[Abstract + References] A Virtual Reality Serious Game for Hand Rehabilitation Therapy – IEEE Conference Publication


The human hand is the body part most frequently injured in occupational accidents, accounting for one out of five emergency cases and often requiring surgery with subsequently long periods of rehabilitation. This paper proposes a Virtual Reality game to improve conventional physiotherapy in hand rehabilitation, focusing on resolving recurring limitations reported in most technological solutions to the problem, namely the limited diversity support of movements and exercises, complicated calibrations and exclusion of patients with open wounds or other disfigurements of the hand. The system was assessed by seven able-bodied participants using a semistructured interview targeting three evaluation categories: hardware usability, software usability and suggestions for improvement. A System Usability Score (SUS) of 84.3 and participants’ disposition to play the game confirm the potential of both the conceptual and technological approaches taken for the improvement of hand rehabilitation therapy.


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[Abstract] RehabFork: An Interactive Game-assisted Upper Limb Stroke Rehabilitation System – IEEE Conference Publication


In this paper, we present the design and development of a game-assisted stroke rehabilitation system RehabFork that allows a user to train their upper-limb to perform certain functions related to the task of eating.

The task of eating is divided into several components: (i) grasping the eating utensils such as a fork and knife; (ii) lifting the eating utensils; (iii) using the eating utensils to cut a piece of food; (iv) transferring the food to the mouth; and (v) chewing the food. The RehabFork supports the user through sub-tasks (i)–(iii).

The hardware components of RehabFork consist of an instrumented fork and knife, and a 3D printed pressure pad, that measure and communicate information on user performance to a gaming environment to render an integrated rehabilitation system.

The gaming environment consists of an interactive game that utilizes sensory data as well as user information about the severity of their disability and current level of progress to adjust the difficulty levels of the game to maintain user motivation. Information pertaining to the user, including performance data, is stored and can be shared with care providers for ongoing oversight.


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[Abstract] A Wearable Hand Rehabilitation System with Soft Gloves


Hand paralysis is one of the most common complications in stroke patients, which severely impacts their daily lives. This paper presents a wearable hand rehabilitation system that supports both mirror therapy and task-oriented therapy. A pair of gloves, i.e., a sensory glove and a motor glove, was designed and fabricated with a soft, flexible material, providing greater comfort and safety than conventional rigid rehabilitation devices. The sensory glove worn on the non-affected hand, which contains the force and flex sensors, is used to measure the gripping force and bending angle of each finger joint for motion detection. The motor glove, driven by micromotors, provides the affected hand with assisted driving-force to perform training tasks. Machine learning is employed to recognize the gestures from the sensory glove and to facilitate the rehabilitation tasks for the affected hand. The proposed system offers 16 kinds of finger gestures with an accuracy of 93.32%, allowing patients to conduct mirror therapy using fine-grained gestures for training a single finger and multiple fingers in coordination. A more sophisticated task-oriented rehabilitation with mirror therapy is also presented, which offers six types of training tasks with an average accuracy of 89.4% in real-time.

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[ARTICLE] Adaptive Treadmill-Assisted Virtual Reality-Based Gait Rehabilitation for Post-Stroke Physical Reconditioning—a Feasibility Study in Low-Resource Settings – Full Text


Objectives: Individuals with chronic stroke suffer from heterogeneous functional limitations, including cardiovascular dysfunction and gait disorders (associated with increased energy expenditure) besides psychological factors, e.g., motivation. To recondition their cardiovascular endurance and gait, rehabilitation exercises with gradually increasing exercise intensity suiting their individualized capabilities need to be offered. In principal accordance, here we (i) implemented an adaptive Virtual Reality (VR)-based treadmill-assisted platform sensitive to energy expenditure, (ii) investigated its safety and feasibility of use and (iii) examined the implications of gait exercise with this platform on cardiac and gait performance along with energy expenditure, clinical measures (to estimate physical reconditioning of subjects with stroke) and their views on community ambulation capabilities. Methods: Ten able-bodied subjects volunteered in a study to ensure its safety and feasibility of use. Nine subjects with chronic stroke underwent physical reconditioning over multiple exposures using our platform. We investigated the patients’ cardiac and gait performance prior and post exposure to our platform along with studying the clinical relevance of gait parameters in estimating their physical reconditioning. We collected the patients’ feedback. Results: We found statistical improvement in the gait parameters and reduction in energy expenditure during overground walk following ~1 month of gait exercise with our platform. They reported that the VR-based tasks were motivating. Conclusion: Results show that this platform can pave the way towards implementing home-based individualized exercise platform that can monitor one’s cardiac and gait performance capabilities while offering an adaptive and progressive gait exercise environment within safety thresholds suiting one’s exercise capabilities.

