Interactive visuo-motor therapy system for stroke rehabilitation

We present a virtual reality (VR)-based motor neurorehabilitation system for stroke patients with upper limb paresis. It is based on two hypotheses: (1) observed actions correlated with self-generated or intended actions engage cortical motor observation, planning and execution areas ("mirror neurons”); (2) activation in damaged parts of motor cortex can be enhanced by viewing mirrored movements of non-paretic limbs. We postulate that our approach, applied during the acute post-stroke phase, facilitates motor re-learning and improves functional recovery. The patient controls a first-person view of virtual arms in tasks varying from simple (hitting objects) to complex (grasping and moving objects). The therapist adjusts weighting factors in the non-paretic limb to move the paretic virtual limb, thereby stimulating the mirror neuron system and optimizing patient motivation through graded task success. We present the system's neuroscientific background, technical details and preliminary result

Interactive visuo-motor therapy system for stroke rehabilitation

We present a virtual reality (VR)-based motor neurorehabilitation system for stroke patients with upper limb paresis. It is based on two hypotheses: (1) observed actions correlated with self-generated or intended actions engage cortical motor observation, planning and execution areas ("mirror neurons"); (2) activation in damaged parts of motor cortex can be enhanced by viewing mirrored movements of non-paretic limbs. We postulate that our approach, applied during the acute post-stroke phase, facilitates motor re-learning and improves functional recovery. The patient controls a first-person view of virtual arms in tasks varying from simple (hitting objects) to complex (grasping and moving objects). The therapist adjusts weighting factors in the non-paretic limb to move the paretic virtual limb, thereby stimulating the mirror neuron system and optimizing patient motivation through graded task success. We present the system's neuroscientific background, technical details and preliminary results.info:eu-repo/semantics/publishedVersio

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

An integrative virtual reality cognitive-motor intervention approach in stroke rehabilitation: a pilot study

Stroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patient’s capability to live independently. In post-stroke it is imperative to initiate a process of intensive rehabilitation and personalized objectives to maximize functional cognitive and motor recovery. Virtual Reality (VR) technology is being widely applied to rehabilitation of stroke, however, not in an integrative manner. Like traditional rehabilitation, these new tools mostly focus either in the cognitive or in the motor domain, which can take to a reduced impact in the performance of activities of daily living, most of them dual-task. Assuming the existence of cognitive and motor recovery interdependence, RehabNet proposes a holistic approach. Here we present a one-month long pilot study with three stroke patients whose training was a game-like VR version of the Toulouse-Piéron cancellation test, adapted to be performed by repetitive arm reaching movements. A standardized motor and cognitive assessment was performed pre and post intervention. The first results on this intervention support a holistic model for rehabilitation of stroke patients, sustaining interdependence on cognitive and motor recovery. Furthermore, we observed that the impact of the integrative VR approach generalizes to the performance of the activities of daily living.info:eu-repo/semantics/publishedVersio

Inducing Visuomotor Adaptation Using Virtual Reality Gaming with a Virtual Shift as a Treatment for Unilateral Spatial Neglect

Unilateral spatial neglect after stroke is characterized by reduced responses to stimuli on the contralesional side, causing significant impairments in self-care and safety. Conventional visuomotor adaptation (VMA) with prisms that cause a lateral shift of the visual scene can decrease neglect symptoms but is not engaging according to patients. Performing VMA within a virtual reality (VR) environment may be more engaging but has never been tested. To determine if VMA can be elicited in a VR environment, healthy subjects (n=7) underwent VMA that was elicited by either wearing prisms that caused an optical shift, or by application of a virtual shift of the hand cursor within the VR environment. A low cost VR system was developed by coupling the Kinect v2 gaming sensor to online games via the Flexible Action and Articulated Skeleton Toolkit (FAAST) software. The adaptation phase of training consisted of a reaching task in online games or in a custom target pointing program. Following the adaptation phase the optical or virtual shift was removed and participants were assessed during the initial portion of the de-adaptation phase for the presence of an after-effect on their reaching movements, with lateral reaching errors indicating the successful induction of VMA. Results show that practicing reaching in a VR environment with a virtual shift lead to a horizontal after-effect similar to conventional prism adaptation. The results demonstrate that VMA can be elicited in a VR environment and suggest that VR gaming therapy could be used to improve recovery from unilateral spatial neglect

