Technology-assisted stroke rehabilitation in Mexico: a pilot randomized trial comparing traditional therapy to circuit training in a Robot/technology-assisted therapy gym

Background Stroke rehabilitation in low- and middle-income countries, such as Mexico, is often hampered by lack of clinical resources and funding. To provide a cost-effective solution for comprehensive post-stroke rehabilitation that can alleviate the need for one-on-one physical or occupational therapy, in lower and upper extremities, we proposed and implemented a technology-assisted rehabilitation gymnasium in Chihuahua, Mexico. The Gymnasium for Robotic Rehabilitation (Robot Gym) consisted of low- and high-tech systems for upper and lower limb rehabilitation. Our hypothesis is that the Robot Gym can provide a cost- and labor-efficient alternative for post-stroke rehabilitation, while being more or as effective as traditional physical and occupational therapy approaches. Methods A typical group of stroke patients was randomly allocated to an intervention (n = 10) or a control group (n = 10). The intervention group received rehabilitation using the devices in the Robot Gym, whereas the control group (n = 10) received time-matched standard care. All of the study subjects were subjected to 24 two-hour therapy sessions over a period of 6 to 8 weeks. Several clinical assessments tests for upper and lower extremities were used to evaluate motor function pre- and post-intervention. A cost analysis was done to compare the cost effectiveness for both therapies. Results No significant differences were observed when comparing the results of the pre-intervention Mini-mental, Brunnstrom Test, and Geriatric Depression Scale Test, showing that both groups were functionally similar prior to the intervention. Although, both training groups were functionally equivalent, they had a significant age difference. The results of all of the upper extremity tests showed an improvement in function in both groups with no statistically significant differences between the groups. The Fugl-Meyer and the 10 Meters Walk lower extremity tests showed greater improvement in the intervention group compared to the control group. On the Time Up and Go Test, no statistically significant differences were observed pre- and post-intervention when comparing the control and the intervention groups. For the 6 Minute Walk Test, both groups presented a statistically significant difference pre- and post-intervention, showing progress in their performance. The robot gym therapy was more cost-effective than the traditional one-to-one therapy used during this study in that it enabled therapist to train up to 1.5 to 6 times more patients for the approximately same cost in the long term. Conclusions The results of this study showed that the patients that received therapy using the Robot Gym had enhanced functionality in the upper extremity tests similar to patients in the control group. In the lower extremity tests, the intervention patients showed more improvement than those subjected to traditional therapy. These results support that the Robot Gym can be as effective as traditional therapy for stroke patients, presenting a more cost- and labor-efficient option for countries with scarce clinical resources and funding. Trial registration ISRCTN98578807

Rehabilitative devices for a top-down approach

In recent years, neurorehabilitation has moved from a "bottom-up" to a "top down" approach. This change has also involved the technological devices developed for motor and cognitive rehabilitation. It implies that during a task or during therapeutic exercises, new "top-down" approaches are being used to stimulate the brain in a more direct way to elicit plasticity-mediated motor re-learning. This is opposed to "Bottom up" approaches, which act at the physical level and attempt to bring about changes at the level of the central neural system. Areas covered: In the present unsystematic review, we present the most promising innovative technological devices that can effectively support rehabilitation based on a top-down approach, according to the most recent neuroscientific and neurocognitive findings. In particular, we explore if and how the use of new technological devices comprising serious exergames, virtual reality, robots, brain computer interfaces, rhythmic music and biofeedback devices might provide a top-down based approach. Expert commentary: Motor and cognitive systems are strongly harnessed in humans and thus cannot be separated in neurorehabilitation. Recently developed technologies in motor-cognitive rehabilitation might have a greater positive effect than conventional therapies

Using a multi-task adaptive vr system for upper limb rehabilitation in the acute phase of stroke

Nowadays, stroke has become one the main causes of adult disability leading to life-lasting effects, including motor and cognitive deficits. Here we explore the benefits of the use of virtual reality (VR) for the rehabilitation of motor deficits following stroke. We have developed the Rehabilitation Gaming System (RGS), a VR-based apparatus designed for the treatment of the upper extremities. The RGS is a multi-level adaptive system that provides a task oriented training of graded complexity that is online adjusted to the capabilities of the patients. We show results from an ongoing study that evaluates the impact of this system on the recovery of patients in the acute phase of stroke (n=14). The results suggest that the system induces a sustained improvement during treatment, with observed benefits in the performance of activities of daily living.info:eu-repo/semantics/publishedVersio

Integrating the Nintendo Wii into Therapy: Resources for Occupational Therapy Practitioners