Physiological Cost Index sensitive Adaptive Response Technology (PCI-ART) for post-stroke physical reconditioning. Note: PCI- Physiological Cost Index; SST-Single Support Time; AL- Affected limb; UAL- Unaffected limb.

Physiological Cost Index sensitive Adaptive Response Technology (PCI-ART) for post-stroke physical reconditioning. Note: PCI- Physiological Cost Index; SST-Single Support Time; AL- Affected limb; UAL- Unaffected limb. 



Neurological disorders, such as stroke is a leading cause of disability with a prevalence rate of 424 in 100,000 individuals in India [1]. Often, these patients suffer from functional disabilities, heterogeneous physical deconditioning along with deteriorated cardiac functioning [2], [3] and a sedentary lifestyle immediately following stroke [4]. A deconditioned patient requires reconditioning of his/her cardiac capacity and ambulation capabilities that can be achieved through individualized rehabilitation [5]. This needs to be done under the supervision of a clinician who can monitor one’s functional capability, cardiac capacity and gait performance thereby recommending an appropriate dosage of the gait rehabilitation exercise intensity to the patient along with feedback. Such gait rehabilitation is crucial since about 80% of these patients have been reported to suffer from gait-related disorders [6] along with more energy expenditure than able-bodied individuals [7] often accompanied with reduced cardiac capacity [2], [4]. However, given the low doctor-to-patient ratio [8], lack of rehabilitation facilities and patients being released early from rehabilitation clinics followed by home-based exercise [9], particularly in developing countries like India, availing individualized rehabilitation services becomes difficult. Again, undergoing home-based exercises under clinician’s one-on-one supervision becomes difficult given the restricted healthcare resources, thereby limiting the rehabilitation outcomes [10]. Again, given the restricted healthcare resources, getting a clinician visiting the homes for delivering therapy sessions to patients is often costly causing the patients to miss the expert inputs on the exercise intensity suiting his/her exercise capability along with motivational feedback from the clinician [11]. This necessitates the use of a complementary technology-assisted rehabilitation platform that can be availed by the patient at his/her home [12] following a short stay at the rehabilitation clinic [13]. Again, it is preferred that this platform be capable of offering individualized gait exercise while varying the dosage of exercise intensity (based on the patient’s exercise capability) along with motivational feedback [14]. Additionally, exercise administered by this platform can be complemented with intermediate clinician-mediated assessments of rehabilitation outcomes, thereby reducing continuous demands on the restricted clinical resources. Thus, it is important to investigate the use of such technology-assisted gait exercise platforms that are capable of offering exercise based on one’s individualized capability along with motivational feedback.

Researchers have explored the use of technology-assisted solutions to offer rehabilitative gait exercises to these patients, along with presenting motivational feedback [15]–[16][17][18][19][20][21][22][23][24]. Specifically, investigators have used Virtual Reality (VR) coupled with a treadmill (having a limited footprint and making it suitable for home-based settings) while delivering individualized feedback [15] to the patient during exercise. Again, VR can help to project scenarios that can make the exercise engaging and interactive for a user [16]–[17][18][19]. In fact, Finley et al. have shown that the visual feedback offered by VR provides an optical flow that can induce changes in the gait performance (quantified in terms of gait parameters, e.g., Step Length, Step Symmetry, etc.) of such patients during treadmill-assisted walk [20]. Further, Jaffe et al. have reported positive implications of VR-based treadmill-assisted walking exercise on the gait performance of individuals with stroke [23], leading to improvement in their community ambulation [24]. These studies have shown the efficacy of the VR-based treadmill-assisted gait exercise platform to contribute towards gait rehabilitation of individuals suffering from stroke. Though promising, none of these platforms are sensitive to one’s individualized exercise capability and thus, in turn, could not decide an optimum dosage of exercise intensity suiting one’s capability, e.g., cardiac capacity and ambulation capability. This is particularly critical for individuals with stroke since they possess diminished exercise ability along with deteriorated cardiac functioning [2], [4].