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

Augmented visual, auditory, haptic, and multimodal feedback in motor learning: A review

It is generally accepted that augmented feedback, provided by a human expert or a technical display, effectively enhances motor learning. However, discussion of the way to most effectively provide augmented feedback has been controversial. Related studies have focused primarily on simple or artificial tasks enhanced by visual feedback. Recently, technical advances have made it possible also to investigate more complex, realistic motor tasks and to implement not only visual, but also auditory, haptic, or multimodal augmented feedback. The aim of this review is to address the potential of augmented unimodal and multimodal feedback in the framework of motor learning theories. The review addresses the reasons for the different impacts of feedback strategies within or between the visual, auditory, and haptic modalities and the challenges that need to be overcome to provide appropriate feedback in these modalities, either in isolation or in combination. Accordingly, the design criteria for successful visual, auditory, haptic, and multimodal feedback are elaborate

“I started to feel again.” : an individually guided dance rehabilitation intervention may enhance mood, abstract reasoning, and quality of life in traumatic brain injury : a pilot study

Tutkimuksen tarkoitus: Traumaattinen aivovamma on merkittävä kansanterveysongelma, jolla on pitkäaikaisia kognitiivisia, emotionaalisia ja fyysisiä seurauksia. Aivovammakuntoutukseen tarvitaan uusia, vaikuttavia, multimodaalisia ja monialaisia kuntoutuskäytäntöjä. Tanssi on multimodaalista ja aktivoi useita aivoalueita yhtä aikaa ja saattaa siten myös kuntouttaa monimutkaisia toimintoja. Tanssi myös yhdistää liikunnan ja musiikin, joilla kummallakin on positiivisia vaikutuksia sekä terveisiin että neuropatologisiin kohderyhmiin. Tutkimushankkeen tavoite oli kehittää monialainen tanssikuntoutusmenetelmä ja arvioida sen käytettävyyttä ja vaikuttavuutta vakavan aivovamman kroonisessa vaiheessa. Tässä tutkimuksessa tarkastellaan intervention vaikutuksia kognitioon, masentuneeseen mielialaan ja terveyteen liittyvään elämänlaatuun sekä arvioidaan menetelmän käytettävyyttä. Menetelmät: Tutkimukseen osallistui 11 vakavan traumaattisen aivovamman saanutta 19 – 45 -vuotiasta henkilöä, joista neljä oli naisia ja seitsemän miehiä. Tutkimuksen alkaessa vammautumisesta oli kulunut keskimäärin 7,6 vuotta. Tutkimuksessa käytettiin crossover-asetelmaa, jossa osallistujat satunnaistettiin kahteen ryhmään. Interventio kesti kolme kuukautta, sisälsi kaksi viikottaista tanssituntia ja sen toteuttivat yhdessä tanssinopettaja ja fysioterapeutti. Neuropsykologiset tutkimukset tehtiin tutkimuksen alussa (t0) ja kahdesti sen jälkeen kolmen kuukauden välein (t3 ja t6). Suoriutumista yleisen kognition, otsalohkotoimintojen, abstraktin päättelyn, visuospatiaalisen päättelyn ja työmuistin tehtävissä sekä itsearvioitua mielialaa, terveyteen liittyvää elämänlaatua ja toiminnanohjausta ennen interventiota ja sen jälkeen tutkittiin parittaisilla t-testeillä. Ryhmien eroavaisuuksia tutkittiin toistettujen mittausten varianssianalyyseillä. Tulokset: Abstrakti päättelykyky, terveyteen liittyvä elämänlaatu sekä merkittävimmin mieliala paranivat intervention aikana. Laadulliset löydökset kertoivat myös mielialan kohentumisesta. Eräs osallistujista kertoi saaneensa yhteyden tunteisiinsa ensimmäistä kertaa vammautumisen jälkeen ja useat muut osallistujat kuvasivat positiivisia tuntemuksia ja kokemuksia intervention aikana. Johtopäätökset: Tanssikuntoutus näyttää vaikuttavan positiivisesti mielialaan, abstraktiin päättelykykyyn sekä elämänlaatuun vakavan aivovamman kroonisessa vaiheessa. Tulokset ovat alustavia ja tarvitaan lisää tutkimuksia suuremmilla otoksilla vahvistamaan löydökset.Objective: Traumatic brain injury (TBI) is a major public health issue leading to long-term cognitive, emotional, and physical impairments. New, effective, multimodal and multidisciplinary rehabilitation practices are needed. Dance is a multimodal activity that engages several brain regions simultaneously and, therefore, might be ideal for enhancing complex functions. Dance also combines physical exercise and the use of music, both of which positively affect healthy and neuropathological populations. The aim of the research project was to develop a multidisciplinary dance rehabilitation method and to evaluate its feasibility and effectiveness in chronic severe TBI. The current study investigates the intervention’s effects on cognition, depressive mood, and health-related quality of life. The feasibility of the intervention is also discussed. Methods: The current study had 11 participants with severe TBI; four women and seven men, 19 – 45 years old, with an average time of 7.6 years from the acquisition of the injury. A two-group crossover design with random allocation was used. The intervention (three months, two weekly sessions) was carried out together by a dance instructor and a physiotherapist. Neuropsychological assessments were conducted at the beginning of the study (t0), and twice after that every three months (t3 and t6). Performance before and after the intervention in general cognition, frontal lobe functions, abstract reasoning, visuo-spatial reasoning, working memory, mood, health-related quality of life, and executive functions were compared with paired sample t-tests. Time and group interactions were studied by repeated measures analyses of variance. Results: Abstract reasoning, health-related quality of life, and most saliently, mood improved significantly during the intervention. Qualitative findings also indicated enhanced mood. One of the participants described being reconnected to emotions for the first time a after the acquisition of the TBI and several other participants expressed positive feelings and experiences during the intervention. Conclusions: The current study suggests that dance rehabilitation may improve mood, abstract reasoning, and quality of life in the chronic state of severe TBI. These results are tentative and more research with larger samples is needed to verify the findings

