[WEB] Recover From Stroke With The Right Engineering

A stroke management team involves a Neuro physician, neuro surgeon, neuro physiotherapist, speech therapist, occupational therapist and a mental health team with a psychiatrist and psychologist

Stroke is a potentially life changing event that can have lasting physical and emotional effects. It is a major public health concern and remains a leading cause of adult disability. Each type of stroke has a different set of potential causes and the symptoms of a stroke often appear without warning. They serve as warning signs for future cerebrovascular events. Hence it is important that people should treat them as medical emergencies, even if the symptoms are temporary. Rehabilitation is an important and ongoing part of managing an individual with stroke.

Stroke can cause trouble in speaking and understanding what others are saying. One may also experience confusion, severe headache, sudden dizziness, slur words, blurred vision, sudden numbness, weakness or paralysis in the face, arm or leg. This often affects just one side of the body. However, in recent years, advances in rehabilitation sciences have provided an opportunity for much better and faster recovery and prognosis. In this case, rehabilitation is a multi-disciplinary endeavour and not a ‘one size fits all’ intervention. There is great interest now in exploring novel technologies to augment conventional therapies to reduce neurological disability and improve function.

Managing stroke involves a multi-dimensional team in achieving the best outcomes. A stroke management team involves a Neuro physician, neuro surgeon, neuro physiotherapist, speech therapist, occupational therapist and a mental health team with a psychiatrist and psychologist. In addition, the nutritionist can also play a significant role in recovery. Recent advances and the right use of technology is a boon in stroke recovery.

The team-based approach with a patient centric approach ensures the patient is the focus and all the healthcare professionals work as a team to address the various aspects required for recovery. Today with multi-specialty integrated teams, the use of assistive devices, robotic rehabilitation technology, artificial intelligence and advanced therapeutic tools, techniques stroke recovery is a reality.

Careful planning, inter disciplinary communication builds the foundation for a robust recovery process. The rehabilitation team looks at the individual functionally, socially, physically and mentally and understand the exact need and extent of intervention without overwhelming or burdening the individual financially, emotionally or mentally. Strokes can cause a major depressive episode. Signs of post-stroke depression include feelings of sadness, hopelessness or helplessness, alterations to appetite and sleep, and irritability. Hence creating a value driven integrated approach where multiple specialists across domains in recovery science integrates and helps in breaking the vicious cycle of chronic disease is crucial.

Chronic disease like stroke causes reduced functionality and activity which could further lead other co morbidities. To complete the circle of rehabilitation, the X factor today is Rehab tech. Emerging AI based technology ensures safe rehabilitation by precisely measuring all vital parameters. Wearable tech ensures patient monitoring throughout the entire rehabilitation journey is objective measured and precise leading to better prognosis.

The message is loud and clear. Though times can be stressful for individuals and the family diagnosed with chronic illness. We can take solace in the fact that there is a positive road to recovery. Effective neuro-rehabilitation is a key factor in reducing disability after stroke. A stroke, heart attack or spinal cord injury doesn’t mean the end of the road. Yes, these are barriers but in today’s world we can overcome it. With the right technology, in depth bio-mechanical, near scientific understanding of the body, mind and movement, a rehabilitation team significantly improves longevity and lifespan and exponentially upgrades quality of life for those with chronic illness.

Early, targeting and precise rehabilitation strategies are critical in stroke recovery. Unfortunately, that’s not always the standard practice. In spite of good potentials for recovery, these rehabilitative measures are underutilized and major barriers are limited availability, geographical distance and lack of awareness about its benefits.  While some stroke survivors overcome obstacles with more ease than others, the healing journey is always challenging. That’s why seeking the right type of care makes all the difference. With its personalized, motivational approach, advanced rehabilitation technology has revolutionized post-stroke therapy. The right care, if done right away, can save lives and quality of life. The long-term goal of rehabilitation is to help improve the stroke survivor’s physical and cognitive functions and to ultimately improve their overall quality of life so that they can become as independent as possible.

