A Wii Bit of Fun: A Novel Platform to Deliver Effective Balance Training to Older Adults

BACKGROUND: Falls and fall-related injuries are symptomatic of an aging population. This study aimed to design, develop, and deliver a novel method of balance training, using an interactive game-based system to promote engagement, with the inclusion of older adults at both high and low risk of experiencing a fall.STUDY DESIGN: Eighty-two older adults (65 years of age and older) were recruited from sheltered accommodation and local activity groups. Forty volunteers were randomly selected and received 5 weeks of balance game training (5 males, 35 females; mean, 77.18 ± 6.59 years), whereas the remaining control participants recorded levels of physical activity (20 males, 22 females; mean, 76.62 ± 7.28 years). The effect of balance game training was measured on levels of functional balance and balance confidence in individuals with and without quantifiable balance impairments.RESULTS: Balance game training had a significant effect on levels of functional balance and balance confidence (P Peer reviewedFinal Published versio

Psychological and care impact of the daily use of a pediatric gait exoskeleton in children with spinal muscular atrophy

Introducción: La Atrofia Muscular Espinal Tipo II, es una enfermedad neurodegenerativa de origen genético que cursa con debilidad muscular y provoca deterioro motor e incapacidad para caminar en los niños. Se relaciona con graves problemas respiratorios, musculoesqueléticos, gastrointestinales y otros de salud y cuidado. Los exoesqueletos robóticos de miembros inferiores son dispositivos médicos que ayudan a la marcha de pacientes que no pueden caminar. Nuestro objetivo fue evaluar el impacto en la dimensión psicológica y de autocuidado derivado del uso del exoesqueleto ATLAS en el hogar en niños con Atrofia Muscular Espinal Tipo II. Metodología: tres niños con Atrofia Muscular Espinal Tipo II utilizaron el exoesqueleto en casa cinco días a la semana durante un período de dos meses para caminar y realizar actividades. Se realizó una evaluación del autocuidado de enfermería antes y durante el uso del dispositivo para evaluar los cambios en los resultados del autocuidado y los diagnósticos de enfermería. Se realizaron entrevistas en profundidad y semiestructuradas, además de la observación durante las sesiones, para evaluar el impacto de la experiencia en la dimensión psicológica de los participantes. Resultados: el uso del exoesqueleto produjo cambios en los condicionantes básicos de los niños y una mejora en los organismos de autocuidado. También aparecieron nuevas demandas de autocuidado. Tres de los diez diagnósticos de enfermería fueron resueltos. Asimismo, los niños mostraron una buena tolerancia a la actividad además de una mejora funcional evaluada en el tercer participante. Los niños y los cuidadores principales valoraron la experiencia como positiva y significativa. Los niños tenían una mayoría de emociones positivas, y se incrementó su autonomía y comportamiento social y exploratorio. Conclusiones: la tecnología del exoesqueleto podría considerarse como un nuevo recurso para el cuidado de niños con enfermedades neuromusculares. Su uso tuvo un impacto positivo tanto en las variables de autocuidado como en la dimensión psicológica de tres niños con atrofia muscular espinal tipo II. Aunque este estudio aporta ya evidencia, más estudios sobre el tema aportarían un mayor conocimiento

A Framework for Gamification of Human Joint Remote Rehabilitation, Incorporating Non-Invasive Sensors

Patients who have suffered soft tissue injuries or undergone surgery often experience reduced muscle strength, flexibility, and pain in the affected area, which can interfere with daily activities. Rehabilitation exercises are crucial in reducing symptoms and returning patients to normal activities. This research presents a framework for human joint rehabilitation that enables clinicians to set engaging gamified rehabilitation tasks for their patients utilising non-invasive sensors and machine learning algorithms

The effects of virtual rehabilitation therapy on multiple sclerosis

In this review article, the effect of virtual rehabilitation therapy on multiple sclerosis, a neurodegenerative disorder, is explored. Multiple sclerosis is characterized by damaged nerves that result in incomplete signal processing between the brain and the spinal cord. The symptoms of this condition can include vision loss, decreased coordination, pain, fatigue, and deteriorating motor output. The severity of the symptoms and the rate of progression of multiple sclerosis can vary from person to person; some individuals live the majority of their lives with mild symptoms while others become bedridden and immobile. There is no cure for this disease, however implementation of virtual reality rehabilitation therapy shows promise in slowing the progression of deterioration in motor output and cognition. Through a variety of methods incorporating virtual reality, this review investigates the effects of this type of therapy on balance, manual dexterity, and mental health in patients with multiple sclerosis

