Posts Tagged technology
[ARTICLE] Utilizing the intelligence edge framework for robotic upper limb rehabilitation in home – Full Text
Posted by Kostas Pantremenos in Paretic Hand, Rehabilitation robotics, Tele/Home Rehabilitation on February 4, 2024
Abstract
Robotic devices are gaining popularity for the physical rehabilitation of stroke survivors. Transition of these robotic systems from research labs to the clinical setting has been successful, however, providing robot-assisted rehabilitation in home settings remains to be achieved. In addition to ensure safety to the users, other important issues that need to be addressed are the real time monitoring of the installed instruments, remote supervision by a therapist, optimal data transmission and processing. The goal of this paper is to advance the current state of robot-assisted in-home rehabilitation. A state-of-the-art approach to implement a novel paradigm for home-based training of stroke survivors in the context of an upper limb rehabilitation robot system is presented in this paper. First, a cost effective and easy-to-wear upper limb robotic orthosis for home settings is introduced. Then, a framework of the internet of robotics things (IoRT) is discussed together with its implementation. Experimental results are included from a proof-of-concept study demonstrating that the means of absolute errors in predicting wrist, elbow and shoulder angles are 0.89180,2.67530 and 8.02580, respectively. These experimental results demonstrate the feasibility of a safe home-based training paradigm for stroke survivors. The proposed framework will help overcome the technological barriers, being relevant for IT experts in health-related domains and pave the way to setting up a telerehabilitation system increasing implementation of home-based robotic rehabilitation. The proposed novel framework includes:
- •A low-cost and easy to wear upper limb robotic orthosis which is suitable for use at home.
- •A paradigm of IoRT which is used in conjunction with the robotic orthosis for home-based rehabilitation.
- •A machine learning-based protocol which combines and analyse the data from robot sensors for efficient and quick decision making.
Graphical abstract
[WEB] Soft robo-glove can help stroke patients relearn to play music
Posted by Kostas Pantremenos in Music/Music therapy, Rehabilitation robotics on January 25, 2024
By Mischa Dijkstra, Frontiers science writer
Researchers have developed the prototype of a comfortable and flexible ‘soft smart hand exoskeleton’ or robo-glove, which gives feedback to wearers who need to relearn tasks that require manual dexterity and coordination, for example after suffering a stroke. The present study focused on patients who need to relearn to play the piano as a proof-of-principle, but the glove can easily be adapted to help relearn other daily tasks.
Stroke is the most important cause of disability for adults in the EU, which affects approximately 1.1 million inhabitants each year. After a stroke, patients commonly need rehabilitation to relearn to walk, talk, or perform daily tasks. Research has shown that besides physical and occupational therapy, music therapy can help stroke patients to recover language and motor function. But for people trained in music and who suffered a stroke, playing music may itself be a skill that needs to be relearned. Now, a study in Frontiers in Robotics and AI has shown how novel soft robotics can help recovering patients to relearn playing music and other skills that require dexterity and coordination.
“Here we show that our smart exoskeleton glove, with its integrated tactile sensors, soft actuators, and artificial intelligence, can effectively aid in the relearning of manual tasks after neurotrauma,” said lead author Dr Maohua Lin, an adjunct professor at the Department of Ocean & Mechanical Engineering of Florida Atlantic University.
Credit: Dr Maohua Lin et al
Whom the glove fits: custom-made ‘smart hand’
Lin and colleagues designed and tested a ‘smart hand exoskeleton’ in the shape of a multi-layered, flexible 3D-printed robo-glove, which weighs only 191g. The entire palm and wrist area of the glove are designed to be soft and flexible, and the shape of the glove can be custom-made to fit each wearer’s anatomy.
Soft pneumatic actuators in its fingertips generate motion and exert force, thus mimicking natural, fine-tuned hand movements. Each fingertip also contains an array of 16 flexible sensors or ‘taxels’, which give tactile sensations to the wearer’s hand upon interaction with objects or surfaces. Production of the glove is straightforward, as all actuators and sensors are put in place through a single molding process.
“While wearing the glove, human users have control over the movement of each finger to a significant extent,” said senior author Dr Erik Engeberg, a professor at Florida Atlantic University’s Department of Ocean & Mechanical Engineering.
“The glove is designed to assist and enhance their natural hand movements, allowing them to control the flexion and extension of their fingers. The glove supplies hand guidance, providing support and amplifying dexterity.”
The authors foresee that patients might ultimately wear a pair of these gloves, to help both hands independently to regain dexterity, motor skills, and a sense of coordination.
