A wearable biofeedback device to improve motor symptoms in Parkinson’s disease

Dissertação de mestrado em Engenharia BiomédicaThis dissertation presents the work done during the fifth year of the course Integrated Master’s in Biomedical Engineering, in Medical Electronics. This work was carried out in the Biomedical & Bioinspired Robotic Devices Lab (BiRD Lab) at the MicroElectroMechanics Center (CMEMS) established at the University of Minho. For validation purposes and data acquisition, it was developed a collaboration with the Clinical Academic Center (2CA), located at Braga Hospital. The knowledge acquired in the development of this master thesis is linked to the motor rehabilitation and assistance of abnormal gait caused by a neurological disease. Indeed, this dissertation has two main goals: (1) validate a wearable biofeedback system (WBS) used for Parkinson's disease patients (PD); and (2) develop a digital biomarker of PD based on kinematic-driven data acquired with the WBS. The first goal aims to study the effects of vibrotactile biofeedback to play an augmentative role to help PD patients mitigate gait-associated impairments, while the second goal seeks to bring a step advance in the use of front-end algorithms to develop a biomarker of PD based on inertial data acquired with wearable devices. Indeed, a WBS is intended to provide motor rehabilitation & assistance, but also to be used as a clinical decision support tool for the classification of the motor disability level. This system provides vibrotactile feedback to PD patients, so that they can integrate it into their normal physiological gait system, allowing them to overcome their gait difficulties related to the level/degree of the disease. The system is based on a user- centered design, considering the end-user driven, multitasking and less cognitive effort concepts. This manuscript presents all steps taken along this dissertation regarding: the literature review and respective critical analysis; implemented tech-based procedures; validation outcomes complemented with results discussion; and main conclusions and future challenges.Esta dissertação apresenta o trabalho realizado durante o quinto ano do curso Mestrado Integrado em Engenharia Biomédica, em Eletrónica Médica. Este trabalho foi realizado no Biomedical & Bioinspired Robotic Devices Lab (BiRD Lab) no MicroElectroMechanics Center (CMEMS) estabelecido na Universidade do Minho. Para efeitos de validação e aquisição de dados, foi desenvolvida uma colaboração com Clinical Academic Center (2CA), localizado no Hospital de Braga. Os conhecimentos adquiridos no desenvolvimento desta tese de mestrado estão ligados à reabilitação motora e assistência de marcha anormal causada por uma doença neurológica. De facto, esta dissertação tem dois objetivos principais: (1) validar um sistema de biofeedback vestível (WBS) utilizado por doentes com doença de Parkinson (DP); e (2) desenvolver um biomarcador digital de PD baseado em dados cinemáticos adquiridos com o WBS. O primeiro objetivo visa o estudo dos efeitos do biofeedback vibrotáctil para desempenhar um papel de reforço para ajudar os pacientes com PD a mitigar as deficiências associadas à marcha, enquanto o segundo objetivo procura trazer um avanço na utilização de algoritmos front-end para biomarcar PD baseado em dados inerciais adquiridos com o dispositivos vestível. De facto, a partir de um WBS pretende-se fornecer reabilitação motora e assistência, mas também utilizá-lo como ferramenta de apoio à decisão clínica para a classificação do nível de deficiência motora. Este sistema fornece feedback vibrotáctil aos pacientes com PD, para que possam integrá-lo no seu sistema de marcha fisiológica normal, permitindo-lhes ultrapassar as suas dificuldades de marcha relacionadas com o nível/grau da doença. O sistema baseia-se numa conceção centrada no utilizador, considerando o utilizador final, multitarefas e conceitos de esforço menos cognitivo. Portanto, este manuscrito apresenta todos os passos dados ao longo desta dissertação relativamente a: revisão da literatura e respetiva análise crítica; procedimentos de base tecnológica implementados; resultados de validação complementados com discussão de resultados; e principais conclusões e desafios futuros

