Posts Tagged technology

[Abstract] A smart brace to support spasticity management in post-stroke rehabilitation – Master Thesis

Abstract

This report covers the design of a product to help stroke survivors who are suffering from chronic spasticity manage their everyday activities. In the Netherlands alone, 44.000 people suffer from a Cerebro-Vascular Accident (CVA) each year. A CVA, more commonly known as a stroke, results in brain trauma with afflictions such as paralysis, fatigue and spasticity. It is possible to recover some, if not all, motor function though intensive physiotherapy, which requires long-term stay at a rehabilitation clinic in severe cases. Due to limited room and staff, only 12% of stroke survivors end up rehabilitating in a clinic. The remaining survivors are sent home, and will to travel to the clinic 3-5 times per week for therapy as part of the outpatient rehabilitation. Adjuvo Motion, a young start-up, aims to improve the situation of stroke survivors by bringing the rehabilitation centre to their home through the Adjuvo Platform, which allows them to perform exercises in the context of virtual tasks. They proposed an assignment to extend their product portfolio with a Range of Motion assessment device that is suited for those suffering from spasticity. Spasticity occurs in roughly 60% of stroke survivors with varying degrees of intensity. It is caused by the damaged parts of the brain sending conflicting signals to the muscles, causing them to contract. This inhibits the survivor’s ability to perform daily tasks, but can be solved temporarily with stretching exercises. A solution to compensate for these spastic forces using a passive-assist device was proposed at the start of this project. The project was divided into four stages: Analysis, Synthesis, Embodiment and Evaluation. During the Analysis stage, interviews with a Physiotherapist and stroke survivor and literature studies regarding anatomy, the state of the art and relevant technologies were used to create a framework for the design of a smart passive-assist glove. Looking at competing products, there is a demand for passive assist and Range of Motion assessment functionalities, yet a combination of these in a single device is not yet present in the market. During the Synthesis stage, the design problem of the passive assist device was split into three groups: Orthoses; the connections to the body, Passive Assist; the compensation medium, and RoM measurement; the sensing mechanism(s). These three groups were further split into sub-problems, the solutions to which were compiled into a Morphological Chart. By combining the solution within this chart, three promising concept designs were created: One upgrade to the existing sensor glove, one full integration of sensing and passive assist, and one passive assist glove with removeable sensors. To evaluate these concepts, eight criteria were established and weighted with the help of a physiotherapist. In order to create an objective assessment, the criteria were kept strictly quantitative and the three designs were first scored against the Raphael Smart Glove by Neofect using early prototypes. These scores were then used to evaluate the designs relative to each other, which resulted in an overall higher score for the concept with separable electronics. Making the sensor part of the brace removeable allowed the product to be used during daily life as well as physiotherpy exercises, and proved a key benefit in keeping the product clean. Based on the chosen design, four iterations of prototypes were made, which were tested with healthy subject. During this stage, it became clear that flex sensors are be best suited to create a range of motion assessment for spastic stroke patients, since it is less important to know how well they perform a task, and more important to know if they can actually perfrom it. Based on a quantified use case, the four sub-assemblies; the Wrist Wrap, Finger Modules and Sensor Module, and their connections were materialized in the Embodiment design stage. When selecting production methods, the main challenge was a small batch size of 1000 units, which made conventional techniques for mass production, such as Injection Molding, less attractive. This stage ended in an assesment of the product’s production price and durability: The product would cost €250 to make, and would last for 2.5 years before the Velcro connection on the Wrist Wrap would become too weak to sustain the spasticity forces. In the Evaluation stage, the product was evaluated on the seven most important requirements established during the analysis stage. For several of these, a user test was performed, again with healthy subject. While the Adjuvo Auxilius passed most theoretical requirements, the user tests on healthy subjects could not be used to draw any conclusions regarding its effectiveness on spastic stroke patients. However, since the product’s working principle is based on that of existing spasticity compensation products, the prediction is that the Auxilius will be an effective therapy supplement. The result of this project is the Adjuvo Auxilius; a spasticity-compensation glove with modular sensors, which can be added to allow virtual (stretching) exercises through the Adjuvo Motion’s platform. The results of these exercises are used to create a remote assessment of the patients motor skills, and to adjust the therapy if needed.

via A smart brace to support spasticity management in post-stroke rehabilitation | TU Delft Repositories

 

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[ARTICLE] A Cloud-Based Virtual Reality App for a Novel Telemindfulness Service: Rationale, Design and Feasibility Evaluation – Full Text

ABSTRACT

Background: Worldwide, there has been a marked increase in stress and anxiety, also among patients with traumatic brain injury (TBI). Access to psychology services is limited, with some estimates suggesting that over 50% of sufferers are not accessing the existing services available to them for reasons such as inconvenience, embarrassment, or stigmatization concerns around mental health. Health service providers have increasingly been turning to drug-free therapies, such as mindfulness programs, as complementary treatments.

