Posts Tagged Older Adults

[Abstract] The Use of Virtual Reality Applications in Stroke Rehabilitation for Older Adults : Technology Enhanced Relearning


After stroke rehabilitation is a long-term relearning process that can be divided into cognitive relearning, speech relearning and motoric relearning. Today with an aging population it it interesting to look at technology enhanced and game-based solutions that can facilitate independent living for older adults. The aim of the study was to identify and categorise recently conducted research in the field of virtual reality applications for older adults’ relearning after stroke. This study was conducted as a systematic literature review with results categorised in a pre-defined framework. Findings indicate that virtual reality-based stroke rehabilitation is an emerging field that can renew after stroke rehabilitation. Most found studies were on stroke patients’ motoric and game-based relearning, and with less studies on speech rehabilitation. The conclusion is that virtual reality systems should not replace the existing stroke rehabilitation, but rather to have the idea of combining and extending the traditional relearning process where human-to-human interaction is essential. Finally, there are no virtual reality applications that can fit all stroke patients’ needs, but a thoughtful selection of exercises that matches each individual user would have a potential to enhance the current relearning therapy for older adults after stroke.

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[WEB SITE] Depression: MedlinePlus

Also called: Clinical depression, Dysthymic disorder, Major depressive disorder, Unipolar depression

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Depression is a serious medical illness. It’s more than just a feeling of being sad or “blue” for a few days. If you are one of the more than 19 million teens and adults in the United States who have depression, the feelings do not go away. They persist and interfere with your everyday life. Symptoms can include

  • Feeling sad or “empty”
  • Loss of interest in favorite activities
  • Overeating, or not wanting to eat at all
  • Not being able to sleep, or sleeping too much
  • Feeling very tired
  • Feeling hopeless, irritable, anxious, or guilty
  • Aches or pains, headaches, cramps, or digestive problems
  • Thoughts of death or suicide

Depression is a disorder of the brain. There are a variety of causes, including genetic, biological, environmental, and psychological factors. Depression can happen at any age, but it often begins in teens and young adults. It is much more common in women. Women can also get postpartum depression after the birth of a baby. Some people get seasonal affective disorder in the winter. Depression is one part of bipolar disorder.

There are effective treatments for depression, including antidepressants, talk therapy, or both.

NIH: National Institute of Mental Health

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[ARTICLE] Home rehabilitation supported by a wearable soft-robotic device for improving hand function in older adults: A pilot randomized controlled trial – Full Text



New developments, based on the concept of wearable soft-robotic devices, make it possible to support impaired hand function during the performance of daily activities and intensive task-specific training. The wearable soft-robotic ironHand glove is such a system that supports grip strength during the performance of daily activities and hand training exercises at home.


This pilot randomized controlled clinical study explored the effect of prolonged use of the assistive ironHand glove during daily activities at home, in comparison to its use as a trainings tool at home, on functional performance of the hand.


In total, 91 older adults with self-perceived decline of hand function participated in this study. They were randomly assigned to a 4-weeks intervention of either assistive or therapeutic ironHand use, or control group (received no additional exercise or treatment). All participants performed a maximal pinch grip test, Box and Blocks test (BBT), Jebsen-Taylor Hand Function Test (JTHFT) at baseline and after 4-weeks of intervention. Only participants of the assistive and therapeutic group completed the System Usability Scale (SUS) after the intervention period.


Participants of the assistive and therapeutic group reported high scores on the SUS (mean = 73, SEM = 2). The therapeutic group showed improvements in unsupported handgrip strength (mean Δ = 3) and pinch strength (mean Δ = 0.5) after 4 weeks of ironHand use (p≤0.039). Scores on the BBT and JTHFT improved not only after 4 weeks of ironHand use (assistive and therapeutic), but also in the control group. Only handgrip strength improved more in the therapeutic group compared to the assistive and control group. No significant correlations were found between changes in performance and assistive or therapeutic ironHand use (p≥0.062).


