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[ARTICLE] Stroke patients’ and non-professional coaches’ experiences with home-based constraint-induced movement therapy: a qualitative study – Full Text

To investigate the experiences of chronic stroke patients and non-professional coaches with home-based constraint-induced movement therapy (homeCIMT).

Qualitative study embedded within a cluster randomized controlled trial investigating the efficacy of homeCIMT to improve the use of the affected arm in daily activities.

Patients’ home environment.

13 stroke patients and 9 non-professional coaches’ alias family members who had completed the four-week homeCIMT programme in the context of the HOMECIMT trial.

Semi-structured interviews; qualitative data were analysed using the methodology of the hermeneutic phenomenological data analysis.

We identified six themes in the qualitative analysis describing the experiences of patients and non-professional coaches with homeCIMT: (1) homeCIMT can be integrated into everyday life with varying degrees of success; (2) training together may produce positive experiences as well as strain; (3) self-perceived improvements during and following homeCIMT; (4) using the affected arm in everyday life is challenging; (5) subjective evaluation of and experiences with homeCIMT-specific exercises; and (6) impact of professional therapists’ guidance and motivation during homeCIMT. Statements regarding theme five and six were only provided by patients, whereas the other themes contain both, the experiences of stroke patients and non-professional coaches.

Patients’ and non-professional coaches’ narratives offer a detailed insight into the manifold experiences with the practical implementation of homeCIMT that may help improve implementing the homeCIMT programme and similar approaches involving increased training duration and intensity and/or involvement of family members.


In stroke rehabilitation, repetitive, task-specific training is one of the key principles.1,2 For stroke patients with upper limb dysfunction, constraint-induced movement therapy and its modifications are one of the most promising techniques taking this principle into account.14 To induce the use of the affected arm in everyday life,5 constraint-induced movement therapy comprises an intensive motor training, the use of adherence-enhancing behavioural methods and the immobilization of the non-affected hand.5,6 A four-week home-based training in conjunction with the support of a non-professional coach (e.g. family member) and reduced professional assistance to meet ambulatory care conditions (home-based constraint-induced movement therapy (homeCIMT)) is one way to deliver constraint-induced movement therapy to patients in long-term care.7 The HOMECIMT trial showed homeCIMT to be superior to conventional therapies with regard to the self-perceived use of the stroke-affected arm in daily activities.8

HomeCIMT and other forms of constraint-induced movement therapy have been shown to be particularly effective in improving upper limb function post stroke.1,3 However, these interventions will only work if patients adhere to them. Constraint-induced movement therapy requires numerous hours of repetitive exercises, which are likely to present a challenge for patients.9,10 Regarding homeCIMT, the involvement of a non-professional coach might be an additional challenging aspect for both, patients and non-professional coaches. Thus, it is vital to better understand the users’ experiences with different forms of constraint-induced movement therapies in order to adapt the way how we deliver these interventions and maximize adherence to them. However, there are only few investigations with the users’ perspectives on constraint-induced movement therapies. We are only aware of three minor qualitative studies investigating the experiences of two or three patients with modified constraint-induced movement therapies.1113 A qualitative research approach, in particular, provides information about the users’ experiences with the practical application of a therapy.14,15

In addition to the cluster randomized controlled HOMECIMT trial, we conducted a comprehensive qualitative study to explore the users’ perspectives on homeCIMT following the driving question: What are the experiences of chronic stroke patients and non-professional coaches with homeCIMT?[…]


Continue —> Stroke patients’ and non-professional coaches’ experiences with home-based constraint-induced movement therapy: a qualitative study – Anne Stark, Christine Färber, Britta Tetzlaff, Martin Scherer, Anne Barzel, 2019

Figure 1. Themes regarding the experiences of patients and non-professional coaches with homeCIMT.


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[ARTICLE] Long-Dose Intensive Therapy Is Necessary for Strong, Clinically Significant, Upper Limb Functional Gains and Retained Gains in Severe/Moderate Chronic Stroke – Full Text

Background. Effective treatment methods are needed for moderate/severely impairment chronic stroke.

Objective. The questions were the following: (1) Is there need for long-dose therapy or is there a mid-treatment plateau? (2) Are the observed gains from the prior-studied protocol retained after treatment?

Methods. Single-blind, stratified/randomized design, with 3 applied technology treatment groups, combined with motor learning, for long-duration treatment (300 hours of treatment). Measures were Arm Motor Ability Test time and coordination-function (AMAT-T, AMAT-F, respectively), acquired pre-/posttreatment and 3-month follow-up (3moF/U); Fugl-Meyer (FM), acquired similarly with addition of mid-treatment.

