Posts Tagged motor rehabilitation

[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

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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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[ARTICLE] Increasing upper limb training intensity in chronic stroke using embodied virtual reality: a pilot study – Full Text

Abstract

Background

Technology-mediated neurorehabilitation is suggested to enhance training intensity and therefore functional gains. Here, we used a novel virtual reality (VR) system for task-specific upper extremity training after stroke. The system offers interactive exercises integrating motor priming techniques and embodied visuomotor feedback. In this pilot study, we examined (i) rehabilitation dose and training intensity, (ii) functional improvements, and (iii) safety and tolerance when exposed to intensive VR rehabilitation.

Methods

Ten outpatient stroke survivors with chronic (>6 months) upper extremity paresis participated in a ten-session VR-based upper limb rehabilitation program (2 sessions/week).

Results

All participants completed all sessions of the treatment. In total, they received a median of 403 min of upper limb therapy, with 290 min of effective training. Within that time, participants performed a median of 4713 goal-directed movements. Importantly, training intensity increased progressively across sessions from 13.2 to 17.3 movements per minute. Clinical measures show that despite being in the chronic phase, where recovery potential is thought to be limited, participants showed a median improvement rate of 5.3% in motor function (Fugl-Meyer Assessment for Upper Extremity; FMA-UE) post intervention compared to baseline, and of 15.4% at one-month follow-up. For three of them, this improvement was clinically significant. A significant improvement in shoulder active range of motion (AROM) was also observed at follow-up. Participants reported very low levels of pain, stress and fatigue following each session of training, indicating that the intensive VR intervention was well tolerated. No severe adverse events were reported. All participants expressed their interest in continuing the intervention at the hospital or even at home, suggesting high levels of adherence and motivation for the provided intervention.

Conclusions

This pilot study showed how a dedicated VR system could deliver high rehabilitation doses and, importantly, intensive training in chronic stroke survivors. FMA-UE and AROM results suggest that task-specific VR training may be beneficial for further functional recovery both in the chronic stage of stroke. Longitudinal studies with higher doses and sample sizes are required to confirm the therapy effectiveness.

Background

Stroke affects about 17 million people per year worldwide, with an increasing rate every year [1]. Stroke survivors often suffer from physical and mental disabilities, heavily impacting their quality of life. Five years after the first stroke, nearly 66% of patients exhibit different degrees of disability and only 34% are functionally independent in their activities of daily living [2].[…]

 

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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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[ARTICLE] Increasing upper limb training intensity in chronic stroke using embodied virtual reality: a pilot study – Full Text

Abstract

Background

Technology-mediated neurorehabilitation is suggested to enhance training intensity and therefore functional gains. Here, we used a novel virtual reality (VR) system for task-specific upper extremity training after stroke. The system offers interactive exercises integrating motor priming techniques and embodied visuomotor feedback. In this pilot study, we examined (i) rehabilitation dose and training intensity, (ii) functional improvements, and (iii) safety and tolerance when exposed to intensive VR rehabilitation.

Methods

Ten outpatient stroke survivors with chronic (>6 months) upper extremity paresis participated in a ten-session VR-based upper limb rehabilitation program (2 sessions/week).

Results

All participants completed all sessions of the treatment. In total, they received a median of 403 min of upper limb therapy, with 290 min of effective training. Within that time, participants performed a median of 4713 goal-directed movements. Importantly, training intensity increased progressively across sessions from 13.2 to 17.3 movements per minute. Clinical measures show that despite being in the chronic phase, where recovery potential is thought to be limited, participants showed a median improvement rate of 5.3% in motor function (Fugl-Meyer Assessment for Upper Extremity; FMA-UE) post intervention compared to baseline, and of 15.4% at one-month follow-up. For three of them, this improvement was clinically significant. A significant improvement in shoulder active range of motion (AROM) was also observed at follow-up. Participants reported very low levels of pain, stress and fatigue following each session of training, indicating that the intensive VR intervention was well tolerated. No severe adverse events were reported. All participants expressed their interest in continuing the intervention at the hospital or even at home, suggesting high levels of adherence and motivation for the provided intervention.

Conclusions

This pilot study showed how a dedicated VR system could deliver high rehabilitation doses and, importantly, intensive training in chronic stroke survivors. FMA-UE and AROM results suggest that task-specific VR training may be beneficial for further functional recovery both in the chronic stage of stroke. Longitudinal studies with higher doses and sample sizes are required to confirm the therapy effectiveness.

