Assessing the immediate impact of a movement tracking-based intervention for unilateral spatial neglect experienced by stroke survivors

Includes bibliographical references.2015 Summer.To view the abstract, please see the full text of the document

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

The Existing Of Supportive Technology Tools For Hand Motor-Impaired User: A Systematic Literature Review

Diabetes Users who encounter physical and motor impairment persist in struggle to archive the target of performance in the form of hand gesture improvement. Hand gestures are allowed people to give a sign as a communicate medium and to hold, grip and pinch the object. The low ability of hands makes the movement or gesture limited and difficult for them to do the routine activity. This review aim to evaluate the effect of whether the existing supportive technology can assist the hand motor-impairment user. A total of 31 papers were identified and only 10 papers were selected in this review. In this paper, the existing supportive technology tools in the field of motor rehabilitation which is focused on hand motor-impaired users are reviewed. The existing of supportive technology for hand motor-impaired user is not a new field as the paper reviewed from 2014 until 2019. There are few innovations or initiatives from the previous research and study that give a positive effect on the users were identified. Future research is needed to further appreciate and improved the desired role of people with hands motor-impaired in meaningful technology development

Integrating the Nintendo Wii into Therapy: Resources for Occupational Therapy Practitioners

Therapists have the challenge of identifying a variety of interesting, meaningful, and purposeful intervention activities for individuals needing rehabilitation services (Weiss, Rand, Katz, & Kizony, 2004). The purpose of this project was to develop educational resources for occupational therapists on the integration of the Nintendo Wii as an intervention. An extensive literature review was conducted using PubMed, SCOPUS, CINAHL, professional journals, and news articles to investigate the health related effects of utilizing virtual reality and video games in the rehabilitation process. Currently, there is minimal research identifying the benefits of video games in occupational therapy practice and no protocols were found to assist occupational therapists with implementing the Nintendo Wii into occupational therapy practice. Resources were developed to educate occupational therapy practitioners on integrating the Nintendo Wii as an occupational therapy intervention. Resources include an educational in-service, a system set-up guide, instructions for creating a Mii character, an activity analysis of the Nintendo Wii Sports games, suggested intervention chart for select performance skills, and case scenario application activities. The educational inservice provides information on the role of virtual reality in rehabilitation, benefits and precautions/contraindications of virtual reality, identification of Nintendo Wii equipment, and system set-up instructions. The Adult Learning Theory and the Model of Human Occupation were utilized in the development of the product. This educational in-service provides occupational therapists with information on the integration of the Nintendo Wii. It provides foundational knowledge allowing therapists to adapt and modify the use of the Nintendo Wii to facilitate occupational performance and client-centered practice. The authors of this scholarly project recommend that the Nintendo Wii be used as an adjunct to occupation-based intervention. It is also recommended that more research be conducted regarding the use of video games, specifically the Nintendo Wii, in occupational therapy to determine the efficacy of this type of approach

