The health care system needs to face new and advanced medical technologies that can improve the patients’ quality of life by replacing lost or decreased functions. In stroke patients, the disabilities that follow cerebral lesions may impair the mandatory daily activities of an independent life. These activities are dependent mostly on the patient’s upper limb function so that they can carry out most of the common activities associated with a normal life. Therefore, an upper limb exoskeleton device for stroke patients can contribute a real improvement of quality of their life. The ethical problems that need to be considered are linked to the correct adjustment of the upper limb skills in order to satisfy the patient’s expectations, but within physiological limits. The debate regarding the medical devices dedicated to neurorehabilitation is focused on their ability to be beneficial to the patient’s life, keeping away damages, injustice, and risks.
Posts Tagged neuro-rehabilitation
Submitted by Sinead Gorham on Tue, 06/12/2011 – 16:44
Due to the high costs of clinical neuro-rehabilitation, post stroke treatments are limited in all countries to only a few weeks to months after the stroke event. Any system aimed at pro-longing neuro-rehabilitation out of the clinics, for example at patients’ homes; that can use low cost treatments, addresses a major issue in our current health care management systems.
How SCRIPT will contribute:
The SCRIPT project will produce two prototype robotic devices, a passive‐actuated device and one actuated actively, both of which can be used in the stroke patient’s home. Provision of motivating and challenging therapeutic activities using a robotic hand and wrist rehabilitation device at home, will provide a chance for more frequent therapies and interactions. It is thought that such frequent interaction will further influence recovery at chronic phases of stroke rehabilitation.
The principal aims of SCRIPT are to:
• use such rehabilitative technologies at patient’s home to enable better management of chronic stroke patients
• focus on hand and wrist exercise; as this presents the least researched area with the most functional relevance and potential for contribution to personal independence.
• look at differences between passive and active actuated devices.
• provide an educational, motivational and engaging interaction, therefore making a therapy session more enjoyable for patients.
• focus on remote management and support of the patient.
• deduce from summative evaluation in this project, the impact on health and recovery and its potential cost implications.
The SCRIPT multidisciplinary team has existing expertise in all aspects of robot‐mediated therapy, clinical evaluation and interface design and usability. After their discharge from the hospital a patient can begin using the SCRIPT developed robotic tools at home. SCRIPT systems will be adaptive to the user requirements and provide immediate feedback to a patient on their performance. The feedback will also be provided to an “off-site” health care professional with in‐depth considerations for security and confidentiality, who can remotely monitor progress, making adjustments to the support that the device provides.
We believe that the SCRIPT systems will be beneficial to patient recovery and can assist with improving their quality of life. SCRIPT will reduce hospital and home visits for patients & carers, and therefore have a large impact on reducing hospital costs; improving the quality and standard of care.
The SCRIPT project is partially funded by the European Commission under the 7th Framework Programme. The project activities will last for 36 months.
The Project partners are:
Coordinator: UNIVERSITY OF HERTFORDSHIRE HIGHER EDUCATION CORPORATION (UH), UK
R.U.ROBOTS LIMITED (RUR), United Kingdom
THE UNIVERSITY OF SHEFFIELD (USFD), United Kingdom
UNIVERSITEIT TWENTE (UT), Netherlands
ROESSINGH RESEARCH AND DEVELOPMENT BV (RRD),Netherlands
MOOG BV (MOOG), Netherlands
SAN RAFFAELE S.p.A. (SRS), Italy
USER INTERFACE DESIGN GMBH (UID), Germany
For any further information about project development and implementation, please contact:
School of Computer Science
University of Hertfordshire
Hatfield Herts AL10 9AB
Further information can be found at:
See our links section for other media coverage from the press release
Neuro-rehabilitation services are essential in reducing post-stroke impairments, enhancing independence, and improving recovery in hospital and post-discharge. However these services are therapist-dependent and resource intensive. Patients’ disengagement and boredom in stroke units are common which adversely affect functional and psychological outcomes. Novel techniques such as use of iPads™ are increasingly researched to overcome such challenges.
