Development Of Robot-Based Cognitive And Motor Assessment Tools For Stroke And Hiv Neurorehabilitation

Stroke and HIV are leading causes of disability worldwide. HIV is an independent risk factor for stroke, resulting in an emerging population dealing with both but without guidelines on how to manage the co-presentation of these conditions. There is a need for solutions to combat functional decline that results from the cognitive and motor dysfunction associated with these conditions. Rehabilitation robotics has been explored as a solution to provide therapy in the stroke population, but its application to people living with HIV has not yet been examined. Additionally, current technology-based approaches generally tend to treat cognitive and motor impairments in isolation. As such, a major barrier to the clinical utility of these approaches is that improvements on robotic rehabilitation tasks do not transfer to activities of daily living. In this thesis, I combine rehabilitation robotics, cognitive neuroscience, and bioengineering principles to design robot-based assessment tasks capable of measuring both cognitive and motor impairment. I use clinical assessment and robotic tools to first explore the impact of cognitive impairment on motor performance in the chronic stroke population. The results from this investigation demonstrate that motor performance on a robotic task is sensitive to cognitive impairment due to stroke. I then tested additional assessment tasks against standard clinical assessments of cognitive and motor function relevant in both HIV and stroke. These results showed the ability of robot-based metrics to capture differences in performance between varying levels of impairment among people living with HIV. After demonstrating the concurrent validity of this approach in the U.S., I implemented this approach in Botswana. The preliminary results demonstrated that robotic assessment was feasible in this context and that some of our models had good predictive value. This work expands the application of rehabilitation robotics to new populations, including people living with HIV, those with cognitive impairments, and people residing in LMICs. My hope is that the work presented in this thesis will lead to future efforts that can overcome the barriers to better health by enabling the development of more effective and accessible rehabilitation technologies

Computational neurorehabilitation: modeling plasticity and learning to predict recovery

Despite progress in using computational approaches to inform medicine and neuroscience in the last 30 years, there have been few attempts to model the mechanisms underlying sensorimotor rehabilitation. We argue that a fundamental understanding of neurologic recovery, and as a result accurate predictions at the individual level, will be facilitated by developing computational models of the salient neural processes, including plasticity and learning systems of the brain, and integrating them into a context specific to rehabilitation. Here, we therefore discuss Computational Neurorehabilitation, a newly emerging field aimed at modeling plasticity and motor learning to understand and improve movement recovery of individuals with neurologic impairment. We first explain how the emergence of robotics and wearable sensors for rehabilitation is providing data that make development and testing of such models increasingly feasible. We then review key aspects of plasticity and motor learning that such models will incorporate. We proceed by discussing how computational neurorehabilitation models relate to the current benchmark in rehabilitation modeling – regression-based, prognostic modeling. We then critically discuss the first computational neurorehabilitation models, which have primarily focused on modeling rehabilitation of the upper extremity after stroke, and show how even simple models have produced novel ideas for future investigation. Finally, we conclude with key directions for future research, anticipating that soon we will see the emergence of mechanistic models of motor recovery that are informed by clinical imaging results and driven by the actual movement content of rehabilitation therapy as well as wearable sensor-based records of daily activity

Do informal caregivers of people with dementia mirror the cognitive deficits of their demented patients?:A pilot study

Recent research suggests that informal caregivers of people with dementia (ICs) experience more cognitive deficits than noncaregivers. The reason for this is not yet clear. Objective: to test the hypothesis that ICs ‘mirror' the cognitive deficits of the demented people they care for. Participants and methods: 105 adult ICs were asked to complete three neuropsychological tests: letter fluency, category fluency, and the logical memory test from the WMS-III. The ICs were grouped according to the diagnosis of their demented patients. One-sample ttests were conducted to investigate if the standardized mean scores (t-scores) of the ICs were different from normative data. A Bonferroni correction was used to correct for multiple comparisons. Results: 82 ICs cared for people with Alzheimer's dementia and 23 ICs cared for people with vascular dementia. Mean letter fluency score of the ICs of people with Alzheimer's dementia was significantly lower than the normative mean letter fluency score, p = .002. The other tests yielded no significant results. Conclusion: our data shows that ICs of Alzheimer patients have cognitive deficits on the letter fluency test. This test primarily measures executive functioning and it has been found to be sensitive to mild cognitive impairment in recent research. Our data tentatively suggests that ICs who care for Alzheimer patients also show signs of cognitive impairment but that it is too early to tell if this is cause for concern or not