From literature review, we find that after stroke, treadmill-assisted cardiac exercise programs can lead to one’s improved fitness and exercise capability [25]. For example, researchers have presented studies on Moderate-Intensity Continuous Exercise and High-Intensity Interval Training in which exercise protocols are individualized by a clinician based on one’s cardiac capacity while contributing to effective gait rehabilitation [26]–[27][28][29]. Though promising, these have not offered a progressive and adaptive exercise environment in which the dosage of exercise intensity is varied based on one’s cardiac capacity in real-time. Thus, the choice of optimum dosage of exercise intensity that can be individualized in real-time for a patient, still remains as inadequately explored [4]. For deciding the optimal dosage of rehabilitative exercise intensity, clinicians often refer to the guidelines recommended by the American College of Sports Medicine (ACSM) [30]. These guidelines suggest thresholds to decide the intensity of the exercise based on one’s metabolic energy consumption in terms of oxygen intake, heart rate, etc. Deciding the dosage of exercise intensity is crucial, particularly for individuals with stroke since their energy requirements have been reported to be 55-100% higher than that of their able-bodied counterparts [7]. Specifically, higher energy requirement often limits the capabilities of these patients and challenges their rehabilitation outcomes. This can be addressed if the technology-assisted gait exercise platform can offer individualized exercise (maintaining the safe exercise thresholds) based on the energy expenditure of the patients acquired in real-time during the exercise.

The energy expenditure can be defined as the cost of physical activity [4] and it is often expressed in terms of oxygen consumption or heart rate [31]. Thus, investigators have monitored the oxygen consumption and heart rate to estimate the energy expenditure of individuals with stroke during their walk [31], [32]. However, monitoring oxygen consumption during exercise requires a cumbersome setup [31], making it unsuitable for home-based rehabilitation. On the other hand, one’s heart rate (HR) can be monitored using portable solutions [33] that can be integrated with a treadmill in home-based settings. Researchers have explored treadmill-assisted gait exercise platforms that are sensitive to the user’s heart rate. For example, researchers have offered treadmill training to subjects with stroke in which some of them varied treadmill speed to achieve 45%-50% [34], while others varied speed to achieve 85% to 95% [35], [36] of one’s age-related maximum heart rate. Again, Pohl et al. have offered treadmill-assisted exercise to subjects with stroke while ensuring that the user’s heart rate settled to the respective resting-state heart rate [37]. Again of late, there had been advanced treadmills, available off-the-shelf, that can monitor one’s heart rate and vary the treadmill speed to maintain the user’s heart rate at a predefined level [38], [39]. Though one’s heart rate is an important indicator that needs to be considered during treadmill-assisted exercise, one’s walking speed while using the treadmill also offers important information on one’s exercise capability. This is because gait rehabilitation aims to improve one’s community ambulation that is related to one’s walking speed [40]. Thus, it would be interesting to explore the composite effect of one’s walking speed along with working and resting-state heart rates during treadmill-assisted gait exercise to study one’s energy expenditure, quantified in terms of a proxy index, namely Physiological Cost Index (PCI) [31].

Given that there are no existing studies that have used a treadmill-assisted gait exercise platform deciding the dosage of exercise intensity based on one’s PCI estimated in real-time during exercise, it might be interesting to explore the use of such an individualized gait exercise platform for individuals with stroke. Thus, we wanted to extend a treadmill-assisted gait exercise platform by making it adaptive to one’s individualized PCI. Additionally, we wanted to augment this platform with VR-based user interface to offer visual feedback to the user undergoing gait exercise. We hypothesized that such a gait exercise platform can recondition a patient’s exercise capability in terms of cardiac and gait performance to achieve improved community ambulation. The objectives of our research were three-fold, namely to (i) implement a novel PCI-sensitive Adaptive Response Technology (PCI-ART) offering VR-based treadmill-assisted gait exercise, (ii) investigate the safety and feasibility of use of this platform among able-bodied individuals before applying it to subjects with stroke and (iii) examine implications of undergoing gait exercise with this platform on the patients’ (a) cardiac and gait performance along with energy expenditure, (b) clinical measures estimating the physical reconditioning and (c) views on their community ambulation capabilities.