AI trained the glove to be a music teacher
The authors used machine learning to successfully teach the glove to ‘feel’ the difference between playing a correct versus incorrect versions of a beginner’s song on the piano. Here, the glove operated autonomously without human input, with preprogrammed movements. The song was ‘Mary had a little lamb’, which requires four fingers to play.
“We found that the glove can learn to distinguish between correct and incorrect piano play. This means it could be a valuable tool for personalized rehabilitation of people who wish to relearn to play music,” said Engeberg.
Now that the proof-of-principle has been shown, the glove can be programmed to give feedback to the wearer about what went right or wrong in their play, either through haptic feedback, visual cues, or sound. These would enable her or him to understand their performance and make improvements.
Picking up the gauntlet for remaining challenges
Lin added: “Adapting the present design to other rehabilitation tasks beyond playing music, for example object manipulation, would require customization to individual needs. This can be facilitated through 3D scanning technology or CT scans to ensure a personalized fit and functionality for each user.”
“But several challenges in this field need to be overcome. These include improving the accuracy and reliability of tactile sensing, enhancing the adaptability and dexterity of the exoskeleton design, and refining the machine learning algorithms to better interpret and respond to user input.”
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[Video] Fascinating TEDx Talk discusses how everyone has a part to play in making AT accessible and equitable for all
Posted by Kostas Pantremenos in Assistive Technology, Video on January 22, 2024
Pascal Bijleveld, CEO of ATscale, recently delivered an eye-opening TEDx Talk about the transformative power of assistive technology in improving lives but how access to such devices is not equitable worldwide.
Pascal joined ATscale, the Global Partnership for Assistive Technology, as its first CEO in November 2021. ATscale is a cross-sector global partnership with a mission to transform people’s lives through assistive technology (AT). It has an ambitious goal to ensure that 500 million people in low- and middle-income countries get the transformative assistive technologies they need by 2030.
ATscale’s bold goal is based on the most recent figures from the World Health Organization (WHO), which reveal almost one billion people globally who need assistive technology are denied access.
The shocking disparity between the number of people needing assistive technology and those who have access to such necessary devices formed the basis of Pascal’s powerful TEDx Talk. His presentation is titled ‘Unlocking Potential: The Transforming Power of Assistive Technology’.
At the start of his presentation, he explained how many people rely on assistive technology, potentially without realising, including glasses, wheelchairs, hearing aids, walking sticks, and captioning on smartphones.
He said: “In Europe, things function pretty well because most people who need assistive technology can access it, sometimes free of charge, or it is covered by your health insurance or social benefits. We don’t think twice about it.
“But imagine a world where that is not the reality or where access to assistive technology is not so straightforward. Just imagine if you walk up to your bus in the morning and the bus driver says ‘Sorry I can’t take you to work today. I broke my glasses, and there’s no replacement’.”
Pascal mentioned his own reliance on glasses to easily do things, such as drive, go to the cinema, and even finish school. He noted how assistive devices are vital for children to live independently, whether it is getting out and about, socialising, going to school, or getting a job.
However, he pointed out that a lack of access to crucial assistive technology is sadly a reality for millions worldwide. This lack of access is particularly prevalent in low- and middle-income countries, where it can be as low as three percent.
“That inequity is unacceptable in today’s world,” Pascal said. “AT is a basic human right. It’s a moral imperative that we have to address this inequity today. We’re failing millions of people.”
He said that this assistive technology inequity is due to several reasons, including a lack of awareness and understanding, stigma, governments not delivering on commitments, devices being too expensive, a lack of available financing options, not enough human resources, insufficient supply chains, and more.
To meet ATscale’s bold goal, Pascal underlined that users, organisations of people with disabilities, governments, the private sector, innovators, investors, and academic research institutions all need to come together, agree on a common goal, and put their resources behind it.
Importantly, Pascal emphasised that everyone has a role to play in ensuring inclusive access to assistive technology.
He remarked. “Talk to your family, talk to your friends, talk to your colleagues, express your outrage on social media, ask your local politicians what they’re doing about this. In your workplace or in your schools, make sure that the environments are inclusive, are accessible, and have the needs of assistive technology are being catered for.
“AT cuts across all sectors: health, education, the environment, livelihoods, humanitarian responses, and conflict. If you’re working in any of those spaces, make sure that the programmes are inclusive and that the needs of assistive technology are being planned for.”
Pascal Bijleveld, CEO of ATscale, recently delivered an eye-opening TEDx Talk about the transformative Η δύναμη της υποστηρικτικής τεχνολογίας στη βελτίωση της ζωής, αλλά πώς η πρόσβαση σε τέτοιες συσκευές δεν είναι δίκαιη παγκοσμίως.
