Posts Tagged Training

[WEB SITE] Top 10 Virtual Reality Applications In Today’s World

The premise of virtual reality has always been exciting. Slip-on a pair of goggles or a headset, and you’re on your way to another world. Unlike at the cinema or in front of your TV screen, you’re free to interact with your surroundings and wander wherever you please.

VR exploded into public consciousness around the same time as the personal computer in the late ‘80s and early ‘90s. Back in those days, however, the difference between the real world and the pixel-heavy digital landscapes of the time was too great for everyone but for the most hardcore fans. As a result, VR was more or less put on the backburner for a couple of decades.

However, the birth of the Oculus Rift in 2012 and its subsequent purchase by Facebook in 2014 led to a renewal of interest in virtual reality applications. It also served as an uptick in virtual reality recruitment as companies cottoned on to the medium’s vast potential.

How Does Virtual Reality Work?

So, how does virtual reality work? Nowadays, virtual reality is implemented using computer technology via tools such as headsets, goggles, treadmills, and handsets. These tools stimulate our senses to create an illusion of reality. This is far more complicated than it seems: human physiology is calibrated to provide a finely synchronized experience, and if anything is ‘odd’, our bodies will usually let us know via unpleasant sensations such as nausea or motion sickness. A successful virtual reality experience involves careful synchronicity of software, hardware, and of our senses. The most memorable virtual reality uses are those that enable us to interact naturally with our surroundings with no latency or glitches that could create a feeling of artificiality.

This leads us to ask ourselves, “Why do we go to all that trouble to create these highly technical worlds that just aim to imitate reality?” The truth is, virtual reality applications are numerous and beneficial across many fields.

How Does Virtual Reality Work?
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Ten Most Exciting Applications Of Virtual Reality

1.  Entertainment

Entertainment is an obvious application of virtual reality. Who wouldn’t want to slip on a headset and escape into another world?

The first thing that comes to mind is gaming. It is a historical virtual reality application that is still very much among the main VR uses today. Other entertainment forms are however hot on its heels. While 3D cinema has been around for quite a while now, the rise of VR headsets is providing users with immersive cinema experiences without them even having to leave the house. Apps such as Oculus Cinema enable viewers to watch movies on their very own virtual screen. At the same time, developers are working on software that will enable sports fans to cheer on their favorite teams from the comfort of their couches. An example is LiveLike VR’s virtual stadium.

Using virtual reality, music lovers can attend concerts and festivals taking place on the other side of the world. Moreover, those who have been bitten by the travel bug can wander sunny beaches without leaving their front yard. What’s not to love?

Virtual Reality In Entertainment
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2.  Training

It is essential for military personnel to gain first-hand experience of the terrain of their deployment. Likewise, when you get on a commercial flight, you assume your pilot has mastered the aircraft and can respond appropriately in any kind of emergency. But have you ever wondered how rookie soldiers and pilots get in their training hours without putting themselves in danger?

Some activities are just too dangerous, impractical, or expensive for beginners to be able to practice them from the get-go. This is where VR comes in. Virtual reality education companies offer software aimed at training new personnel. The US military uses virtual reality simulators to train soldiers before deployment. These VR simulators enable them to practice working together in the kind of environments they will come up against. Likewise, flight simulators are used to train new pilots or refresh their knowledge before they can get before the controls of a real-life plane.

Virtual Reality In Training
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 3. Healthcare

With elevated costs, a tendency towards personnel shortages, and people’s lives at stake, the healthcare industry is generally quick to adopt exciting new tech that can boost efficiency and improve performance. Virtual reality is no exception.

Medical institutions can use VR to make diagnoses and define treatments. Some VR simulators are now able to use images from MRIs or CAT scans to create 3D models of a patient’s anatomy. The training applications of virtual reality enable trainee doctors to practice surgery with no risk to patients. Moreover, they can help more experienced ones to determine the safest way to operate.

There are other interesting virtual reality applications in the healthcare industry beyond surgery and diagnoses. For rehabilitation of stroke and brain injury victims, healthcare industries use VR. It provides virtual exercises to help patients gain independence in everyday activities, aided by real-time feedback.

Virtual Reality In Healthcare
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4. The Arts

Fans of the performing arts will probably find the idea of a screen between the artist and audience a strange one. However, there are many exciting virtual reality applications when it comes to theatre, opera, dance, circus, and other performing art forms that are characterized by their fleetingness. That is, you have to be there on the night, or else, it’s gone forever. VR enables you to watch a live performance at any time you please. You can even be in the best seat in your house. Why not even from the middle of the stage if you’re feeling adventurous?

