[Abstract] Music-based techniques and related devices in neurorehabilitation: a scoping review

ABSTRACT

Introduction:

The music as a powerful, and versatile stimulus for the brain, is at the date sometimes used in neurorehabilitation and proposed as a promising complementary strategy provided in combination with other therapy in individuals with neurological disorders. Different techniques and devices have been developed in the field of the music-based neurorehabilitation.

Areas covered:

This scoping review analyzes the current scientific literature concerning the different techniques and devices used in the music-supported neurorehabilitation, also focusing on the devices used in music-based therapies in patients with neurological disorders: 46 studies met the inclusion criteria and were included.

Expert opinion:

Included studies, highlight the potentiality and the versatility of the music-based therapy in the rehabilitation of neurological disorders. The variety of existing techniques allow to applied the music-based therapy in different situations and conditions. Moreover, the wide range of used devices that ranging from the simple musical instruments to the more advanced technologies, allows to develop customized exercises based on the needs of the patient. This review may be considered as a starting point to better design future RCTs that would investigate the effectiveness of music therapy on neurological disorders.

Article highlights

• The use of specific techniques based on music, has been shown to induce brain adaptation which involves auditory, sensory and motor circuits, in both childhood and adulthood
• The Neurologic Music Therapy (NMT) is placed as the therapeutic application of the music to recovery cognitive, sensory and motor disorders in patients with neurological diseases
• Studies shown a wide variability in terms of techniques and used devices for administering music therapy that limits the possibility to find strong scientific evidences about the best possible approach.

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[ARTICLE] The effect of mirror therapy on lower extremity motor function and ambulation in post-stroke patients: A prospective, randomized-controlled study – Full Text

Abstract

Objectives: This study aims to evaluate the effects of mirror therapy (MT) on lower extremity motor function and ambulation in post-stroke patients.

Patients and methods: A total of 42 post-stroke patients (25 males, 17 females; mean age 58 years; range, 32 to 71 years) were included. All patients were randomly divided into two groups as the control group (n=21) receiving a conventional rehabilitation program for four weeks (60 to 120 min/day for five days a week) and as the MT group (n=21) receiving MT for 30 min in each session in addition to the conventional rehabilitation program. The Brunnstrom stages of stroke recovery, Functional Independence Measure (FIM), Berg Balance Scale (BBS) and Motricity Index (MI) scores, six-minute walking test (6MWT), Functional Ambulation Category (FAC), and the degree of ankle plantar flexion spasticity using the Modified Ashworth Scale (MAS) were evaluated at baseline (Day 0), at post-treatment (Week 4), and eight weeks after the end of treatment (Week 12).

Results: There were significant differences in all parameters between the groups, except for the degree of ankle plantar flexion spasticity, and in all time points between Week 0 and 4 and between Week 0 and 12 (p<0.05).

Conclusion: These results suggest that MT in addition to conventional rehabilitation program yields a greater improvement in the lower extremity motor function and ambulation, which sustains for a short period of time after the treatment.

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[ARTICLE] Neurophysiological Changes Induced by Music-Supported Therapy for Recovering Upper Extremity Function after Stroke: A Case Series – Full Text

Abstract

Music-supported therapy (MST) follows the best practice principles of stroke rehabilitation and has been proven to instigate meaningful enhancements in motor recovery post-stroke. The existing literature has established that the efficacy and specificity of MST relies on the reinforcement of auditory-motor functional connectivity in related brain networks. However, to date, no study has attempted to evaluate the underlying cortical network nodes that are key to the efficacy of MST post-stroke. In this case series, we evaluated changes in connectivity within the auditory-motor network and changes in upper extremity function following a 3-week intensive piano training in two stroke survivors presenting different levels of motor impairment. Connectivity was assessed pre- and post-training in the α- and the β-bands within the auditory-motor network using magnetoencephalography while participants were passively listening to a standardized melody. Changes in manual dexterity, grip strength, movement coordination, and use of the upper extremity were also documented in both stroke survivors. After training, an increase in the clinical measures was accompanied by enhancements in connectivity between the auditory and motor network nodes for both the α- and the β-bands, especially in the affected hemisphere. These neurophysiological changes associated with the positive effects of post-stroke MST on motor outcomes delineate a path for a larger scale clinical trial.

