Posts Tagged Motor

[WEB PAGE] Home-Based Rehab Program for Stroke Patients

MindMaze and Mount Sinai Health System announce the launch of an at-home tele-neurorehabilitation program for stroke patients, utilizing the FDA-cleared and CE-marked MindMotion GO.

With this system, patients can continue their recovery at home with virtual support from clinicians at Mount Sinai’s Abilities Research Center (ARC).

This initiative expands patient access to MindMotion GO, which has been adopted by the Rehabilitation Innovation team at Mount Sinai since June to provide critical neurorehabilitation across the continuum of care.

Using MindMaze’s gamified digital therapy program, Mount Sinai patients can seamlessly transition between inpatient to outpatient rehabilitation and continue their recovery at home while still receiving support and care from their physical therapists. Designed to keep acute and chronic stroke patients training for longer periods, MindMotion GO guides a complete range of body parts including the upper and lower limbs, hands, and trunk, to improve motor and task functions, a media release from MindMaze explains.

“The COVID-19 pandemic has set back the recovery and rehabilitation of stroke patients worldwide, underscoring the need for cutting-edge digital neurotherapeutics.

“MindMotion GO has enabled thousands of stroke patients to recover within the safety of their homes. We are excited to collaborate with Mount Sinai to expand access to the telerehabilitation solutions patients need and rightly deserve.”

— Tej Tadi, CEO and founder of MindMaze

MindMotion GO features several therapeutic games developed to help clinicians create personalized therapy regimens and provide patients with real-time audio and visual feedback. It also features full-body motion capture technology and hand dexterity hardware, offering therapists a way to monitor the quality of each patient’s movements and provide a tactical level of support similar to being physically present with them.

“With MindMotion GO, we’ve been able to provide our patients with continued access to top-tier telerehabilitation and support despite constant changes in the traditional hospital and treatment settings.

“We look forward to growing this program as we’ve seen our patients enjoy a new level of ownership over their treatment, helping them make great strides in their recovery.”

— David Putrino, PhD, Director of Rehabilitation Innovation for the Mount Sinai Health System

[Source(s): MindMaze, PR Newswire]

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[ARTICLE] Sleep Disruption After Brain Injury Is Associated With Worse Motor Outcomes and Slower Functional Recovery – Full Text


Background. Sleep is important for consolidation of motor learning, but brain injury may affect sleep continuity and therefore rehabilitation outcomes. Objective. This study aims to assess the relationship between sleep quality and motor recovery in brain injury patients receiving inpatient rehabilitation. Methods. Fifty-nine patients with brain injury were recruited from 2 specialist inpatient rehabilitation units. Sleep quality was assessed (up to 3 times) objectively using actigraphy (7 nights) and subjectively using the Sleep Condition Indicator. Motor outcome assessments included Action Research Arm test (upper limb function), Fugl-Meyer Assessment (motor impairment), and the Rivermead Mobility Index. The Functional Independence Measure (FIM) was assessed at admission and discharge by the clinical team. Fifty-five age- and gender-matched healthy controls completed one assessment. Results. Inpatients demonstrated lower self-reported sleep quality (P < .001) and more fragmented sleep (P < .001) than controls. For inpatients, sleep fragmentation explained significant additional variance in motor outcomes, over and above that explained by admission FIM score (P < .017), such that more disrupted sleep was associated with poorer motor outcomes. Using stepwise linear regression, sleep fragmentation was the only variable found to explain variance in rate of change in FIM (R2adj = 0.12, P = .027), whereby more disrupted sleep was associated with slower recovery. Conclusions. Inpatients with brain injury demonstrate impaired sleep quality, and this is associated with poorer motor outcomes and slower functional recovery. Further investigation is needed to determine how sleep quality can be improved and whether this affects outcome.


