Evaluation of cervical posture improvement of children with cerebral palsy after physical therapy based on head movements and serious games

Background: This paper presents the preliminary results of a novel rehabilitation therapy for cervical and trunk control of children with cerebral palsy (CP) based on serious videogames and physical exercise. Materials: The therapy is based on the use of the ENLAZA Interface, a head mouse based on inertial technology that will be used to control a set of serious videogames with movements of the head. Methods: Ten users with CP participated in the study. Whereas the control group (n=5) followed traditional therapies, the experimental group (n=5) complemented these therapies with a series of ten sessions of gaming with ENLAZA to exercise cervical flexion-extensions, rotations and inclinations in a controlled, engaging environment. Results: The ten work sessions yielded improvements in head and trunk control that were higher in the experimental group for Visual Analogue Scale, Goal Attainment Scaling and Trunk Control Measurement Scale (TCMS). Significant differences (27% vs. 2% of percentage improvement) were found between the experimental and control groups for TCMS (p<0.05). The kinematic assessment shows that there were some improvements in the active and the passive range of motion. However, no significant differences were found pre- and post-intervention. Conclusions:Physical therapy that combines serious games with traditional rehabilitation could allow children with CP to achieve larger function improvements in the trunk and cervical regions. However, given the limited scope of this trial (n=10) additional studies are needed to corroborate this hypothesis

Enhancement of Robot-Assisted Rehabilitation Outcomes of Post-Stroke Patients Using Movement-Related Cortical Potential

Post-stroke rehabilitation is essential for stroke survivors to help them regain independence and to improve their quality of life. Among various rehabilitation strategies, robot-assisted rehabilitation is an efficient method that is utilized more and more in clinical practice for motor recovery of post-stroke patients. However, excessive assistance from robotic devices during rehabilitation sessions can make patients perform motor training passively with minimal outcome. Towards the development of an efficient rehabilitation strategy, it is necessary to ensure the active participation of subjects during training sessions. This thesis uses the Electroencephalography (EEG) signal to extract the Movement-Related Cortical Potential (MRCP) pattern to be used as an indicator of the active engagement of stroke patients during rehabilitation training sessions. The MRCP pattern is also utilized in designing an adaptive rehabilitation training strategy that maximizes patients’ engagement. This project focuses on the hand motor recovery of post-stroke patients using the AMADEO rehabilitation device (Tyromotion GmbH, Austria). AMADEO is specifically developed for patients with fingers and hand motor deficits. The variations in brain activity are analyzed by extracting the MRCP pattern from the acquired EEG data during training sessions. Whereas, physical improvement in hand motor abilities is determined by two methods. One is clinical tests namely Fugl-Meyer Assessment (FMA) and Motor Assessment Scale (MAS) which include FMA-wrist, FMA-hand, MAS-hand movements, and MAS-advanced hand movements’ tests. The other method is the measurement of hand-kinematic parameters using the AMADEO assessment tool which contains hand strength measurements during flexion (force-flexion), and extension (force-extension), and Hand Range of Movement (HROM)

Visual feedback alters force control and functional activity in the visuomotor network after stroke.

Modulating visual feedback may be a viable option to improve motor function after stroke, but the neurophysiological basis for this improvement is not clear. Visual gain can be manipulated by increasing or decreasing the spatial amplitude of an error signal. Here, we combined a unilateral visually guided grip force task with functional MRI to understand how changes in the gain of visual feedback alter brain activity in the chronic phase after stroke. Analyses focused on brain activation when force was produced by the most impaired hand of the stroke group as compared to the non-dominant hand of the control group. Our experiment produced three novel results. First, gain-related improvements in force control were associated with an increase in activity in many regions within the visuomotor network in both the stroke and control groups. These regions include the extrastriate visual cortex, inferior parietal lobule, ventral premotor cortex, cerebellum, and supplementary motor area. Second, the stroke group showed gain-related increases in activity in additional regions of lobules VI and VIIb of the ipsilateral cerebellum. Third, relative to the control group, the stroke group showed increased activity in the ipsilateral primary motor cortex, and activity in this region did not vary as a function of visual feedback gain. The visuomotor network, cerebellum, and ipsilateral primary motor cortex have each been targeted in rehabilitation interventions after stroke. Our observations provide new insight into the role these regions play in processing visual gain during a precisely controlled visuomotor task in the chronic phase after stroke