1. Introduction

Stroke is a leading cause of disability that can result in a contralesional upper extremity paresis [1,2], including impaired gross and fine motor functions, changes in muscle tone, and reduced range of motion [3,4]. Current rehabilitation approaches often yield modest to moderate motor improvements [5,6,7], with residual upper extremity impairments becoming permanent and leading to activity restrictions [8] and reduced quality of life [2,9]. Longitudinal studies have shown that 46% to 66% of stroke survivors do not regain functional independence in the upper extremity 6 months post-stroke [3,4,10,11]. Best practice principles in stroke rehabilitation indicate that interventions should be individually tailored, meaningful, task specific, variable, and should involve sufficient repetition and challenge to promote recovery [12,13,14,15]. Previous studies including the ones from our laboratory [16,17], indicate that music-supported therapy (MST) can not only meet but extend beyond these imperatives to yield improvements in motor skills, cognitive functions [18,19,20,21,22,23,24,25,26,27], and stress reduction [28].

The efficacy and specificity of MST are hypothesized to be mediated by the auditory-motor network, which is required to play music as well as to support recovery and/or compensate for stroke-related dysfunction [29,30]. Pascual-Leone’s work clearly demonstrates that training with a musical instrument such as piano can instigate neural plasticity by inducing swift unmasking of existing synapses and the formation of newer ones [31]. In expert and novice musicians, MST-induced auditory-motor coupling engages a network of distributed brain regions that includes the auditory and primary motor cortices (M1s), the dorsal and ventral parts of the premotor area (PMd and PMv), the inferior frontal gyrus (IFG), and the supplementary motor area (SMA) [29,32]. In stroke survivors, MST has been shown to increase motor cortex excitability in the affected hemisphere and to be associated with partial recovery of motor functions of the paretic hand [17,18,33]. Recent systematic reviews and meta-analyses [18,19,34] have also highlighted the beneficial effects of MST on upper extremity recovery in chronic stroke survivors. In the context of this study, we sought to clarify the neurophysiological mechanisms that underlie the beneficial effects of MST when used as a tool for rehabilitation post-stroke [18,19].

Neuroimaging techniques have been used to evaluate the neurophysiological effects associated with MST in stroke survivors [33,35,36,37] during passive listening [36,37] or silent tapping of musical instruments [33]. Using functional magnetic resonance imaging (fMRI), Rojo et al. [37] reported greater activation in motor areas contralateral to the affected upper limb during passive music listening after MST. They also observed bilateral enhanced cortical excitability as indexed by a larger amplitude of motor evoked potentials (MEP) that were evoked with transcranial magnetic stimulation (TMS). Amengual et al. [35] also reported MEPs’ enhancement following MST, although it was restricted to the lesioned hemisphere. Using magnetoencephalography (MEG), Fujioka et al. [36] observed event-related desynchronization (ERD) (i.e., power decrease) in the β-band (15–35 Hz) in auditory and sensorimotor cortices after MST, while stroke participants were passively listening to a metronome. The focus on neurophysiological effects in the α- and β-bands is due to their remarkable signal strength in humans, and their well-studied association with cognitive vigilance [38,39] and motor performance [30], respectively. A critical electroencephalography (EEG) study by Altenmuller et al. [33] also evaluated ERD and intracortical connectivity changes in the α- and β-bands in stroke participants actively playing a muted-drum or a muted-piano instrument. The authors reported greater ERD in the β-band during silent playing after MST, and no differences in the α-band. They also observed increased β-band intra- and interhemispheric coherence between the frontal and parietal regions when stroke participants played the muted electronic drum sets using either the affected or unaffected arms after MST. Here too, no pre/post MST changes in coherence were observed by the authors in the α-band. The authors interpreted these effects as reflecting increased auditory-motor coupling in stroke survivors following MST. From the current state of literature, gaps in knowledge exist regarding the extent of changes in the functional connectivity between the auditory-motor network nodes after MST. Moreover, the literature fails to explain as to how MST-induced functional connectivity changes might differ in stroke survivors not presenting the same level of motor impairment at baseline.

MST studies involving stroke participants have reported treatment effects in pre-determined regions of interest (ROIs) of the auditory-motor network, such as in M1 and the auditory cortex (AC). However, because stroke causes changes in functional brain organization, ROIs based on standard coordinates or atlases of brain anatomy may not be accurate in individuals with brain lesions within these areas [40,41,42,43]. We therefore sought to determine how the neurophysiological effects of MST are related to clinical outcomes, using brain ROIs selected based on functional localizers in the motor and sensory regions in chronic stroke participants. We anticipated that MST would induce enhanced functional coupling between multiple nodes of the auditory-motor network following an intensive, 3-week piano training intervention in stroke survivors. Furthermore, previous data from our laboratory showed that stroke survivors who had greater functional status prior to MST experienced the largest gains in manual dexterity and functional use of their upper extremity following MST [17]. In the present study, we therefore hypothesized that baseline motor performance would be predictive of changes in functional connectivity in the auditory-motor network following MST. We anticipate observing larger post-MST enhancements in auditory-motor functional connectivity in stroke survivors with better baseline functional capability as compared to stroke survivors with poorer baseline capability.[…]