Use of stance control knee-ankle-foot orthoses : a review of the literature

The use of stance control orthotic knee joints are becoming increasingly popular as unlike locked knee-ankle-foot orthoses, these joints allow the limb to swing freely in swing phase while providing stance phase stability, thus aiming to promote a more physiological and energy efficient gait. It is of paramount importance that all aspects of this technology is monitored and evaluated as the demand for evidence based practice and cost effective rehabilitation increases. A robust and thorough literature review was conducted to retrieve all articles which evaluated the use of stance control orthotic knee joints. All relevant databases were searched, including The Knowledge Network, ProQuest, Web of Knowledge, RECAL Legacy, PubMed and Engineering Village. Papers were selected for review if they addressed the use and effectiveness of commercially available stance control orthotic knee joints and included participant(s) trialling the SCKAFO. A total of 11 publications were reviewed and the following questions were developed and answered according to the best available evidence: 1. The effect SCKAFO (stance control knee-ankle-foot orthoses) systems have on kinetic and kinematic gait parameters 2. The effect SCKAFO systems have on the temporal and spatial parameters of gait 3. The effect SCKAFO systems have on the cardiopulmonary and metabolic cost of walking. 4. The effect SCKAFO systems have on muscle power/generation 5. Patient’s perceptions/ compliance of SCKAFO systems Although current research is limited and lacks in methodological quality the evidence available does, on a whole, indicate a positive benefit in the use of SCKAFOs. This is with respect to increased knee flexion during swing phase resulting in sufficient ground clearance, decreased compensatory movements to facilitate swing phase clearance and improved temporal and spatial gait parameters. With the right methodological approach, the benefits of using a SCKAFO system can be evidenced and the research more effectively converted into clinical practice

The effect of prefabricated wrist-hand orthoses on performing activities of daily living

Wrist-hand orthoses (WHOs) are commonly prescribed to manage the functional deficit associated with the wrist as a result of rheumatoid changes. The common presentation of the wrist is one of flexion and radial deviation with ulnar deviation of the fingers. This wrist position Results in altered biomechanics compromising hand function during activities of daily living (ADL). A paucity of evidence exists which suggests that improvements in ADL with WHO use are very task specific. Using normal subjects, and thus in the absence of pain as a limiting factor, the impact of ten WHOs on performing five ADLs tasks was investigated. The tasks were selected to represent common grip patterns and tests were performed with and without WHOs by right-handed, females, aged 20-50 years over a ten week period. The time taken to complete each task was recorded and a wrist goniometer, elbow goniometer and a forearm torsiometer were used to measure joint motion. Results show that, although orthoses may restrict the motion required to perform a task, participants do not use the full range of motion which the orthoses permit. The altered wrist position measured may be attributable to a modified method of performing the task or to a necessary change in grip pattern, resulting in an increased time in task performance. The effect of WHO use on ADL is task specific and may initially impede function. This could have an effect on WHO compliance if there appears to be no immediate benefits. This orthotic effect may be related to restriction of wrist motion or an inability to achieve the necessary grip patterns due to the designs of the orthoses

The effect of prefabricated wrist-hand orthoses on grip strength

Prefabricated wrist-hand orthoses (WHOs) are commonly prescribed to manage the functional deficit and compromised grip strength as a result of rheumatoid changes. It is thought that an orthosis which improves wrist extension, reduces synovitis and increases the mechanical advantage of the flexor muscles will improve hand function. Previous studies report an initial reduction in grip strength with WHO use which may increase following prolonged use. Using normal subjects, and thus in the absence of pain as a limiting factor, the impact of ten WHOs on grip strength was measured using a Jamar dynamometer. Tests were performed with and without WHOs by right-handed, female subjects, aged 20-50 years over a ten week period. During each test, a wrist goniometer and a forearm torsiometer were used to measure wrist joint position when maximum grip strength was achieved. The majority of participants achieved maximum grip strength with no orthosis at 30° extension. All the orthoses reduced initial grip strength but surprisingly the restriction of wrist extension did not appear to contribute in a significant way to this. Reduction in grip must therefore also be attributable to WHO design characteristics or the quality of fit. The authors recognize the need for research into the long term effect of WHOs on grip strength. However if grip is initially adversely affected, patients may be unlikely to persevere with treatment thereby negating all therapeutic benefits. In studies investigating patient opinions on WHO use, it was a stable wrist rather than a stronger grip reported to have facilitated task performance. This may explain why orthoses that interfere with maximum grip strength can improve functional task performance. Therefore while it is important to measure grip strength, it is only one factor to be considered when evaluating the efficacy of WHOs