Background

Stroke affects about 17 million people per year worldwide, with an increasing rate every year [1]. Stroke survivors often suffer from physical and mental disabilities, heavily impacting their quality of life. Five years after the first stroke, nearly 66% of patients exhibit different degrees of disability and only 34% are functionally independent in their activities of daily living [2].

Motor rehabilitation after stroke

Motor dysfunction is the most prevalent impairment, with 9 out of 10 stroke survivors suffering from some form of upper limb motor disability [3], and it is a strong predictor of poor functional recovery [4]. Thus, there is a strong need for rehabilitative approaches enhancing motor recovery for stroke patients [5]. To maximize neural, motor and functional recovery, training needs to be long-lasting, challenging, repetitive, task-specific, motivating, salient, and intensive [6]. Standard motor rehabilitation after stroke typically includes neurofacilitation techniques, task-specific training and task-oriented training [7]. Further approaches include strength training, trunk restraint, somatosensory training, constraint-induced movement therapy, bilateral arm training, coordination of reach to grasp, mirror training, action observation and neuromuscular electrical stimulation [8].

Time scheduled for therapy and its frequency are determinant factors for the outcome of motor rehabilitation [9], with a recommended initial amount of at least 45 min for a minimum of 5 days per week [10]. However, the frequency of the delivered therapy usually decreases with time, with therapy being discontinued between 3 and 6 months after the vascular accident [7]. Under these rehabilitation conditions, recovery of motor function has been observed to be strongest during the first month after stroke and to slow down during subsequent months, reaching a “plateau” by 3–6 months post stroke [1112]. Clinical evidence for motor improvement in chronic stroke [13] suggests that the “plateau” may depend not only on neurobiological factors, but may also be caused by other factors such as reduction in rehabilitation services [14].

Thus, increasing therapy dose, also in the chronic phase of the disease, might be a critical factor to achieve a positive outcome. Although several guidelines for upper limb rehabilitation have been recently issued [510], the relationship between training intensity and recovery patterns is not yet fully established. Indeed, it is not fully clear how to quantify the dose increase leading to a positive outcome. Training volume, understood as the number of repetitions, seems to be a more relevant parameter of dose than just the total time allocated for therapy [9]. An important issue is how to quantify and capture this concept in a measurable parameter. Intensity of training, understood as the number of repetitions divided by the number of minutes of active therapy, might be a fundamental factor (together with amount and frequency of therapy) to quantify training efficiency. This knowledge becomes critical in order to evaluate cost-effectiveness of new technology-mediated interventions and to select the most valuable therapy procedures at the different stages of the continuum of care for stroke survivors.

Virtual reality for motor rehabilitation

Different complementary solutions have been proposed during the last decades to help increase and maintain the rehabilitation dose in the long term, mainly through continued therapy. Virtual reality (VR) based motor rehabilitation is a relatively recent approach, showing evidence of moderate effectiveness in improving upper limb and ADL function when compared to conventional therapy [15].

Many VR setups, and often generic (i.e. not developed for rehabilitation purposes) commercial off-the-shelf computer games, are used to perform a series of exercises, where patients move in front of a console and receive mostly visual feedback about their movements [161718]. This represents a limited approach, whereby the level of immersion and potential feedback is restricted to a single sensorimotor action-perception loop: the patient moves and receives only abstract visual feedback from the screen. A rather different approach implies embodied sensorimotor feedback, where movements of the patient in the real world are reproduced as movements of an anthropomorphic avatar in the virtual environment. Under such conditions, VR allows for more elaborated sensorimotor activation, which may impact the recovery process. In particular, through sensorimotor resonance mechanisms, embodied sensorimotor feedback allows the integration of motor priming techniques and cognitive principles related to body perception and action, including mirror therapy [19] and action observation [2021], which have been shown to improve functional recovery and increase cortical activation of the ipsilesional side after stroke. This embodied technology can be achieved by using motion capture technology that interprets the patient’s movements and provides multisensory (vision, audio, touch) feedback to the user about the movement performance. Such enriched VR experiences have been demonstrated to increase patients’ motivation [22] and facilitate functional recovery by engaging appropriate neural circuits in the motor system [23].