This study showed that support of the wearable soft-robotic ironHand system either as assistive device or as training tool may be a promising way to counter functional hand function decline associated with ageing.



Hand function predominantly determines the quality of performance in activities of daily living (ADL) and work-related functioning. Older adults with age-related loss of muscle mass (i.e. sarcopenia) [1] and/or age-related diseases (e.g. stroke, arthritis) [23] suffer from loss of hand function. As a consequence, they experience functional limitations, which affects independence in performing ADL [35].

An effective intervention for improving hand function of (stroke) patients should consist of several key aspects of motor learning, such as high-intensity and task-specificity in repetitive and functional exercises that are actively initiated by the patient him/herself [67]. In a traditional rehabilitation setting, those kinds of interventions are performed with one-on-one attention from the healthcare professional for each patient. This might become problematic in the near future when the population of older adults with age-related diseases (e.g. stroke, rheumatoid arthritis) with hand function decline will rise, resulting in an increased need for healthcare professionals and a rise of healthcare costs [8]. Therefore, new alternatives to provide intensive therapy for all patients are needed in the future.

New technological developments, such as robot-assisted hand training, have the potential to provide such intensive, repetitive and task-specific therapy. Several reviews [911] already showed positive results on motor function after robot-assisted training of the upper extremity. However, limiting factors of robot-assisted therapy are the need for supervision of a healthcare professional, the high costs of the devices and the limited availability of wearable devices for training at home [12]. Furthermore, it is often not efficient in transferring the trained movements into daily situations [6]. Therefore, the next generation robotic training approaches should pay substantial attention towards home-based rehabilitation and the functional nature of the exercise involved.

A new way of providing functional, intensive and task-specific hand training would involve using new technological innovations that enable support of the affected hand directly during the performance of ADL, based on the concept of a wearable robotic glove [1318]. In this way, the affected hand can be used repeatedly and for prolonged periods of time during functional daily activities. These robotic gloves can use different human-robot interfaces to provide assistance for the affected hand, such as an EMG-controlled glove, a tendon driven glove, a glove controlled by force sensors etc. [1314161819]. All these robotic gloves use soft and flexible materials to make such devices more lightweight and easy to use, accommodating wearable applications. This concept of a wearable soft-robotic glove allows persons with reduced hand function to use their hand(s) during a large variety of functional activities and may even turn performing daily activities into extensive training, independent from the availability of healthcare professionals. This is thought to improve hand function and patient’s independence in performing ADL.

Therefore, an easy to use and wearable soft-robotic glove (ironHand system), supporting grip strength and hand training exercises at home, was developed within the ironHand project [20]. Previous studies have examined feasibility [20] and the orthotic effect of the ironHand system [21]. In a first randomized controlled clinical study, the effect of prolonged use of such an assisting glove during ADL at home on functional performance of the hand was explored, in comparison to its use as a training tool at home.[…]


Continue —> Home rehabilitation supported by a wearable soft-robotic device for improving hand function in older adults: A pilot randomized controlled trial

Fig 2.
Overview of the ironHand system with assistive functionality (left panel) and therapeutic functionality (right panel). * Reprinted from Bioservo Technologies under a CC BY license, with permission from Bioservo Technologies, original copyright 2017.


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[ARTICLE] Effects of liaison between physiotherapists and occupational therapists for home-visit rehabilitation: preliminary study


[Purpose] Home-visit rehabilitation is used to restructure patients’ home lives and involves comprehensive intervention. In Japan, liaison between physiotherapists and occupational therapists occurs, but impact of this cooperation is unclear. The present study aimed to investigate therapeutic efficacy of this liaison.
[Participants and Methods] The study used a cross-sectional design. Participants were community-dwelling older adults who required long-term care and were receiving home-visit rehabilitation provided in the Chubu region. They were divided into a single-intervention group with either physiotherapy or occupational therapy alone, and a liaison intervention group with therapy coordinated between the 2 professions. In addition to basic information, the Barthel Index, Frenchay Activities Index, Health Utility Index Mark 3, and subjective health assessments were evaluated.
[Results] Eighteen participants were recruited. No significant differences were observed between groups for the Barthel Index, whereas the total Frenchay Activities Index score and items of the Frenchay Activities Index (outdoor domestic chores and outdoor activities) were significantly higher in the liaison-intervention group. The emotion
item in the Health Utility Index Mark 3 and subjective health assessments were also significantly higher in the liaison-intervention group.
[Conclusion] These findings suggest that this liaison is effective for improving activities of daily living and increasing quality of life. This is probably due to each therapist performing a specialized intervention and professional cooperation.

