Rehabilitative devices for a top-down approach

In recent years, neurorehabilitation has moved from a "bottom-up" to a "top down" approach. This change has also involved the technological devices developed for motor and cognitive rehabilitation. It implies that during a task or during therapeutic exercises, new "top-down" approaches are being used to stimulate the brain in a more direct way to elicit plasticity-mediated motor re-learning. This is opposed to "Bottom up" approaches, which act at the physical level and attempt to bring about changes at the level of the central neural system. Areas covered: In the present unsystematic review, we present the most promising innovative technological devices that can effectively support rehabilitation based on a top-down approach, according to the most recent neuroscientific and neurocognitive findings. In particular, we explore if and how the use of new technological devices comprising serious exergames, virtual reality, robots, brain computer interfaces, rhythmic music and biofeedback devices might provide a top-down based approach. Expert commentary: Motor and cognitive systems are strongly harnessed in humans and thus cannot be separated in neurorehabilitation. Recently developed technologies in motor-cognitive rehabilitation might have a greater positive effect than conventional therapies

Enhancing Upper Limb Recovery and Reducing Stress and Anxiety Through Non-Immersive Virtual Reality in Subacute and Chronic Stroke Survivors: An Experimental Study

Introduction: Stroke is the third-leading cause of major long-term disability and the second-leading cause of mortality worldwide. Paralysis, paresis (muscle weakness), spasticity, difficulty walking, difficulty controlling motions, and limb discomfort are frequent limb impairments. Nearly 80% of stroke survivors are affected. Stroke survivors suffer with physical disabilities in addition to a reduced quality of life in terms of their health, a higher degree of worry, and a loss of independence. With a prevalence of 55% to 75%, hand motor deficits are the most prevalent post-stroke.1 The most common impairment is motor dysfunction, which affects 90% of stroke survivors with some kind of upper limb motor disability. Motor dysfunction is a strong indicator of poor functional recovery. The most typical post-stroke symptom is hemiparesis.1 Objectives: The study's objective was to use a virtual reality system to enhance upper limb strength and function in hemiparesis. The study's secondary goal was to lessen tension and anxiety in stroke Survivors. Methods: This research was experimental. A patient was chosen from UEM Hospital in Jaipur, Rajasthan, based on inclusion and exclusion criteria. Upper Extremity Functional Index (UEFI) and Depression Anxiety Stress Scale (DASS-21) were employed as outcome measures to evaluate the patients. Result: The outcome of the post-intervention data revealed that the Upper Extremity Functional Index (UEFI) had significant values of P.311. P .002 was used to determine the importance of the Depression Anxiety Stress Scale (DASS-21). That indicates that following the intervention, all outcome indicators showed a considerable improvement. Conclusion: The post-intervention values of the depression anxiety stress scale (DASS 21) and the upper extremity functional index (UEFI) both indicated a substantial improvement. In order to improve strength and upper limb functions following hemiparesis and to lessen tension and anxiety as a result of the handicap, a low-cost VR system might be employed

Realidade virtual para reabilitação pós-avc: estudos de utilizadores e desenvolvimento de jogos