Findings. There was no group difference in treatment response (P ≥ .16), therefore data were combined for remaining analyses (n = 31; except for FM pre/mid/post, n = 36). Pre-to-Mid-treatment and Mid-to-Posttreatment gains of FM were statistically and clinically significant (P < .0001; 4.7 points and P < .001; 5.1 points, respectively), indicating no plateau at 150 hours and benefit of second half of treatment. From baseline to 3moF/U: (1) FM gains were twice the clinically significant benchmark, (2) AMAT-F gains were greater than clinically significant benchmark, and (3) there was statistically significant improvement in FM (P < .0001); AMAT-F (P < .0001); AMAT-T (P < .0001). These gains indicate retained clinically and statistically significant gains at 3moFU. From posttreatment to 3moF/U, gains on FM were maintained. There were statistically significant gains in AMAT-F (P = .0379) and AMAT-T P = .003.

Many stroke survivors do not fully recover upper limb function following stroke, leading to significant disability and diminished quality of life.1 Effective treatments are needed for chronic, severely impaired stroke survivors.2 Other studies showed improved upper limb motor function in chronic stroke for mild/moderately impaired,313 with traditional “constraint induced” treatment studies enrolling only those with preserved wrist and finger extension (acceptance rate, 10%).14 However, for those with moderate/severe impairment after stroke, improvement in function has been more difficult to realize. A recent study of constraint-induced movement therapy in more severe stroke reported no clinically significant change in upper limb Fugl-Meyer assessment scores.15 Others have also tested the application of technologies and devices, in moderately/severely impaired chronic stroke survivors, with the following: functional electrical stimulation (FES),1618 sequenced bilateral and unilateral task orientated training,19 mirror therapy,20 progressive abduction loading therapy,21 contralaterally controlled FES,22 and robotics.2327 Limitations included small sample size,1618,2223 lacking control group,16,23 lacking statistically significant gains on impairment or functional measures,23 lacking clinically significant change,20,21,2325,27 lacking retention of clinically significant gains,16,19,25,26 or lacking study of retention.20,23 Furthermore, many studies do not include both a measure of impairment and an array of actual everyday functional tasks. Our work has focused on moderately/severely impaired chronic stroke survivors, and in prior work we developed and tested a protocol that combines technology applications and motor learning.28,29 We found clinically and statistically significant gains for those with moderate/severe stroke considerably beyond that reported by others (eg, gains in coordination, Fugl-Myer coordination scale [FM], and gains on the Arm Motor Ability Test [AMAT; 13 complex functional tasks]).

Others have cited this work stating that “a change in impairment of this magnitude was previously considered almost impossible in chronic stroke patients,”30 and that this is important first evidence for use of high dose neurorehabilitation.31 Therefore, we considered it important to replicate the administration of the upper limb motor learning protocol in a follow-on study and again quantify response. Another consideration was that we had not given technology a full chance in application to the “whole arm,” that is, both distal and proximal upper limb regions. Therefore, a first purpose was to replicate administration of the upper limb motor learning protocol and to include a treatment group that would receive technology applications to both distal and proximal limb regions. In addition, there were 2 important and unanswered questions regarding the dose and efficacy of this new treatment protocol.

The first question is whether a shorter treatment duration (ie, <300 hours) could produce the same degree of recovery, given that the existing protocol was tested in the paradigm of long-duration dose of 300 hours of therapy. Therefore, in the current work, we administered the same protocol as in prior work,28 and acquired mid-treatment (at 150 hours of treatment) data on the Fugl-Meyer impairment measure, which underlies complex functional task performance. We studied whether a mid-treatment plateau occurred or whether significant recovery occurred in response to the second half of treatment (mid-treatment to posttreatment).

The second question is whether the observed gains can be retained after cessation of treatment. Therefore, we studied retention of gains at 3 months after treatment ended.[…]


Continue —> Long-Dose Intensive Therapy Is Necessary for Strong, Clinically Significant, Upper Limb Functional Gains and Retained Gains in Severe/Moderate Chronic Stroke – Janis J. Daly, Jessica P. McCabe, John Holcomb, Michelle Monkiewicz, Jennifer Gansen, Svetlana Pundik, 2019

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[REVIEW] A review of international clinical guidelines for rehabilitation of people with neurological conditions: what recommendations are made for upper limb assessment?

