A system to provide guidance to stroke patients during independent physiotherapy

Stroke is a serious disease that leaves many sufferers physically disabled. Treatment resources are limited, meaning stroke patients, are in many cases, discharged prior to reaching their full potential of physical recovery. The hypothesis of this research is that a system that enables regular guided and monitored therapeutic exercises in the home can provide a means for stroke patients to achieve a higher level of physical rehabilitation. This research is based on the design, build and testing of an experimental prototype system to allow this, with the aim of investigating the feasibility and potential value for such systems. Any system to assist rehabilitation in the home must clearly be low cost, safe and easy to use. The prototype system therefore aimed to achieve these features as well as focusing on the upper limb. Literature is reviewed in the fields of stroke, human anatomy and mechanisms, motor performance, feedback during motor learning, and existing systems and technology. Interviews are also conducted with stroke physiotherapists to gain input and feedback on concepts that were generated. Although systems exist with similar aims to those mentioned in the hypothesis, there are some areas where investigation is lacking. The prototype system measures movement using a novel combination of gyro sensors and flex sensors. The prototype system is designed with a focus on the method of interaction with patients and the provision of guidance and feedback that simulates that provided by a physiotherapist. The prototype system also provides a unique combination of quantitative information to patients of their personal improvements and graphical feedback of their movements and target movements. Finally, a novel categorisation of movement synergism (a form of movement coordination) is established and a novel method for detecting movement synergism is developed and tested. Performance of the prototype hardware is tested, and it is concluded that identified requirements have been met, although variability of recorded data is high. Tests also indicate that the prototype system is capable of detecting movement synergism. Finally, a controlled test involving healthy participants is performed to investigate the efficacy of the prototype as a whole. It was found that use of the prototype system resulted in a statistically significant improvement in conformance to target movements (ρ < 0.05). Findings are discussed in detail and the hypothesis is concluded as being supported overall. Recommendations for future research are made

Healing Textile - Terveydenhoidossa käytettävien kompressiotekstiilien tutkiminen ja suunnittelu

Healing Textile is a research-driven textile design project that explores compression textiles in the field of healthcare and suggests design approaches to improve the visual, functional, and tactile qualities of these textiles. The main function of compression textiles is to exert pressure on specific body parts, and they are used as a part of the treatment of several disorders in the field of healthcare. Considering an aid that plays a vital role in an individual’s quality of life raised the question of whether there is a demand to develop these textiles. From this starting point, the investigation of healthcare compression textiles is made with a special focus on qualities affecting the wearing experience. Additionally, the thesis uses the constructive prototyping process as a method to contribute to the development of these textiles as a textile designer. The background research begins with a review of medical textiles and compression textile applications for venous and lymphatic diseases, wound management, hypertrophic scars, and rehabilitation. Semi-structured interviews with healthcare professionals were conducted to deepen the knowledge of compression textile applications. To determine the prototyping technique, an overview of compression textile materials and structures is provided. Informed by the background research, the design development part uses a constructive design research approach in the development of conceptual textile prototypes. Knitting is the primary method while weaving and braiding are supplementary methods. The background research findings indicated the reasons for the development of healthcare compression textiles to improve the wearing experience from a textile design perspective. Relying on the background research findings, the wearing experience is a result of several dimensions such as visuality, functionality, and feel of the fabric. By developing these qualities, the design development suggests improvements to the healthcare compression textiles with a group of conceptual textile prototypes. In summary, thesis results show that healthcare compression textiles have potential areas to be improved related to the wearing experience and that textile design has a significant role in the development of compression textiles for healthcare use. In a broader context, this project indicates the important relationship between the fields of textile design and healthcare.Healing Textile on tutkimuslähtöinen tekstiilisuunnitteluprojekti terveydenhoidossa käytettävistä kompressiotekstiileistä. Opinnäytteen tavoitteena on tutkia näiden kompressiotekstiilien käyttöä sekä esittää tekstiilisuunnittelun keinoja kehittää niiden visuaalisia, funktionaalisia ja tuntuun liittyviä ominaisuuksia. Terveydenhoidossa kompressiotekstiilien pääasiallinen tehtävä on luoda painetta määrätylle kehon alueelle ja siten vaikuttaa kehon toimintoihin osana sairauksien ja vammojen hoitoa. Kompressiotekstiilien vaikutus yksilön elämänlaatuun voi olla merkittävä, ja suunnittelijana tämä herätti kiinnostuksen erityisesti niiden tuotekehityksen tarpeesta. Tästä lähtökohdasta opinnäyte perehtyy kompressiotekstiilien käyttöön terveydenhoidossa painottaen niiden käyttökokemukseen vaikuttavia ominaisuuksia ja havainnollistaa miten tekstiiliprototyyppien valmistaminen voi edistää tuotesuunnittelua. Taustatutkimus alkaa lääketieteellisten tekstiilien esittelyllä ja katsauksella kompressiotekstiilituotteisiin, joita käytetään laskimo- ja lymfaattisten sairauksien, haavojen ja arpien hoidossa sekä kuntoutuksen puolella. Teemahaastattelut terveydenhuollon ammattilaisten kanssa syventävät tietoa tekstiilien käytöstä, ja lisäksi esittely kompressiotekstiileissä käytettävistä materiaaleista ja rakenteista tukee suunnitteluosuutta. Konstruktiivista muotoilututkimusta hyödynnetään suunnitteluosiossa, jossa kehitetään tekstiiliprototyyppejä konseptitasolla. Taustatutkimukseen pohjautuva suunnitteluosuus sisältää prototyyppien valmistuksen, jossa pääasiallisena menetelmänä on neulonta sekä lisäksi kudonta ja punonta. Taustatutkimuksen löydökset tuovat esiin syitä kehittää terveydenhoidon kompressiotekstiilejä tekstiilisuunnittelun avulla käyttökokemuksen parantamiseksi. Taustatutkimuksen pohjalta käyttömukavuuteen vaikuttavat useat tekijät, kuten tekstiilin ulkonäkö, funktionaalisuus ja tuntu. Näitä ominaisuuksia painottaen opinnäytteen suunnitteluosuus antaa kehitysehdotuksia kompressiotekstiileille esittelemällä joukon konseptuaalisia prototyyppejä. Opinnäyte tuo esiin terveydenhoidossa käytettävien kompressiotekstiilien kehitettäviä ominaisuuksia käyttömukavuuteen liittyen ja on osoitus tekstiilisuunnittelun keskeisestä osasta niiden tuotekehityksessä. Laajemmassa kontekstissa tämä projekti korostaa terveydenhoito- ja tekstiilisuunnittelualan välistä merkittävää yhteyttä