Objective: Virtual reality (VR) as a new delivery method for meditation-based stress and anxiety reduction therapy offers configurable environments and privacy protection. Our objective was to design a serious learning-meditation environment and to test the feasibility of the developed telemindfulness approach based on cloud technologies.

Methods: We developed a cloud-based system, which consisted of a Web interface for the mindfulness instructor and remote clients, who had 3D VR headsets. The mindfulness instructor could communicate over the Web interface with the participants using the headset. Additionally, the Web app enabled group sessions in virtual rooms, 360-degree videos, and real interactions or standalone meditation. The mindfulness program was designed as an 8-week Mindfulness-Based Stress Reduction course specifically for the developed virtual environments. The program was tested with four employees and four patients with TBI. The effects were measured with psychometric tests, the Mindful Attention Awareness Scale (MAAS) and the Satisfaction With Life Scale (SWLS). Patients also carried out the Mini-Mental State Examination (MMSE). An additional objective evaluation has also been carried out by tracking head motion. Additionally, the power spectrum analyses of similar tasks between sessions were tested.

Results: The patients achieved a higher level of life satisfaction during the study (SWLS: mean 23.0, SD 1.8 vs mean 18.3, SD 3.9) and a slight increase of the MAAS score (mean 3.4, SD 0.6 vs mean 3.3, SD 0.4). Particular insight into the MAAS items revealed that one patient had a lower MAAS score (mean 2.3). Employees showed high MAAS scores (mean 4.3, SD 0.7) and although their SWLS dropped to mean 26, their SWLS was still high (mean 27.3, SD 2.8). The power spectrum showed that the employees had a considerable reduction in high-frequency movements less than 0.34 Hz, particularly with the 360-degree video. As expected, the patients demonstrated a gradual decrease of high-frequency movements while sitting during the mindfulness practices in the virtual environment.

Conclusions: With such a small sample size, it is too early to make any specific conclusions, but the presented results may accelerate the use of innovative technologies and challenge new ideas in research and development in the field of mindfulness/telemindfulness.

Introduction

Attention impairment has often been considered a hallmark of mental illness. Attention training is an important part of meditation, and has proven to augment the ability to sustain attention [1]. Mindfulness as a meditation tool has an important role in psychology, self-awareness, and well-being. The authors Brown and Ryan [2] reported that mindfulness over time was related to a reduction in variable mood and stress in patients with cancer. Mindfulness is an internationally recognized therapy that teaches self-awareness, maintaining own thoughts, sensations, feelings, emotions, and appreciation of your living environment [3]. The mindfulness meditation technique may help patients manage potentially negative outcomes and improve well-being by controlling unselfconsciousness (thoughts on failure). Avoiding problems associated with the future, focusing on the present, being “now,” and controlling the tracking of time may, in addition to well-being, lead to mindfulness. A person who can achieve such an active and open attention state can control thoughts from a distance, free to judge whether they are good or not [4]. In this context, mindfulness can also be considered an important tool for managing anxiety and stress in patients [2]. Kabat-Zinn [3] designed an 8-week meditation course, Mindfulness-Based Stress Reduction, which provides 2 hours of meditation in a group with additional homework. Mindfulness-Based Stress Reduction has demonstrated that awareness of the mind, unconscious thoughts, feelings, and other emotions positively affect major physiological processes and thus decreases the level of stress-related disorders [46].

Anxiety and stress disorders can be related to pressure at work, incurable diseases, or neuromuscular disorders, such as Parkinson disease, light traumatic brain injury (TBI), multiple sclerosis, or other diseases of the muscular or central nervous system. Deficits in executive functions, memory, and learning are often documented after TBI. In addition, at least half of those suffering from TBI experience chronic pain and/or sleep disorders, depression, and substance abuse [7].

A review of the literature shows that neural systems are modifiable networks and changes in the neural structure can occur in adults as a result of training [8]. The study reported on anatomical magnetic resonance imaging (MRI) images from 16 healthy meditation-naïve participants who underwent the 8-week mindfulness program [8]. The results obtained before and after the program suggested that participation in a Mindfulness-Based Stress Reduction course was associated with changes in gray matter concentration in the regions of the brain involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking.

Early rehabilitation in the acute and subacute phase may be a critical period and a key to effective rehabilitation, especially in TBI [9]. A significant drawback is that patients often stay in hospital for a limited time and are soon discharged for recovery at home. Afterward they can visit an outpatients’ clinic. Patients residing close may find the outpatient service convenient, but it could be very inconvenient for those who are in need of ongoing care, are dependent on public transport, or in the worst case do not have access to transport at all. Consequently, external factors such as travel fatigue may hinder the effectiveness of the therapy and, in some, may even increase anxiety and stress. In addition, modern diseases caused by stress and anxiety in the workplace are on the increase, but access to treatment and therapy is usually not possible during working hours [10].

