Posts Tagged stroke rehabilitation
Rehabilitation technology leader Tyromotion has developed a rehabilitation device that combines virtual reality with robotic therapy to make stroke rehabilitation faster and more efficient.
Tyromotion has created a rehabilitation device that uses a bilateral 3D arm robot and virtual reality glasses to fully immerse stroke patients in virtual worlds where both the visual and physical environments can be shaped. The device is designed to help patients with limited arm function perform daily tasks by challenging and encouraging them to increase their range of motion and the number of repetitions during their therapy sessions. Both these elements are vital to motor learning.
The introduction of virtual reality into therapy delivers a 3D training environment that can be adapted to each individual patient’s abilities. The virtual setting has a gaming element to it, which helps motivate patients to keep repeating their exercises.
Tyromotion’s device is currently being tested by leading rehabilitation facilities in Europe and the United States. The initial reports from therapists and doctors have been very positive, indicating that the new approach to therapy has a strong potential to transform it by increasing patient motivation and making therapy programs more cost effective across the board.
Diego, the robot-assisted arm rehabilitation device used to deliver VR therapy, is the world’s most versatile arm-shoulder rehabilitation device, one that combines robotics with intelligent gravity compensation (IGC) and virtual reality to help patients regain lost arm function. The device offers passive, active and assistive, uni- and bilateral applications that are easily adapted to meet the needs of each patient.
The gravity compensation feature makes heavy arms lighter, allowing physiological movement of the arms in every phase of rehabilitation. The device gives patients more room and more freedom to move and is particularly well suited for task-oriented training with real objects.
Diego offers a versatile range of therapy options with interactive therapy modules that provide haptic and audiovisual feedback, immersing patients in motion in the virtual environment. The therapy modules have different levels of difficulty, which motivates patients to keep making progress. Their progress is then recorded to make their achievements visible.
Diego is suitable for patients of all ages and can be used in all phases of arm rehabilitation. Watch the video below to learn more about its features and benefits.
[REVIEW] Robotic Devices and Brain Machine Interfaces for Hand Rehabilitation Post-stroke: Current State and Future Potentials – Full Text PDF
This paper reviews the current state of the art in robotic-aided hand physiotherapy for post-stroke rehabilitation, including the use of brain machine interfaces (BMI). The main focus is on the technical speciﬁcations required for these devices to achieve their goals. From the literature reviewed, it is clear that these rehabilitation devices can increase the functionality of the human hand post-stroke. However, there are still several challenges to be overcome before they can be fully deployed. Further clinical trials are needed to ensure that substantial improvement can be made in limb functionality for stroke survivors, particularly as part of a programme of frequent at-home high-intensity training over an extended period.
This review serves the purpose of providing valuable insights into robotics rehabilitation techniques in particular for those that could explore the synergy between BMI and the novel area of soft robotics.
Strokes are a global issue aﬀecting people of all ethnicities, genders and ages ; approximately 20 million people per year worldwide suﬀer a stroke [2, 3]. Five million of those patients remain severely handicapped and dependent on assistance in daily life . Once a stroke has occurred the patient may be left with mild to severe disabilities, depending on the type and severity of the stroke. This paper will focus on the primary issues experienced which are the clawing of the hand and stiﬀening of the wrist. In recent years, several new forms of rehabilitation have been proposed using robot-aided therapy. This work reviews the current state-ofthe-art robotic devices and brain-machine interfaces (BMI) for post-stroke hand rehabilitation, analysing current challenges, highlighting the future potential and addressing any inherent ethical issues.[…]
[Case Study] Goal-oriented feedback on motor behavior in virtual reality based stroke therapy: A case study using the rehabilitation gaming system – Full Text PDF
Aims: We address the role of short-term goals in virtual reality (VR) applications for motor relearning, which benefit stroke therapy.
Methods: We let stroke patients as well as healthy participants perform reaching tasks in a VR environment for motor rehabilitation, the so-called rehabilitation gaming system (RGS). During the task, patients were provided
with feedback about one’s own performance (mastery goal), healthy participants additionally received feedback of others performances (ego
goal). Measurements include protocols for motor learning and different kinetic variables (both stroke patients and healthy participants) as well as subscales of the intrinsic motivation inventory (IMI) (only healthy participants). As healthy participants showed lower fatigue levels, we could apply additional measurements.