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[ARTICLE] Clinical Effectiveness of Non-Immersive Virtual Reality Tasks for Post-Stroke Neuro-Rehabilitation of Distal Upper-Extremities: A Case Report – Full Text

Abstract

A library of non-immersive Virtual Reality (VR) tasks were developed for post-stroke rehabilitation of distal upper extremities. The objective was to evaluate the rehabilitation impact of the developed VR-tasks on a patient with chronic stroke. The study involved a 50-year-old male patient with chronic (13 month) stroke. Twenty VR therapy sessions of 45 min each were given. Clinical scales, cortical-excitability measures, functional MRI (fMRI), and diffusion tensor imaging (DTI) data were acquired pre-and post-therapy to evaluate the motor recovery. Increase in Fugl-Meyer Assessment (wrist/hand) by 2 units, Barthel Index by 5 units, Brunnstrom Stage by 1 unit, Addenbrooke’s Cognitive Examination by 3 units, Wrist Active Range of Motion by 5° and decrease in Modified Ashworth Scale by 1 unit were observed. Ipsilesional Motor Evoked Potential (MEP) amplitude (obtained using Transcranial Magnetic Stimulation) was increased by 60.9µV with a decrease in Resting Motor Threshold (RMT) by 7%, and contralesional MEP amplitude was increased by 56.2µV with a decrease in RMT by 7%. The fMRI-derived Laterality Index of Sensorimotor Cortex increased in precentral-gyrus (from 0.28 to 0.33) and in postcentral-gyrus (from 0.07 to 0.3). The DTI-derived FA-asymmetry decreased in precentral-gyrus (from 0.029 to 0.024) and in postcentral-gyrus (from 0.027 to 0.017). Relative reduction in task-specific performance metrics, i.e., time taken to complete the task (31.6%), smoothness of trajectory (76.7%), and relative percentage error (80.7%), were observed from day 1 to day 20 of the VR therapy. VR therapy resulted in improvement in clinical outcomes in a patient with chronic stroke. The research also gives insights to further improve the overall system of rehabilitation.

1. Introduction

Residual upper-arm disabilities are common morbidities in the chronic phase of recovery, affecting more than 66% of patients with stroke [1]. The literature suggests the requirement of intensive practice to facilitate functional recovery in the chronic phase [2]. However, factors such as lack of objective assessment, associated clinical burden and boredom highly limit the effectiveness of traditional rehabilitation [3]. In recent years, Virtual Reality (VR)-assisted rehabilitation has emerged as a supplementary approach to address some of the limitations associated with traditional physiotherapy [4,5]. Post-stroke rehabilitation of distal upper extremities is comparatively slower and requires intensive targeted practice to conduct Activities of Daily Living (ADL) [6]. However, limited literature exists to support targeted VR-based rehabilitation of distal upper extremities [7]. Furthermore, the exact neurophysiological aspects showing enhanced post-stroke recovery at the neuronal level are still unclear [8]. In our previous study, a library of VR tasks specific to distal-joint rehabilitation was developed, and task-specific outcome metrics were validated with forty healthy subjects and two patients with stroke [9]. In this study, we present the case of a 50-year-old male patient with 13-month chronic stroke who participated in VR therapy and the associated functional and neuronal changes observed in response to the therapy. The primary objectives of this study were to evaluate the efficacy of the developed VR tasks and to investigate the neurophysiological behavior supporting post-stroke motor recovery in response to the VR therapy during the chronic phase.

2. Case Description

The study was approved by the Institutional Review Board (IRB) at All India Institute of Medical Science (AIIMS), New Delhi, India, under protocol-number IEC-229/11.4.2020. The patient provided written informed consent before enrollment in this study.

