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

Home-based rehabilitation of the shoulder using auxiliary systems and artificial intelligence: an overview

Advancements in modern medicine have bolstered the usage of home-based rehabilitation services for patients, particularly those recovering from diseases or conditions that necessitate a structured rehabilitation process. Understanding the technological factors that can influence the efficacy of home-based rehabilitation is crucial for optimizing patient outcomes. As technologies continue to evolve rapidly, it is imperative to document the current state of the art and elucidate the key features of the hardware and software employed in these rehabilitation systems. This narrative review aims to provide a summary of the modern technological trends and advancements in home-based shoulder rehabilitation scenarios. It specifically focuses on wearable devices, robots, exoskeletons, machine learning, virtual and augmented reality, and serious games. Through an in-depth analysis of existing literature and research, this review presents the state of the art in home-based rehabilitation systems, highlighting their strengths and limitations. Furthermore, this review proposes hypotheses and potential directions for future upgrades and enhancements in these technologies. By exploring the integration of these technologies into home-based rehabilitation, this review aims to shed light on the current landscape and offer insights into the future possibilities for improving patient outcomes and optimizing the effectiveness of home-based rehabilitation programs.info:eu-repo/semantics/publishedVersio

Implementation of Open Source applications “Serious Game” for rehabilitation

Serious Games and Virtual Reality (VR) are present nowadays as an alternative to traditional rehabilitation therapies. This project describes the workflow to develop videogames for health monitoring as well as a source of entertainment for physiotherapy patients, primarily patients that suffer hemiparesis caused by a neurological disease like a stroke. We propose the last version of Microsoft Kinect sensors as low cost game controller and the software Unity to develop Open Source Rehabilitation Serious Games. These Serious Games try to imitate physiotherapy sessions performed in movement recovery therapies, reducing the waiting list of patients together with time and costs to hospitals. The premise is that the gameplay makes patients execute upper body exercises alongside equilibrium training, meanwhile they are monitored extracting useful data and results for the physicians.Ingeniería Biomédic

Home-based physical therapy with an interactive computer vision system

In this paper, we present ExerciseCheck. ExerciseCheck is an interactive computer vision system that is sufficiently modular to work with different sources of human pose estimates, i.e., estimates from deep or traditional models that interpret RGB or RGB-D camera input. In a pilot study, we first compare the pose estimates produced by four deep models based on RGB input with those of the MS Kinect based on RGB-D data. The results indicate a performance gap that required us to choose the MS Kinect when we tested ExerciseCheck with Parkinson’s disease patients in their homes. ExerciseCheck is capable of customizing exercises, capturing exercise information, evaluating patient performance, providing therapeutic feedback to the patient and the therapist, checking the progress of the user over the course of the physical therapy, and supporting the patient throughout this period. We conclude that ExerciseCheck is a user-friendly computer vision application that can assist patients by providing motivation and guidance to ensure correct execution of the required exercises. Our results also suggest that while there has been considerable progress in the field of pose estimation using deep learning, current deep learning models are not fully ready to replace RGB-D sensors, especially when the exercises involved are complex, and the patient population being accounted for has to be carefully tracked for its “active range of motion.”Published versio

An Overview of Self-Adaptive Technologies Within Virtual Reality Training

This overview presents the current state-of-the-art of self-adaptive technologies within virtual reality (VR) training. Virtual reality training and assessment is increasingly used for five key areas: medical, industrial & commercial training, serious games, rehabilitation and remote training such as Massive Open Online Courses (MOOCs). Adaptation can be applied to five core technologies of VR including haptic devices, stereo graphics, adaptive content, assessment and autonomous agents. Automation of VR training can contribute to automation of actual procedures including remote and robotic assisted surgery which reduces injury and improves accuracy of the procedure. Automated haptic interaction can enable tele-presence and virtual artefact tactile interaction from either remote or simulated environments. Automation, machine learning and data driven features play an important role in providing trainee-specific individual adaptive training content. Data from trainee assessment can form an input to autonomous systems for customised training and automated difficulty levels to match individual requirements. Self-adaptive technology has been developed previously within individual technologies of VR training. One of the conclusions of this research is that while it does not exist, an enhanced portable framework is needed and it would be beneficial to combine automation of core technologies, producing a reusable automation framework for VR training

The use and effect of video game design theory in the creation of game-based systems for upper limb stroke rehabilitation