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Regions of interests of the auditory-motor network created by Brainstorm. M1 and AC ROIs were defined from individual functional data pre- and post-MST; SMA, PMd, and PMv were selected from a previously published study [58]; IFG was selected from the Broadmann area maps’ atlas [59] (P1: Participant 1, P2: Participant 2, M1: primary motor cortex, S1: somatosensory cortex, AC: auditory cortex, IFG: inferior frontal gyrus, pre-MST: before music-supported therapy, post-MST: after music-supported therapy, SMA: supplementary motor area: PMv: premotor ventral area, PMd: premotor dorsal area).

[ARTICLE] Serious games for upper limb rehabilitation after stroke: a meta-analysis – Full Text

Abstract

Background

Approximately two thirds of stroke survivors maintain upper limb (UL) impairments and few among them attain complete UL recovery 6 months after stroke. Technological progress and gamification of interventions aim for better outcomes and constitute opportunities in self- and tele-rehabilitation.

Objectives

Our objective was to assess the efficacy of serious games, implemented on diverse technological systems, targeting UL recovery after stroke. In addition, we investigated whether adherence to neurorehabilitation principles influenced efficacy of games specifically designed for rehabilitation, regardless of the device used.

Method

This systematic review was conducted according to PRISMA guidelines (PROSPERO registration number: 156589). Two independent reviewers searched PubMed, EMBASE, SCOPUS and Cochrane Central Register of Controlled Trials for eligible randomized controlled trials (PEDro score ≥ 5). Meta-analysis, using a random effects model, was performed to compare effects of interventions using serious games, to conventional treatment, for UL rehabilitation in adult stroke patients. In addition, we conducted subgroup analysis, according to adherence of included studies to a consolidated set of 11 neurorehabilitation principles.

Results

Meta-analysis of 42 trials, including 1760 participants, showed better improvements in favor of interventions using serious games when compared to conventional therapies, regarding UL function (SMD = 0.47; 95% CI = 0.24 to 0.70; P < 0.0001), activity (SMD = 0.25; 95% CI = 0.05 to 0.46; P = 0.02) and participation (SMD = 0.66; 95% CI = 0.29 to 1.03; P = 0.0005). Additionally, long term effect retention was observed for UL function (SMD = 0.42; 95% CI = 0.05 to 0.79; P = 0.03). Interventions using serious games that complied with at least 8 neurorehabilitation principles showed better overall effects. Although heterogeneity levels remained moderate, results were little affected by changes in methods or outliers indicating robustness.

Conclusion

This meta-analysis showed that rehabilitation through serious games, targeting UL recovery after stroke, leads to better improvements, compared to conventional treatment, in three ICF-WHO components. Irrespective of the technological device used, higher adherence to a consolidated set of neurorehabilitation principles enhances efficacy of serious games. Future development of stroke-specific rehabilitation interventions should further take into consideration the consolidated set of neurorehabilitation principles.

Background

Each year more than 1 million Europeans suffer from stroke and approximately two-thirds of survivors maintain upper limb (UL) paresis [1]. This number is expected to rise by 35% in upcoming years [2] leading to additional rehabilitation needs. To this date, few people attain complete UL recovery 6 months after stroke [3]. New interventions targeting the UL aim for better outcomes in activities of daily living (ADL), functional independence and quality of life. Alongside conventional therapies, recent developments offer possibilities in self- and tele-rehabilitation [4] which could help manage, cost-efficiently [5], increasing rehabilitation demands.

Technological improvements in robot assisted therapy (RAT) and virtual reality (VR) systems (VRS) enhance patient care and facilitate therapist assistance during UL rehabilitation [6, 7]. First, RAT promotes the use of the affected limb, intensifies rehabilitation through task repetition and offers task-specific practice [7]. Effectiveness of RAT is established for UL rehabilitation after stroke [8, 9]. Secondly, VRS provide augmented feedback, preserve motivation and are becoming cost-efficient [5]. Recent meta-analyses suggest a superior effect of VR-based interventions compared to conventional treatment on UL function and activity after stroke, especially if developed for this specific purpose [10–12]. Authors attributed these findings to the fact that VRS specifically developed for rehabilitation, as opposed to commercial video-games (CVG), fulfil numerous neurorehabilitation principles.