Stroke is one of the leading causes of disability and death in the world, and rehabilitation is a relevant part of the life of stroke survivors. Physical therapy is necessary to recover some movement during the acute phase, but also to maintain muscle strength and avoid deterioration and weakness during the chronic phase. The global pandemic caused shortages of rehabilitation activities, and Virtual Reality (VR) games could be used as a complementary type of therapy for stroke rehabilitation to be used at home. This dissertation proposes a user study to better understand the needs and preferences of stroke survivors and the development of game prototypes to better ascertain the potential of VR-based serious games. With this goal, a Questionnaire and a Focus Group were done with survivors, and based on their results, two VR-based game prototypes were developed, focused on the movements that survivors need to perform as well as providing an equivalent to Mirror Therapy. This study found that stroke survivors in chronic stage are more interested in applications based on real-world activities, especially activities they used to perform before the onset symptoms. Negative feedback is also an issue they prefer to avoid based on mental health conditions commonly associated with stroke. The game prototypes were tested concerning usability and were scored high with healthy participants on the System Usability Scale when performed normally, but low when their movements were mirrored, though perhaps survivors are more used to this kind of exercise. The performance of the game prototypes needs improvement, but they were considered easy to use and to learn. The next step will be an evaluation of the improved versions by stroke survivors.O AVC é uma das principais causas de invalidez e morte no mundo, e a reabilitação é uma parte relevante da vida dos sobreviventes do AVC. A fisioterapia é necessária para recuperar algum movimento durante a fase aguda, mas também para manter a força muscular e evitar a deterioração e fraqueza durante a fase crónica. A pandemia global causou escassez de atividades de reabilitação, e jogos de Realidade Virtual (RV) poderiam ser usados como um tipo complementar de terapia para reabilitação de AVC com o uso em casa. Esta dissertação propõe um Estudo com Utilizadores para melhor compreender as necessidades e preferências de sobreviventes do AVC e o desenvolvimento de protótipos de jogos para melhor averiguar o potencial de jogos sérios baseados em RV. Com este objetivo, um Questionário e um Grupo Focal foram feitos com os sobreviventes e, com base em seus resultados, dois protótipos de jogos baseados em RV foram desenvolvidos, focados nos movimentos que os sobreviventes precisam realizar, além de fornecer um modo equivalente à Terapia do Espelho. Este estudo descobriu que sobreviventes de AVC em estágio crónico estão mais interessados em aplicações baseadas em atividades do mundo real, especialmente atividades que eles costumavam realizar antes do início dos sintomas. O feedback negativo também é um problema que eles preferem evitar com base nas condições de saúde mental comumente associadas ao AVC. Os protótipos do jogo foram testados com base em usabilidade e pontuaram alto com os participantes saudáveis na Escala de Usabilidade do Sistema quando executados normalmente, mas pontuaram baixo quando seus movimentos foram espelhados, embora talvez os sobreviventes estejam mais acostumados a esse tipo de exercício. O desempenho dos protótipos de jogos precisa de melhorias, mas eles foram considerados fáceis de usar e aprender. O próximo passo será a avaliação de versões melhoradas por sobreviventes de AVC.Mestrado em Engenharia Informátic

Effect of virtual reality rehabilitation on motor function in patients with stroke : a narrative review

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021Introdução: O acidente vascular cerebral é uma das principais causas de morte e incapacidade no mundo, sendo descrita como uma epidemia global. Défices motores causados por esta etiologia, afetam as tarefas diárias, bem como, a atividade profissional destas pessoas, resultando num dia-a-dia repleto de obstáculos. Desta forma, a reabilitação tem um papel fulcral, na melhoria destas queixas e consequentemente na qualidade de vida. A realidade virtual é uma ferramenta, que nos recentes anos tem vindo a ganhar um papel cada vez de maior importância para estes doentes. Nesta revisão narrativa, pretendemos comparar a reabilitação convencional com a reabilitação baseada na realidade virtual e perceber, desta forma, se existe benefício na combinação de ambas. Métodos: A nossa estratégia de pesquisa consistiu na pesquisa de ensaios clínicos randomizados em três diferentes plataformas (PubMed, sci-Elo e medRxiv), publicados nos últimos 10 anos cujo objetivo primário se focasse na função motora dos membros superiores. Usamos as seguintes palavras-chave como ponto de partida para a pesquisa de artigos: “Virtual Reality”, “rehabilitation”, “stroke”. Após ser aplicada a estratégia de pesquisa acima mencionada, obtivemos um total de 100 artigos. Após análise destes mesmos 100 artigos, somente 26 tinham os critérios necessários para a sua utilização na revisão, com uma amostra total de 1382 pacientes envolvidos nesta revisão de narrativa. Resultados: Como referido previamente, dos 100 artigos, somente 26 foram utilizados para a construção desta revisão narrativa. Os 74 artigos foram excluídos por não preencherem os critérios necessários para a sua inclusão. O facto do artigo não se focar na função motora do membro superior, foi a principal causa de exclusão de artigos. Outras razões como duplicados, não ter acesso livre, não focar o seu estudo na reabilitação do acidente vascular cerebral e não focar no estudo da realidade virtual também foram motivos para exclusão. Conclusão: Devido a inúmeras variáveis entre os diferentes ensaios, é impossível a conclusão de possíveis conexões entre a intervenção e os resultados obtidos. Sugere-se a realização de estudos em que certas variáveis como a intervenção realizada ao grupo de intervenção, o número de sessões, a duração das mesmas, sejam homogeneizados.Introduction: Stroke is one of the leading causes of death and disability and has been described as a worldwide epidemic. Motor function deficits due to stroke affect the patients' performance in daily tasks as well as in their jobs, which results in an increased difficulty in their everyday life. This way, rehabilitation in these patients plays an important role trying to improve their motor function and therefore their quality of life. Virtual reality, in recent years, has been increasingly more popular in this type of patients. In this narrative review, we aim to compare conventional therapy versus virtual reality-based therapy and find out if there is any kind of benefit in combining conventional therapy with virtual reality-based therapy. Methods: Our search strategy consisted in searching for randomized controlled trials published in the last 10 years with the primary outcome focusing on upper limb motor function, in three different platforms (PubMed, sci-Elo and medRxiv) using the following keywords: “virtual reality”, “rehabilitation”, “stroke”. After applied our search strategy we ended up with a total of 100 articles. After analyzing the 100 trials, only 26 of them met the necessary criteria to take part of this review, with a total sample of 1382 patients involved in the narrative review. Results: As previously mentioned, of the 100 articles, only 26 were used to build this narrative review. 74 articles excluded for not meeting the necessary criteria to make part of this review. The fact that the article did not focus on the motor function of the upper limb was the main reason for the exclusion of articles. Other reasons such as duplicates, not having open access, not focusing their study on stroke rehabilitation and not focusing on the study on virtual reality were also reasons for exclusion. Conclusion: Due to numerous variables between the different trials, it is impossible to conclude possible connections between the intervention and the results obtained. It is suggested that studies should be carried out with certain variables, such as the intervention carried out in the intervention group, the number of sessions, the duration of the sessions, homogenized

