A physical therapy system for encouraging specific motion in wrist rehabilitation exercises

The objective this research is to design a passive therapy device with rehabilitation gaming suite that employs an adaptive algorithm that alters game play in order to best fit the needs of the user. The goal of physical therapeutic exercises is to increase proficiency of a motor skill. Physical therapeutic exercises are commonly prescribed to individuals with motor disabilities. During the physical therapy process, individuals will usually practice once a week with the assistance of a clinician and six days a week in isolation. When practicing exercises in the presence of a skilled clinician, an individual receives several benefits including: (1) real-time feedback on accuracy of motions; (2) real-time adaptations to an exercise plan that accommodates the client's skill level and performance; (3) social interactions that increase engagement; and (4) positive feedback that increases morale. These benefits are not realized by the client when practicing exercises in isolation, causing clients to struggle to comply with therapeutic regimens at home. To create this system, first, we designed a passive exoskeleton with a rehabilitation gaming suite that encourages therapeutic motions. Then, we verified its ability to increase participant engagement while completing therapeutic exercises. Next, we verified the ability of our system to encourage accurate therapeutic motions. We then used machine learning techniques to process data from popular video games in order to classify task difficulty and make the rehabilitation game adaptive, so it has the capability to learn and grow with users. A final experiment was conducted with elderly adults and stroke survivors that suggests that adaptive user experiences help promote expedited learning of the task.Ph.D

Recent developments in biofeedback for neuromotor rehabilitation

The original use of biofeedback to train single muscle activity in static positions or movement unrelated to function did not correlate well to motor function improvements in patients with central nervous system injuries. The concept of task-oriented repetitive training suggests that biofeedback therapy should be delivered during functionally related dynamic movement to optimize motor function improvement. Current, advanced technologies facilitate the design of novel biofeedback systems that possess diverse parameters, advanced cue display, and sophisticated control systems for use in task-oriented biofeedback. In light of these advancements, this article: (1) reviews early biofeedback studies and their conclusions; (2) presents recent developments in biofeedback technologies and their applications to task-oriented biofeedback interventions; and (3) discusses considerations regarding the therapeutic system design and the clinical application of task-oriented biofeedback therapy. This review should provide a framework to further broaden the application of task-oriented biofeedback therapy in neuromotor rehabilitation

The role of sound in robot-assisted hand function training post-stroke

In Folge eines Schlaganfalls leiden 90% aller Patienten an einer Handparese, die sich in 30-40% als chronisch manifestiert. Derzeit wächst seitens der Neurologie und Technologie das Forschungsinteresse an der Effektivität robotergestützter Therapieansätze, welche für schwer betroffene Patienten als besonders vielversprechend eingestuft werden. Die hierfür verwendeten Therapieroboter setzen sich aus einem mechanischen Teil und einer softwaregestützten virtuellen Umgebung zusammen, welche neben dem graphischen Interface, audio-visuelles Feedback sowie Musik beinhaltet. Bisher wurden Effekte der klanglichen Anteile dieses Szenarios noch nicht hinsichtlich möglicher Einflüsse auf Motivation, Bewegungsdurchführung, motorisches Lernen und den gesamten Rehabilitationsprozess untersucht. Die vorliegende Arbeit untersucht die Rolle von Sound in robotergestütztem Handfunktionstraining. Die Hauptziele im Rahmen dessen sind es, 1) Potentiale von Sound/ Musik für den Kontext robotergestützten Handfunktionstrainings zu explorieren, 2) spezifizierte klangliche Umgebungen zu entwickeln, 3) zu untersuchen, ob Schlaganfallpatienten von diesen spezifizierten Soundanwendungen profitieren, 4) ein besseres Verständnis über Wirkmechanismen von Sound und Musik mit Potential für robotergestützte Therapie darzulegen, und 5) Folgetechnologien über eine effektive Applikation von Sound/ Musik in robotergestützter Therapie zu informieren.90% of all stroke survivors suffer from a hand paresis which remains chronic in 30-40% of all cases. Currently, there is an increasing research interest in neurology and technology on the effectiveness of robot-assisted therapies. Robotic training is considered as especially promising for patients suffering from severe limitations. Commonly, rehabilitation robots consist of a mechanical part and a virtual training environment with a graphical user interface, audio-visual feedback, sound, and music. So far, the effects of sound and music that are embedded within these scenarios have never been evaluated in particular while taking into account that it might influence motivation, motor execution, motor learning and the whole recovery process. This thesis investigates the role of sound in robot-assisted hand function training post-stroke. The main goals of this work are 1) to explore potentials of sound/ music for robotic hand function training post-stroke, 2) to develop specified sound-/ music-applications for this context, 3) to examine whether stroke patients benefit from these specified sound/ music-application, 4) to gain a better understanding of sound-/ music-induced mechanisms with therapeutic potentials for robotic therapy, and 5) to inform further arising treatment approaches about effective applications of sound or music in robotic post-stroke motor training