Typically, a common denominator of VRS and RAT is playful interventions by means of serious games [13, 14]. A serious game is defined as a game that has education or rehabilitation as primary goal. These games combine entertainment, attentional engagement and problem solving to challenge function and performance [15, 16]. Moreover, they comply with several motor relearning principles that constitute the basis of effective interventions in neurorehabilitation [11, 16]. For example, some devices adapt game difficulty to stimulate recovery and maintain motivation [15]. Others incorporate functional tasks mimicking ADL in virtual environments and provide performance feedback during and/or after task completion [17]. Characteristics of serious games differ depending on targeted rehabilitation purposes and technical specificities of the system they are implemented on.

Previous work on the efficacy of VR-based interventions indicated that serious games may enhance UL recovery after stroke [11, 12, 18]. However, why such interventions, specifically developed for rehabilitation purposes and implemented on various types of devices (such as robots, smartphones, tablets, motion capture systems, etc.), may constitute effective therapies for UL rehabilitation after stroke needs to be further investigated. Recent theoretical research proposed consolidation of commonly acknowledged neurorehabilitation principles [16]. Usually, serious games comply with several of these principles which creates an opportunity to evaluate clinical applicability of the consolidated set of principles. To this day, it remains unclear whether higher adherence to this consolidated set of neurorehabilitation principles enhances efficacy of interventions. In addition, it is not well known whether adherence to specific principles influences efficacy. Finally, rehabilitation effects on participation outcomes remain relatively unexplored. In this context, efficacy of interventions should be addressed in terms of all components of the World Health Organization’s International Classification of Function, Disability, and Health (ICF-WHO) model [19].

The main objective of this systematic review and meta-analysis was to address the following question in PICOS form: in adults after stroke (P), do serious games, implemented on various technological systems (I), show better efficacy than conventional treatment (C), to rehabilitate UL function and activity, and patient’s participation (O)? A secondary objective was to assess whether higher adherence to a consolidated set of neurorehabilitation principles enhances efficacy of games specifically designed for rehabilitation, irrespective of the technological device used.[…]

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[Abstract] of the auditory-motor system: How does interact with movement?

Abstract

Human musicality is a complex problem because it involves the coupling of multiple exogenous and endogenous signals with different physical properties. The synchronization of these signals translates into specific behaviors. The study of this synchronization, based on the physical properties of two oscillatory bodies, is the first step in understanding the behaviors associated with rhythmic auditory stimuli. In recent years, different neurorehabilitation therapies have emerged for motor pathologies involving music. However, the neurophysiological bases that describe the coupling phenomenon are not yet fully understood. In this article, two theories are addressed that attempt to explain the convergence of the auditory system and the motor system according to new neuroanatomical, neurophysiological and artificial neural network findings. It also reflects on the different approaches to a complex problem in cognitive neuroscience and the need for a study model for the different motor behaviors evoked by auditory stimuli.

Introduction

Our mind is a living mosaic whose study has focused on the disarticulation of its parts [1]. Research on information processing in the human brain brings together various theoretical perspectives that aim to describe individual modules that explain a series of events. In this sense, cognitive neuroscience has been a breakthrough and its approach to the modularity of the mind has significantly changed the way we think about the higher cognitive processes that we perform on a daily basis [2]. For example, auditory-motor synchronization is a critical element in human behavior, different activities depend on this ability such as walking, talking, dancing or playing an instrument [3].

The effect of music offers an opportunity for comprehensive analysis because it is not an entity but a phenomenon that generates a set of events, musical forms are emerging and evolving over time [4]. The definition of music is described as the science or art of arranging tones or sounds in succession, in combination and in temporal relationships to produce a composition that has unity and continuity [5]. However, defining a concept necessarily implies expressing the meaning of that which is being defined and, in this aspect, it fails widely. The problem lies in the search for not the understanding of music, but of human musicality.

Probably the most studied quality related to music is the compulsion to move. It has been proposed that movement evoked by a rhythmic auditory stimulus, such as moving the head, feet or hands, is intended to assist in the understanding of a complex sound. Motor synchronization, in this case, breaks down the most noticeable auditory patterns [6]. The concordance between signals of different modes and speeds, which are processed in different brain areas in a specific time, represents a complex synchronization. One way of explaining the relationship between auditory stimulus and motor system is through rhythmic entrainment. This model offers a simplified view of the coupling between these signals. The rhythmic entrainment is based on the description of transferring energy from one pendulum to another along the same axis. Therefore, pendulums assume a common period in a given time. This phenomenon, described in 1966, is a principle of Physics [7].

