New techniques for neuro-rehabilitation: Transcranial Electric Stimulation and Virtual Reality

Recovery of motor and cognitive performances after a neurological illness remains a significant challenge for rehabilitation specialists. The traditional rehabilitative interventions are usually delivered using a multidisciplinary approach, whose results are not always satisfactory. These limitations in functional recovery have led researchers to consider alternative approaches. The hypothesis of providing new therapeutic possibilities in the different patients treated is, as a rehabilitator, very rewarding and represents a challenge for the future. The application of simple and low-cost techniques, defined by the literature as "unconventional" or “novel”, can provide new ideas not only in the field of research but above all of application in clinical reality.A suitable approach to improve the rehabilitation outcome is to utilize these novel rehabilitation techniques that act as a substitute or an addition to the traditional ones. In this context, some recent approaches have been proposed that might increase the effectiveness of a traditional treatment. Among them, two techniques have been demonstrated to be very promising, namely non-invasive brain stimulation (NIBS) and Virtual Reality (VR).In light of the foregoing, my thesis has been divided into two main lines of research, namely: a) the study of the effects of transcranial direct current stimulation (tDCS) in different neurological conditions; b) the application of VR (used alone or combined with tDCS) in the treatment of some neurocognitive disorders. A semi-immersive VR tool (ReMOVES system) has been used as a user-friendly platform providing activities based on exergames

Sustainable Technology and Elderly Life

The coming years will see an exponential increase in the proportion of elderly people in our society. This accelerated growth brings with it major challenges in relation to the sustainability of the system. There are different aspects where these changes will have a special incidence: health systems and their monitoring; the development of a framework in which the elderly can develop their daily lives satisfactorily; and in the design of intelligent cities adapted to the future sociodemographic profile. The discussion of the challenges faced, together with the current technological evolution, can show possible ways of meeting the challenges. There are different aspects where these changes will have a special incidence: health systems and their monitoring; the development of a framework in which the elderly can develop their daily lives satisfactorily; and in the design of intelligent cities adapted to the future sociodemographic profile. This special issue discusses various ways in which sustainable technologies can be applied to improve the lives of the elderly. Six articles on the subject are featured in this volume. From a systematic review of the literature to the development of gamification and health improvement projects. The articles present suggestive proposals for the improvement of the lives of the elderly. The volume is a resource of interest for the scientific community, since it shows different research gaps in the current state of the art. But it is also a document that can help social policy makers and people working in this domain to planning successful projects

Serious Games and Mixed Reality Applications for Healthcare

Virtual reality (VR) and augmented reality (AR) have long histories in the healthcare sector, offering the opportunity to develop a wide range of tools and applications aimed at improving the quality of care and efficiency of services for professionals and patients alike. The best-known examples of VR–AR applications in the healthcare domain include surgical planning and medical training by means of simulation technologies. Techniques used in surgical simulation have also been applied to cognitive and motor rehabilitation, pain management, and patient and professional education. Serious games are ones in which the main goal is not entertainment, but a crucial purpose, ranging from the acquisition of knowledge to interactive training.These games are attracting growing attention in healthcare because of their several benefits: motivation, interactivity, adaptation to user competence level, flexibility in time, repeatability, and continuous feedback. Recently, healthcare has also become one of the biggest adopters of mixed reality (MR), which merges real and virtual content to generate novel environments, where physical and digital objects not only coexist, but are also capable of interacting with each other in real time, encompassing both VR and AR applications.This Special Issue aims to gather and publish original scientific contributions exploring opportunities and addressing challenges in both the theoretical and applied aspects of VR–AR and MR applications in healthcare

Improving personalized elderly care: an approach using cognitive agents to better assist elderly people