Therapists have the challenge of identifying a variety of interesting, meaningful, and purposeful intervention activities for individuals needing rehabilitation services (Weiss, Rand, Katz, & Kizony, 2004). The purpose of this project was to develop educational resources for occupational therapists on the integration of the Nintendo Wii as an intervention. An extensive literature review was conducted using PubMed, SCOPUS, CINAHL, professional journals, and news articles to investigate the health related effects of utilizing virtual reality and video games in the rehabilitation process. Currently, there is minimal research identifying the benefits of video games in occupational therapy practice and no protocols were found to assist occupational therapists with implementing the Nintendo Wii into occupational therapy practice. Resources were developed to educate occupational therapy practitioners on integrating the Nintendo Wii as an occupational therapy intervention. Resources include an educational in-service, a system set-up guide, instructions for creating a Mii character, an activity analysis of the Nintendo Wii Sports games, suggested intervention chart for select performance skills, and case scenario application activities. The educational inservice provides information on the role of virtual reality in rehabilitation, benefits and precautions/contraindications of virtual reality, identification of Nintendo Wii equipment, and system set-up instructions. The Adult Learning Theory and the Model of Human Occupation were utilized in the development of the product. This educational in-service provides occupational therapists with information on the integration of the Nintendo Wii. It provides foundational knowledge allowing therapists to adapt and modify the use of the Nintendo Wii to facilitate occupational performance and client-centered practice. The authors of this scholarly project recommend that the Nintendo Wii be used as an adjunct to occupation-based intervention. It is also recommended that more research be conducted regarding the use of video games, specifically the Nintendo Wii, in occupational therapy to determine the efficacy of this type of approach

Virtual reality based rehabilitation speeds up functional recovery of the upper extremities after stroke: a randomized controlled pilot study in the acute phase of stroke using the rehabilitation gaming system

Given the incidence of stroke, the need has arisen to consider more self-managed rehabilitation approaches. A promising technology is Virtual Reality (VR). Thus far, however, it is not clear what the benefits of VR systems are when compared to conventional methods. Here we investigated the clinical impact of one such system, the Rehabilitation Gaming System (RGS), on the recovery time course of acute stroke. RGS combines concepts of action execution and observation with an automatic individualization of training. METHODS. Acute stroke patients (n = 8) used the RGS during 12 weeks in addition to conventional therapy. A control group (n = 8) performed a time matched alternative treatment, which consisted of intense occupational therapy or non-specific interactive games. RESULTS. At the end of the treatment, between-group comparisons showed that the RGS group displayed significantly improved performance in paretic arm speed that was matched by better performance in the arm subpart of the Fugl-Meyer Assessment Test and the Chedoke Arm and Hand Activity Inventory. In addition, the RGS group presented a significantly faster improvement over time for all the clinical scales during the treatment period. CONCLUSIONS. Our results suggest that rehabilitation with the RGS facilitates the functional recovery of the upper extremities and that this system is therefore a promising tool for stroke neurorehabilitation.info:eu-repo/semantics/publishedVersio

ENGAGE: Guided Activity-Based Gaming in Neurorehabilitation after Stroke: A Pilot Study

Introduction. Stroke is a leading cause of disability in healthy adults. The purpose of this pilot study was to assess the feasibility and outcomes of a novel video gaming repetitive practice paradigm, (ENGAGE) enhanced neurorehabilitation: guided activity-based gaming exercise. Methods. Sixteen individuals at least three months after stroke served as participants. All participants received concurrent outpatient therapy or took part in a stroke exercise class and completed at least 500 minutes of gaming. Primary baseline and posttest outcome measures included the Wolf motor function test (WMFT) and the Fugl-Meyer assessment (FMA). ENGAGE uses a game selection algorithm providing focused, graded activity-based repetitive practice that is highly individualized and directed. The Wilcoxon signed ranks test was used to determine statistical significance. Results. There were improvements in the WMFT (=0.003) and the FMA (=0.002) that exceeded established values of minimal clinically important difference. Conclusions. ENGAGE was feasible and an effective adjunct to concurrent therapy after stroke

Combining brain-computer interfaces and assistive technologies: state-of-the-art and challenges

In recent years, new research has brought the field of EEG-based Brain-Computer Interfacing (BCI) out of its infancy and into a phase of relative maturity through many demonstrated prototypes such as brain-controlled wheelchairs, keyboards, and computer games. With this proof-of-concept phase in the past, the time is now ripe to focus on the development of practical BCI technologies that can be brought out of the lab and into real-world applications. In particular, we focus on the prospect of improving the lives of countless disabled individuals through a combination of BCI technology with existing assistive technologies (AT). In pursuit of more practical BCIs for use outside of the lab, in this paper, we identify four application areas where disabled individuals could greatly benefit from advancements in BCI technology, namely,“Communication and Control”, “Motor Substitution”, “Entertainment”, and “Motor Recovery”. We review the current state of the art and possible future developments, while discussing the main research issues in these four areas. In particular, we expect the most progress in the development of technologies such as hybrid BCI architectures, user-machine adaptation algorithms, the exploitation of users’ mental states for BCI reliability and confidence measures, the incorporation of principles in human-computer interaction (HCI) to improve BCI usability, and the development of novel BCI technology including better EEG devices