2.1. Subject

The patient was a 50-year-old right-handed male (henceforth, referred as “P”); he was well educated and was a lawyer by profession. He had an incidence of right thalamo-gangliocapsular-bleed in October 2020 (Supplement Figure S1). Additional clinical-presentation details are provided in the Supplementary Materials (Section S1). He had no history of substance abuse, such as consuming tobacco or alcohol, but experienced hypertension in the past 10 years and diabetes for past 1 year. After onset of stroke, he was admitted to a local hospital and discharged after 14 days for rehabilitation management at home. He underwent supervised home-based physiotherapy after 3 months after stroke-onset (see Supplementary Materials). Assessment scores at enrollment are given in Figure 1.

Figure 1. Timeline with relevant data from the episodes of care and clinical assessment scores obtained at the time of enrollment. * Details in Supplementary Material.

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[Abstract] What can virtual reality offer to stroke patients? A narrative review of the literature

Abstract

Background: Studies demonstrated the efficacy of virtual reality (VR) as a method supporting the post-stroke neuro-rehabilitation process by activating motor learning processes. Nevertheless, stroke is frequently accompanied by serious psychological problems including depression, which is associated with an increased risk of mortality, lower post-stroke physical activity, and higher disability in stroke patients.

Objectives: To explore the current use of VR as a method supporting the neuro-rehabilitation process, both in physical and psychological dimensions.

Methods: An exploratory review was conducted with a narrative synthesis. PubMed was used for literature search. Search includes the use of VR in physical rehabilitation, and as support therapy in psychiatric disorders. Both primary research and systematic reviews were included.

Results: In neurological disorders rehabilitation, out of 22 studies, 16 concerned stroke survivors. In psychiatric disorders, 44 literature reviews were included.

Conclusion: The studies confirmed the effectiveness of various forms of VR treatment in the alleviation of psychological and behavioral problems and psychiatric disorders. There is a shortage of VR-based technological solutions that would, besides physical rehabilitation, offer stroke patients therapeutic tools to alleviate psychological disturbance and improve the patient’s mood and motivation. Such solutions will most likely become a field of intensive research in the coming years.

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• Virtual reality gait training versus non-virtual reality gait training for improving participation in subacute stroke survivors: study protocol of the ViRTAS randomized controlled trial.de Rooij IJM, van de Port IGL, Visser-Meily JMA, Meijer JG.Trials. 2019 Jan 29;20(1):89. doi: 10.1186/s13063-018-3165-7.PMID: 30696491 Free PMC article.
• Evaluating the effect and mechanism of upper limb motor function recovery induced by immersive virtual-reality-based rehabilitation for subacute stroke subjects: study protocol for a randomized controlled trial.Huang Q, Wu W, Chen X, Wu B, Wu L, Huang X, Jiang S, Huang L.Trials. 2019 Feb 6;20(1):104. doi: 10.1186/s13063-019-3177-y.PMID: 30728055 Free PMC article.
• Immersive virtual reality in traumatic brain injury rehabilitation: A literature review.Aida J, Chau B, Dunn J.NeuroRehabilitation. 2018;42(4):441-448. doi: 10.3233/NRE-172361.PMID: 29660958 Review.
• Can robotic gait rehabilitation plus Virtual Reality affect cognitive and behavioural outcomes in patients with chronic stroke? A randomized controlled trial involving three different protocols.Manuli A, Maggio MG, Latella D, Cannavò A, Balletta T, De Luca R, Naro A, Calabrò RS.J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104994. doi: 10.1016/j.jstrokecerebrovasdis.2020.104994. Epub 2020 Jun 13.PMID: 32689601 Clinical Trial.
• Stroke: Virtual reality no better than simple recreational activity in stroke recovery.Fyfe I.Nat Rev Neurol. 2016 Aug;12(8):432. doi: 10.1038/nrneurol.2016.108. Epub 2016 Jul 15.PMID: 27418375 Review. No abstract available.

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[Abstract] Psychological status and role of caregivers in the neuro-rehabilitation of patients with severe Acquired Brain Injury (ABI)

ABSTRACT

Objective

To investigate the relationships between (a) the psychological status of the caregiver, (b) the specific features of caregiving as perceived by the cognitive therapist in neuro-rehabilitation, (c) the caregivers’ subjective approach to neuro-rehabilitation, and (d) the functional outcome of the patient.