Neuromechanical Biomarkers for Robotic Neurorehabilitation

: One of the current challenges for translational rehabilitation research is to develop the strategies to deliver accurate evaluation, prediction, patient selection, and decision-making in the clinical practice. In this regard, the robot-assisted interventions have gained popularity as they can provide the objective and quantifiable assessment of the motor performance by taking the kinematics parameters into the account. Neurophysiological parameters have also been proposed for this purpose due to the novel advances in the non-invasive signal processing techniques. In addition, other parameters linked to the motor learning and brain plasticity occurring during the rehabilitation have been explored, looking for a more holistic rehabilitation approach. However, the majority of the research done in this area is still exploratory. These parameters have shown the capability to become the "biomarkers" that are defined as the quantifiable indicators of the physiological/pathological processes and the responses to the therapeutical interventions. In this view, they could be finally used for enhancing the robot-assisted treatments. While the research on the biomarkers has been growing in the last years, there is a current need for a better comprehension and quantification of the neuromechanical processes involved in the rehabilitation. In particular, there is a lack of operationalization of the potential neuromechanical biomarkers into the clinical algorithms. In this scenario, a new framework called the "Rehabilomics" has been proposed to account for the rehabilitation research that exploits the biomarkers in its design. This study provides an overview of the state-of-the-art of the biomarkers related to the robotic neurorehabilitation, focusing on the translational studies, and underlying the need to create the comprehensive approaches that have the potential to take the research on the biomarkers into the clinical practice. We then summarize some promising biomarkers that are being under investigation in the current literature and provide some examples of their current and/or potential applications in the neurorehabilitation. Finally, we outline the main challenges and future directions in the field, briefly discussing their potential evolution and prospective

The effect of shoulder stability training on upper limb function and quality of life in patients with hemiplegia

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Master of Science in Physiotherapy Johannesburg, 2016INTRODUCTION Stroke is a major cause of mortality and long-term adult disability and has a significant physical and psychosocial impact on individuals and their Health-Related Quality of Life (HRQoL). The loss of upper limb function post-stroke directly impacts on shoulder girdle stability of the affected side. Shoulder girdle stability is essential for optimal functioning of the upper limb; good shoulder function is a prerequisite for effective hand function and the execution of the expected tasks with regard to activities of daily living (ADL). It is well known that the rehabilitation of the upper limb post-stroke remains challenging. AIM The aim of the study was to determine the effect of shoulder stability training using the Biodex Balance System (BBS) on shoulder girdle stability, upper-limb function, pain control and HRQoL in patients with hemiplegia post-stroke. METHODS The study utilised a quantitative longitudinal randomised control trial design with single blinding. Participants who met the inclusion criteria and who gave informed consent were assigned to one of two groups, the experimental or the control group, using computer-generated random numbers with concealed allocation. Participants were included in the study if they met the following criteria: were either male or female patients, who had a stroke, resulting in hemiplegia and/or shoulder instability, and were between the ages of 18 and 85 years. In addition to usual care, shoulder girdle stability training using the BBS was given to the participants in the experimental group. Assessments were done at baseline and one, three and six month’s post-baseline. All the participants were assessed by the research assistant using the following: pain measured by the Wong-Baker FACES Pain Rating Scale, the functionality of the upper limb measured by the Fugl-Meyer Assessment Upper Extremity, the shoulder girdle stability measured by the Postural Stability Test on the BBS and HRQoL measured by the SF-36v2 Health Survey. RESULTS AND DISCUSSION A total of 17 participants were included in the main study after screening and, 53% were males. The median age of the study sample was 53 years. The control group comprised more female (n=5) than male (n=2) participants, while the experimental group comprised more male (n=7) than female (n=3) participants. All the participants in the control group were right-handed implying that more of them had their dominant hand affected than those in the experimental group. At baseline the two groups were comparable with regard to shoulder girdle stability, upper limb function and the HRQoL, but were not comparable regarding pain, as the control group experienced significantly more pain than the experimental group. There were no statistically significant differences between the two groups with regard to shoulder girdle stability on any of the three BBS stability levels neither at the baseline (p=0.69) nor at one-month follow-up post-baseline (p=0.77). There was no significant difference in upper limb function (baseline p=0.5, one month follow-up post-baseline p=0.93) between the control and the experimental groups for the entire study period. The severity of the impairment of upper limb function for both the control and the experimental group was comparable at baseline and improved from moderate (56-79) to mild (>79) during the duration of the study. At baseline the participants in the control group already expierienced more pain than the experimental group (p=0.05). Participants in the control group experienced significantly more shoulder pain than the experimental group at the one-month followup (p=0.02), but no differences were found at the three- (p=0.17) and sixmonths( p=0.12) follow-up post-baseline. At baseline a statistically significant difference was found regarding the impact of emotional problems on role limitation (p = 0.03) and pain (p = 0.05) between the two groups, with the control group indicating lower scores than the experimental group. At one month a statistically significant difference was found between the two groups regarding the extent of impaired social functioning (p = 0.05). The participants in the experimental group reported improvement in their health over time (baseline = 67.5 and six-month follow-up post baseline = 86.11). None of the factors investigated in this study impacted on HRQoL outcomes over time. CONCLUSION Shoulder girdle stability training using the BBS did not result in significant improvements in shoulder girdle stability, upper limb function, pain relief and HRQoL post-stroke in this cohort. The findings in this study could have been influenced by the small sample size (the power calculation was done only for the shoulder girdle stability) and also by participants in the control and experimental group continuing with their standard care, which included an intensive rehabilitation programme. This could have been a confounding factor impacting on the outcome. Further research in this field is required.MT201

