Posts Tagged YouGrabber
[ARTICLE] Effect of a four-week virtual reality-based training versus conventional therapy on upper limb motor function after stroke: A multicenter parallel group randomized trial – Full Text
Virtual reality-based training has found increasing use in neurorehabilitation to improve upper limb training and facilitate motor recovery.
The aim of this study was to directly compare virtual reality-based training with conventional therapy.
In a multi-center, parallel-group randomized controlled trial, patients at least 6 months after stroke onset were allocated either to an experimental group (virtual reality-based training) or a control group receiving conventional therapy (16×45 minutes within 4 weeks). The virtual reality-based training system replicated patients´ upper limb movements in real-time to manipulate virtual objects.
Blinded assessors tested patients twice before, once during, and twice after the intervention up to 2-month follow-up for dexterity (primary outcome: Box and Block Test), bimanual upper limb function (Chedoke-McMaster Arm and Hand Activity Inventory), and subjective perceived changes (Stroke Impact Scale).
54 eligible patients (70 screened) participated (15 females, mean age 61.3 years, range 20–81 years, time since stroke 3.0±SD 3 years). 22 patients were allocated to the experimental group and 32 to the control group (3 drop-outs). Patients in the experimental and control group improved: Box and Block Test mean 21.5±SD 16 baseline to mean 24.1±SD 17 follow-up; Chedoke-McMaster Arm and Hand Activity Inventory mean 66.0±SD 21 baseline to mean 70.2±SD 19 follow-up. An intention-to-treat analysis found no between-group differences.
Patients in the experimental and control group showed similar effects, with most improvements occurring in the first two weeks and persisting until the end of the two-month follow-up period. The study population had moderate to severely impaired motor function at entry (Box and Block Test mean 21.5±SD 16). Patients, who were less impaired (Box and Block Test range 18 to 72) showed higher improvements in favor of the experimental group. This result could suggest that virtual reality-based training might be more applicable for such patients than for more severely impaired patients.
Virtual reality-based rehabilitation systems are gaining popularity because of their ease of use, applicability to wide range of patients, and ability to provide patient-personalized training [1–3]. Additional reported benefits of virtual reality systems for both patients and health providers include increased therapy efficiency and a high level of attention in patients during training .
One of the main struggles therapists encounter is keeping patients motivated throughout conventional training sessions. The Yerkes-Dodson Law describes the relationship between arousal or motivation and performance . At first, an increase in arousal and motivation leads to an increase in performance. But once a certain point is reached, this point can vary based on many factors including the task, the participant, and the context, the relationship becomes inverse and increases in arousal caused decreases in performance. In line with these ideas, previous research has shown that increased performance leads to greater improvement in patients after stroke up to a certain point. Virtual reality-based systems allow manipulation of arousal through training settings to ensure that peak performance is maintained for as large a portion of the therapy time as possible .
Laver et al. systematically evaluated the literature regarding the efficacy of virtual reality-based training in stroke rehabilitation in 2011 and in its updates in 2015 and 2017 [3, 7, 8]. Their current meta-analysis of 22 trials including 1038 patients after stroke that focused on upper limb function did not reveal a statistically significant difference between VR-based training and conventional therapy (0.07 standard deviation higher in virtual reality-based compared to conventional therapy. Furthermore, the authors rated the quality of evidence as low, based on the GRADE system. However, for ADL function the experimental groups showed a 0.25 higher standard deviation than the conventional therapy groups based on ten studies, including 466 patients after a stroke with moderate quality of evidence.
Only 10% of the included studies included more than 50 participants, with mean ages between 46 to 76 years. However, due to the different systems used no conclusion could be drawn regarding grip strength, dosage, type or program of the virtual reality-based training. Furthermore, the authors pointed out the low sample sizes and the low methodological quality of the reported trials. In their recommendations for further research, the authors encouraged researchers and clinicians again to conduct larger trials and to increase the detail in reporting to enable more firm conclusions.