Pascal joined ATscale, the Global Partnership for Assistive Technology, as its first CEO in November 2021. ATscale is a cross-sector global partnership with a mission to transform people’s lives through assistive technology (AT). It has an ambitious goal to ensure that 500 million people in low- and middle-income countries get the transformative assistive technologies they need by 2030.
ATscale’s bold goal is based on the most recent figures from the World Health Organization (WHO), which reveal almost one billion people globally who need assistive technology are denied access.
The shocking disparity between the number of people needing assistive technology and those who have access to such necessary devices formed the basis of Pascal’s powerful TEDx Talk. His presentation is titled ‘Unlocking Potential: The Transforming Power of Assistive Technology’.
At the start of his presentation, he explained how many people rely on assistive technology, potentially without realising, including glasses, wheelchairs, hearing aids, walking sticks, and captioning on smartphones.
He said: “In Europe, things function pretty well because most people who need assistive technology can access it, sometimes free of charge, or it is covered by your health insurance or social benefits. We don’t think twice about it.
“But imagine a world where that is not the reality or where access to assistive technology is not so straightforward. Just imagine if you walk up to your bus in the morning and the bus driver says ‘Sorry I can’t take you to work today. I broke my glasses, and there’s no replacement’.”
Pascal mentioned his own reliance on glasses to easily do things, such as drive, go to the cinema, and even finish school. He noted how assistive devices are vital for children to live independently, whether it is getting out and about, socialising, going to school, or getting a job.
However, he pointed out that a lack of access to crucial assistive technology is sadly a reality for millions worldwide. This lack of access is particularly prevalent in low- and middle-income countries, where it can be as low as three percent.
“That inequity is unacceptable in today’s world,” Pascal said. “AT is a basic human right. It’s a moral imperative that we have to address this inequity today. We’re failing millions of people.”
He said that this assistive technology inequity is due to several reasons, including a lack of awareness and understanding, stigma, governments not delivering on commitments, devices being too expensive, a lack of available financing options, not enough human resources, insufficient supply chains, and more.
To meet ATscale’s bold goal, Pascal underlined that users, organisations of people with disabilities, governments, the private sector, innovators, investors, and academic research institutions all need to come together, agree on a common goal, and put their resources behind it.
Importantly, Pascal emphasised that everyone has a role to play in ensuring inclusive access to assistive technology.
He remarked. “Talk to your family, talk to your friends, talk to your colleagues, express your outrage on social media, ask your local politicians what they’re doing about this. In your workplace or in your schools, make sure that the environments are inclusive, are accessible, and have the needs of assistive technology are being catered for.
“AT cuts across all sectors: health, education, the environment, livelihoods, humanitarian responses, and conflict. If you’re working in any of those spaces, make sure that the programmes are inclusive and that the needs of assistive technology are being planned for.”
Watch the full TEDx Talk below.
[WEB] Revolutionizing Stroke Recovery: The Smart Glove Aid
Posted by Kostas Pantremenos in Artificial intelligence, Assistive Technology, Paretic Hand on January 17, 2024
In recent years, technology has played a crucial role in transforming the healthcare sector. Among the exciting innovations, the ‘smart glove’ stands out as a groundbreaking tool designed to aid stroke survivors in their recovery process. Created by a team at Texavie, this innovative technology is set to revolutionize stroke rehabilitation by providing precise and personalized therapy for each individual.
The Concept Behind the Smart Glove
The smart glove is a technological marvel that incorporates a network of highly sensitive sensor yarns and pressure sensors woven into a comfortable, stretchy fabric. This innovative design enables the glove to track even the minutest hand and finger movements during rehabilitation exercises. It’s much like a wearable motion-capture camera, capturing movements with unparalleled precision and speed.
What sets the glove apart is its ability to wirelessly transmit this data, allowing for remote monitoring and analysis of exercise programs. This feature is especially crucial in times where social distancing is the norm, enabling therapists to track their patients’ progress remotely. It also allows patients to engage in rehabilitation exercises from the comfort of their homes, making the recovery process more flexible and less stressful.
The Role of Artificial Intelligence
Artificial Intelligence (AI) plays a pivotal role in the functionality of the smart glove. AI technology not only helps track movements but also analyses the data to provide personalized therapy for each individual. This aspect of individualization is vital in stroke rehabilitation, where each person’s recovery process is unique and requires a tailored approach.
AI-driven technology in the glove adapts the rehabilitation program to the individual’s recovery pace and progress. It can adjust the difficulty level of exercises, making them more challenging as the patient’s hand function and mobility improve. This adaptive capability ensures that the rehabilitation process is efficient and effective, promoting faster recovery.