Innovative technologies can ensure real-time communication and data recording/sharing over long distances, even within larger groups of participants [11]. Nowadays, privacy, data security, shyness, and pride are among the most frequent reasons to avoid therapy if a mental disease or neuromuscular disorder is related to work or social status [12].

Some patients prefer to remain anonymous and do not want to reveal their problems, even to colleagues. The sense of “total immersion” created by virtual reality (VR) is an emerging technology that may entirely replace mainstream videoconferencing techniques [13]. These technologies may fulfill patient expectations [14] regarding anonymity and enhance presence [15]. Patients can hide their identify using an avatar and their voices can be disguised. Psychologists and other experts may observe the kinematic changes in motion patterns, gestures, face mimics, and other measurable features [12]. If there is a group, the VR avatars can be synchronized and controlled in real time, using cloud-based technologies. The operator can form groups, deliver individual or group tasks, or lead a private conversation with selected participants. We have developed a technology that is available for home and workplace use, called Realizing Collaborative Virtual Reality for Well-being and Self-Healing (ReCoVR), for which the VR headset is coupled with a mobile phone. The only requirement is a connection to Wi-Fi/4G Internet, plus communication with the cloud server allows remote interaction with other users residing thousands of miles away.

This cloud-based app is used for interaction and communication between a mindfulness expert and participants. Each participant uses a commercially available mobile phone and a simple head-mounted VR headset to join the mindfulness session in the virtual environment (VE). Our main objectives were to design a suitable mindfulness protocol based on Mindfulness-Based Stress Reduction, with tasks in the VE with 360-degree videos, and to test the feasibility of the developed mindfulness/telemindfulness app in a real environment. Additionally, we analyzed head movements during mindfulness sessions to stimulate further initiatives in this research space. […]

Continue —> JRP-A Cloud-Based Virtual Reality App for a Novel Telemindfulness Service: Rationale, Design and Feasibility Evaluation | Cikajlo | JMIR Research Protocols

Figure 1. The ReCoVR system consists of a cloud server, serving information for the WebGL scenery and synchronization of the data (audio, video, data) between the server and clients. The clients connect to the server as mindfulness experts (using a computer with Web browser) and as mindfulness therapy participants (using Samsung GearVR 3D headset with Wi-Fi/LTE).

Figure 2. The mindfulness instructor uses the Web interface to manage the group therapy in the virtual room. The Web interface enables video-audio communication with the participants (below left), making subgroups, and assigning tasks (right) for mindfulness sessions. Additionally, the therapist can share documents and lead the session, while everybody can send/receive messages and talk to other group members.

 

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[WEB SITE] Using Tech to Improve life with Epilepsy

Jennifer’s Story

Colleen’s life began with so much uncertainty; none of her doctors knew what to expect and what she would be capable of. As she’s gotten older, we’ve had to overcome many issues, including communication and safety. But this is where technology has begun to play a key role.

Having both epilepsy and cerebral palsy, I thought her crib would work for her for a while. It was lowered to as far as it would go, and I thought that it was enough to keep her safe. One day, much to my surprise, she managed to get out of her crib and crawl to the landing at the top of the stairway. Thank goodness for some left-out Easter decorations, or I don’t want to know what could have happened. I knew at that point, Colleen needed a better option. We worked with her service coordinator and I began to search online for solutions. A lot of options were large and clunky. Or, they left me wondering just how long they would work for. I found and petitioned for the Safety Sleeper, also known as Abrams Bed. It’s an enclosed bed designed for special needs and has been an absolute life-saver. Colleen loves it and I can sleep well at night knowing she can’t fall out or get into anything unsafe. What makes the Safety Sleeper better for our needs is that it is portable. It came with it’s own suitcase and is very easy to assemble. So, when we make our annual trip to Boston Children’s or want to go on vacation (this actually hasn’t quite happened yet!) it can be brought with us!

Colleen, spent 20 days in the NICU. There was a lot of uncertainty, questions that couldn’t be fully answered. But I believed when they thought she would eventually grow out of it. The medications changed, but her EEG’s stayed the same. Throughout, I still hoped that maybe one day when we went in for that EEG, we’d finally be told that there was an improvement. She had two seizures in the NICU, and one in 2013. But there was a dramatic increase in visible seizures in 2015 (I say visible because her EEG showed seizure activity, but we couldn’t tell she was having anything, other than maybe a slight pause or some blinking). This is when I discovered the very real and very scary SUDEP. None of her doctors ever told me about the risk. I was always scared about Colleen having a seizure at night, but with her increase, I became very scared of this possibility. I remembered having seen a GoFundMe campaign for the Embrace epilepsy monitoring watch.