One reason that makes the study of rhythmic entrainment difficult is the fact that what is known about the organization of the brain comes from research on non-human species [8] and musicality and its value are found only in our species. The debates that have arisen about the differences between the anatomical characteristics of the brain in animal models and in humans become more important in this type of cognitive neuroscience research. It has even been shown that among closely related mammal species, significant differences may exist in cell genotypes and their connectivity, leading to distinctions in cortical organization [9,10].

The question of how science deals with a complex problem is fundamental when studying a phenomenon like music. For some neuroscientists, studying the origin of an organ has the purpose of revealing its function. This approach in the study of brain anatomy or embryology is valuable, but in the case of music, its origin (if we could know it) does not provide traces of its function. Possibly nothing can be fully understood just because of its origin.

Such is the case with exaptations. According to Gould, exaptation is a structure of the organism originally intended for one purpose but which, over time, is used for a different activity [11]. The most characteristic examples of exaptations include the hearing of vertebrates, which originally had the function of sucking water into the gills and bones of vertebrates, the purpose of which was the deposition of calcium and not the protection of organs. Whether the circuits involved in musical perception have been specially developed for musical enjoyment or have been adapted for this purpose, the meaning of music does not necessarily imply the dissection of its evolution [12,13].

It has been thought that another way of studying human musicality is a current of thought not far away from that of the origin called localizationism, this current intended to relate an anatomical brain structure with a specific function. The idea of localizationism was simple: a function, a location [14,15], its main mode of study, based on clinical cases, frequently describes an extraordinary picture that cannot be taken to the generality. Localizationism fails in its vision of a whole but the lines of research based on the fragmented study of the brain continue to be frequent, so why does this current prevail? [16]. Perhaps, the reason goes back to the verification of Cajal’s theory about the independence of the nerve cells. The confirmation of autonomous neurons contributed to the fact that the study of the brain was conceived as increasingly particular and less global [14], the difficulty in studying neuronal networks and cognitive processes are also factors that intervene in the development of a focused study.

The theory that emerges as a counterpart is associationism, which gives sensations and emotions the character of compounds [17], with this vision artificial neural networks appear. Conceiving the brain from its complexity would be the right approach, but to achieve this, we would have to eliminate more variables, so that we now have multiple models of how certain higher cognitive processes work, but we do not really know if these models are adequate. In addition, artificial neural networks ignore personal experience. Simply put, when trying to describe higher cognitive processes, individual variability is inevitable.

There is another ideology that understands cognitive processes as a dynamic system. For dynamic systems, cognition emerges from the coupling between the body, the Central Nervous System (CNS) and the environment, modifying one’s perception of the environment. Therefore, there are a series of processes that influence each other and each one of them is perceived as dependent on the other [18]. This current constitutes a significant advance with respect to those previously mentioned because it considers the individual experience of knowledge. For a dynamic system, knowledge is formed from the overlap between experience and the biological substrate. The study of the CNS under this concept of thought is inclined towards the investigation of brain dynamics on a large scale through Neurodynamics and Neurophenomenology. Both the Dynamic Attention Theory (DAT) and the Sensorimotor Theory of Rhythm Perception (SMT) are based on this approach.

This article will focus on describing the relationship between the motor system and the auditory system through two theories: the DAT and the TMS, which are formulated to understand the phenomenon of convergence between the two systems, as well as some clinical applications of rhythmic entrainment. For this purpose, the article has been divided into 5 sections: 1) introduction, 1.2) How does musicality is studied?, 2) the rhythmic entrainment, 2.1) The rhythmic entrainment according to the DAT and the SMT, 3) The clinical use of auditory stimuli for rehabilitation, 4) conclusions and 5) perspectives.

Figures

1. The auditory system and its main areas of association. Cochlear nerve (CN), superior olive complex (SOC), inferior colicle (IC), medial geniculate body (MGB), primary auditory area (A1), Broca´s area …
2. Sound waves and their relationship with entrainment. The image represents a sine wave and two of its characteristics; the phase and the period. The phase of the wave is the state of vibration of a poi…
3. The vestibular system and some of its areas of association. Vestibular nuclei (VN), abducens nerve (VI), trochlear nerve (IV), oculomotor nerve (III), thalamic nuclei (TN), primary somatosensory area …
4. Two parallel sensory-motor pathways for the detection of a beat in a somatotopic representation according to the SMT. In green the auditory-parieto-cerebellar-premotora pathway and in blue the auditor…

Section snippets

The rhythmic entrainment

Rhythmic entrainment is a concept that has been adapted in Neuroscience to refer to the ability of human beings to synchronize their body movements to a specific pulse or beat [19]. Dr. Patel proposed in 2014, three criteria to identify rhythmic entrainment: 1. Ability to combine stimuli that are more complex than a simple pulse train (such as metronome beats); 2. The stimulus covers a wide variety of tempos and 3. The tempos are in a different mode of response, so the reaction is not simply an …