Enhancement of Robot-Assisted Rehabilitation Outcomes of Post-Stroke Patients Using Movement-Related Cortical Potential

Post-stroke rehabilitation is essential for stroke survivors to help them regain independence and to improve their quality of life. Among various rehabilitation strategies, robot-assisted rehabilitation is an efficient method that is utilized more and more in clinical practice for motor recovery of post-stroke patients. However, excessive assistance from robotic devices during rehabilitation sessions can make patients perform motor training passively with minimal outcome. Towards the development of an efficient rehabilitation strategy, it is necessary to ensure the active participation of subjects during training sessions. This thesis uses the Electroencephalography (EEG) signal to extract the Movement-Related Cortical Potential (MRCP) pattern to be used as an indicator of the active engagement of stroke patients during rehabilitation training sessions. The MRCP pattern is also utilized in designing an adaptive rehabilitation training strategy that maximizes patients’ engagement. This project focuses on the hand motor recovery of post-stroke patients using the AMADEO rehabilitation device (Tyromotion GmbH, Austria). AMADEO is specifically developed for patients with fingers and hand motor deficits. The variations in brain activity are analyzed by extracting the MRCP pattern from the acquired EEG data during training sessions. Whereas, physical improvement in hand motor abilities is determined by two methods. One is clinical tests namely Fugl-Meyer Assessment (FMA) and Motor Assessment Scale (MAS) which include FMA-wrist, FMA-hand, MAS-hand movements, and MAS-advanced hand movements’ tests. The other method is the measurement of hand-kinematic parameters using the AMADEO assessment tool which contains hand strength measurements during flexion (force-flexion), and extension (force-extension), and Hand Range of Movement (HROM)

Augmented visual, auditory, haptic, and multimodal feedback in motor learning: A review

It is generally accepted that augmented feedback, provided by a human expert or a technical display, effectively enhances motor learning. However, discussion of the way to most effectively provide augmented feedback has been controversial. Related studies have focused primarily on simple or artificial tasks enhanced by visual feedback. Recently, technical advances have made it possible also to investigate more complex, realistic motor tasks and to implement not only visual, but also auditory, haptic, or multimodal augmented feedback. The aim of this review is to address the potential of augmented unimodal and multimodal feedback in the framework of motor learning theories. The review addresses the reasons for the different impacts of feedback strategies within or between the visual, auditory, and haptic modalities and the challenges that need to be overcome to provide appropriate feedback in these modalities, either in isolation or in combination. Accordingly, the design criteria for successful visual, auditory, haptic, and multimodal feedback are elaborate

An integrative framework for tailoring virtual reality based motor rehabilitation after stroke