Background: Upper limb impairment is a common problem for people with neurological disabilities, affecting activity, performance, quality of life and independence. Accurate, timely assessments are required for effective rehabilitation, and development of novel interventions. International consensus on upper limb assessment is needed to make research findings be more meaningful, provide a benchmark for quality in clinical practice, more cost-effective neurorehabilitation and improved outcomes for neurological patients undergoing rehabilitation.

Aim: To conduct a systematic review, as part of the output of a European COST Action, to identify what recommendations are made for upper limb assessment.

Methods: We systematically reviewed published guidance on measures and protocols for assessing upper limb function in neurological rehabilitation via electronic databases from January 2007 – December 2017. Additional records were then identified through other sources. Records were selected for inclusion based on scanning of titles, abstracts and full text by two authors working independently, and a third author if there was disagreement. Records were included if they referred to ‘rehabilitation’ and ‘assessment’ or ‘measurement’. Reasons for exclusion were documented.
Results: From the initial 552 records identified (after duplicates were removed), 34 satisfied our criteria for inclusion and only six recommended specific outcome measures and /or protocols. Records were divided into National Guidelines and other practice guidelines published in peer reviewed Journals. There was agreement that assessment is critical, should be conducted early and at regular intervals and that there is a need for standardised measures. Assessments should be conducted by a healthcare professional trained in using the measure and should encompass body function and structure, activity and participation.
Conclusions: We present a comprehensive, critical and original summary of current recommendations. Defining a core set of measures and agreed protocols requires international consensus between experts representing the diverse and multi-disciplinary field of neurorehabilitation including clinical researchers and practitioners, rehabilitation technology researchers and commercial developers. Current lack of guidance may hold-back progress in understanding function and recovery. Together with a Delphi consensus study and an overview of systematic reviews of outcome measures it will contribute to the development of international guidelines for upper limb assessment in neurological conditions.


via Frontiers | A review of international clinical guidelines for rehabilitation of people with neurological conditions: what recommendations are made for upper limb assessment? | Neurology

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[Conference paper] Wrist Rehabilitation Equipment Based on the Fin-Ray® Effect – Abstract + References


A swift post-traumatic recovery of upper limbs can be achieved best by means of dedicated rehabilitation equipment. A speedy recovery process ensures the early reintegration of patients into society. The rehabilitation equipment proposed in this paper is conceived for the simultaneous passive mobilization of the radiocarpal, metacarpophalangeal and interphalangeal joints. The paper presents and discusses the construction and actuation system of the equipment. The elements of novelty put forward by this equipment refer to the Fin-Ray® effect underlying the design of the hand support and to its operation by means of a pneumatic muscle – an actuator with inherently compliant behavior. The discussion includes the occurring of hysteresis, and concludes that it does not affect the efficiency of the rehabilitation exercises..


  1. 1.
    Bulbul, M.K.: Study on Carpal Tunnel syndrome incidence, a tardy complication of distal meta- and physeal fractures of the forearm in correlation with their treatment. Ph.D. thesis, Oradea University (2015). (in Romanian)Google Scholar
  2. 2.
    Skirven, T.M.: Rehabilitation of the Hand and Upper Extremity, vol. 1. Elsevier Mosby, Philadelphia (2011)Google Scholar
  3. 3.
  4. 4.
    W2 Wrist CPM. Accessed 10 Sept 2018
  5. 5.
    WaveFlex Hand. Accessed 20 Sept 2018
  6. 6.
    Deaconescu, T., Deaconescu, A.: Pneumatic muscle-actuated adjustable compliant gripper system for assembly operations. Strojniški vestnik J. Mech. Eng. 63(4), 225–234 (2017)CrossRefGoogle Scholar
  7. 7.
    Van Ham, R., Sugar, T.G., Vanderborght, B., Hollander, K.W., Lefeber, D.: Compliant actuator designs. IEEE Robot. Autom. Mag. 16, 81–94 (2009)CrossRefGoogle Scholar
  8. 8.
    The Hand Mentor Pro. Accessed 22 Nov 2018
  9. 9.
    Andrikopoulos, G., Nikolakopoulos, G., Manesis, S.: Motion control of a novel robotic wrist exoskeleton via pneumatic muscle actuators. In: 2015 IEEE 20th Conference on Emerging Technologies & Factory Automation (ETFA), pp. 1–8 (2015)Google Scholar
  10. 10.
    Petre, I., Deaconescu, A., Sârbu, F., Deaconescu, T.: Pneumatic muscle actuated wrist rehabilitation equipment based on the fin ray principle. Strojniški vestnik J. Mech. Eng. 64(6), 383–392 (2018)Google Scholar
  11. 11.
    Kniese, L.: Load carrying element with flexible outer skin. EP1040999A2. Patent (1999)Google Scholar
  12. 12.
    Filip, O., Deaconescu, T.: Mathematical modelling of a Fin Ray type mechanism, used in the case of the wrist rehabilitation equipment. In: 4th International Conference on Computing and Solutions in Manufacturing Engineering, Brasov, vol. 94 (2017). Scholar

via Wrist Rehabilitation Equipment Based on the Fin-Ray® Effect | SpringerLink

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[WEB SITE] RATULS Trial Using BIONIK InMotion Researches Robot-Assisted Stroke Therapy

