Advances in the Rehabilitation of Hemispatial Inattention

PURPOSE OF REVIEW: There continue to be a plethora of approaches to the rehabilitation of hemispatial inattention, from different forms of sensory stimulation (visual, auditory and somatosensory feedback), through all major modes of non-invasive brain stimulation to drug therapies. Here we summarise trials published in the years 2017-2022 and tabulate their effect sizes, with the aim of drawing on common themes that may serve to inform future rehabilitative studies. RECENT FINDINGS: Immersive virtual reality approaches to visual stimulation seem well tolerated, although they have yet to yield any clinically relevant improvements. Dynamic auditory stimulation looks very promising and has high potential for implementation. Robotic interventions are limited by their cost and are perhaps best suited to patients with a co-occurring hemiparesis. Regarding brain stimulation, rTMS continues to demonstrate moderate effects but tDCS studies have yielded disappointing results so far. Drugs, primarily aimed at the dopaminergic system, often demonstrate beneficial effects of a medium size, but as with many of the approaches, it seems difficult to predict responders and non-responders. Our main recommendation is that researchers consider incorporating single-case experimental designs into their studies as rehabilitation trials are likely to remain small in terms of patient numbers, and this is the best way to deal with all the factors that cause large between-subject heterogeneity

Kinematic and Kinetic Comparisons of Arm and Hand Reaching Movements with Mild and Moderate Gravity-Supported, Computer-Enhanced Armeo®spring: A Case Study

Background: Stroke has been recognized as a leading cause of serious long-term disability in the United States (U.S.) with 795,000 people experience a new or recurrent stroke each year (Roger et al., 2011). The most apparent defect after stroke is motor impairments (Masiero, Armani, & Rosati, 2011). Statistically, half of stroke survivors suffer from upper extremity hemiparesis and approximately one quarter become dependent in activities of daily living (Sanchez et al., 2006). There is strong evidence that intensity and task specificity are the main drivers in an effective treatment program after stroke. In addition, this training should be repetitive, functional, meaningful, and challenging for a patient (Van Peppen et al., 2004). The use of robotic systems to complement standard poststroke multidisciplinary programs is a recent approach that looks very promising. Robotic devices can provide high-intensity, repetitive, task-specific, interactive treatment of the impaired limb and can monitor patients\u27 motor progress objectively and reliably, measuring changes in quantitative movement kinematics and forces (Masiero, Armani, & Rosati, 2011). Objective: The purpose of this study was to examine the role of Armeo®Spring (Hocoma, Inc.), a gravity-supported, computer-enhanced robotic devise, on reaching movements while using two different gravity-support levels (mild and moderate weight support) on individuals with stroke. Methods: One stroke subject and one gender-matched healthy control participated in this study after gaining their informed consent. Both subjects performed a computer-based game (picking apples successfully and placing them in a shopping cart) under two gravity weight-support conditions (mild and moderate) provided by the Armeo®Spring device. The game tasks were described as a reaching cycle which consisted of five phases (initiation, reaching, grasping, transporting, and releasing). Joint angles for the glenohumeral and elbow joints throughout the reaching cycle were found. Three kinematic parameters (completion time, moving velocity, acceleration) and one kinetic parameter (vertical force acting on the forearm) was calculated for various instances and phases of the reaching motion. In addition, the muscle activation patterns for anterior deltoid, middle deltoid, biceps, triceps, extensor digitorum, flexor digitorum, and brachioradialis were found and the mean magnitude of the electromyography (EMG) signal during each phase of the reaching cycle was found as a percentage of the subject\u27s maximum voluntary contraction (MVC). Results: Within the healthy control subject, results demonstrated no significant differences in mean completion time, moving velocity, or acceleration between mild to moderate gravity-support levels during all phases of the cycle. The stroke subject results revealed a significant decrease in the cycle mean completion time (p= 0.042) between the two gravity-support levels, specifically in mean completion time of the grasping phase. A significant increase was found in the initiation phase moving velocity (p=0.039) and a significant decrease was found in the grasping phase (p=0.048) between two gravity-support levels in the stroke subject. Between subjects, significant increase in the cycle mean completion time was found under both mild and moderate conditions (p\u3c.001 for both conditions). Additionally, significant decreases in the moving velocities were found in all phases of the cycle between the healthy control and the stroke subject under both conditions. With increasing weight support, the healthy control subject showed an increase in abduction and flexion degrees at the glenohumeral joint level, and an increase in flexion degrees of the elbow joint. On the other hand, the stroke subject showed a decrease in abduction degrees and an increase in flexion degrees at the glenohumeral joint level, and a decrease in flexion degrees of the elbow joint after increasing the weight-support level. Results demonstrated an increase in the mean of vertical forces when changing gravity-support levels from mild to moderate during all phases of the cycle in both stroke and healthy subjects. Last, the average EMG magnitude during the reaching cycle phases was reduced for muscles acting against gravity (anterior deltoid, middle deltoid, biceps, and brachioradialis) in both the healthy control and the stroke subject. Conclusion: The significant differences in movement performance between mild and moderate physical weight support suggested a preliminary result that the gravity-supported mechanism provides a mean to facilitate functional upper limb motor performance in individuals with stroke. Future studies should examine such effects with larger sample sizes