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[ARTICLE] Novel use of the Nintendo Wii board as a measure of reaction time: a study of reproducibility in older and younger adults – Full Text HTML



Reaction time (RT) has been associated with falls in older adults, but is not routinely tested in clinical practice. A simple, portable, inexpensive and reliable method for measuring RT is desirable for clinical settings. We therefore developed a custom software, which utilizes the portable and low-cost standard Nintendo Wii board (NWB) to record RT. The aims in the study were to (1) explore if the test could differentiate old and young adults, and (2) to study learning effects between test-sessions, and (3) to examine reproducibility.


A young (n = 25, age 20–35 years, mean BMI of 22.6) and an old (n = 25, age ≥65 years, mean BMI of 26.3) study-population were enrolled in this within- and between-day reproducibility study. A standard NWB was used along with the custom software to obtain RT from participants in milliseconds. A mixed effect model was initially used to explore systematic differences associated with age, and test-session. Reproducibility was then expressed by Intraclass Correlation Coefficients (ICC), Coefficient of Variance (CV), and Typical Error (TE).


The RT tests was able to differentiate the old group from the young group in both the upper extremity test (p < 0.001; −170.7 ms (95%CI −209.4;-132.0)) and the lower extremity test (p < 0.001; −224.3 ms (95%CI −274.6;-173.9)). Moreover, the mixed effect model showed no significant learning effect between sessions with exception of the lower extremity test between session one and three for the young group (−35,5 ms; 4.6 %; p = 0.02). A good within- and between-day reproducibility (ICC: 0.76-0.87; CV: 8.5-12.9; TE: 45.7-95.1 ms) was achieved for both the upper and lower extremity test with the fastest of three trials in both groups.


A low-cost and portable reaction test utilizing a standard Nintendo wii board showed good reproducibility, no or little systematic learning effects across test-sessions, and could differentiate between young and older adults in both upper and lower extremity tests.

Continue —> BMC Geriatrics | Full text | Novel use of the Nintendo Wii board as a measure of reaction time: a study of reproducibility in older and younger adults.

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[REVIEW] Virtual reality using games for improving physical functioning in older adults. – Full Text PDF


The use of virtual reality through exergames or active video game, i.e. a new form of interactive gaming, as a complementary tool in rehabilitation has been a frequent focus in research and clinical practice in the last few years. However, evidence of their effectiveness is scarce in the older population.

This review aim to provide a summary of the effects of exergames in improving physical functioning in older adults. A search for randomized controlled trials was performed in the databases EMBASE, MEDLINE, PsyInfo, Cochrane data base, PEDro and ISI Web of Knowledge. Results from the included studies were analyzed through a critical review and methodological quality by the PEDro scale. Thirteen studies were included in the review.

The most common apparatus for exergames intervention was the Nintendo Wii gaming console (8 studies), followed by computers games, Dance video game with pad (two studies each) and only one study with the Balance Rehabilitation Unit. The Timed Up and Go was the most frequently used instrument to assess physical functioning (7 studies). According to the PEDro scale, most of the studies presented methodological problems, with a high proportion of scores below 5 points (8 studies). The exergames protocols and their duration varied widely, and the benefits for physical function in older people remain inconclusive. However, a consensus between studies is the positive motivational aspect that the use of exergames provides. Further studies are needed in order to achieve better methodological quality, external validity and provide stronger scientific evidence.



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