Engagement Study of an Integrated Rehabilitation Robotic Tablet-Based Gaming System

© 2014 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other users, including reprinting/ republishing this material for advertising or promotional purposes, creating new collective works for resale or redistribution to servers or lists, or reuse of any copyrighted components of this work in other works.2014 IEEE Workshop on Advanced Robotics and its Social Impacts (ARSO), 11-13 September 2014. Evanston, IL.DOI: 10.1109/ARSO.2014.7020973Physical therapy is a common treatment for the rehabilitation of hemiparesis, or the weakness of one side of the body. However, a significant issue in the therapy process is that patients may struggle with motivation to complete the required therapy sessions. For this purpose, a rehabilitation gaming system was created that combines a hand rehabilitation robot with a gaming application on a tablet to promote engagement and discourage boredom. A study was also conducted to compare engagement between the gaming system and traditional therapeutic exercises. The results of this study show that participants prefer playing rehabilitation games more than they do exercising with traditional rehabilitation methods. On average, participants spent approximately four times longer playing the rehabilitation game before becoming bored than they did with traditional exercises. From their responses to the retrospective survey, the participants experienced significantly more enjoyment and engagement when exercising with the tablet game. They also experienced significantly less boredom. The participants unanimously agreed that if they were required to exercise their wrists for an hour a day, as is a normal requirement for patients in stroke therapy, that they would prefer to do so by playing the tablet game

Traumatic brain injury increases levels of miR-21 in extracellular vesicles: implications for neuroinflammation

Traumatic brain injury (TBI) is an important health concern and effective treatment strategies remain elusive. Understanding the complex multicellular response to TBI may provide new avenues for intervention. In the context of TBI, cell–cell communication is critical. One relatively unexplored form of cell–cell communication in TBI is extracellular vesicles (EVs). These membrane‐bound vesicles can carry many different types of cargo between cells. Recently, miRNA in EVs have been shown to mediate neuroinflammation and neuronal injury. To explore the role of EV‐associated miRNA in TBI, we isolated EVs from the brain of injured mice and controls, purified RNA from brain EVs, and performed miRNA sequencing. We found that the expression of miR‐212 decreased, while miR‐21, miR‐146, miR‐7a, and miR‐7b were significantly increased with injury, with miR‐21 showing the largest change between conditions. The expression of miR‐21 in the brain was primarily localized to neurons near the lesion site. Interestingly, adjacent to these miR‐21‐expressing neurons were activated microglia. The concurrent increase in miR‐21 in EVs with the elevation of miR‐21 in neurons, suggests that miR‐21 is secreted from neurons as potential EV cargo. Thus, this study reveals a new potential mechanism of cell–cell communication not previously described in TBI

Mapping alterations to the endogenous elemental distribution within the lateral ventricles and choroid plexus in brain disorders using X-ray fluorescence imaging

The choroid plexus and cerebral ventricles are critical structures for the production of cerebral spinal fluid (CSF) and play an important role in regulating ion and metal transport in the brain, however many aspects of its roles in normal physiology and disease states, such as psychiatric illness, remain unknown. The choroid plexus is difficult to examine in vivo, and in situ ex vivo, and as such has typically been examined indirectly with radiolabeled tracers or ex vivo stains, making measurements of the endogenous K+, Cl-, and Ca+ distributions unreliable. In the present study, we directly examined the distribution of endogenous ions and biologically relevant transition metals in the choroid plexus and regions surrounding the ventricles (ventricle wall, cortex, corpus callosum, striatum) using X-ray fluorescence imaging (XFI). We find that the choroid plexus was rich in Cl- and Fe while K+ levels increase further from the ventricle as Cl- levels decrease, consistent with the known role of ion transporters in the choroid plexus CSF production. A polyI:C offspring displayed enlarged ventricles, elevated Cl- surrounding the ventricles, and intraventricular calcifications. These observations fit with clinical findings in patients with schizophrenia and suggest maternal treatment with polyI:C may lead to dysfunctional ion regulation in offspring. This study demonstrates the power of XFI for examining the endogenous elemental distributions of the ventricular system in healthy brain tissue as well as disease models

Encouraging Specific Intervention Motions via a Robotic System for Rehabilitation of Hand Function: A Healthy Pilot Study

© 2014 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other users, including reprinting/ republishing this material for advertising or promotional purposes, creating new collective works for resale or redistribution to servers or lists, or reuse of any copyrighted components of this work in other works.2014 IEEE Symposium on Computational Intelligence in Robotic Rehabilitation and Assistive Technologies (CIR2AT 2014), 9-12 December 2014, Orlando, FL.DOI: 10.1109/CIRAT.2014.7009741A knowledge gap exists for how to improve hand rehabilitation after stroke using robotic rehabilitation methods, and non-robotic hand rehabilitation methods show only small patient improvements. A proposed solution for this knowledge gap is to integrate the strengths of three of the most favorable rehabilitation strategies for post-stroke rehabilitation of hand function, which are constraint-induced movement therapy (CIMT), high-intensity therapy, and repetitive task training, with a robotic rehabilitation gaming system. To create a system that is composed of collaborative therapy efforts, we must first understand how to encourage rehabilitation intervention motions. An experiment was conducted in which healthy participants were asked to complete six levels of a rehabilitation game, each level designed to encourage a specific therapeutic intervention, and a control, where participants were asked to complete undefined exercise motions. The results showed that participants’ motions were significantly different than the control while playing each of the levels. Upon comparing the actual paths of participants to the paths encouraged by the levels, it was discovered that the participants followed the intended path while encouragement was being provided for them to do so. When the encouraged motions required quick, hard motions, the participants would follow an aliased version of the intended path. This study suggests that robotic rehabilitation systems can not only change how a participant moves, but also encourage specific motions designed to mimic therapeutic interventions