Results: Both mastery goals and ego goals potentially enhance intrinsic motivation and adherence, as they show to foster task performance (e.g., response time in mastery goals decreased with p = 0.014 for healthy participants, for stroke patients with p = 0.011 in the first iteration) as well as perceived effort (p = 0.007 for mastery, p = 0.008 for ego goals). As a secondary outcome, by controlling task difficulty, motor learning does not change across conditions (p = 0.316 for stroke patients, p = 0.323 for healthy participants). This raises the question whether or not task difficulty alone fosters the effectivity of VR based therapy applications, i.e., motor learning, to which motivators such as short-term goals provide little trade-off.
Conclusion: Firstly, we suggest the implementation of mastery and ego goals in VR based stroke therapy, as adherence benefits from the motivational context they provide. Secondly, we argue towards simplicity regarding heuristics in therapeutic game design, which apparently often does not differ from conventional game design apart from setting the right level of challenge.
[ARTICLE] The Effect of High Intensity Training on Stroke Rehabilitation: A Systematic Review – Full Text
Background and Purpose: Stroke is one of the leading causes of disability worldwide. Stroke can cause deficits in one’s ability to walk independently, cause deficits in balance, and lead to a variety of other health issues as a sequela of paresis and prolonged physical inactivity.1 The purpose of this systematic review is to evaluate the efficacy of high intensity training (HIT) for the rehabilitation of patients with stroke.
Methods: A systematic review was performed utilizing five databases using search terms “stroke rehabilitation” and “high intensity training”. Article titles and abstracts were screened to include key words “stroke”, “high intensity training”, “resistance training”, “interval training”, “power training”, or “step training”. Research studies using subjects with co-morbidities other than stroke and its residuum were excluded.
Results: After meeting the selection criteria, 10 studies were selected for review. A review of each article’s subject population, tests performed, intervention, and result, reveal that many types of high intensity training have a positive effect on functional and health outcomes in patients with stroke.
Conclusion: High intensity training (HIT) has a positive effect on the rehabilitative potential of patients with stroke. HIT is shown to improve patient’s respiratory function, walking ability, balance, functional ability and other key areas.
Stroke can be defined as an acute neurologic dysfunction of vascular origin from a hemorrhagic or ischemic event causing a disruption of blood flow to tissues of the brain.2 Strokes are a global health issue affecting 16 million people each year. It is estimated that by the year 2030 there will be 77 million survivors of stroke worldwide. Each year, 114 of 100,000 people in the United States will suffer their first stroke, accounting for 75% of hospitalizations due to stroke. The remaining 25% of stroke hospitalizations are of patients with recurrent strokes. Patient risk factors for stroke include, but are not limited to hypertension, smoking, diabetes, obesity, dyslipidemia, and elevated homocysteine.3 The long-term implications of a stroke depend upon how early a stroke is recognized and treated. Clinical manifestations following a stroke can include a loss of balance, speech and visual deficits, cognitive dysfunction and hemiparesis. There is potential for the spontaneous recovery of certain deficits in the first few weeks following a stroke, however there is likelihood for long-term dysfunction. The most prevalent long-term dysfunction after a stroke are motor impairments secondary to hemiparesis; which reduces muscle mass and the force of muscle contraction causing lower limb weakness, loss of mobility and gait deficiencies of the affected side.2,3
Continue —> https://www.linkedin.com/pulse/effect-high-intensity-training-stroke-rehabilitation-review-timothy
[ARTICLE] User-centered design of a patient’s work station for haptic robot-based telerehabilitation after stroke – Full Text
Robotic therapy devices have been an important part of clinical neurological rehabilitation for several years. Until now such devices are only available for patients receiving therapy inside rehabilitation hospitals. Since patients should continue rehabilitation training after hospital discharge at home, intelligent robotic rehab devices could help to achieve this goal. This paper presents therapeutic requirements and early phases of the user-centered design process of the patient’s work station as part of a novel robot-based system for motor telerehabilitation.
