A RGBD-Based interactive system for gaming-driven rehabilitation of upper limbs

Current physiotherapy services may not be effective or suitable for certain patients due to lack of motivation, poor adherence to exercises, insufficient supervision and feedback or, in the worst case, refusal to continue with the rehabilitation plan. This paper introduces a novel approach for rehabilitation of upper limbs through KineActiv, a platform based on Microsoft Kinect v2 and developed in Unity Engine. KineActiv proposes exergames to encourage patients to perform rehabilitation exercises prescribed by a specialist, controls the patient's performance, and corrects execution errors on the fly. KineActiv comprises a web platform where the physiotherapist can review session results, monitor patient health, and adjust rehabilitation routines. We recruited 10 patients for assessing the system usability as well as the system performance. Results show that KineActiv is a usable, enjoyable and reliable system, that does not cause any negative feelings

Feasibility Study of a Proton Irradiation Facility for Radiobiological Measurements at an 18 MeV Cyclotron

A feasibility study of an experimental setup for the irradiation of biological samples at the cyclotron facility installed at the National Centre of Accelerators (Seville, Spain) is presented. This cyclotron, which counts on an external beam line for interdisciplinary research purposes, produces an 18 MeV proton beam, which is suitable for the irradiation of mono-layer cultures for the measurement of proton cell damages and Relative Biological Effectiveness (RBE) at energies below the beam nominal value. Measurements of this kind are of interest for proton therapy, since the variation of proton RBE at the distal edge of the Bragg curve may have implications in clinical proton therapy treatments. In the following, the characteristics of the beam line and the solutions implemented for the irradiation of biological samples are described. When dealing with the irradiation of cell cultures, low beam intensities and broad homogeneous irradiation fields are required, in order to assure that all the cells receive the same dose with a suitable dose rate. At the cyclotron, these constraints have been achieved by completely defocusing the beam, intercepting the beam path with tungsten scattering foils and varying the exit-window-to-sample distance. The properties of the proton beam thus obtained have been analysed and compared with Monte Carlo simulations. The results of this comparison, as well as the experimental measurement of the lateral dose profiles expected at the position of samples are presented. Meaningful dose rates of about 2–3 Gy/min have been obtained. Homogeneous lateral dose profiles, with maximum deviations of 5%, have been measured at a distance of approximately 50 cm in air from the exit window, placing a tungsten scattering foil of 200 μm in the beam path

Investigating the mechanisms of α-particle therapy in prostate cancer

The use of α-particle radionuclide emitters in the treatment of bone metastasis has been an active area of research within targeted radionuclide therapies. From a radiobiological perspective, α-particles are known to be more effective at killing cells in comparison to low linear energy transfer (LET) radiation particles, such as X-rays, with increased relative biological effectiveness of around a factor of 3 in most models. α-particle irradiated cells also show a reduced dependency on radioresistance mechanisms observed in the absence of oxygen, with an oxygen enhancement ratio (OER) close to 1.0. Such advantageous radiobiological properties of α-particles demonstrate their potential for radiotherapy treatments. In recent years, the bone targeting high LET radionuclide Radium-223 (223Ra) has been shown to not only have a palliative effect but also a survival prolonging effect in castration resistant prostate cancer patients with bone metastases. This has encouraged the use of 233Ra in more extensive clinical trials. Despite the clinical utility of 233Ra, little is known regarding the radionuclide’s mechanisms of action in this treatment setting, where accurate assessments of the dosimetry underpinning its effectiveness are lacking. There is a pressing need to model and quantify α-emitter effects in pre-clinical models so the next generation of trials utilising 223Ra can be optimally designed. The research work presented in this thesis focused on studying the dosimetry involved in α-particle irradiation systems for in vitro and clinical settings, using computational simulation methods. We have also studied the α-particle irradiation effects on cell survival, DNA damage and tumour control, focusing specifically on 223Ra treatment scenarios

Artificial and Natural Genetic Information Processing

Conventional methods of genetic engineering and more recent genome editing techniques focus on identifying genetic target sequences for manipulation. This is a result of historical concept of the gene which was also the main assumption of the ENCODE project designed to identify all functional elements in the human genome sequence. However, the theoretical core concept changed dramatically. The old concept of genetic sequences which can be assembled and manipulated like molecular bricks has problems in explaining the natural genome-editing competences of viruses and RNA consortia that are able to insert or delete, combine and recombine genetic sequences more precisely than random-like into cellular host organisms according to adaptational needs or even generate sequences de novo. Increasing knowledge about natural genome editing questions the traditional narrative of mutations (error replications) as essential for generating genetic diversity and genetic content arrangements in biological systems. This may have far-reaching consequences for our understanding of artificial genome editing

Combined cognitive-motor rehabilitation in virtual reality improves motor outcomes in chronic stroke–a pilot study

Stroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patients' capability to live independently. Virtual Reality (VR) based methods for stroke rehabilitation have mainly focused on motor rehabilitation but there is increasing interest toward the integration of cognitive training for providing more effective solutions. Here we investigate the feasibility for stroke recovery of a virtual cognitive-motor task, the Reh@Task, which combines adapted arm reaching, and attention and memory training. 24 participants in the chronic stage of stroke, with cognitive and motor deficits, were allocated to one of two groups (VR, Control). Both groups were enrolled in conventional occupational therapy, which mostly involves motor training. Additionally, the VR group underwent training with the Reh@Task and the control group performed time-matched conventional occupational therapy. Motor and cognitive competences were assessed at baseline, end of treatment (1 month) and at a 1-month follow-up through the Montreal Cognitive Assessment, Single Letter Cancelation, Digit Cancelation, Bells Test, Fugl-Meyer Assessment Test, Chedoke Arm and Hand Activity Inventory, Modified Ashworth Scale, and Barthel Index. Our results show that both groups improved in motor function over time, but the Reh@Task group displayed significantly higher between-group outcomes in the arm subpart of the Fugl-Meyer Assessment Test. Improvements in cognitive function were significant and similar in both groups. Overall, these results are supportive of the viability of VR tools that combine motor and cognitive training, such as the Reh@Task. Trial Registration: This trial was not registered because it is a small clinical study that addresses the feasibility of a prototype device.info:eu-repo/semantics/publishedVersio