Design of a wearable active ankle-foot orthosis for both sides

Dissertação de mestrado integrado em Engenharia Biomédica (área de especialização em Biomateriais, Reabilitação e Biomecânica)Portugal is the west European country with the highest rate of stroke-related mortality, being that, of those who suffer cerebrovascular accidents, 40% feature an impairment which can manifest itself through motor sequelae, namely drop foot. An ankle-foot orthosis is often recommended to passively accommodate these motor problems; however, active/powered exoskeletons are also a suitable solution for post-stroke patients. Due to the high complexity of the human ankle joint, one of the problems regarding these active devices is the misalignment occurring between the rehabilitation device and the human joint, which is a cause of parasitic forces, discomfort, and pain. The present master dissertation proposes the development of an adjustable wearable active ankle-foot orthosis that is able to tackle this misalignment issue concerning commercially available lower limb orthotic devices. This work is integrated on the SmartOs – Smart, Stand-alone Active Orthotic System – project that proposes an innovative robotic technology (a wearable mobile lab) oriented to gait rehabilitation. The conceptual design of a standard version of the SmartOs wearable active orthosis was initiated with the analysis of another ankle-foot orthosis – Exo-H2 (Technaid) – from which the necessary design changes were implemented, aiming at the improvement of the established device. In order to achieve a conceptual solution, both the practical knowledge of the Orthos XXI design team and several design methods were used to ensure the accomplishment of the defined requirements. The detailed design process of the standard SmartOs wearable active orthosis prototype is disclosed. With the purpose of validating the design, the critical components were simulated with the resources available in SolidWorks®, and the necessary CAD model’s adaptations were implemented to guarantee a reliable and safe design. The presented design is currently set for further production in Orthos XXI, followed by the mandatory mechanical tests.Portugal é o país da Europa ocidental com maior taxa de mortalidade por acidente vascular cerebral (AVC), sendo que, dos que sofrem acidentes vasculares cerebrais, 40% apresentam uma deficiência que pode manifestar-se por sequelas motoras, nomeadamente o pé pendente. Uma ortótese do tornozelo é recomendada frequentemente para acomodar passivamente esses problemas motores; no entanto, exoesqueletos ativos são também uma solução adequada para pacientes pós-AVC. Devido à alta complexidade da articulação do tornozelo humano, um dos problemas associados a esses dispositivos ativos é o desalinhamento que ocorre entre o dispositivo de reabilitação e a articulação humana, que é uma causa de forças parasitas, desconforto e dor. A presente dissertação de mestrado propõe o desenvolvimento de uma ortótese ativa do tornozelo ajustável e vestível, que seja capaz de resolver esse problema de desalinhamento relativo aos dispositivos ortóticos de membros inferiores disponíveis comercialmente. Este trabalho está integrado no projeto SmartOs - Smart, Stand-alone Active Orthotic System - projeto que propõe uma tecnologia robótica inovadora (wearable mobile lab) direcionada para a reabilitação da marcha. O projeto conceptual de uma versão padrão da ortótese ativa vestível do projeto SmartOs foi iniciado com a análise de outra ortótese do tornozelo – Exo-H2 (Technaid) - a partir da qual foram implementadas as alterações de projeto necessárias, visando o aprimoramento do dispositivo estabelecido. Para se chegar a uma solução conceptual, tanto o conhecimento prático da equipa de projeto da Orthos XXI como os diversos métodos de projeto foram utilizados para garantir o cumprimento dos requisitos definidos. O processo do desenho detalhado da versão padrão da ortótese ativa SmartOs será também divulgado. Com o objetivo de validar o projeto, os componentes críticos foram simulados com os recursos disponíveis no SolidWorks® e as adaptações necessárias do modelo CAD foram implementadas para garantir um projeto fidedigno e seguro. O projeto apresentado está atualmente em preparação para produção na empresa Orthos XXI, depois do qual se seguem os ensaios mecânicos obrigatórios

Mechatronic Systems

Mechatronics, the synergistic blend of mechanics, electronics, and computer science, has evolved over the past twenty five years, leading to a novel stage of engineering design. By integrating the best design practices with the most advanced technologies, mechatronics aims at realizing high-quality products, guaranteeing at the same time a substantial reduction of time and costs of manufacturing. Mechatronic systems are manifold and range from machine components, motion generators, and power producing machines to more complex devices, such as robotic systems and transportation vehicles. With its twenty chapters, which collect contributions from many researchers worldwide, this book provides an excellent survey of recent work in the field of mechatronics with applications in various fields, like robotics, medical and assistive technology, human-machine interaction, unmanned vehicles, manufacturing, and education. We would like to thank all the authors who have invested a great deal of time to write such interesting chapters, which we are sure will be valuable to the readers. Chapters 1 to 6 deal with applications of mechatronics for the development of robotic systems. Medical and assistive technologies and human-machine interaction systems are the topic of chapters 7 to 13.Chapters 14 and 15 concern mechatronic systems for autonomous vehicles. Chapters 16-19 deal with mechatronics in manufacturing contexts. Chapter 20 concludes the book, describing a method for the installation of mechatronics education in schools