One of the VR advantages is that it enables simulated practice of functional tasks at a higher dosage than traditional therapies [15]. Lohse and colleagues recently reviewed the duration, time and frequency scheduled for different VR and computer games interventions, but training intensity (as defined above) was no reported [24]. In general, authors reported an overall median of 570 min of VR (or computer games) therapy delivered, with duration ranging from 20 to 60 min per session, and 8 to 36 sessions [24]. Otherwise, intensity of training is rarely reported for VR training (see [25] for an exception). However, this is a critical factor to estimate cost-effectiveness of VR-based interventions.

Objectives of the study

The present study aims at investigating the feasibility of admninistering intensive training in chronic stroke patients using a dedicated VR-based system that embeds real-time 3D motion capture and embodied visual feedback to deliver functional exercises designed to train impaired motor skills of the upper limb. Our primary goal was to assess (i) rehabilitation dose and training intensity in chronic patients. Additionally, we asked (ii) whether chronic stroke survivors improve functional outcomes of the upper limb when exposed to intensive VR-based therapy, and we measured (iii) safety and tolerance to such a technology-mediated intervention. We hypothesize that intensive VR-based rehabilitation may lead to high rehabilitation doses and functional improvement in chronic stroke survivors.[…]

Fig. 1a Participant performing an upper limb exercise (Grasping) with the MindMotion ™ PRO technology; b Participant doing the Reaching exercise; c Participant doing a Fruitchamp exercise

 

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[Conference paper] ePHoRt Project: A Web-Based Platform for Home Motor Rehabilitation – Abstract

Abstract

ePHoRt is a project that aims to develop a web-based system for the remote monitoring of rehabilitation exercises in patients after hip replacement surgery. The tool intends to facilitate and enhance the motor recovery, due to the fact that the patients will be able to perform the therapeutic movements at home and at any time. As in any case of rehabilitation program, the time required to recover is significantly diminished when the individual has the opportunity to practice the exercises regularly and frequently. However, the condition of such patients prohibits transportations to and from medical centers and many of them cannot afford a private physiotherapist. Thus, low-cost technologies will be used to develop the platform, with the aim to democratize its access. By taking into account such a limitation, a relevant option to record the patient’s movements is the Kinect motion capture device. The paper describes an experiment that evaluates the validity and accuracy of this visual capture by a comparison to an accelerometer sensor. The results show a significant correlation between both systems and demonstrate that the Kinect is an appropriate tool for the therapeutic purpose of the project.

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[ARTICLE] A motion intention-based upper limb rehabilitation training system to stimulate motor nerve through virtual reality – Full Text

Motor rehabilitation strategies for treating motor deficits after stroke are based on the understanding of the neural plasticity. In recent years, various upper limb rehabilitation robots have been proposed for the stroke survivors to provide relearning of motor skills by stimulating the motor nerve. However, several aspects including costing, human–robot interaction, and effective stimulation of motor nerve still remain as major issues. In this article, a new upper limb rehabilitation training system named as motion intention-based virtual reality training system is developed to close the aforementioned issues. The system identifies the user’s motion intention via force sensors mounted on the rehabilitation robot to conduct therapeutic exercises and stimulates the user’s motor nerve by introducing the illusion of immersion in virtual reality environment. The illusion of immersion is developed by creating Virtual Exoskeleton Robot model which is driven by user’s motion intention and reflecting the motion states in real time. The users can be present to the training exercises by themselves and fully engage in the virtual reality environment, so that they can relax, move, and recreate motor neuro-pathways. As preliminary phase, six healthy subjects were invited to participate in experiments. The experimental results showed that the motion intention-based virtual reality training system is effective for the upper limb rehabilitation exoskeleton and the evaluations of the developed system showed a significant reduction of the performance error in the training task.

Stroke is a major cause of acquired physical disability in adults worldwide. Motor deficits affecting the upper limb are a common manifestation of stroke and greatly contribute to decreasing the individual’s functional performance.1 It is widely appreciated that motor rehabilitation after stroke plays an essential role in reducing the individual’s physical disability.2 The rehabilitation strategies for treating motor deficits after stroke are based on the understanding of the neural plasticity which is known by the phenomenon that the human brain changes itself in response to different types of experience through the reorganization of its neuronal connections.3 To exhibit the neural plasticity, motor relearning is the most important matter because it can produce changes in synapses, neurons, and neuronal networks within specific brain regions.4 Exoskeletons are robotic systems designed to work linked with parts (or the whole) of the human body. The robotic exoskeleton structure is always maintaining contact with the human operator’s limb. It can be suitably employed in robotic-assisted rehabilitation to assist the users to proceed relearning movement training exercises. And it can also make the process of upper limb rehabilitation repeatable, with objective estimation and decrease the dependence on specialized personnel availability.