Technology-supported training of arm-hand skills in stroke

Impaired arm-hand performance is a serious consequence of stroke that is associated with reduced self-efficacy and poor quality of life. Task-oriented arm training is a therapy approach that is known to improve skilled arm-hand performance, even in chronic stages after stroke. At the start of this project, little knowledge had been consolidated regarding taskoriented arm training characteristics, especially in the field of technology-supported rehabilitation. The feasibility and effects of technology-supported client-centred task-oriented training on skilled arm-hand performance had not been investigated but to a very limited degree. Reviewing literature on rehabilitation and motor learning in stroke led to the identification of therapy oriented criteria for rehabilitation technology aiming to influence skilled arm-hand performance (chapter 2). Most rehabilitation systems reported in literature to date are robotic systems that are aimed at providing an engaging exercise environment and feedback on motor performance. Both, feedback and engaging exercises are important for motivating patients to perform a high number of exercise repetitions and prolonged training, which are important factors for motor learning. The review also found that current rehabilitation technology is focussed mainly on providing treatment at a function level, thereby improving joint range of motion, muscle strength and parameters such as movement speed and smoothness of movement during analytical movements. However, related research has found no effects of robot-supported training at the activity level. The review concluded that a challenge exists for upper extremity rehabilitation technology in stroke patients to also provide more patienttailored task-oriented arm-hand training in natural environments to support the learning of skilled arm-hand performance. Besides mapping the strengths of different technological solutions, the use of outcome measures and training protocols needs to become more standardized across similar interventions, in order to help determine which training solutions are most suitable for specific patient categories. Chapter 4 contributes towards such a standardization of outcome measurement. A concept is introduced which may guide the clinician/researcher to choose outcome measures for evaluating specific and generalized training effects. As an initial operationalization of this concept, 28 test batteries that have been used in 16 task-oriented training interventions were rated as to whether measurement components were measured by the test. Future research is suggested that elaborates the concept with information on the relative weighing of components in each test, with more test batteries (which may lead to additional components) and by adding more test properties into the concept (e.g. psychometric properties of the tests, possible floor- or ceiling effects). Task-oriented training is one of the training approaches that has been shown to be beneficial for skilled arm-hand performance after stroke. Important mechanisms for motor learning that are identified are patient motivation for such training, and the learning of efficient goaloriented movement strategies and task-specific problem solving. In this thesis we operationalize task-oriented training in terms of 15 components (chapter 3). A systematic review that included 16 randomized controlled trials using task-oriented training in stroke patients, evaluated the effects of these training components on skilled arm-hand performance. The number of training components used in an intervention aimed at improving arm-hand performance after stroke was not associated with the post-treatment effect size. Distributed practice and feedback were associated with the largest post-intervention effect sizes. Random practice and use of clear functional training goals were associated with the largest follow-up effect sizes. It may be that training components that optimize the storage of learned motor performance in the long-term memory are associated with larger treatment effects. Unfortunately, feedback, random practice and distributed practice were reported in very few of the included randomized controlled trials (in only 6,3 and 1 out of the 17 studies respectively). Client-centred training, i.e. training on exercises that support goals that are selected by the patients themselves, improves patient motivation for training. Motivation in turn has proven to positively influence motor learning in stroke patients, as attention during training is heightened and storage of information in the long-term memory improves. Chapter 5 reports on an interview of 40 stroke patients, investigating into training preferences. A list of 46 skills, ranked according to descending training preference scores, was provided that can be used for implementation of exercises in rehabilitation technology, in order for technologysupported training to be client-centred. Chapter 6 introduces T-TOAT, a technology supported task-oriented arm training method that was developed together with colleagues at Adelante (Hoensbroek, NL). T-TOAT enables the implementation of exercises that support task-oriented training in rehabilitation technology. The training method is applicable for different technological systems, e.g. robot and sensor systems, or in combination with functional electrical stimulation, etc. To enable the use of TTOAT for training with the Haptic Master Robot (MOOG-FCS, NL), special software named Haptic TOAT was developed in Adelante together with colleagues at the Centre of Technology in Care of Zuyd University (chapter 6). The software enables the recording of the patient’s movement trajectories, given task constraints and patient possibilities, using the Haptic Master as a recording device. A purpose-made gimbal was attached to the endeffector, leaving the hand free for the use and manipulating objects. The recorded movement can be replayed in a passive mode or in an active mode (active, active-assisted or activeresisted). Haptic feedback is provided when the patient deviates from the recorded movement trajectory, as the patient receives the sensation of bouncing into a wall, as well as feeling a spring that pulls him/her back to the recorded path. The diameter of the tunnel around the recorded trajectory (distance to the wall), and the spring force can be adjusted for each patient. An ongoing clinical trial in which chronic stroke patients train with Haptic-TOAT examines whether Haptic Master provides additional value compared to supporting the same exercises by video-instruction only. Together with Philips Research Europe (Eindhoven,Aachen), the T-TOAT method has been implemented in a sensor based prototype, called Philips Stroke Rehabilitation Exerciser. This system included movement tracking sensors and an exercise board interacting with real life objects. A very strong feature of the system is that feedback is provided to patients (real-time and after exercise performance), based on a comparison of the patient’s exercise performance to individual targets set by the therapist. Chapter 7 reports on a clinical trial investigating arm-hand treatment outcome and patient motivation for technology-supported task-oriented training in chronic stroke patients. It was found that 8 weeks of T-TOAT training improved arm-hand performance in chronic stroke patients significantly on Fugl-Meyer, Action Research Arm Test, and Motor Activity Log. An improvement was found in health-related quality of life. Training effects lasted at least 6 months post-training. Participants reported feeling intrinsically motivated and competent to use the system. The results of this study showed that T-TOAT is feasible. Despite the small number of stroke patients tested (n=9), significant and clinically relevant improvements in skilled arm-hand performance were found. In conclusion, this thesis has made several contributions. It motivated the need for clientcentred task-oriented training, which it has operationalized in terms of 15 components. Four of these 15 components were identified as most beneficial for the patient. A prioritized inventory of arm-hand training preferences of stroke patients was compiled by means of an interview study of 40 subacute and chronic stroke patients. T-TOAT, a method for technology-supported, client-centred, task-oriented training, was conceived and implemented in two target technologies (Haptic Master and Philips Stroke Rehabilitation Exerciser). Its feasibility was demonstrated in a clinical trial showing substantial and durable benefits for the stroke patients. Finally, the thesis contributes towards the standardization of outcome measures which is necessary for charting progress and guiding future developments of technology-supported stroke rehabilitation. Methodological considerations were discussed and several suggestions for future research were presented. The variety of treatment approaches and the various ways of support and challenge that are offered by existing rehabilitation technologies hold a large potential for offering a variety of extra training opportunities to stroke patients that may improve their arm-hand performance. Such solutions will be of increasing importance, to alleviate therapists and reduce economic pressure on the health care system, as the stroke incidence is increasing rapidly over the coming decades