What amazing technology! Something that could detect seizures and alert caregivers? I didn’t even know that was possible. But at that point in time, they weren’t ready. So I began to search for other options and found the SAMi camera. This gets mounted to a wall near their bed, and can detect seizure movements. This was the first step to being able to sleep better at night. I cannot say just how much better it makes you feel to know that your loved one, your child has a constant watch on them. Once the Embrace watch was released, Colleen received hers and we could not be happier. It has alerted up on a few occasions where we were able to get to Colleen and make sure she’s safe until the end of her seizure. This device is also invaluable.

Through all this, even with the close monitoring, you still want what is best for your child, no matter what. And as technology also advances, so does medical innovation. I clearly remember the words of Colleen’s neurologist. She has scar tissue on her right and left frontal lobe from her birth injury. “Once the neurons are damaged, they cannot regrow.” It was crushing, but I knew it was true. I just hoped that her brain, as little as she was, would be able to “remap” itself to avoid the damage. Still, instead of accepting that as it was, I researched “neuron regeneration” when we got home from the neurologist and found two research studies; one in the U.S and one in Europe. Maybe not now, but in the future, there could be hope!

But, what if there is hope today? As I was browsing Instagram one day, I found a post from one of the families I follow whose daughter also has cerebral palsy, and she talked about receiving stem cell therapy. I immediately began to research and even emailed the mother who had posted about the therapy. The doctor she brought her daughter to in California uses cord blood stem cells. Stem cells are thought to be able to travel to areas of the body where they are needed. They are able to bridge gaps and form new neurons.

I was elated. We got in touch with the doctor and were able to raise enough money to take her. One of the things that struck me most about the doctor was when he was talking about stem cell therapy. He told me so many successes and stories of hope and miracles. The stem cells themselves are screened, as with the mom and baby, almost like if you were donating blood. They are 100% safe. I see the progress of the family on Instagram, and I had a co-worker come to me and tell me about their niece, who had had the therapy within a medical study.

The therapy session itself is very easy. We traveled from New York to California. Her appointment was at 9AM. Walking talking through everything with us, we gave Colleen a dose of her emergency med to help her relax. He also programed a Microcurrent machine, which was a surprise. When you get an EEG, electrodes are placed on your head, and they can essentially read the brain waves. Microcurrent is able to focus on those areas, almost as a way to direct the stem cells where to go. Colleen’s microcurrent program was directed to her right and left frontal lobe as well as her ears (she has bilateral hearing loss).

We are two months post-stem cells and so far, very happy with the results. Colleen is babbling a lot more. She’s making sounds that she never did prior. She’s experiencing far less stomach issues. She can incredibly close to needing a feeding tube as she was failure to thrive. After having to see her literally suffer for months and months, it’s amazing that she’s no longer uncomfortable and in pain. She’s more aware of her surroundings and has been more careful. She’s using her arms more and seems stronger. A week after stem cells, she went to see her neurologist. I was sad to find out there was really no change in her EEG, but that’s okay. When she’s gotten enough sleep, we’ve seen far less myoclonic jerks. After one treatment, I think it’s safe to say that this medical innovation is a life-changer and we plan on bringing Colleen back for additional treatment.

Epilepsy makes me feel out of control. In some sense, I have felt that no matter what we did, we just couldn’t help her in the way we would like. What has made me feel empowered is researching. The more knowledge I have, the more prepared I can be for the uncertainties. Technology has given me peace of mind, and I have no doubt that there are and can be better options in the future. Of course, as a mother, nothing would make me happier than for there to be a cure for epilepsy.

This is where, I believe, medical innovation will come into play. And based on what we’ve been able to do so far, I have faith.

If you would like any more information about stem cell therapy, or any of the other things I have talked about, please feel free to email me at jennylouns@email.com

via Using Tech to Improve life with Epilepsy – Alert News Today

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[CORDIS] A sensor-fitted suit to analyse stroke patients’ movements.

The moment when stroke patients return home after treatment has always been a source of concern for both themselves and their physicians, as the latter are left blind without any feedback. But this is now a thing of the past: a novel suit fitted with 41 sensors is finally ready for commercialisation.

A sensor-fitted suit to analyse stroke patients’ movements

© Wright Studio, Shutterstock 

Could resorting to rehabilitation clinics be less of a necessity in the near future? Whilst these clinics effectively help patients to face post-stroke everyday life, stakeholders tend to agree that a better understanding of how these people function in the absence of medical support could lead to more effective rehabilitation at a lower cost.