About 30 existing robotic exoskeleton devices are reviewed by Proietti et al.5 As it has been mentioned, most publications in the field of exoskeletons focused only on mechatronic design of the devices, while we do believe a paramount aspect for robots potentiality lays on the control side. So the development of innovative and improved human–robot interaction control strategies will make a certain contribution to the upper limb rehabilitation assisted by the robotic exoskeleton devices.

The virtual reality (VR) technology has been proved useful in terms of motivating and challenging patients for longer training duration and cadence, modifying patient’s participating level, and updating subjects with their training performance.6 VR-based rehabilitation protocols may significantly improve the quality of rehabilitation by offering strong functional motivations to the patient who can therefore be more attentive to the movement to be performed. VR can provide an even more stimulating video game-like rehabilitation environment when integrated with force feedback devices, thus enhancing the quality of the rehabilitation.7

An upper limb force feedback exoskeleton for robotic assisted rehabilitation in VR is presented in Frisoli et al.8 A specific VR application focused on the reaching task was developed and evaluated in the system, but the system can’t provide adjustment when the reaching is far away too much. And little details are given to the control aspects of the robotic exoskeleton. An assistive control system with a special kinematic structure of an upper limb rehabilitation robot embedded with force/torque sensors is presented by Chen et al.9 A three-dimensional (3-D) GUI system for upper limb rehabilitation using electromyography and inertia measurement unit sensor feedback is developed by Alhajjar et al.10 It encourages the patients by recording the results and providing 3-D VR arm to simulate the arm movement during the exercise. A haptic device and an inertial sensor are used to implement rehabilitation tasks proposed by Song et al.,11 the system provides the vision through the monitor and force feedback through the haptic device. Gesture therapy was presented by Sucar et al.,12 a VR-based platform for rehabilitation of the upper limb was introduced. Similarly, the patients’ use of a home-based VR system portrayed by Standen et al.13 provides a low-cost VR system that translates movements of the hand, fingers, and thumb into game play which was designed to provide a flexible and motivating approach to increasing adherence to home-based rehabilitation. It is suitable for the patients with slight independence ability, which doesn’t have to be assisted by the robotic exoskeleton.

By considering all the aforementioned limitations, motion intention-based virtual reality training system (MIVRTS) is developed by integrating motion intention identification-based upper limb therapeutic exercises and the illusion of immersion in VR. The system identifies the user’s motion intention via force sensors mounted on the rehabilitation robot to conduct therapeutic exercises and stimulates the user’s motor nerve by introducing the illusion of immersion in VR environment. The illusion of immersion is developed by creating Virtual Exoskeleton Robot model which is driven by user’s motion intention and reflecting the motion states in real time.

The rest of the article is organized as follows. “The rehabilitation robotic exoskeleton” section presents the main features of the rehabilitation robotic exoskeleton system. An overview of the developed MIVRTS system employed in this study for the validation of the exoskeleton in upper limb rehabilitation is given in “MIVRTS system” section. In “Motion intention-based application” section, the motion intention identifying method is described and an application for rehabilitation exercises is developed. “Evaluation on six participants” section explains the experiment and evaluation results, followed by conclusion described in the final section.[…]

Figure

Figure 1. 5-DOF upper limb rehabilitative exoskeleton robot. DOF: degrees of freedom.