The rest of the paper is organized as follows: Section II presents our system design. Section III explains the experiments and procedures of this study. Section IV discusses the results. In Section V, we summarize our findings, limitations, and scope of future research.[…]

Continue —-> Adaptive Treadmill-Assisted Virtual Reality-Based Gait Rehabilitation for Post-Stroke Physical Reconditioning—a Feasibility Study in Low-Resource Settings – IEEE Journals & Magazine

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[ARTICLE] Portable Motion-Analysis Device for Upper-Limb Research, Assessment, and Rehabilitation in Non-Laboratory Settings – Full Text


This study presents the design and feasibility testing of an interactive portable motion-analysis device for the assessment of upper-limb motor functions in clinical and home settings. The device engages subjects to perform tasks that imitate activities of daily living, e.g. drinking from a cup and moving other complex objects. Sitting at a magnetic table subjects hold a 3D printed cup with an adjustable magnet and move this cup on the table to targets that can be drawn on the table surface. A ball rolling inside the cup can enhance the task challenge by introducing additional dynamics. A single video camera with a portable computer tracks real-time kinematics of the cup and the rolling ball using a custom-developed, color-based computer-vision algorithm. Preliminary verification with marker-based 3D-motion capture demonstrated that the device produces accurate kinematic measurements. Based on the real-time 2D cup coordinates, audio-visual feedback about performance can be delivered to increase motivation. The feasibility of using this device in clinical diagnostics is demonstrated on 2 neurotypical children and also 3 children with upper-extremity impairments in the hospital, where conventional motion-analysis systems are difficult to use. The device meets key needs for clinical practice: 1) a portable solution for quantitative motor assessment for upper-limb movement disorders at non-laboratory clinical settings, 2) a low-cost rehabilitation device that can increase the volume of in-home physical therapy, and 3) the device affords testing and training a variety of motor tasks inspired by daily challenges to enhance self-confidence to participate in day-to-day activities.



An integral part of clinical care for individuals with motor disorders is to assess motor function to guide and evaluate medical treatment, surgical intervention or physical therapy. One of the challenges for assessing motor function is to define sensitive and quantitative measures that can be readily obtained in clinical practice. The objective of this study was to develop a device that affords quantitative assessment of motor impairments in non-laboratory settings. The specific focus is on individuals with upper-limb movement disorders. One central goal was to ground the task in scientific research to relate clinical measures to research and capitalize on insights from fundamental research.

This paper first lays out the need for such a device particularly for children with motor disorders and post-stroke rehabilitation. We then motivate the specific motor task that was originally conceived for basic research on motor control. We then detail the design of the prototype with all hardware and software components so that it can be replicated. One design goal was to make the device low-cost, so that it can be used in many clinical environments including at home for therapeutic exercises. We conclude with first results from pilot experiments acquired both in a traditional laboratory setting and in an Epilepsy Monitoring Unit. These first data were obtained from children with dystonia. However, the device is not limited to this population and is currently further modified for the assessment of stroke patients.

A. Clinical Assessments of Motor Disorders

A motor disorder manifests as an impaired ability to execute a movement with the intended spatial and temporal pattern. This includes abnormal posturing, presence of unintended excessive movement, and normal movements occurring at unintended or inappropriate times [1]. Patients with upper-limb impairments require special assistance to perform common motor tasks associated with self-care, such as feeding and dressing. Challenges in their movement control result in frustration, which leads to less engagement and practice, and thereby fewer opportunities to attenuate their motor disabilities and improve their movement control.

Motor disorder are observed also among children. Cerebral Palsy (CP) is a common cause of movement disorders among children, affecting 3 to 4 individuals per 1000 births in the US. The dyskinetic form of CP occurs in 15% of all cases [2]. Due to inflexible postures, caused by muscle spasms and contractures together with involuntary jerky movements, children with dyskinetic CP are often prevented from participation in many daily activities. This also prevents them from acquiring age-appropriate motor skills during critical periods of skill development [3], [4]. This is particularly aggravated when the condition affects the upper limbs.

For clinical motor assessments, the current standard tools are clinical scales. For cerebral palsy, typical tests are the gross motor function classification system (GMFCS) [5], the manual ability classification system (MACS) [6], the House Scale [7], the Melbourne Assessment [8], the Assisting Hand Assessment [9], the Hypertonia Assessment Tool (HAT) [10], the Barry-Albright Dystonia (BAD) scale [11], and the Shriners Hospital for Children Upper Extremity Evaluation [12]. These outcome measures were devised to satisfy the typical criteria for effective outcome measures, including reliability, validity, specificity, and responsiveness [13]. Although useful, these rating scales rely on subjective assessment and questionnaires that are vulnerable to inter-rater and test-retest reliability, nonlinearity, multi-dimensionality, and ceiling or floor effects [14]. These shortcomings need to be overcome by more quantitative outcome measures to provide a better evaluation of the individual’s motor functions and abilities, and potentially utilize such measures to objectvely assess and titrate interventions.

