focus on facilitating recovery through motor learning principles (Kleim and Jones, 2008). However, learning engages also cognitive processes such as attention, memory and executive functioning, all of which may be affected by stroke (Cumming et al., 2013). Still, conventional rehabilitation methodologies are mostly motor focused, although 70% of patients experience some degree of cognitive decline (Gottesman and Hillis, 2010), which also affects their capability to live independently (Langhorne et al., 2011).[…]

 

Continue —> Frontiers | Combined Cognitive-Motor Rehabilitation in Virtual Reality Improves Motor Outcomes in Chronic Stroke – A Pilot Study | Psychology

FIGURE 1. Experimental setup and VR task. (A) The user works on a tabletop and arm movements are captured by augmented reality pattern tracking. These movements are mapped onto the movements of a virtual arm on the screen for the execution of the cancelation task. (B) The target stimuli can be letters, numbers, and symbols in black or different colors. The target stimuli in this picture are ordered by increasing complexity.

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[Abstract + References] Using Orientation Sensors to Control a FES System for Upper-Limb Motor Rehabilitation

Abstract

Contralaterally controlled functional electrical stimulation (CCFES) is a recent therapy aimed at improving the recovery of impaired limbs after stroke. For hemiplegic patients, CCFES uses a control signal from the non-impaired side of the body to regulate the intensity of electrical stimulation delivered to the affected muscles of the homologous limb on the opposite side of the body. CCFES permits an artificial muscular contraction synchronized with the patient’s intentionality to carry out functional tasks, which is a way to enhance neuroplasticity and to promote motor learning. This work presents an upper extremity motor rehabilitation system based on CCFES, using orientation sensors for control. Thus, the stimulation intensity (current amplitude) delivered to the paretic extremity is proportional to the degree of joint amplitude of the unaffected extremity. The implemented controller uses a control strategy that allows the delivered electrical stimulation intensity, to be comparable to the magnitude of movement. It was carried out a set of experiments to validate the overall system, for executing five bilateral mirror movements that include human wrist and elbow joints. Obtained results showed that movements voluntary signals acquired from right upper-limb were replicated successfully on left upper-limb using the FES system.

References

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    Hara, Y., Obayashi, S., Tsujiuchi, K., Muraoka, Y.: The effects of electromyography controlled functional electrical stimulation on upper extremity function and cortical perfusion in stroke patients. Clin. Neurophysiol. 124, 2008–2015 (2013)CrossRefGoogle Scholar
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    Sheffler, L., Chae, J.: Neuromuscular electrical stimulation in neurorehabilitation. Muscle Nerve 35, 562–590 (2007)CrossRefGoogle Scholar
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    Doucet, B.M., Lamb, A., Griffin, L.: Neuromuscular electrical stimulation for skeletal muscle function. Yale J. Biol. Med. 85, 201–215 (2012)Google Scholar
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    Popovic, D.B., Sinkjærc, T., Popovic, M.B.: Electrical stimulation as a means for achieving recovery of function in stroke patients. NeuroRehabilitation 25, 45–58 (2009)Google Scholar
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    Knutson, J.S., Harley, M.Y., Hisel, T.Z., Makowski, N.S., Fu, M.J., Chae, J.: Contralaterally controlled functional electrical stimulation for stroke rehabilitation. In: Proceedings of IEEE Engineering and Medicine and Biology Society, pp. 314–317 (2012)Google Scholar
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    Knutson, J.S., Harley, M.Y., Hisel, T.Z., Makowski, N.S., Chae, J.: Contralaterally controlled functional electrical stimulation for recovery of elbow extension and hand opening after stroke: a pilot case series study. Am. J. Phys. Med. Rehabil. 93(6), 528–539 (2014)CrossRefGoogle Scholar
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    Sabatini, A.M.: Estimating three-dimensional orientation of human body parts by inertial/magnetic sensing. Sensors 11, 1489–1525 (2011)CrossRefGoogle Scholar
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    Ferrarin, M., Palazzo, F., Riener, R., Quintern, J.: Model-based control of FES-induced single joint movements. IEEE Trans. Neural Syst. Rehabil. Eng. 9(3), 245–257 (2001)CrossRefGoogle Scholar
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    Knutson, J.S., Gunzler, D.D., Wilson, R.D., Chae, J.: Contralaterally controlled functional electrical stimulation improves hand dexterity in chronic hemiparesis. Stroke. 47(12), 2596–2602 (2016)CrossRefGoogle Scholar

via Using Orientation Sensors to Control a FES System for Upper-Limb Motor Rehabilitation | SpringerLink

