A Telerehabilitation System for the Selection, Evaluation and Remote Management of Therapies

Telerehabilitation systems that support physical therapy sessions anywhere can help save healthcare costs while also improving the quality of life of the users that need rehabilitation. The main contribution of this paper is to present, as a whole, all the features supported by the innovative Kinect-based Telerehabilitation System (KiReS). In addition to the functionalities provided by current systems, it handles two new ones that could be incorporated into them, in order to give a step forward towards a new generation of telerehabilitation systems. The knowledge extraction functionality handles knowledge about the physical therapy record of patients and treatment protocols described in an ontology, named TRHONT, to select the adequate exercises for the rehabilitation of patients. The teleimmersion functionality provides a convenient, effective and user-friendly experience when performing the telerehabilitation, through a two-way real-time multimedia communication. The ontology contains about 2300 classes and 100 properties, and the system allows a reliable transmission of Kinect video depth, audio and skeleton data, being able to adapt to various network conditions. Moreover, the system has been tested with patients who suffered from shoulder disorders or total hip replacement.This research was funded by the Spanish Ministry of Economy and Competitiveness grant number FEDER/TIN2016-78011-C4-2R

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

Elbow exoskeleton mechanism for multistage poststroke rehabilitation.

More than three million people are suffering from stroke in England. The process of post-stroke rehabilitation consists of a series of biomechanical exercises- controlled joint movement in acute phase; external assistance in the mid phase; and variable levels of resistance in the last phase. Post-stroke rehabilitation performed by physiotherapist has many limitations including cost, time, repeatability and intensity of exercises. Although a large variety of arm exoskeletons have been developed in the last two decades to substitute the conventional exercises provided by physiotherapist, most of these systems have limitations with structural configuration, sensory data acquisition and control architecture. It is still difficult to facilitate multistage post-stroke rehabilitation to patients sited around hospital bed without expert intervention. To support this, a framework for elbow exoskeleton has been developed that is portable and has the potential to offer all three types of exercises (external force, assistive and resistive) in a single structure. The design enhances torque to weight ratio compared to joint based actuation systems. The structural lengths of the exoskeleton are determined based on the mean anthropometric parameters of healthy users and the lengths of upperarm and forearm are determined to fit a wide range of users. The operation of the exoskeleton is divided into three regions where each type of exercise can be served in a specific way depending on the requirements of users. Electric motor provides power in the first region of operation whereas spring based assistive force is used in the second region and spring based resistive force is applied in the third region. This design concept provides an engineering solution of integrating three phases of post-stroke exercises in a single device. With this strategy, the energy source is only used in the first region to power the motor whereas the other two modes of exercise can work on the stored energy of springs. All these operations are controlled by a single motor and the maximum torque of the motor required is only 5 Nm. However, due to mechanical advantage, the exoskeleton can provide the joint torque up to 10 Nm. To remove the dependency on biosensor, the exoskeleton has been designed with a hardware-based mechanism that can provide assistive and resistive force. All exoskeleton components are integrated into a microcontroller-based circuit for measuring three joint parameters (angle, velocity and torque) and for controlling exercises. A user-friendly, multi-purpose graphical interface has been developed for participants to control the mode of exercise and it can be managed manually or in automatic mode. To validate the conceptual design, a prototype of the exoskeleton has been developed and it has been tested with healthy subjects. The generated assistive torque can be varied up to 0.037 Nm whereas resistive torque can be varied up to 0.057 Nm. The mass of the exoskeleton is approximately 1.8 kg. Two comparative studies have been performed to assess the measurement accuracy of the exoskeleton. In the first study, data collected from two healthy participants after using the exoskeleton and Kinect sensor by keeping Kinect sensor as reference. The mean measurement errors in joint angle are within 5.18 % for participant 1 and 1.66% for participant 2; the errors in torque measurement are within 8.48% and 7.93% respectively. In the next study, the repeatability of joint measurement by exoskeleton is analysed. The exoskeleton has been used by three healthy users in two rotation cycles. It shows a strong correction (correlation coefficient: 0.99) between two consecutive joint angle measurements and standard deviation is calculated to determine the error margin which comes under acceptable range (maximum: 8.897). The research embodied in this thesis presents a design framework of a portable exoskeleton model for providing three modes of exercises, which could provide a potential solution for all stages of post- stroke rehabilitation

Multimodal adaptive interfaces for 3D robot-mediated upper limb neuro-rehabilitation: An overview of bio-cooperative systems

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Using brain-computer interaction and multimodal virtual-reality for augmenting stroke neurorehabilitation

