A review of wearable motion tracking systems used in rehabilitation following hip and knee replacement

Clinical teams are under increasing pressure to facilitate early hospital discharge for total hip replacement and total knee replacement patients following surgery. A wide variety of wearable devices are being marketed to assist with rehabilitation following surgery. A review of wearable devices was undertaken to assess the evidence supporting their efficacy in assisting rehabilitation following total hip replacement and total knee replacement. A search was conducted using the electronic databases including Medline, CINAHL, Cochrane, PsycARTICLES, and PubMed of studies from January 2000 to October 2017. Five studies met the eligibility criteria, and all used an accelerometer and a gyroscope for their technology. A review of the studies found very little evidence to support the efficacy of the technology, although they show that the use of the technology is feasible. Future work should establish which wearable technology is most valuable to patients, which ones improve patient outcomes, and the most economical model for deploying the technolog

Performance adaptive training control strategy for recovering wrist movements in stroke patients: a preliminary, feasibility study

<p>Abstract</p> <p>Background</p> <p>In the last two decades robot training in neuromotor rehabilitation was mainly focused on shoulder-elbow movements. Few devices were designed and clinically tested for training coordinated movements of the wrist, which are crucial for achieving even the basic level of motor competence that is necessary for carrying out ADLs (activities of daily life). Moreover, most systems of robot therapy use point-to-point reaching movements which tend to emphasize the pathological tendency of stroke patients to break down goal-directed movements into a number of jerky sub-movements. For this reason we designed a wrist robot with a range of motion comparable to that of normal subjects and implemented a self-adapting training protocol for tracking smoothly moving targets in order to facilitate the emergence of smoothness in the motor control patterns and maximize the recovery of the normal RoM (range of motion) of the different DoFs (degrees of Freedom).</p> <p>Methods</p> <p>The IIT-wrist robot is a 3 DoFs light exoskeleton device, with direct-drive of each DoF and a human-like range of motion for Flexion/Extension (FE), Abduction/Adduction (AA) and Pronation/Supination (PS). Subjects were asked to track a variable-frequency oscillating target using only one wrist DoF at time, in such a way to carry out a progressive splinting therapy. The RoM of each DoF was angularly scanned in a staircase-like fashion, from the "easier" to the "more difficult" angular position. An Adaptive Controller evaluated online performance parameters and modulated both the assistance and the difficulty of the task in order to facilitate smoother and more precise motor command patterns.</p> <p>Results</p> <p>Three stroke subjects volunteered to participate in a preliminary test session aimed at verify the acceptability of the device and the feasibility of the designed protocol. All of them were able to perform the required task. The wrist active RoM of motion was evaluated for each patient at the beginning and at the end of the test therapy session and the results suggest a positive trend.</p> <p>Conclusion</p> <p>The positive outcomes of the preliminary tests motivate the planning of a clinical trial and provide experimental evidence for defining appropriate inclusion/exclusion criteria.</p

Playful ARM hand training after stroke

This paper presents the design of an interactive system designed to support arm-hand rehabilitation of stroke survivors through gaming. It consists in an interactive tabletop game and wearable sensing technology that provides feedback to patients to assist with the correct execution of movements. We present the motivation for this design, the main choices made during the design process, an initial evaluation, and an outline of ongoing work for developing this system further

Wearable technology for posture monitoring at the workplace

\u3cp\u3eProlonged strenuous postures in occupational context may lead to low back pain. Avoiding such occurrences is known to help prevent low back pain episodes or may contribute to recovery. This research concerns wearable sensing technology to support posture monitoring for the prevention of occupational low back pain and, more specifically, how smart garments can help nurses avoid prolonged strenuous postures at work. We introduce BackUp, a system comprising of a smart shirt connected to a smartphone application that provides feedback and advice on low back posture, and we describe its design and implementation. We report on a series of studies that contributed to its development: an anthropometric study (N = 60) to decide on the placement of sensors on the lower spine; a brief field study aimed at evaluating user experience and attitudes towards the shirt (N = 17), and a second field study intended to assess its effectiveness in helping nurses avoid prolonged strenuous postures at work (N = 13). These studies demonstrate how smart clothing can support posture feedback in real life conditions. While the results from the field studies are encouraging regarding the potential of this technology, further research is needed to establish the durability of the behaviour modification achieved through smart garments.\u3c/p\u3

