Stretch hyperreflexia in children with cerebral palsy:Assessment - Contextualization - Modulation

Cerebral palsy (CP) is a neurological disorder and the most frequent cause of motor impairment in children in Europe. Around 85% of children with CP experience stretch hyperreflexia, also known as “spasticity”. Stretch hyperreflexia is an excessive response to muscle stretch, leading to increased joint resistance. The joint hyper-resistance causes limitations in activities such as walking. Multiple methods have been developed to measure stretch hyperreflexia, but evidence supporting the use of these methods for diagnostics and treatment evaluation in children with CP is insufficient. Furthermore, most methods are designed to assess stretch reflexes in passive conditions, which might not translate to the limitations encountered due to stretch reflexes during activities. Furthermore, while a broad range of stretch hyperreflexia treatments is available, many are invasive, non-specific, or temporary and might have adverse side effects. Training methods to reduce stretch reflexes using biofeedback are promising non-invasive methods with potential long-term sustained effects. Still, clinical feasibility needs to be improved before implementation in clinical rehabilitation of children with CP. This thesis aimed to develop methods to assess stretch hyperreflexia of the calf muscles during passive conditions, as well as in the context of walking. Additionally, this thesis aimed to develop clinically feasible methods to modulate stretch hyperreflexia in the calf muscle of children with CP. The outcomes are described in eight different studies presented in this thesis. All in all, the work presented in this thesis shows that sagittal plane clinical gait analysis can be performed using the human body model and can be complemented with ultrasound imaging of the calf muscle. Motorized methods to assess stretch hyperreflexia in passive conditions might be useful for evaluation in adults after SCI/Stroke. Still, limitations regarding feasibility and validity limit clinical application for children with CP. Furthermore, this thesis provides additional evidence that the deviating muscle activation patterns during walking, particularly the increased activation around initial contact, are caused by stretch hyper-reflexes in children with CP. The deviating muscle activation patterns, with increased activation during early stance and reduced activation around push-off, can be modulated within one session by several children with CP. Therefore, the next step is to develop a training program to modulate the activation pattern and potentially decrease stretch hyper-reflexes in children with CP to improve the gait patter

Wearable Computing for Health and Fitness: Exploring the Relationship between Data and Human Behaviour

Health and fitness wearable technology has recently advanced, making it easier for an individual to monitor their behaviours. Previously self generated data interacts with the user to motivate positive behaviour change, but issues arise when relating this to long term mention of wearable devices. Previous studies within this area are discussed. We also consider a new approach where data is used to support instead of motivate, through monitoring and logging to encourage reflection. Based on issues highlighted, we then make recommendations on the direction in which future work could be most beneficial

Gamification Strategies as Socialization Tools in the Context of Paediatric Hospitalization

[ES] En la presente tesis doctoral se aborda el problema de la socialización de los pacientes pediátricos en el contexto de su ingreso hospitalario, estudiando las posibilidades de mejorar este ámbito de la salud del paciente mediante diversas estrategias y herramientas tecnológicas teniendo en cuenta la problemática planteada y las dificultades propias del contexto. En primer lugar, se realizará una evaluación del estado del arte, así como una justificación de la problemática existente, planteando claramente los objetivos e hipótesis del presente trabajo, así como la metodología seguida. A continuación, se presentarán las diferentes herramientas implementadas y evaluadas, analizando los resultados obtenidos y situándolos en su contexto y marco tecnológico. Estas herramientas, que combinan actividades y aplicaciones presenciales, remotas o híbridas, implementan diferentes estrategias para poder valorar cuáles son las más adecuadas o que presentan un mayor impacto en el paciente. Tras esto, se propone un modelo de diseño basado en los resultados obtenidos en estudios anteriores, así como su posible aplicación en diferentes ámbitos, discutiendo el mismo y justificando las decisiones de diseño adoptadas. Finalmente, se establecerán las conclusiones obtenidas tras el análisis de los resultados y se plantearán cuáles son las posibles aplicaciones y trabajos futuros relacionados con el trabajo realizado en el marco de la tesis doctoral.[CA] Aquesta tesi doctoral aborda el problema de la socialització dels pacients pediàtrics durant la seua estada hospitalària, i s'estudien les possibilitats de millorar aquest àmbit de la salut del pacient mitjançant diverses estratègies i eines tecnològiques, considerant la problemàtica plantejada i les dificultats pròpies de l'entorn. En primer lloc, es realitzarà una avaluació de l'estat de l'art, així com una justificació de la problemàtica existent, i es plantejaran clarament els objectius i la hipòtesi del treball, així com la metodologia emprada. Seguidament, es presentaran les diferents eines implementades i avaluades, analitzant els resultats obtinguts i situant-los al seu context i marc tecnològic. Aquestes eines, que combinen activitats i aplicacions presencials, remotes o híbrides, implementen diferents estratègies per a poder valorar quines són les més adients, o les que presenten un major impacte en el pacient. A continuació, es proposa un model de disseny basat en els resultats obtinguts als estudis previs, així com la seua possible aplicació en diferents àmbits, discutint el model i justificant les decisions de disseny adoptades. Finalment, s'establiran les conclusions obtingudes després d'analitzar els resultats i es plantejaran les possibles aplicacions i treballs futurs relacionats amb els continguts desenvolupats durant la tesi doctoral.[EN] In this document, the problems for socialization for pediatric patients in the context of their hospital internment are considered, analyzing the possibilities of improving this aspect of the patient's health through the use of different strategies and technological tools considering the difficulties posed by the environment and the context. In the first place, an evaluation of the state of the literature and a justification of the existing problematic will be presented, clearly stating the objectives and hypothesis of this work, and also the methodology that has been followed. Afterwards, the different tools that have been implemented and evaluated will be described, analyzing the obtained results and placing them in their context and technological frame. These tools, that combine physically placed activities and applications with remote or hybrid ones, implement different strategies in order to be able to analyze which are the most convenient or the ones that show a higher benefit for the patient. In the following section, a design model, which is based on the results obtained in the previous studies, is proposed, with the justification of the design decisions made and a description of different applications and contexts in which the proposed model could be useful. Finally, the conclusions obtained after the analysis of the results will be presented, and a short discussion about possible applications and future related works will be done.Thanks to the Ministry for Education, that have funded my research through grant FPU17/03333Montaner Marco, J. (2023). Gamification Strategies as Socialization Tools in the Context of Paediatric Hospitalization [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/20155