Tesis por compendio de publicaciones[ES]El envejecimiento de la población a nivel global es una constante cada vez más presente en el día a día y las consecuencias derivadas de este problema son cada vez más impactantes para el correcto funcionamiento y estructuración de la sociedad. En este contexto, hablamos de consecuencias a nivel de crecimiento económico, estilos de vida (y jubilación), relaciones familiares, recursos disponibles por el gobierno a la franja etaria más anciana e inevitablemente la prevalencia de enfermedades crónicas. Es ante esta realidad que surge la necesidad de desarrollo y promoción de estrategias eficaces en el acompañamiento, prevención y estímulo al envejecimiento activo y saludable de la población para garantizar que las personas ancianas continúen teniendo un papel relevante en la sociedad en lugar de someterse al aislamiento y fácil deterioro de las capacidades físicas, cognitivas, emocionales y sociales. De esta forma, tiene todo el sentido aprovechar todos los desarrollos tecnológicos verificados en los últimos años, principalmente en lo que se refiere a avances en las áreas de dispositivos móviles, inteligencia artificial y sistemas de monitoreo y crear soluciones capaces de brindar apoyo diariamente al recopilar datos e indicadores del estado de salud y, en respuesta, proporcionar diversas acciones personalizadas que motiven la adopción de mejores hábitos de salud y medios para lograr este envejecimiento activo y saludable. El desafío consiste en motivar a esta población a conciliar su día a día con el interés y la voluntad de utilizar aplicaciones y sistemas que brinden este apoyo personalizado. Algunas de las abordajes recientemente explorados en la literatura con este objetivo y que han alcanzado resultados prometedores se basan en la utilización de técnicas de gamificación e incentivo al cumplimiento de desafíos a nivel de salud (como si la persona estuviera jugando un juego) y la utilización de interacciones personalizadas con objetos (ya sean físicos como robots o virtuales como avatares) capaces de brindar feedback más personal, creando así una conexión más cercana entre ambas entidades. El trabajo aquí presentado combina estas ideas y resulta en un enfoque inteligente para la promoción del bienestar de la población anciana a través de un sistema de cuidados de salud personalizado. Este sistema incorpora diversas técnicas de gamificación para la promoción de mejores hábitos y comportamientos, y la utilización de un asistente virtual cognitivo capaz de entender las necesidades e intereses del usuario para posibilitar un feedback e interacción personalizados con el fin de ayudar y motivar al cumplimiento de los diferentes desafíos y objetivos que se identifiquen. El enfoque propuesto fue validado a través de un estudio con 12 usuarios ancianos y se lograron resultados significativos en términos de usabilidad, aceptación y efectos de salud. Específicamente, los resultados obtenidos permiten respaldar la importancia y el efecto positivo de combinar técnicas de gamificación e interacción con un asistente virtual cognitivo que traduzca el progreso del estado de salud del usuario, ya que se lograron mejoras significativas en los resultados de salud después de la intervención. Además, los resultados de usabilidad obtenidos mediante la cumplimentación de un cuestionario de usabilidad confirmaron la buena adhesión a el enfoque presentado. Estos resultados validan la hipótesis de la investigación estudiada en el desarrollo de esta disertación

Biosignal‐based human–machine interfaces for assistance and rehabilitation : a survey

As a definition, Human–Machine Interface (HMI) enables a person to interact with a device. Starting from elementary equipment, the recent development of novel techniques and unobtrusive devices for biosignals monitoring paved the way for a new class of HMIs, which take such biosignals as inputs to control various applications. The current survey aims to review the large literature of the last two decades regarding biosignal‐based HMIs for assistance and rehabilitation to outline state‐of‐the‐art and identify emerging technologies and potential future research trends. PubMed and other databases were surveyed by using specific keywords. The found studies were further screened in three levels (title, abstract, full‐text), and eventually, 144 journal papers and 37 conference papers were included. Four macrocategories were considered to classify the different biosignals used for HMI control: biopotential, muscle mechanical motion, body motion, and their combinations (hybrid systems). The HMIs were also classified according to their target application by considering six categories: prosthetic control, robotic control, virtual reality control, gesture recognition, communication, and smart environment control. An ever‐growing number of publications has been observed over the last years. Most of the studies (about 67%) pertain to the assistive field, while 20% relate to rehabilitation and 13% to assistance and rehabilitation. A moderate increase can be observed in studies focusing on robotic control, prosthetic control, and gesture recognition in the last decade. In contrast, studies on the other targets experienced only a small increase. Biopotentials are no longer the leading control signals, and the use of muscle mechanical motion signals has experienced a considerable rise, especially in prosthetic control. Hybrid technologies are promising, as they could lead to higher performances. However, they also increase HMIs’ complex-ity, so their usefulness should be carefully evaluated for the specific application

Wearables for Movement Analysis in Healthcare

Quantitative movement analysis is widely used in clinical practice and research to investigate movement disorders objectively and in a complete way. Conventionally, body segment kinematic and kinetic parameters are measured in gait laboratories using marker-based optoelectronic systems, force plates, and electromyographic systems. Although movement analyses are considered accurate, the availability of specific laboratories, high costs, and dependency on trained users sometimes limit its use in clinical practice. A variety of compact wearable sensors are available today and have allowed researchers and clinicians to pursue applications in which individuals are monitored in their homes and in community settings within different fields of study, such movement analysis. Wearable sensors may thus contribute to the implementation of quantitative movement analyses even during out-patient use to reduce evaluation times and to provide objective, quantifiable data on the patients’ capabilities, unobtrusively and continuously, for clinical purposes

Utilisation de la téléréadaptation combinée à la réalité virtuelle non immersive pour la réadaptation du membre supérieur à la suite d'un accident vasculaire cérébral