B. Quantitative Assessment of Motor Function

Motion tracking technologies have provided quantitative means of recording movements through a variety of sensing technology that tracks and stores movement. Camera-based motion capture, such as Vicon (Vicon Motion Systems, Oxford, UK) and Optitrak (Northern Digital Inc, Ontario, CA) requires external markers or sensors placed on key anatomical landmarks to reconstruct the skeletal model of human body parts. These state-of-the-art technologies track motion to very high precision with high sampling rates and they have been used for pre- and post-treatment assessment of upper- or lower-extremity pathologies. However, such data acquisition is limited to traditional laboratory settings because the multi-camera systems are expensive and not portable.

On the other hand, there are low-cost inertial measurement units (IMUs) that directly measure acceleration, rotational change and magnetic orientation. While these sensors have the advantage that they are self-contained and wearable, drawbacks are degraded accuracy due to drift, calibration errors and noise inherent to inertial sensors and the need to frequently recharge batteries for real-time data streaming [15]. Moreover, attaching sensors to body parts can be inconvenient or even impossible for certain clinical populations, and many children will not tolerate them.

In view of the above arguments, there is a strong need for less invasive devices that can provide quantitative measurements in tasks related to upper-extremeity motor function. Preferably, such a device should allow for portability and be low-cost to reach large populations.

C. Low-Cost Rehabilitation at Home

Rehabilitation follows standard practice and frequently requires one-on-one interaction with a therapist for extended periods of time. For these reasons, robotic devices have emerged to deliver higher-dosage and higher-intensity training for patients with movement disorders such as cerebral palsy and stroke [16]–[17][18][19]. However, while effective, robotic therapy is expensive and to date can only be used in clinical settings. To increase the volume in therapy, lower-cost devices that can be used at home are urgently needed.

Performance improvements with predominant home training are indeed possible. This was demonstrated by pediatric constraint-induced movement therapy (CIMT) for children with hemiparetic CP [20], [21]. Further, it was shown that even children with severe dystonia can improve their performance if they use an interface or device that enables and facilitates their severely handicapped movements [22].

A portable low-cost device for home use that is able to provide reliable quantitative measurements would help address the above shortcomings. Measurements could also be streamed to careproviders on a secure cloud protocol, for diagnosis of interventions, analysis of therapeutic outcomes, and further follow up.

D. Theoretically-Grounded Rehabilitation

Motor tasks for home therapy should be engaging to avoid boredom and attrition and should also have functional relevance. With this goal in mind, we developed a motor task that was motivated by the daily self-feeding activity of leading a cup of coffee or a spoon filled with soup to the mouth. The core challenge of actions of this kind is that moving such an object with sloshing liquid presents complex interaction forces: any force applied to the cup also applies a force to the liquid that then acts back on the hand. When such internal dynamics is present, interaction forces become quite complex, and the human performing the task needs to predict and preempt the internal dynamics of the moving liquid. Clearly, better understanding task is like guiding a cup of coffee to one’s mouth or a spoonful of soup has high functional relevance. While many such functional tasks have been developed for rehabiltation (e.g., the box-and-block and the pegboard task), the quantitative assessment should allow for more than descriptive outcome measures such as error or success rate. Monitoring the ‘process’ continuously should provide more detailed insight into coordinative challenges. This is indeed possible in the task of guiding a cup of coffee as we explain next.

In previous research, we abstracted a relevant, yet simplified model task, inspired by guiding a cup of coffee [23]–[24][25][26]. To reduce the complexity and afford theoretical analyses, the “cup of coffee” was simplified to a rigid object with a rolling ball inside. The rolling ball represents the moving liquid; this is also similar to the children’s game of transporting an egg in a spoon [27]. Fig.1A-C shows the transition from the real object to the simplified physical model. Importantly, the original task (Fig.1A) was reduced to a two-dimensional model, where the subject interacts with the object via a robotic manipulandum. The virtual model consists of a cart with a suspended pendulum, a well-known benchmark problem in control theory.