Continue —-> A motion intention-based upper limb rehabilitation training system to stimulate motor nerve through virtual realityInternational Journal of Advanced Robotic Systems – Li Xing, Xiaofeng Wang, Jianhui Wang, 2017

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

Virtual Reality for Physical and Motor Rehabilitation

Front Cover

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

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

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

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

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

Preview this book »

Source: Virtual Reality for Physical and Motor Rehabilitation – Google Books

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[ARTICLE] Personalized Brain-Computer Interface Models for Motor Rehabilitation – Full Text PDF

Abstract

We propose to fuse two currently separate research lines on novel therapies for stroke rehabilitation: brain-computer interface (BCI) training and transcranial electrical stimulation (TES). Specifically, we show that BCI technology can be used to learn personalized decoding models that relate the global configuration of brain rhythms in individual subjects (as measured by EEG) to their motor performance during 3D reaching movements. We demonstrate that our models capture substantial across-subject heterogeneity, and argue that this heterogeneity is a likely cause of limited effect sizes observed in TES for enhancing motor performance. We conclude by discussing how our personalized models can be used to derive optimal TES parameters, e.g., stimulation site and frequency, for individual patients.

I. INTRODUCTION
Motor deficits are one of the most common outcomes of stroke. According to the World Health Organization, 15 million people worldwide suffer a stroke each year. Of these, five million are permanently disabled. For this third, upper limb weakness and loss of hand function are among the most devastating types of disabilities, which affect the quality of their daily life [1]. Despite a wide range of rehabilitation therapies, including medication treatment [2], conventional physiotherapy [3], and robot physiotherapy [4], only approximately 20% of patients achieve some form of functional recovery in the first six months [5], [6].

Current research on novel therapies includes neurofeedback training based on brain-computer interface (BCI) technology and transcranial electrical stimulation (TES). The former approach attempts to support cortical reorganization by providing haptic feedback with a robotic exoskeleton that is congruent to movement attempts, as decoded in real-time from neuroimaging data [7], [8]. The latter type of research aims to reorganize cortical networks in a way that supports motor performance, because post-stroke alterations of cortical networks have been found to correlate with the severity of motor deficits [9], [10]. While initial evidence suggested that both approaches, BCIbased training [11] and TES [12], have a positive impact, the significance of these results over conventional physiotherapy was not always achieved by different studies [13], [14], [15].

One potential explanation for the difficulty to replicate the initially promising findings is the heterogeneity of stroke patients. Different locations of stroke-induced structural changes
are likely to result in substantial across-patient variance in the functional reorganization of cortical networks. As a result, not all patients may benefit from the same neurofeedback or stimulation protocol. We thus propose to fuse these two research themes and use BCI technology to learn personalized models that relate the configuration of cortical networks to each patient’s motor deficits. These personalized models may then be used to predict which TES parameters, e.g., spatial location and frequency band, optimally support rehabilitation in each individual patient.

In this study, we address the first step towards personalized TES for stroke rehabilitation. Using a transfer learning framework developed in our group [16], we show how to create personalized decoding models that relate the EEG of healthy subjects during a 3D reaching task to their motor performance in individual trials. We further demonstrate that the resulting decoding models capture substantial acrosssubject heterogeneity, thereby providing empirical support for the need to personalize models. We conclude by reviewing our findings in the light of TES studies to improve motor performance in healthy subjects, and discuss how personalized TES parameters may be derived from our models.[…]

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[Abstract] Play seriously: Effectiveness of serious games and their features in motor rehabilitation. A meta-analysis.

Abstract

BACKGROUND:

Evidence for the effectiveness of serious games (SGs) and their various features is inconsistent in the motor rehabilitation field, which makes evidence based development of SGs a rare practice.

OBJECTIVE:

To investigate the effectiveness of SGs in motor rehabilitation for upper limb and movement/balance and to test the potential moderating role of SGs features like feedback, activities, characters and background.

METHODS:

We ran a meta-analysis including 61 studies reporting randomized controlled trials (RCTs), controlled trials (CTs) or case series designs in which at least one intervention for motor rehabilitation included the use of SGs as standalone or in combination.

RESULTS:

There was an overall moderate effect of SGs on motor indices, d = 0.59, [95% CI, 0.48, 0.71], p <  0.001. Regarding the game features, only two out of 17 moderators were statistically different in terms of effect sizes: type of activity (combination of group with individual activities had the highest effects), and realism of the scenario (fantasy scenarios had the highest effects).

CONCLUSIONS:

While we showed that SGs are more effective in improving motor upper limb and movement/balance functions compared to conventional rehabilitation, there were no consistent differences between various game features in their contribution to effects. Further research should systematically investigate SGs features that might have added value in improving effectiveness.

Source: Play seriously: Effectiveness of serious games and their features in motor rehabilitation. A meta-analysis. – PubMed – NCBI

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