Testimonials and Success Stories
Stroke survivors who have used this innovative smart glove technology have shared their success stories, providing real-life evidence of the glove’s effectiveness. Users have reported significant improvements in hand function and mobility, contributing to an overall better quality of life post-stroke.
The smart glove has not only helped stroke survivors regain their independence but also boosted their confidence. The ability to track progress in real-time has been highly motivating, encouraging patients to stay committed to their rehabilitation program.
Future Applications
While currently focused on aiding stroke rehabilitation, the smart glove’s potential applications extend beyond this. The technology’s precision and speed match the performance of costly motion-capture cameras, making it a potential tool for use in virtual reality, augmented reality, animation, and robotics. The smart glove technology could significantly impact these fields, making it a truly transformative invention.
In conclusion, the smart glove is a promising leap forward in stroke rehabilitation. It not only offers a personalized approach to recovery but also enables remote therapy, making the process more accessible and convenient for stroke survivors. With its potential to expand into other fields, the smart glove is indeed a game-changer in healthcare technology.
[Review] Brain–Computer Interfaces for Upper Limb Motor Recovery after Stroke: Current Status and Development Prospects – Full Text
Posted by Kostas Pantremenos in Paretic Hand on January 17, 2024
Brain–computer interfaces (BCIs) are a group of technologies that allow mental training with feedback for post-stroke motor recovery. Varieties of these technologies have been studied in numerous clinical trials for more than 10 years, and their construct and software are constantly being improved. Despite the positive treatment results and the availability of registered medical devices, there are currently a number of problems for the wide clinical application of BCI technologies. This review provides information on the most studied types of BCIs and its training protocols and describes the evidence base for the effectiveness of BCIs for upper limb motor recovery after stroke. The main problems of scaling this technology and ways to solve them are also described.
Introduction
Brain–computer interface (BCI) is a technology that allows to convert data on the electrical or metabolic activity of the brain into control signals for an external technical device. In post-stroke rehabilitation, BCI is used to provide feedback to a patient during motor imagery training [1–3]. The scientific justification for this method has been the data on the positive effect of the motor imagery process on neuroplasticity due to activation of motor structures of the central nervous system (CNS) [4–8]. By providing feedback during motor imagery, the BCI systems enhance the effectiveness of such training sessions [9]. In general, training with the use of the BCI technology in patients after stroke includes the following processes: a patient is asked to mentally perform a movement of the paralyzed limb; the BCI technology using non-invasive sensors records brain signals accompanying the mental performance of the task; in real time, these signals are recognized and converted into a control command for an external device; the patient is provided with feedback on the quality of the mental task performance using the external device [10].
To date, at least 20 randomized controlled trials (RCTs) on the use of BCI for upper limb motor recovery after stroke are known worldwide, and 11 systematic reviews, 8 of which are accompanied by a meta-analysis, have been published on this topic between 2019 and 2023 [11–21]. Foreign and domestic manufacturers have developed several medical devices for use in clinical practice of post-stroke rehabilitation [22–25].
In Russia, clinical trials of BCI after stroke first began in 2011 at Research Center of Neurology (Moscow, Russia) [26, 27]. In a subsequent multicentre RCT, it was shown that a course of training with the BCI–exoskeleton complex improved the rehabilitation results of patients with focal brain damage in terms of hand motor recovery [28]. The proven technology was subsequently registered as a medical device and is currently used in a number of clinical centres [24, 29].
Despite the extensive evidence base and the availability of ready-made BCI technologies, there are currently some limitations to their widespread use in post-stroke rehabilitation, and further research and development is underway [30–37].
The aim of this review is to analyse scientific articles devoted to the study of the use of BCI technologies in post-stroke upper limb paresis, to outline the main problems and prospects for further development in this field.
Literature search methodology
Articles from peer-reviewed, full-text, open access scientific journals on the use of non-invasive BCIs for upper limb motor recovery after stroke were selected for analysis. The search query was formulated according to the rules of the MEDLINE bibliographic database: ((brain–computer[tiab] OR brain–machine[tiab] OR neural interfac*[tiab]) OR “Brain–Computer interfaces”[Mesh]) AND stroke[mh] AND (upper extremity[tiab] OR hand[tiab] OR arm[tiab]). Additionally, a literature search was conducted in the eLIBRARY.RU system using the key words “brain–computer interface”, “neurocomputer interface”, “neurointerface”. The date of the search was July 3, 2023.
Varieties of brain–computer interface systems and their application after stroke
All BCIs used in research or in the practice of post-stroke rehabilitation have distinctive features (see the Figure). The training protocols and BCI models studied in RCTs differ in the control paradigm of the interface, the type of signal recorded, the online signal processing algorithm, and the type of external technical device for providing feedback.