FIGURE 1.Model for the task of carrying a cup of coffee. A: The real object. B: The simplified physical model. C: The equivalent cart-and pendulum model implemented in the virtual task.


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[Abstract + References] eConHand: A Wearable Brain-Computer Interface System for Stroke Rehabilitation


Brain-Computer Interface (BCI) combined with assistive robots has been developed as a promising method for stroke rehabilitation. However, most of the current studies are based on complex system setup, expensive and bulky devices. In this work, we designed a wearable Electroencephalography(EEG)-based BCI system for hand function rehabilitation of the stroke. The system consists of a customized EEG cap, a small-sized commercial amplifer and a lightweight hand exoskeleton. In addition, visualized interface was designed for easy use. Six healthy subjects and two stroke patients were recruited to validate the safety and effectiveness of our proposed system. Up to 79.38% averaged online BCI classification accuracy was achieved. This study is a proof of concept, suggesting potential clinical applications in outpatient environments.

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13. X. Shu , S. Chen , L. Yao et al “Fast Recognition of BCI-Inefficient Users Using Physiological Features from EEG Signals: A Screening Study of Stroke Patients”, Frontiers in Neuroscience, vol. 12, pp. 93, 2018.

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[Abstract + References] Self-paced movement intention recognition from EEG signals during upper limb robot-assisted rehabilitation


Currently, one of the challenges in EEG-based brain-computer interfaces (BCI) for neurorehabilitation is the recognition of the intention to perform different movements from same limb. This would allow finer control of neurorehabilitation and motor recovery devices by end-users [1]. To address this issue, we assess the feasibility of recognizing two self-paced movement intentions of the right upper limb plus a rest state from EEG signals recorded during robot-assisted rehabilitation therapy. In addition, the work proposes the use of Multi-CSP features and deep learning classifiers to recognize movement intentions of the same limb. The results showed performance peaked greater at (80%) using a novel classification models implemented in a multiclass classification scenario. On the basis of these results, the decoding of the movement intention could potentially be used to develop more natural and intuitive robot assisted neurorehabilitation therapies
1. S. R. Soekadar , N. Birbaumer , M. W. Slutzky , and L. G. Cohen , “Brain machine interfaces in neurorehabilitation of stroke,” Neurobiology of Disease, vol. 83, pp. 172-179, 2015.

2. P. Ofner , A. Schwarz , J. Pereira , and G. R. Müller-Putz , “Upper limb movements can be decoded from the time-domain of low-frequency EEG,” PLoS One, vol. 12, no. 8, p. e0182578, Aug 2017, poNE-D- 17-04785[PII].

3. F. Shiman , E. Lopez-Larraz , A. Sarasola-Sanz , N. Irastorza-Landa , M. Spler , N. Birbaumer , and A. Ramos-Murguialday , “Classification of different reaching movements from the same limb using EEG,” Journal of Neural Engineering, vol. 14, no. 4, p. 046018, 2017.

4. J. Pereira , A. I. Sburlea , and G. R. Müller-Putz , “EEG patterns of self- paced movement imaginations towards externally-cued and internally- selected targets,” Scientific Reports, vol. 8, no. 1, p. 13394, 2018.

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[Abstract] The SonicHand Protocol for Rehabilitation of Hand Motor Function: a validation and feasibility study


Musical sonification therapy is a new technique that can reinforce conventional rehabilitation treatments by increasing therapy intensity and engagement through challenging and motivating exercises. Aim of this study is to evaluate the feasibility and validity of the SonicHand protocol, a new training and assessment method for the rehabilitation of hand function. The study was conducted in 15 healthy individuals and 15 stroke patients. The feasibility of implementation of the training protocol was tested in stroke patients only, who practiced a series of exercises concurrently to music sequences produced by specific movements. The assessment protocol evaluated hand motor performance during pronation/supination, wrist horizontal flexion/extension and hand grasp without sonification. From hand position data, 15 quantitative parameters were computed evaluating mean velocity, movement smoothness and angular excursions of hand/fingers. We validated this assessment in terms of its ability to discriminate between patients and healthy subjects, test-retest reliability and concurrent validity with the upper limb section of the Fugl-Meyer scale (FM), the Functional Independence Measure (FIM) and the Box & Block Test (BBT). All patients showed good understanding of the assigned tasks and were able to correctly execute the proposed training protocol, confirming its feasibility. A moderate-to-excellent intraclass correlation coefficient was found in 8/15 computed parameters. Moderate-to-strong correlation was found between the measured parameters and the clinical scales. The SonicHand training protocol is feasible and the assessment protocol showed good to excellent between-group discrimination ability, reliability and concurrent validity, thus enabling the implementation of new personalized and motivating training programs employing sonification for the rehabilitation of hand function.