Methods

Twenty-four patients with severe acquired brain injury and their 24 caregivers participated in this observational study. Caregivers underwent a psychological assessment examining emotional distress, burden and family strain; their subjective approach to neuro-rehabilitation has been evaluated by two specific answers. The patients’ cognitive therapists responded to an ad-hoc questionnaire, namely the “Caregiving Impact on Neuro-Rehabilitation Scale” (CINRS), evaluating the features (i.e., amount and quality) of caregiving. Finally, the functional outcome of the patient was assessed through standardized scales of disability and cognitive functioning.

Results

The caregivers’ psychological well-being was associated to the features of caregiving, to the subjective approach to neuro-rehabilitation, and to the functional recovery of their loved ones. A better caregivers’ approach to neuro-rehabilitation was also associated to an overall positive impact of caregiving in neuro-rehabilitation and to a better functional outcome of the patients.

Conclusions

We posited a virtuous circle involving caregivers within the neuro-rehabilitation process, according to which the caregivers’ psychological well-being could be strictly associated to a better level of caregiving and to a better functional outcome of the patients that, in turn, could positively influence the caregivers’ psychological well-being. Although preliminary, these results suggest a specific psycho-educational intervention, aimed at improving the caregivers’ psychological well-being and at facilitating their caring of the loved one.

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[BLOG POST] Technology: Filling the gaps in occupational and physical therapy

It is unsurprising that, as the population increases and ages, more therapists will be needed for rehabilitation, but the therapist numbers are not growing to match the need for therapy. The resulting deficit leaves even top rehabilitation centers at a loss; fewer therapy experts means less rehab time for patients.

The human element of therapy is undeniable—people need people in order to heal. However, time and physical effort is required to manually facilitate high-repetition therapy exercises desperately needed by patients and this limits their execution, even in world-class facilities. Therapists are the limiting factor in patient care simply because there are not enough experts and their physical resources are limited, especially in case of severely affected patients who require high physical support. This problem is only expected to worsen.

Technology, in the form of robotic rehabilitation, solves this issue elegantly by relieving therapists of the burden of attending to every repetition, allowing them to serve more patients, more efficiently, and with better outcomes.

In stroke and neuro rehabilitation, intensity is key

Many studies have shown that in various types of injuries, rehabilitation that includes hundreds to thousands of repetitions produce best clinical outcomes for upper and lower extremity movements. Task specificity and muscle reconditioning, in addition to neuroplasticity, are important factors influenced by intense, targeted, repetitive motor training.

A shocking study conducted in 2017 on spinal cord rehab patients found that:

• As much at 40% of therapy time was dedicated to non-therapeutic actions, such as sling transfers and activity set up
• Patients spent only 12-15 minutes in group-based rehab activity
• Up to 2/3 of patients did not participate in group activities at all
• The highest-repetition groups did not exceed 100 repetitions for occupational and physiotherapy combined
• The daily repetitions were significantly lower than those require for muscle and neural improvements.¹

Furthermore, the following table from a study of outpatients suffering from partial paralysis post-stroke shows less than 100 repetitions per session with the exception of walking steps.²

 

 

In animal studies, however, it was found that at least 400-600 repetitions are necessary to lead to structural neural changes for upper limb.¹ There is clearly a significant disparity between the therapy needed for full recovery and the therapy available to patients. In addition, researchers surveyed 7 stroke survivors, 6 caregivers, and 20 rehab staff and found that outside of rehab:

“subsequent time was described as ‘dead and wasted.’ Main careers perceived stroke survivors felt ‘out of control … at everyone’s mercy’ and lacked knowledge of ‘what to do and why’ outside of therapy. Clinical staff perceived the stroke survivor’s ability to drive their own recovery was limited by the lack of ‘another place to go’ and the ‘passive rehab culture and environment’.”³

This passive rehab culture is a significant factor for reduced therapy outcomes. When dependent on limited rehab time for recovery, stroke patients feel unproductive and hopeless. More active therapy time can not only improve a patient’s daily function and physical health, but their mental health as well.

