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

A usability study in patients with stroke using MERLIN, a robotic system based on serious games for upper limb rehabilitation in the home setting

Neuroscience and neurotechnology are transforming stroke rehabilitation. Robotic devices, in addition to telerehabilitation, are increasingly being used to train the upper limbs after stroke, and their use at home allows us to extend institutional rehabilitation by increasing and prolonging therapy. The aim of this study is to assess the usability of the MERLIN robotic system based on serious games for upper limb rehabilitation in people with stroke in the home environment.This research is part of a MERLIN project, which has received funding from EIT Health (Grant no. 20649). EIT Health is supported by the European Institute of Innovation and Technology (EIT), a body of the European Union which receives support from the European Union’s Horizon 2020 Research and innovation programme

Diseño de entornos de realidad virtual aplicables a sistemas de robótica asistencial: un análisis literario

Virtual Reality (VR) environments can be applied to assistive robotics to improve the effectiveness and the user experience perception in the rehabilitation process due to its innovative nature, getting to entertain patients while they recover their motor functions. This literature review pretends to analyze some design principles of VR environments developed for upper limb rehabilitation processes. The idea is to identify features related to peripheral and central nervous systems, types of information included as feedback to increase the user's levels of immersion having a positive impact on the user's performance and experience during the treatment. A total of 32 articles published in Scopus, IEEE, PubMed, and Web of Science in the last four years were reviewed. We present the article selection process, the division by concepts presented previously, and the guidelines that can be considered for the design of VR environments applicable to assistive robots for upper limbs rehabilitation processes.Los entornos de Realidad Virtual (RV) aplicables a sistemas de robótica asistencial pueden ser diseñados de manera que mejoren la efectividad y la experiencia de usuario de los procesos de rehabilitación debido a su naturaleza novedosa, logrando entretener a los pacientes mientras recuperan sus funciones motoras. Esta revisión literaria pretende analizar los criterios de diseño de entornos de RV utilizados en procesos de rehabilitación de miembro superior, identificando las características de entornos para rehabilitación de problemas asociados el sistema nervioso central y periféricos, los tipos de información que se realimenta al usuario para beneficiar los niveles de inmersión y su impacto en términos del desempeño y la experiencia del usuario en tratamiento. Un total de 32 artículos publicados en revistas indexadas de Scopus, IEEE, PubMed y Web of Science en los últimos cuatro años fueron revisados. Se presenta el proceso de selección de artículos, la división por las temáticas presentadas anteriormente y los lineamientos generales que pueden ser considerados para el diseño de entornos de RV aplicables a robots asistenciales en procesos de rehabilitación de miembro superior

Multi-user Touch Surfaces to Promote Social Participation and Self-efficacy in Upper-limb Stroke Rehabilitation