The clinical use of auditory stimuli for rehabilitation

The study of the Neurobiology of rhythm has been fundamental in establishing a new role for music in research dedicated to neurorehabilitation [41], especially in pathologies that present bradykinesia, myopathy, paralysis and/or difficulty in coordination such as Parkinson’s disease (PD), multiple sclerosis (MS), epilepsy, cranioencephalic trauma (CET) and, especially, in the sequelae of stroke that include hemiplegia, hemiparesis, facial paralysis and aphasia.

One of the most important findings …

Conclusions

For a long time, the predominant point of view in music research was related to the socio-cultural quality of music [43,44]. However, studies about human musicality and compulsion to move began to emerge, and efforts to clarify the theories of the auditory-motor system are a consequence of this [45]. The way to describe the delicate relationship between two systems is, in itself, complex. The DAT suggests that the coupling of an auditory signal with a motor response is possible thanks to the …

Perspectives

As part of the efforts for the association of theories, the project called The Human Brain Project (HBP) was initiated, which brings together the knowledge obtained from the CNS and aims to contribute to the progress of Medicine, Computer Science and Neuroscience. The HBP is basically a research platform that brings together the results of more than 500 researchers whose topics include Neuroinformatics, brain simulation (which describes the anatomical structure of the brain), Computational…

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[WEB] Specialist rehab facility reveals new cutting-edge rehab tech to improve client outcomes

By Sarah Sarsby

Sheffield-based STEPS Rehabilitation, a specialist facility that delivers intensive rehabilitation for people recovering from brain injury, spinal cord injury, strokes and complex trauma injuries, is now home to “cutting-edge” rehabilitation equipment.

The specialist facility has launched STEPS RehaHub, which has become the first place in the UK to provide clients with access to “word-class” robotics and virtual reality (VR) technology.

The suite of assistive technology focuses on upper and lower limb robotic therapy, as well as cognitive feedback and training for a complete solution for neurorehabilitation.

It comes after STEPS Rehabilitation has been working with innovators in Singapore and Switzerland.Advertisement | Continue story below

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Fourier Intelligence is a Singapore-based technology company that develops pioneering exoskeleton and rehabilitation robotics. By combining the expertise and experience of researchers, therapists, and patients, the company excels in developing new robotic solutions to support the rehabilitation process and lives of patients.

“We’re offering this new tech in conjunction with Thor Assistive Technologies,” reveals STEPS Rehabilitation Business Development Director Jules Leahy. “We’ve been working with the founder, Stephen Ruffle, for a while now with ReWalk Exoskeleton, and we know just how much clients can progress with the assistance of the right technology.”

Stephen explains: “The RehabHub is a suite of rehab technology which focus on both upper and lower limb robotic therapy, as well as cognitive feedback and training, providing a complete solution for neurorehabilitation.

“The unique and innovative ‘Force Feedback’ technology creates an immersive game environment which facilitates highly effective rehabilitation. Use of the technology naturally encourages repetition and intensity which improves client engagement and outcomes.

“As the devices are all linked, it enables client-against-client gaming competition, which enhances motivation and stamina. The technology also provides therapists and clients with performance feedback which tracks client progress and helps shape individual rehabilitation programmes.”

The suite of equipment includes the latest in cycle motion, arm, wrist, finger, and ankle rehabilitation robotics.

“Clients can access the pioneering OTParvos alone or in conjunction with the HandyRehab,” comments STEPS Rehabilitation Clinical Director Toria Chan. “These amazing pieces of kit used together provide a portable intelligent solution for therapy, supporting the functional rehabilitation of the upper limb, fine motor skills of the fingers, hand-eye coordination and cognitive ability.

“They allow clients to undertake training using everyday objects with the assistance of a lightweight robotic glove, with quantifiable data being recorded in real time enhancing the rehabilitation process. We can’t wait to see the results!”

As well as being the first UK Fourier Intelligence Rehabilitation Hub, the specialist rehabilitation facility is also now one of two UK facilities offering clients access to the “revolutionary” MindMaze VR rehabilitation technology.

Developed in Switzerland, MindMaze equipment helps clients who have sustained a traumatic brain injury.

“We’ve been carefully exploring what VR technology is out there, and the portfolio of MindMaze equipment is truly impressive,” adds Toria. “It includes the MindMotion GO, a first-of-its-kind mobile neurorehabilitation therapy system that comes with a large variety of gamified engaging activities covering motor and task functions. Thanks to the motivating effects of the 3D virtual environment, early results suggest an increased client engagement and adherence to therapy.”

