A System for Monitoring Stroke Patients in a Home Environment

Currently, the changes of functional capacity and performance of stroke patients after returning home from a rehabilitation hospital is unknown for a physician, having no objective information about the intensity and quality of a patient's daily-life activities. Therefore, there is a need to develop and validate an unobtrusive and modular system for objectively monitoring the stroke patient's upper and lower extremity motor function in daily-life activities and in home training. This is the main goal of the European FP7 project named “INTERACTION‿. A complete sensing system is developed, whereby Inertial Measurement Units (IMU), Knitted Piezoresistive Fabric (KPF) goniometers, KPF strain sensors, EMG electrodes and force sensors are integrated into a modular sensor suit designed for stroke patients. In this paper, we describe the systems architecture. Data from the sensors are captured wirelessly and stored in a remote secure database for later access and processing via portal technology. In collaboration with clinicians and engineers, clinical outcome measures were defined and the question of how to present the data on the web portal was addressed. The first implementation of the complete system includes a basic version of all components and is currently being extended to include all sensors within the INTERACTION system

Design and develop virtual reality games utilising the 'anti‐gravity' arm support for stroke rehabilitation therapy

Approximately 16,000 Australians each year are left with a disability as a direct consequence of stroke. The number of strokes that occur in Australia each year is increasing, putting a strong reliance on home and community based rehabilitation having an increasing role in the rehabilitation process. Strokes are caused by a sudden disruption to the flow of blood to parts of the brain. If an artery is blocked, the brain cells (neurons) cannot make enough energy and will eventually stop working. Stroke affects patients in a number of different ways depending on the severity of the stroke and the type of stroke in which the patient suffers from. There two main types of disabilities that are a result of stroke: hemiplegia and hemiparesis. The project aims to develop a virtual reality application to assist in the rehabilitation of the upper extremities of stoke patients who suffer from hemiparesis. The project will endeavour to design a low cost, home based system that will motivate patients by creating intermediate goals that can be adopted into the rehabilitation process. The project will utilise the 'anti‐gravity' arm support system to lessen the affect of reduced muscle strength and control. The project objectives are to: - Research relevant background information on the effects of stroke. - Research traditional methods of stroke rehabilitation and assessment of rehabilitation progression. - Implement hardware and program for position data acquisition. - Develop virtual reality application for exercise and rehabilitation assessment. The project is based around detecting the movement or the patients arm and creating a computer representation. This has been performed by monitoring the potentiometers on the 'anti‐gravity' arm support utilizing the PIC AXE microcontroller. The microcontroller to converts the signal into a digital integer and transfers them to the computer via a serial link. The games were designed around conventional physiotherapy exercises allowing the user to complete the exercises in a self motivating environment. The games were developed in both 2D and 3D environments utilizing Microsoft's XNA games studio. The project has been successful in accurately representing a user's movement within a virtual environment. This has been tested by use of advance 3D mapping techniques; however the project is still not a stage where it is practical to perform clinical trials

Development and preliminary evaluation of a novel low cost VR-based upper limb stroke rehabilitation platform using Wii technology.

Abstract Purpose: This paper proposes a novel system (using the Nintendo Wii remote) that offers customised, non-immersive, virtual reality-based, upper-limb stroke rehabilitation and reports on promising preliminary findings with stroke survivors. Method: The system novelty lies in the high accuracy of the full kinematic tracking of the upper limb movement in real-time, offering strong personal connection between the stroke survivor and a virtual character when executing therapist prescribed adjustable exercises/games. It allows the therapist to monitor patient performance and to individually calibrate the system in terms of range of movement, speed and duration. Results: The system was tested for acceptability with three stroke survivors with differing levels of disability. Participants reported an overwhelming connection with the system and avatar. A two-week, single case study with a long-term stroke survivor showed positive changes in all four outcome measures employed, with the participant reporting better wrist control and greater functional use. Activities, which were deemed too challenging or too easy were associated with lower scores of enjoyment/motivation, highlighting the need for activities to be individually calibrated. Conclusions: Given the preliminary findings, it would be beneficial to extend the case study in terms of duration and participants and to conduct an acceptability and feasibility study with community dwelling survivors. Implications for Rehabilitation Low-cost, off-the-shelf game sensors, such as the Nintendo Wii remote, are acceptable by stroke survivors as an add-on to upper limb stroke rehabilitation but have to be bespoked to provide high-fidelity and real-time kinematic tracking of the arm movement. Providing therapists with real-time and remote monitoring of the quality of the movement and not just the amount of practice, is imperative and most critical for getting a better understanding of each patient and administering the right amount and type of exercise. The ability to translate therapeutic arm movement into individually calibrated exercises and games, allows accommodation of the wide range of movement difficulties seen after stroke and the ability to adjust these activities (in terms of speed, range of movement and duration) will aid motivation and adherence - key issues in rehabilitation. With increasing pressures on resources and the move to more community-based rehabilitation, the proposed system has the potential for promoting the intensity of practice necessary for recovery in both community and acute settings.The National Health Service (NHS) London Regional Innovation Fund

