Ethical Issues Linked to the Development of Telerehabilitation: A Qualitative Study

While telerehabilitation (TR) makes it possible to respond to many significant health system problems, TR still gives rise to debates, particularly concerning ethical issues. This qualitative study collected the opinions of stakeholders with varied profiles. A guided interview focused on discerning strategies that might foster the ethical deployment of TR. Such strategies were found to be linked to the decision-making of the public authorities, the role of scientific and professional bodies, the training of health professionals, and the management of patient information. Ethical issues relating to the development of TR included universal accessibility, patients’ free choice, respect of privacy, and professional confidentiality. The ethical development of TR can be fostered by the provision of information to stakeholders as well as reminding practitioners of the ethical framework that regulates medical practice

Age Effects on Upper Limb Kinematics Assessed by the REAplan Robotin Healthy School-Aged Children

The use of kinematics is recommended to quantitatively evaluate upper limb movements. The aims of this study were to determine the age effects on upper limb kinematics and establish norms in healthy children. Ninetythree healthy children, aged 3–12 years, participated in this study. Twenty-eight kinematic indices were computed from four tasks. Each task was performed with the REAplan, a distal effector robotic device that allows upper limb displacements in the horizontal plane. Twenty-four of the 28 indices showed an improvement during childhood. Indeed, older children showed better upper limb movements. This study was the first to use a robotic device to show the age effects on upper limb kinematics and establish norms in healthy children

A robotic device to assess and rehabilitate upper limb movements in cerebral palsy children and stroke adults

Cerebral palsy (CP) and stroke are major causes of permanent disabilities. These disabilities justify intensive interdisciplinary rehabilitation and regular assessments, which could be optimized using robotics. This PhD thesis investigated the clinical interest in robotic devices to assess and rehabilitate upper limb movements in CP children and stroke adults. This investigation was performed with the REAplan robot, which is an end-effector robotic device that moves the patient’s upper limb in a horizontal plane using various assistance modes (i.e., active, active-passive, passive). The first part of this thesis investigated how a robotic device could quantitatively assess upper limb movements in both populations. A standardized protocol was developed to assess upper limb kinematics using the REAplan robot in CP children and stroke adults. The reproducibility, validity, responsiveness and reference standards of this protocol were established, and a short version of this protocol was provided to facilitate the assessment of upper limb kinematics in routine clinical practice. The second part of this thesis investigated how a robotic device could efficiently rehabilitate upper limb movements in CP children. A standardized protocol for robot-assisted therapy (RAT) was first developed according to the current recommendations in CP neuro-rehabilitation. This protocol was used in a single-blind randomized controlled trial that assessed the efficacy of RAT in CP children. This trial showed that the combination of conventional therapy (CT) and RAT could significantly improve upper limb kinematics and manual dexterity in CP children compared with CT alone. Thus, robotic devices could quantitatively assess and efficiently rehabilitate upper limb movements in CP children and stroke adults. These findings would not have been possible without close collaboration between engineers, technicians, clinicians and researchers. Further similar collaborations should be encouraged to facilitate technological integration in rehabilitation.L’infirmité motrice d’origine cérébrale (IMoC) et les accidents vasculaires cérébraux (AVC) sont les principales causes d'invalidités permanentes. Ces pathologies justifient une rééducation interdisciplinaire intensive et des évaluations régulières, pouvant être optimisées par la robotique. Cette thèse de doctorat a étudié l'intérêt clinique de dispositifs robotiques afin d'évaluer et de rééduquer les mouvements du membre supérieur chez les enfants IMoC et les adultes AVC. Cette investigation a été réalisée à l’aide du robot REAplan. REAplan est un dispositif robotique à effecteur distal permettant la mobilisation du membre supérieur dans le plan horizontal grâce à différents modes d'assistance (i.e., actif, activo-passif, passif). La première partie de cette thèse a investigué comment un dispositif robotique pouvait évaluer quantitativement les mouvements du membre supérieur au sein des deux populations. Un protocole standardisé a été développé afin d’évaluer la cinématique du membre supérieur chez les enfants et adultes cérébro-lésés, en utilisant le dispositif robotique REAplan. La reproductibilité, la validité, la sensibilité au changement et les normes de référence de ce protocole ont été établies. Une version courte de ce protocole a été créée afin de faciliter l'évaluation de la cinématique du membre supérieur en routine clinique. La deuxième partie de cette thèse a étudié comment un dispositif robotique pouvait efficacement rééduquer le membre supérieur chez les enfants IMoC. Un protocole standardisé de thérapie assistée par la robotique (TAR) a été développé en tenant compte des recommandations connues en rééducation neuro-pédiatrique. Ce protocole a été utilisé dans une étude randomisée contrôlée en simple aveugle afin d'évaluer l'efficacité de la TAR chez les enfants IMoC. Cette étude a montré que la combinaison d'une thérapie conventionnelle (TC) et de la TAR améliorait significativement la cinématique du membre supérieur et la dextérité manuelle des enfants IMoC par rapport à la TC seul. Cette thèse de doctorat a montré que les dispositifs robotiques pouvaient quantitativement évaluer et efficacement rééduquer les mouvements du membre supérieur chez les enfants et adultes cérébro-lésés. Cette recherche n'aurait pas été possible sans l'étroite collaboration entre ingénieurs, techniciens, cliniciens et chercheurs. Nous encourageons la continuation de telles collaborations afin de favoriser l'intégration de la technologie en rééducation.(MOTR - Sciences de la motricité) -- UCL, 201