VRShape: A Virtual Reality Tool for Shaping Movement Compensation

The majority of persons living with chronic stroke experience some form of upper extremity motor impairment that affects their functional movement, performance of meaningful activities, and participation in the flow of daily life. Stroke survivors often compensate for these impairments by adapting their movement patterns to incorporate additional degrees of freedom at new joints and body segments. One of the most common compensatory movements is the recruitment of excessive trunk flexion when reaching with the affected upper extremity. Long-term use of these compensations may lead to suboptimal motor recovery and chronic pain or injury due to overuse. Rehabilitation focuses on repetitive practice with the impaired limb to stimulate motor learning and neuroplasticity; however, few interventions achieve the required repetition dose or address the possible negative effects of compensatory movements. Virtual reality (VR) is an emerging tool in rehabilitation science that may be capable of (1) objectively measuring compensation during upper extremity movement, (2) motivating persons to perform large doses of repetitive practice through the integration of virtual environments and computer games, and (3) providing the basis for a motor intervention aimed at improving motor performance and incrementally reducing, or shaping, compensation. The purpose of this project was to develop and test a VR tool with these capabilities for shaping movement compensation for persons with chronic stroke, and to achieve this we performed three separate investigations (Chapters 2-4).First, we investigated the validity and reliability of two generations of an off-the-shelf motion sensor, namely the Microsoft Kinect, for measuring trunk compensations during reaching (Chapter 2). A small group of healthy participants performed various reaching movements on two separate days while simultaneously being recorded by the two sensors and a third considered to be the gold standard. We found that the second generation Kinect sensor was more accurate and showed greater validity for measuring trunk flexion relative to the gold standard, especially during extended movements, and therefore recommended that sensor for future VR development. Research with a more heterogeneous and representative population, such as persons with stroke, will further improve the evaluation of these sensors in future work.Second, we tested a newly-designed VR tool, VRShape, for use during a single session of upper extremity movement practice (Chapter 3). VRShape integrates the Microsoft Kinect and custom software to convert upper extremity movements into the control of various virtual environments and computer games while providing real-time feedback about compensation. A small group of participants with stroke used VRShape to repetitively perform reaching movements while simultaneously receiving feedback concerning their trunk flexion relative to a calibrated threshold. Our tool was able to elicit a large number of successful reaches and limit the amount of trunk flexion used during a single practice session while remaining usable, motivating, and safe. However, areas of improvement were identified relative to the efficiency of the software and the variety of virtual environments available. Third, we implemented VRShape over the course of a motor intervention for persons with stroke and evaluated its feasibility and effect on compensation during reaching tasks (Chapter 4). A small group of participants took part in 18 interventions session using VRShape for repetitive reaching practice with incrementally shaped trunk compensation. Trunk flexion decreased significantly and reaching kinematics improved significantly as a result of the intervention. Even with extended use, participants were able to complete intense practice and thousands of repetitions while continually rating the system as usable, motivating, engaging, and safe. Our VR tool demonstrated feasibility and preliminary efficacy within a small study, but future work is needed to identify its ideal applications and address its limitations. In summary, this project shows that use of a VR tool incorporating an accurate sensor (Chapter 2) and feedback from initial testing (Chapter 3) is capable of changing the amount of trunk flexion used during reaching movements for persons with stroke (Chapter 4). More research is needed to establish its efficacy and effectiveness, but improvements in motor recovery and associated decreases in compensation associated with the use of VRShape are important rehabilitation goals that may lead to improved participation and quality of life for persons living with long-term impairments due to chronic stroke

State of Evidence for Everyday Technology Use in Upper Extremity Motor Recovery Post-Stroke

The research team, in consultation with collaborating clinician Sarah Bicker, an OTR/L at Harborview Medical Center, researched everyday technology applications. The team conducted a systematic review considering what evidence exists about the effectiveness of commercially available everyday technology (ET) for improving upper extremity motor control and/or motivation to participate in therapy in clients post-stroke. The evidence was promising in support of the use of ET as indicated by improved upper extremity motor control outcomes and client and clinician reports of satisfaction, motivation, and engagement in post-stroke rehabilitation. Clinicians should consider the benefits of implementing ET for upper extremity motor recovery for clients post-stroke. Due to the changing nature of ET, the research team chose to minimize recommendations of specific applications. Instead, the team created a decision chart to help therapists identify what elements to consider when choosing a technology application to address the upper extremity motor control conditions/impairments with clients post-stroke. The decision tree considers performance skills according to the Occupational Therapy Practice Framework (OTPF), and includes current applications as examples. The research findings and decision chart were presented as an in-service to occupational therapy (OT) practitioners at Harborview Medical Center. Feedback from the in-service indicated that practitioners were positively receptive to the information provided and were more likely to incorporate ET into rehabilitation with their clients as a result of learning the research findings. Reviewing the literature indicates the need for more research regarding technology use for rehabilitation of individuals post-stroke