A Haptic Feedback System for Lower Limb Amputees Based on Gait Event Detection

Lower limb amputation has significant effects on a person’s quality of life and ability to perform activities of daily living. Prescription of prosthetic device post amputation aims to help restore some degrees of mobility function, however studies have shown evidence of low balance confidence and higher risk of falling among amputee community, especially those suffering from above knee amputation. While advanced prostheses offer better control, they often lack a form of feedback that delivers the awareness of the limb position to the prosthetic user while walking. This research presents the development and evaluation of a wearable skinstretch haptic feedback system intended to deliver cues of two crucial gait events, namely the Initial Contact (IC) and Toe-off (TO) to its wearer. The system comprises a haptic module that applies lateral skin-stretch on the upper leg or the trunk, corresponding to the gait event detection module based on Inertial Measurement Unit (IMU) attached at the shank. The design and development iterations of the haptic module is presented, and characterization of the feedback parameters is discussed. The validation of the gait event detection module is carried out and finally the integration of the haptic feedback system is described. Experimental work with healthy subjects and an amputee indicated good perceptibility of the feedback during static and dynamic (walking) condition, although higher magnitude of stretch was required to perceive the feedback during dynamic condition. User response time during dynamic activity showed that the haptic feedback system is suitable for delivering cues of IC and TO within the duration of the stance phase. In addition, feedback delivered in discernible patterns can be learned and adapted by the subjects. Finally, a case study was carried out with an above-knee amputee to assess the effects of the haptic feedback on spatio-temporal gait parameters and on the vertical ground reaction force during treadmill and overground walking. The research presented in this report introduces a novel design of a haptic feedback device. As such, the outcome includes a well-controlled skin-stretch effect which contributes to the research by investigating skin-stretch feedback for conveying discrete event information rather than conveying direction information as presented in other studies. In addition, it is found that stretch magnitude as small as 3 mm could be perceived in short duration of 150 ms during dynamic condition, making it a suitable alternative to other widely investigated haptic modality such as vibration for ambulatory feedback application. With continuous training, the haptic feedback system could possibly benefit lower limb amputees by creating awareness of the limb placement during ambulation, potentially reducing visual dependency and increasing walking confidence

Design and Assessment of Vibrotactile Biofeedback and Instructional Systems for Balance Rehabilitation Applications.

Sensory augmentation, a type of biofeedback, is a technique for supplementing or reinforcing native sensory inputs. In the context of balance-related applications, it provides users with additional information about body motion, usually with respect to the gravito-inertial environment. Multiple studies have demonstrated that biofeedback, regardless of the feedback modality (i.e., vibrotactile, electrotactile, auditory), decreases body sway during real-time use within a laboratory setting. However, in their current laboratory-based form, existing vibrotactile biofeedback devices are not appropriate for use in clinical and/or home-based rehabilitation settings due to the expense, size, and operating complexity of the instrumentation required. This dissertation describes the design, development, and preliminary assessment of two technologies that support clinical and home-based balance rehabilitation training. The first system provides vibrotactile-based instructional motion cues to a trainee based on the measured difference between the expert’s and trainee’s motions. The design of the vibrotactile display is supported by a study that characterizes the non-volitional postural responses to vibrotactile stimulation applied to the torso. This study shows that vibration applied individually by tactors over the internal oblique and erector spinae muscles induces a postural shift of the order of one degree oriented in the direction of the stimulation. Furthermore, human performance is characterized both experimentally and theoretically when the expert–trainee error thresholds and nature of the control signal are varied. The results suggest that expert–subject cross-correlation values were maximized and position errors and time delays were minimized when the controller uses a 0.5 error threshold and proportional plus derivative feedback control signal, and that subject performance decreases as motion speed and complexity increase. The second system provides vibrotactile biofeedback about body motion using a cell phone. The system is capable of providing real-time vibrotactile cues that inform corrective trunk tilt responses. When feedback is available, both healthy subjects and those with vestibular involvement significantly reduce their anterior-posterior or medial-lateral root-mean-square body sway, have significantly smaller elliptical area fits to their sway trajectory, spend a significantly greater mean percentage time within the no feedback zone, and show a significantly greater A/P or M/L mean power frequency.Ph.D.Mechanical EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/91546/1/channy_1.pd