Stroke is one of the dominant causes of acquired disability  and it is the second leading cause of death worldwide . The high incidence of the disease and the current demographic developments are likely to increase the number of stroke patients in the future. Most of the survivors have physical, cognitive and functional limitations and require intensive rehabilitation in order to resume independent everyday life . Therefore, the main goal of motor rehabilitation is relearning of voluntary movement capability, a process which takes at least several months, some improvement can occur even after years. In the rehabilitation clinic, patients usually receive a daily intensive therapy program. However, for further improvement of motor abilities, severely affected patients are required to continue their rehabilitation training outside the rehabilitation settings, after being discharged from the rehabilitation clinic. Langhammer and Stanghelle  found that a lack of follow-up rehabilitation treatment at home leads to deterioration of activities of daily living (ADL) and to motor functions in general. A possible solution is an individualized and motivating telerehabilitation system in the patient’s domestic environment. Some studies ,  have confirmed the advantage of home rehabilitation after stroke and showed that telerehabilitation received high acceptance and satisfaction, both from patients, as well as from health professionals . Most of the existing telesystems ,  are based on audio-visual conferencing or on virtual environments and contain rather simple software for monitoring patients’ condition. However, in neurological rehabilitation the sensorimotor loop needs to be activated by provision of physiological haptic feedback (touch and proprioception) .
Robot-based rehabilitation is currently one of the most prevalent therapeutic approaches. It is often applied in hospitals alongside conventional therapy and is beneficial for motor recovery . Rehabilitation training including a haptic-therapy device may therefore be even more promising for home environments than non-haptic telerehabilitation. Several telerehabilitation systems, which include not only audio and visual, but also haptic modality, already exist ,  . Most of these solutions use low-cost commercial haptic devices (e.g. joysticks) for therapy training, with the goal of cost minimization and providing procurable technology. Nonetheless, devices specifically developed for stroke rehabilitation, which are already established in clinical settings, may have greater impact on motor relearning and could therefore also be more effective at home, compared with existing home rehabilitation devices.
In a previous paper , we presented a concept and design overview of a haptic robot-based telerehabilitation system for upper extremities which is currently under development. In the present work, we describe therapeutic requirements, user-centred development  and implementation of the patient’s station of the telesystem.
[ARTICLE] A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training – Full Text
Although motor learning theory has led to evidence-based practices, few trials have revealed the superiority of one theory-based therapy over another after stroke. Nor have improvements in skills been as clinically robust as one might hope. We review some possible explanations, then potential technology-enabled solutions.
Over the Internet, the type, quantity, and quality of practice and exercise in the home and community can be monitored remotely and feedback provided to optimize training frequency, intensity, and progression at home. A theory-driven foundation of synergistic interventions for walking, reaching and grasping, strengthening, and fitness could be provided by a bundle of home-based Rehabilitation Internet-of-Things (RIoT) devices.
A RIoT might include wearable, activity-recognition sensors and instrumented rehabilitation devices with radio transmission to a smartphone or tablet to continuously measure repetitions, speed, accuracy, forces, and temporal spatial features of movement. Using telerehabilitation resources, a therapist would interpret the data and provide behavioral training for self-management via goal setting and instruction to increase compliance and long-term carryover.
On top of this user-friendly, safe, and conceptually sound foundation to support more opportunity for practice, experimental interventions could be tested or additions and replacements made, perhaps drawing from virtual reality and gaming programs or robots. RIoT devices continuously measure the actual amount of quality practice; improvements and plateaus over time in strength, fitness, and skills; and activity and participation in home and community settings. Investigators may gain more control over some of the confounders of their trials and patients will have access to inexpensive therapies.
Neurologic rehabilitation has been testing a motor learning theory for the past quarter century that may be wearing thin in terms of leading to more robust evidence-based practices. The theory has become a mantra for the field that goes like this. Repetitive practice of increasingly challenging task-related activities assisted by a therapist in an adequate dose will lead to gains in motor skills, mostly restricted to what was trained, via mechanisms of activity-dependent induction of molecular, cellular, synaptic, and structural plasticity within spared neural ensembles and networks.
This theory has led to a range of evidence-based therapies, as well as to caricatures of the mantra (eg, a therapist says to patient, “Do those plasticity reps!”). A mantra can become too automatic, no longer apt to be reexamined as a testable theory. A recent Cochrane review of upper extremity stroke rehabilitation found “adequately powered, high-quality randomized clinical trials (RCTs) that confirmed the benefit of constraint-induced therapy paradigms, mental practice, mirror therapy, virtual reality paradigms, and a high dose of repetitive task practice.”1 The review also found positive RCT evidence for other practice protocols. However, they concluded, no one strategy was clearly better than another to improve functional use of the arm and hand. The ICARE trial2 for the upper extremity after stroke found that both a state-of-the-art Accelerated Skill Acquisition Program (motor learning plus motivational and psychological support strategy) compared to motor learning-based occupational therapy for 30 hours over 10 weeks led to a 70% increase in speed on the Wolf Motor Function Test, but so did usual care that averaged only 11 hours of formal but uncharacterized therapy. In this well-designed RCT, the investigators found no apparent effect of either the dose or content of therapy. Did dose and content really differ enough to reveal more than equivalence, or is the motor-learning mantra in need of repair?