An Adaptive Robotic Tablet Gaming System for Post-Stroke Hand Function Rehabilitation

Permission to make digital or hard copies of part or all of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage, and that copies bear this notice and the full citation on the first page. Copyrights for third-party components of this work must be honored. For all other uses, contact the owner/author(s). Copyright is held by the author/owner(s).Tenth Annual ACM/IEEE International Conference on Human-Robot Interaction, 02-05 March 2015, Portland, OR.DOI: 10.1145/2701973.2701974 ; http://dx.doi.org/10.1145/2701973.2702725Physical therapy is a common treatment for the rehabilitation of hemiparesis, or the weakness of one side of the body. Stroke is a common cause of hemiparesis. Stroke survivors regularly struggle with motivation and engagement, especially in-between sessions when the therapist is absent from the exercising process. As a solution, we have developed a robotic tablet gaming system to facilitate post-stroke hand function rehabilitation. Healthy subject pilot studies have been completed to verify that this system increases engagement and is capable of encouraging specific therapeutic motions. In the future, a learning model algorithm will be added to the system to assess the patient’s progress and optimize the recovery time

Increasing Motor Learning During Hand Rehabilitation Exercises Through the Use of Adaptive Games: A Pilot Study

Copyright ©2015 ACM3rd International Workshop on Intelligent Digital Games for Empowerment and Inclusion (IDGEI 2015), 29 March 2015, Atlanta, GA.Physical therapy is a common treatment for the rehabilitation of hemiparesis, or the weakness of one side of the body [1]. Unfortunately, a recent study found that about one third of stroke patients who are prescribed rehabilitation in hospital settings are ranked as poor participators in physical therapy [2]. In an attempt to increase morale and participation of stroke survivors in hand function motor therapy, a robotic rehabilitation system is being designed to counteract these hindrances to hand function recovery. For this system, an adaptive game that is only controllable through hand movement has been designed to optimize the challenges and rewards presented to the user. A healthy subjects pilot study was conducted to assess the adaptive game’s ability to increase the motor learning of participants during rehabilitation exercises. During this experiment, participants were asked to wear a robotic wrist sensor that functions as a game controller and play a rehabilitative tablet game that encourages therapeutic motions. To play this game users had to reach various targets in the game scenario by moving their hand in pre-determined ranges of motion. Two game scenarios presented the participant with a constant level of challenge, one of which was an easy scenario and the other a hard scenario, while a third scenario adjusted the game difficulty in order to maintain a constant balance of challenge and reward. When participants were presented with a constant level of challenge, their performance did not increase or decrease linearly during the session. This lack of linear growth or decay suggests that the participants did not experience significant learning and their performances were not hindered by negative emotions such as frustration or boredom. Participants that played the adaptive scenario performed similarly to the fixed difficulty levels when presented with an easy scenario for the beginning portion of the gaming experience and a difficult portion at the end. However, if participants were presented with a difficult scenario at the beginning of their gaming experience and an easy scenario at the end, they performed similarly to the fixed difficulty during the hard portion yet much better than the fixed difficulty during the easy portion. The averages for the easy portion of the adaptive level and the fixed easy level were 90.33% and 82.72%, respectively, and the standard deviations were 10.25% and 17.82%, respectively

Measurement of shoulder abduction angles in dogs: an ex vivo study of accuracy and repeatability

OBJECTIVE: The aim of this study was to determine the accuracy and repeatability of the shoulder abduction test and to assess the effect of transection of the medial shoulder support structures in canine cadavers. MATERIALS AND METHODS: The shoulder abduction angle was measured by three separate observers, both with the shoulder extended and at a neutral angle. Shoulder abduction was then measured, using craniocaudal fluoroscopic images. Arthroscopy was performed in all shoulder joints, with the medial support structures transected in one shoulder of each dog. The three observers again measured shoulder abduction angles in all dogs. Shoulder abduction was measured again using fluoroscopy. Accuracy and repeatability of the abduction test were assessed using linear mixed models. RESULTS: All three observers had different measured abduction angles when compared with fluoroscopy ( < 0.01); however, the experienced surgeon had an error of only 2.9°. Inter-observer repeatability was poor, with all three observers having different abduction measurements ( < 0.001). Intra-observer repeatability, however, indicated no differences on repeated measurements ( = 0.26). Placing the shoulder at a neutral standing angle, and transection of support structures caused an average increase in abduction by 8.2° ( < 0.001) and 4.4° respectively. CONCLUSION: Significant variation exists between observers performing this test, increased accuracy seen in the more experienced observer. Shoulder flexion angle can significantly affect measured abduction angles