[WEB] The Use of Virtual Reality in Physical Therapy
Posted by Kostas Pantremenos in Virtual reality rehabilitation on January 7, 2024
By Medriva
THE FUTURE IS HERE: LEVERAGING VIRTUAL REALITY IN PHYSICAL THERAPY
As we stride into the 21st century, the fusion of health and technology has brought about a major revolution in the medical field. One such innovation is the use of Virtual Reality (VR) in physical therapy. This groundbreaking development is changing the game for therapists and patients alike, making therapy sessions more engaging, effective, and manageable. Let’s delve into the realm of VR and its transformative impact on physical therapy.
Understanding Virtual Reality
Virtual Reality, often abbreviated as VR, is a computer-generated simulation that allows users to interact in an artificial three-dimensional environment using electronic devices such as special goggles with a screen or gloves fitted with sensors. It provides the user with an immersive experience that can be similar to or entirely different from the real world.
The Emergence of VR in Physical Therapy
Physical therapy has traditionally been a field that relies heavily on physical interaction, manipulation, and exercises. However, technology has started to seep into this field, with Virtual Reality leading the charge. VR in physical therapy, sometimes referred to as “VR Physiotherapy,” is an innovative approach to treatment that leverages the immersive qualities of VR to aid in patient rehabilitation.
How Does VR Physiotherapy Work?
In VR physiotherapy, patients wear VR headsets that transport them to a virtual environment. In this environment, they can perform a series of exercises or maneuvers guided by their therapist. The technology allows for the tracking of movements and measurement of progress, providing valuable data for both the patient and the healthcare provider.
The Benefits of Using VR in Physical Therapy
VR in physical therapy is not just a fancy tech upgrade; it brings several substantial benefits to the table.
- Increased Engagement: VR can make physical therapy sessions more engaging and enjoyable for patients. Instead of monotonous exercises, they get to interact with a stimulating virtual environment.
- Better Compliance: The fun and interactive nature of VR physiotherapy can lead to better compliance with therapy regimes, which is often a major challenge in physical therapy.
- Improved Physical Performance: VR physiotherapy can lead to improved balance, muscle strength, and overall physical performance, as found in several research studies.
- Enhanced Feedback: VR systems can provide real-time feedback, helping patients understand their progress and areas of improvement.
- Reduced Perception of Pain: The immersive nature of VR can act as a distraction, reducing the perception of pain during strenuous exercises.
The Future of VR in Physical Therapy
While the use of VR in physical therapy is still in its early stages, the future looks promising. As technology advances, we can expect to see more sophisticated VR systems that provide personalized therapy experiences, better motion tracking, and even remote therapy options. Furthermore, with the cost of VR technology decreasing, it will become a more accessible tool for a larger number of clinics and patients.
Conclusion
The use of Virtual Reality in physical therapy is an exciting development that is transforming the field. It is enhances patient engagement, improves therapy outcomes, and offers a novel approach to rehabilitation. As we continue to explore and develop this technology, the realm of physical therapy is set to become even more dynamic and patient-friendly.
[BLOG POST] Empowering Love: How Dateability is Changing the Dating Game for People with Disabilities
Posted by Kostas Pantremenos in Assistive Technology, Disability and Sex on January 4, 2024
| Jacqueline Child, a 29-year-old woman living with disabilities, faced continual rejection and discrimination on mainstream dating apps. This struggle, stemming from her invisible disabilities such as lupus and dysautonomia, prompted her to cofound a dating app specifically for people with disabilities along with her sister Alexa in 2021. The app, called Dateability, aims to provide a space where the disabled community can engage in dating and casual relationships without the stigma and challenges encountered on other platforms. Jacqueline’s experience highlights the need for more inclusive dating environments and the importance of discussing the disabled experience in the context of dating and romance. Jacqueline’s journey to self-acceptance and her pursuit of love have been significantly shaped by her health challenges. Having undergone over 40 surgeries for multiple medical conditions, she struggled with the stigma attached to her disability, often feeling embarrassed and unworthy. These feelings were reinforced by hurtful comments and rejection in her dating life. However, through therapy, Jacqueline confronted her internalized ableism and came to appreciate the value of shared experiences with others who have chronic illnesses. This shift in perspective led her to seek a more understanding and inclusive dating environment, culminating in the creation of Dateability. https://youtu.be/-mhIoVLSVGk?si=Q1XBFSQkhq1XBz1p Dateability, launched in October 2022, is the only free dating app designed exclusively for the disabled and chronically ill community. With nearly 11,000 users, the platform provides a safe and inclusive environment where individuals can openly disclose their disabilities through a feature called Dateability Deets. This has significantly reduced the pressure and anxiety around dating for its users. The success of the app is evident in its positive impact on users’ lives, with many finding meaningful connections and even moving towards cohabitation. For Jacqueline, Dateability has been more than just an app; it has given her a sense of purpose and boosted her self-confidence, transforming her life beyond just the realm of dating. https://youtu.be/NQBHlLUn5ZQ?si=ng9SiwvT7AmFuPoh Dateability is available on iOS, Android, and on the web at dateabilityapp.com. |
[WEB] Could virtual reality be the answer to post-stroke rehabilitation?