Rehabilitation system and method

A rehabilitation system for rehabilitation of a subject comprising at least one end-effector for interacting with the subject, the said end-effector having at least two degrees of freedom of motion, at least one actuator for actuating the at least one end-effector, at least one sensor for measuring at least the position and the speed of the at least one endeffector; at least one sensor for measuring the interaction force between the subject and the end-effector; a memory comprising at least two initial coefficients and a session comprising at least one exercise including at least one reference trajectory to be carried out by the subject through actuation of the end effector ; and a controlling unit for controlling the actuator; wherein the memory is connected to the controlling unit for delivering the initial coefficients and the session, the sensors are connected to the controlling unit for delivering measurement signals, and the controlling unit is adapted to provide a force-controlled feedback based on the said initial coefficients

Reliability and validity of a kinematic spine model during active trunk movement in healthy subjects and patients with chronic non-specific low back pain

Objective: To develop a standardized, reliable, valid spine model of active trunk movements that accurately discriminates kinematic patterns of patients with chronic non-specific low back pain from those of healthy subjects. Design: Comparative cohort study. Subjects: Healthy subjects (n = 25) and patients with chronic non-specific low back pain (n = 25) aged 30-65 years. Methods: Subjects performed 7 trunk movements from a seated position at non-imposed speed during 2 sessions. Nine markers on bony landmarks measured range of motion and speed of 5 spinal segments, recorded by 8 optoelectronic cameras. Results: Both groups showed good-excellent reliability in all movements for range of motion and speed of all spinal segments (intraclass correlation (ICC), 0.70-0.96; standard error of measurement, expressed as a percentage, 19.4-3.3%). The minimal detectable change in the patient group was 16.7-53.7%. Range of motion and speed in all spinal segments for trunk flexion, rotation, and flexion with rotation differed significantly between groups (p < 0.001), with large/very large effect sizes (Cohen's d = 1.2-2). Binary logistic regression yielded sensitivities/specificities of 92%/84% for range of motion and 92%/80% for speed. Conclusion: Kinematic variables are valid, reliable measures and can be used clinically to diagnose chronic non-specific low back pain, manage treatment, and as quantitative outcome measures for clinical trial interventions

Cognitive-behavioral therapy and urge urinary incontinence in women. A systematic review

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Effectiveness of upper limb robotic-assisted therapy in the early phase of stroke rehabilitation: a single-blind, randomised, controlled trial

Introduction/Background: Upper limb (UL) robotic assisted therapy (RAT) is a powerful promising tool for stroke rehabilitation, particularly in the early stage. Associated to conventional therapy (CT), studies agreed that RAT decrease UL impairment. When it is provided as substitution, RAT is at least as effective as CT, but it remains uncertain if it is more effective than CT. In addition, studies often confine themselves to a single domains of the International Classification of Functioning framework (ICF). This study aims to perform a single- blind randomized controlled trial to evaluate effectiveness of UL RAT in the acute phase of stroke rehabilitation following ICF, with RAT as partial substitution to CT. Materials and Methods: Forty-five acute stroke patients were randomized into two groups (CT group, n=22 and RAT group, n=23). Both interventions were dose-matched about the duration of treatment and lasted nine weeks. The CT followed a standard rehabilitation. In the RAT group, four sessions of CT (25%) were substituted by RAT each week. RAT consisted of moving the paretic UL along a reference trajectory while the robot provided an assistance-as-needed. A blinded assessor evaluated the patients before and after the intervention and at 6-month post-stroke according to all domains of ICF. Results: Seventeen patients dropped out during the study. The UL motor control (Fugl Meyer +16%; p=0.05) and gross manual dexterity (Box and Block test +10 blocks/min; p=0.02) improved significantly more in the RAT group than in the CT group at 6-months post-stroke. The ability to perform activities of daily living and their social participation tend also to improve more in the RAT group than in CT group. Conclusion: RAT is effective for the UL motor rehabilitation in the acute phase of stroke rehabilitation. Thus, a RAT protocol can be included in practice increasing patient intensity of rehabilitation and decreasing patient’s impairments