This is what Bart Klaassen, PhD student at the University of Twente, and and a large team of researchers from across Europe have been working on under the INTERACTION project. Together they developed and validated an unobtrusive and modular system for monitoring daily life activities and for training motor function in stroke subjects, in the shape of a multi-sensor-equipped suit.

This project is presented by Klaassen and his team as a world first. ‘There has long been a great need for systems like this, but the technology simply was not ready,’ he says. ‘That is now changing rapidly, thanks to rapid developments in the fields of battery technology, wearables, smart e-textiles and big data analysis.’

The INTERACTION suit has been extensively tested on patients over a period of three months, during which they were asked to wear it under their regular clothes. The data was then transmitted, stored and processed thanks to a portable transmitter that can relay all of the information gathered through the internet to data processing servers at the University of Twente. The 41 sensors included in the suit monitor a large number of body segments, providing information on muscle strength, stretch and force.

‘We have been able to demonstrate that all the information is transmitted successfully, that this process is very efficient, and much more besides,’ Klaassen enthuses. ‘We have succeeded in modelling all of the relevant movements, and in cleaning up the data that is relevant for the therapist by filtering out the rest. Our project has delivered new techniques and methods that can be used to monitor patients at home for extended periods of time, and to identify any differences with structured clinical measurements. We are currently engaged in further research to obtain final verification that these methods are indeed an ideal way of supervising rehabilitation.’

The press release recently published by the University of Twente says no word about a potential date of commercialisation. However, the fact that both insurance companies and healthcare professionals were involved from the early stages of the project leaves little doubt that stroke patients will soon benefit from this technological breakthrough.

For more information, please see:
CORDIS project page

Source: Based on a press release from the University of Twente

 

via European Commission : CORDIS : News and Events : A sensor-fitted suit to analyse stroke patients’ movements

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[BOOK] Atlas of Orthoses and Assistive Devices E-Book – Google Books

 

Front Cover
Elsevier Health SciencesNov 24, 2017 – Medical – 672 pages

Advances in the material sciences, 3D printing technology, functional electrical stimulation, smart devices and apps, FES technology, sensors and microprocessor technologies, and more have lately transformed the field of orthotics, making the prescription of these devices more complex than ever beforeAtlas of Orthoses and Assistive Devices, 5th Edition, brings you completely up to date with these changes, helping physiatrists, orthopaedic surgeons, prosthetists, orthotists, and other rehabilitative specialists work together to select the appropriate orthotic device for optimal results in every patient.

 

 

via Atlas of Orthoses and Assistive Devices E-Book – Joseph Webster, Douglas Murphy – Google Books

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[BLOG POST] Guidelines To Flying After A Stroke – Saebo

After suffering from a stroke, it is likely that a survivor will have limited activity. Issues with daily routines and general mobility are common, but one of the most difficult factors to consider is the idea of traveling by plane.

Transporting yourself or a loved one who has just battled a stroke can seem frightening, and with good reason. In most cases, neurological damage from a stroke has impacted the body, which creates concern when placing an individual into an environment where altitude and air pressure are variables. But as risky as it may appear, flying poses no immediate threat to a stroke survivor as long as necessary precautions are taken.

Is it Safe to Fly After a Stroke?

When it comes down to a stroke survivor’s ability to fly, the answer is yes. Flying shouldn’t be a detriment to a survivor’s health, but there are several things to consider before booking a ticket.

Timing

First off, it is crucial to avoid flying within the first couple weeks of having a stroke. This span can reveal some of the strongest signs of mental and physical impairment, so giving a survivor time to adjust is important. In any situation, make sure to consult with a doctor before making travel plans.

Less Oxygen

Once you or a loved one are on board, another factor to keep in mind is the amount of oxygen available on an aircraft. Typically, cabins provide less oxygen than a normal environment, so if one has any respiratory issues or heart complications, this is something to account for. Generally speaking, lower oxygen levels shouldn’t cause a problem, but making sure you or a loved one are comfortable is always a top priority.

Deep Vein Thrombosis (DVT)

No matter who you are, sitting for a long time can cause pain in your muscles, especially your legs. For shorter flights (one to two hours), inactivity may not be so severe, but longer flights (5 hours or more) are a different story. When seated for an extended time, blood flow in the body begins to slow down, making it easier for blood to clot. Basically, Deep Vein Thrombosis (DVT) is a blood clot that forms within a vein, mostly occurring in the legs.

Cases of a DVT have the ability to become more severe if a small clot dislodges itself and travels to the lungs, heart, or brain. As scary as this may sound, a DVT can happen to anybody during long-distance travel, so there is no need to worry too much, but those who have a history of stroke are more prone to experiencing it. The best way to avoid having a DVT is to stand and stretch every hour so that blood circulates efficiently. If standing is not possible, then manually bending the arms and legs is a good alternative.