Novel Clinical Applications of Marker-less Motion Capture as a Low-cost Human Motion Analysis Method in the Detection and Treatment of Knee Osteoarthritis

Marker-less motion capture is a rapidly advancing field that can take simple RGB image sequences, or more advanced Red Green Blue Depth (RGB-D) image sequences obtained using depth sensors, and outputs an estimated human pose. This method of human pose estimation allows for the extraction of biomechanical features which can then be analysed by clinicians to give more insights into a patient’s movement capabilities. When compared to other, more clinically proven technologies such as the Knee Kinesiography (KneeKG), biomechanics presented have the advantage of being more representative of natural movement without the obstructive markers placed on the body. This Significant difference of up to 10 degrees in a range of motion for the knee could be the key to better identifying a person’s gait or tracking their natural walking pattern over time, while also being more robust and better suited to a smaller clinical environment

Flexible Virtual Reality System for Neurorehabilitation and Quality of Life Improvement

As life expectancy is mostly increasing, the incidence of many neurological disorders is also constantly growing. For improving the physical functions affected by a neurological disorder, rehabilitation procedures are mandatory, and they must be performed regularly. Unfortunately, neurorehabilitation procedures have disadvantages in terms of costs, accessibility and a lack of therapists. This paper presents Immersive Neurorehabilitation Exercises Using Virtual Reality (INREX-VR), our innovative immersive neurorehabilitation system using virtual reality. The system is based on a thorough research methodology and is able to capture real-time user movements and evaluate joint mobility for both upper and lower limbs, record training sessions and save electromyography data. The use of the first-person perspective increases immersion, and the joint range of motion is calculated with the help of both the HTC Vive system and inverse kinematics principles applied on skeleton rigs. Tutorial exercises are demonstrated by a virtual therapist, as they were recorded with real-life physicians, and sessions can be monitored and configured through tele-medicine. Complex movements are practiced in gamified settings, encouraging self-improvement and competition. Finally, we proposed a training plan and preliminary tests which show promising results in terms of accuracy and user feedback. As future developments, we plan to improve the system's accuracy and investigate a wireless alternative based on neural networks.Comment: 47 pages, 20 figures, 17 tables (including annexes), part of the MDPI Sesnsors "Special Issue Smart Sensors and Measurements Methods for Quality of Life and Ambient Assisted Living

Digital innovation in Multiple Sclerosis Management

Due to innovation in technology, a new type of patient has been created, the e-patient, characterized by the use of electronic communication tools and commitment to participate in their own care. The extent to which the world of digital health has changed during the COVID-19 pandemic has been widely recognized. Remote medicine has become part of the new normal for patients and clinicians, introducing innovative care delivery models that are likely to endure even if the pendulum swings back to some degree in a post-COVID age. The development of digital applications and remote communication technologies for patients with multiple sclerosis has increased rapidly in recent years. For patients, eHealth apps have been shown to improve outcomes and increase access to care, disease information, and support. For HCPs, eHealth technology may facilitate the assessment of clinical disability, analysis of lab and imaging data, and remote monitoring of patient symptoms, adverse events, and outcomes. It may allow time optimization and more timely intervention than is possible with scheduled face-to-face visits. The way we measure the impact of MS on daily life has remained relatively unchanged for decades, and is heavily reliant on clinic visits that may only occur once or twice each year.These benefits are important because multiple sclerosis requires ongoing monitoring, assessment, and management.The aim of this Special Issue is to cover the state of knowledge and expertise in the field of eHealth technology applied to multiple sclerosis, from clinical evaluation to patient education