Posted by Kostas Pantremenos in REHABILITATION, Virtual reality rehabilitation on September 19, 2023
- Download PDF Copy
- By Neha Mathur ,Sep 19 2023, Reviewed by Sophia Coveney
In a recent article published in eClinicalMedicine, researchers evaluated the effectiveness and safety of virtual reality (VR), an innovative neurorehabilitation modality, in people diagnosed with cerebral stroke.
Background
Over 12 million new strokes occur each year globally. However, by 2050, the global stroke burden may double.
According to the World Health Organisation (WHO) estimates, upper limb impairment, decreased ability to self-care, and social inactivity are common in stroke survivors, which can cause a deterioration in quality of life.
Given the continuous expansion in the number of stroke survivors, there is a need for more engaging, interactive, patient-centered, and relatively inexpensive modalities to enhance functional recovery.
One can access VR via personal computers, mobile devices, VR glasses, and head-mounted displays. It allows a patient to immerse in environments similar to real-world events and objects.
Moreover, they provide real-time feedback through their sensory channels. Furthermore, VR can be non-, semi-, or fully immersive based on the extent of a user’s perceived presence and interaction with the virtual environment.
Systems that utilize concave surface projection, head-mounted displays, or video capture are immersive, while single-screen projection or desktop displays where users can interact with a computer-generated avatar are non-immersive. VR glasses that enable users to navigate by a visual stimulus are semi-immersive VR.
VR appears to have the potential to maximize motor learning after a stroke. Many previous systematic reviews uncovered the discordances of VR use on upper limb function (arm and hands) and activity compared to conventional therapy, emphasizing the need for an overview of reviews in accordance with the Cochrane guidelines.
About the study
In the present study, researchers searched 11 databases, e.g., SCOPUS and grey literature, from inception to January 17, 2023, and identified systematic reviews published in English that covered adult patients with a clinical diagnosis of stroke undergoing VR intervention with/without conventional therapy vs. conventional therapy only.
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Eligible systematic reviews with and without meta-analysis of randomized controlled trials (RCTs) or both RCTs and non-randomized studies of interventions (NRSI) involved adult patients with a clinical diagnosis of acute or chronic stroke who had motor impairments and were undergoing non-, semi-, or non-immersive VR interventions.
The primary study outcome was upper limb function and activity, and secondary outcomes were measures of gait, activities of daily living (ADL), participation restriction and quality of life, cognitive function, and other adverse events.
Results
The current overview of multiple (n=58) systematic reviews summarized the evidence from 42 meta-analyses, including 345 primary studies on VR intervention used for stroke.
Almost 40% of the trials were published in the last five years, suggesting the need for new evidence to update the available evidence.
Multiple meta-analyses using the Fugl Meyer Assessment scale (FMA-UE) to measure upper limb function and activity found that VR with or without conventional therapy was superior to conventional therapy, with low to moderate certainty of evidence (CoE) and probable to definite clinical relevance.
On the contrary, VR motor rehabilitation did not affect arm activity assessed with the Box and Block Test (BBT), Wolf Motor Function Test (WMFT), and Action Research Arm Test (ARAT).
Some reviews reported equal effects of VR and conventional therapy between study groups. VR might be useful for patients who need to perform a cognitive task but also refine the quality of movement during task execution. Further, VR might have a beneficial effect on mobility, balance, and ADL.
Thus, overall, VR could be considered a safe neurorehabilitation intervention with few mild adverse events. However, there is a need to minimize the risk of falling during balance training.
Conclusions
Clinicians should evaluate ways to incorporate VR into post-stroke rehabilitation interventions for patient’s motor recovery.
Depending on a patient’s training aims, they could introduce tailored exercises with visual, auditory, and tactile feedback, which might help patients improve performance and personal capacity.
Given the current expansion of knowledge regarding gender medicine and individualized therapy, clinicians should incorporate this research into VR rehabilitation.
For example, higher stress levels might increase female susceptibility to simulator sickness and discomfort during VR. Clinicians should be ready to handle this by defining the type of technology and intervention dose appropriate for each patient.