How Technology Can Help

It is clear that patients are not currently getting the volume and intensity of therapy required for ideal outcomes, and this not only has a physical cost, but also takes a mental toll on patients. Robot-assisted rehab can improve current therapy practices in the following ways:

• Assisted gait training – research shows that robots can assist with “highly repetitive training of complex gait cycles, something a single therapist cannot easily do alone”⁴
• Precision feedback – virtual reality and sophisticated measurements can provide precise movement feedback to leverage the recovering brain’s neuroplasticity and enhance proprioception⁵
• High repetition and intensity – without constant physical assistance from a therapist, which then frees the therapist to perform other types of supporting tasks

While therapists cannot be replaced by robot-assisted rehabilitation technology, these tools can augment their practice to both reduce strain and fatigue in therapists and improve patient outcomes, sometimes making possible what was impossible previously, such as walking. Robot-assisted rehabilitation can reduce physical strain in therapists while providing for patients the high volume of repetitions needed to achieve best outcomes in therapy.

References:

¹ Zbogar D, Eng JJ, Miller WC, Krassioukov AV, Verrier MC. Movement repetitions in physical and occupational therapy during spinal cord injury rehabilitation. Spinal Cord. 2017;55(2):172–179. doi:10.1038/sc.2016.129
² Lang CE, MacDonald JR, Gnip C. Counting repetitions: an observational study of outpatient therapy for people with hemiparesis post-stroke. J Neurol Phys Ther. 2007 Mar;31(1):3-10. PubMed PMID: 17419883.
³ Eng XW, Brauer SG, Kuys SS, Lord M, Hayward KS. Factors Affecting the Ability of the Stroke Survivor to Drive Their Own Recovery outside of Therapy during Inpatient Stroke Rehabilitation. Stroke Res Treat. 2014;2014:626538. doi:10.1155/2014/626538
⁴ Morone G, Paolucci S, Cherubini A, et al. Robot-assisted gait training for stroke patients: current state of the art and perspectives of robotics. Neuropsychiatr Dis Treat. 2017;13:1303–1311. Published 2017 May 15. doi:10.2147/NDT.S114102
⁵ Turner DL, Ramos-Murguialday A, Birbaumer N, Hoffmann U, Luft A. Neurophysiology of robot-mediated training and therapy: a perspective for future use in clinical populations. Front Neurol. 2013;4:184. Published 2013 Nov 13. doi:10.3389/fneur.2013.00184

Originally published on 25.2.2020

via Technology: Filling the gaps in occupational and physical therapy – Hocoma

[Abstract] Robotic Exoskeleton for Wrist and Fingers Joint in Post-Stroke Neuro-Rehabilitation for Low-Resource Settings

Abstract

Robots have the potential to help provide exercise therapy in a repeatable and reproducible manner for stroke survivors. To facilitate rehabilitation of the wrist and fingers joint, an electromechanical exoskeleton was developed that simultaneously moves the wrist and metacarpophalangeal joints.

The device was designed for the ease of manufacturing and maintenance, with specific considerations for countries with limited resources. Active participation of the user is ensured by the implementation of electromyographic control and visual feedback of performance. Muscle activity requirements, movement parameters, range of motion, and speed of the device can all be customized to meet the needs of the user.

Twelve stroke survivors, ranging from the subacute to chronic phases of recovery (mean 10.6 months post-stroke) participated in a pilot study with the device. Participants completed 20 sessions, each lasting 45 minutes. Overall, subjects exhibited statistically significant changes (p < 0.05) in clinical outcome measures following the treatment, with the Fugl-Meyer Stroke Assessment score for the upper extremity increasing from 36 to 50 and the Barthel Index increasing from 74 to 89. Active range of wrist motion increased by 190 while spasticity decreased from 1.75 to 1.29 on the Modified Ashworth Scale.

