Development Of Robot-Based Cognitive And Motor Assessment Tools For Stroke And Hiv Neurorehabilitation

Stroke and HIV are leading causes of disability worldwide. HIV is an independent risk factor for stroke, resulting in an emerging population dealing with both but without guidelines on how to manage the co-presentation of these conditions. There is a need for solutions to combat functional decline that results from the cognitive and motor dysfunction associated with these conditions. Rehabilitation robotics has been explored as a solution to provide therapy in the stroke population, but its application to people living with HIV has not yet been examined. Additionally, current technology-based approaches generally tend to treat cognitive and motor impairments in isolation. As such, a major barrier to the clinical utility of these approaches is that improvements on robotic rehabilitation tasks do not transfer to activities of daily living. In this thesis, I combine rehabilitation robotics, cognitive neuroscience, and bioengineering principles to design robot-based assessment tasks capable of measuring both cognitive and motor impairment. I use clinical assessment and robotic tools to first explore the impact of cognitive impairment on motor performance in the chronic stroke population. The results from this investigation demonstrate that motor performance on a robotic task is sensitive to cognitive impairment due to stroke. I then tested additional assessment tasks against standard clinical assessments of cognitive and motor function relevant in both HIV and stroke. These results showed the ability of robot-based metrics to capture differences in performance between varying levels of impairment among people living with HIV. After demonstrating the concurrent validity of this approach in the U.S., I implemented this approach in Botswana. The preliminary results demonstrated that robotic assessment was feasible in this context and that some of our models had good predictive value. This work expands the application of rehabilitation robotics to new populations, including people living with HIV, those with cognitive impairments, and people residing in LMICs. My hope is that the work presented in this thesis will lead to future efforts that can overcome the barriers to better health by enabling the development of more effective and accessible rehabilitation technologies

Neuromechanical Biomarkers for Robotic Neurorehabilitation

: One of the current challenges for translational rehabilitation research is to develop the strategies to deliver accurate evaluation, prediction, patient selection, and decision-making in the clinical practice. In this regard, the robot-assisted interventions have gained popularity as they can provide the objective and quantifiable assessment of the motor performance by taking the kinematics parameters into the account. Neurophysiological parameters have also been proposed for this purpose due to the novel advances in the non-invasive signal processing techniques. In addition, other parameters linked to the motor learning and brain plasticity occurring during the rehabilitation have been explored, looking for a more holistic rehabilitation approach. However, the majority of the research done in this area is still exploratory. These parameters have shown the capability to become the "biomarkers" that are defined as the quantifiable indicators of the physiological/pathological processes and the responses to the therapeutical interventions. In this view, they could be finally used for enhancing the robot-assisted treatments. While the research on the biomarkers has been growing in the last years, there is a current need for a better comprehension and quantification of the neuromechanical processes involved in the rehabilitation. In particular, there is a lack of operationalization of the potential neuromechanical biomarkers into the clinical algorithms. In this scenario, a new framework called the "Rehabilomics" has been proposed to account for the rehabilitation research that exploits the biomarkers in its design. This study provides an overview of the state-of-the-art of the biomarkers related to the robotic neurorehabilitation, focusing on the translational studies, and underlying the need to create the comprehensive approaches that have the potential to take the research on the biomarkers into the clinical practice. We then summarize some promising biomarkers that are being under investigation in the current literature and provide some examples of their current and/or potential applications in the neurorehabilitation. Finally, we outline the main challenges and future directions in the field, briefly discussing their potential evolution and prospective

Do informal caregivers of people with dementia mirror the cognitive deficits of their demented patients?:A pilot study

Recent research suggests that informal caregivers of people with dementia (ICs) experience more cognitive deficits than noncaregivers. The reason for this is not yet clear. Objective: to test the hypothesis that ICs ‘mirror' the cognitive deficits of the demented people they care for. Participants and methods: 105 adult ICs were asked to complete three neuropsychological tests: letter fluency, category fluency, and the logical memory test from the WMS-III. The ICs were grouped according to the diagnosis of their demented patients. One-sample ttests were conducted to investigate if the standardized mean scores (t-scores) of the ICs were different from normative data. A Bonferroni correction was used to correct for multiple comparisons. Results: 82 ICs cared for people with Alzheimer's dementia and 23 ICs cared for people with vascular dementia. Mean letter fluency score of the ICs of people with Alzheimer's dementia was significantly lower than the normative mean letter fluency score, p = .002. The other tests yielded no significant results. Conclusion: our data shows that ICs of Alzheimer patients have cognitive deficits on the letter fluency test. This test primarily measures executive functioning and it has been found to be sensitive to mild cognitive impairment in recent research. Our data tentatively suggests that ICs who care for Alzheimer patients also show signs of cognitive impairment but that it is too early to tell if this is cause for concern or not

