Posts Tagged upper extremity rehabilitation
[Abstract] Upper Extremity Rehabilitation Using Fully Immersive Virtual Reality Games with a Head Mount Display: A Feasibility Study
Rehabilitation therapy using virtual reality (VR) system for stroke patients has gained attention. However, only few studies have investigated fully immersive VR using a head‐mount display (HMD) for upper extremity rehabilitation in stroke patients.
To investigate the feasibility, preliminary efficacy, and usability of a fully immersive VR rehabilitation program using a commercially available HMD for upper‐limb rehabilitation in stroke patients.
A feasibility study
Two rehabilitation centers
Twelve stroke patients with upper extremity weakness
Five upper extremity rehabilitation tasks were implemented in a virtual environment, and the participants wore an HMD (HTC Vive) and trained with appropriate tasks. Participants received a total of 10 sessions two to three times a week, consisting of 30 minutes per session.
Main Outcome Measures
Both patients’ participation and adverse effects of VR training and were monitored. Primary efficacy was assessed using functional outcomes (action arm reach test, box and block test, and modified Barthel index), before and after the intervention. Usability was assessed using a self‐reported questionnaire.
Three patients discontinued VR training, and nine patients completed the entire training sessions and there were no adverse effects due to motion sickness. The patients who received all sessions showed significant functional improvement in all outcome measures after training (P < .05 for all measures). The overall satisfaction was 6.3 ± 0.8 on a 7‐point Likert scale in all participants.
A fully immersive VR rehabilitation program using an HMD for rehabilitation of the upper extremities following stroke is feasible and, in this small study, no serious adverse effects were identified.
A study was conducted to investigate the effectiveness of virtual activities of daily living (ADL) practice using the SaeboVR software system for the recovery of upper extremity (UE) motor function following stroke. The system employs Kinect sensor-based tracking to translate human UE motion into the anatomical pose of the arm of the patient’s avatar within a virtual environment, creating a virtual presence within a simulated task space. Patients gain mastery of 12 different integrated activities while traversing a metaphorical ‘road to recovery’ that includes thematically linked levels and therapist-selected difficulty settings. Clinical trials were conducted under the study named Virtual Occupational Therapy Application. A total of 15 chronic phase stroke survivors completed a protocol involving three sessions per week over eight weeks, during which they engaged in repetitive task practice through performance of the virtual ADLs. Results show a clinically important improvement and statistically significant difference in Fugl-Meyer UE assessment scores in the study population of chronic stroke survivors over the eight-week interventional period compared with a non-interventional control period of equivalent duration. Statistically significant and clinically important improvements are also found in the wolf motor function test scores. These results provide new evidence for the use of virtual ADL practice as a tool for UE therapy for stroke patients. Limitations of the study include non-blinded assessments and the possibility of selection and/or attrition bias. © 2017 IEEE.
Brain Computer Interfaces (BCI), is a modern technology which is currently revolutionizing the field of signal processing. BCI helped in the evolution of a new world where man and computer had never been so close. Advancements in cognitive neuro-sciences facilitated us with better brain imaging techniques and thus interfaces between machines and the human brain became a reality. Electroencephalography (EEG), which is the measurement and recording of electric signals using sensors arrayed across the scalp can be used for applications like prosthetic devices, applications in warfare, gaming, virtual reality and robotics upon signal conditioning and processing.
This paper is entirely based on Brain-Computer Interface with an objective of actuating a robotic arm with the help of device commands derived from EEG signals. This system unlike any other existing technology is purely non-invasive in nature, cost effective and is one of its kinds that can serve various requirements such as prosthesis. This paper suggests a low cost system implementation that can even serve as a reliable substitute for the existing technologies of prosthesis like BIONICS. […]
[STUDY] Developing a Digital Game for Stroke Patients’ Upper Extremity Rehabilitation – Design, Usability and Effectiveness Assessment – Full Text PDF
The purpose of this study was to develop a digital game system for rehabilitation and to assess their feasibility, usability and effectiveness. A questionnaire was designed to evaluate the usability and feasibility associated with using this game. The results of this study can be summarized as follows:
1) the upper extremity rehabilitation gardening game (UERG game) is special designed for domestic stroke patients.
2) This UERG game uses Kinect’s skeletal tracking features and motion sensor to interaction with patients.
3) design features are as following: game contents include three difficult levels according to different upper limb motor function recovery stages; to record user’s motor performance; to provide feedback information (for example: to record the completed the task time and to detect whether the user has compensatory action, etc.).
4) A total of 10 patients to assess this set of games. The results showed that 90% of patients reported that using UERG game in treatment increased their treatment motivation.; 70% of them reported that this games is very interactive; 80% patients considered this game is conducive to recovery their upper extremity functions; 80% patients considered the feedback information provided help them to understand their performance in each session after training; 60% patients indicated the game interfaces were easy to operate and learning; 90% of patients reported that this game is enjoyment and satisfied with this game for rehabilitation. Overall, the UERG game is feasibility to use in rehabilitation.
[ARTICLE] Improvement in paretic arm reach-to-grasp following Low frequency repetitive transcranial magnetic stimulation depends on object size: a pilot study – Full Text PDF
Introduction. Low frequency repetitive transcranial magnetic stimulation (LF-rTMS) delivered to the non-lesioned hemisphere has shown to improve limited function of the paretic upper extremity (UE) following stroke. The outcome measures have largely included clinical assessments with little investigation on changes in kinematics and coordination. To date, there is no study investigating how the effects of LF-rTMS are modulated by the sizes of an object to be grasped.
Objective. To investigate the effect of LF- rTMS on kinematics and coordination of the paretic hand reach-to-grasp (RTG) for two object sizes in chronic stroke.