Materiality and human cognition

In this paper, we examine the role of materiality in human cognition. We address issues such as the ways in which brain functions may change in response to interactions with material forms, the attributes of material forms that may cause change in brain functions, and the spans of time required for brain functions to reorganize when interacting with material forms. We then contrast thinking through materiality with thinking about it. We discuss these in terms of their evolutionary significance and history as attested by stone tools and writing, material forms whose interaction endowed our lineage with conceptual thought and meta-awareness of conceptual domains

The General Motor Ability Hypothesis: An old idea revisited

While specific motor abilities have become a popular explanation for motor performance, the older, alternate notion of a general motor ability should be revisited. Current theories lack consensus, and most motor assessment tools continue to derive a single composite score to represent motor capacity. In addition, results from elegant statistical procedures such as higher order factor analyses, cluster analyses, and Item Response Theory support a more global motor ability. We propose a contemporary model of general motor ability as a unidimensional construct that is emergent and fluid over an individual’s lifespan, influenced by both biological and environmental factors. In this article, we address the implications of this model for theory, practice, assessment, and research. Based on our hypothesis and Item Response Theory, our Lifespan Motor Ability Scale can identify motor assessment tasks that are relevant and important across varied phases of lifespan development

Robot-assisted therapy for upper limb impairments in cerebral palsy:A scoping review and suggestions for future research

A growing number of studies investigate the use of robotics therapy for motor (re)habilitation with children with cerebral palsy (CP). Most of these studies use functional robots in very repetitive sessions. While the therapy is effective, very few studies employ social robots, which appears to be a missed opportunity to design more compelling and enjoyable sessions for the children. In this article, we will review robot-assisted upper limb motor (re)habilitation for children with CP. Previous reviews of robot-assisted therapy for CP had mostly focused on lower limbs, or the review was made from a medical point of view, with the sole concern being the therapy's effectiveness. Here, we focus our review on robot-assisted upper limb (re)habilitation and address human-robot interaction considerations. We searched PubMed, Scopus, and IEEE databases and argue that although this area of research is promising and already effective, it would benefit from the inclusion of social robots for a more engaging and enjoyable experience. We suggest four scenarios that could be developed in this direction. The goal of this article is to highlight the relevance of the past work and encourage the development of new ideas where therapy will socially engage and motivate children.</p

Brain-machine interfaces for rehabilitation in stroke: A review

BACKGROUND: Motor paralysis after stroke has devastating consequences for the patients, families and caregivers. Although therapies have improved in the recent years, traditional rehabilitation still fails in patients with severe paralysis. Brain-machine interfaces (BMI) have emerged as a promising tool to guide motor rehabilitation interventions as they can be applied to patients with no residual movement. OBJECTIVE: This paper reviews the efficiency of BMI technologies to facilitate neuroplasticity and motor recovery after stroke. METHODS: We provide an overview of the existing rehabilitation therapies for stroke, the rationale behind the use of BMIs for motor rehabilitation, the current state of the art and the results achieved so far with BMI-based interventions, as well as the future perspectives of neural-machine interfaces. RESULTS: Since the first pilot study by Buch and colleagues in 2008, several controlled clinical studies have been conducted, demonstrating the efficacy of BMIs to facilitate functional recovery in completely paralyzed stroke patients with noninvasive technologies such as the electroencephalogram (EEG). CONCLUSIONS: Despite encouraging results, motor rehabilitation based on BMIs is still in a preliminary stage, and further improvements are required to boost its efficacy. Invasive and hybrid approaches are promising and might set the stage for the next generation of stroke rehabilitation therapies.This study was funded by the Bundesministerium für Bildung und Forschung BMBF MOTORBIC (FKZ13GW0053)andAMORSA(FKZ16SV7754), the Deutsche Forschungsgemeinschaft (DFG), the fortüne-Program of the University of Tübingen (2422-0-0 and 2452-0-0), and the Basque GovernmentScienceProgram(EXOTEK:KK2016/00083). NIL was supported by the Basque Government’s scholarship for predoctoral students