Thus, this device shows promise for improving rehabilitation outcomes, especially for patients in countries with limited resources.

via Robotic Exoskeleton for Wrist and Fingers Joint in Post-Stroke Neuro-Rehabilitation for Low-Resource Settings – IEEE Journals & Magazine

[NEWS] Thunderbirds fund cutting-edge rehab enhancements for Barrow

Above: The Thunderbirds Charities gift to Barrow Neurological Foundation is being used to acquire four new devices, similar to this robotic hand. These instruments enable therapists at the Barrow Neuro-Robotics Rehabilitation Center to personalize therapy based on a patient’s abilities.

Patients recovering from stroke, traumatic brain and spine injuries will now have a leg up in their recovery journeys, thanks to a $350,000 grant from Thunderbirds Charities to Barrow Neurological Foundation.

An estimated 13.8 million Americans live with a disability caused by a brain or spinal cord injury, and each year, Barrow records more than 30,000 outpatient visits in the Neuro-Rehabilitation Center. With this gift from Thunderbirds Charities, Barrow will acquire four cutting-edge devices for its Neuro-Robotics Rehabilitation Center, which provides personalized therapy to deliver better outcomes in less time. These robotics include: • A body weight-supported treadmill that uses augmented and virtual reality to simulate challenges in everyday life, such as walking a golf course. • A robot-assisted shoulder and arm rehabilitation device with intelligent gravity compensation and virtual reality to work on skills needed for daily function. • A sensor-based device used to work on balance and posture training. • An interactive surface for upper extremity, cognitive and sensory retraining to allow patients to practice motor skills. Barrow has been at the forefront in the use of robotics, which mimic normal human movements and can be programmed to support or challenge a patient’s abilities. Many of these devices incorporate an interactive component, creating a game-like experience for the patient to conquer. “These new robotics will help Barrow patients relearn how to stand, walk and perform skills that many take for granted, while also providing our therapists with more advanced tools to monitor progress,” said Katie Cobb, president of Barrow Neurological Foundation. “We want to thank Thunderbirds Charities for providing these life-changing tools for our patients’ continued recovery.” “Barrow’s Neuro-Robotics Rehabilitation Center is making a positive, profound impact on the health of patients recovering from severe and debilitating injuries, and we are honored to be able to support such a great mission,” said Carlos Sugich, President of Thunderbirds Charities.

via Thunderbirds fund cutting-edge rehab enhancements for Barrow | AZ Big Media

[VIDEO] Relearning and Retraining in Brain Injury Rehabilitation Does VR help? – YouTube

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Δημοσιεύτηκε στις 20 Ιουν 2018

Dr. Sharan Srinivasan | Stereotactic and Functional Neurosurgeon, CMD-NewRo- the neuro rehab experts presents on “Relearning and Retraining in Brain Injury Rehabilitation Does VR help?” at the vamrr Summit on Virtual Reality in Health | 21 March | Bengaluru

 

via Relearning and Retraining in Brain Injury Rehabilitation Does VR help? – YouTube

[Abstract + References] Classifying Imaginary Hand Movement through Electroencephalograph Signal for Neuro-rehabilitation

Abstract

Brain-Computer-Interface (BCI) has been widely used in the field of neuro-rehabilitation such as automatic controls based on brain commands to upper and lower extremity prosthesis devices in patients with paralysis. In a post-stroke period, approximately 50% of stroke sufferers have unilateral motor deficits leading to a chronic decline in chronic upper extremity function. Stroke affects patients in their productive and elderly age which is potentially creating new problems in national health development. BCI can be used to aid post-stroke patient recovery, thus motion detection and classification is essential for optimizing BCI device control. Therefore, this study aims to distinguish several hand functions such as grasping, pinching, and hand lifting from releasing movement in accordance with the usual movements performed during post-stroke rehabilitation based on brain signals obtained from electroencephalogram (EEG). In this study, the information that obtained from the processing of EEG signals were be used as inputs for artificial neural networks then classified to distinguish two types of imaginary hand movements (grasping v. releasing, pinching v. releasing, hand lifting v. releasing). The results of these classifications using Extreme Learning Machine (ELM) based on spectral analysis and CSP (Common Spatial Pattern) calculation show that ELM and CSP was a good feature in distinguishing two types of motion with software/system accuracy average above 95%. This could be useful for optimizing BCI devices in neuro-rehabilitation, such as combining with Functional Electrical Stimulator (FES) device as a self-therapy for post-stroke patient.