The aim of this review is to determine the feasibility, effectiveness, acceptability, and barriers to the use of iPads™ in stroke neuro-rehabilitation. Four databases and manual literature search were used to identify published studies using the terms “iPad”, “Stroke”, and “neuro-rehabilitation”. Studies were included in accordance with the review selection criteria. A total of 16 articles were included in the review. The majority of the studies focused on iPads use in speech and language therapy. Although of small scale, the studies highlighted that iPads are feasible, have the potential to improve rehabilitation outcomes, and can improve patient’s social isolation. Patients’ stroke severity and financial limitations are some of the barriers highlighted in this review. This review presents preliminary data supportive for the use of iPad technology in stroke neuro-rehabilitation. However, further research is needed to determine impact on rehabilitation goals acquisition, clinical efficacy, and cost-efficiency.
Baltimore-based Restorative Therapies Inc announces that its new Xcite Functional Electrical Stimulation (FES) rehabilitation system has received a CE mark and has been approved for marketing in Canada.
The system delivers up to 12 channels of electrical stimulation to nerves that activate core, leg, and arm muscles and help enable them to move.
“Xcite system inherits many of the popular RT300 FES cycle’s great features including personalized muscle selection, secure Internet connectivity and physical therapy clinic ease of use.” says Andrew Barriskill, CEO of Restorative Therapies, in a media release from the company. “We are excited to have obtained CE marking and Canadian approval for this product, which will allow us to market the system in Canada and many other international markets.”
“Xcite is a physical and occupational therapy system which provides a library of coordinated multichannel FES therapies for people with neurological impairments,” states Prof David Ditor of Brock University, in Ontario, Canada. “After being involved in the development trials, we are excited to see the system obtain the CE mark and Canadian approval making the system more widely available.”
“In addition to combining several valuable neuro-rehabilitation interventions, functional electrical stimulation, mass practice, and neuromuscular re-education, Xcite is portable and easy enough to use that it could be used in the patient’s home,” adds Prof Susan Harkema of the Kentucky Spinal Cord Injury Research Center, University of Louisville, according to the release.
[Source(s): Restorative Therapies Inc, PRWeb]
[WEB SITE] The Rehabilitation Gaming System – NEURO-REHABILITATION | SPECS – Synthetic, Perceptive, Emotive and Cognitive Systems group
The Rehabilitation Gaming System is a novel technology for Neuro-Rehabilitation that assists in the recovery of function after lesions to the brain. RGS is based on concrete neuroscientific principles of brain mechanisms of function in health and disease. RGS was initially developed via the project http://rgs-project.eu.
RGS was developed by combining the idea of interactive media use for neurorehabilitation, in particular virtual reality, with the DAC theory of mind and brain. This decision was a key step in the realization of RGS since it made choices on the content of non-arbitrary treatment protocols and every intervention became a well defined interaction with a user from which lessons could be immediately drawn. By now RGS incorporates about 20 specific DAC derived principles that range from the key role of sensori-motor contingencies in organizing cognition and action (see Prochnow, D. et al., Eur. J. of Neurosc. 2013) to the importance of goal-oriented and error-driven intervention. (see Belen Rubio Ballestr et al., J. NeuroEng. Rehab. 2015)
RGS has advanced over the last decade with an extensive experimental agenda realized with dedicated partners in Barcelona
To support our experimental studies we have installed RGS therapy stations which are in continuous use in associated hospitals (see collaborators below). As a result, RGS has build up an unprecedented empirical track record (see key references sbelow) having been tested with over 500 patients at the acute and chronic stages of stroke, including at home settings. Building on these results, together with our clinical partners, we are now validating the generalization of RGS to other neuropathologies such as Parkinson’s disease, cerebral palsy, traumatic brain injury and spinal cord lesions and the initial analysis looks very encouraging.
Many of the patients in our clinical experiments have asked to be able to continue the RGS therapy.