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[Abstract] A Greedy Assist-as-Needed Controller for Upper Limb Rehabilitation


Previous studies on robotic rehabilitation have shown that subjects’ active participation and effort involved in rehabilitation training can promote the performance of therapies. In order to improve the voluntary effort of participants during the rehabilitation training, assist-as-needed (AAN) control strategies regulating the robotic assistance according to subjects’ performance and conditions have been developed. Unfortunately, the heterogeneity of patients’ motor function capability in task space is not taken into account during the implementation of these controllers. In this paper, a new scheme called greedy AAN (GAAN) controller is designed for the upper limb rehabilitation training of neurologically impaired subjects. The proposed GAAN control paradigm includes a baseline controller and a Gaussian RBF network that is utilized to model the functional capability of subjects and to provide corresponding a task challenge for them. In order to avoid subjects’ slacking and encourage their active engagement, the weight vectors of RBF networks evaluating subjects’ impairment level are updated based on a greedy strategy that makes the networks progressively learn the maximum forces over time provided by subjects. Simultaneously, a challenge level modification algorithm is employed to adjust the task challenge according to the task performance of subjects. Experiments on 12 subjects with neurological impairment are conducted to validate the performance and feasibility of the GAAN controller. The results show that the proposed GAAN controller has significant potential to promote the subjects’ voluntary engagement during training exercises.

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[Abstract + References] Synergy-Based FES for Post-Stroke Rehabilitation of Upper-Limb Motor Functions


Functional electrical stimulation (FES) is capable of activating muscles that are under-recruited in neurological diseases, such as stroke. Therefore, FES provides a promising technology for assisting upper-limb motor functions in rehabilitation following stroke. However, the full benefits of FES may be limited due to lack of a systematic approach to formulate the pattern of stimulation. Our preliminary work demonstrated that it is feasible to use muscle synergy to guide the generation of FES patterns.In this paper, we present a methodology of formulating FES patterns based on muscle synergies of a normal subject using a programmable multi-channel FES device. The effectiveness of the synergy-based FES was tested in two sets of experiments. In experiment one, the instantaneous effects of FES to improve movement kinematics were tested in three patients post ischemic stroke. Patients performed frontal reaching and lateral reaching tasks, which involved coordinated movements in the elbow and shoulder joints. The FES pattern was adjusted in amplitude and time profile for each subject in each task. In experiment two, a 5-day session of intervention using synergy-based FES was delivered to another three patients, in which patients performed task-oriented training in the same reaching movements in one-hour-per-day dose. The outcome of the short-term intervention was measured by changes in Fugl–Meyer scores and movement kinematics. Results on instantaneous effects showed that FES assistance was effective to increase the peak hand velocity in both or one of the tasks. In short-term intervention, evaluations prior to and post intervention showed improvements in both Fugl–Meyer scores and movement kinematics. The muscle synergy of patients also tended to evolve towards that of the normal subject. These results provide promising evidence of benefits using synergy-based FES for upper-limb rehabilitation following stroke. This is the first step towards a clinical protocol of applying FES as therapeutic intervention in stroke rehabilitation.

I. Introduction

Muscle activation during movement is commonly disrupted due to neural injuries from stroke. A major challenge for stroke rehabilitation is to re-establish the normal ways of muscle activation through a general restoration of motor control, otherwise impairments may be compensated by the motor system through a substitution strategy of task control [1]. In post-stroke intervention, new technologies such as neuromuscular electrical stimulation (NMES) or functional electrical stimulation (FES) offer advantages for non-invasively targeting specific groups of muscles [2]–[4] to restore the pattern of muscle activation. Nevertheless, their effectiveness is limited by lack of a systematic methodology to optimize the stimulation pattern, to implement the optimal strategy in clinical settings, and to design a protocol of training towards the goal of restoring motor functions. This pioneer study addresses these issues in clinical application with a non-invasive FES technology.

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via Synergy-Based FES for Post-Stroke Rehabilitation of Upper-Limb Motor Functions – IEEE Journals & Magazine

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