References

Badan Penelitian dan Pengembangan Kesehatan. Riset Kesehatan Dasar 2013, Available at : http://www.depkes.go.id/resources/download/general/Hasil%20Riskesdas%202013.pdf, accesed February 2017.

J. A. Franck. Concise Arm and Hand Rehabilitation Approach in Stroke. vol. 3. no. 4. 2015.

N. Birbaumer. A. R. Murguialday. and L. Cohen. Brain-computer interface in paralysis. Curr. Opin. Neurol. vol. 21. no. 6. pp. 634–8. 2008.

J. J. Daly. R. Cheng. J. Rogers. K. Litinas. K. Hrovat. and M. Dohring. Feasibility of a New Application of Noninvasive Brain Computer Interface (BCI): A Case Study of Training for Recovery of Volitional Motor Control After Stroke. J. Neurol. Phys. Ther. vol. 33. no. 4. pp. 203–211. 2009.

K. K. Ang. C. Guan. K. S. Phua. C. Wang. L. Zhou. K. Y. Tang. G. J. Ephraim Joseph. C. W. K. Kuah. and K. S. G. Chua. Brain-computer interface-based robotic end effector system for wrist and hand rehabilitation: results of a three-armed randomized controlled trial for chronic stroke.. Front. Neuroeng. vol. 7. no. July. p. 30. 2014.

E. Buch. C. Weber. L. G. Cohen. C. Braun. M. A. Dimyan. T. Ard. J. Mellinger. A. Caria. S. Soekadar. A. Fourkas. and N. Birbaumer. Think to move: A neuromagnetic brain-computer interface (BCI) system for chronic stroke. Stroke. vol. 39. no. 3. pp. 910–917. 2008.

G.-B. Huang. Q. Zhu. C. Siew. G. H. Ã. Q. Zhu. C. Siew. G.-B. Huang. Q. Zhu. and C. Siew. Extreme learning machine: Theory and applications. Neurocomputing. vol. 70. no. 1–3. pp. 489–501. 2006.

Emotiv Insight User Manual. 2015, Availabe at : https://www.emotiv.com, accessed June 2017

P. Szachewicz. Classification of Motor Imagery for Brain-Computer Interfaces. p. 50. 2013.

B. Shoelson. edfRead, Available at : https://www.mathworks.com/matlabcentral/fileexchange/ 31900-edfread, accesed February 2017.

J. Ethridge and W. Weaver. Common Spatial Patterns Alogarithm. MatlabCentral. 2009. .

Q. Yuan. W. Zhou. S. Li. and D. Cai. Epileptic EEG classification based on extreme learning machine and nonlinear features. Epilepsy Res. vol. 96. no. 1–2. pp. 29–38. 2011.

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M. H.. A. Samaha. and K. AlKamha. Automated Classification of L/R Hand Movement EEG Signals using Advanced Feature Extraction and Machine Learning. Int. J. Adv. Comput. Sci. Appl. vol. 4. no. 6. p. 6. 2013.

G. Lange. C. Y. Low. K. Johar. F. A. Hanapiah. and F. Kamaruzaman. Classification of Electroencephalogram Data from Hand Grasp and Release Movements for BCI Controlled Prosthesis. Procedia Technol. vol. 26. pp. 374–381. 2016.

