Posts Tagged physical rehabilitation

[Abstract] Virtual Reality Interventions for Personal Development: A Meta-Analysis of Hardware and Software


Virtual reality (VR) has been repeatedly applied for personal development purposes, ranging from learning and training (cognitive outcomes), to psychological therapies (emotional outcomes), to physical rehabilitation (physical outcomes). Several factors lead to a successful VR intervention, most notably the hardware and software. In the current article, a meta-analysis is performed to test the effect of specialized input hardware (e.g motion sensors, floor pads, etc.), advanced output hardware (i.e., head-mounted displays, surround-screen displays, etc.), and game elements (i.e., score, competition, etc.) across and within the three noted applications of VR intervention. When analyzing the overall effects, only game elements had a significant impact on outcomes. When analyzing specific applications, input hardware did not have a notable impact on outcomes for any application; output hardware had a notable impact on cognitive and emotional outcomes but not physical; and game elements had a notable impact on cognitive outcomes but not emotional or physical. From these results, the current article provides direct suggestions for future research and practice. Particularly, certain mediating mechanisms are suggested to explain the impact of output hardware and game elements on VR intervention outcomes, sparking possible new directions for research and practice. Copyright © 2018 Taylor & Francis Group, LLC

via Scopus preview – Scopus – Document details


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[BLOG POST] Physical rehabilitation after stroke – Evidently Cochrane

Physical rehabilitation after stroke

In this blog for stroke survivors, their families and clinical staff, Mark Smith, Consultant Physiotherapist in Stroke Rehabilitation, looks at Cochrane evidence on physical rehabilitation approaches for the recovery of function and mobility following stroke and explores the importance of the findings with respect to service delivery in an ever changing landscape of health and social care.

Stroke is often termed a “recovering neurological condition”, but how much recovery can we expect in response to what sorts of intervention and in what doses? Strokes happen as a result of a disturbance of the blood supply to the brain, mostly in older people and mostly due to the blocking of arteries supplying oxygenated blood to the brain. But less commonly, strokes can affect younger people (and children) and may also be the result of a burst blood vessel causing a haematoma (collection of blood) within the brain mass.

Acting FAST

The stroke “pathway” extends from the initial hyper-acute episode, usually the first minutes and hours post onset of symptoms in the community setting, emphasising that “time is brain” through the “FAST” (Face, Arm, Speech, Time to call 999) campaign supported by the main UK stroke charities, Stroke Association and Chest, Heart & Stroke Scotland. The aim is to deliver patients with a suspected stroke to appropriately specialist hospital/stroke unit care as soon as possible in order to receive life saving and disability reducing hyper-acute interventions such as thrombolysis (using clot-busting drugs) and more recently thrombectomy (breaking and removing the clot with tools) in patients who meet the necessary criteria.

ambulance emergency

This hyper-acute stage of the pathway is highly evidence-based, medicalised and thoroughly audited across the UK by the two main stroke audits – Sentinel Stroke National Audit Programme (SNNAP) in England and Wales, and the Scottish Stroke Care Audit (SSCA) in Scotland, with a view to time critical delivery to all eligible patients. However, the subsequent audit around rehabilitation interventions can be less thorough despite a growing body of evidence to support physical interventions.

Ongoing physical rehabilitation: what should we do?

Most patients with stroke will need some kind of ongoing physical rehabilitation to assist them in achieving best outcomes possible (with respect to the severity of the stroke but also with respect to the resource available) and we are increasingly becoming aware that there are some critical elements in achieving that. But can we, and do we, deliver what patients should receive in our publicly funded UK health and social care system and is the evidence sufficiently persuasive to argue strongly for this? How do we ensure that a health condition such as stroke which spans a pathway from the community through hyper-acute medical hospital care, possibly downstream in-patient rehabilitation and back to the community via health and social care is fit for purpose? And how do we remove the diagnostic stroke “badge” and simply allow an individual to function again in society with the support they need to manage their long term condition?

Perhaps there is a persuasive argument for delivering evidence-based stroke rehabilitation with appropriate levels of quality and intensity as it is considered a human right in many societies?

The evidence for physical rehabilitation after stroke

Evidence for physical interventions relating to walking and physical rehabilitation after stroke is becoming increasingly available in the form of high quality systematic reviews that can inform clinical guidelines as well as high level government strategy with respect to stroke. We tend to find it mostly relating to physical therapy and exercise/fitness interventions.