Virtual Reality Games for Motor Rehabilitation

This paper presents a fuzzy logic based method to track user satisfaction without the need for devices to monitor users physiological conditions. User satisfaction is the key to any product’s acceptance; computer applications and video games provide a unique opportunity to provide a tailored environment for each user to better suit their needs. We have implemented a non-adaptive fuzzy logic model of emotion, based on the emotional component of the Fuzzy Logic Adaptive Model of Emotion (FLAME) proposed by El-Nasr, to estimate player emotion in UnrealTournament 2004. In this paper we describe the implementation of this system and present the results of one of several play tests. Our research contradicts the current literature that suggests physiological measurements are needed. We show that it is possible to use a software only method to estimate user emotion

EEG-based brain-computer interfaces using motor-imagery: techniques and challenges.

Electroencephalography (EEG)-based brain-computer interfaces (BCIs), particularly those using motor-imagery (MI) data, have the potential to become groundbreaking technologies in both clinical and entertainment settings. MI data is generated when a subject imagines the movement of a limb. This paper reviews state-of-the-art signal processing techniques for MI EEG-based BCIs, with a particular focus on the feature extraction, feature selection and classification techniques used. It also summarizes the main applications of EEG-based BCIs, particularly those based on MI data, and finally presents a detailed discussion of the most prevalent challenges impeding the development and commercialization of EEG-based BCIs

Effectiveness of intensive physiotherapy for gait improvement in stroke: systematic review

Introduction: Stroke is one of the leading causes of functional disability worldwide. Approximately 80% of post-stroke subjects have motor changes. Improvement of gait pattern is one of the main objectives of physiotherapists intervention in these cases. The real challenge in the recovery of gait after stroke is to understand how the remaining neural networks can be modified, to be able to provide response strategies that compensate for the function of the affected structures. There is evidence that intensive training, including physiotherapy, positively influences neuroplasticity, improving mobility, pattern and gait velocity in post-stroke recovery. Objectives: Review and analyze in a systematic way the experimental studies (RCT) that evaluate the effects of Intensive Physiotherapy on gait improvement in poststroke subjects. Methodology: Were only included all RCT performed in humans, without any specific age, that had a clinical diagnosis of stroke at any stage of evolution, with sensorimotor deficits and functional gait changes. The databases used were: Pubmed, PEDro (Physiotherapy Evidence Database) and CENTRAL (Cochrane Center Register of Controlled Trials). Results: After the application of the criteria, there were 4 final studies that were included in the systematic review. 3 of the studies obtained a score of 8 on the PEDro scale and 1 obtained a score of 4. The fact that there is clinical and methodological heterogeneity in the studies evaluated, supports the realization of the current systematic narrative review, without meta-analysis. Discussion: Although the results obtained in the 4 studies are promising, it is important to note that the significant improvements that have been found, should be carefully considered since pilot studies with small samples, such as these, are not designed to test differences between groups, in terms of the effectiveness of the intervention applied. Conclusion: Intensive Physiotherapy seems to be safe and applicable in post-stroke subjects and there are indications that it is effective in improving gait, namely speed, travelled distance and spatiotemporal parameters. However, there is a need to develop more RCTs with larger samples and that evaluate the longterm resultsN/

Self-management in rehabilitation practice:On the design and implementation of a serious theory-based analogue problem-solving game called ‘Think Along?’.