This thesis addresses the growing incidence of stroke and its impact on long-term disability, emphasizing the importance of post-stroke rehabilitation. Predicting a 34% increase in stroke cases by 2025, this work focuses on factors affecting post-stroke motor rehabilitation, such as depressive symptoms, while recognizing the role of social participation and self-efficacy in modulating these outcomes. To tackle these challenges, we propose the use of a multi-user interactive table for upper limb rehabilitation. This innovative approach involves detecting objects of various sizes and shapes as interfaces for serious games, fostering collective therapeutic activities targeting motor rehabilitation, depressive symptoms, social participation, and self-efficacy. Four exploratory studies informed the development of the interactive table. The studies determined game mechanics, object types, and game features. Three game modes (competitive, co-active, and collaborative) were explored, with the collaborative mode showing higher social engagement and more positive outcomes. Subsequent studies involving stroke survivors confirmed the effectiveness of collaborative gameplay. Feasibility, engagement, and usability were tested using objects of different sizes and shapes, revealing insights into task performance, grasping, and task complexity adjustments. The developed interactive table accommodates up to four participants, using top down object shape tracking and a multi-touch panel. Four serious games were designed to target specific upper limb skills, played in collaborative mode with incorporated features to enhance the overall experience. A pilot study with 12 stroke survivors over four weeks demonstrated significant improvements in motor outcomes, including range of motion, dexterity, strength, and coordination. The participants reported high enjoyment and interest in the system, with good usability scores. The study suggests that a group-based holistic motor rehabilitation approach, as presented, holds potential for enhancing motor outcomes by promoting social interaction and self-efficacy. These results indicate the viability of the proposed system as a promising solution for stroke rehabilitation.Esta tese aborda a crescente incidência do AVC e o seu impacto na funcionalidade a longo prazo, realçando a importância da reabilitação pós-AVC. Prevendo-se um aumento de 34% nos casos de AVC até 2025, este trabalho foca-se em fatores que afetam a reabilitação motora pós-AVC, como os sintomas depressivos, reconhecendo o papel da participação social e do sentimento de auto-eficácia na nestes sintomas. Para enfrentar esses desafios, propomos o uso de uma mesa interativa multi utilizador para reabilitação dos membros superiores. Esta abordagem inovadora envolve a deteção de objetos de vários tamanhos e formas como interfaces para os jogos sérios, permitindo atividades terapêuticas em grupo direcionadas à reabilitação motora, sintomas depressivos, participação social e autoeficácia. Quatro estudos exploratórios suportaram o desenvolvimento da mesa interativa, determinando mecânicas de jogo, tipos de objetos e recursos do jogo. Três modos de jogo (competitivo, co-ativo e colaborativo) foram investigados, com o modo colaborativo mostrando maior envolvimento social e resultados mais positivos. Estudos subsequentes envolvendo sobreviventes de AVC confirmaram a eficácia do jogo colaborativo. Viabilidade, envolvimento e usabilidade foram testados usando objetos de diferentes tamanhos e formas, revelando insights importantes relativos ao desempenho nas tarefas, preensões e ajustes de complexidade da tarefa. A mesa interativa desenvolvida acomoda até quatro participantes, e permite a deteção de objectos para serem usados como interfaces e um painel multi-toque. Quatro jogos sérios foram projetados para reabilitar competências específicas dos membros superiores, desenhados para serem jogados em modo colaborativo e com recursos incorporados para potenciar o processo de reabilitação e a experiência do utilizador. Um estudo piloto com 12 sobreviventes de AVC ao longo de quatro semanas, demonstrou melhorias significativas nos resultados motores, nomeadamente amplitude de movimento, destreza, força e coordenação. Os participantes reportaram níveis altos de prazer e interesse no sistema, e pontuações de usabilidade promissoras. Este trabalho sugere que uma abordagem de reabilitação motora holística e em grupo, como apresentada, tem potencial para melhorar os resultados motores promovendo a interação social e o sentimento de auto-eficácia. Estes resultados sugerem a viabilidade do sistema proposto como uma solução promissora para a reabilitação motora no AVC

Development and implementation of technologies for physical telerehabilitation in Latin America:

La telerehabilitation ha surgido debido a la inclusión de tecnologías emergentes para la captura, transmisión, análisis y visualización de patrones de movimiento asociados a pacientes con trastornos músculo-esqueléticos. Esta estrategia permite llevar a cabo procesos de diagnóstico y tratamientos de rehabilitación a distancia. Este artículo presenta una revisión sistemática del desarrollo e implementación actual de las tecnologías de telerehabilitación en la región latinoamericana. El objetivo principal es explorar, a partir de la literatura científica reportada y fuentes divulgativas, si las tecnologías de telerehabilitación han logrado ser introducidas en esta región. Asimismo, este trabajo revela los prototipos actuales o sistemas que están en desarrollo o que ya están siendo usados. Se llevó a cabo una revisión sistemática, mediante dos búsquedas diferentes. La primera implicó una búsqueda bibliográfica rigurosa en los repositorios digitales científicos más relevantes en el área y la segunda incluyó proyectos y programas de telerehabilitación implementados en la región, encontrados a partir de una búsqueda avanzada en Google. Se encontró un total de 53 documentos de seis países (Colombia, Brasil, México, Ecuador, Chile y Argentina); la mayoría de ellos estaban enfocados en iniciativas académicas y de investigación para el desarrollo de prototipos tecnológicos para telerehabilitación de pacientes pediátricos y adultos mayores, afectados por deficiencias motoras o funcionales, parálisis cerebral, enfermedades neurocognitivas y accidente cerebrovascular. El análisis de estos documentos reveló la necesidad de un extenso enfoque integrado de salud y sistema social para aumentar la disponibilidad actual de iniciativas de telerehabilitación en la región latinoamericana.Telerehabilitation has arised by the inclusion of emerging technologies for capturing, transmitting, analyzing and visualizing movement patterns associated to musculoskeletal disorders. This therapeutic strategy enables to carry out diagnosis processes and provide rehabilitation treatments. This paper presents a systematic review of the current development and implementation of telerehabilitation technologies in Latin America. The main goal is to explore the scientific literature and dissemination sources to establish if such technologies have been introduced in this region. Likewise, this work highlights existing prototypes or systems that are to being used or that are still under development. A systematic search strategy was conducted by two different searches: the first one involves a rigorous literature search from the most relevant scientific digital repositories; the second one included telerehabilitation projects and programs retrieved by an advanced Google search. A total of 53 documents from six countries (Colombia, Brazil, Mexico, Ecuador, Chile and Argentina) were found. Most of them were focused on academic and research initiatives to develop in-home telerehabilitation technologies for pediatric and elderly populations affected by motor and functional impairment, cerebral palsy, neurocognitive disorders and stroke. The analysis of the findings revealed the need for a comprehensive approach that integrates health care and the social system to increase the current availability of telerehabilitation initiatives in Latin America