YouGrabber (now renamed Bi-Manu Trainer), a game-based virtual reality system designed for upper-limb rehabilitation, has been shown to be effective in children with cerebral palsy. A 2-subject feasibility study indicated that the findings might extend to chronic stroke patients [9, 10]. Both male subjects, who were trained three years after insult onset, showed increases in scores for the bimanual activities of daily living focused Chedoke McMaster Arm and Hand Activity Inventory (CAHAI) that persisted at the final follow-up, and corresponding cortical changes measured with fMRI.
Based on these findings the present multicenter parallel group randomized single-blinded trial aimed to investigate the efficacy of a virtual reality-based training with the YouGrabber training device (now renamed Bi-Manu Trainer) compared to conventional therapy. The study was designed to test the hypothesis that patients in the chronic stage after stroke in the virtual reality-based training group will show no higher post-intervention performance in the Box and Block Test (BBT) compared to patients receiving an equal training time of physiotherapy or occupational therapy.
For comparison with published and ongoing international studies we selected the Box and Block Test as the primary outcome measure and the CAHAI as the secondary outcome measure.
Methods and materials
This prospective, multicenter, single-blinded, parallel-group randomized trial was conducted in the outpatient departments of three rehabilitation hospitals in the German and French speaking parts of Switzerland: University hospital Inselspital Bern, Buergerspital Solothurn, and Reha Rheinfelden. In the study plan, each hospital was responsible for the recruitment, assessment, and therapy of 20 patients: 10 patients for the experimental group (EG) and 10 for the control group (CG), respectively.
More details regarding the study methodology can be found in the study flow chart in Fig 1 and the previously published study protocol strictly followed by each center (http://trialsjournal.biomedcentral.com/articles/10.1186/1745-6215-15-350) . Ethics approval was warranted by the ethics committee of the Canton Aargau (2012/065) and the Canton Berne (220/12). The study was registered with ClinicalTrials.gov: NCT01774669 before the start of patient recruitment.
Playing virtual reality games could be as effective as adding extra physical therapy sessions to a stroke patient’s rehab regimen, according to researchers.
“It is not a question of choosing one thing over the other, rather of having different training alternatives to provide variation,” says Iris Brunner, author of a study, published recently in Neurology, that explored a variety of medical uses for virtual reality.
“Virtual reality cannot replace physical therapy. But it can be experienced as a game, motivating patients to do an extra treatment session,” adds Brunner, associate professor with the University of Aarhus and Hammel Neurocenter, in Denmark.
Brunner and her team’s study included 120 stroke patients with mild to severe hand weakness, all of whom were randomly assigned to add 16 hour-long therapy sessions to their routine rehabilitation over a month. One group performed physical therapy, while the other group played a virtual reality game called YouGrabber, notes a media release from HealthDay.
In the game, Brunner explains, “the patients wear gloves with sensors, and their movements are tracked by an infrared camera and transferred to a virtual arm on screen.”
“In different scenarios, they can grasp objects that come toward them or pick carrots. In other games, patients steer a plane or a car with their movement. The therapist chooses the movements to be trained and the level of difficulty.”
Fifty patients in the physical therapy group and 52 in the virtual reality group completed the study and were evaluated after 3 months.
The researchers found no difference between the two groups with regard to the improvement in their hand and arm function.
“Patients who started out with moderately to mildly impaired arm and hand motor function achieved, on average, a level of good motor function,” Brunner states, while those with severe weakness were able to use their arms to make movements.
Patients with severe hand weakness appreciated how even small movements translated to the virtual arms on screen, she adds. And even the older patients liked the virtual reality game, she notes, possibly because the graphics are simpler than those in commercial video games.
Brunner concludes by noting that larger studies are needed to understand the potential value of virtual reality as a stroke recovery treatment.
The YouGrabber is part of the YouRehab rehabilitative therapy suite composed also of YouKicker and YouInteract, all of which feature virtual reality devices and therapy management software.
According to the product’s website, the YouGrabber can be used with such indications as central nervous system disorders or damage, spinal cord disorders or damage, peripheral nerve lesions, orthopaedic impairments, and cognitive attention and reaction deficits.
Areas to be trained can include arm pronation and supination, arm lifting and lowering, hand and finger extension, grasping movements, fine finger movements, wrist flexion and extension, and elbow flexion and extension.