Challenges and opportunities for the future of Brain-Computer Interface in neurorehabilitation

Brain-computer interfaces (BCIs) provide a unique technological solution to circumvent the damaged motor system. For neurorehabilitation, the BCI can be used to translate neural signals associated with movement intentions into tangible feedback for the patient, when they are unable to generate functional movement themselves. Clinical interest in BCI is growing rapidly, as it would facilitate rehabilitation to commence earlier following brain damage and provides options for patients who are unable to partake in traditional physical therapy. However, substantial challenges with existing BCI implementations have prevented its widespread adoption. Recent advances in knowledge and technology provide opportunities to facilitate a change, provided that researchers and clinicians using BCI agree on standardisation of guidelines for protocols and shared efforts to uncover mechanisms. We propose that addressing the speed and effectiveness of learning BCI control are priorities for the field, which may be improved by multimodal or multi-stage approaches harnessing more sensitive neuroimaging technologies in the early learning stages, before transitioning to more practical, mobile implementations. Clarification of the neural mechanisms that give rise to improvement in motor function is an essential next step towards justifying clinical use of BCI. In particular, quantifying the unknown contribution of non-motor mechanisms to motor recovery calls for more stringent control conditions in experimental work. Here we provide a contemporary viewpoint on the factors impeding the scalability of BCI. Further, we provide a future outlook for optimal design of the technology to best exploit its unique potential, and best practices for research and reporting of findings

Técnicas y métodos para el seguimiento de la evolución de la habilidad motriz fina de miembro superior : revisión de la literatura

Introduction: This review article is the product of research on the methods, techniques and devices used in the measurement of fine motor skills of upper limbs and its respective evolution, developed at Universidad del Cauca in 2018. Problem: Objective measurement of the evolution of upper limb motor skills in the rehabilitation processes.  Objective: To identify the conventional techniques and electronic devices used in the measurement of the evolution of upper limb motor ability.  Methodology: Four scientific databases were reviewed in addition to the Google Scholar search engine. The keywords used for the search were: "fine motor skills", "hand measurement", "hand rehabilitation"and "hand function", among others.  Results: Approximately 3840 articles related to the subject were found. When applying the exclusion criteria, the article number to be revised was reduced to 63, which were analyzed in the present review. Conclusions: The tools applied by health professionals are convenient due to their rapid execution and easy access, however they can be subject to human error since they depend on the experience of the user. Electronic systems present objective measurements, however, their complexity and cost are high. Originality: This work presents information on the therapeutic techniques and technological devices used, in certain pathologies, for the evaluation of upper limb motor ability. Limitations: Not all articles analyzed have a detailed description of the people in which the studies were conducted.Introducción: El artículo es producto de una investigación sobre los métodos, técnicas y dispositivos utilizados en la medición de la habilidad motriz fina de miembro superior y su respectiva evolución, desarrollada en la Universidad del Cauca en el año 2018. Problema: Medición objetiva la evolución de la habilidad motriz de miembro superior en los procesos de rehabilitación. Objetivo: Identificar las técnicas convencionales y dispositivos electrónicos utilizados en la medición de la evolución de la habilidad motriz de miembro superior. Metodología: Se revisaron cuatro bases de datos científicas además del motor de búsqueda Google Académico. Para la búsqueda se utilizaron las palabras clave: “fine motor skills”, “hand measurement”, “hand rehabilitation”, “hand function”, entre otras. Resultados: Se encontraron aproximadamente 3840 artículos relacionados con la temática. Al aplicar los criterios de exclusión el número de artículo a revisar se redujo a 63, los cuales fueron analizados en la presente revisión. Conclusiones: Las herramientas aplicadas por profesionales de la salud son convenientes debido a su rápida ejecución y fácil acceso, sin embargo pueden estar sujetas al error humano puesto que dependen de la experiencia de quien las utiliza. Los sistemas electrónicos, presentan mediciones objetivas, no obstante, su complejidad y costo es elevado. Originalidad: Este trabajo presenta información sobre las técnicas terapéuticas y dispositivos tecnológicos, utilizados en ciertas patologías, para la evaluación de la habilidad motriz de miembro superior. Limitaciones: No todos los artículos analizados cuentan con una descripción detallada de las personas en las que los estudios fueron realizados