Development of a Hardware/Software System for Proprioception Exergaming

Physiotherapy and rehabilitation are getting ever more relevance as an integral part of healthcare devising and employing new, effective methodologies and tools. However, not seldom are such tools boring and difficult to use properly for achieving the given training and therapeutic goals. Exergaming, the combination of physical exercise and video gaming, may help to overcome these issues by offering enjoyment and motivation. However, the literature lacks papers investigating how to integrate such devices into a serious game combining effectiveness and enjoyment. In this paper, we focus on the Balance Board (BB), a device used in gyms and in several health-related applications [1], and present an exergaming system for proprioception training. The system includes a BB, which was instrumented to act as a motion controller for an ad-hoc developed, simple 3D video game. The system aims to provide enjoyable training with the BB, boosting equilibrium exercising through the simulation of downhill skiing. We validated the score computation and tested the efficacy of the system in a user test with 40 participants, in ecological settings. The evaluation concerned user performance and a game experience questionnaire. The results showed statistically significant improvement in players’ ability to use the BB. Users also reported a positive gameplay experience

Design and development of a weight support device for upper limb stroke rehabilitation

Upper limb recovery following a stroke is generally quite poor. Upper limb therapy at clinic is usually limited due to lack of time and resources to accommodate the growing stroke population. Consequently, a small percentage of therapy is spent on improving upper limb movement and is generally limited to range of motion and stretching exercises. As a result, upper limb exercises are prescribed to stroke survivors to perform at home. Subsequently, the potential to facilitate self-practice at home has been realized leading to the development of numerous rehabilitative and assistive devices for the upper limb. However, commercially available devices do not tend to be adopted for home use due to practical and economic factors. This thesis details the design, development, and evaluation of a weight support device for home-based upper limb rehabilitation, driven through a user-designed approach. This was achieved through engaging with stakeholders (i.e. stroke survivors, therapists) throughout the design process via informal interviews, focus groups, and prototype testing, ensuring that their desired requirements were incorporated into the final device. From this process, a low-cost, portable, weight support device was manufactured with supports for both the upper arm and forearm. Furthermore, an external feedback system was created to provide real-time feedback to the user to help motivate and encourage them to engage in independent practice at home with the weight support device. Testing the device and feedback system with participants in their home environment showed that it was acceptable for home use, suggesting that it could be feasible for aiding with the facilitation of self-practice. Further refinements towards range of motion and portability of the device will be required as desired by participants in addition to providing a diverse range of feedback applications to engage with.Upper limb recovery following a stroke is generally quite poor. Upper limb therapy at clinic is usually limited due to lack of time and resources to accommodate the growing stroke population. Consequently, a small percentage of therapy is spent on improving upper limb movement and is generally limited to range of motion and stretching exercises. As a result, upper limb exercises are prescribed to stroke survivors to perform at home. Subsequently, the potential to facilitate self-practice at home has been realized leading to the development of numerous rehabilitative and assistive devices for the upper limb. However, commercially available devices do not tend to be adopted for home use due to practical and economic factors. This thesis details the design, development, and evaluation of a weight support device for home-based upper limb rehabilitation, driven through a user-designed approach. This was achieved through engaging with stakeholders (i.e. stroke survivors, therapists) throughout the design process via informal interviews, focus groups, and prototype testing, ensuring that their desired requirements were incorporated into the final device. From this process, a low-cost, portable, weight support device was manufactured with supports for both the upper arm and forearm. Furthermore, an external feedback system was created to provide real-time feedback to the user to help motivate and encourage them to engage in independent practice at home with the weight support device. Testing the device and feedback system with participants in their home environment showed that it was acceptable for home use, suggesting that it could be feasible for aiding with the facilitation of self-practice. Further refinements towards range of motion and portability of the device will be required as desired by participants in addition to providing a diverse range of feedback applications to engage with