Enhancing Motivation in Physiotherapy for People with Parkinson’s Disease: An Exploration of Serious Games and Virtual Reality

Parkinson’s Disease (PD) is a degenerative disorder of the central nervous system that mainly affects the motor system. There is currently no cure for PD, although it is possible to slow down its progression and control its symptoms with medication, surgery and physiotherapy. Physical exercise is an essential component of the treatment, helping patients to stay active, maintain physical performance and stimulate cognitive function. One of the main problems is that patients are more vulnerable to apathy and lack of motivation, which affects their willingness to follow an exercises plan and maintain their quality of life. Therefore, the necessity to develop an effective tool that persuades and actively engages patients becomes evident. Persuasive Technology is defined as any interactive computing system designed to change a person’s attitudes or behaviors. Gamification has demonstrated successful results in healthcare by increasing physical activity levels. Moreover, treatment can take advantage of Serious Games by combining the physical exercise component with cognitive function stimulation. If well aligned with therapy these can be used as Persuasive Technology. Therefore, this dissertation aimed to tackle this challenge by studying a motivational approach to persuade People with PD to practice even more therapy exercises. The proposed solution is based on the exploration of Serious Games and Virtual Reality (VR), mainly to study and discover the best natural user interfaces that could be used. A collection of Serious Games was implemented under a preliminary study to determine which devices were more suited to use in the implementation of the motivational strategy. Afterwards, the solution was based on the development of two VR-based Serious Games, one using Kinect V2 and the other fully immersive with Oculus Quest 2. A human factors study was then designed, showing very positive results in the first evaluation phase before moving on to the final assessment with patients. The research produced conclusions about the devices to use, but also about the design process of these solutions, from non to fully immersive VR.A Doença de Parkinson é uma doença degenerativa do sistema nervoso central que afecta principalmente o sistema motor. Actualmente, não existe cura para a doença, embora seja possível abrandar a sua progressão e controlar os seus sintomas com medicação, cirurgia e fisioterapia. O exercício físico é um componente essencial do tratamento, que ajuda os doentes a manterem-se ativos, a manter o desempenho físico e a estimular a função cognitiva. Um dos principais problemas é que os doentes são mais vulneráveis à apatia e à falta de motivação, o que afeta a sua vontade de seguir um plano de exercícios e de manter a sua qualidade de vida. Por conseguinte, torna-se evidente a necessidade de desenvolver uma ferramenta eficaz que persuada e envolva ativamente os doentes. A Tecnologia Persuasiva é definida como qualquer sistema informático interativo concebido para alterar as atitudes ou os comportamentos de uma pessoa. A Gamificação demonstrou resultados de sucesso nos cuidados de saúde, aumentando os níveis de atividade física. Além disso, o tratamento pode tirar partido de Jogos Sérios, combinando a componente de exercício físico com a estimulação da função cognitiva. Se bem alinhados com a terapia, podem ser usados como Tecnologia Persuasiva. Assim, esta dissertação teve como objetivo enfrentar este desafio, estudando uma abordagem motivacional para persuadir as pessoas com a Doença de Parkinson a praticar ainda mais exercícios terapêuticos. A solução proposta baseia-se na exploração de Jogos Sérios e Realidade Virtual, principalmente para estudar e desenvolver as melhores interfaces de utilizador naturais que podem ser utilizadas. Foi implementada uma coleção de Jogos Sérios num estudo preliminar para determinar quais os dispositivos mais adequados para utilizar na implementação da estratégia motivacional. Posteriormente, a solução baseou-se no desenvolvimento de dois Jogos Sérios baseados em Realidade Virtual, um utilizando o Kinect V2 e o outro totalmente imersivo com o Oculus Quest 2. Foi então concebido um estudo de fatores humanos, com resultados muito positivos na primeira fase de avaliação, antes de passar à avaliação final com os pacientes. A investigação produziu conclusões sobre os dispositivos a utilizar, mas também sobre o processo de conceção destas soluções, desde a Realidade Virtual não imersiva até à totalmente imersiva