This demand combined with the clinical results that show that RGS is more effective than any other intervention available today, has lead to the creation of the spin-off company Eodyne.com together with the University Pompeu Fabra and the Catalan Institute of Advanced Studies. Eodyne’s goal is to make RGS available to as many people as possible for a minimum cost.
The SPECS laboratory lead by prof. Paul Verschure collaborates with Hospital la Esperanza, in particular with Dr Ester Duarte and “TiC Salut Foundation” a catalan agency that is part of the Ministry of Health.
[ARTICLE] Multimodal adaptive interfaces for 3D robot-mediated upper limb neuro-rehabilitation: an overview of bio-cooperative systems – Full Text HTML
- Novel classification of bio-cooperative robotic systems.
- A multimodal 3D robotic platform for upper limb rehabilitation of post stroke patients.
- Mechatronic module for guaranteeing arm-weight support during therapy.
Robot-mediated neuro-rehabilitation has been proved to be an effective therapeutic approach for upper limb motor recovery after stroke, though its actual potential when compared to other conventional approaches has still to be fully demonstrated. Most of the proposed solutions use a planar workspace. One key aspect for influencing motor recovery mechanisms, such as neuroplasticity and the level of motivation and involvement of the patient in the exercise, is the design of patient-tailored protocols and on-line adaptation of the assistance provided by the robotic agent to the patient performance. Also, when abilities for performing activities of daily living shall be targeted, exercises in 3D workspace are highly preferable. This paper wants to provide a complete overview on bio-cooperative systems on neuro-rehabilitation, with a special focus on 3D multimodal adaptive interfaces, by partly in-depth reviewing the literature and partly proposing an illustrative case of how to build such a bio-cooperative based on the authors’ current research. It consists of an operational robotic platform for 3D upper limb robot-aided rehabilitation, directly derived from the MAAT system previously developed by the same research group. The system features on-line adaptation of therapy characteristics to specific patient needs and to the measured level of performance, by including the patient in the control loop. The system is composed of a 7-DoF robot arm, an adaptive interaction control system, a motorized arm-weight support system and a module for on-line evaluation of patient performance. Such module records patient biomechanical data through an unobtrusive, wearable sensory system, evaluates patient biomechanical state and updates robot control parameters for modifying level of assistance and task complexity in the 3D workspace. In addition, a multimodal interface provides information needed to control the motorized arm-weight support by means of a dedicated cable-pulley system.
[Abstract] Hand synergies: Integration of robotics and neuroscience for understanding the control of biological and artificial hands
Synergies have been extensively studied by neuroscientists to understand the control of movements involving multiple muscles and joints.
The overarching theoretical framework underlying the concept of synergies is that they emerge from the interaction of neural and biomechanical factors. This interaction leads to a reduction in the number of independent degrees of freedom to be controlled.
The field of robotics has recently exploited the concept of synergies to design and build artificial systems, in particular artificial hands, and reduce the complexity associated with controlling a large number of degrees of freedom.
Neuroscience has leveraged recent advances in robotics research by using novel tools and methodological approaches to study how the central nervous system integrates sensory feedback with motor commands for hand control.
The term ‘synergy’ – from the Greek synergia – means ‘working together’. The concept of multiple elements working together towards a common goal has been extensively used in neuroscience to develop theoretical frameworks, experimental approaches, and analytical techniques to understand neural control of movement, and for applications for neuro-rehabilitation. In the past decade, roboticists have successfully applied the framework of synergies to create novel design and control concepts for artificial hands, i.e., robotic hands and prostheses. At the same time, robotic research on the sensorimotor integration underlying the control and sensing of artificial hands has inspired new research approaches in neuroscience, and has provided useful instruments for novel experiments.