Updating Cochrane evidence: a novel approach

Pollock et al (2014a) revisited an older Cochrane Review (Pollock et al 2009). Previous versions of the review had focussed on physiotherapy interventions for the lower limb and walking after stroke but they decided to use a novel approach in the reappraisal of the literature and update of the evidence. The review was subsequently re-titled Physical Rehabilitation Approaches for the Recovery of Function, Balance and Walking following Stroke. The academic elements of reviewing papers followed the usual Cochrane protocol.

Seeking “real world” views on the evidence

In order to gauge the relevance of the evidence for clinical practice, but also critically for stroke survivors and carers, in parallel with revisiting the evidence through systematic review,co Pollock and colleagues also convened a multi key stakeholder short life working group comprised of stroke survivors, carers and clinical staff. This group was charged with sense-checking and “validating” the evidence as being clinically relevant as it emerged, using formal group consensus methods based on nominal group techniques. This involved a system of voting which focussed the group in reaching consensus. The academic researchers involved in the systematic review attended the working group meetings and presented the various options in directing the review, but did not vote themselves so as to minimise bias. This arm of the project culminated in a presentation at the 2014 Cochrane UK and Ireland Symposium, held in Manchester, in which key stakeholders in the review led a workshop on user-involvement in writing Cochrane Reviews. The dual aims of this work were to determine if physical treatment approaches are effective in the recovery of function and mobility in patients with stroke and to see whether any one physical treatment approach is more effective than any other approach.

The presentation of the updated evidence as a result

Ninety six studies, involving 10,401 stroke were included in the review (Pollock et al 2014a). Results of 27 studies (3243 stroke survivors) could be combined comparing physical rehabilitation with no treatment at all. Twenty five of these studies were carried out in China and were unusual in that they compared an active treatment/intervention group to a control group with no clinical intervention. Additional physical rehabilitation versus usual care was described in 12 of these studies demonstrating improved motor function (887 stroke survivors), standing balance (five studies, 246 stroke survivors) and walking speed (14 studies, 1126 stroke survivors). There was also limited evidence of dose intensity for the first time, with treatment durations given between 30 and 60 minutes per day apparently carrying the most significant benefits, but future research needs to verify this.

Key messages:

  • Physiotherapy, using a mix of components from different approaches, is effective for the recovery of function and mobility after stroke. Treatment sessions of 30-60 minutes, 5-7 days a week may provide a significant beneficial effect.
  • No one approach to physical treatment is any more (or less) effective in promoting recovery of function and mobility after stroke.

Physiotherapists should use their expert clinical reasoning to select individualised, patient-centred, evidence-based physical treatment, with consideration of all available treatment components, and should not limit their practice to a single “named” approach.

physical rehabilitation

Fitness training after stroke

This work is supported by another recently updated Cochrane Review around Fitness Training for Stroke Survivors (Saunders et al 2016) which included 58 trials involving 2797 participants with stroke. These studies were grouped according to the type of fitness training intervention – cardiorespiratory (28 trials, 1408 participants) resistance (13 trials, 432 participants) and mixed training (17 trials, 4342 participants).

Key messages:

  • Cardiovascular fitness training, particularly involving walking, can improve exercise ability and walking after stroke.
  • Mixed training improves walking ability and improves balance.
  • Unable to draw reliable conclusions regarding effects on quality of life, mood or cognitive function.
  • No evidence of injury or other health problems and exercise appears to be a safe intervention.

Circuit Class Therapy

English et al (2017) included 17 trials involving 1297 stroke survivors (most of whom could walk 10 metres) in another recent Cochrane Rcoeview to examine the effectiveness and safety of Circuit Class Therapy (CCT) on mobility in adults with stroke. Ten studies (835 participants) measured walking capacity, demonstrating that CCT was superior to the comparison intervention, eight measured gait speed again finding that CCT was of significant benefit. Their conclusion was that there was moderate evidence to suggest that CCT is effective in improving mobility for people after stroke. These effects may be greater later after the stroke and stroke survivors may be able to walk further, faster, with more independence and confidence in their balance, but further high quality research is required.