ArmAssist Robotic System versus Matched Conventional Therapy for Poststroke Upper Limb Rehabilitation: A Randomized Clinical Trial

The ArmAssist is a simple low-cost robotic system for upper limb motor training that combines known benefits of repetitive task-oriented training, greater intensity of practice, and less dependence on therapist assistance. The aim of this preliminary study was to compare the efficacy of ArmAssist (AA) robotic training against matched conventional arm training in subacute stroke subjects with moderate-to-severe upper limb impairment. Twenty-six subjects were enrolled within 3 months of stroke and randomly assigned to the AA group or Control group (n = 13 each). Both groups were trained 5 days per week for 3 weeks. The primary outcome measure was Fugl-Meyer Assessment-Upper Extremity (FMA-UE) motor score, and the secondary outcomes were Wolf Motor Function Test-Functional Ability Scale (WMFT-FAS) and Barthel index (BI). The AA group, in comparison to the Control group, showed significantly greater increases in FMA-UE score (18.0 +/- 9.4 versus 7.5 +/- 5.5, p = 0.002) and WMFT-FAS score (14.1 +/- 7.9 versus 6.7 +/- 7.8, p = 0.025) after 3 weeks of treatment, whereas the increase in BI was not significant (21.2 +/- 24.8 versus 13.1 +/- 10.7, p = 0.292). There were no adverse events. We conclude that arm training using the AA robotic device is safe and able to reduce motor deficits more effectively than matched conventional arm training in subacute phase of stroke.Andrej M. Savic and Milica S. Isakovic are employed at Tecnalia Serbia Ltd., Belgrade, Serbia, and Cristina Rodriguez-de-Pablo and Thierry Keller are employed at TECNALIA, San Sebastian, Spain, from which they receive financial compensation. No external support was received for conducting this study

HoMEcare aRm rehabiLItatioN (MERLIN): telerehabilitation using an unactuated device based on serious games improves the upper limb function in chronic stroke

HoMEcare aRm rehabiLItatioN (MERLIN) is an unactuated version of the robotic device ArmAssist combined with a telecare platform. Stroke patients are able to train the upper limb function using serious games at home. The aim of this study is to investigate the effect of MERLIN training on the upper limb function of patients with unilateral upper limb paresis in the chronic phase of stroke (> 6 months post stroke). Patients trained task specific serious games for three hours per week during six weeks using an unactuated version of a robotic device. Progress was monitored and game settings were tailored through telerehabilitation. Measurements were performed six weeks pre-intervention (T0), at the start (T1), end (T2) and six weeks post-intervention (T3). Primary outcome was the Wolf Motor Function Test (WMFT). Secondary outcomes were other arm function tests, quality of life, user satisfaction and motivation.This research is part of MERLIN project (19094 and 20649) that has received funding from EIT Health. EIT Health is supported by the European Institute of Innovation and Technology (EIT), a body of the European Union receives support from the European Union´s Horizon 2020 Research and innovation program

Immersive Virtual Environments and Wearable Haptic Devices in rehabilitation of children with neuromotor impairments: a single-blind randomized controlled crossover pilot study

Background: The past decade has seen the emergence of rehabilitation treatments using virtual reality. One of the advantages in using this technology is the potential to create positive motivation, by means of engaging environments and tasks shaped in the form of serious games. The aim of this study is to determine the efficacy of immersive Virtual Environments and weaRable hAptic devices (VERA) for rehabilitation of upper limb in children with Cerebral Palsy (CP) and Developmental Dyspraxia (DD). Methods: A two period cross-over design was adopted for determining the differences between the proposed therapy and a conventional treatment. Eight children were randomized into two groups: one group received the VERA treatment in the first period and the manual therapy in the second period, and viceversa for the other group. Children were assessed at the beginning and the end of each period through both the Nine Hole Peg Test (9-HPT, primary outcome) and Kinesiological Measurements obtained during the performing of similar tasks in a real setting scenario (secondary outcomes). Results: All subjects, not depending from which group they come from, significantly improved in both the performance of the 9-HPT and in the parameters of the kinesiological measurements (movement error and smoothness). No statistically significant differences have been found between the two groups. Conclusions: These findings suggest that immersive VE and wearable haptic devices is a viable alternative to conventional therapy for improving upper extremity function in children with neuromotor impairments. Trial registration ClinicalTrials, NCT03353623. Registered 27 November 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03353623