There are many other virtual reality applications when it comes to the arts. Directors can create a stage set before they build it. Applications such as Tvori enable you to create 3D animations that you can walk around. The possibilities are endless!

Virtual Reality In The Arts
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5. Meditation

According to the World Health Organization, stress is the health epidemic of the 21st century. Furthermore, many seem to think that tech is part of the problem. But what if it was also part of the solution? Apps along the lines of Calm and Headspace already enable you to take a break wherever you happen to be. Moreover, VR is promising to add an extra dimension to your meditation experience.

One of the hardest things about meditation for people who are just starting their meditation journey is learning to just “let go”. Virtual reality meditation apps make that all easier by allowing you to slip on your headset and instantly slip into another world.

Virtual Reality in Meditation
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6. Mental Health

Virtual reality applications help you relax and let go. Likewise, its applications include therapeutic tools for people who have been through traumatizing experiences or suffer from debilitating stress, PTSD, or phobias.

Virtual reality can provide a safe virtual environment. This enables patients to come into contact with the source of their phobias or fears without endangering themselves. Moreover, interesting advances have already made notably in the field of treatment for war veterans suffering from PTSD.

Benefits Of Using Virtual Reality For Mental Health
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7. Marketing

AI-powered data analysis is enabling digital marketers to tailor experiences to fit individual tastes like never before. At the same time, consumers are constantly bombarded with advertising. It means that banner blindness is becoming a real problem – and that’s before we even mention adblockers.

VR is a gamechanger for marketers. It enables them to provide exciting, immersive experiences with high entertainment value. In the UK, the cheese manufacturer, Boursin, recently offered a delightful virtual reality exhibit. Users were taken on a journey through a fridge filled with tasty treats, complete with wind simulators for an even more immersive experience.

8. Shopping

Imagine that you’re wandering through a fashionable SoHo boutique looking to pick out a new accessory, and at the same time on your couch several hundred miles away in your pajamas.

Online retailers are now part and parcel of our day-to-day life and are looking to get a make-over. Thanks to the power of VR. The VR start-up Trillenium creates virtual stores for online retailers and has already partnered with the likes of ASOS, one of Europe’s biggest online retailers. Instead of clicking their way through online catalogs, shoppers can go on a virtual tour of a store for a real-time shopping experience. They can even share it with their friends.

9. Journalism

Another exciting virtual reality application is on journalism and online media. VR is enabling media outlets to create immersive storytelling experiences that give the viewer the impression of truly being part of the action. Major players such as the Washington Post and the New York Times are now entering the VR field by offering 360° reports and documentaries. The New York Times made a big splash in 2014 by sending Google Cardboard headsets to its subscribers for them to use with their smartphones.

 10. Architecture

Another exciting application of virtual reality is in architecture. This is for being able to offer their clients virtual walkthroughs, a great way for firms to showcase their projects compared to more traditional 3D projection. It is by giving clients a true sense of space and design.

The potential uses of virtual reality are widespread and diverse, spanning everything from entertainment to healthcare and from journalism to digital marketing. With technology becoming cheaper and more widely available, we can expect to see many more exciting virtual reality applications in the years to come. Stay tuned!

 

via Top 10 Virtual Reality Applications In Today’s World | Robots.net

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[Abstract] Remote Upper Limb Exoskeleton Rehabilitation Training System Based on Virtual Reality

Abstract

According to the present situation that the treatment means for apoplectic patients is lagging and weak, a set of long-distance exoskeleton rehabilitation training system with 5 DOF for upper limb was developed. First, the mechanical structure and control system of the training system were designed. Then a new kind of building method for virtual environment was proposed. The method created a complex model effectively with good portability. The new building method was used to design the virtual training scenes for patients’ rehabilitation in which the virtual human model can move following the trainer on real time, which can reflect the movement condition of arm of patient factually and increase the interest of rehabilitation training. Finally, the network communication technology was applied into the training system to realize the remote communication between the client-side of doctor and training system of patient, which makes it possible to product rehabilitation training at home.

via Remote Upper Limb Exoskeleton Rehabilitation Training System Based on Virtual Reality – IEEE Conference Publication

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

Abstract

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

2. E. Donchin , K. Spencer and R. Wijesinghe , “The mental prosthesis: assessing the speed of a P300-based brain-computer interface”, IEEE Transactions on Rehabilitation Engineering, vol. 8, no. 2, pp. 174-179, 2000.