Other relevant reviews

There have also been Cochrane Reviews providing low to moderate quality evidence of the rehabilitation benefits of electro mechanically or robotic assisted gait training devices (Mehrholz et al 2017a), treadmill training for stroke patients who could already walk (Mehrholz et al 2017b) and repetitive task training (French et al 2016). A Cochrane overview (a review of systematic reviews) presenting moderate quality evidence for upper limb rehabilitation after stroke, suggested beneficial effects of constraint-induced movement therapy (CIMT), mental practice, mirror therapy, interventions for sensory impairment, virtual reality and a relatively high dose of repetitive task practice (Pollock et a. 2014b). Again, information was insufficient to reveal the relative effectiveness of different interventions.

So what…

Well, the research evidence, albeit largely of moderate quality, points to the efficacy of a broad range of interventions in the physical rehabilitation of people with stroke, with little detail about which specific interventions are of most value in which settings, and indeed the best delivery mechanisms to make them most easily and effectively implemented. More research is needed to generate higher quality evidence and implementation guidance. Recommendations in stroke guidelines (RCP 2016) and stroke strategies (Scottish Government 2014) have been made on the basis of these findings, particularly with respect to adequate dose. However, given that studies are disparate, have been derived from around the world and as a result conducted within a great variety of different healthcare (and social care/leisure) settings, it is challenging for clinicians to know exactly how to implement the reported findings.

The work of Pollock et al (2014) in engaging multi key stakeholders in making more “real” the findings of their systematic review made an effort to think about how we might implement the evidence, particularly in relation to the views of stroke survivors, carers and therapists. Perhaps we need to be less defensive of historical professional and service silo boundaries and use this evidence in the best interests of the stroke survivors we aim to serve, though imaginative use of commissioning mechanisms, third sector organisations, the leisure industry, healthcare staff resources and the capacity we have to deliver stroke rehabilitation interventions?

The World Health Organisation (WHO) has recently argued that the benefits of rehabilitation are realised beyond the health sector and that delivered appropriately can reduce care costs and enable participation in education and gainful employment (WHO 2017). With respect to the stroke pathway, if we are serious about saving lives at the “front door”, let’s also make them worth living at the “back door” and beyond.

Join in the conversation on Twitter with @CochraneUK #LifeAfterStroke or leave a comment on the blog.

References may be found here.

Mark Smith is a Trustee of the Stroke Association.


via Physical rehabilitation after stroke – Evidently Cochrane

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[Proceeding] Mobile, Exercise-agnostic, Sensor-based Serious Games for Physical Rehabilitation at Home – Full Text PDF

Serious games can improve the physical rehabilitation of patients with different conditions. By monitoring exercises and offering feedback, serious games promote the correct execution of exercises outside the clinic. Nevertheless, existing serious games are limited to specific exercises, which reduces their practical impact. This paper describes the design of three exercise-agnostic games, that can be used for a multitude of rehabilitation scenarios. The developed games are displayed on a smartphone and are controlled by a wearable device, containing inertial and electromyography sensors. Results from a preliminary evaluation with 10 users are discussed, together with plans for future work.

Full Text PDF

via Mobile, Exercise-agnostic, Sensor-based Serious Games for Physical Rehabilitation at Home

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[WEB SITE] Cheap Rehab System Powered by Kinect Camera

Physical rehabilitation often involves using expensive, over-engineered equipment that does its job well but is often difficult to afford. It’s one reason the overall cost of rehab can be steep, as buying and maintaining pricey equipment can quickly add up. Some of the more advanced systems for analyzing people’s motion involve multiple cameras that track how the arms, legs, and every other part of the body move in relation to each other. These can be tens of thousands of dollars per room, which means you’re often just better off hiring another rehab specialist. Researchers at University of Missouri have developed a body motion analysis system that uses a Microsoft Kinect 2.0 depth-sensing camera and a laptop that analyzes the incoming data.

The team compared the performance of their tinkered-together body analysis system versus a high-end commercial one, that uses reflective tags placed on different parts of the body, at monitoring lower body movements, specifically when performing drop vertical jumps and lateral leg raises. They found that the two systems provided comparable data and that the new system showed enough detail to be clinically useful by rehab specialists.

Sadly, Microsoft is ending production of the Kinect cameras, but surely there will be other affordable depth sensing cameras with similar capabilities.