According to the authors, this is the broadest overview of systematic reviews examining VR as a stroke rehabilitation intervention yet. However, since many of the reviews included in this overview used poor methodological quality, its findings must be interpreted with caution.
Journal reference:
- Bargeri S, Scalea S, Agosta F, et al. (2023). Effectiveness and safety of virtual reality rehabilitation after stroke: an overview of systematic reviews, eClinicalMedicine. doi:10.1016/j.eclinm.2023.102220. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00397-8/fulltext
[ARTICLE] Reversing the Ruin: Rehabilitation, Recovery, and Restoration After Stroke – Full Text
Posted by Kostas Pantremenos in REHABILITATION on April 6, 2023
Abstract
Purpose of Review
Stroke is a common cause of disability in aging adults. A given individual’s needs after stroke vary as a function of the stroke extent and location. The purpose of this review was to discuss recent clinical investigations addressing rehabilitation of an array of overlapping functional domains.
Recent Findings
Research is ongoing in the domains of movement, cognition, attention, speech, language, swallowing, and mental health. To best assist patients’ recovery, innovative research has sought to develop and evaluate behavioral approaches, identify and refine synergistic approaches that augment the response to behavioral therapy, and integrate technology where appropriate, particularly to introduce and titrate real-world complexity and improve the overall experience of therapy.
Summary
Recent and ongoing trials have increasingly adopted a multidisciplinary nature — augmenting refined behavioral therapy approaches with methods for increasing their potency, such as pharmaceutical or electrical interventions. The integration of virtual reality, robotics, and other technological advancements has generated immense excitement, but has not resulted in consistent improvements over more universally accessible, lower technology therapy.
Introduction
An estimated 7.6 million American adults have had a stroke, and projections show that by 2030, an additional 3.4 million will, a 20% increase in prevalence over the next 10 years [1, 2]. However, recent advancements have driven an age-adjusted decrease in death from stroke and complementary increase in demand for rehabilitation [3]. A given individual’s needs after stroke vary widely as a function of the stroke extent and location. Motor impairments are the most common [4], but post-stroke cognitive impairments have been estimated in as much as half of surviving adults [5, 6] and may include deficits in reasoning, attention [7, 8], memory [9], and language that significantly contribute to a reduced quality of life [10]. Mental health also has been identified as an important mediating factor for rehabilitation success [11, 12].
Post-stroke recovery is impacted by numerous activity-dependent mechanisms including axonal sprouting [13, 14, 15], dendritic spine elaboration [16, 17], and migration of subventricular stem cells to peri-infarct regions [18, 19, 20]. Synaptic plasticity is the dominant mechanism for recovery. Thus, the basic principles of behaviorally supported neuroplasticity apply; frequent, rigorous, specific exercises lead to recovery of function [21]. The standard of care for post-stroke rehabilitation remains characterized by task-specific and task-oriented training strategies facilitated by a clinician and deployed for 30–60 min per day for each domain (physical and cognitive-linguistic) in the acute phase and tapering over time as a function of recovery and ongoing access to services.
The goal of physiatric research is maximizing the effectiveness and efficiency of supported recovery. This work can be broadly classified in one of three ways. First is the development and evaluation of activities and strategies to facilitate behavioral modification. Second is identification and refinement of synergistic approaches to behavioral therapy that decrease the threshold for long-term potentiation and depression through direct manipulations like transcranial direct current stimulation (tDCS) [22, 23, 24] or pharmacological adjuncts [25, 26•]. Finally, there is considerable enthusiasm for the introduction of emerging technology, such as robotics, virtual reality (VR), and gamification for the enhancement of therapy, which offer promising ways of improving rehabilitation adherence. These innovations also allow rehabilitation specialists to introduce and titrate real-world complexity and multifaceted demands, particularly in the inpatient setting. Patients may use these tools in conjunction with other technologies. For example, a patient may engage in a gamified version of a therapy task, meaning it integrates elements like scoring points, rules, puzzles, and competition, typically to increase interest and engagement in the activity’s goal, but instead of moving a joystick or pressing keys, the interaction with the task is electromyographically directed, meaning the electrical activity in the patient’s muscle is the input used to interact with the task.