Sleep disturbance is a common complaint after brain injury, including stroke, with a high proportion (30%-70%) of patients presenting with impaired subjective sleep quality and meeting the criteria for at least one sleep disorder.14 Sleep disturbance could be resulting from direct damage to brain areas, or due to secondary effects such as being in the hospital environment, depression, anxiety or pain, and could potentially have an impact on rehabilitation through reduced engagement or impaired learning and consolidation.5

There is some evidence for improvements in sleep quality from the acute to the chronic stage of stroke6,7; however, stroke survivors at the chronic stage continue to have impaired subjective and objective sleep quality and worse quality of life than controls.8,9 Interestingly, the longer the time since stroke, the worse the perceived daytime sleepiness becomes.10 This suggests that sleep disturbance may be persistent throughout the rehabilitation period for some, and changes within this time frame in patients with different types of brain injuries are yet to be determined.

The link between sleep quality and function after stroke and brain injury is currently emerging. Siccoli et al11 demonstrated a cross-sectional correlation between the National Institute for Health Stroke Scale (NIHSS) score and wake after sleep onset (WASO), in a small sample of acute stroke patients. A larger study12 found a cross-sectional relationship between subjective sleep quality and the functional ambulation score after stroke but had no objective sleep measures. Similarly, Kalmbach et al13 found that patients with subjective difficulties initiating sleep had lower function at multiple time-points over the first 6 months of recovery from traumatic brain injury (TBI). Sleep variables, such as total sleep time, WASO and daytime napping, have also been shown to explain significant variance in Barthel Index (BI) score at the acute stage of stroke,14,15 and the percentage of sleep stages I and rapid eye movement (REM) are negatively associated with NIHSS.16

However, there is little research to indicate whether sleep quality over the rehabilitation period correlates with outcome or change in function over time, and studies that are available are somewhat inconsistent in their findings. The presence of sleep-disordered breathing at the acute stage has been found to be associated with reduced modified Rankin scale (mRS) and BI at 6 weeks poststroke17 and other studies have demonstrated that stroke patients categorized with a “poor” functional outcome have a lower sleep efficiency, less REM sleep or a reduced REM sleep latency at the acute stage than those with a better outcome.16,18,19 In contrast, Joa et al20 found no difference in the change in NIHSS or BI between patients reporting sleep disturbance at 1 month poststroke and those reporting no disturbance. They did, however, find that the group reporting no sleep disturbance had a greater improvement in the Berg Balance Scale (BBS). This was particularly evident for the moderate-severe stroke patients compared with mild (on the basis of NIHSS score at 1 week poststroke), suggesting sleep may have a greater impact on functional recovery in those who have the most relearning to achieve. The studies by Iddagoda et al4 and Joa et al20 used only subjective sleep measures and many of the studies have divided participants into groups based on outcome or the presence/absence of sleep disturbance, rather than examining both sleep quality and outcome as a continuum which may be more sensitive to differences across participants. Studies that did assess objective sleep quality as a continuum are mixed in their findings. Bakken et al15 found no correlation between sleep variables in the acute stage and BI at 6 months poststroke whereas Vock et al7 found that higher WASO or lower sleep efficiency at the acute stage poststroke was associated with worse outcome (mRS or BI score) at discharge. Similarly, Huang et al14 demonstrate that total sleep time correlates positively, and sleep latency correlates negatively, with the change in BI with rehabilitation.

As there is no clear consensus on the relationship between sleep quality measures and the rate of recovery with rehabilitation, and it is unclear how sleep quality changes over the course of rehabilitation, we sought to conduct a prospective assessment of sleep quality in neurological inpatients and explore the relationship with neurorehabilitation outcomes. We therefore assessed objective and subjective sleep quality at up to 3 time-points throughout the rehabilitation period and examined the relationship between sleep quality and motor and functional outcome measures. Specifically, we aimed to address the following questions:

  1. Does sleep quality at a single time-point correlate with function/impairment at that time-point?
  2. Does sleep quality change over the inpatient rehabilitation period?
  3. Does objective sleep quality averaged over the inpatient rehabilitation period explain variance in motor outcomes over that explained by baseline function?
  4. Does objective or subjective sleep quality averaged over the inpatient rehabilitation period explain variance in the rate of recovery in addition to covariates such as initial independence, age, and time since injury?