3. D. McFarland and J. Wolpaw , “Brain-Computer Interface Operation of Robotic and Prosthetic Devices”, Computer, vol. 41, no. 10, pp. 52-56, 2008.

4. Xiaorong Gao , Dingfeng Xu , Ming Cheng and Shangkai Gao , “A bci-based environmental controller for the motion-disabled”, IEEE Transactions on Neural Systems and Rehabilitation Engineering, vol. 11, no. 2, pp. 137-140, 2003.

5. A. Ramos-Murguialday , D. Broetz , M. Rea et al “Brain-machine interface in chronic stroke rehabilitation: A controlled study”, Annals of Neurology, vol. 74, no. 1, pp. 100-108, 2013.

6. F. Pichiorri , G. Morone , M. Petti et al “Brain-computer interface boosts motor imagery practice during stroke recovery”, Annals of Neurology, vol. 77, no. 5, pp. 851-865, 2015.

7. M. A. Cervera , S. R. Soekadar , J. Ushiba et al “Brain-computer interfaces for post-stroke motor rehabilitation: a meta-analysis”, Annals of Clinical and Translational Neurology, vol. 5, no. 5, pp. 651-663, 2018.

8. K. Ang , K. Chua , K. Phua et al “A Randomized Controlled Trial of EEG-Based Motor Imagery Brain-Computer Interface Robotic Rehabilitation for Stroke”, Clinical EEG and Neuroscience, vol. 46, no. 4, pp. 310-320, 2014.

9. N. Bhagat , A. Venkatakrishnan , B. Abibullaev et al “Design and Optimization of an EEG-Based Brain Machine Interface (BMI) to an Upper-Limb Exoskeleton for Stroke Survivors”, Frontiers in Neuroscience, vol. 10, pp. 122, 2016.

10. J. Webb , Z. G. Xiao , K. P. Aschenbrenner , G. Herrnstadt , and C. Menon , “Towards a portable assistive arm exoskeleton for stroke patient rehabilitation controlled through a brain computer interface”, in Biomedical Robotics and Biomechatronics (BioRob), 2012 4th IEEE RAS & EMBS International Conference, pp. 1299-1304, 2012.

11. A. L. Coffey , D. J. Leamy , and T. E. Ward , “A novel BCI-controlled pneumatic glove system for home-based neurorehabilitation”, in Engineering in Medicine and Biology Society (EMBC), 2014 36th Annual International Conference of the IEEE, pp. 3622-3625, 2014.

12. D. Bundy , L. Souders , K. Baranyai et al “Contralesional Brain-Computer Interface Control of a Powered Exoskeleton for Motor Recovery in Chronic Stroke Survivors”, Stroke, vol. 48, no. 7, pp. 1908-1915, 2017.

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

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16. M. H. B. Azhar , A. Casey , and M. Sakel , “A cost-effective BCI assisted technology framework for neurorehabilitation”, The Seventh International Conference on Global Health Challenges, 18th-22nd November, 2018. (In Press)

17. C. M. McCrimmon , M. Wang , L. S. Lopes et al “A small, portable, battery-powered brain-computer interface system for motor rehabilitation”, Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, pp. 2776-2779, 2016.

18. J. Meng , B. Edelman , J. Olsoe et al “A Study of the Effects of Electrode Number and Decoding Algorithm on Online EEG-Based BCI Behavioral Performance”, Frontiers in Neuroscience, vol. 12, pp. 227, 2018.

19. T. Mullen , C. Kothe , Y. Chi et al “Real-time neuroimaging and cognitive monitoring using wearable dry EEG”, IEEE Transactions on Biomedical Engineering, vol. 62, no. 11, pp. 2553-2567, 2015.

 

via eConHand: A Wearable Brain-Computer Interface System for Stroke Rehabilitation – IEEE Conference Publication

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[Abstract + References] Electromyographic indices of muscle fatigue of a severely paralyzed chronic stroke patient undergoing upper limb motor rehabilitation

Abstract

Modern approaches to motor rehabilitation of severe upper limb paralysis in chronic stroke decode movements from electromyography for controlling rehabilitation orthoses. Muscle fatigue is a phenomenon that influences these neurophysiological signals and may diminish the decoding quality. Characterization of these potential signal changes during movement patterns of rehabilitation training could therefore help improve the decoding accuracy. In the present work we investigated how electromyographic indices of muscle fatigue in the Deltoid Anterior muscle evolve during typical forward reaching movements of a rehabilitation training in healthy subjects and a stroke patient. We found that muscle fatigue in healthy subjects changed the neurophysiological signal. In the patient, however, no consistent change was observed over several sessions.
1. V. L. Feigin , B. Norrving , M. G. George , J. L. Foltz , A. Roth Gregory , and G. A. Mensah , “Prevention of stroke: a strategic global imperative,” Nat. Rev. Neurol., vol. 107, pp. 501–512, 2016.