Rastreamento do corpo humano e aplicações interactivas para reabilitação de equilíbrio

In recent years with the development of Virtual Reality and gaming industry, a number of Virtual Reality and Motion tracking devices have been offered on the market for an affordable price. Besides the applications in gaming, Virtual Reality potential in the medical rehabilitation was recognized as well. It offers a new approach to treatment in Stroke and Spinal Cord (SCI) Injury rehabilitation. The aim of this work is a research of the application of VR games in the rehabilitation; Identification of how they can increase the motivation of Spinal Cord Injury and Stroke patients for performing exercises relevant for their recovery. This work was performed in collaboration with the Rovisco Pais Rehabilitation Center. Based on the case study of the rehabilitation center and consultancies with the therapists, a set of mini-games was produced. In the first produced mini-game, the aim was training of the upper limb movements for Stroke patients. The developed game yet, hasn’t been tested because of the lack of the occupational therapists. Therefore, the work continued in the direction of producing the mini-game for gait restoring. However, since the evaluation of the Kinect v2 sensor for motion tracking proved that it doesn’t have enough precision the next game developed was a trunk balance training game. The target audience of the game was SCI patients. The produced game was tested with 9 students and based on the results it was further improved and tested with 6 SCI patients. The testing’s results suggested that these types of games can be helpful in the recovery process of SCI patients and can be motivate the patients for the recovery.Nos últimos anos tem surgido no mercado um grande número de dispositivos de interacção, display e tracking adequados a aplicações de Realidade Virtual, a preços bastante acessíveis, que têm sido usados pela Indústria de Jogos; no entanto, a Realidade Virtual tem também grande potencial na área da Medicina de Reabilitação, podendo oferecer abordagens inovadoras no tratamento de pacientes que recuperam Acidentes Vasculares Cerebrais (AVCs) ou de lesões medulares. O principal objectivo deste trabalho consistiu no estudo da possibilidade de usar aplicações de Realidade Virtual para aumentar a motivação daqueles pacientes na realização continuada de exercícios necessários para a sua recuperação. Este trabalho foi realizado em colaboração com o Centro de Medicina de Reabilitação da Região Centro – Rovisco Pais. Estudaram-se os desafios que os seus médicos, terapeutas e pacientes enfrentam e desenvolveu-se um mini-jogo e adaptou-se um outro para ajudar na recuperação do equilíbrio daqueles pacientes que foi testado primeiro com participantes saudáveis e depois com pacientes. Foi ainda estudada a possibilidade de utilização do sensor Kinect v2 para análise de marcha.Mestrado em Engenharia de Computadores e Telemátic