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[Abstract] Implementing biomarkers to predict motor recovery after stroke.



There is growing interest in using biomarkers to predict motor recovery and outcomes after stroke. The PREP2 algorithm combines clinical assessment with biomarkers in an algorithm, to predict upper limb functional outcomes for individual patients. To date, PREP2 is the first algorithm to be tested in clinical practice, and other biomarker-based algorithms are likely to follow.


This review considers how algorithms to predict motor recovery and outcomes after stroke might be implemented in clinical practice.


There are two tasks: first the prediction information needs to be obtained, and then it needs to be used. The barriers and facilitators of implementation are likely to differ for these tasks. We identify specific elements of the Consolidated Framework for Implementation Research that are relevant to each of these two tasks, using the PREP2 algorithm as an example. These include the characteristics of the predictors and algorithm, the clinical setting and its staff, and the healthcare environment.


Active, theoretically underpinned implementation strategies are needed to ensure that biomarkers are successfully used in clinical practice for predicting motor outcomes after stroke, and should be considered in parallel with biomarker development.

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[Thesis] Post-stroke rehabilitation of hand function based on Electromyography biofeedback – Full Text PDF


The aim of my thesis work is the application and validation of an electromyographic biofeedback (EMG-BF) system in post-stroke rehabilitation setting. The absolute number of strokes is expected to dramatically increase in coming years, thus suggesting a need for strategies to improve post-stroke assistance and rehabilitation. The electromyogram (EMG) signal has shown good perspectives in the analysis of movements and motor impairment and the introduction of closed loop rehabilitation strategies revealed an increase of patient self-consciousness and motivation. Results are promising but a lack in the optimization of the devices for the application in the clinical context has been revealed. The device and the related software employed in the present research have been specifically conceived with this purpose. The device has been optimized during a clinical pilot study and then, a complete clinical trial has been started to investigate the characteristics of post stroke patients eligible for a rehabilitation therapy with the device, and the short-term clinical effect of the therapy on the recovery of the hand functionality. A statistical analysis has been performed on the dataset collected for 3 months. The data analysis included both clinical data and data collected from patients with the device during the execution of the experimental protocol. The preliminary results of the data analysis have confirmed the suitability of the system for its intended use and highlighted that the patient ability of controlling the EMG-BF based device is related to the degree of impairment with minimum p-value<0.001, depending on the patient clinical picture and on the exercise performed.
Moreover, according preliminary results observed on four patients that received a 15 hours therapy for 3 weeks, the improvement of the parameters related to the hand and fingers motor function, suggests the efficacy of the therapy. Finally, aspects related to the analysis of continuous motions of the wrist performed during the therapy have been investigated and the relevance of the temporal information in the interpretation of this type of movements has been revealed (p<<0.01).

Full Text PDF

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[Systematic Review] Trends in robot-assisted and virtual reality-assisted neuromuscular therapy: a systematic review of health-related multiplayer games – Full Text



Multiplayer games have emerged as a promising approach to increase the motivation of patients involved in rehabilitation therapy. In this systematic review, we evaluated recent publications in health-related multiplayer games that involved patients with cognitive and/or motor impairments. The aim was to investigate the effect of multiplayer gaming on game experience and game performance in healthy and non-healthy populations in comparison to individual game play. We further discuss the publications within the context of the theory of flow and the challenge point framework.


A systematic search was conducted through EMBASE, Medline, PubMed, Cochrane, CINAHL and PsycINFO. The search was complemented by recent publications in robot-assisted multiplayer neurorehabilitation. The search was restricted to robot-assisted or virtual reality-based training.


Thirteen articles met the inclusion criteria. Multiplayer modes used in health-related multiplayer games were: competitive, collaborative and co-active multiplayer modes. Multiplayer modes positively affected game experience in nine studies and game performance in six studies. Two articles reported increased game performance in single-player mode when compared to multiplayer mode.