The effectiveness of lycra compression garments on the upper limb in patients with stroke

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Occupational Therapy. Johannesburg, 2017Introduction: Lycra compression garments have been documented as beneficial in affecting spasticity in children with cerebral palsy but there is little research on the use of Lycra compression garments in adults with neurological conditions. Thus, the purpose of this study was to explore the effectiveness of Lycra compression garments on motor function and functional use of the upper limb, in patients with stroke. Methods: A randomised control design with a control or intervention group was used. Both groups received routine upper limb rehabilitation while the experimental group also received a custom Lycra compression garment worn for a minimum of six hours a day. Results: Change between an initial assessment and assessment at six weeks, was measured on the Fugl-Meyer Assessment of Motor Recovery (FMA) and The Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH). While both groups had significant improvement in upper limb movement, statistically significant differences for change in total motor function, wrist and hand movement and coordination were found when the experimental group and the control group were compared. Small differences in measurements of pain, passive range of motion, sensation and functional use of the upper limb were found between the two groups. Conclusion: Results indicate that Lycra compression garments may be beneficial in facilitating the return of movement in the upper limb in individuals with stroke.MT201

How 5G wireless (and concomitant technologies) will revolutionize healthcare?

The need to have equitable access to quality healthcare is enshrined in the United Nations (UN) Sustainable Development Goals (SDGs), which defines the developmental agenda of the UN for the next 15 years. In particular, the third SDG focuses on the need to “ensure healthy lives and promote well-being for all at all ages”. In this paper, we build the case that 5G wireless technology, along with concomitant emerging technologies (such as IoT, big data, artificial intelligence and machine learning), will transform global healthcare systems in the near future. Our optimism around 5G-enabled healthcare stems from a confluence of significant technical pushes that are already at play: apart from the availability of high-throughput low-latency wireless connectivity, other significant factors include the democratization of computing through cloud computing; the democratization of Artificial Intelligence (AI) and cognitive computing (e.g., IBM Watson); and the commoditization of data through crowdsourcing and digital exhaust. These technologies together can finally crack a dysfunctional healthcare system that has largely been impervious to technological innovations. We highlight the persistent deficiencies of the current healthcare system and then demonstrate how the 5G-enabled healthcare revolution can fix these deficiencies. We also highlight open technical research challenges, and potential pitfalls, that may hinder the development of such a 5G-enabled health revolution

Applications of Artificial Intelligence in Healthcare

Now in these days, artificial intelligence (AI) is playing a major role in healthcare. It has many applications in diagnosis, robotic surgeries, and research, powered by the growing availability of healthcare facts and brisk improvement of analytical techniques. AI is launched in such a way that it has similar knowledge as a human but is more efficient. A robot has the same expertise as a surgeon; even if it takes a longer time for surgery, its sutures, precision, and uniformity are far better than the surgeon, leading to fewer chances of failure. To make all these things possible, AI needs some sets of algorithms. In Artificial Intelligence, there are two key categories: machine learning (ML) and natural language processing (NPL), both of which are necessary to achieve practically any aim in healthcare. The goal of this study is to keep track of current advancements in science, understand technological availability, recognize the enormous power of AI in healthcare, and encourage scientists to use AI in their related fields of research. Discoveries and advancements will continue to push the AI frontier and expand the scope of its applications, with rapid developments expected in the future

Seeing the wood for the trees. Carer related research and knowledge: A scoping review

This NIHR-SSCR funded scoping review provides a comprehensive mapping of what is known about carers and caring, and aims to help inform policy, practice and research in relation to carers. The review was undertaken by searching 10 electronic bibliographic databases, supplemented by additional web searches to identify academic research, grey literature and wider knowledge. The analysis adopts a selective thematic approach covering: carer variables - the characteristics of different types of carer and different caring situations; types of care - the nature of needs of the cared for person and the features of the care situation; the impact of caring – resilience and coping, employment and health; and carer support and needs assessment. The final section highlights key messages identified from the review. It found that caring involves all sections and age groups of the population, with people are likely to experience one or more periods of caregiving over their lifetime. The uniqueness of each caring relationship is also highlighted. In relation to types of carers, knowledge about ‘hard to reach’ groups, such as BAME and LGBT carers, remains sparse. Older carers are also relatively invisible in policy and research terms. It found that much of the knowledge about carers identified in the review relates to their characteristics, their lived experience and the nature of their caregiving, with relatively less being known about the effectiveness of interventions to support them. The report concludes by offering suggestions for policy and practice. An appendix provides a bibliography of the 3,434 items identified in review, classified into 17 types of reference