Upper limb exercise is often neglected during post-stroke rehabilitation. Video games have been shown to be useful in providing environments in which patients can practise repetitive, functionally meaningful movements, and in inducing neuroplasticity. The design of video games is often focused upon a number of fundamental principles, such as reward, goals, challenge and the concept of meaningful play, and these same principles are important in the design of games for rehabilitation. Further to this, there have been several attempts for the strengthening of the relationship between commercial game design and rehabilitative game design, the former providing insight into factors that can increase motivation and engagement with the latter. In this article, we present an overview of various game design principles and the theoretical grounding behind their presence, in addition to attempts made to utilise these principles in the creation of upper limb stroke rehabilitation systems and the outcomes of their use. We also present research aiming to move the collaborative efforts of designers and therapists towards a model for the structured design of these games and the various steps taken concerning the theoretical classification and mapping of game design concepts with intended cognitive and motor outcomes

StableHand VR: a virtual reality serious game for hand rehabilitation

Dissertação de mestrado integrado em Biomedical Engineering Medical InformaticsA third of all injuries at work are sustained to the hand, and hand and wrist injuries are estimated to account between 10% to 30% of all Emergency Department (ED) attendances. In 2017, there were approximately 18 million hand and wrist fractures, 2 million thumb amputations and 4 million non-thumb digit amputations worldwide. Several injuries, disabilities and diseases can affect manual motor control. Hand physiotherapy is indispensable to restore hand functionality. However, this process is often a strenuous and cognitively demanding experience. This work proposes a Virtual Reality (VR) serious game to improve conventional physiotherapy in hand rehabilitation. It focuses on resolving recurring limitations reported in most technological solutions to the problem, namely the limited diversity support of movements and exercises, complicated calibrations, and exclusion of patients with open wounds or other disfigurements of the hand. Concepts such as mixed reality, serious games for health, and hand rehabilitation are addressed in this dissertation to provide the reader with a background for the project. The latest developments of digital games and technologies in the hand rehabilitation field, specifications, requirements, general game characteristics and the most relevant details of the game implementation process are also presented in this dissertation. The system was assessed in two mid-term validations to test its viability and adjust the development. The first validation was performed with eight able-bodied participants and the second with four health professionals working in the rehabilitation field. The validations were performed following ten minutes of guided functional task practices followed by a Semi-Structured Interview for the first validation and an online questionnaire for the second validation. The questions made in the interview and online questionnaire focused on the participants’ familiarity with videogames, opinion about the Oculus Quest and its hand tracking system, and the StableHand VR game. The System Usability Scale (SUS) scores obtained and the participants’ positive feedback showed the potential of both conceptual and technological approaches adopted for this game as a viable complement to conventional hand rehabilitation. The project’s main objectives were achieved, and several relevant topics for further research were identified.Um terço de todos os ferimentos no trabalho afetam a mão e estima-se que 10% a 30% de todos os atendimentos nas Urgências se devem a ferimentos na mão e no pulso. Em 2017, houve aproximadamente 18 milhões de fraturas da mão e do pulso, 2 milhões de amputações do polegar e 4 milhões de amputações de dígitos não polegares em todo o mundo. Vários ferimentos, deficiências e doenças podem afetar o controlo motor manual. A fisioterapia é indispensável para recuperar a funcionalidade da mão. No entanto, este processo é frequentemente uma experiência extenuante e cognitivamente exigente. Este trabalho propõe um jogo sério em Realidade Virtual para melhorar a fisioterapia convencional na reabilitação da mão. O trabalho desenvolvido concentra-se na resolução de recorrentes limitações relatadas na maioria das soluções tecnológicas para o problema, nomeadamente o apoio limitado de diversidade de movimentos e exercícios, calibrações complicadas e exclusão de pacientes com feridas abertas ou outras desfigurações da mão. Esta dissertação aborda conceitos como a realidade mista, jogos sérios para a saúde e reabilitação para fornecer ao leitor contextualização para o projeto. Os últimos desenvolvimentos de jogos digitais e tecnologias no campo da reabilitação da mão são também apresentados nesta dissertação, assim como especificações, requisitos, características gerais do jogo e o processo de implementação do mesmo. O sistema foi avaliado através de dois ensaios realizados durante o processo de desenvolvimento, para testar a viabilidade e proceder a ajustes da solução especificada. A primeira validação foi conduzida com oito participantes saudáveis e a segunda validação com quatro profissionais de saúde que trabalham em reabilitação. As validações foram realizadas após dez minutos de práticas funcionais orientadas, seguidas de uma Entrevista Semiestruturada, no caso da primeira validação, ou de um questionário online, no caso da segunda validação. As perguntas feitas na entrevista e no questionário online centraram-se na familiaridade dos participantes com os videojogos, opinião sobre o Oculus Quest e o seu sistema de localização de mãos e o jogo StableHand VR. As pontuações obtidas no System Usability Scale e o feedback positivo dos participantes demostrou o potencial das abordagens conceptuais e tecnológicas adotadas para que este jogo fosse visto como um complemento viável para a reabilitação convencional das mãos. Os principais objetivos do projeto foram alcançados, tendo também sido identificado um conjunto de tópicos relevantes de investigação futura