2. A. Ramos-Murguialday et al , “Brain-machine interface in chronic stroke rehabilitation: a controlled study,” Ann. Neurol., vol. 74, no. 1, pp. 100–108, 2013.

3. A. Sarasola-Sanz et al , “A hybrid brain-machine interface based on EEG and EMG activity for the motor rehabilitation of stroke patients,” IEEE Int Conf Rehabil Robot, vol. 2017, pp. 895–900, Jul. 2017.

4. R. M. Enoka and J. Duchateau , “Muscle fatigue: what, why and how it influences muscle function,” J Physiol, vol. 586, no. 1, pp. 11–23, Jan. 2008.

5. M. González-Izal , A. Malanda , E. Gorostiaga , and M. Izquierdo , “Electromyographic models to assess muscle fatigue,” J. Electromyogr. Kinesiol., vol. 22, no. 4, pp. 501–512, Aug. 2012.

6. A. Sarasola Sanz et al , “EMG-based multi-joint kinematics decoding for robot-aided rehabilitation therapies,” in 2015 IEEE International Conference on Rehabilitation Robotics (ICORR), 2015.

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

Abstract

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

via The SonicHand Protocol for Rehabilitation of Hand Motor Function: a validation and feasibility study – IEEE Journals & Magazine

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

Abstract

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

via A Greedy Assist-as-Needed Controller for Upper Limb Rehabilitation – IEEE Journals & Magazine

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

Abstract

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

I. Introduction

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

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[Abstract] A Virtual Reality based Training and Assessment System for Hand Rehabilitation – IEEE Conference Publication

Abstract

Virtual reality is widely applied in rehabilitation robot to help post-stoke patients complete rehabilitation training for the body function recovery. Most of virtual rehabilitation training systems lack scientific assessment standards and doctors don’t usually use quantitative examinations but qualitative observation and conversation with patients to evaluate the motor function of limb. Based on this situation, a virtual rehabilitation training and assessment system is designed, which contains two rehabilitation training games and one assessment system. The virtual system can attract patient attention and decrease the boredom of rehabilitation training and assessment. Compared with the existing rehabilitation assessment methods, the proposed virtual assessment system can give the assessment results similar to Fugl-Meyer Assessment, which is more quantitative, interesting and convenient. Five volunteers participate in the study of assessment system and the experimental results confirm the effectiveness of assessment system.

I. Introduction

In recent years, according to American Heart Association, stroke is the leading cause of serious long-term disability in the US and about 795,000 people suffer from a stroke each year [1]. China is also facing the same problem. The stroke is the first leading cause of death. Every year, 2.4 million people suffer from stroke [2]. Fortunately, about 60-75 percent of those can survive. However, about 65 percent of them still remain severely handicapped because of the neurological damage caused by stroke, for example, movement disorders, hemiparesis and so on [3], [4]. Those sequelae have an effect on body movement function, especially arm and hand function [4], [5]. The lost of hand movement function will affect the Activities of Daily Living (ADLs), which will decrease the quality of life [6].[…]

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[Abstract] Gesture Interaction and Augmented Reality based Hand Rehabilitation Supplementary System – IEEE Conference Publication

Abstract:

The existing systems of hand rehabilitation always design different rehabilitation medical apparatus and systems according to the patients’ needs. This kind of system always contain problems such as complexity, using only single training programs, inconvenient to wear and high cost. For these reasons, this paper uses gesture recognition technology and augmented reality technology to design a simple and interactive hand rehabilitation supplementary system. The system uses a low-cost, non-contact device named Leap Motion as the input device, and Unity3D as the development engine, realizing three functional modules: conventional training, AR game training and auxiliary functions. This rehabilitation training project with different levels of difficulty increases the fun and challenge of the rehabilitation process. Users can use the system to assist the treatment activity of hand rehabilitation anytime and anywhere. The system, which has good application value, can also be used in other physical rehabilitation fields.