Methods: Nine participants received two TMS conditions: real-and sham-rTMS conditions. Before and after the rTMS conditions, cortico-motor excitability (CE) of the non-lesioned hemisphere, RTG kinematics and coordination. Object sizes were 1.2 and 7.2 cm in diameter. Results. Compared to sham rTMS, real rTMS significantly reduced CE of the non-lesioned M1. While rTMS had no effect on RTG action for the larger object, real-rTMS significantly improved movement time, aperture opening and RTG coordination for the smaller object.
Conclusions. LFrTMS improves RTG action for only the smaller object in chronic stroke. The findings suggest a dissociation between effects of rTMS on M1 and task difficulty for this complex skill.
[ARTICLE] Developing a Digital Game for Domestic Stroke Patients’ Upper Extremity Rehabilitation – Design and Usability Assessment
Digital games have been proven effective in upper extremity rehabilitation for stroke patients in addition to arousing higher motivation and feelings of pleasure. A well designed upper extremity rehabilitation digital game should intentionally meet the purpose of rehabilitation. Therefore, it is desirable to dmestically develop digital upper extremity rehabilitation games for the local hospitals as well as individual users.
We are proposing this research to develop such digital games for rehabilitation and their feasibility assessment. A questionnaire was designed to evaluate the usability and feasibility associated with using this game. The results of this study can be summarized as follows:
(1) the set of upper extremity rehabilitation game was named as upper extremity rehabilitation gardening game (UERG game). It is special designed for domestic stroke patients.
(2) This UERG game uses Kinect’s skeletal tracking features and motion sensor to interaction with patients.
(3) design features are as following: game contents include three difficult levels according to different upper limb motor function recovery stages; to record user’s motor performance; to provide feedback information (for example: to record the completed the task time and to detect whether the user has compensatory action, etc.).
(4) A total of 10 patients to assess this set of games. The results showed that 90 % of patients reported that using UERG game in treatment increased their treatment motivation.; 70 % of them reported that this games is very interactive; 80 % patients considered this game is conducive to recovery their upper extremity functions; 80 % patients considered the feedback information provided help them to understand their performance in each session after training; 60 % patients indicated the game interfaces were easy to operate and learning; 90 % of patients reported that this game is enjoyment and satisfied with this game for rehabilitation.
They are willing to continue to use.
[ARTICLE] Low frequency repetitive transcranial magnetic stimulation to the non-lesioned hemisphere improves paretic arm reach-to-grasp performance after chronic stroke.
Purpose: To investigate the effect of inhibitory low frequency repetitive Transcranial Magnetic Stimulation (rTMS) applied to the non-lesioned hemisphere on kinematics and coordination of paretic arm reach-to-grasp (RTG) actions in individuals with stroke.
Relevance: This study is designed as a phase I trial to determine the feasibility and efficacy of low frequency rTMS applied to the non-lesioned hemisphere for the recovery of reach-to-grasp actions in individuals with hemiparesis secondary to stroke. The results have important implications for the use of rTMS in parallel with complex paretic arm skill practice.
Participants: Nine adults, anterior circulation unilateral stroke. Their average age was 59 years, the average time since stroke was 4.8 years.
Method and analysis: Two TMS treatments were performed on two separate days: active rTMS and sham rTMS. Cortico-motor excitability (CE) of the non-lesioned hemisphere as well as RTG kinematics of the paretic hand as participants reached for a dowel of 1.2 cm in diameter was assessed before and after the rTMS treatments. In the active condition, rTMS was applied over the “hot spot” of the extensor digitorum communis muscle (EDC) in primary motor cortex (M1) of the non-lesioned hemisphere at 90% resting motor threshold. TMS pulses were delivered at 1 Hz for 20 min. In the sham condition, a sham coil was positioned similar to the active condition; TMS clicking noise was produced but no TMS pulse was delivered.
Dependent measures: CE was measured as peak-to-peak amplitude of the motor evoked potential at 120% of resting motor threshold. RTG kinematics included movement time, peak transport velocity, peak aperture, time of peak transport velocity and time of peak aperture. RTG coordination was captured by cross correlation coefficient between transport velocity and grasp aperture size.
Results: While 1 Hz rTMS applied over non-lesioned M1 significantly decreased the MEP amplitude of non-paretic EDC, sham TMS did not have a significant effect on MEP amplitude. Active rTMS significantly decreased total movement time and increased peak grasp aperture. There were no changes in peak transport velocity or the time of peak transport velocity or the time of peak aperture after application of active rTMS. Additionally, the participants completed RTG actions with a more coordinated pattern after undergoing active rTMS. Following sham TMS, there were no changes in CE, RTG kinematics or coordination. While there were no significant correlation between changes in cortico-motor excitability and RTG kinematics, the decrease in cortico-motor excitability of the non-lesioned hemisphere showed a strong correlation with an increase in cross-correlation coefficient.
Conclusions and implications: The findings demonstrate the feasibility and efficacy of low frequency rTMS applied to the non-lesioned hemisphere for the recovery of reach-to-grasp actions in individuals with hemiparesis secondary to stroke. The inhibitory effect of low frequency rTMS resulted in improved paretic hand reach-to-grasp performance with faster movement time and more coordinated reach-to-grasp pattern. These results have important implications for the use of rTMS for stroke rehabilitation.
Implications for Rehabilitation
- Low frequency repetitive transcranial magnetic stimulation (LF-rTMS) to the non-lesioned hemisphere improves paretic arm reach-to-grasp performance.
- The preliminary results have important implications for the use of LF-rTMS as conjunctive intervention for stroke rehabilitation.
via Low frequency repetitive transcranial magnetic stimulation to the non-lesioned hemisphere improves paretic arm reach-to-grasp performance after chronic stroke, Disability and Rehabilitation: Assistive Technology, Informa Healthcare.