Walking trials after stroke and spinal cord injury,3–8 such as robot-assisted stepping and body weight-supported treadmill training (BWSTT), were conceived as adhering to the task-oriented practice mantra. But they too have not improved outcomes more than conventional over-ground physical therapy. Indeed, the absolute gains in primary outcomes for moderate to severely impaired hemiplegic participants after BWSTT and other therapies have been in the range of only 0.12 to 0.22 m/s for fastest walking speed and 50 to 75 m for 6-minute walking distance after 12 to 36 training sessions over 4 to 12 weeks.3,9 These 15% to 25% increases are just as disappointing when comparing gains in those who start out at a speed of <0.4 m/s compared to >0.4 to 0.8 m/s.3
Has mantra-oriented training reached an unanticipated plateau due to inherent limitations? Clearly, if not enough residual sensorimotor neural substrate is available for training-induced adaptation or for behavioral compensation, more training may only fail. Perhaps, however, investigators need to reconsider the theoretical basis for the mantra, that is, whether they have been offering all of the necessary components of task-related practice, such as enough progressively difficult practice goals, the best context and environment for training, the behavioral training that motivates compliance and carryover of practice beyond the sessions of formal training, and blending in other physical activities such as strengthening and fitness exercise that also augment practice-related neural plasticity? These questions point to new directions for research….
Components of a Rehabilitation-Internet-of-Things: wireless chargers for sensors (1), ankle accelerometers with gyroscopes (2) and Android phone (3) to monitor walking and cycling, and a force sensor (4) in line with a stretch band (5) to monitor resistance exercises.
[ARTICLE] Efficacy of home-based visuomotor feedback training in stroke patients with chronic hemispatial neglect – Full Text
Hemispatial neglect is a severe cognitive condition frequently observed after a stroke, associated with unawareness of one side of space, disability and poor long-term outcome. Visuomotor feedback training (VFT) is a neglect rehabilitation technique that involves a simple, inexpensive and feasible training of grasping-to-lift rods at the centre. We compared the immediate and long-term effects of VFT vs. a control training when delivered in a home-based setting. Twenty participants were randomly allocated to an intervention (who received VFT) or a control group (n = 10 each). Training was delivered for two sessions by an experimenter and then patients self-administered it for 10 sessions over two weeks. Outcome measures included the Behavioural Inattention Test (BIT), line bisection, Balloons Test, Landmark task, room description task, subjective straight-ahead pointing task and the Stroke Impact Scale. The measures were obtained before, immediately after the training sessions and after four-months post-training. Significantly greater short and long-term improvements were obtained after VFT when compared to control training in line bisection, BIT and spatial bias in cancellation. VFT also produced improvements on activities of daily living. We conclude that VFT is a feasible, effective, home-based rehabilitation method for neglect patients that warrants further investigation with well-designed randomised controlled trials on a large sample of patients.
[Abstract] A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training
Although motor learning theory has led to evidence-based practices, few trials have revealed the superiority of one theory-based therapy over another after stroke. Nor have improvements in skills been as clinically robust as one might hope.
We review some possible explanations, then potential technology-enabled solutions. Over the Internet, the type, quantity, and quality of practice and exercise in the home and community can be monitored remotely and feedback provided to optimize training frequency, intensity, and progression at home. A theory-driven foundation of synergistic interventions for walking, reaching and grasping, strengthening, and fitness could be provided by a bundle of home-based Rehabilitation Internet-of-Things (RIoT) devices. A RIoT might include wearable, activity-recognition sensors and instrumented rehabilitation devices with radio transmission to a smartphone or tablet to continuously measure repetitions, speed, accuracy, forces, and temporal spatial features of movement.
Using telerehabilitation resources, a therapist would interpret the data and provide behavioral training for self-management via goal setting and instruction to increase compliance and long-term carryover. On top of this user-friendly, safe, and conceptually sound foundation to support more opportunity for practice, experimental interventions could be tested or additions and replacements made, perhaps drawing from virtual reality and gaming programs or robots. RIoT devices continuously measure the actual amount of quality practice; improvements and plateaus over time in strength, fitness, and skills; and activity and participation in home and community settings. Investigators may gain more control over some of the confounders of their trials and patients will have access to inexpensive therapies.