Hypercoagulability (Thrombophilia)

For some individuals, a condition known as hypercoagulability (formally known as Thrombophilia) can be a serious issue to consider before flying. Hypercoagulability is an abnormality that heightens the risk of blood clotting. Check with your doctor regarding treatment options such as blood thinners or compression stockings. It is also most likely to be a concern for those who have suffered from a DVT in the past. If you have or a loved one has experienced a DVT, talk with your doctor to see if you may be susceptible to hypercoagulability.

What Medication Should I Take to Fly?

When it comes to medication, being prepared is key. Flights are notorious for running late and experiencing delays, so it is highly recommended that you pack whatever medications you may need into your carry-on luggage. In the off-chance that your carry-on luggage needs to be checked, you can get innovative and pack your necessities into a purse or backpack that you can carry with you at all times. Most airlines allow you to bring liquid medications or dietary supplements on board, but checking your airline’s safety regulations beforehand is always a good idea. To provide additional support, consider getting a note or prescription from your primary doctor that lists the medication you will be taking with you; that way, you can avoid any potential interruptions.

What Extra Steps Will There Be For Me?

Along with making arrangements for the actual flight, it is extremely helpful to take advantage of every opportunity the airline itself can provide. For example, if you know in advance that your itinerary will be strenuous, you can call the airline before your trip—preferably 48 hours prior—to discuss any concerns.

More than likely, your airline will accommodate you as much as possible, but remember that crew members are not allowed to give any kind of physical, individualized care. If you or a loved one cannot perform certain physical requirements, or if there is limited mobility, it may be a good idea to travel with a friend or an affordable attendant that can assist in any situation.

If any kind of portable equipment is needed for air travel, the majority of airlines will store up to two items free of charge; however, substantial items—a wheelchair or something larger—must be checked.

In the Air Again

Being a stroke survivor certainly comes with its challenges, but it doesn’t mean that you or a loved one can’t live a full life. With any serious medical condition, a certain level of patience and resilience is required to prevail, and traveling via plane is doable with the right amount of support.

If you or a loved one plan to fly in the future, make sure to get the proper clearance and guidance from a healthcare professional, and check with the airline on the assistance they can offer. By asking questions and being prepared, you can ensure that your next trip will be successful. For more answers on common questions about recovering after a stroke, click here.

via Guidelines To Flying After A Stroke | Saebo

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[ARTICLE] How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers – Full Text

Abstract

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program.

Background

Disabilities cause complex problems in society often unique to each person. A physical disability can limit a person’s ability to access buildings and other facilities, drive, use public transportation, or obtain the health benefits of regular exercise. Blindness can limit a person’s ability to interpret images or navigate the environment. Disabilities in speaking or writing ability may limit the effectiveness of communication. Cognitive disabilities can alter a person’s employment opportunities. In total, a substantial fraction of the world’s population – at least 1 in 6 people – face these individualized problems that combine to create major societal impacts, including limited participation. Further, the average person in the United States can expect to live 20% of his or her life with disability, with the rate of disability increasing seven-fold by age 65 [1].

In light of these complex, pervasive issues, the field of rehabilitation engineering asks, “How can technology help?” Answering this question is also complex, as it often requires the convergence of multiple engineering and design fields (mechanical, electrical, materials, and civil engineering, architecture and industrial design, information and computer science) with clinical fields (rehabilitation medicine, orthopedic surgery, neurology, prosthetics and orthotics, physical, occupational, and speech therapy, rehabilitation psychology) and scientific fields (neuroscience, neuropsychology, biomechanics, motor control, physiology, biology). Shaping of policy, generation of new standards, and education of consumers play important roles as well.

In the US, a unique research center structure was developed to try to facilitate this convergence of fields. In the 1970’s the conceptual model of a Rehabilitation Engineering Center (REC), focusing engineering and clinical expertise on particular problems associated with disability, was first tested. The first objective of the nascent REC’s, defined at a meeting held by the Committee on Prosthetic Research and Development of the National Academy of Sciences, was “to improve the quality of life of the physically handicapped through a total approach to rehabilitation, combining medicine, engineering, and related science” [2]. This objective became a working definition of Rehabilitation Engineering [2].

The first five centers focused on topics including functional electrical stimulation, powered orthoses, neuromuscular control, the effects of pressure on tissue, prosthetics, sensory feedback, quantification of human performance, total joint replacement, and control systems for powered wheelchairs and the environment [2]. The first two RECs were funded by the Department of Health, Education, and Welfare in 1971 at Rancho Los Amigos Medical Center in Downey, CA, and Moss Rehabilitation Hospital in Philadelphia. Three more were added the following year at the Texas Institute for Rehabilitation and Research in Houston, Northwestern University/the Rehabilitation Institute of Chicago, and the Children’s Hospital Center in Boston, involving researchers from Harvard and the Massachusetts Institute of Technology [3]. The Rehabilitation Act of 1973 formally defined REC’s and mandated that 25 percent of research funding under the Act go to them [2]. The establishment of these centers was stimulated by “the polio epidemic, thalidomide tragedy and the Vietnam War, as well as the disability movement of the early 70s with its demands for independence, integration and employment opportunities” [3].