Quantifying cognitive-motor interference in virtual reality training after stroke: the role of interfaces

Globally, stroke is the second leading cause of death above the age of 60 years, with the actual number of strokes to increase because of the ageing population. Stroke results into chronic conditions, loss of independence, affecting both the families of stroke survivors but also public health systems. Virtual Reality (VR) for rehabilitation is considered a novel and effective low-cost approach to re-train motor and cognitive function through strictly defined training tasks in a safe simulated environment. However, little is known about how the choice of VR interfacing technology affects motor and cognitive performance, or what the most cost-effective rehabilitation approach for patients with different prognostics is. In this paper we assessed the effect of four different interfaces in the training of the motor and cognitive domains within a VR neurorehabilitation task. In this study we have evaluated the effect of training using 2-dimensional and 3-dimensional as well as traditional and natural user interfaces with both stroke survivors and healthy participants. Results indicate that 3-dimensional interfaces contribute towards better results in the motor domain at the cost of lower performance in the cognitive domain, suggesting the use 2-dimensional natural user interfaces as a trade-off. Our results provide useful pointers for future directions towards a cost-effective and meaningful interaction in virtual rehabilitation tasks in both motor and cognitive domains.info:eu-repo/semantics/publishedVersio

Music meets robotics : a prospective randomized study on motivation during robot aided therapy

Robots have been successfully applied in motor training during neurorehabilitation. As music is known to improve motor function and motivation in neurorehabilitation training, we aimed at integrating music creation into robotic-assisted motor therapy. We developed a virtual game-like environment with music for the arm therapy robot ARMin, containing four different motion training conditions: a condition promoting creativity (C+) and one not promoting creativity (C-), each in a condition with (V+) and without (V-) a visual display (i.e., a monitor). The visual display was presenting the game workspace but not contributing to the creative process itself. In all four conditions the therapy robot haptically displayed the game workspace. Our aim was to asses the effects of creativity and visual display on motivation