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

Visual complexity, player experience, performance and physical exertion in motion-based games for older adults

Motion-based video games can have a variety of benefits for the players and are increasingly applied in physical therapy, rehabilitation and prevention for older adults. However, little is known about how this audience experiences playing such games, how the player experience affects the way older adults interact with motion-based games, and how this can relate to therapy goals. In our work, we decompose the player experience of older adults engaging with motion-based games, focusing on the effects of manipulations of the game representation through the visual channel (visual complexity), since it is the primary interaction modality of most games and since vision impairments are common amongst older adults. We examine the effects of different levels of visual complexity on player experience, performance, and exertion in a study with fifteen participants. Our results show that visual complexity affects the way games are perceived in two ways: First, while older adults do have preferences in terms of visual complexity of video games, notable effects were only measurable following drastic variations. Second, perceived exertion shifts depending on the degree of visual complexity. These findings can help inform the design of motion-based games for therapy and rehabilitation for older adults

Diseño de entornos de realidad virtual aplicables a sistemas de robótica asistencial: un análisis literario

Virtual Reality (VR) environments can be applied to assistive robotics to improve the effectiveness and the user experience perception in the rehabilitation process due to its innovative nature, getting to entertain patients while they recover their motor functions. This literature review pretends to analyze some design principles of VR environments developed for upper limb rehabilitation processes. The idea is to identify features related to peripheral and central nervous systems, types of information included as feedback to increase the user's levels of immersion having a positive impact on the user's performance and experience during the treatment. A total of 32 articles published in Scopus, IEEE, PubMed, and Web of Science in the last four years were reviewed. We present the article selection process, the division by concepts presented previously, and the guidelines that can be considered for the design of VR environments applicable to assistive robots for upper limbs rehabilitation processes.Los entornos de Realidad Virtual (RV) aplicables a sistemas de robótica asistencial pueden ser diseñados de manera que mejoren la efectividad y la experiencia de usuario de los procesos de rehabilitación debido a su naturaleza novedosa, logrando entretener a los pacientes mientras recuperan sus funciones motoras. Esta revisión literaria pretende analizar los criterios de diseño de entornos de RV utilizados en procesos de rehabilitación de miembro superior, identificando las características de entornos para rehabilitación de problemas asociados el sistema nervioso central y periféricos, los tipos de información que se realimenta al usuario para beneficiar los niveles de inmersión y su impacto en términos del desempeño y la experiencia del usuario en tratamiento. Un total de 32 artículos publicados en revistas indexadas de Scopus, IEEE, PubMed y Web of Science en los últimos cuatro años fueron revisados. Se presenta el proceso de selección de artículos, la división por las temáticas presentadas anteriormente y los lineamientos generales que pueden ser considerados para el diseño de entornos de RV aplicables a robots asistenciales en procesos de rehabilitación de miembro superior