East Midlands Research into Ageing Network (EMRAN) Discussion Paper Series

Academic geriatric medicine in Leicester . There has never been a better time to consider joining us. We have recently appointed a Professor in Geriatric Medicine, alongside Tom Robinson in stroke and Victoria Haunton, who has just joined as a Senior Lecturer in Geriatric Medicine. We have fantastic opportunities to support students in their academic pursuits through a well-established intercalated BSc programme, and routes on through such as ACF posts, and a successful track-record in delivering higher degrees leading to ACL post. We collaborate strongly with Health Sciences, including academic primary care. See below for more detail on our existing academic set-up. Leicester Academy for the Study of Ageing We are also collaborating on a grander scale, through a joint academic venture focusing on ageing, the ‘Leicester Academy for the Study of Ageing’ (LASA), which involves the local health service providers (acute and community), De Montfort University; University of Leicester; Leicester City Council; Leicestershire County Council and Leicester Age UK. Professors Jayne Brown and Simon Conroy jointly Chair LASA and have recently been joined by two further Chairs, Professors Kay de Vries and Bertha Ochieng. Karen Harrison Dening has also recently been appointed an Honorary Chair. LASA aims to improve outcomes for older people and those that care for them that takes a person-centred, whole system perspective. Our research will take a global perspective, but will seek to maximise benefits for the people of Leicester, Leicestershire and Rutland, including building capacity. We are undertaking applied, translational, interdisciplinary research, focused on older people, which will deliver research outcomes that address domains from: physical/medical; functional ability, cognitive/psychological; social or environmental factors. LASA also seeks to support commissioners and providers alike for advice on how to improve care for older people, whether by research, education or service delivery. Examples of recent research projects include: ‘Local History Café’ project specifically undertaking an evaluation on loneliness and social isolation; ‘Better Visits’ project focused on improving visiting for family members of people with dementia resident in care homes; and a study on health issues for older LGBT people in Leicester. Clinical Geriatric Medicine in Leicester We have developed a service which recognises the complexity of managing frail older people at the interface (acute care, emergency care and links with community services). There are presently 17 consultant geriatricians supported by existing multidisciplinary teams, including the largest complement of Advance Nurse Practitioners in the country. Together we deliver Comprehensive Geriatric Assessment to frail older people with urgent care needs in acute and community settings. The acute and emergency frailty units – Leicester Royal Infirmary This development aims at delivering Comprehensive Geriatric Assessment to frail older people in the acute setting. Patients are screened for frailty in the Emergency Department and then undergo a multidisciplinary assessment including a consultant geriatrician, before being triaged to the most appropriate setting. This might include admission to in-patient care in the acute or community setting, intermediate care (residential or home based), or occasionally other specialist care (e.g. cardiorespiratory). Our new emergency department is the county’s first frail friendly build and includes fantastic facilities aimed at promoting early recovering and reducing the risk of hospital associated harms. There is also a daily liaison service jointly run with the psychogeriatricians (FOPAL); we have been examining geriatric outreach to oncology and surgery as part of an NIHR funded study. We are home to the Acute Frailty Network, and those interested in service developments at the national scale would be welcome to get involved. Orthogeriatrics There are now dedicated hip fracture wards and joint care with anaesthetists, orthopaedic surgeons and geriatricians. There are also consultants in metabolic bone disease that run clinics. Community work Community work will consist of reviewing patients in clinic who have been triaged to return to the community setting following an acute assessment described above. Additionally, primary care colleagues refer to outpatients for sub-acute reviews. You will work closely with local GPs with support from consultants to deliver post-acute, subacute, intermediate and rehabilitation care services. Stroke Medicine 24/7 thrombolysis and TIA services. The latter is considered one of the best in the UK and along with the high standard of vascular surgery locally means one of the best performances regarding carotid intervention