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[ARTICLE] Arm Ability Training (AAT) Promotes Dexterity Recovery After a Stroke—a Review of Its Design, Clinical Effectiveness, and the Neurobiology of the Actions – Full Text

Arm Ability Training (AAT) has been specifically designed to promote manual dexterity recovery for stroke patients who have mild to moderate arm paresis. The motor control problems that these patients suffer from relate to a lack of efficiency in terms of the sensorimotor integration needed for dexterity. Various sensorimotor arm and hand abilities such as speed of selective movements, the capacity to make precise goal-directed arm movements, coordinated visually guided movements, steadiness, and finger dexterity all contribute to our “dexterity” in daily life. All these abilities are deficient in stroke patients who have mild to moderate paresis causing focal disability. The AAT explicitly and repetitively trains all these sensorimotor abilities at the individual’s performance limit with eight different tasks; it further implements various task difficulty levels and integrates augmented feedback in the form of intermittent knowledge of results. The evidence from two randomized controlled trials indicates the clinical effectiveness of the AAT with regard to the promotion of “dexterity” recovery and the reduction of focal disability in stroke patients with mild to moderate arm paresis. In addition, the effects have been shown to be superior to time-equivalent “best conventional therapy.” Further, studies in healthy subjects showed that the AAT induced substantial sensorimotor learning. The observed learning dynamics indicate that different underlying sensorimotor arm and hand abilities are trained. Capacities strengthened by the training can, in part, be used by both arms. Non-invasive brain stimulation experiments and functional magnetic resonance imaging data documented that at an early stage in the training cortical sensorimotor network areas are involved in learning induced by the AAT, yet differentially for the tasks trained. With prolonged training over 2 to 3 weeks, subcortical structures seem to take over. While behavioral similarities in training responses have been observed in healthy volunteers and patients, training-induced functional re-organization in survivors of a subcortical stroke uniquely involved the ipsilesional premotor cortex as an adaptive recruitment of this secondary motor area. Thus, training-induced plasticity in healthy and brain-damaged subjects are not necessarily the same.

Motor Deficits of Stroke Survivors With Mild to Moderate Arm Paresis

Arm paresis post stroke shows a bi-modal distribution. Many stroke survivors have either severe arm paresis and are only able to use their arms functionally in everyday life to a very limited extent, if at all, or mild to moderate arm paresis with the ability to use their paretic arm for functional tasks, yet with a lack of dexterity (12). Thus, the motor control deficits of these subgroups are quite different and hence so too are their therapeutic needs.

Clinically, stroke survivors with mild to moderate arm paresis have reduced strength and endurance of their paretic arm and are functionally limited by a lack of speed, accuracy and co-ordination of arm, hand, and finger movements and a lack of dexterity when handling objects. Key to understanding any functional deficits and the need and opportunities to improve function by training is a focused analysis of the specific motor control deficits involved in this clinical syndrome. A way to do this is to test various domains of sensorimotor control that have been shown to be independent by factorial analysis (34).

When motor performance of healthy people across various tasks has been analyzed by factorial analysis certain independent arm motor abilities have been documented. These are different independent sensorimotor capacities that together contribute to our skilfulness in everyday life. What are these abilities? They are our ability to make fast selective wrist and finger movements (wrist-finger speed), to manipulate small objects (finger dexterity) or larger objects (manual dexterity) efficiently, our ability to keep our arm steady (steadiness), to move our arm quickly and precisely to an intended target (aiming), or to move it under constant visual control along a line (tracking) (5).

When tested among stroke survivors with mild to moderate arm paresis all these abilities are deficient, indicating the complex nature of sensorimotor control deficits in this clinical condition (67).

The Arm Ability Training as a “Tailor-Made training” to Meet Specific Rehabilitation Demands

The Arm Ability Training (AAT) was designed to train all these sensorimotor abilities and thus to meet the specific rehabilitation demands of this subgroup of stroke survivors (89). The eight training tasks collectively cover these affordances (Figure 1).

Figure 1. Training tasks of the Arm Ability Training. Description of the eight training tasks of the Arm Ability Training (AAT) that are repetitively exercised daily. Together they train various independent arm and hand sensorimotor abilities. During the AAT sensorimotor performance is trained at its individual limit. Further aspects thought to promote motor learning are a high repetition rate of trained tasks, variation in the difficulty of training tasks, and the augmented feedback provided in the form of intermittent knowledge of the results.

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