La réalité virtuelle et la téléréadaptation sont deux technologies qui pourraient permettre d’avoir accès à des programmes de réadaptation stimulants et d’assurer un suivi aux survivants d’accident vasculaire cérébral (AVC) présentant des séquelles chroniques du membre supérieur. L’intégration de techniques motivationnelles et comportementales au cours du suivi est d’autant plus importante, face à la nature chronique de la maladie, pouvant permettre l’autonomisation des survivants d’AVC. Toutefois, l’utilisation combinée de la réalité virtuelle et de la téléréadaptation (VirTele) est peu explorée dans la littérature. Ainsi les objectifs de cette thèse étaient de : 1) Déterminer la faisabilité de VirTele pour la réadaptation du membre supérieur à domicile, auprès des survivants d'AVC en phase chronique; 2) Explorer l’efficacité préliminaire de VirTele sur la fonction motrice du membre supérieur, la quantité et la qualité d'utilisation du membre supérieur, la qualité de vie et la motivation, chez les survivants d'AVC, comparé aux traitements conventionnels prodigués à domicile; 3) Explorer les déterminants de l'intention et du comportement d'utilisation de VirTele; 4) Identifier les stratégies motivationnelles et comportementales utilisées par les cliniciens et explorer leur impact sur l’autonomisation des survivants d'AVC. Pour répondre à ces objectifs, trois études ont été réalisées. Premièrement, une étude de cas unique a évalué la faisabilité et l’efficacité préliminaire de VirTele, ainsi que les déterminants de l’intention et du comportement d’utilisation de la technologie, auprès d’un citoyen partenaire en phase chronique d’AVC. Deuxièmement, une évaluation des neuf premiers participants d’un essai clinique randomisé a exploré la faisabilité et l’efficacité préliminaire de VirTele, comparé à un traitement conventionnel. Troisièmement, une étude de cas multiples imbriquée à l’essai clinique randomisé a identifié les stratégies motivationnelles et comportementales utilisées par deux cliniciens au cours de l’intervention, ainsi que leur impact sur l’autonomisation de trois survivants d’AVC. Cette étude a aussi exploré plus en détail les déterminants d’utilisation de VirTele. En résumé, les résultats de ces études confirment la faisabilité et la sécurité de prodiguer un programme de réadaptation à distance par VirTele. De plus, les résultats suggèrent que le programme VirTele pourrait entrainer des effets comparables au programme standardisé conventionnel au niveau de la récupération du membre supérieur. La motivation autonome à s’engager au programme d’entrainement semble être plus élevée au cours de VirTele, tandis que l'amélioration de la qualité de vie n'a été observée que dans le groupe contrôle. Par ailleurs, des techniques de changement de comportement et techniques motivationnelles spécifiques à VirTele ont été intégrées par les cliniciens, au cours de l’intervention. Ces techniques auraient possiblement potentialisé l’autonomisation des survivants d’AVC, à travers une adhérence plus élevée au programme d’entrainement et une utilisation plus fréquente du membre supérieur. Enfin, la combinaison des résultats des trois études a permis de concevoir une image plus complète des déterminants de l’intention et le comportement d’utilisation de VirTele par les survivants d’AVC et les cliniciens. En somme, les résultats de ces études soutiennent la pertinence de continuer les efforts de recherche dans le contexte de la réadaptation à la suite d’un AVC par la réalité virtuelle combinée à la téléréadaptation.Virtual reality and telerehabilitation are two technologies that could provide access to stimulating rehabilitation programs and follow-up for stroke survivors with chronic upper extremity sequelae. The integration of motivational and behavioral techniques during follow-up, is especially important given the chronic nature of the disease, which can empower stroke survivors. However, the combined use of virtual reality and telerehabilitation (VirTele) is not yet well understood. Thus the objectives of this thesis were to 1) Determine the feasibility of VirTele for home-based upper extremity rehabilitation in chronic stroke survivors; 2) Explore the preliminary efficacy of VirTele on upper extremity motor function, quantity and quality of upper extremity use, quality of life, and motivation, in stroke survivors compared to conventional treatment; 3) Explore the determinants of intention and use behavior of VirTele; 4) Identify the motivational and behavioral strategies used by clinicians and their impact on the empowerment of stroke survivors. To address these objectives, three studies were conducted. First, a single case study assessed the feasibility and preliminary efficacy of VirTele, as well as the determinants of intention and use behavior of the technology, with a citizen partner in the chronic phase of stroke. Second, an evaluation of the first nine participants in a randomized clinical trial explored the feasibility and preliminary efficacy of VirTele compared with conventional treatment provided at home. Third, a multiple case study embedded in the randomized clinical trial identified the motivational and behavioral strategies used by two clinicians during the intervention and their impact on empowerment of three stroke survivors. This study also explored in more detail the determinants of VirTele use. In summary, the results of these studies support the feasibility and safety of delivering a remote rehabilitation program using VirTele. In addition, the results suggest that the VirTele program may result in effects comparable to the conventional standardized program in terms of upper extremity recovery. Autonomous-motivation to engage in the training program appeared to be higher during VirTele, whereas improvement in quality of life was only observed in the control group. In addition, behavioral change and motivational techniques specific to VirTele were incorporated by the clinicians during the intervention. These techniques may have enhanced the empowerment of stroke survivors through higher adherence to the training program and more frequent use of the upper extremity. Finally, combining the results of the three studies allowed us to develop a more complete picture of the determinants of intention and use behavior of VirTele by stroke survivors and clinicians. In sum, the results of these studies support the relevance of continued research efforts in the context of stroke rehabilitation using virtual reality combined with telerehabilitation