The MindPod Dolphin is an engaging animated gaming experience that promotes the recovery of motor skills and cognitive function.

Toria continues: “The dolphin has been designed by Pixar animators no less! It comes with an anti-gravity vest that de-weights the arm and trains fine-motor control of the upper-limb by encouraging continuous exploration of its immersive oceanic environment.”

Now, STEPS is in discussions to collaborate with the Advanced Wellbeing Research Centre (AWRC) at Sheffield Hallam University to undertake new research that will investigate and explore the benefits of this new rehabilitation technology. The specialist centre at the university is dedicated to improving the health and wellbeing through movement, harnessing world-class research and design.

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[WEB] MindMaze inks deals to bring game-based brain repair software to Europe, South America, Middle East

by Andrea Park 

MindMaze’s video game-based platform supports the physical therapy regimens of patients with neurological conditions like stroke and Parkinson’s disease to promote neurorehabilitation and neurorestoration. (MindMaze)

What’s better than one new partnership expanding the global reach of MindMaze’s neurotherapeutic platform? Simple: Four new partnerships expanding the global reach of MindMaze’s neurotherapeutic platform.

The Swiss company has joined forces with new partners in Europe, South America and the Middle East, all with a goal of bringing its neurorehabilitation and neurorestoration software to even more patients around the globe.

MindMaze’s new European partners are Guttmann Barcelona’s Brain Health and Neurorehabilitation Institute and Swiss Rehabilitation, an outpatient rehab facility specializing in brain injury recovery. In South America, MindMaze has linked with Surgicorp, which develops medical equipment for use in Peru, Ecuador and Bolivia. And in Saudi Arabia, it will partner with Alkholi Medical, which imports new technologies and operates medical centers throughout the country.

Through the partnerships, each of those four organizations will be able to offer MindMaze’s range of neurotherapeutics to their respective patient populations.

RELATED: Virtual reality startup reels in $100M for rehabilitation device

At the core of the portfolio is MindMotion PRO, which has been cleared by the FDA and received a CE mark for neurorehabilitation. The platform includes 17 games that promote upper-limb exercises to rebuild strength and movement in patients being treated for conditions like stroke, traumatic brain injury, multiple sclerosis and Parkinson’s disease.

The software connects to a camera to track motion and is powered by artificial intelligence to measure movement and analyze progress.

MindMaze has also developed an at-home version of this software, MindMotion GO, which connects to an app so that physical therapists can continue to monitor their patients’ progress from afar. Last September, MindMaze and Mount Sinai Health System partnered to launch an at-home tele-neurorehabilitation program for stroke patients centering on the use of MindMotion GO.

RELATED: FDA approves wireless brace that uses brainwaves to improve hand function in stroke patients

For neurorestoration, the company has created another series of digital games that help patients recover motor skills and cognitive function.

With MindPod Dolphin, which has been tested in patients at risk of Alzheimer’s disease and dementia, an anti-gravity vest makes the arm feel weightless, allowing patients to focus on retraining fine motor controls. TOAP Run, meanwhile, was developed to help Parkinson’s patients make faster and bigger movements as they guide an animated mouse down a fast-moving track.

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[Abstract] Rhythmic Auditory Stimulation and Gait Training in Traumatic Brain Injury: A Pilot Study

Abstract

Rhythmic auditory stimulation (RAS) has been well researched with stroke survivors and individuals who have Parkinson’s disease, but little research exists on RAS with people who have experienced traumatic brain injury (TBI). This pilot study aimed to (1) assess the feasibility of the study design and (2) explore potential benefits. This single-arm clinical trial included 10 participants who had a 2-week control period between baseline and pretreatment. Participants had RAS daily for a 2-week treatment period and immediately completed post-treatment assessments. Participants then had a 1-week control period and completed follow-up assessment. The starting cadence was evaluated each day of the intervention period due to the variation in daily functioning in this population. All 10 participants were 1-20 years post-TBI with notable deviations in spatial-temporal aspects of gait including decreased velocity, step symmetry, and cadence. All participants had a high risk of falling as defined by achieving less than 22 on the Functional Gait Assessment (FGA). The outcome measures included the 10-m walk test, spatial and temporal gait parameters, FGA, and Physical Activity Enjoyment Scale. There were no adverse events during the study and gait parameters improved. After the intervention, half of the participants achieved a score of more than 22 on the FGA, indicating that they were no longer at high risk of experiencing falls.