Every year millions of people suffer from stroke resulting to initial paralysis, slow motor recovery and chronic conditions that require continuous reha bilitation and therapy. The increasing socio-economical and psychological impact of stroke makes it necessary to find new approaches to minimize its sequels, as well as novel tools for effective, low cost and personalized reha bilitation. The integration of current ICT approaches and Virtual Reality (VR) training (based on exercise therapies) has shown significant improve ments. Moreover, recent studies have shown that through mental practice and neurofeedback the task performance is improved. To date, detailed in formation on which neurofeedback strategies lead to successful functional recovery is not available while very little is known about how to optimally utilize neurofeedback paradigms in stroke rehabilitation. Based on the cur rent limitations, the target of this project is to investigate and develop a novel upper-limb rehabilitation system with the use of novel ICT technolo gies including Brain-Computer Interfaces (BCI’s), and VR systems. Here, through a set of studies, we illustrate the design of the RehabNet frame work and its focus on integrative motor and cognitive therapy based on VR scenarios. Moreover, we broadened the inclusion criteria for low mobility pa tients, through the development of neurofeedback tools with the utilization of Brain-Computer Interfaces while investigating the effects of a brain-to-VR interaction.Todos os anos, milho˜es de pessoas sofrem de AVC, resultando em paral isia inicial, recupera¸ca˜o motora lenta e condic¸˜oes cr´onicas que requerem re abilita¸ca˜o e terapia cont´ınuas. O impacto socioecon´omico e psicol´ogico do AVC torna premente encontrar novas abordagens para minimizar as seque las decorrentes, bem como desenvolver ferramentas de reabilita¸ca˜o, efetivas, de baixo custo e personalizadas. A integra¸c˜ao das atuais abordagens das Tecnologias da Informa¸ca˜o e da Comunica¸ca˜o (TIC) e treino com Realidade Virtual (RV), com base em terapias por exerc´ıcios, tem mostrado melhorias significativas. Estudos recentes mostram, ainda, que a performance nas tare fas ´e melhorada atrav´es da pra´tica mental e do neurofeedback. At´e a` data, na˜o existem informac¸˜oes detalhadas sobre quais as estrat´egias de neurofeed back que levam a uma recupera¸ca˜o funcional bem-sucedida. De igual modo, pouco se sabe acerca de como utilizar, de forma otimizada, o paradigma de neurofeedback na recupera¸c˜ao de AVC. Face a tal, o objetivo deste projeto ´e investigar e desenvolver um novo sistema de reabilita¸ca˜o de membros supe riores, recorrendo ao uso de novas TIC, incluindo sistemas como a Interface C´erebro-Computador (ICC) e RV. Atrav´es de um conjunto de estudos, ilus tramos o design do framework RehabNet e o seu foco numa terapia motora e cognitiva, integrativa, baseada em cen´arios de RV. Adicionalmente, ampli amos os crit´erios de inclus˜ao para pacientes com baixa mobilidade, atrav´es do desenvolvimento de ferramentas de neurofeedback com a utilizac¸˜ao de ICC, ao mesmo que investigando os efeitos de uma interac¸˜ao c´erebro-para-RV

Kires: a data-centric telerehabilitation system based on kinect

185 p.It is widely accepted that the worldwide demand for rehabilitation services. To meet these needs, there will have to be developed systems of telerehabilitation that will bring services to even the most remote locations, through Internet and related technologies.This thesis is addressing the area of remote health care delivery, in particular telerehabilitation. We present KiReS; a Kinect based telerehabilitation system which covers the needs of physiotherapists in the process of designing, managing and evaluating physiotherapy protocols and sessions and also covers the needs of the users providing them an intuitive and encouraging interface and giving useful feedback to enhance the rehabilitation process. As required for multi-disciplinary projects, physiotherapists were consulted and feedback from patients was incorporated at different development stages.KiReS aims to outcome limitations of other telerehabilitation systems and bring some novel features: 1) A friendly and helpful interaction with the system using Kinect and motivational interfaces based on avatars. 2) Provision of smart data that supports physiotherapists in the therapy design process by: assuring the maintenance of appropriate constraints and selecting for them a set of exercises that are recommended for the user. 3) Monitoring of rehabilitation sessions through an algorithm that evaluates online performed exercises and sets if they have been properly executed. 4) Extensibility, KiReS is designed to be loaded with a broad spectrum of exercises and protocols

Investigation of Virtual Reality as a new model of delivery for evidence-based stroke rehabilitation

Virtual reality-aided exercise-based training has shown promise for post-stroke upper limb motor recovery in the home. Robust studies are needed to develop evidence-based guidelines and facilitate uptake in clinical practice. Thus, a three-phase mixed methods design was used to (I) identify if VR can drive neural recovery; (II) incorporate end-users into the refinement of a device and (III) provide a robust feasibility trial within the home to inform a future clinical efficacy trial. Phase I was a systematic review that demonstrated there is insufficient robust data to identify neurophysiological changes correlated with or accompanying a reduction in motor impairment, in response to VR. The four included studies reported a varying impact of VR on motor recovery and were of poor quality. Thus, revealing the need for research to address the mechanisms by which VR potentially drives motor recovery, and for more robust initial investigations to guide the development of clinical trials. Phase II incorporated the views of ten stroke survivors, seven informal carers and nine clinicians into the refinement of a virtual reality device. Demonstrations of the Virtualrehab platform and a small home-trial confirmed the need for a low-cost non-immersive VR device that can deliver personalised home-based therapy. The end-users provided key recommendations for the next iteration of the device; in order to facilitate acceptability, usability and uptake of such technology. Phase III investigated the feasibility of delivering upper limb therapy via VR, within the home of eleven stroke survivors. The 12-week intervention demonstrated that this mode of delivery was feasible and acceptable to stroke survivors; of note was the 87.5% therapy adherence. The results identified practical challenges for delivering and investigating VR within the home; particularly recommendations for collecting neural and behavioural outcomes. Thus, providing results to inform a future dose-optimisation study and then a clinical efficacy trial