The multiplayer modes of training reviewed improved game experience and game performance compared to single-player modes. However, the methods reviewed were quite heterogeneous and not exhaustive. One important take-away is that adaptation of the game conditions can individualize the difficulty of a game to a player’s skill level in competitive multiplayer games. Robotic assistance and virtual reality can enhance individualization by, for example, adapting the haptic conditions, e.g. by increasing haptic support or by providing haptic resistance. The flow theory and the challenge point framework support these results and are used in this review to frame the idea of adapting players’ game conditions.


Robotic assistance and virtual reality in neuromuscular therapy

Neurological deficits can result in impaired motor function that affect a person’s quality of life. Researchers have been working to restore the nervous system and reduce the neurological deficits of people suffering from stroke, spinal cord injury, or traumatic brain injury [1]. For people with neurological deficits, impaired motor function is among the most prominent factors limiting the quality of life [2]. Motor neurorehabilitation can lead to permanent improvements in motor function [3]. Robotic assistance and virtual reality have the potential to enhance rehabilitation of neuromuscular deficits beyond the levels possible with conventional training strategies [45].

Game experience and task performance in multiplayer games

Robot- and virtual reality-assisted single-player games are well integrated in neurorehabilitation schedules. Recently, multiplayer games have been tested to complement neuromuscular therapy. Multiplayer games are expected to motivate the patients and increase the potential of robot- and virtual reality-assisted neuromuscular therapy.

Multiplayer games incorporate social interaction to promote the enjoyment of the involved players. The additional player adds new possibilities to the game environment, generally missed in single-player gaming against preprogrammed challenges or artificially controlled opponents. The multiplayer environment and related game mechanics can facilitate social interaction, ranging from conversation to haptic interaction. Due to the this added social interaction, the game experience is thought to be better in multiplayer compared to single-player gaming [6].

The mode of the game specifies whether the players compete or cooperate with one another [7]. In line with the flow theory, a competitive mode requires opponents of similar skill level to achieve enjoyment as the task difficulty experienced by one opponent [8]. Comparable skill levels prevent boredom or stress and result in a meaningful challenge level that leads to a flow state when training [9]. In such training conditions the players have a positive game experience.

In positive game experience players increase their game performance [910]. Increased game performance facilitates the general idea of serious games, i.e., playing for a primary purpose other than pure entertainment [11]. If enhanced game performance is achieved by increased physical activity, training intensity is also increased. In neuromuscular therapy, training intensity – alongside early treatment, user-centered, and task-oriented training – is one of the key factors in neurorehabilitation [1213]. Therefore, multiplayer gaming has great potential to further increase the benefits of robot-assisted neuromuscular and virtual reality-assisted therapy [1415].



Continue —> Trends in robot-assisted and virtual reality-assisted neuromuscular therapy: a systematic review of health-related multiplayer games | Journal of NeuroEngineering and Rehabilitation | Full Text


Fig. 4Difficulty adaptation based on individual condition setting in multiplayer games. Game experience (left) can be optimized by balancing the game performance (right). – Left: The initial game experience under nominal conditions relates to the skill level of the opponent and is non-optimal for differently skilled players (squares). Optimal game experience is perceived by the players when the condition adapts the difficulty towards the players’ skill level (circles). – Right: A common initial game performance state consists of a conditional task difficulty and its corresponding player specific game performance (square). Player specific difficulty adaptation can balance the game performances of the two players (circles)

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[Abstract] Tele-Rehabilitation after Stroke: An Updated Systematic Review of the Literature



Tele-rehabilitation for stroke survivors has emerged as a promising intervention for remotely supervised administration of physical, occupational, speech, and other forms of therapies aimed at improving motor, cognitive, and neuropsychiatric deficits from stroke.


We aimed to provide an updated systematic review on the efficacy of tele-rehabilitation interventions for recovery from motor, higher cortical dysfunction, and poststroke depression among stroke survivors.