Rehabilitation therapists as software creators? Introducing end-user development in a healthcare setting

The authors discuss the feasibility of End-User Development (EUD) for non-information workers in the context of neurorehabilitation. The authors present a three-week long field deployment of TagTrainer, a system that enables therapists to create, share, and use exercises for arm-hand training with a tangible interactive tabletop application. The experiences suggest that therapists are capable and motivated to create content that is tailored to the training needs of their patients. Three key challenges are identified for enabling EUD practices in a clinical setting, which appear to have a broader relevance outside the specific domain of neurorehabilitation: more support for retrieval and sharing of existing solutions developed by end users, guiding end-user developers to ensure usability and software quality for their creations, and aligning with the revenue model of the organization

TagTrainer : supporting exercise variability and tailoring in technology supported upper limb training

Background Rehabilitation technology for upper limb training can potentially increase the amount, duration, and quality of therapy offered to patients by targeting the needs of individual patients. Empirical evaluations of such technologies focus on clinical effectiveness; however, little is known regarding the implications of their implementation in daily practice. Tailoring training content to patients requires active participation by therapists, and requires an extension of their role to include authoring and modifying exercises. It is not yet known whether this is feasible, and the socio-technical requirements that will make it successful in practice have not yet been explored. The current study investigates the extent to which therapists can take the role of authoring patient-specific training content and whether effort savings can be achieved by sharing the created content. Method We present TagTrainer: an interactive tabletop system for rehabilitation that can be operated by manipulating every day physical objects in order to carry out exercises that simulate daily living tasks. TagTrainer supports therapists in creating their own exercises that fit individual patient needs, in adjusting existing exercises, and in putting together personalized exercise programs for and with patients. Four therapists in stroke- and paraplegia-rehabilitation have used TagTrainer for three weeks. Semi-structured interviews were conducted with the therapists, questionnaires were administered to them, and observation notes and usage logs were collected. Results A total of 20 exercises were created from scratch, while another three exercises were created as variations of the existing ones. Importantly, all these exercises were created to address specific needs that patients expressed. The patients found the exercises motivating and these exercises were integrated into their regular training. Conclusions TagTrainer can support arm-hand rehabilitation training by increasing therapy variability and tailoring. Therapists consider TagTrainer most suited for group sessions where they supervise many patients at once. Therapists are motivated and are able to, with minimal training, create and tailor exercises for patients fitting individual needs and capabilities. Future research will examine the socio-technical conditions that will encourage therapists to contribute and share training content, and provide the peer support needed for the adoption of a new technology

Influence of task-oriented training content on skilled arm-hand performance in stroke:a systematic review

Objective. This review evaluates the underlying training components currently used in task-oriented training and assesses the effects of these components on skilled arm—hand performance in patients after a stroke. Methods. A computerized systematic literature search in 5 databases (PubMed, CINAHL, EMBASE, PEDro, and Cochrane) identified randomized clinical trials, published through March 2009, evaluating the effects of task-oriented training. Relevant article references listed in publications included were also screened. The methodological quality of the selected studies was assessed with the Van Tulder Checklist. For each functional outcome measure used, the effect size (bias corrected Hedges’s g) was calculated. Results. The intervention results in 528 patients (16 studies) were studied. From these, 15 components were identified to characterize task-oriented training. An average of 7.8 (standard deviation = 2.1) components were used in the included trials. There was no correlation between the number of task-oriented training components used in a study and the treatment effect size. “Distributed practice” and “feedback” were associated with the largest postintervention effect sizes. “Random practice” and “use of clear functional goals” were associated with the largest follow-up effect sizes. Conclusion. The task-oriented training was operationalized with 15 components. The number of components used in an intervention aimed at improving arm—hand performance after stroke was not associated with the posttreatment effect size. Certain components, which optimize storage of learned motor performance in the long-term memory, occurred more in studies with larger treatment effects