“Flexpoint is honored to be a part of this exciting, collaborative relationship with YouRehab. The company is setting new standards for next-gen, virtual reality enabled technology in the medical rehabilitative space,” comments Paul Sexauer, Flexpoint vice president of sales and marketing, in a media release from the company.
[Source(s): Flexpoint Sensor Systems Inc, PR Newswire]
[ARTICLE] A Mixed Methods Small Pilot Study to Describe the Effects of Upper Limb Training Using a Virtual Reality Gaming System in People with Chronic Stroke – Full Text
Introduction. This small pilot study aimed to examine the feasibility of an upper limb rehabilitation system (the YouGrabber) in a community rehabilitation centre, qualitatively explore participant experiences, and describe changes after using it.
Methods and Material. Chronic stroke participants attending a community rehabilitation centre in the UK were randomised to either a YouGrabber or a gym group and completed 18 training sessions over 12 weeks. The motor activity log, box and block, and fatigue severity score were administered by a blinded assessor before and after the intervention. Semistructured interviews were used to ascertain participants’ views about using the YouGrabber.
Results. Twelve participants (6 females) with chronic stroke were recruited. All adhered to the intervention. There were no adverse events, dropouts, or withdrawal. There were no significant differences between the YouGrabber and gym groups although there were significant within group improvements on the motor activity log (median change: 0.59, range: 0.2–1.25; ) within the YouGrabber group. Participants reported that the YouGrabber was motivational but they expressed frustration with technical challenges.
Conclusions. The YouGrabber appeared practical and may improve upper limb activities in people several months after stroke. Future work could examine cognition, cost effectiveness, and different training intensities.
There are approximately 33 million stroke survivors worldwide . Whilst the survival rate of stroke continues to improve, it is recognised that many survivors continue to be left with functional deficits that impact upon their quality of life and limit their return to vital functions and hobbies . The ability to return to activities of daily living after stroke can be maximised by rehabilitative therapy which improves quality of life and facilitates independence . A key component of physical therapy after stroke is repetition, or practice, of challenging movements that are focused on achieving a task or function . This repeated task practice has been shown to facilitate and harness positive adaptations within the brain to aid recovery . Whilst an ideal amount of practice to improve daily functioning has not been established , animal studies suggest that in excess of 400 repetitions are needed to promote plastic changes in the brain . In clinical studies, two to three hours a day of practice for six weeks has been shown to elicit meaningful improvements in stroke survivors . Meta-analyses of clinical trials also indicate that higher doses of practice promote better outcomes in impairments and activities of daily living for people after stroke [4, 7–9].
Facilitating increased practice of task orientated movements may be particularly helpful in improving the upper limb in people after stroke. Between half and two-thirds of stroke survivors report problems with their upper limb which significantly affects their activities of daily living  and has considerable negative effects upon participation and quality of life [11, 12]. Recovery of the upper limb may be particularly difficult as an individual’s use of the affected arm has been observed to be minimal after stroke . Furthermore, restoration of the upper limb often is not the primary aim of initial rehabilitation for both the patient and therapist, who are likely to be more focused on regaining the ability to walk . Consequently it is unsurprising that less than 10 minutes of a typical therapy session are focused upon activities for the upper limb [13, 15].
There is good quality evidence for the use of interventions which require repetitive, task orientated, and task specific activities to improve the recovery of the upper limb after stroke [16, 17]. These interventions include constraint induced movement therapy (CIMT), virtual reality, and interactive video games . Interactive video gaming using forms of virtual reality (VR) have grown in popularity as a method to increase repeated practice of challenging and engaging movements for people after stroke. Training using interactive VR games can provide task oriented, unpredictable and graduated learning , and augmented feedback regarding performance and results which motivate and engage players .
Although there is insufficient evidence to compare different upper limb interventions , the literature suggests that interactive VR game training is at least as effective as conventional exercises to elicit improvements in the upper limb after stroke . However, many studies use a broad range of gaming systems in mostly acute stroke survivors where participants were typically based in hospital settings . Consequently, the effects of virtual reality gaming upon the upper limb function of community dwelling stroke survivors who have had their strokes many months or years ago are not established. Furthermore, only a few studies have considered the views of participants about using virtual reality gaming systems for rehabilitation of the upper limb. Whilst these views have been largely positive, similar findings cannot be assumed between different training locations and gaming systems .