Stroke is a leading cause of life-lasting motor impairments, undermining the quality of life of stroke survivors and their families, and representing a major chal lenge for a world population that is ageing at a dramatic rate. Important technologi cal developments and neuroscientific discoveries have contributed to a better under standing of stroke recovery. Virtual Reality (VR) arises as a powerful tool because it allows merging contributions from engineering, human computer interaction, reha bilitation medicine and neuroscience to propose novel and more effective paradigms for motor rehabilitation. However, despite evidence of the benefits of these novel training paradigms, most of them still rely on the choice of particular technologi cal solutions tailored to specific subsets of patients. Here we present an integrative framework that utilizes concepts of human computer confluence to 1) enable VR neu rorehabilitation through interface technologies, making VR rehabilitation paradigms accessible to wide populations of patients, and 2) create VR training environments that allow the personalization of training to address the individual needs of stroke patients. The use of these features is demonstrated in pilot studies using VR training environments in different configurations: as an online low-cost version, with a myo electric robotic orthosis, and in a neurofeedback paradigm. Finally, we argue about the need of coupling VR approaches and neurocomputational modelling to further study stroke and its recovery process, aiding on the design of optimal rehabilitation programs tailored to the requirements of each user.info:eu-repo/semantics/publishedVersio

Haptic wearables as sensory replacement, sensory augmentation and trainer - a review

Sensory impairments decrease quality of life and can slow or hinder rehabilitation. Small, computationally powerful electronics have enabled the recent development of wearable systems aimed to improve function for individuals with sensory impairments. The purpose of this review is to synthesize current haptic wearable research for clinical applications involving sensory impairments. We define haptic wearables as untethered, ungrounded body worn devices that interact with skin directly or through clothing and can be used in natural environments outside a laboratory. Results of this review are categorized by degree of sensory impairment. Total impairment, such as in an amputee, blind, or deaf individual, involves haptics acting as sensory replacement; partial impairment, as is common in rehabilitation, involves haptics as sensory augmentation; and no impairment involves haptics as trainer. This review found that wearable haptic devices improved function for a variety of clinical applications including: rehabilitation, prosthetics, vestibular loss, osteoarthritis, vision loss and hearing loss. Future haptic wearables development should focus on clinical needs, intuitive and multimodal haptic displays, low energy demands, and biomechanical compliance for long-term usage

Effectiveness of intensive physiotherapy for gait improvement in stroke: systematic review

Introduction: Stroke is one of the leading causes of functional disability worldwide. Approximately 80% of post-stroke subjects have motor changes. Improvement of gait pattern is one of the main objectives of physiotherapists intervention in these cases. The real challenge in the recovery of gait after stroke is to understand how the remaining neural networks can be modified, to be able to provide response strategies that compensate for the function of the affected structures. There is evidence that intensive training, including physiotherapy, positively influences neuroplasticity, improving mobility, pattern and gait velocity in post-stroke recovery. Objectives: Review and analyze in a systematic way the experimental studies (RCT) that evaluate the effects of Intensive Physiotherapy on gait improvement in poststroke subjects. Methodology: Were only included all RCT performed in humans, without any specific age, that had a clinical diagnosis of stroke at any stage of evolution, with sensorimotor deficits and functional gait changes. The databases used were: Pubmed, PEDro (Physiotherapy Evidence Database) and CENTRAL (Cochrane Center Register of Controlled Trials). Results: After the application of the criteria, there were 4 final studies that were included in the systematic review. 3 of the studies obtained a score of 8 on the PEDro scale and 1 obtained a score of 4. The fact that there is clinical and methodological heterogeneity in the studies evaluated, supports the realization of the current systematic narrative review, without meta-analysis. Discussion: Although the results obtained in the 4 studies are promising, it is important to note that the significant improvements that have been found, should be carefully considered since pilot studies with small samples, such as these, are not designed to test differences between groups, in terms of the effectiveness of the intervention applied. Conclusion: Intensive Physiotherapy seems to be safe and applicable in post-stroke subjects and there are indications that it is effective in improving gait, namely speed, travelled distance and spatiotemporal parameters. However, there is a need to develop more RCTs with larger samples and that evaluate the longterm resultsN/