Recognition of elementary arm movements using orientation of a tri-axial accelerometer located near the wrist

In this paper we present a method for recognising three fundamental movements of the human arm (reach and retrieve, lift cup to mouth, rotation of the arm) by determining the orientation of a tri-axial accelerometer located near the wrist. Our objective is to detect the occurrence of such movements performed with the impaired arm of a stroke patient during normal daily activities as a means to assess their rehabilitation. The method relies on accurately mapping transitions of predefined, standard orientations of the accelerometer to corresponding elementary arm movements. To evaluate the technique, kinematic data was collected from four healthy subjects and four stroke patients as they performed a number of activities involved in a representative activity of daily living, 'making-a-cup-of-tea'. Our experimental results show that the proposed method can independently recognise all three of the elementary upper limb movements investigated with accuracies in the range 91–99% for healthy subjects and 70–85% for stroke patients

Trends in virtual reality technologies for the learning patient

NextMed convened the Medicine Meets Virtual Reality 22 (MMVR 22) conference in 2016. Since 1992, the conference has brought together a diverse group of researchers to share creative solutions for the evolving challenge of integrating virtual reality tools into medical education. Virtual reality (VR) and its enabling technologies utilize hardware and software to simulate environments and encounters where users can interact and learn. The MMVR 22 symposium proceedings contain projects that support a variety of learners: medical students, practitioners, soldiers, and patients. This report will contemplate the trends in virtual reality technologies for patients navigating their medical and healthcare learning. The learning patient seeks more than intervention; they seek prevention. From virtual humans and environments to motion sensors and haptic devices, patients are surrounded by increasingly rich and transformative data-driven tools. Applied data enables VR applications to simulate experience, predict health outcomes, and motivate new behavior. The MMVR 22 presents investigations into the usability of wearable devices, the efficacy of avatar inclusion, and the viability of multi-player gaming. With increasing need for individualized and scalable programming, only committed open source efforts will align instructional designers, technology integrators, trainers, and clinicians. Curriculum and InstructionCurriculum and Instructio

Healthcare PANs: Personal Area Networks for trauma care and home care

The first hour following the trauma is of crucial importance in trauma care. The sooner treatment begins, the better the ultimate outcome for the patient. Generally the initial treatment is handled by paramedical personnel arriving at the site of the accident with an ambulance. There is evidence to show that if the expertise of the on-site paramedic team can be supported by immediate and continuous access to and communication with the expert medical team at the hospital, patient outcomes can be improved. After care also influences the ultimate recovery of the patient. After-treatment follow up often occurs in-hospital in spite of the fact that care at home can offer more advantages and can accelerate recovery. Based on emerging and future wireless communication technologies, in a previous paper [1] we presented an initial vision of two future healthcare settings, supported by applications which we call Virtual Trauma Team and Virtual Homecare Team. The Virtual Trauma Team application involves high quality wireless multimedia communications between ambulance paramedics and the hospital facilitated by paramedic Body Area Networks (BANs) [2] and an ambulance-based Vehicle Area Network (VAN). The VAN supports bi-directional streaming audio and video communication between the ambulance and the hospital even when moving at speed. The clinical motivation for Virtual Trauma Team is to increase survival rates in trauma care. The Virtual Homecare Team application enables homecare coordinated by home nursing services and supported by the patient's PAN which consists of a patient BAN in combination with an ambient intelligent home environment. The homecare PAN provides intelligent monitoring and support functions and the possibility to ad hoc network to the visiting health professionals’ own BANs as well as high quality multimedia communication links to remote members of the virtual team. The motivation for Virtual Homecare Team is to improve quality of life and independence for patients by supporting care at home; the economic motivation is to replace expensive hospital-based care with homecare by virtual teams using wireless technology to support the patient and the carers. In this paper we develop the vision further and focus in particular on the concepts of personal and body area networks