Design of a vibrotactile stimulus paradigm for a biofeedback device to improve gait rehabilitation of lower limb amputees

Dissertação de mestrado integrado em Biomedical Engineering (specialization in Biomaterials Rehabilitation and Biomechanics)A lower limb amputation not only affects locomotion, but also the amputee's somatosensory system, body perception, and mental health and, naturally, the fear of falling is more pronounced. Consequently, the patient is faced with the challenge of developing motor strategies that allow him to carry out daily activities since the use of the prosthesis does not fully compensate for the deficiencies acquired by a prosthetic gait, such as, for instance, asymmetry and variation in the duration of the gait events. Faced with the absence of effective treatments that restore locomotor functionality, the BioWalk project presents a rehabilitation solution: a biofeedback system that assists amputees during gait training sessions. This system consists in applying a vibrotactile stimulus on the skin of the affected leg. This stimulus can be activated at different moments of the prosthetic gait, allowing the patient to have a better perception and awareness of his body and locomotion to be able to detect any abnormal motor behaviours during the rehabilitation sessions and, in the future, to establish an adequate and healthy gait pattern. Consequently, there is a need to analyse muscular and kinematic data of the gait of amputees to detect which events are critical in prosthetic gait, which muscles are activated or most required in gait, how the centre of mass behaves in the gait of an amputee, among other parameters. Thus, in this dissertation, the main goal is to investigate and propose the best way (i.e., paradigm) to apply a vibrotactile stimulus to be used in a biofeedback device during rehabilitation sessions.Uma amputação do membro inferior não afeta apenas a locomoção, mas também o sistema somatosensorial do amputado, a sua perceção corporal, a sua saúde mental e, naturalmente, o medo de cair encontra-se mais acentuado. Consequentemente, o paciente é confrontado com o desafio de desenvolver estratégias motoras que lhe permitam a realização de atividades diárias dado que o uso da prótese não compensa totalmente as deficiências adquiridas por uma marcha protética, como por exemplo, a assimetria e a variação na duração dos eventos de marcha. Perante a ausência de tratamentos eficazes que restaurem a funcionalidade locomotora, o projeto BioWalk apresenta uma solução de reabilitação: um sistema de biofeedback que auxilie a pessoa amputada durante sessões de treino de marcha. Este sistema consiste na aplicação de um estímulo vibrotátil sobre a pele da perna afetada. Este estímulo pode ser ativado em diversos momentos da marcha protética permitindo ao paciente uma melhor percetibilidade e consciência sobre o seu corpo e locomoção para que seja capaz de detetar algum comportamento motor anormal durante as sessões de reabilitação e para, futuramente, estabelecer um padrão de marcha adequado e saudável. Consequentemente, surge a necessidade de analisar dados musculares e cinemáticos da marcha de amputados de forma a detetar quais os eventos críticos na marcha protética, quais são os músculos ativados ou os que são mais requeridos na marcha, como se comporta o centro de massa na marcha de um amputado, entre outros parâmetros. Assim, nesta dissertação, o objetivo é propor um paradigma de estímulos vibrotáteis para serem usados num dispositivo de biofeedback durante sessões de reabilitação

SWORD: um dispositivo vibratório vestível para uma rabilitação mais eficiente em doentes com AVC