This thesis describes the place of the concept of self-management within rehabilitation practice at UMCG Beatrixoord in Haren and the development of a serious game called "Denk je Mee?" ("Think Along?"). Better self-management skills in patients are expected to improve their transfer from the rehabilitation centre to their homes. A literature review by means of a comparative language analysis revealed that besides similarities, there are also differences between the concepts self-management and rehabilitation. Extensive qualitative research (document analysis, observations, and interviews) provided insights into the extent to which self-management is interwoven into daily rehabilitation practice. These research findings were then used to develop a serious game, "Think Along?". It was designed as a problem-solving game since problem solving is considered as one of the important self-management skills. While playing the serious game, players are given the opportunity to experiment with problems they will very likely encounter in their home situation. To give the serious game a place in existing healthcare logistics, it was implemented in a circular way through seven steps. Whenever it became clear during a step that an adaptation was needed, this was done always in consultation with the practitioners. This way of working has led to "Think Along?" being an integral part of care logistics in both the pulmonary and oncology departments of rehabilitation centre UMCG Beatrixoord until this day

Virtual Reality: An Evidence-Based Guide for Occupational Therapy

Problem: Virtual reality (VR) is an emerging technology that serves to position the user in control of a virtual environment to maximize interest and function. VR is a context for intervention included in the Occupational Therapy Practice Framework: Domain and Process 3rd edition (OTPF-3; AOTA, 2014). It is crucial that occupational therapy (OT) practitioners enhance their knowledge about VR technology used by their clients to provide effective client-centered practice (AOTA, 2010). There is a lack of organization of the literature and research evidence regarding the use of VR as an intervention modality. While there has been a significant increase in recent literature supporting the use of VR in OT, there is a need for manuals and resources to guide clinicians in using VR as a therapeutic modality (Levac & Miller, 2013; Proffitt & Lange, 2015). Methods: An extensive literature review for articles regarding the use of the Xbox Kinect and Nintendo Wii within OT was conducted using five databases. Relevant data was extracted from each article related to the use of the Xbox Kinect or Nintendo Wii in intervention to synthesize the findings into charts. The construction of the charts followed the organization of the OTPF-3 (AOTA, 2014). Product: The authors of this product created an evidence-based resource to guide OT practitioners\u27 use of VR. The intended purpose of this product, Virtual Reality: An Evidence-Based Guide, is to assist OT practitioners\u27 adaptation and/or modification of VR activities to address individual client needs. Using this product as a guide to current knowledge and evidence regarding intervention in the context of VR, OT practitioners will be better equipped to make safe and effective choices. To further support development of literature regarding VR, the authors of this product recommended areas for future research

Down-Conditioning of Soleus Reflex Activity using Mechanical Stimuli and EMG Biofeedback

Spasticity is a common syndrome caused by various brain and neural injuries, which can severely impair walking ability and functional independence. To improve functional independence, conditioning protocols are available aimed at reducing spasticity by facilitating spinal neuroplasticity. This down-conditioning can be performed using different types of stimuli, electrical or mechanical, and reflex activity measures, EMG or impedance, used as biofeedback variable. Still, current results on effectiveness of these conditioning protocols are incomplete, making comparisons difficult. We aimed to show the within-session task- dependent and across-session long-term adaptation of a conditioning protocol based on mechanical stimuli and EMG biofeedback. However, in contrast to literature, preliminary results show that subjects were unable to successfully obtain task-dependent modulation of their soleus short-latency stretch reflex magnitude