Technologically-assisted interventions in neurological and psychological applied disciplines in South Africa : a scoping review

Mini Dissertation (MA (Clinical Psychology))--University of Pretoria, 2023.Technologically-assisted interventions are evolving modern tools in the field of healthcare that have had international success in the treatment of pervasive psychological disorders. They have also been used successfully as an adjunct to traditional medical procedures and as an aid to facilitating patient rehabilitation. Technologically-assisted interventions provide unique opportunities in the treatment of various conditions associated with numerous psychological and neurological disorders, which have resulted in improved learning experiences and social interactions. The purpose of this distinctive study was to explore the nature of primary research on technologically-assisted interventions in South Africa published between and including the years 1996 and 2021. These interventions were chosen due to their specific applications in neurology and psychology. Applications in neurorehabilitation were also investigated in the study, which are currently clinically under-utilised in South Africa. Using specific exclusion and inclusion criteria, and the PRISMA-ScR search strategy, 14 databases were used for the search. After the appropriate screening, 13 studies were included in the scoping review and five prominent trends were found to exist in the research. First, the geographic locations of the reviewed studies, which indicated that studies appeared to have been largely located in provinces with large populations and/or economic input. Second, the year of publication of the studies, which highlighted their growing accessibility. Third, the sample size and study population of the selected studies, which contextualised the range of participants observed in each study. Fourth, the modality of the technologically-assisted interventions utilised in the scoped studies, which highlighted a gap in South African literature in the neurological and psychological sciences as the bulk of readily accessible literature focused on telemedicine. Finally, the use of telemedicine as a popular modality played a significant role in the types of mHealth intervention and treatment support, where mHealth was defined within the broad terminology used to refer to improving the delivery of healthcare and services to individuals in rural and remote communities. This paper provides a novel overview of the current landscape of technologically-assisted interventions in psychological and neurological therapeutic treatments in South Africa. These findings have also been seen as crucial in understanding the limitations exsisting in the South African healthcare system context as well as avenues for further research into the ubiquitous potential of technologically-assisted interventions in this field.PsychologyMA (Clinical Psychology)RestrictedFaculty of HumanitiesSDG-03: Good health and well-beingSDG-09: Industry, innovation and infrastructureSDG-10: Reduces inequalitiesSDG-11: Sustainable cities and communitiesSDG-16: Peace, justice and strong institutionsSDG-17: Partnerships for the goal

Cerebellar Motor Learning Deficits: Structural mapping, neuromodulation and training-related interventions

Movement allows us to interact with our direct environment, manipulate objects and communicate with each other. Moreover, we can adjust our movements to fit a remarkable range of situations and circumstances. The ability to adjust movements in response to changes in the environment and task demands is referred to as motor learning. The cerebellum is a key neural structure for motor learning. As such, disease of the cerebellum, in addition to the clinical symptom of ataxia, results in various motor learning deficits. There is a consensus that supportive therapy (e.g. physiotherapy, occupational therapy or speech therapy) can reduce ataxia symptoms of cerebellar patients, but little is known about the mechanisms underlying the improvements, and how patients can benefit most. Additionally, motor learning deficits are associated with reduced efficacy of supportive therapy. With the work described in this thesis, we sought to unravel the structural components of cerebellar disease and the relationship between cerebellar integrity and motor learning. Furthermore, we investigated whether motor learning deficits in cerebellar patients could be ameliorated with neuromodulation or training-related interventions, under experimental conditions, hoping to support the development of interventions relevant for application in a clinical setting

2008 IMSAloquium, Student Investigation Showcase

Marking its twentieth year, IMSA’s Student Inquiry and Research Program (SIR) is a powerful expression of the Academy’s mission, “to ignite and nurture creative ethical minds that advance the human condition.”https://digitalcommons.imsa.edu/archives_sir/1000/thumbnail.jp

Effects of dance therapy on balance, gait and neuro-psychological performances in patients with Parkinson's disease and postural instability

Postural Instability (PI) is a core feature of Parkinson’s Disease (PD) and a major cause of falls and disabilities. Impairment of executive functions has been called as an aggravating factor on motor performances. Dance therapy has been shown effective for improving gait and has been suggested as an alternative rehabilitative method. To evaluate gait performance, spatial-temporal (S-T) gait parameters and cognitive performances in a cohort of patients with PD and PI modifications in balance after a cycle of dance therapy