Doutoramento em Engenharia ElectrotécnicaAnualmente ocorrem cerca de 16 milhões AVCs em todo o mundo. Cerca de metade dos sobreviventes irá apresentar défice motor que necessitará de reabilitação na janela dos 3 aos 6 meses depois do AVC. Nos países desenvolvidos, é estimado que os custos com AVCs representem cerca de 0.27% do Produto Interno Bruto de cada País. Esta situação implica um enorme peso social e financeiro. Paradoxalmente a esta situação, é aceite na comunidade médica a necessidade de serviços de reabilitação motora mais intensivos e centrados no doente. Na revisão do estado da arte, demonstra-se o arquétipo que relaciona metodologias terapêuticas mais intensivas com uma mais proficiente reabilitação motora do doente. Revelam-se também as falhas nas soluções tecnológicas existentes que apresentam uma elevada complexidade e custo associado de aquisição e manutenção. Desta forma, a pergunta que suporta o trabalho de doutoramento seguido inquire a possibilidade de criar um novo dispositivo de simples utilização e de baixo custo, capaz de apoiar uma recuperação motora mais eficiente de um doente após AVC, aliando intensidade com determinação da correcção dos movimentos realizados relativamente aos prescritos. Propondo o uso do estímulo vibratório como uma ferramenta proprioceptiva de intervenção terapêutica a usar no novo dispositivo, demonstra-se a tolerabilidade a este tipo de estímulos através do teste duma primeira versão do sistema apenas com a componente de estimulação num primeiro grupo de 5 doentes. Esta fase validará o subsequente desenvolvimento do sistema SWORD. Projectando o sistema SWORD como uma ferramenta complementar que integra as componentes de avaliação motora e intervenção proprioceptiva por estimulação, é descrito o desenvolvimento da componente de quantificação de movimento que o integra. São apresentadas as diversas soluções estudadas e o algoritmo que representa a implementação final baseada na fusão sensorial das medidas provenientes de três sensores: acelerómetro, giroscópio e magnetómetro. O teste ao sistema SWORD, quando comparado com o método de reabilitação tradicional, mostrou um ganho considerável de intensidade e qualidade na execução motora para 4 dos 5 doentes testados num segundo grupo experimental. É mostrada a versatilidade do sistema SWORD através do desenvolvimento do módulo de Tele-Reabilitação que complementa a componente de quantificação de movimento com uma interface gráfica de feedback e uma ferramenta de análise remota da evolução motora do doente. Finalmente, a partir da componente de quantificação de movimento, foi ainda desenvolvida uma versão para avaliação motora automatizada, implementada a partir da escala WMFT, que visa retirar o factor subjectivo da avaliação humana presente nas escalas de avaliação motora usadas em Neurologia. Esta versão do sistema foi testada num terceiro grupo experimental de cinco doentes.About 16 million first ever-strokes occur worldwide every year. Half of stroke survivors are left with some degree of physical impairment that needs rehabilitation in the 3 to 6 month after-stroke time window. This situation implies a high economic and social burden. In developed countries, stroke cost is estimated to represent an average of 0.27% of each country’s gross domestic product. Paradoxically, it is accepted in the medical community the need for more intensive and patient-centered rehabilitation services. In the state of art review, it is demonstrated the archetype that relates the intensity on rehabilitation with a proficient motor recovery of the patient. Additionally, it is shown that the major pitfalls in current technological solutions in the field of motor rehabilitation are due to their intrinsic complexity and associated cost. Given this state of the art, the research question that supports this thesis, inquiries the possibility of creating a novel low-cost device targeted at the motor rehabilitation of stroke patients, capable of providing a more efficient treatment through enabling higher intensity and automated determination of the correctness of the movements performed by the recovering patient. The validity of the vibratory stimulus is presented from an historic and neurophysiologic point of view. Furthermore, a state of art review of motion capture systems is presented. Intending the use of the vibratory stimulus as a proprioceptive therapeutic tool to be integrated in the new device, it is demonstrated the tolerability of the stimulus from the experimental test of a first version of the device, incorporating the stimulation component, in a first group of five patients. Projecting the SWORD device as a tool that combines both features of motor function evaluation with proprioceptive intervention through vibratory stimulation, it is described the development of the motion capture component. Several solutions were studied and the final algorithm, based on the sensory fusion of the measures from three sensors (accelerometer, gyroscope and magnetometer), is described in detail. The experimental test of the SWORD system on a second group of patients showed that, when compared with a typical treatment, it is capable of providing a more intensive intervention and with a higher quality in 4 out of 5 patients. To demonstrate the versatility of the SWORD system, it was developed the tele-rehabilitation module that complements the motion capture component with a graphical feedback interface and a remote tool for the clinician to evaluate the performance of the patient through out the time he uses the system in his home or any other remote environment. Finally, from the motion capture component, a motor function evaluation version of the system was deployed. Implemented from the WMFT scale, it aims to eliminate the human subjectivity present in the traditional evaluation scales used in the neurology medical area. This system was evaluated on a third group of five patients