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A landmark Robot Assisted Training for the Upper Limb after Stroke (RATULS) trial utilizing BIONIK Laboratories Corp’s InMotion Robotic Therapy Systems was completed recently, the Toronto-based company announces.

The RATULS trial, which began in 2014 and was completed at the end of 2018, compared the clinical effectiveness of robot-assisted training, enhanced upper limb therapy, and usual care for patients with moderate or severe upper limb functional limitation.

Results were presented recently at the European Stroke Organisation Conference (ESOC) in Milan, Italy, and published in The Lancet.

“We are pleased that the RATULS trial confirmed the finding of previous research studies which demonstrated that robot-assisted therapy improved upper limb impairment when compared with conventional care methods for stroke victims.

“The trial’s finding that robotic therapy is the only therapy to statistically maintain a significant impairment advantage at six months after treatment is a strong signal that robotic therapy is critical for achieving positive patient outcomes,” says Dr Eric Dusseux, CEO, BIONIK Laboratories, in a media release.

For the RATULS trial, the primary outcome for upper limb success was determined by Action Research Arm Test (ARAT), with four distinct success criteria that varied according to baseline severity, not used previously and developed by the RATULS trial team.

Although the findings demonstrated that robot-assisted therapy improved upper limb impairment, using this ARAT measurement, the trial was unable to conclude that robot-assisted therapy or enhanced upper limb therapy resulted in improved upper limb functionality after stroke compared with usual care provided to patients with stroke-related upper limb functional limitation. The attrition rate was also drastically reduced in patient population following either robotic therapy or enhanced upper limb therapy versus usual care only, and most of the withdrawals before 3 months in usual care were due to disappointment with treatment allocation, the release explains.

“The combination of evidenced-based medicine and real-world clinical feedback have led to the release of substantially improved versions of the InMotion ARM Robotic Therapy System announced in early 2018, and the InMotion ARM/HAND Robotic Therapy System announced beginning of 2019. These versions of our products include enhanced software applications with patient-centric configurable protocols to assist the therapist in providing specialized treatment of stroke and traumatic brain injury.”

[Source(s): BIONIK Laboratories Corp, Business Wire]


via RATULS Trial Using BIONIK InMotion Researches Robot-Assisted Stroke Therapy – Rehab Managment

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[ARTICLE] Effects of virtual reality therapy on upper limb function after stroke and the role of neuroimaging as a predictor of a better response – Full Text



Virtual reality therapy (VRT) is an interactive intervention that induces neuroplasticity. The aim was to evaluate the effects of VRT associated with conventional rehabilitation for an upper limb after stroke, and the neuroimaging predictors of a better response to VRT.


Patients with stroke were selected, and clinical neurological, upper limb function, and quality of life were evaluated. Statistical analysis was performed using a linear model comparing pre- and post-VRT. Lesions were segmented in the post-stroke computed tomography. A voxel-based lesion-symptom mapping approach was used to investigate the relationship between the lesion and upper limb function.


Eighteen patients were studied (55.5 ± 13.9 years of age). Quality of life, functional independence, and dexterity of the upper limb showed improvement after VRT (p < 0.001). Neuroimaging analysis showed negative correlations between the internal capsule lesion and functional recovery.


VRT showed benefits for patients with stroke, but when there was an internal capsule lesion, a worse response was observed.


Stroke can be defined as a neurological deficit resulting from focal and acute central nervous system injury. It is considered a major cause of mortality and disability worldwide1. Stroke is the second leading cause of death in Brazil and the leading cause of chronic disability in adults, resulting in socioeconomic consequences and reduced quality of life. Therefore, it is an important public health problem, particularly because of long-term dependence on public health services2,3.

Cerebrovascular injury may damage the cells of the cortex and emerging axons, generating dysfunction of the upper motor neurons. Motor function can be impaired, reducing functional capacity, particularly that of the upper limbs4. Approximately 85% of individuals experience hemiparesis immediately after the stroke, particularly in an upper limb, and 55%–75% of these individuals have persistence of motor deficits, making it difficult to return to work and leisure, consequently worsening their quality of life5.