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via Classifying Imaginary Hand Movement through Electroencephalograph Signal for Neuro-rehabilitation | Rahma | Walailak Journal of Science and Technology (WJST)

[ARTICLE] Development of a robotic device for post-stroke home tele-rehabilitation – Full Text

Abstract

This work deals with the complex mechanical design task of converting a large pneumatic rehabilitation robot into an electric and compact system for in-home post-stroke therapies without losing performance. It presents the new HomeRehab robot that supports rehabilitation therapies in three dimensions with an adaptive controller that optimizes patient recovery. A preliminary usability test is also conducted to show that its performance resembles that found in RoboTherapist 2D commercial system designed for hospitals. The mechanical design of a novel and smart two-dimensional force sensor at the end-effector is also described.

Introduction

According to the World Health Organization, by 2050, the number of persons over 65 years old will increase by 73% in the industrialized countries and by 207% worldwide.¹ This segment of population is particularly prone to suffer a cerebrovascular accident or stroke, since the relative incidence of stroke doubles every decade after age 55. Stroke survivors immediately experience hemiparesis, resulting in impairment of extremities associated with diminished health-related quality of life.² Rehabilitation can help hemiparetic patients to learn new ways of using and moving their weak arms and legs. It is also possible with immediate therapy that people who suffer from hemiparesis may eventually regain movement. However, reductions in healthcare reimbursement place constant demands on rehabilitation specialists to reduce the cost of care and improve productivity.³ Service providers have responded by shortening the length of patient hospitalization.^4,5 Additionally, early home supported discharge of subacute stroke patients has been proved to have a significant impact on motor recovery after stroke although it requires some level of innovation of methods and tools for service delivery to really become a sustainable solution for the healthcare system.^6,7 All these reasons support the necessity of in-home rehabilitation systems as the one proposed in this work.

Socially, chronic stroke patients can highly benefit from innovative approaches based on home rehabilitation therapy.⁸ Technological and scientifically, only a few commercial systems are currently available for in-home use (e.g. HandMentor™,⁹ ReJoyce,¹⁰ and ArmeoBoom from Hocoma), and their performances are not comparable to in-person therapies.¹¹ Key challenges not addressed properly for home systems include features such as affordability, autonomy, and high performance. Only if all requirements are satisfied, it will be possible to encourage national health systems, insurance companies, and patients to apply such platforms.

This work is part of an ongoing project called HomeRehab that will develop a new tele-rehabilitation robotic system for delivering therapy to stroke patients at home. Instead, Technologies has a robotic system called RoboTherapist 2D (Figure 1) developed to provide rehabilitation to patients who suffer from stroke and/or other neurological disorders.¹² Currently, the system, as the majority of commercial devices, is only designed to be used in hospitals and medical centers in collaboration with nurses and medical staff.¹³

Figure 1. RoboTherapist 2D system from Instead Technologies.

HomeRehab aims to modify and adapt the system so it can be used at home by patients easily and supporting the premise of tele-rehabilitation.¹⁴ This article describes in detail the mechanical design of the new HomeRehab system that adapts the RoboTherapist 2D for in-home use by making it smaller, lighter, and cheaper, but maintaining its high performance. Additionally, the system includes a third degree-of-freedom (DOF) plus a novel low-cost force sensor that were not considered for the original platform, but they are very interesting features for a complete in-home solution. Another key feature of the whole system is that it integrates patient monitoring techniques using wearable devices to monitor the physiological state of the patient and modify exercises based on that information.

The following section briefly summarizes the main requirements considered to develop a successful device, and afterward in section “Mechanical design,” the mechanical design of the new system is described in detail. Section “Robot controller” presents the controller of the robot as well as the adaptive controller implemented for the rehabilitation therapies. Section “Usability pilot study” carries out a validation phase by conducting several tests and surveys to compare the usability of RoboTherapist 2D with HomeRehab, and last section gathers main conclusions. […]

 

Continue —>   Development of a robotic device for post-stroke home tele-rehabilitationAdvances in Mechanical Engineering – Iñaki Díaz, José María Catalan, Francisco Javier Badesa, Xabier Justo, Luis Daniel Lledo, Axier Ugartemendia, Jorge Juan Gil, Jorge Díez, Nicolás García-Aracil, 2018