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[ARTICLE] Movement visualisation in virtual reality rehabilitation of the lower limb: a systematic review – Full Text

Background

Virtual reality (VR) based applications play an increasing role in motor rehabilitation. They provide an interactive and individualized environment in addition to increased motivation during motor tasks as well as facilitating motor learning through multimodal sensory information. Several previous studies have shown positive effect of VR-based treatments for lower extremity motor rehabilitation in neurological conditions, but the characteristics of these VR applications have not been systematically investigated. The visual information on the user’s movement in the virtual environment, also called movement visualisation (MV), is a key element of VR-based rehabilitation interventions. The present review proposes categorization of Movement Visualisations of VR-based rehabilitation therapy for neurological conditions and also summarises current research in lower limb application.

Methods

A systematic search of literature on VR-based intervention for gait and balance rehabilitation in neurological conditions was performed in the databases namely; MEDLINE (Ovid), AMED, EMBASE, CINAHL, and PsycInfo. Studies using non-virtual environments or applications to improve cognitive function, activities of daily living, or psychotherapy were excluded. The VR interventions of the included studies were analysed on their MV.

Results

In total 43 publications were selected based on the inclusion criteria. Seven distinct MV groups could be differentiated: indirect MV (N = 13), abstract MV (N = 11), augmented reality MV (N = 9), avatar MV (N = 5), tracking MV (N = 4), combined MV (N = 1), and no MV (N = 2). In two included articles the visualisation conditions included different MV groups within the same study. Additionally, differences in motor performance could not be analysed because of the differences in the study design. Three studies investigated different visualisations within the same MV group and hence limited information can be extracted from one study.

Conclusions

The review demonstrates that individuals’ movements during VR-based motor training can be displayed in different ways. Future studies are necessary to fundamentally explore the nature of this VR information and its effect on motor outcome.

Background

Virtual reality (VR) in neurorehabilitation has emerged as a fairly recent approach that shows great promise to enhance the integration of virtual limbs in one`s body scheme [1] and motor learning in general [2]. Virtual Rehabilitation is a “group [of] all forms of clinical intervention (physical, occupational, cognitive, or psychological) that are based on, or augmented by, the use of Virtual Reality, augmented reality and computing technology. The term applies equally to interventions done locally, or at a distance (tele-rehabilitation)” [3]. The main objectives of intervention for facilitating motor learning within this definition are to (1) provide repetitive and customized high intensity training, (2) relay back information on patients’ performance via multimodal feedback, and (3) improve motivation [24]. VR therapies or interventions are based on real-time motion tracking and computer graphic technologies displaying the patients’ behaviour during a task in a virtual environment.

The interaction of the user and Virtual environment can be described as a perception and action loop [5]. This motor performance is displayed in the virtual environment and subsequently, the system provides multimodal feedback related to movement execution. Through external (e.g. vision) and internal (proprioception) senses the on-line sensory feedback is integrated into the patient’s mental representation. If necessary, the motor plan is corrected in order to achieve the given goal [5].

A previous Cochrane Review from Laver, George, Thomas, Deutsch, and Crotty [2] on Virtual Reality for stroke rehabilitation showed positive effects of VR intervention for motor rehabilitation in people post-stroke. However, grouped analysis from this review on recommendation for VR intervention provides inconclusive evidence. The author further comments that “[…] virtual reality interventions may vary greatly […], it is unclear what characteristics of the intervention are most important” ([2], p. 14).

Virtual rehabilitation system provides three different types of information to the patient: movement visualisation, performance feedback and context information [6]. During a motor task the patient’s movements are captured and represented in the virtual environment (movement visualisation). According to the task success, information about the accomplished goal or a required movement alteration is transmitted through one or several sensory modalities (performance feedback). Finally, these two VR features are embedded in a virtual world (context information) that can vary from a very realistic to an abstract, unrealistic or reduced, technical environment.

Performance feedback often relies on theories of motor learning and is probably the most studied information type within VR-based motor rehabilitation. Moreover, context information is primarily not designed with a therapeutic purpose. Movement observation, however, plays an important role for central sensory stimulation therapies, such as mirror therapy or mental training. The observation or imagination of body movements facilitates motor recovery [79] and provides new possibilities for cortical reorganization and enhancement of functional mobility. Thus, it appears that movement visualisation may also play an important role in motor rehabilitation [1012], although this aspect is yet to be systematically investigated [13].