Epidemiological clinical studies have suggested that 33%–66% of stroke patients had no motor recovery after six months. Several techniques aiming to improve upper limb function are still being developed. However, the implementation of these techniques requires great team work, a high degree of specialization, and requires more time5,6. Currently, there are new approaches to rehabilitation, and virtual reality is still developing, with the objective of restoring the functional capacity of individuals after stroke as an easy, interactive, and low-cost intervention7,8.

The objective of stroke rehabilitation is to provide maximal physical, functional, and psychosocial recovery for the patients9. Comprehensive rehabilitation initiated early after stroke (within the first 24 hours) is generally accepted as being associated with better motor outcomes for these patients9. Strength training is an important part of the therapeutic process for upper-limb motor impairment after stroke10.

Virtual reality is defined as any hardware or software system that provides a simulated environment with real or imagined conditions that allow participating individuals to interact with the environment. The interaction is made by body movements using motion capture technology or by manipulating a device11. This interaction generates information necessary for proper understanding of the movement with particular emphasis on the upper limbs12. The technique consists of an avatar (graphic representation of the person) generated by the video game, where the individual manages a wireless control, directing the movement during the practice of different activities5. This is a good option for rehabilitation for individuals with stroke due to the variety of nonimmersive video game systems developed by the entertainment industry for home use.

This wide availability makes virtual reality an accessible and inexpensive rehabilitation method for rehabilitation centers13. Despite the ease of application, virtual reality therapy (VRT), added to conventional physical therapy has not been associated with a better outcome than recreational activity13. Adverse events usually are mild and the main effects described are transient dizziness and headache, pain and numbness13,14. Time since the onset of stroke, severity of impairment, and the type of device (commercial or customized) usually do not influence the outcome14. However, the variable methodology is an important bias for these investigations14. Therefore, virtual reality is still a promising tool. Some authors have reported that VRT can be combined with conventional rehabilitation to improve upper limb function after stroke15,16. The clinical situations wherein VRT may best be used have not yet been established in the literature. Also, the exact mechanism of action of this treatment modality is not yet fully understood.

The objectives of this study were to evaluate the effects of VRT combined with conventional rehabilitation for upper limb function in the recovery of individuals after stroke. Neuroimaging characteristics that could be used as predictors of a better response to VRT were also investigated.[…]

Continue —>  Effects of virtual reality therapy on upper limb function after stroke and the role of neuroimaging as a predictor of a better response

Figure Brain areas affected in nine patients with stroke and upper limb impairment underwent virtual reality therapy (A). Findings are overlaid in a template of axial magnetic resonance image slices and in a three-dimensional model of the brain (B). The color code bar in the inferior portion of the figure indicates the number of patients with the area injured. 

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[Abstract] Effects of kinesiotaping on hemiplegic hand in patients with upper limb post-stroke spasticity: a randomized controlled pilot study

BACKGROUND: Post-stroke spasticity is a common complication in patients with stroke and a key contributor to impaired hand function after stroke.
AIM: The purpose of this study was to investigate the effects of Kinesiotaping on managing spasticity of upper extremity and motor performance in patients with subacute stroke.
DESIGN: A Randomized Controlled Pilot Study.
SETTING: One hospital center.
POPULATION: Participants with stroke within six months.
METHODS: Thirty-one participants were enrolled. Patients were randomly allocated into Kinesiotaping (KT) group or control group. In KT group, Kinesio tape was applied as an add- on treatment over the dorsal side of the affected hand during the intervention. Both groups received regular rehabilitation 5 days a week for 3 weeks. The primary outcome was muscle spasticity measured by modified Ashworth Scale (MAS). Secondary outcomes were functional performances of affected limb measured by using Fugl-Meyer assessment for upper extremity (FMA-UE), Brunnstrom stage, and the Simple Test for Evaluating Hand Function (STEF). Measures were taken before intervention, right after intervention (the third week) and two weeks later (the fifth week).
RESULTS: Within-group comparisons yielded significant differences in FMA-UE and Brunnstrom stages at the third and fifth week in the control group (p=0.003-0.019). In the KT group, significant differences were noted in FMA-UE, Brunnstrom stage, and MAS at the third and fifth week (p=0.001-0.035), and in the proximal part of FMA-UE between the third and fifth week (p=0.005). Between-group comparisons showed a significant difference in the distal part of FMA-UE at the fifth week (p=0.037).
CONCLUSIONS: Kinesiotaping could provide some benefits in reducing spasticity and in improving motor performance on the affected hand in patients with subacute stroke.
CLINICAL REHABILITATION IMPACT: Kinesiotaping could be a choice for clinical practitioners to use for effectively managing post-stroke spasticity.