Using brain-computer interaction and multimodal virtual-reality for augmenting stroke neurorehabilitation

Every year millions of people suffer from stroke resulting to initial paralysis, slow motor recovery and chronic conditions that require continuous reha bilitation and therapy. The increasing socio-economical and psychological impact of stroke makes it necessary to find new approaches to minimize its sequels, as well as novel tools for effective, low cost and personalized reha bilitation. The integration of current ICT approaches and Virtual Reality (VR) training (based on exercise therapies) has shown significant improve ments. Moreover, recent studies have shown that through mental practice and neurofeedback the task performance is improved. To date, detailed in formation on which neurofeedback strategies lead to successful functional recovery is not available while very little is known about how to optimally utilize neurofeedback paradigms in stroke rehabilitation. Based on the cur rent limitations, the target of this project is to investigate and develop a novel upper-limb rehabilitation system with the use of novel ICT technolo gies including Brain-Computer Interfaces (BCI’s), and VR systems. Here, through a set of studies, we illustrate the design of the RehabNet frame work and its focus on integrative motor and cognitive therapy based on VR scenarios. Moreover, we broadened the inclusion criteria for low mobility pa tients, through the development of neurofeedback tools with the utilization of Brain-Computer Interfaces while investigating the effects of a brain-to-VR interaction.Todos os anos, milho˜es de pessoas sofrem de AVC, resultando em paral isia inicial, recupera¸ca˜o motora lenta e condic¸˜oes cr´onicas que requerem re abilita¸ca˜o e terapia cont´ınuas. O impacto socioecon´omico e psicol´ogico do AVC torna premente encontrar novas abordagens para minimizar as seque las decorrentes, bem como desenvolver ferramentas de reabilita¸ca˜o, efetivas, de baixo custo e personalizadas. A integra¸c˜ao das atuais abordagens das Tecnologias da Informa¸ca˜o e da Comunica¸ca˜o (TIC) e treino com Realidade Virtual (RV), com base em terapias por exerc´ıcios, tem mostrado melhorias significativas. Estudos recentes mostram, ainda, que a performance nas tare fas ´e melhorada atrav´es da pra´tica mental e do neurofeedback. At´e a` data, na˜o existem informac¸˜oes detalhadas sobre quais as estrat´egias de neurofeed back que levam a uma recupera¸ca˜o funcional bem-sucedida. De igual modo, pouco se sabe acerca de como utilizar, de forma otimizada, o paradigma de neurofeedback na recupera¸c˜ao de AVC. Face a tal, o objetivo deste projeto ´e investigar e desenvolver um novo sistema de reabilita¸ca˜o de membros supe riores, recorrendo ao uso de novas TIC, incluindo sistemas como a Interface C´erebro-Computador (ICC) e RV. Atrav´es de um conjunto de estudos, ilus tramos o design do framework RehabNet e o seu foco numa terapia motora e cognitiva, integrativa, baseada em cen´arios de RV. Adicionalmente, ampli amos os crit´erios de inclus˜ao para pacientes com baixa mobilidade, atrav´es do desenvolvimento de ferramentas de neurofeedback com a utilizac¸˜ao de ICC, ao mesmo que investigando os efeitos de uma interac¸˜ao c´erebro-para-RV