After the initial establishment of these RECs, the governmental funding agency evolved into the National Institute on Disability and Rehabilitation Research (NIDRR, a part of the U.S. Department of Education), and now is the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR, a part of the U.S. Department of Health and Human Services. Today, as we describe below, the RERC’s study a diverse set of technologies and their use by people with a disability, including human-computer interaction, mobile computing, wearable sensors and actuators, robotics, computer gaming, motion capture, wheeled mobility, exoskeletons, lightweight materials, building and transportation technology, biomechanical modeling, and implantable technologies. For this review, we invited all RERCs that were actively reporting to NIDILRR at the onset of this review project in 2015, and had not begun in the last two years, to participate. These were centers that were funded (new or renewal) in the period 2008-2013, except the RERC Wheelchair Transportation Safety, which was funded from 2001-2011. Two of the RERCs did not respond (see Table 1). For each center, we asked it to describe the user needs it targets, summarize key advances that it had made, and identify emerging innovations and opportunities. By reviewing the scope of rehabilitation engineering research through the lens of the RERCs, our goal was to better understand the evolving nature and demands of rehabilitation technology development, as well as the influence of a multidisciplinary structure, like the RERCs, in shaping the producing of such technology. We also performed an analysis of how multidisciplinary the current RERCs actually are (see Table 3), and asked the directors to critique and suggest future directions for the RERC program.[…]

Continue —>  How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 14 Some MARS RERC projects. a) The KineAssist MX® Gait and Balance Device b) The Armeo Spring® reaching assistance device c) The March Hare virtual reality therapy game d) The Lokomat® gait assistance robot e) Robotic Error Augmentation between the therapist and patient f) lever drive wheelchair g) Ekso® exoskeleton h) Body-machine interface for device control

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[Abstract] Providing Sources of Self-Efficacy Through Technology Enhanced Post-Stroke Rehabilitation in the Home.

Abstract

This research explores the impact of receiving feedback through a Personalised Self-Managed Rehabilitation System (PSMrS) for home-based post-stroke rehabilitation on the users’ self-efficacy; more specifically, mastery experiences and the interpretation of biomechanical data. Embedded within a realistic evaluation methodological approach, exploring the promotion of self-efficacy from the utilisation of computer-based technology to facilitate post-stroke upper-limb rehabilitation in the home included; semi-structured interviews, quantitative user data (activity and usage), observations and field notes. Data revealed that self-efficacy was linked with obtaining positive knowledge of results feedback. Encouragingly, this also transferred to functional activities such as, confidence to carry out kitchen tasks and bathroom personal activities. Findings suggest the PSMrS was able to provide key sources of self-efficacy by providing feedback which translated key biomechanical data to the users. Users could interpret and understand their performance, gain a sense of mastery and build their confidence which in some instances led to increased confidence to carry out functional activities. However, outcome expectations and socio-structural factors impacted on the self-efficacy associated with the use of the system. Increasing the understanding of how these factors promote or inhibit self-management and self-efficacy is therefore crucial to the successful adoption of technology solutions and promotion of self-efficacy.

Source: Providing Sources of Self-Efficacy Through Technology Enhanced Post-Stroke Rehabilitation in the Home. – PubMed – NCBI

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[WEB SITE] How It All Works – Brainworks

eRehabilitation™: The future of rehab!


One thing we know for certain is that the future of rehab is inseparable from the Internet. To be client–centred, we have to go where our clients are … and our clients are everywhere, throughout the community and all over the Internet. The growth and complexity of knowledge, research and evidence for best practices in health mirrors the growth of the Internet and its tools to disseminate information, to provide forums for eclectic interactions and informative discussions. Our clients are aptly at this intersection – they are at the centre and we need to meet them there. This intersection is a magical place; it‘s on fire with prolific activity.

We are the benefactors of a modern revolution: the intersection of advances in technology, creative interfaces and evidence-based therapies are taking healthcare to levels only dreamed of. “The motive behind the use of this technology is to maintain the essential qualities of the health-care interaction, while improving access by overcoming barriers such as economics, culture, climate, and geography,” (Rees, 2004).

Telehealth has been touted as the most significant contribution to health-care delivery systems of the future (Bashshur, 1997). eRehabilitation™, a component of telehealth, is a cutting-edge, yet flourishing means of delivering rehabilitation, psychological & mental health services.