Neurorehabilitation using the virtual reality based Rehabilitation Gaming System: methodology, design, psychometrics, usability and validation

<p>Abstract</p> <p>Background</p> <p>Stroke is a frequent cause of adult disability that can lead to enduring impairments. However, given the life-long plasticity of the brain one could assume that recovery could be facilitated by the harnessing of mechanisms underlying neuronal reorganization. Currently it is not clear how this reorganization can be mobilized. Novel technology based neurorehabilitation techniques hold promise to address this issue. Here we describe a Virtual Reality (VR) based system, the Rehabilitation Gaming System (RGS) that is based on a number of hypotheses on the neuronal mechanisms underlying recovery, the structure of training and the role of individualization. We investigate the psychometrics of the RGS in stroke patients and healthy controls.</p> <p>Methods</p> <p>We describe the key components of the RGS and the psychometrics of one rehabilitation scenario called Spheroids. We performed trials with 21 acute/subacute stroke patients and 20 healthy controls to study the effect of the training parameters on task performance. This allowed us to develop a Personalized Training Module (PTM) for online adjustment of task difficulty. In addition, we studied task transfer between physical and virtual environments. Finally, we assessed the usability and acceptance of the RGS as a rehabilitation tool.</p> <p>Results</p> <p>We show that the PTM implemented in RGS allows us to effectively adjust the difficulty and the parameters of the task to the user by capturing specific features of the movements of the arms. The results reported here also show a consistent transfer of movement kinematics between physical and virtual tasks. Moreover, our usability assessment shows that the RGS is highly accepted by stroke patients as a rehabilitation tool.</p> <p>Conclusions</p> <p>We introduce a novel VR based paradigm for neurorehabilitation, RGS, which combines specific rehabilitative principles with a psychometric evaluation to provide a personalized and automated training. Our results show that the RGS effectively adjusts to the individual features of the user, allowing for an unsupervised deployment of individualized rehabilitation protocols.</p

Adaptable videogame platform for interactive upper extremity rehabilitation

The primary objective of this work is to design a recreational rehabilitation videogame platform for customizing motivating games that interactively encourage purposeful upper extremity gross motor movements. Virtual reality (VR) technology is a popular application for rehabilitation therapies but there is a constant need for more accessible and affordable systems. We have developed a recreational VR game platform can be used as an independent therapy supplement without laboratory equipment and is inexpensive, motivating, and adaptable. The behaviors and interactive features can be easily modified and customized based on players\u27 limitations or progress. A real-time method of capturing hand movements using programmed color detection mechanisms to create the simulated virtual environments (VEs) is implemented. Color markers are tracked and simultaneously given coordinates in the VE where the player sees representations of their hands and other interacting objects whose behaviors can be customized and adapted to fit therapeutic objectives and players\u27 interests. After gross motor task repetition and involvement in the adaptable games, mobility of the upper extremities may improve. The videogame platform is expanded and optimized to allow modifications to base inputs and algorithms for object interactions through graphical user interfaces, thus providing the adaptable need in VR rehabilitation

Use of commercial gaming console WII for rehabilitation of hand impairments in young adults with Cerebral Palsy

Abstract The purpose of this study examined the feasibility of using a low-cost, commercially available gaming platform, the Wii® on improving the hand dexterity impairments in young adults with cerebral palsy. The study included 5 young adults with spastic cerebral palsy with a score of 1-3 on the GMFCS scale and a score of 1-2 on the MACS scale. The participants underwent an 8-week training intervention using the Wii™ for approximately 30 min/day 2 times a week. Training was performed using the Wii™ sports games software, including boxing, tennis, bowling, and archery. Three outcomes measures for hand impairments were used and tested during the study: such as the Hand dynamometer for the grip strength, Purdue peg board for the fine finger dexterity and the Box and Block test for the manual gross dexterity pre-and post- intervention as well as the family-reported activities of daily living before and after the interventions. A student’s t-test was used to analyse the pre- and the post-test results. The feasibility of using the virtual reality (Wii™) in the rehabilitation settings for young adults with CP showed positive outcomes in improving their hand impairments and manual ability. Additional hypotheses were proposed from the study for additional research