Study and development of custom “serious games” for patients and users

Video games are part of our culture and permeate several segments of society, from casual entertainment to serious purposes. This research work focuses on the latter, more specifically on the use of Serious Games in the healthcare context. In this sense, Serious Games have been researched through clinical studies, implemented to improve several conditions and have already proved to be efficient and valid, especially due to their ability to captivate and motivate the patient. With this in mind, this research explored the use of Serious Games for physical rehabilitation of stroke impaired patients and how this approach could be implemented in the Portuguese healthcare system. The research started with a thorough literature review of the validity and effectiveness of the use of Serious Games for this type of patients. Then, through surveys and interviews with healthcare professionals and game developers, the main barriers to the implementation and development of Serious Games for physical rehabilitation were accessed. Posteriorly, the feasibility of implementing a business model for this specific niche (in Portugal) was evaluated through a market analysis, abridging social, economic, political and technological aspects that culminated in the design of several hypothetical scenarios that envisioned the possibility of making this approach work. This research allowed to achieve an understanding of what needs to be overcome in order for this technique to be successful: Serious Games are still widely unknown among healthcare professionals and there is an underlying stigma against video games that clouds the possible benefits of using Serious Games. Moreover, the social context of future users will also determine their acceptance and compliance. Nevertheless, the research has evidenced that the implementation of this paradigm is economically viable as it would indirectly allow the monetization of rehabilitation therapies by making them available to a larger slice of the disabled population, which is of utmost importance, mainly during the times we currently live in.Os videojogos fazem parte da nossa cultura e permeiam vários segmentos da sociedade, desde entretenimento casual até propósitos mais sérios. Este trabalho de investigação concentra-se na segunda opção – mais especificamente, no uso de Serious Games no contexto da saúde. Neste sentido, os Serious Games têm sido investigados através de estudos clínicos, implementados para melhorar diversas condições e patologias e já provaram ser eficientes e válidos, principalmente graças à sua capacidade de motivar e cativar o paciente. Tendo isto em conta, esta investigação explorou o uso dos Serious Games para reabilitação física de pacientes pós-AVC e de que forma é que esta abordagem poderia ser implementada no Serviço Nacional de Saúde. A investigação começou com uma revisão bibliográfica completa da validade e eficácia do uso de Serious Games para este tipo de pacientes. De seguida, através de questionários e entrevistas a profissionais de saúde e desenvolvedores de videojogos, as principais barreiras para implementação e desenvolvimento de Serious Games para reabilitação física foram levantadas. Posteriormente, a viabilidade de executar um business plan para esse nicho específico (em Portugal) foi avaliada através de uma análise de mercado, abrangendo aspetos sociais, económicos, políticos e tecnológicos, que culminou no desenho de vários cenários hipotéticos que previam a possibilidade de fazer com que este paradigma se tornasse possível e funcional. Este trabalho de investigação permitiu atingir uma compreensão daquilo que necessita de ser ultrapassado para que esta abordagem tenha sucesso: os Serious Games ainda são amplamente desconhecidos entre os profissionais de saúde e existe um estigma subjacente aos videojogos que obscurece os possíveis benefícios do seu uso. Para além disso, o contexto social dos futuros utilizadores também irá determinar a sua aceitação e adesão. No entanto, esta investigação evidenciou que a implementação deste modelo é economicamente viável, pois iria permitir, de uma forma indireta, a rentabilização de terapias de reabilitação ao fazer com que estas fossem acessíveis a uma fatia mais larga da população debilitada, o que é de extrema importância, principalmente nos dias de hoje

An exploration of movement and handling by physiotherapists in a rehabilitation setting: a motion analysis study.