The main goal of the present review is to identify various movement visualisation groups in VR-based motor interventions for lower extremities, by means of a systematic literature search. Secondarily, the included studies are further analysed for their effect on motor learning. This will help guide future research in rehabilitation using VR.

An interim analysis of the review published in 2013 showed six MV groups for upper and lower extremity training and additional two MV groups directed only towards lower extremity training. In this paper, we analysed only studies involving lower limb training, leading to a revision and expansion of the previously published MV groups findings [1315].[…]

 

Continue —> Movement visualisation in virtual reality rehabilitation of the lower limb: a systematic review

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[Abstract] Combining tDCS and computerized mirror therapy in upper limb rehabilitation in stroke patients. A feasibility study

Introduction/Background

Mirror therapy (MT) relies on a mirror and movements of the healthy limb to generate visual illusions of movement of the paralyzed limb. MT has proven to be effective for the motor rehabilitation of the upper limb of stroke patients, but suffers several limitations for patients. To overcome these difficulties, a computerized mirror therapy device was developed (IVS3™, Dessintey). MT effects could also be enhanced by applying simultaneous neuromodulation with tDCS. This small sample trial was conducted to evaluate the feasibility and tolerance of an IVS3 motor training combined with simultaneous bi-hemispheric tDCS.

Material and method

Four patients with right or left hemiparesis following stroke were included in this trial. They received 20 sessions of computerized MT (IVS3 ™, Dessintey; 5 sessions/week; 1 hour and 200 movements/session) combined with bi-hemispheric tDCS over the hand motor cortex (2 mA, 20 minutes). The primary endpoint was adherence to the therapeutic program. The secondary judgment criteria were the safety assessmentand the evolution of the tolerance of repeated tDCS stimulation coupled with IVS3.

Results

The synergy of these two therapies is well tolerated by patients with a compliance rate of 99% ± 0.025. There have been no serious adverse reactions or unknown side effects. The upper limb motor function of the 4 patients improved, but this small sample non-controlled trial do not allow to conclude on a significant effect.

Conclusion

In this feasibility small sample study, the 4 patients well tolerated and perfectly complied with the computerized mirror therapy associated with bi-hemispheric tDCS. This finding calls for clinical controlled study to evaluate the efficacy of this combined IVS3-tDCS program in stroke patients.

via Combining tDCS and computerized mirror therapy in upper limb rehabilitation in stroke patients. A feasibility study – ScienceDirect

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[Abstract + Related Articles] Adaptive gameplay and difficulty adjustment in a gamified upper-limb rehabilitation – IEEE Conference Publication

 

Abstract

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.

Related Articles

via Adaptive gameplay and difficulty adjustment in a gamified upper-limb rehabilitation – IEEE Conference Publication

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[Abstract] Motor imagery: a systematic review of its effectiveness in the rehabilitation of the upper limb following a stroke.

Abstract

INTRODUCTION:

Motor imagery or mental practice of movement is a relatively new intervention that is being used on an increasingly more frequently basis in the treatment of stroke patients. It consists in the person evoking a movement or gesture in order to learn or improve its execution. Neuroimaging studies have shown that imagining movements activates neuronal patterns that are similar to those produced when they are actually performed.

PATIENTS AND METHODS:

A systematic review was conducted between January and June 2017 in the Web of Science, PubMed, CINHAL, PEDro and Scopus databases to select clinical trials carried out with stroke patients in whom this technique was used as rehabilitation. Thirteen randomised clinical trials were included. The characteristics of the studies and the measures of results were summarised and the evidence of their outcomes was described.

RESULTS:

Most of the studies found significant differences in terms of improved motor rehabilitation of the upper limb among the subjects in the experimental groups. Only one of the studies failed to show any evidence of its effectiveness in isolation. None of them made any reference to its effectiveness in improving sensory alterations.

CONCLUSIONS:

Motor imagery, combined with conventional therapy (physiotherapy or occupational therapy), seems to have positive effects on the motor rehabilitation of the upper limb following a stroke. Further research is needed to improve the heterogeneity of the interventions and to evaluate their effectiveness in the long term.

 

via [Motor imagery: a systematic review of its effectiveness in the rehabilitation of the upper limb following a stroke]. – PubMed – NCBI

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