The ambitious goal of integrating expertise and research approaches in robotics and neuroscience to study the properties and applications of the concept of synergies is generating a number of multidisciplinary cooperative projects, among which the recently finished 4-year European project “The Hand Embodied” (THE). This paper reviews the main insights provided by this framework. Specifically, we provide an overview of neuroscientific bases of hand synergies and introduce how robotics has leveraged the insights from neuroscience for innovative design in hardware and controllers for biomedical engineering applications, including myoelectric hand prostheses, devices for haptics research, and wearable sensing of human hand kinematics. The review also emphasizes how this multidisciplinary collaboration has generated new ways to conceptualize a synergy-based approach for robotics, and provides guidelines and principles for analyzing human behavior and synthesizing artificial robotic systems based on a theory of synergies.
[ Conference Proceedings] Use of Virtual Reality in Neurorehabilitation: How the effects of immersion and presence may contribute to motor and cognitive recovery – Full Text PDF
This paper discusses the effects of virtual reality immersion in the functional recovery of neurological patients. To do so, we conducted a review of the literature after identifying relevant articles published between 2000 and 2013.
The results of this review show that high levels of immersion can cause a greater sensation of presence, which can make some applications more effective. The most important level is the realistic experience that immersive VR prompts the user to have.
By requiring to have a high level of sensory, visual, auditory and haptic fidelity, the
immersive virtual environment enables the experience in the virtual world to correspond, as far as possible, to experiencing the real world being simulated.
more –> Full Text PDF
Neuro-rehabilitation (physical therapy, occupational therapy, etc.) helps hemaparetic stroke patients confronted with loss of motor skills on one side of their body, to recover some of their motor functions after a cerebrovascular accident. One of the most promising tracks in neuro-rehabilitation consists of amplifying the motor learning ability after a stroke, in other words how to learn (again) how to make movements with the parts of the human body impacted after a stroke.
Pilot studies have shown that tDCS (transcranial direct current stimulation) – a non-invasive and painless cerebral stimulation method – modulated the cerebral activity and increased the motor performances of patients who have had a stroke. This method consists of applying low voltage electric currents to the patient’s head by means of electrodes during short periods of time. In 2012, a first study conducted by the teams of Professors Yves Vandermeeren and Patrice Laloux demonstrated that tDCS amplified the motor learning and the long-term motor memory of the patient after a stroke. This study was awarded the Fernand Depelchin Prize of the Université catholique de Louvain (UCL) and allowed the CHU Neurology Team to continue its research, in particular via the use of functional Magnetic Resonance Imaging (fMRI) of the brain.
Nineteen hemiparetic stroke patients (with a motor deficit in the upper limb) participated in this new clinical trial. In order to avoid study bias, the stimulations were performed in a double-blind, randomised fashion. Each patient received a real stimulation as well as a placebo-stimulation during two separate sessions. It was impossible for patients to determine whether they received a true or a placebo-stimulation.
During the first stimulation session (real or placebo), the patients learned how to perform a task with a paralysed hand, combining speed and accuracy. One week later, they performed the learned task while the functional MRI scanner recorded their cerebral activity. After one week, this experience was repeated with the other stimulation (placebo or real).
As in the previous study, the non-invasive cerebral stimulation amplified the motor learning capacity with the paralyzed hand and the long-term memory retention in a spectacular way for patients following chronic stroke.
Thanks to functional MRI, this second study demonstrated that the combination of motor learning and non-invasive cerebral stimulation improves the efficiency of the cerebral activity. Indeed, one week after the placebo stimulation, the cerebral activations measured via the functional MRI was very diffuse. Large cerebral zones were somehow ‘recruited’ although motor performance was low (poor retention). On the other hand, one week after real stimulation, the cerebral activation was focused on the essential motor zones, almost identical to a person without stroke-impact although the motor performance was significantly better (enhanced task retention). In other words, the combination of motor learning and tDCS reinforced the essential motor zones and this specific network was reactivated one week after the real intervention.
For thousands of stroke victims, this study opens considerable perspectives in the domain of neuro-rehabilitation. A better understanding of the cerebral functioning after a stroke and how non-invasive cerebral stimulation works will help researchers to develop the neuro-rehabilitation of the future. The results of this study will be implemented within the consortium Louvain Bionics, inaugurated recently at UCL.