334 research outputs found
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
Cerebral Palsy
Nowadays, cerebral palsy (CP) rehabilitation, along with medical and surgical interventions in children with CP, leads to better motor and postural control and can ensure ambulation and functional independence. In achieving these improvements, many modern practices may be used, such as comprehensive multidisciplinary assessment, clinical decision making, multilevel surgery, botulinum toxin applications, robotic ambulation applications, treadmill, and other walking aids to increase the quality and endurance of walking. Trainings are based on neurodevelopmental therapy, muscle training and strength applications, adaptive equipment and orthotics, communication, technological solves, and many others beyond the scope of this book. In the years of clinical and academic experiences, children with cerebral palsy have shown us that the world needs a book to give clinical knowledge to health professionals regarding these important issue. This book is an attempt to fulfill and to give “current steps” about CP. The book is intended for use by physicians, therapists, and allied health professionals who treat/rehabilitate children with CP. We focus on the recent concepts in the treatment of body and structure problems and describe the associated disability, providing suggestions for further reading. All authors presented the most frequently used and accepted treatment methods with scientifically proven efficacy and included references at the end of each chapter
Studying Serious Games for the Therapy of Children with Disabilities following a Co-Design Process
Therapy can be a long and tedious process where progress is usually not immediately
visible. This slow process can discourage younger patients, especially children who do not
understand exactly what they are doing. Serious Games can help in these situations since
they are games designed for a primary purpose other than pure entertainment. These
games can be helpful as therapy tools because they promote engagement on the side of
the patients, which in turn will make them feel more motivated to follow the therapeutic
programme.
In order to develop a game with a meaningful experience for users, beyond the fun
of playing it, which helps them in their therapy, experts in the area need to be involved
through close collaboration throughout the whole research process. Therefore, we de-
veloped a game suite for the therapy of children with disabilities following a co-design
process that included Cresce com Amor as the partner clinic. Cresce com Amor provided
therapy expertise to the research team, collaborating in several phases of the process.
Furthermore, by developing a classification system for serious games, based on the
International Classification of Functioning, Disability and Health (ICF), which matches
each game with body functions and therapy areas, we intend to support the classification
of serious games in order to make them more suitable for their ultimate purpose. An
in-house developed platform, called PLAY, supports the games by acting as a repository
for the data collected and giving the therapists an interface to interact with and adjust
the game parameters.
The games use different interaction methods, other than the usual keyboard and
mouse, to allow patients to seamlessly perform exercises that simulate the ones done
in current traditional therapy sessions. By using off-the-shelf controllers, such as the
balance board and dance mat, we can translate real-life movements more naturally into
character movements in the virtual space.A terapia pode ser um processo longo e tedioso onde o progresso geralmente não é imedi-
atamente visível. Este processo lento pode desencorajar os pacientes mais jovens, especi-
almente as crianças que não entendem exatamente o que estão a fazer. Jogos Sérios podem
ajudar nestas situações, uma vez que são jogos concebidos com um propósito principal
que não seja apenas entretenimento. Estes jogos podem ser úteis como ferramentas te-
rapêuticas porque promovem o envolvimento do lado dos pacientes, o que, por sua vez,
fará com que se sintam mais motivados para seguir o programa terapêutico.
Para desenvolver um jogo com uma experiência significativa para os utilizadores, para
além da diversão de jogar, que os ajude na sua terapia, os especialistas na área precisam
de estar envolvidos através de uma estreita colaboração ao longo de todo o processo de
investigação. Assim, desenvolvemos uma suite de jogos para a terapia de crianças com
incapacidades seguindo um processo de co-criação que incluiu a Cresce com Amor como
clínica parceira. A Cresce com Amor adicionou conhecimentos terapêuticos à equipa de
investigação, colaborando em várias fases do processo.
Além disso, ao desenvolver um sistema de classificação para jogos sérios, baseado na
Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), que combina
cada jogo com funções corporais e áreas de terapia, pretendemos apoiar a classificação de
jogos sérios, a fim de torná-los mais adequados ao seu propósito final. Uma plataforma
desenvolvida internamente, chamada PLAY, suporta os jogos, agindo como um repositório
para os dados coletados e dando aos terapeutas uma interface para interagir e ajustar os
parâmetros do jogo.