Remote Biofeedback Method for Biomedical Data Analysis

In recent years, the introduction of methods supported by technology has positively modified the traditional paradigm of rehabilitation. Interactive systems have been developed to facilitate patient involvement and to help therapist in patient\u2019s management. ReMoVES (REmote MOnitoring Validation Engineering System) platform addresses the problem of continuity of care in a smart and economical way. It can help patients with neurological, post-stroke and orthopedic impairments in recovering physical, psychological and social functions; such system will not only improve the quality of life and accelerate the recovery process for patients, but also aims at rationalizing and help the manpower required monitoring and coaching individual patients at rehabilitation centers. In order to help and support therapist work, the Remote Biofeedback Method is proposed as an instrument to understand how the patient has executed the rehabilitation exercises without seeing him directly. Therefore, the purpose of this method is to demonstrate that through the joint observation of data from simple sensors, it is possible to determine: time and method of execution of the exercises, performance and improvements during the rehabilitation session, pertinence of exercise and plan of care. The system, during the rehabilitation session, automatically transmits patient\u2019s biofeedback through three different channels: movement, physiological signals and a questionnaire. The therapist uses patient\u2019s data to determine whether the plan of care assigned is appropriate for the recovery of lost functionalities. He will then return a remote feedback to the patient who will not see any kind of graphical or verbal output, but you will see lighter rehabilitative session if it was too difficult or more intense if one assigned was too simple. The rehabilitation protocol proposed consists of the performance of different exercises, which begins with a breathing activity, designed to relax the patient before the \u201ceffective\u201d rehabilitation session. To make the subject comfortable, and to bring again the heartbeat to a basal value, before the rehabilitation session, the patient, in a sitting position, is leading to breathing with a regular rhythm by following a \u201cbreath ball\u201d. From the results obtained in the breathing exercise, it can be concluded that the negative trend of the regression line that approximates the heartbeat signal is an index of relaxation, principal goal for which the exercise was designed. The proposed activities include execution of reaching and grasping, balance and control posture functional exercises, masked through serious games to simulate some of the most common gestures of daily life. In some exercises, a cognitive component will also be involved in achieving the goal required by the activity. For each activity, heart rate, gameplay scores, and different motion parameters were captured and analyzed depending on the type of exercise performed. The heart rate was used as an indicator of motivation and involvement during the execution of several rehabilitative exercises. Others parameters analyzed are the score obtained during the execution of the task, and the time interval between the execution of one exercise and the following one. In addition to the analysis of the individual signals, a preliminary analysis of the correlation between the trend of the heart rate and the performance of the score was also carried out. The results showed that heartbeat in conjunction with score and inter-exercise time could be a high-quality indicator of a patient\u2019s status. The indicators extracted, in fact, in most cases, correspond to the information reported from the therapist who observed the patients during the rehabilitation session. A deep analysis of movement signal was carried on, with the extraction of several indicators for the different body segments involved in rehabilitation, such as the upper limb, the hand, the lower limbs and the posture, included the detection of compensation strategies to reach the targets proposed by the exercise. The results have been extracted by comparing the patient performance to a model extracted by a healthy subjects group. Of particular importance is the spatial map for patients with neglect, an innovative tool that traces the positions where the movement was performed and also provides the therapist with the spatial coordinates where the targets were proposed. Another innovative aspect is the analysis of Center of Pressure (CoP) without the use of a specific footboard, but only through the processing of data from the motion sensor. The results obtained by the application of the Remote Biofeedback Methods to the signals acquired during ReMoVES testing phase show interesting applications of the method to the clinical practice. In fact, the indicators extracted show a realistic correspondence between the disabilities affected the patients and the performance obtained during the execution of the exercises. From the study of the different exercises it can be concluded that the analysis of the signals and the parameters extracted individually, do not provide enough information to outline how the rehabilitation exercise has been executed. By combining the different indicators, it is possible to outline an accurate picture that allows the therapist to make decisions about the assigned plan of care. In conclusion, the Remote Biofeedback Method proposed is now ready to be tested on a wider dataset in order to be consolidated on a larger number of athologies and to associate, if necessary, particular indicators to a particular disease. The future steps will be, a creation of a model starting from patients signals, in order to have a better comparison term, and a testing phase on a larger number of patients, following a clinical protocol, subdividing subject by disease

Flexible Virtual Reality System for Neurorehabilitation and Quality of Life Improvement

As life expectancy is mostly increasing, the incidence of many neurological disorders is also constantly growing. For improving the physical functions affected by a neurological disorder, rehabilitation procedures are mandatory, and they must be performed regularly. Unfortunately, neurorehabilitation procedures have disadvantages in terms of costs, accessibility and a lack of therapists. This paper presents Immersive Neurorehabilitation Exercises Using Virtual Reality (INREX-VR), our innovative immersive neurorehabilitation system using virtual reality. The system is based on a thorough research methodology and is able to capture real-time user movements and evaluate joint mobility for both upper and lower limbs, record training sessions and save electromyography data. The use of the first-person perspective increases immersion, and the joint range of motion is calculated with the help of both the HTC Vive system and inverse kinematics principles applied on skeleton rigs. Tutorial exercises are demonstrated by a virtual therapist, as they were recorded with real-life physicians, and sessions can be monitored and configured through tele-medicine. Complex movements are practiced in gamified settings, encouraging self-improvement and competition. Finally, we proposed a training plan and preliminary tests which show promising results in terms of accuracy and user feedback. As future developments, we plan to improve the system's accuracy and investigate a wireless alternative based on neural networks.Comment: 47 pages, 20 figures, 17 tables (including annexes), part of the MDPI Sesnsors "Special Issue Smart Sensors and Measurements Methods for Quality of Life and Ambient Assisted Living

Healthy You

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