Therefore, this small, prospective mixed methods study was developed to
- examine the feasibility of a custom made virtual reality upper limb interactive gaming tool called the YouGrabber® (YouRehab) in people after stroke who are attending a community outpatient rehabilitation centre,
- describe the changes in upper limb function after using the YouGrabber and estimate the magnitude of the change in order to inform the sample size needed for a future trial,
- explore the experiences of participants who had used the YouGrabber for rehabilitation of the upper limb after stroke.
[ARTICLE] Preparing a neuropediatric upper limb exergame rehabilitation system for home-use: a feasibility study | Journal of NeuroEngineering and Rehabilitation | Full Text
Home-based, computer-enhanced therapy of hand and arm function can complement conventional interventions and increase the amount and intensity of training, without interfering too much with family routines. The objective of the present study was to investigate the feasibility and usability of the new portable version of the YouGrabber® system (YouRehab AG, Zurich, Switzerland) in the home setting.
Fifteen families of children (7 girls, mean age: 11.3y) with neuromotor disorders and affected upper limbs participated. They received instructions and took the system home to train for 2 weeks. After returning it, they answered questions about usability, motivation, and their general opinion of the system (Visual Analogue Scale; 0 indicating worst score, 100 indicating best score; ≤30 not satisfied, 31–69 average, ≥70 satisfied). Furthermore, total pure playtime and number of training sessions were quantified. To prove the usability of the system, number and sort of support requests were logged.
The usability of the system was considered average to satisfying (mean 60.1–93.1). The lowest score was given for the occurrence of technical errors. Parents had to motivate their children to start (mean 66.5) and continue (mean 68.5) with the training. But in general, parents estimated the therapeutic benefit as high (mean 73.1) and the whole system as very good (mean 87.4). Children played on average 7 times during the 2 weeks; total pure playtime was 185 ± 45 min. Especially at the beginning of the trial, systems were very error-prone. Fortunately, we, or the company, solved most problems before the patients took the systems home. Nevertheless, 10 of 15 families contacted us at least once because of technical problems.
Despite that the YouGrabber® is a promising and highly accepted training tool for home-use, currently, it is still error-prone, and the requested support exceeds the support that can be provided by clinical therapists. A technically more robust system, combined with additional attractive games, likely results in higher patient motivation and better compliance. This would reduce the need for parents to motivate their children extrinsically and allow for clinical trials to investigate the effectiveness of the system.
Data glove, Pediatrics ,Neurorehabilitation, Upper extremities ,YouGrabber, Tele-rehabilitation, Game-based, Cerebral palsy, Children and adolescents, Clinical utility, User satisfaction
The Innovative YouGrabber Concept
Complete Pair of Therapy Data Gloves
From Early Rehabilitation……
..… to Training at Home
YouGrabber offers a broad variety of different training targets. It can be used to make the effects of even the smallest movements easily visible. This immediate positive reinforcement is extremely motivating for patients and can be recalibrated at any time to accommodate continuously the newly acquired abilities of the patient.
Inpatient and Outpatient Rehabilitation
The YouGrabber system is easy to transport by hand and can be used during early-stage rehabilitation at the bedside. Thanks to the wide variety of training possibilities and the different levels of difficulty, YouGrabber can support the patient from early-phase stationary rehabilitation all the way to ambulant treatment. The YouGrabber system continuously challenges and motivates the patient according to his/her abilities and needs.
Rehabilitation at Home
Rehabilitation from many conditions, particularly neurological diseases, is a long process which continues after the patient has returned home. YouGrabber can be rented or purchased by the patient directly from a certified medical supply house (Germany only). Together with the patient’s physician, the medical supply house will carefully evaluate the patient’s situation and then prescribe YouGrabber. YouRehab and the medical supply house will then support the patient after the medical prescription for obtaining insurance reimbursement approval. The patient can then obtain YouGrabber at the medical supply house and make an appointment with a therapist for initial system training.