Os jogos utilizam diferentes métodos de interação, além do habitual teclado e rato,
para permitir que os pacientes realizem exercícios que simulam os que são feitos nas
sessões de terapia tradicional atuais. Usando controladores comerciais, "prontos para uso",
como a balance board e o dance mat, podemos traduzir de forma mais natural movimentos
da vida real em movimentos de personagens no espaço virtual
Methods and metrics for the improvement of the interaction and the rehabilitation of cerebral palsy through inertial technology
Cerebral palsy (CP) is one of the most limiting disabilities in childhood, with 2.2 cases
per 1000 1-year survivors. It is a disorder of movement and posture due to a defect or
lesion of the immature brain during the pregnancy or the birth. These motor limitations
appear frequently in combination with sensory and cognitive alterations generally result
in great difficulties for some people with CP to manipulate objects, communicate and
interact with their environment, as well as limiting their mobility.
Over the last decades, instruments such as personal computers have become a popular
tool to overcome some of the motor limitations and promote neural plasticity, especially
during childhood. According to some estimations, 65% of youths with CP that present
severely limited manipulation skills cannot use standard mice nor keyboards. Unfortunately,
even when people with CP use assistive technology for computer access, they face
barriers that lead to the use of typical mice, track balls or touch screens for practical
reasons. Nevertheless, with the proper customization, novel developments of alternative
input devices such as head mice or eye trackers can be a valuable solution for these
individuals.
This thesis presents a collection of novel mapping functions and facilitation algorithms
that were proposed and designed to ease the act of pointing to graphical elements on
the screen—the most elemental task in human-computer interaction—to individuals with
CP. These developments were implemented to be used with any head mouse, although
they were all tested with the ENLAZA, an inertial interface. The development of such
techniques required the following approach:
Developing a methodology to evaluate the performance of individuals with CP in
pointing tasks, which are usually described as two sequential subtasks: navigation
and targeting.
Identifying the main motor abnormalities that are present in individuals with CP
as well as assessing the compliance of these people with standard motor behaviour
models such as Fitts’ law.
Designing and validating three novel pointing facilitation techniques to be implemented
in a head mouse. They were conceived for users with CP and muscle
weakness that have great difficulties to maintain their heads in a stable position.
The first two algorithms consist in two novel mapping functions that aim to facilitate
the navigation phase, whereas the third technique is based in gravity wells
and was specially developed to facilitate the selection of elements in the screen.
In parallel with the development of the facilitation techniques for the interaction
process, we evaluated the feasibility of use inertial technology for the control of
serious videogames as a complement to traditional rehabilitation therapies of posture
and balance. The experimental validation here presented confirms that this
concept could be implemented in clinical practice with good results.
In summary, the works here presented prove the suitability of using inertial technology
for the development of an alternative pointing device—and pointing algorithms—based
on movements of the head for individuals with CP and severely limited manipulation
skills and new rehabilitation therapies for the improvement of posture and balance. All
the contributions were validated in collaboration with several centres specialized in CP
and similar disorders and users with disability recruited in those centres.La parálisis cerebral (PC) es una de las deficiencias más limitantes de la infancia, con
un incidencia de 2.2 casos por cada 1000 supervivientes tras un año de vida. La PC
se manifiesta principalmente como una alteración del movimiento y la postura y es
consecuencia de un defecto o lesión en el cerebro inmaduro durante el embarazo o el
parto. Las limitaciones motrices suelen aparecer además en compañía de alteraciones
sensoriales y cognitivas, lo que provoca por lo general grandes dificultades de movilidad,
de manipulación, de relación y de interacción con el entorno.
En las últimas décadas, el ordenador personal se ha extendido como herramienta para la
compensación de parte de estas limitaciones motoras y como medio de promoción de la
neuroplasticidad, especialmente durante la infancia. Desafortunadamente, cerca de un
65% de las personas PC que son diagnosticadas con limitaciones severas de manipulación
son incapaces de utilizar ratones o teclados convencionales. A veces, ni siquiera la
tecnología asistencial les resulta de utilidad ya que se encuentran con impedimentos que
hacen que opten por usar dispositivos tradicionales aun sin dominar su manejo. Para
estas personas, los desarrollos recientes de ratones operados a través de movimientos
residuales con la cabeza o la mirada podrían ser una solución válida, siempre y cuando
se personalice su manejo.