Here’s a video from University of Missouri with more about the technology:

Study in Human Kinetics JournalComparison of 3D Joint Angles Measured With the Kinect 2.0 Skeletal Tracker Versus a Marker-Based Motion Capture System…

Via: University of Missouri…

via Cheap Rehab System Powered by Kinect Camera | Medgadget

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[WEB SITE] KineQuantum Uses Virtual Reality for Real Physical Rehabilitation


Physical rehabilitation can be tedious and boring, and evaluation of a patient’s progress fraught by poor metrics and subjectivity. At the recent CES 2018 in Las Vegas we discovered a new virtual reality-based evaluation, rehab, and follow-up platform that makes it fun and convenient to assess patients, administer various game-based training regimens, and to assess how those exercise routines are working.

The KineQuantum system, developed by a French firm of the same name, relies on the VIVE virtual reality platform and a couple optional hand-held joysticks. The patient is asked to follow objects on the screen with one’s head, touch them with the hands, or play more exciting games such as swatting flies and shooting cannonballs at pirate ships. The activities are made to be fun and to take the mind away from the fact that it’s a therapy. While the user is playing the games and doing virtual tasks, the system measures different characteristics such as response time, range of motion, and other related parameters.

Check out this video from KineQuantum presenting their virtual reality rehab system:


via KineQuantum Uses Virtual Reality for Real Physical Rehabilitation | Medgadget

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[BOOK] Serious Games in Physical Rehabilitation: From Theory to Practice – Google Books

Front Cover
SpringerOct 30, 2017 – Medical – 146 pages

Marketing text: This innovative book explores how games can be serious, even though most people generally associate them with entertainment and fun. It demonstrates how videogames can be a valuable tool in clinics and demonstrates how clinicians can use them in physical rehabilitation for various pathologies. It also describes step by step their integration in rehabilitation, from the (gaming) technology used to its application in clinics. Further, drawing on an extensive literature review, it discusses the pros and cons of videogames and how they can help overcome certain obstacles to rehabilitation.

The last part of the book examines the main challenges and barriers that still need to be addressed to increase and improve the use and efficacy of this new technology for patients. The book is intended for physiotherapists and clinicians alike, providing a useful tool for all those seeking a comprehensive overview of the field of serious games and considering adding it to conventional rehabilitation treatment.

via Serious Games in Physical Rehabilitation: From Theory to Practice – Bruno Bonnechère – Google Books

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[BOOK] Virtual Reality for Physical and Motor Rehabilitation – Google Books

Virtual Reality for Physical and Motor Rehabilitation

Front Cover

Patrice L. Tamar WeissEmily A. KeshnerMindy F. Levin
SpringerJul 24, 2014 – Medical – 232 pages

While virtual reality (VR) has influenced fields as varied as gaming, archaeology, and the visual arts, some of its most promising applications come from the health sector. Particularly encouraging are the many uses of VR in supporting the recovery of motor skills following accident or illness.

Virtual Reality for Physical and Motor Rehabilitation reviews two decades of progress and anticipates advances to come. It offers current research on the capacity of VR to evaluate, address, and reduce motor skill limitations, and the use of VR to support motor and sensorimotor function, from the most basic to the most sophisticated skill levels. Expert scientists and clinicians explain how the brain organizes motor behavior, relate therapeutic objectives to client goals, and differentiate among VR platforms in engaging the production of movement and balance. On the practical side, contributors demonstrate that VR complements existing therapies across various conditions such as neurodegenerative diseases, traumatic brain injury, and stroke. Included among the topics:

  • Neuroplasticity and virtual reality.
  • Vision and perception in virtual reality.
  • Sensorimotor recalibration in virtual environments.
  • Rehabilitative applications using VR for residual impairments following stroke.
  • VR reveals mechanisms of balance and locomotor impairments.
  • Applications of VR technologies for childhood disabilities.

A resource of great immediate and future utility, Virtual Reality for Physical and Motor Rehabilitation distills a dynamic field to aid the work of neuropsychologists, rehabilitation specialists (including physical, speech, vocational, and occupational therapists), and neurologists.

Preview this book »

Source: Virtual Reality for Physical and Motor Rehabilitation – Google Books

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[WEB SITE] Physical rehabilitation goes high tech with the help of virtual reality

Advances in technology are continually shaping the future of medical treatment, but could devices utilising virtual reality (VR), which were once considered the realm of gamers, be the next frontier for physical rehabilitation?

Rohan O’Reilly is a movement therapist in Newcastle, New South Wales, who has been using alternative therapies involving virtual reality devices to help his clients with rehabilitation.

“It really came back to the point of listening to people’s stories who had had large-scale traumas, and their experiences of what they went through, from their initial accident through to therapy,” Mr O’Reilly said.