CONTRAST : gamification of arm-hand training for stroke survivors

This paper describes the design of a serious game that supports arm-hand training for stroke survivors aiming to render rehabilitation training enjoyable and sustainable. The design of this game was based on combining well-known game-design principles and principles of task-oriented training. Most importantly the game involves the manipulation of every day physical objects and the game's difficulty is dynamically adapted to the patient's performance. The game was evaluated in actual training with two stroke patients for a period of a week. Their feedback shows the promise of this approach; the study motivates the further development of game content and further extension of adaptability features

Interactive wearable systems for upper body: a systematic review rehabilitation

The development of interactive rehabilitation technologies which rely on wearable-sensing for upper body rehabilitation is attracting increasing research interest. This paper reviews related research with the aim: 1) To inventory and classify interactive wearable systems for movement and posture monitoring during upper body rehabilitation, regarding the sensing technology, system measurements and feedback conditions; 2) To gauge the wearability of the wearable systems; 3) To inventory the availability of clinical evidence supporting the effectiveness of related technologies.\u3cbr/\u3e\u3cbr/\u3e\u3cbr/\u3eMethod\u3cbr/\u3e\u3cbr/\u3eA systematic literature search was conducted in the following search engines: PubMed, ACM, Scopus and IEEE (January 2010–April 2016).\u3cbr/\u3e\u3cbr/\u3e\u3cbr/\u3eResults\u3cbr/\u3e\u3cbr/\u3eForty-five papers were included and discussed in a new cuboid taxonomy which consists of 3 dimensions: sensing technology, feedback modalities and system measurements. Wearable sensor systems were developed for persons in: 1) Neuro-rehabilitation: stroke (n = 21), spinal cord injury (n = 1), cerebral palsy (n = 2), Alzheimer (n = 1); 2) Musculoskeletal impairment: ligament rehabilitation (n = 1), arthritis (n = 1), frozen shoulder (n = 1), bones trauma (n = 1); 3) Others: chronic pulmonary obstructive disease (n = 1), chronic pain rehabilitation (n = 1) and other general rehabilitation (n = 14). Accelerometers and inertial measurement units (IMU) are the most frequently used technologies (84% of the papers). They are mostly used in multiple sensor configurations to measure upper limb kinematics and/or trunk posture. Sensors are placed mostly on the trunk, upper arm, the forearm, the wrist, and the finger. Typically sensors are attachable rather than embedded in wearable devices and garments; although studies that embed and integrate sensors are increasing in the last 4 years. 16 studies applied knowledge of result (KR) feedback, 14 studies applied knowledge of performance (KP) \u3cbr/\u3efeedback and 15 studies applied both in various modalities. 16 studies have conducted their evaluation with patients and reported usability tests, while only three of them conducted clinical trials including one randomized clinical trial.\u3cbr/\u3e\u3cbr/\u3e\u3cbr/\u3eConclusions\u3cbr/\u3e\u3cbr/\u3eThis review has shown that wearable systems are used mostly for the monitoring and provision of feedback on posture and upper extremity movements in stroke rehabilitation. The results indicated that accelerometers and IMUs are the most frequently used sensors, in most cases attached to the body through ad hoc contraptions for the purpose of improving range of motion and movement performance during upper body rehabilitation. Systems featuring sensors embedded in wearable appliances or garments are only beginning to emerge. Similarly, clinical evaluations are scarce and are further needed to provide evidence on effectiveness and pave the path towards implementation in clinical settings.\u3cbr/\u3e\u3cbr/\u3