via Effects of kinesiotaping on hemiplegic hand in patients with upper limb post-stroke spasticity: a randomized controlled pilot study – European Journal of Physical and Rehabilitation Medicine 2019 Jun 13 – Minerva Medica – Journals

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[Abstract + References] Serious Game Based on Myo Armband for Upper-Limb Rehabilitation Exercises – Conference paper


The purpose of a rehabilitation processes is to restore a person to a state of optimal functioning. A wide variety of rehabilitation processes consist of repetition tasks. Thus, Serious Games (SG) can be used as a technology to assist in this process by motivating patients to perform the exercises during rehabilitation sessions using a variety of devices, with goals or scores to be achieved during sessions. This work addresses the development and usage of SG based on the Myo Armband, an affordable-access device, which is used to build an Assistive Technology for upper-limb rehabilitation. This SG has a circus target shooting as theme, in which the individuals must make the selected upper-limb rehabilitation exercise (the full fist position), in order to shoot with the gun and hit the targets. To test these SG, five healthy volunteers used them during 3 sessions of 10 repetitions each. To evaluate this SG, the volunteers answered a System Usability Scale (SUS) questionnaire and a free questionnaire with questions about the structure of the SG. Results showed that these SG have good potential to be used as a rehabilitation tool, and the suggestions of the free form questionnaire will be useful to make the necessary changes before its usage with impaired patients.


  1. 1.
    Brasil. A Coleção Progestores – Para entender a gestão do SUS. Ciência e Tecnologia em Saúde, 1 ed. Brasília (2007)Google Scholar
  2. 2.
    Brasil. Subsecretaria Nacional de Promoção dos Direitos da Pessoa com Deficiência. Comitê de Ajudas Técnicas. Tecnologia Assistiva. CORDE, 138 pp. Brasília (2009)Google Scholar
  3. 3.
    Brasil. Ministério do Planejamento, Orçamento e Gestão. Instituto Brasileiro de Geografia e Estatística – IBGE. Censo demográfico 2010: características gerais da população, religião e pessoas com deficiência, pp. 1–215. Rio de Janeiro (2010)Google Scholar
  4. 4.
    Robitaille, S.: The Illustrated Guide to Assistive Technology and Devices: Tools and Gadgets for Living Independently. Demos Medical Publishing, New York (2010)Google Scholar
  5. 5.
    Ritterfeld, U., Cody, M., Vorderer, P.: Serious Games: Mechanisms and Effects. Taylor & Francis, New York (2009)CrossRefGoogle Scholar
  6. 6.
    Bonnechère, B.: Serious Games in Physical Rehabilitation. Springer International Publishing, Brussels (2018)CrossRefGoogle Scholar
  7. 7.
    Delisa, A., Gans, M., Walsh, E.: Physical Medicine and Rehabilitation: Principles and Practice, 15th edn. Lippincott Williams & Wilkins, Philadelphia (2005)Google Scholar
  8. 8.
    Monteiro, C.B.D.M.: Realidade virtual e jogos eletrônicos: uma proposta para deficientes. Realidade virtual na paralisia cerebral, pp. 68–87. São Paulo (2011)Google Scholar
  9. 9.
    Masson, S., Fortuna, F., Moura, F., Soriano, D.: Integrating Myo Armband for the control of myoelectric upper limb prosthesis. In: Proceedings of the XXV Congresso Brasileiro de Engenharia Biomédica. Foz do Iguaçu (2016)Google Scholar
  10. 10.
    Kisner, C., Colby, L.A.: Therapeutic Exercise: Foundations and Techniques, 6th edn. Fa Davis, Philadelphia (2012)Google Scholar
  11. 11.
    Levin, F., Weiss, L., Keshner, A.: Emergence of virtual reality as a tool for upper limb rehabilitation: incorporation of motor control and motor learning principles. Phys. Ther. 95(3), 415–425 (2015)CrossRefGoogle Scholar
  12. 12.
    Silva, R., Silva, A.: Tecnologias para Construção de Mundos Virtuais: Um Comparativo Entre as Opções Existentes no Mercado, FAZU em Revista, pp. 211–215 (2012)Google Scholar
  13. 13.
    Hjorungdal, R.M., Sanfilippo, F., Osen, O.L., Rutle, A., Bye, R.T.: A. game-based learning framework for controlling brain-actuated wheelchairs. In: ECMS, pp. 554–563 (2016)Google Scholar
  14. 14.
    Unity Technologies: Unity. (2018). Accessed 18 Feb 2018
  15. 15.
    Blender Foundation: Blender. (2018). Accessed 18 Feb 2018
  16. 16.
    Gimp: Gimp. (2018). Accessed 18 Feb 2018
  17. 17.
    Finstad, K.: The system usability scale and non-native english speakers. J. Usability Stud. 1(4), 185–188 (2006)Google Scholar
  18. 18.
    Bangor, A., Kortum, P., Miller, J.: Determining what individual SUS scores mean: adding an adjective rating scale. J. Usability Stud. 4(3), 114–123 (2009)Google Scholar