We searched PubMed and Cochrane library from January 1, 1980 to July 15, 2017 using the following keywords: “Telerehabilitation stroke,” “Mobile health rehabilitation,” “Telemedicine stroke rehabilitation,” and “Telerehabilitation.” Our inclusion criteria were randomized controlled trials, pilot trials, or feasibility trials that included an intervention group that received any tele-rehabilitation therapy for stroke survivors compared with a control group on usual or standard of care.


This search yielded 49 abstracts. By consensus between 2 investigators, 22 publications met the criteria for inclusion and further review. Tele-rehabilitation interventions focused on motor recovery (n = 18), depression, or caregiver strain (n = 2) and higher cortical dysfunction (n = 2). Overall, tele-rehabilitation interventions were associated with significant improvements in recovery from motor deficits, higher cortical dysfunction, and depression in the intervention groups in all studies assessed, but significant differences between intervention versus control groups were reported in 8 of 22 studies in favor of tele-rehabilitation group while the remaining studies reported nonsignificant differences.


This updated systematic review provides evidence to suggest that tele-rehabilitation interventions have either better or equal salutary effects on motor, higher cortical, and mood disorders compared with conventional face-to-face therapy.


via Tele-Rehabilitation after Stroke: An Updated Systematic Review of the Literature. – PubMed – NCBI

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[Abstract] Dual-task training effects on motor and cognitive functional abilities in individuals with stroke: a systematic review

This systematic review aimed to examine the effects of dual-task balance and mobility training in people with stroke.

An extensive electronic databases literature search was conducted using MEDLINE, PubMed, EBSCO, The Cochrane Library, Web of Science, SCOPUS, and Wiley Online Library. Randomized controlled studies that assessed the effects of dual-task training in stroke patients were included for the review (last search in December 2017). The methodological quality was evaluated using the Cochrane Collaboration recommendation, and level of evidence was determined according to the criteria described by the Oxford Center for Evidence-Based Medicine.

About 13 articles involving 457 participants were included in this systematic review. All had substantial risk of bias and thus provided level IIb evidence only. Dual-task mobility training was found to induce more improvement in single-task walking function (standardized effect size = 0.14–2.24), when compared with single-task mobility training. Its effect on dual-task walking function was not consistent. Cognitive-motor balance training was effective in improving single-task balance function (standardized effect size = 0.27–1.82), but its effect on dual-task balance ability was not studied. The beneficial effect of dual-task training on cognitive function was provided by one study only and thus inconclusive.

There is some evidence that dual-task training can improve single-task walking and balance function in individuals with stroke. However, any firm recommendation cannot be made due to the weak methodology of the studies reviewed.


via Dual-task training effects on motor and cognitive functional abilities in individuals with stroke: a systematic review – Ying He, Lei Yang, Jing Zhou, Liqing Yao, Marco Yiu Chung Pang, 2018

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Stroke is one of the leading causes for disability worldwide . Motor function deficits due to stroke affects the patient’s mobility and contribute to overall quality of life.              Neurorehabilitation training is the most effective way to reduce motor impairments in stroke patients. Conventional rehabilitation found to provide modest and sometimes delayed effects. This systematic review focuses on the impact of Virtual Reality Program on motor rehabilitation of stroke patients. The studies suggested that virtual reality is relatively recent approach that may enable practice of functional tasks at higher dosage than traditional therapies. From this review of  literature , it can be concluded that Virtual Reality is effective in improving motor functions following stroke. Use of Virtual Reality as an adjunct to conventional therapy resulted in greater motor gains than conventional therapy alone . The studies included in this review show optimal level of evidence and grade of recommendations , but further studies with larger sample sizes are needed to draw more reliable conclusion.

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[WEB SITE] Project3 – Flexo-glove


Project Description

Flexo-glove is a 3D printed soft exoskeleton robotic glove with compact and streamlined design for assistance in activities of daily livings and rehabilitation purposes of patients with hand function impairment.