“For most of them it was really [boring] and quite uncomfortable and not inspiring.

“So we thought ‘We need to make this feel better’.

“Lucky for us we’re living in a time where there’s an amazing new array of technologies that are not widely known about.

“Virtual reality would be the one that’s hot at the moment, and essentially that is a game changer. It’s phenomenal what can be done with that as a platform for putting people in a state where they want to play.”

Making therapy fun

Mr O’Reilly said virtual reality helped clients to exercise their bodies in non-traditional ways.

“It’s about emotions,” he said.

“If your rehabilitation just tended to be based around the fact that you had to pick up an inanimate object, which you had no real emotional connection to, repetitively … for most people, they would think ‘OK, I can do this for a little while’, but they’re quickly going to run out of steam.

“If you put someone in virtual reality with everything that reminds them of the things that they love to do, they’re essentially just going to give themselves therapy.

“We’re just simply creating an environment where they can explore their own capabilities.”

Client notices big improvements in health

Almost four years ago, Angus McConnell had an accident that changed his life.

He was riding his bicycle down a hill in Newcastle when a car turned across him.

“I hit the windscreen, bumped off down the road, and ended up with a spinal cord injury — a C7 complete quadriplegic,” Mr McConnell said.

“It hits you on and off, and still does.”

Mr McConnell went through traditional hospital rehabilitation, but was looking for other options to continue his treatment.

“As your journey goes along, you want to work out whether you’re going to ignore the parts of the body that aren’t working, or you’re going to make them move,” he said.

Mr McConnell said he had noticed big improvements in his health after the alternative therapy.

“Originally we started on building up the muscles and hopefully a nerve signal that’s coming through,” he said.

“I can feel further down into my body, with electrodes on parts of my body where the nerves come close to the skin.

“I’m standing up now with the help of electrodes, and that’s something I hadn’t thought possible two-and-a-half years ago.”

Academic says VR effective, but people should be cautious

Associate Professor Coralie English, a stroke researcher at the University of Newcastle, said people should approach alternative therapies with a degree of cautiousness.

“There is a reasonable amount of evidence for the effectiveness of virtual reality training for people after stroke,” she said.

“This sort of therapy is useful for people who’ve already got some movement. There’s certainly no evidence to suggest that if you can’t move at all, trying to move within these environments is going to result in any recovery of function.

“It needs to ensure that the person is practising what they need to practice, and that it’s based on a thorough assessment by a qualified health professional.”

Source: Physical rehabilitation goes high tech with the help of virtual reality – ABC News (Australian Broadcasting Corporation)

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[Abstract] Exploiting Awareness for the Development of Collaborative Rehabilitation Systems


Physical and cognitive rehabilitation is usually a challenging activity as people with any kind of deficit has to carry out tasks difficult due to their abilities damaged. Moreover, such difficulties become even harder while they have to work at home in an isolated manner. Therefore, the development of collaborative rehabilitation systems emerges as one of the best alternatives to mitigate such isolation and turn a difficult task into a challenging and stimulating one. As any other collaborative system, the need of being aware of other participants (their actions, locations, status, etc.) is paramount to achieve a proper collaborative experience. This awareness should be provided by using those feedback stimuli more appropriate according to the physical and cognitive abilities of the patients. This has led us to define an awareness interpretation for collaborative cognitive and physical systems. This has been defined by extending an existing proposal that has been already applied to the collaborative games field. Furthermore, in order to put this interpretation into practice, a case study based on an association image-writing rehabilitation pattern is presented illustrating how this cognitive rehabilitation task has been extended with collaborative features and enriched
with awareness information


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[ARTICLE] Computational architecture of a robot coach for physical exercises in kinaesthetic rehabilitation – Full Text PDF


The rising number of the elderly incurs growing concern about healthcare, and in particular rehabilitation healthcare. Assistive technology and and assistive robotics in particular may help to improve this process. We develop a robot coach capable of demonstrating rehabilitation exercises to patients, watch a patient carry out the exercises and give him feedback so as to improve his performance and encourage him. We propose a general software architecture for our robot coach, which is based on imitation learning techniques using Gaussian Mixture Models. Our system is thus easily programmable by medical experts without specific robotics knowledge, as well as capable of personalised audio feedback to patients indicating useful information to improve on their physical rehabilitation exercise.

Full Text PDF

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