At Brainworks, we have developed eRehabilitation™ as a comprehensive treatment platform that uses interactive audio, video, or data communications to provide rehabilitation services at a distance.

 

Does eRehabilitation™ work?

Absolutely – eRehabilitation™ is Evidence-Based: there is a growing literature base that demonstrates the efficacy of these interactive, online modalities.

There are several areas for which online guided therapy based on CBT could be regarded as empirically-supported (Andersson, 2009), including panic disorder, social anxiety disorder, posttraumatic stress disorder (PTSD), and mild to moderate depression. progress. Carlbring et al. (2005) found equivalent outcomes of individual face-to-face CBT and Internet CBT for panic disorder. In a trial on depression (Spek, Nyklıcek, et al., 2007) found no differences between live group treatment and Internet CBT.

A recent study by Matsura et al. (2002) investigated the interrater reliability of videoconferencing compared with face-to-face assessment interviews. Perfect agreement was obtained between both interviewing conditions. Glueckauf et al. (2002) assessed the effects of videoconferencing-based counselling compared with counselling using a speakerphone, and conventional, face-to-face counselling. The counselling was provided to 22 rural teenagers with epilepsy. All treatment conditions were associated with similar outcomes, including significant reductions in problem severity and frequency.

Day and Schneider (2002) conducted a comprehensive and methodologically sound study evaluating the delivery of brief CBT via videoconferencing. A sample of 80 clients with concerns ranging from weight concerns to personality disorders were randomly assigned to one of three treatment groups (face-to-face, two-way audio, or two-way video) or a waiting list control group. No significant differences were found between treatment groups across outcome measures and all three groups were significantly superior to the no-treatment group.

A number of studies have demonstrated the benefits of conducting assessments via the Internet. These include: ease of administration, collecting data, communicating findings to clients, cost efficiency, reaching disabled persons and those that live in the rural areas (EmmelKamp, 2005; Fischer & Freid, 2001; Naus, Phillip, & Samsi 2009;).


References:

References available upon request. Please contact us for more information and literature to support your referral!

Source: How It All Works – Brainworks

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[Executive Summary] Rehabilitation Research at the National Institutes of Health: Moving the Field Forward – Full Text

Article Outline

  1. Rehabilitation across the lifespan
  2. Technology in rehabilitation: From cutaneous to implanted
  3. Mechanisms and markers of activity and function
    1. Exercise, plasticity, and mechanism: “How is rehabilitation happening?”
  4. Access to the lived environment
  5. Individuals, families, and community
  6. Understanding the context: Environmental impacts in rehabilitation
  7. Effective pathways to evidence for rehabilitation
  8. Central and peripheral mechanisms of rehabilitation
  9. Bending the arc of technology toward rehabilitation and health
  10. Transitions across the lifespan
  11. Novel outcomes in rehabilitation and integration into clinical care
  12. Using data to drive discovery
  13. Preventing secondary disability
  14. Development of an NIH rehabilitation research plan
  15. Acknowledgments

Approximately 53 million Americans live with a disability. For decades, the National Institutes of Health (NIH) has been conducting and supporting research to discover new ways to minimize disability and enhance the quality of life of people with disabilities. After the passage of the American With Disabilities Act, the NIH established the National Center for Medical Rehabilitation Research with the goal of developing and implementing a rehabilitation research agenda. Currently, a total of 17 institutes and centers at NIH invest more than $500 million per year in rehabilitation research. Recently, the director of NIH, Dr Francis Collins, appointed a Blue Ribbon Panel to evaluate the status of rehabilitation research across institutes and centers. As a follow-up to the work of that panel, NIH recently organized a conference under the title “Rehabilitation Research at NIH: Moving the Field Forward.” This report is a summary of the discussions and proposals that will help guide rehabilitation research at NIH in the near future.

The conference took place at the NIH Campus on May 25 and 26, 2016. It was cosponsored by The Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Biomedical Imaging and Bioengineering, the National Institute of Neurological Diseases and Stroke, the National Institute of Nursing Research, the National Institute on Deafness and other Communication Disorders, the National Center for Complementary and Integrative Health, and the Office of Disease Prevention. The main objectives of the Conference were to (1) discuss the current NIH portfolio in rehabilitation research, (2) highlight advances in rehabilitation research supported by NIH, and (3) provide an opportunity for scientists and the general public to comment on gaps in knowledge, opportunities for training, and infrastructure needs. The program included a total of 13 expert panels, four remarks by NIH leaders, a consumer keynote, a town hall, a poster session, and the use of social media to disseminate information in real time. The following is a summary of the discussion and the subheadings correspond to the title of the expert panels.

Continue —> Rehabilitation Research at the National Institutes of Health: Moving the Field Forward (Executive Summary) – Archives of Physical Medicine and Rehabilitation

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