Reliability and Concurrent Validity of the BruininksOseretsky Test in Children with Cerebral Palsy

Background: The Bruininks-Oseretsky test (BOT2) assesses global and fine motor proficiency in healthy children. We evaluated concurrent validity and reliability of the short form (BOT2-SF) and the upper-limb items of the complete form (BOT2-UL) in children with Cerebral Palsy (CP). Methods: 15 CP children, Manual Ability Classification System (MACS)≤4 and Gross Motor Function Classification System (GMFCS) ≤3, were evaluated with the BOT2-UL and 15 with the BOT2-SF. Results: excellent inter- (ICC 0.99-UL, 0.95-SF) and intra- (ICC 0.99-UL, 0.98-SF) rater reliability; excellent inverse correlation between the BOT2-UL and the MACS level (ρ=-0.81-UL, -0.64-SF, p< 0.05); no statistically significant correlation between the BOT2-SF and the GMFCS level. Conclusion: The BOT2-UL and the BOT2-SF are reliable tests to evaluate upper-limb in CP children MACS levels 1-4 & GMFCS levels 1-3. Concurrent validity is excellent. Further studies are required to validate the BOT2-SF in this population

A robotic device as a sensitive quantitati ve tool to assess upper limb impairm ents in stroke pati ents: a preliminaryprospective cohort study

Objective: To compare kinematic indices in age-matched healthy subjects and stroke patients, by evaluating various tasks performed with a robotic device, and to provide an objective and standardized protocol to assess upper limb impairments in stroke patients. Design: A prospective cohort study. Subjects: Age-matched healthy subjects (n = 10) and stroke patients (n = 10). Methods: Various kinematic indices were analysed from 3 randomly assigned tasks performed by the affected arm in stroke patients and the dominant arm in healthy subjects. These tasks, composed of large-amplitude, targeted and geometrical movements, were standardized and performed with the ReaPLAN robotic device. Results: For large-amplitude movements, the stroke patients’ path lengths were less constant in amplitude, less rectilinear and less smooth than those for healthy subjects (p < 0.001). For the targeted movements, the stroke patients’ path lengths were less rectilinear than those of the healthy subjects (p < 0.001). For the geometrical movements, the stroke patients had greater difficulty making the requested shapes compared with the healthy subjects (p < 0.01). Conclusion: Our study proposes an objective and standardized protocol to assess stroke patients’ upper limbs with any robotic device. We suggest that further randomized controlled trials could use this quantitative tool to assess the efficacy of treatments such as robot-assisted therapy

Age Effects on Upper Limb Kinematics Assessed by the REAplan Robot in Healthy Subjects Aged 3 to 93 Years

Kinematics is recommended for the quantitative assessment of upper limb movements. The aims of this study were to determine the age effects on upper limb kinematics and establish normative values in healthy subjects. Three hundred and seventy healthy subjects, aged 3–93 years, participated in the study. They performed two unidirectional and two geometrical tasks ten consecutive times with the REAplan, a distal effector robotic device that allows upper limb displacements in the horizontal plane. Twenty-six kinematic indices were computed for the four tasks. For the four tasks, nineteen of the computed kinematic indices showed an age effect. Seventeen indices (the accuracy, speed and smoothness indices and the reproducibility of the accuracy, speed and smoothness) improved in young subjects aged 3–30 years, showed stabilization in adults aged 30– 60 years and declined in elderly subjects aged 60–93 years. Additionally, for both geometrical tasks, the speed index exhibited a decrease throughout life. Finally, a principal component analysis provided the relations between the kinematic indices, tasks and subjects’ age. This study is the first to assess age effects on upper limb kinematics and establish normative values in subjects aged 3–93 years