via Serious Game Based on Myo Armband for Upper-Limb Rehabilitation Exercises | SpringerLink

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[ARTICLE] Determining the Accuracy of Oculus Touch Controllers for Motor Rehabilitation Applications Using Quantifiable Upper Limb Kinematics: Validation Study – Full Text


Background: As commercial motion tracking technology becomes more readily available, it is necessary to evaluate the accuracy of these systems before using them for biomechanical and motor rehabilitation applications.

Objective: This study aimed to evaluate the relative position accuracy of the Oculus Touch controllers in a 2.4 x 2.4 m play-space.

Methods: Static data samples (n=180) were acquired from the Oculus Touch controllers at step sizes ranging from 5 to 500 mm along 16 different points on the play-space floor with graph paper in the x (width), y (height), and z (depth) directions. The data were compared with reference values using measurements from digital calipers, accurate to 0.01 mm; physical blocks, for which heights were confirmed with digital calipers; and for larger step sizes (300 and 500 mm), a ruler with hatch marks to millimeter units.

Results: It was found that the maximum position accuracy error of the system was 3.5 ± 2.5 mm at the largest step size of 500 mm along the z-axis. When normalized to step size, the largest error found was 12.7 ± 9.9% at the smallest step size in the y-axis at 6.23 mm. When the step size was <10 mm in any direction, the relative position accuracy increased considerably to above 2% (approximately 2 mm at maximum). An average noise value of 0.036 mm was determined. A comparison of these values to cited visual, goniometric, and proprioceptive resolutions concludes that this system is viable for tracking upper-limb movements for biomechanical and rehabilitation applications. The accuracy of the system was also compared with accuracy values from previous studies using other commercially available devices and a multicamera, marker-based professional motion tracking system.

Conclusions: The study found that the linear position accuracy of the Oculus Touch controllers was within an agreeable range for measuring human kinematics in rehabilitative upper-limb exercise protocols. Further testing is required to ascertain acceptable repeatability in multiple sessions and rotational accuracy.


Current gaming and virtual reality platforms [1] that use motion-controlled interfaces offer an affordable and accessible method of tracking human kinematics. However, given that consumer-grade platforms are originally intended for playing video games and to immerse players in virtual environments, their tracking performance should be evaluated before they are employed as tools for biomechanical or clinical analysis [2]. Previously tested rehabilitation protocols using commercial gaming technology such as Wii Motes (Nintendo Co, Ltd, Kyoto, Japan) to provide positional feedback for trunk compensation [3] or a Kinect (Microsoft Corporation, Redmond, United States) to measure range and speed of motion for upper-limb exercises [4,5] have shown potential to be used as rehabilitation tools that could provide quantifiable changes in clients’ kinematic motor abilities to therapists. Other studies using accelerometers to track patterns in functional upper-limb movements were able to capture differences similar to those measured by clinical scales [6] and found benefits from objective quantitative evaluations of changes in motor ability during therapy regimens, which can be collected from in-game progress reports [7]. In addition, success has been found in translating kinematic upper-limb metrics to clinical Fugl-Meyer scoring [8] and in detecting exercise repetitions via kinematic monitoring for telerehabilitation and at-home programs [9]. Current clinical assessments for upper-limb motor function, such as the Fugl-Meyer Assessment and Wolf Motor Function Test, only provide low-resolution point-scores rated qualitatively by therapists, and kinematic analysis of upper-limb motion has been reported to be a useful addition to these clinical assessments [10]. When measuring range of motion in a clinical setting, the goniometer is considered a gold-standard clinical measurement tool used by therapists [11]. However, only static joint angles can be measured, and typically with some visual estimation and multiple testers [12].