Exploring the bases for a mixed reality stroke rehabilitation system, Part II: Design of Interactive Feedback for upper limb rehabilitation

abstract: Background Few existing interactive rehabilitation systems can effectively communicate multiple aspects of movement performance simultaneously, in a manner that appropriately adapts across various training scenarios. In order to address the need for such systems within stroke rehabilitation training, a unified approach for designing interactive systems for upper limb rehabilitation of stroke survivors has been developed and applied for the implementation of an Adaptive Mixed Reality Rehabilitation (AMRR) System. Results The AMRR system provides computational evaluation and multimedia feedback for the upper limb rehabilitation of stroke survivors. A participant's movements are tracked by motion capture technology and evaluated by computational means. The resulting data are used to generate interactive media-based feedback that communicates to the participant detailed, intuitive evaluations of his performance. This article describes how the AMRR system's interactive feedback is designed to address specific movement challenges faced by stroke survivors. Multimedia examples are provided to illustrate each feedback component. Supportive data are provided for three participants of varying impairment levels to demonstrate the system's ability to train both targeted and integrated aspects of movement. Conclusions The AMRR system supports training of multiple movement aspects together or in isolation, within adaptable sequences, through cohesive feedback that is based on formalized compositional design principles. From preliminary analysis of the data, we infer that the system's ability to train multiple foci together or in isolation in adaptable sequences, utilizing appropriately designed feedback, can lead to functional improvement. The evaluation and feedback frameworks established within the AMRR system will be applied to the development of a novel home-based system to provide an engaging yet low-cost extension of training for longer periods of time.The electronic version of this article is the complete one and can be found online at: https://jneuroengrehab.biomedcentral.com/articles/10.1186/1743-0003-8-5

Design, Fabrication, and Validation of 3D Printed, Patient-Specific Compensators for Postmastectomy Radiation Therapy

The purpose of this study was to use 3D printed, patient-specific tissue compensators to overcome the 3D planning limitations for postmastectomy radiation therapy (PMRT). Tissue compensators can be used to reduce dose heterogeneity, hot and cold spots at field junctions, and treatment complexity, but are currently seldom used due to the difficulty in designing, fabricating, and validating them. To produce compensators using 3D printing technology, suitable materials had to be found and characterized. Several materials were found to be promising, but previously unreported material uncertainties were also discovered that must be carefully controlled for in 3D printing studies. A new algorithm was also created to optimally design the compensator shape to conform the dose to the desired region, while maintaining acceptable geometric considerations for 3D printing. Patients’ dose distributions calculated using this algorithm were superior to dose distributions calculated in those same patients using more conventional matched field plans. To validate the idealized dose distributions, a new technique was developed to 3D print patient-specific, large scale radiotherapy phantoms with dosimeters throughout that can accurately reflect patients’ anatomy better than generalized phantoms. Six of these phantoms were created for a sample of patients with a range of body vi sizes. A sample of compensators was designed and printed for these novel phantoms, and radiation doses were measured and compared to planned dose distributions. Measured doses agreed well with planned doses. This study demonstrates that 3D printed, patient-specific compensators can be used to simplify treatments, and improve dose distributions in PMRT patients relative to their conventional 3D plans. Additionally, the algorithm could be applied to calculate compensators for different treatment sites in the future, and the phantoms developed could be used to perform pseudo in vivo dosimetry measurements for a wide range of radiotherapy experiments

Feasibility of 3D tracking and adaptation of VMAT based on VMAT-CT

Background: Local computed tomography (CT) reconstruction is achievable with portal images acquired during volumetric-modulated arc therapy (VMAT) delivery and was named as VMAT-CT. However, the application of VMAT-CT is limited because it has limited field of view and no density information. In addition, the new generation of multi-leaf collimator with faster speed and various collimator angles used in patients’ plans could cause more artifacts in VMAT-CT. The goal of this study was to extend VMAT-CT concept, generate complete three-dimensional (3D) CT images, calculate new 3D dose, track and adapt VMAT plan based on updated images and dose. Materials and methods: VMAT-CT and planning CT of phantoms were fused by rigid or deformable registration to create VMAT-CT+ images. Trackings based on planning CT, VMAT-CT+, and cone beam CT (CBCT) were compared. When prescription dose was not met for planning target volume (PTV), re-planning was demonstrated on an in-house deformable phantom. Possible uncertainties were also evaluated. Results: Tracking based on VMAT-CT+ was accurate and superior to those based on planning CT and CBCT since VMAT-CT+ can detect changes during treatment. PTV coverage in the deformable phantom decreased after deformations but went up and met the prescription goal after re-planning. The impact of uncertainties on dose was minimal. Conclusion: 3D tracking and adaptation of VMAT based on VMAT-CT are feasible. Our study has the potential to increase the confidence of beam delivery, catch and remedy errors during VMAT