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[BLOG POST] Clinical trial shows “significant” improvement for stroke survivors using digital therapy

by Sarah Sarsby 9th March 2021

Constant Therapy Health, a US-based provider of digital therapy for stroke, dementia and traumatic brain injury survivors, has announced positive results of a 10-week clinical trial in using digital therapy to support stroke patients.

Stroke survivors using a research version of Constant Therapy (CT-R), a digital therapeutic application for cognitive and speech therapy, demonstrated “significantly” improved outcomes compared to traditional, paper-based therapies.

At the completion of the trial, patients receiving CT-R’s digital therapy demonstrated an average improvement of 6.75 points on the WAB Aphasia Quotient versus the control group, which showed an average improvement of 0.38 points.Advertisement | Continue story below

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This first-of-a-kind virtual clinical trial was conducted among stroke patients recovering from aphasia across the United States and Canada. The findings proving the efficacy of digital therapy were published in Frontiers of Neurology: Neurorehabilitation.

Patients in the experimental group used Constant Therapy-Research (CT-R) to receive evidence-based, targeted digital therapy based on their unique assessment profile and rehabilitation needs.

CT-R adjusts therapy difficulty automatically, progressing patients based on their task performance and neurological profile using its artificial intelligence based NeuroPerformance Engine (NPE). Patients in the control group completed standard of care (SOC) speech-language pathology workbook exercises.

According to Constant Therapy Health, this clinical trial also proved the viability of remote assessment and the effectiveness of a digital therapeutic treatment with post stroke aphasia patients, as all patients participated remotely from their homes.

“This is aligned with the ever-shifting needs of how people access care,” the company states.

Digital health solutions can also reduce geographic and other challenges that many individuals with aphasia and other neurological disorders face when seeking therapy.

Dr. Swathi Kiran, Constant Therapy Health Founding Scientist and Professor of Neurorehabilitation at the Sargent College of Health and Rehabilitation Sciences at Boston University, said: “This trial demonstrates the power of digital therapy to enable stroke survivors to recover cognitive and speech abilities more effectively compared to traditional paper-based modalities.

“Its significance is heightened during the COVID-19 pandemic that has increased health risks and raised other barriers for patients needing this crucial therapy to continue their recovery journeys.”

Veera Anantha, Chief Executive Officer of Constant Therapy Health, added: “Post stroke survivors who often require sustained rehabilitation and communication practice, face significant burdens in accessing therapy due to shortages in qualified clinicians, insurance limitations and geographic access.

“Digital therapy removes these barriers and enables patients to receive consistent therapy remotely anyplace and anytime via a computer or mobile device.”

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[WEB PAGE] Rise&Walk InClinic Robotic Technology Completes Shepherd Center Pilot Program

Posted by Debbie Overman

Healing Innovations Inc announces the successful completion of the first pilot for the new Rise&Walk InClinic technology at Shepherd Center in Atlanta. The pilot included the technology’s different use cases, and gathered session data including clinician and patient feedback. 

“The Rise&Walk has helped our team facilitate upright lower-extremity motor training with fewer staff than is typically required of some other locomotor-related training activities, while also allowing us to objectively track user progress. We are excited to continue to partner with Healing Innovations to further support advances in rehabilitation technology.”

— Rebecca Washburn, MS, manager of Beyond Therapy

Beyond Therapy is an intensive outpatient neurological rehabilitation program that integrates the disciplines of physical therapy and exercise physiology at Shepherd Center.

“The Rise&Walk enables our team to create intensive and engaging training sessions that are in keeping with the aims and objectives of our program. Individuals have enjoyed using the Rise&Walk, and we see unique opportunities for integrating the technology into the existing repertoire of motor training and conditioning devices we have to offer.”

— Nicholas Evans, MHS, ACSM CEP, lead exercise physiologist in Beyond Therapy

The Rise&Walk InClinic is a robotic neurorehabilitation technology that targets muscle groups important for walking and facilitates locomotor-related movements to help a wide range of patients recovering from neurological injuries. The sit-and-stand device is designed to replicate up to three different therapy modalities, giving clinicians more flexibility in a therapy session, a media release from Healing Innovations Inc explains.

“This pilot was an important first step in the introduction of this technology to the rehabilitation community. The Beyond Therapy team has an incredibly innovative spirit that made them the perfect partner in this initiative.”

— Luke Benda, Chief Executive Officer of Healing Innovations, based in Nashville, Tenn

Healing Innovations will release the Rise&Walk InClinic technology with additional rehabilitation providers in 2021, per the release.

[Source(s): Healing Innovations Inc, PR Newswire]

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