Work-related musculoskeletal disorders (WRMSD) affect between 56-80% of physiotherapists, with patient handling often reported as a risk factor. Physiotherapists use therapeutic handling to aid patient rehabilitation. Therapeutic handling involves the physiotherapist "guiding, facilitating, manipulating or providing resistance" to the patient. Therapeutic handling can subject physiotherapists to high loading forces during patient handling. The aims of this doctoral thesis were to quantify physiotherapists' movement during therapeutic patient handling tasks, assess risk of injury against a frequently used ergonomic tool, and investigate whether there may be a relationship between patient handling and WRMSD. This research employed a descriptive cross-sectional study design and a positivistic approach to explore and quantitatively measure physiotherapist movement. A portable three-dimensional motion analysis system, Xsens MTw Awinda, was used to measure physiotherapist movement during patient treatments in a neurological setting. The physiotherapists' movement and posture were quantified, described and assessed using the Rapid Upper Limb Assessment (RULA) tool. The incidence and personal impact of WRMSD were investigated with the extended Nordic Musculoskeletal Questionnaire (NMQ-E) and potential patient tasks of risk were discussed. The physiotherapists used four main positions during patient handling tasks: 1) kneeling; 2) half-kneeling; 3) standing; and 4) sitting. Eight patient handling tasks were identified: 1) lie-to-sit; 2) sit-to-lie; 3) sit-to-stand; 4) upper limb; 5) lower limb; 6) trunk; 7) standing; and 8) walking facilitation. Kneeling or sitting positions were used by the physiotherapists most often during lie-to-sit, sit-to-lie, sit-to-stand, upper limb, trunk and standing facilitation tasks. Standing was the most common physiotherapist position during lower limb and walking tasks. Kneeling, half-kneeling and sitting positions demonstrated greater neck extension, which scored highly with the RULA and indicated potential risk of injury. Standing demonstrated more cervicothoracic flexion than kneeling and sitting, which demonstrated greater lumbosacral flexion than standing. The physiotherapists' hips and knees often maintained end-range flexion when kneeling or half-kneeling, which is discouraged in ergonomics literature. The low back was the most frequent anatomical area of WRMSD, with 60% of the physiotherapists having experienced discomfort there within their career. Physiotherapists were found to temporarily have changed jobs, sought professional help or taken medication for their shoulder, elbow or low back discomfort. However, none of the physiotherapists had taken sick leave in the last twelve months. This research found that tasks were more often performed in kneeling or sitting positions than in standing. Moving and handling guidance considers the handler in a standing position; guidance should therefore start to consider the handler in the variety of positions found in clinical practice. Ergonomic assessments, such as the RULA, consider the trunk as one joint. This research investigated three trunk joints, with different postures found at the cervicothoracic and lumbosacral junctions. Future research should appreciate how the position of the handler can impact trunk posture. More research needs to be conducted to qualitatively investigate physiotherapists' perceptions and experiences of patient handling. This research has provided a detailed exploration into therapeutic handling the neurological setting which can be used to guide future research

Design, Fabrication, and Control of an Upper Arm Exoskeleton Assistive Robot

Stroke is the primary cause of permanent impairment and neurological damage in the United States and Europe. Annually, about fifteen million individuals worldwide suffer from stroke, which kills about one third of them. For many years, it was believed that major recovery can be achieved only in the first six months after a stroke. More recent research has demonstrated that even many years after a stroke, significant improvement is not out of reach. However, economic pressures, the aging population, and lack of specialists and available human resources can interrupt therapy, which impedes full recovery of patients after being discharged from hospital following initial rehabilitation. Robotic devices, and in particular portable robots that provide rehabilitation therapy at home and in clinics, are a novel way not only to optimize the cost of therapy but also to let more patients benefit from rehabilitation for a longer time. Robots used for such purposes should be smaller, lighter and more affordable than the robots currently used in clinics and hospitals. The common human-machine interaction design criteria such as work envelopes, safety, comfort, adaptability, space limitations, and weight-to-force ratio must still be taken into consideration.;In this work a light, wearable, affordable assistive robot was designed and a controller to assist with an activity of daily life (ADL) was developed. The mechanical design targeted the most vulnerable group of the society to stroke, based on the average size and age of the patients, with adjustability to accommodate a variety of individuals. The novel mechanical design avoids motion singularities and provides a large workspace for various ADLs. Unlike similar exoskeleton robots, the actuators are placed on the patient\u27s torso and the force is transmitted through a Bowden cable mechanism. Since the actuators\u27 mass does not affect the motion of the upper extremities, the robot can be more agile and more powerful. A compact novel actuation method with high power-to-weight ratio called the twisted string actuation method was used. Part of the research involved selection and testing of several string compositions and configurations to compare their suitability and to characterize their performance. Feedback sensor count and type have been carefully considered to keep the cost of the system as low as possible. A master-slave controller was designed and its performance in tracking the targeted ADL trajectory was evaluated for one degree of freedom (DOF). An outline for proposed future research will be presented