Pressure Insoles for Gait and Balance Estimation

Stroke leads to impairment in motor ability, gait, and balance, due to brain tissue damage [1]. Clinical therapy following stroke aims at improving mobility and functional capacity. However, there is lack of objective information about subject’s performance once they are transferred home [2]. A wearable, unobtrusive system is needed to describe and compare clinical capacity and performance in a home setting. ForceShoes™ (Xsens Technologies B.V., The Netherlands) had been developed to provide holistic information about subject’s gait and balance measures, such as Extrapolated Centre of Mass (XCoM) and Dynamic Stability Margin (DSM) [3], [4]. Using these measures, a clear distinction between the capacity and performance of the subject is seen. However, this system is obtrusive and requires a long time to set up. This project addresses the need for a wearable and minimal sensing system with an unobtrusive set up. Pressure insoles are lightweight and inconspicuous, and when coupled with an Inertial Measurement Unit (IMU), several gait and balance measures can be estimated. In this study, a 1-D pressure insole system (medilogic ® insoles, T&T medilogic Medizintechnik GmbH, Germany), coupled with IMUs, is investigated for objective quantification of gait and dynamic balance measures. Although, to obtain such measures, 3D forces and moments are required. Linear regression models were used to model 3D forces/moments from the 1D plantar pressures measured from pressure insoles. The predicted forces and moments were used for estimation of XCoM and DSM. These parameters were compared with the estimations done by the forces and moments from the Force Shoes™. The regression model is tested for different walking speeds. High correlation and low differences between the estimations from predicted and measured values show that pressure insoles can indeed be used as an wearable alternative. The results will also be used in designing a wearable in-shoe system that can be used in daily life monitoring for stroke subjects. The study is a part of project 7 of NeuroCIMT, funded by the Dutch National foundation STW. REFERENCES [1] S. F. Tyson, M. Hanley, J. Chillala, A. Selley, and R. C. Tallis, “Balance disability after stroke.,” Phys. Ther., vol. 86, no. 1, pp. 30–38, 2006. [2] B. Klaassen, B.-J. F. van Beijnum, M. Weusthof, D. Hof, F. B. van Meulen, Ed Droog, H. Luinge, L. Slot, A. Tognetti, F. Lorussi, R. Paradiso, J. Held, A. Luft, J. Reenalda, C. Nikamp, J. H. Buurke, H. J. Hermens, and P. H. Veltink, “A Full Body Sensing System for Monitoring Stroke Patients in a Home Environment,” Commun. Comput. Inf. Sci., vol. 511, pp. 378–393, 2016. [3] F. B. van Meulen, D. Weenk, E. H. F. van Asseldonk, H. M. Schepers, P. H. Veltink, and J. H. Buurke, “Analysis of Balance during Functional Walking in Stroke Survivors,” PLoS One, vol. 11, no. 11, p. e0166789, Nov. 2016. [4] F. B. van Meulen, D. Weenk, J. H. Buurke, B.-J. F. van Beijnum, and P. H. Veltink, “Ambulatory assessment of walking balance after stroke using instrumented shoes,” J. Neuroeng. Rehabil., vol. 13, no. 1, p. 48, 2016. [5] A. L. Hof, M. G. J. Gazendam, and W. E. Sinke, “The condition for dynamic stability,” J. Biomech., vol. 38, no. 1, pp. 1–8, 2005

Future bathroom: A study of user-centred design principles affecting usability, safety and satisfaction in bathrooms for people living with disabilities

Research and development work relating to assistive technology 2010-11 (Department of Health) Presented to Parliament pursuant to Section 22 of the Chronically Sick and Disabled Persons Act 197

Feasibility of a second iteration wrist and hand supported training system for self-administered training at home in chronic stroke

Telerehabilitation allows continued rehabilitation at home after discharge. The use of rehabilitation technology supporting wrist and hand movements within a motivational gaming environment could enable patients to train independently and ultimately serve as a way to increase the dosage of practice. This has been previously examined in the European SCRIPT project using a first prototype, showing potential feasibility, although several usability issues needed further attention. The current study examined feasibility and clinical changes of a second iteration training system, involving an updated wrist and hand supporting orthosis and larger variety of games with respect to the first iteration. Nine chronic stroke patients with impaired arm and hand function were recruited to use the training system at home for six weeks. Evaluation of feasibility and arm and hand function were assessed before and after training. Median weekly training duration was 113 minutes. Participants accepted the six weeks of training (median Intrinsic Motivation Inventory = 4.4 points and median System Usability Scale = 73%). After training, significant improvements were found for the Fugl Meyer assessment, Action Research Arm Test and self-perceived amount of arm and hand use in daily life. These findings indicate that technology-supported arm and hand training can be a promising tool for self-administered practice at home after stroke.Final Accepted Versio