Here, we will summarize the recent evidence for novel behavioral strategies, synergistic approaches, and technological enhancements across three key domains of function: mobility, cognition, and language. Mobility research has been substantially strengthened by the bench to bedside pipeline. However, there is a relative dearth of cognitive rehabilitation studies targeting attention, executive function, and memory, let alone positive trials. Despite considerable interest, studies targeting post-stroke language rehabilitation, or the treatment of aphasia, are even more niche and, thus, that much more difficult to design and execute. For this reason, we have incorporated both meta-analyses and systematic reviews, which near-ubiquitously note the paucity of well-controlled, sufficiently powered clinical trials, and descriptions of select ongoing trials into our review in order to best reflect the leading edge of physiatry research.[…]
[ARTICLE] Research Status and Emerging Trends in Virtual Reality Rehabilitation: Bibliometric and Knowledge Graph Study – Full Text
Posted by Kostas Pantremenos in REHABILITATION, Virtual reality rehabilitation on March 16, 2023
Abstract
Background:Virtual reality (VR) technology has been widely used in rehabilitation training because of its immersive, interactive, and imaginative features. A comprehensive bibliometric review is required to help researchers focus on future directions based on the new definitions of VR technologies in rehabilitation, which reveal new situations and requirements.
Objective:Herein, we aimed to summarize effective research methods for and potential innovative approaches to VR rehabilitation by evaluating publications from various countries to encourage research on efficient strategies to improve VR rehabilitation.
Methods:The SCIE (Science Citation Index Expanded) database was searched on January 20, 2022, for publications related to the application of VR technology in rehabilitation research. We found 1617 papers, and we created a clustered network, using the 46,116 references cited in the papers. CiteSpace V (Drexel University) and VOSviewer (Leiden University) were used to identify countries, institutions, journals, keywords, cocited references, and research hot spots.
Results:A total of 63 countries and 1921 institutes have contributed publications. The United States of America has taken the leading position in this field; it has the highest number of publications; the highest h-index; and the largest collaborative network, which includes other countries. The reference clusters of SCIE papers were divided into the following nine categories: kinematics, neurorehabilitation, brain injury, exergames, aging, motor rehabilitation, mobility, cerebral palsy, and exercise intensity. The research frontiers were represented by the following keywords: video games (2017-2021), and young adults (2018-2021).
Conclusions:Our study comprehensively assesses the current research state of VR rehabilitation and analyzes the current research hot spots and future trends in the field, with the aims of providing resources for more intensive investigation and encouraging more researchers to further develop VR rehabilitation.
Introduction
In recent years, the number of people with rehabilitation needs has increased, particularly among groups of older patients, patients with disabilities, patients with chronic diseases, and patients with functional and cognitive impairments. The loss of movement, sensation, balance, and cognition, as well as other aspects, seriously affects patients’ quality of life, work, study, and social life [1,2]. Such patients require long-term, consistent rehabilitation training and guidance [3]. However, traditional rehabilitation training has a number of problems, including fixed rehabilitation centers, a lack of rehabilitation resources, uninteresting training processes, high treatment costs, and a lack of automatic guidance and incentive mechanisms. These result in a lack of confidence in the rehabilitation process, which in turn affects the outcomes of rehabilitation treatments [4,5].
With the gradual popularization of virtual reality (VR) technology, rehabilitation training systems based on VR technology have been gradually applied in sports, exercise, and functional rehabilitation for various diseases and have achieved positive effect results [6,7]. The combination of VR technology and rehabilitation medicine can enable more patients to train regularly at home or in the community, as VR rehabilitation systems provide an immersive experience that stimulates patients’ interest and improves their participation, thus overcoming the disadvantages of fixed centers and the lack of resources [8]. Furthermore, VR rehabilitation systems can sense and record a patient’s movement and biological data via sensors to further improve existing rehabilitation programs [9]. This rehabilitation technology is a useful supplement to traditional rehabilitation and is a promising new research direction in the field of rehabilitation medicine.
A comprehensive bibliometric review is required to help researchers focus on future directions based on the new definitions of VR technologies in rehabilitation, which reveal new situations and requirements. Although bibliometric methods have yielded positive results in a variety of fields, we found that there is still a significant gap in the research on VR rehabilitation and its development trends by using bibliometric methods.
We used bibliometric methods to analyze SCIE (Science Citation Index Expanded) papers on studies related to VR rehabilitation research. Articles from different countries, regions, and research institutions were included. We identified papers in journals, gathered the top 10 citations, and enumerated how many times these citations were used. The VR rehabilitation knowledge base was analyzed by grouping authors’ co-occurring keyword networks. Burst citations were used to identify research hot spots on this topic, which could provide a useful reference for future research [10,11]. These analyses will provide rehabilitation specialists with a macroscopic understanding of the knowledge domain as a whole, as well as a microscopic characterization. Compared to other reviews, our study is timely and visual and provides an impartial approach to developing and exploring particular knowledge domains. Our findings may encourage more researchers to conduct additional research in this field to further develop VR rehabilitation methods. The following basic information was gathered from studies: titles, abstracts, author information, institutions, countries, regions, keywords, and citations.[…]
TBI Rehabilitation 