  • Overall weight of 330g including battery
  • Providing 22N pinch force, 48N power grasp force and object grasp size of up to 81mm in diameter
  • Two control modes: intention-sensing via wireless surface EMG for assistive mode and externally-directed via an accompanying smartphone

Project Details: —> Visit site

My Role:

  • Initiated the project with the idea of using soft 3D printed materials in design of the Flexo-glove inspired by X-Limb
  • Performed feasibility study for using cable-driven mechanism in actuation of rehabilitation glove
  • Leading a group of four mechatronics engineering students to fabricate the prototype and characterise the grip forces


  • Received Dyason fellowship, $5000 travel fellowship awarded by Melbourne Robotic Lab. to visit Harvard BioRobotics Lab

Related Publications

 A. Mohammadi, J. Lavranos, R. D. Howe, P. Choong and D. Oetomo

  Flexo-glove: A 3D Printed Soft Exoskeleton Robotic Glove for Impaired Hand Rehabilitation and Assistance

  40th International Engineering in Medicine and Biology Conference (EMBC), 2018.

Full Text  PDF 

via Project3 – Flexo-glove

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[WEB SITE] Rutgers VR spinoff moves to NJEDA incubator

New Jersey Economic Development Authority
The New Jersey Economic Development Authority’s Commercialization Center for Innovative Technologies in North Brunswick.

Virtual reality is mostly known as a platform for gamers — allowing its users to escape from the real world by commanding the Enterprise, rescuing their child from a post-apocalyptic wasteland or being transported smack-dab into the middle of a murder mystery.

However, there’s another angle at play.

It can also help alleviate symptoms and improve the health of people who’ve suffered illnesses and injuries.

Patients who have suffered stroke, dementia and traumatic brain injuries are using virtual reality as part of their rehabilitation therapy, thanks to technology developed by Bright Cloud International Corp.

BCI, a Rutgers University spinoff, announced earlier this month it moved its operations into the New Jersey Economic Development Authority’s Commercialization Center for Innovative Technologies in North Brunswick. The move will expand the CCIT’s footprint in New Jersey as a life sciences incubator.

“Having spent the past 30 years here, I know the intrinsic value that New Jersey offers entrepreneurs, including its strong academic institutions and its dynamic life sciences community. I also wanted to maintain strong ties with Rutgers and to offer jobs for students and graduates. In return for the decades of support I have received from the university, I wanted to strengthen BCI while also benefitting Rutgers,” said Grigore “Greg” Burdea, BCI founder and president.

The rehabilitation system, known as BrightBrainer, is a self-contained and mobile rehabilitation medical device that has custom virtual reality therapy games.

The system, which is available for lease or purchase, targets motor skills such as motor control, speed of movement, endurance, hand-eye coordination and task sequencing. It also targets cognitive abilities, including attention, short-term visual and auditory memory, working memory, reading comprehension and dual tasking.

The virtual reality system, according to BCI, is useful in a variety of health care settings, including outpatient clinics, skilled nursing facilities and medical adult day programs.

“Our biggest success to date is the BrightBrainer rehabilitation system. I am proud that it reduces care costs, increases access to care and improves therapy outcomes,” Burdea said.

A team of researchers, engineers, physicians, therapists and game developers created the games, which adapt to each individual patient.

According to BCI, BrightBrainer has been found to benefit a patient’s motor and cognitive skills, as well as a patient’s emotional state, leading to an increased quality of life.

“We know that the brain can rewire itself to bypass non-working neurons, so our technology helps patients build that bypass to regain use of their bodies,” Burdea said. “It also puts a new and interactive spin on the monotony of occupational therapy, bringing an age-old industry into the 21st century.”

Burdea said he moved the incubator to CCIT because of its environment, access to networking and investors, and opportunities for increased visibility.

“Understanding and responding to the needs of the market is imperative to the state’s ability to retain and attract innovative companies and top talent,” EDA CEO Tim Sullivan said. “Nurturing early-stage companies is just one facet of Gov. (Phil) Murphy’s vision of a more robust and equitable economy, and CCIT offers a model of what can be achieved through collaboration between the private, public and academic sectors.”

via Rutgers VR spinoff moves to NJEDA incubator – ROI-NJ

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