Esta tesis presenta un conjunto de novedosas funciones de mapeo y algoritmos de facilitaci
ón que se han propuesto y diseñado con el ánimo de ayudar a personas con PC
en las tareas de apuntamiento de objetos en la pantalla —las más elementales dentro
de la interacción con el ordenador. Aunque todas las contribuciones se evaluaron con
la interfaz inercial ENLAZA, desarrollada igualmente en nuestro grupo, podrían ser
aplicadas a cualquier ratón basado en movimientos de cabeza. El desarrollo de los
trabajos se resume en las siguientes tareas abordadas:
Desarrollo de una metodología para la evaluación de la habilidad de usuarios con
PC en tareas de apuntamiento, que se contemplan como el encadenamiento de dos
sub-tareas: navegación (alcance) y selección (clic).
Identificación de los tipos de alteraciones motrices presentes en individuos con PC
y el grado de ajuste de éstos a modelos estándares de comportamiento motriz como
puede ser la ley de Fitts.
Propuesta y validación de tres técnicas de facilitación del alcance para ser implementadas
en un ratón basado en movimientos de cabeza. La facilitación se ha centrado
en personas que presentan debilidad muscular y dificultades para mantener
la posición de la cabeza. Mientras que los dos primeros algoritmos se centraron
en facilitar la navegación, el tercero tuvo como objetivo ayudar en la selección a
través de una técnica basada en pozos gravitatorios de proximidad.
En paralelo al desarrollo de estos algoritmos de facilitación de la interacción, evaluamos
la posibilidad de utilizar tecnología inercial para el control de videojuegos en
rehabilitación. Nuestra validación experimental demostró que este concepto puede
implementarse en la práctica clínica como complemento a terapias tradicionales de
rehabilitación de la postura y el equilibrio.
Como conclusión, los trabajos desarrollados en esta tesis vienen a constatar la idoneidad
de utilizar sensores inerciales para el desarrollo de interfaces de accesso alternativo al
ordenador basados en movimientos residuales de la cabeza para personas con limitaciones
severas de manipulación. Esta solución se complementa con algoritmos de facilitación
del alcance. Por otra parte, estas soluciones tecnológicas de interfaz con el ordenador
representan igualmente un complemento de terapias tradicionales de rehabilitación de
la postura y el equilibrio. Todas las contribuciones se validaron en colaboración con
una serie de centros especializados en parálisis cerebral y trastornos afines contando con
usuarios con discapacidad reclutados en dichos centros.This thesis was completed in the Group of Neural and Cognitive Engineering (gNEC) of the CAR UPM-CSIC with the financial support of the FP7 Framework EU Research Project ABC (EU-2012-287774), the IVANPACE Project (funded by Obra Social de Caja Cantabria, 2012-2013), and the Spanish Ministry of Economy and Competitiveness in the framework of two projects: the Interplay Project (RTC-2014-1812-1) and most
recently the InterAAC Project (RTC-2015-4327-1)Programa Oficial de Doctorado en Ingeniería Eléctrica, Electrónica y AutomáticaPresidente: Juan Manuel Belda Lois.- Secretario: María Dolores Blanco Rojas.- Vocal: Luis Fernando Sánchez Sante
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
The use of home-based digital technology to support post-stroke upper limb rehabilitation: A scoping review
Objective. To identify, map and synthesize the extent and nature of existing studies on the use of home-based digital technology to support post-stroke upper limb rehabilitation.Data sources. A comprehensive literature search was completed between 30 May 2022 and 05 April 2023, from seven online databases (CINAHL, Cochrane Library, PubMed, ScienceDirect, IEEExplore, Web of Science and PEDro), Google Scholar and the reference lists of already identified articles.Methods. A scoping review was conducted according to Arksey and O’Malley (2005), and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. All English-language studies reporting on the use of home-based digital technology to support upper limb post-stroke rehabilitation were eligible for inclusion.Results. The search generated a total of 1895 records, of which 76 articles met the inclusion criteria. Of these, 52 were experimental studies and the rest, qualitative, case series and case studies. Of the overall 2149 participants, 2028 were stroke survivors with upper limb impairment. The majority of studies were aimed at developing, designing and/or assessing the feasibility, acceptability and efficacy of a digital system for poststroke upper limb rehabilitation in home settings. The thematic analysis found six major categories: Tele-rehabilitation (n = 29), games (n = 45), virtual reality (n = 26), sensor (n = 22), mobile technology (n = 22), and robotics (n = 8).Conclusion. The digital technologies used in post-stroke upper limb rehabilitation were multimodal, and system-based comprising telerehabilitation, gamification, virtual reality, mobile technology, sensors and robotics. Furthermore, future research should focus to determine the effectiveness of these modalities
Proceedings of the 9th international conference on disability, virtual reality and associated technologies (ICDVRAT 2012)
The proceedings of the conferenc
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