One of the latest (released December 2016) devices to be developed for interacting with virtual environments is the Oculus Touch (Oculus VR, LLC, Menlo Park, CA, United States) controller set. The controllers are peripheral accessories of the Oculus Rift virtual reality headset and are employed to track users’ hand movements. Their tracking system employs a proprietary algorithm that collects data from infrared sensors via constellation tracking [13] and inertial measurement units (IMUs). Given that the controllers are wireless, lightweight, low-cost devices that can be used to track a user’s hand position and orientation in 3-dimensional (3D) space, they could have the potential to be employed in rehabilitative and biomechanical motion-tracking applications. At the time of this study, there was no sufficient information about the tracking performance of the controllers provided by the manufacturer, and there is currently a lack of scientific papers employing a systematic approach to test their potential application as tools for motion-tracking data capture. As a result, in this study, we evaluated the tracking accuracy of the Oculus Touch controllers to present a preliminary evaluation that could be informative to the biomechanical and rehabilitation research community. The specific aim of the experiment was to quantify the relative positional accuracy of the Oculus Touch controllers in 3 spatial dimensions. As the controllers are intended for hand-held motion control, the evaluation setup was centered around the movement size for standing/sitting upper-limb reaching tasks.


Technical Setup

An Oculus Touch controller (Figure 1), 2 Oculus Sensors, an Oculus Rift headset, and a computer running Windows 10 (Microsoft Corporation) were employed in this study.

A custom computer application was developed in Unity 2017 (Unity Technologies, San Francisco, United States) to capture and log the controller’s position during the experiment. The data capture was performed at the headset’s native frequency of approximately 90 Hz , using the Unity OVR Plugin package to access controller data. The virtual environment was set up over a 2.4 m x 2.4 m play-space in the x-z plane to be within the recommended manufacturer play area. This space consists of 16 commercial 600 mm square force/torque plates professionally installed on a subfloor of auto-levelling epoxy and flat to within 0.5 mm (Figure 2). The y-axis was only bounded by the camera sensors’ field of view limitations.

To ensure consistency, the Oculus Sensors were placed on the floor at 0.3 m along the front edge of the space and 1.2 m apart, equidistant from the centre line, for the entire experiment. The sensor heads were manually leveled and visually aligned to have parallel, front-facing fields of views. Both the sensors and controllers maintained an initial y-position of 0 at the floor—this would be equivalent to placing the sensors at table height and the controllers at hand height.

All measurements were taken by securing the right-hand Oculus Touch controller to a flat L-shaped jig (Figure 2) and resting it on the floor for 5 seconds. Initial calibration of floor height and play-space size and orientation was done through the official commercial Oculus setup client.

Figure 1. The right-side Oculus Touch controller. Left: front view. Right: top-down view.


Continue —>  JBME – Determining the Accuracy of Oculus Touch Controllers for Motor Rehabilitation Applications Using Quantifiable Upper Limb Kinematics: Validation Study | Shum | JMIR Biomedical Engineering

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[Abstract] Relationship Between Clinical Measures of Upper Limb Movement Quality and Activity Poststroke

Background. Understanding the relationship between movement quality (impairment) and performance (activity) in poststroke patients is important for rehabilitation intervention studies. This has led to an interest in kinematic characterization of upper limb motor impairment. Since instrumented motion analysis is not readily clinically available, observational kinematics may be a viable alternative.

Objective. To determine if upper limb movement quality during a reach-to-grasp task identified by observation could be used to describe the relationship between motor impairments and the time to perform functional tasks.

Methods. Cross-sectional, secondary analysis of baseline data from 141 participants with stroke, age 18 to 85 years, who participated in a multicenter randomized controlled trial. Clinical assessment of movement quality using the Reaching Performance Scale for Stroke (RPSS–Close and Far targets) and of performance (activity) from the Wolf Motor Function Test (WMFT–7 items) was assessed. The degree to which RPSS component scores explained scores on WMFT items was determined by multivariable regression.

Results. Clinically significant decreases (>2 seconds) in performance time for some of the more complex WMFT tasks involving prehension were predicted from RPSS–Close and Far target components. Trunk compensatory movements did not predict either increases or decreases in performance time for the WMFT tasks evaluated. Overall, the strength of the regression models was low.

Conclusions. In lieu of kinematic analysis, observational clinical movement analysis may be a valid and accessible method to determine relationships between motor impairment, compensations and upper limb function in poststroke patients. Specific relationships are unlikely to generalize to all tasks due to kinematic redundancy and task specificity.


via Relationship Between Clinical Measures of Upper Limb Movement Quality and Activity Poststroke – Mindy F. Levin, Vimonwan Hiengkaew, Yongchai Nilanont, Donna Cheung, David Dai, Jennifer Shaw, Mark Bayley, Gustavo Saposnik, 2019

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