The Effect of Robotic Walking and Activity-based Rehabilitation on Functional Capacity, Secondary Complications & Psychological Well-being in Individuals with Spinal Cord Injury (SCI)

Activity-based training (ABT) represents the current standard of care in neurological rehabilitation centers around the world. However, innovative rehabilitation techniques have been developed including robotic locomotor training (RLT). The conceptual basis for RLT initially appeared promising; a rehabilitation modality that removes the need for intensive assistance from therapists, whilst facilitating safe and effective over-ground ambulation. However, small sample sizes and a lack of homogeneity across studies have resulted in an underpowered evidence base supporting the efficacy of RLT for SCI rehabilitation. Thus, this randomized control pilot study aimed to investigate the effects of RLT compared to ABT on functional capacity, secondary complications, and psychological well-being in people with SCI after 24-weeks of rehabilitation. Participants with chronic, traumatic motor incomplete SCI were randomized into two intervention groups: RLT (n = 8) and ABT (n = 8) groups. RLT involved solely walking in the Ekso bionic suit. ABT involved a variety of resistance, cardiovascular and flexibility training combined with regular weight-bearing in the standing position. Outcome measures, including functional strength, ambulatory function, pain, spasticity, bladder/bowel, bone density, body composition, quality of life (QoL) and depression were tested at baseline, 6, 12 and 24-weeks of the intervention. There were no significant differences between the intervention groups for lower or upper extremity motor scores (UEMS effect size (ES) = 0.30; LEMS ES = 0.07), back strength (ES = 0.14) and abdominal strength (ES = 0.13) after training. However, both groups showed a significant increase of 2.00 points in UEMS and a significant increase in abdominal strength from pre- to post intervention. Only the RLT group showed a significant change in LEMS, with a mean increase of 3.00 [0.00; 16.5] points over time. Distance walked in the Functional Ambulatory Inventory (SCI-FAI) increased significantly (p = 0.02) over time only for the RLT group. Therefore, the RLT showed promising evidence for potentially inducing functional strength changes and improvements in ambulatory function after 24 weeks of training. There was some evidence to support RLT to induce bowel improvements in individuals with SCI and both interventions appeared to reduce urinary incontinence and improve bladder function (p = 0.04). Total spasticity and pain intensity were similar between groups (p = 0.25; p = 0.96). However, pain interference ratings significantly increased from pre-post intervention for both groups (p = 0.05). RLT prevented the progressive decline of bone mineral density usually occurring in the SCI population, as hip BMD was maintained during RLT; however, it was significantly reduced (p = 0.04) during ABT, with a mean reduction of 0.06 [-0.34, 0.22] g/cm2 (5%) from pre to post intervention. No change in leg fat-free soft tissue mass (FFSTM) occurred between groups or over time (p = 0.32), however, there was a significant 7% increase in arm FFSTM over time for both groups (p < 0.01). The ABT group was more effective (ES = 1.02) in reducing central and peripheral adiposity, with a significant decrease in visceral adipose tissue (VAT) (p = 0.04) and gynoid FM (p = 0.01) over time. Both groups reported increased QoL and decreased depression ratings over time, with the RLT group having a significant change in the general life and physical health domains, p = 0.03, respectively. This pilot trial offers promising evidence for the effectiveness of RLT for improving functional and ambulatory capacity, reducing secondary complications, and potentially improving QoL in people with incomplete SCI. Thus, this dissertation adds substantial weight to the lacking evidence base on the effects of RLT, by incorporating a large homogenous sample, comprehensive testing procedures and an extended intervention period within South Africa

Biomechanical Spectrum of Human Sport Performance

Writing or managing a scientific book, as it is known today, depends on a series of major activities, such as regrouping researchers, reviewing chapters, informing and exchanging with contributors, and at the very least, motivating them to achieve the objective of publication. The idea of this book arose from many years of work in biomechanics, health disease, and rehabilitation. Through exchanges with authors from several countries, we learned much from each other, and we decided with the publisher to transfer this knowledge to readers interested in the current understanding of the impact of biomechanics in the analysis of movement and its optimization. The main objective is to provide some interesting articles that show the scope of biomechanical analysis and technologies in human behavior tasks. Engineers, researchers, and students from biomedical engineering and health sciences, as well as industrial professionals, can benefit from this compendium of knowledge about biomechanics applied to the human body

2016 IMSAloquium, Student Investigation Showcase

Welcome to the twenty-eighth year of the Student Inquiry and Research Program (SIR)! This is a program that is as old as IMSA. The SIR program represents our unending dedication to enabling our students to learn what it is to be an innovator and to make contributions to what is known on Earth.https://digitalcommons.imsa.edu/archives_sir/1026/thumbnail.jp