Human simulation in stroke patients rehabilitation

Different types of neurological deficits and sequels in the upper extremities that affect the activities of daily living in patients who have undergone stroke, have been analyzed from a subjective clinical point of view. Prognosis recovery after stroke depends on many factors, among which are included individualized program of rehabilitation and cooperation of patients. Simulation patients in the beginning of stroke. The aim of this work is to show a novel environment to simulate the initial improvement upper limb functions a few days after stroke and simulate the functional recovery of patients under a rehabilitation program. Twenty-nine patients in the first four days post stroke were selected. Inclusion criteria were: over eighteen years of age, collaborative patients, and neurological deficits in upper extremities post stroke without a previous history of stroke of motor sequelae second to other neurological or osteoarticular diseases that might identify pre-existing disability. Assessments were performed with 3-4 days and 7 days and 1, and 3 months post stroke recording the following variables: demographics, stroke type, stroke classification according to the Oxford scale, neurological deficit determined by the NIHSS, disability measures (Barthel’s Index, Rankin Scale), assessment of the motor dysfunction of the upper extremities according to the Fugl-Meyer Scale as well as muscle tone (Ashworth’s Scale) and muscle balance of the upper extremities. We measured the deficits of angles, lengths and range of motion for the arm and hand affected. These measures were implemented in a virtual environment with 29 DOF for each arm and hand. The different types of deficit and sequelae seen in the upper extremities of stroke patients impairing their activities of daily living have been analysed from a subjective clinical standpoint based on clinical and functional assessments. The prognosis for recovery of each patient very much depends on many factors, which can be found in the rehabilitation program and individual goals together with the collaboration afforded by the patients themselves while they are unaware a priori of the objective outcome of the rehabilitation process.Postprint (published version

Valoración del daño corporal en personas afectadas de secuelas neurológicas

Objetivo: Mostrar un nuevo sistema para simular la recuperación inicial de las funciones de la extremidad superior los primeros días después del ictus y simular la recuperación funcional de los pacientes bajo los programas de rehabilitación. Pacientes y metodología: Seleccionamos 29 pacientes en los primeros cuatro días después de padecer un ictus, valorados a los tres y siete días y uno, tres y seis meses, recogiendo tipo de ictus, clasificación (escala de Oxford), déficit neurológico (escala de NIHSS), medidas de discapacidad, valoración de la función motora de la extremidad superior (escala de Fugl-Meyer), tono muscular y balance muscular de la extremidad superior. Resultados: Los pacientes que presentaron un tono muscular disminuido tuvieron más dificultad en mejorar el control motor de las articulaciones de la extremidad superior. Los pacientes TACI presentaron mayor déficit neurológico, mientras que los tipos de ictus POCI y LACI tenían una función motora mejor con mayor independencia para el desarrollo de sus actividades de la vida diaria. Conclusión: La simulación virtual del brazo y la mano en pacientes afectados por un ictus proporciona a los médicos y fisioterapeutas una nueva herramienta que permite simular la evolución de los déficits en algunos pacientes.Postprint (published version

Quantitative assessment of hand function in healthy subjects and post-stroke patients with the action research arm test

The Action Research Arm Test (ARAT) can provide subjective results due to the difficulty assessing abnormal patterns in stroke patients. The aim of this study was to identify joint impairments and compensatory grasping strategies in stroke patients with left (LH) and right (RH) hemiparesis. An experimental study was carried out with 12 patients six months after a stroke (three women and nine men, mean age: 65.2 ± 9.3 years), and 25 healthy subjects (14 women and 11 men, mean age: 40.2 ± 18.1 years. The subjects were evaluated during the performance of the ARAT using a data glove. Stroke patients with LH and RH showed significantly lower flexion angles in the MCP joints of the Index and Middle fingers than the Control group. However, RH patients showed larger flexion angles in the proximal interphalangeal (PIP) joints of the Index, Middle, Ring, and Little fingers. In contrast, LH patients showed larger flexion angles in the PIP joints of the Middle and Little fingers. Therefore, the results showed that RH and LH patients used compensatory strategies involving increased flexion at the PIP joints for decreased flexion in the MCP joints. The integration of a data glove during the performance of the ARAT allows the detection of finger joint impairments in stroke patients that are not visible from ARAT scores. Therefore, the results presented are of clinical relevancePeer ReviewedPostprint (published version

Hand motion analysis during the execution of the action research arm test using multiple sensors

The Action Research Arm Test (ARAT) is a standardized outcome measure that can be improved by integrating sensors for hand motion analysis. The purpose of this study is to measure the flexion angle of the finger joints and fingertip forces during the performance of three subscales (Grasp, Grip, and Pinch) of the ARAT, using a data glove (CyberGlove II®) and five force-sensing resistors (FSRs) simultaneously. An experimental study was carried out with 25 healthy subjects (right-handed). The results showed that the mean flexion angles of the finger joints required to perform the 16 activities were Thumb (Carpometacarpal Joint (CMC) 28.56°, Metacarpophalangeal Joint (MCP) 26.84°, and Interphalangeal Joint (IP) 13.23°), Index (MCP 46.18°, Index Proximal Interphalangeal Joint (PIP) 38.89°), Middle (MCP 47.5°, PIP 42.62°), Ring (MCP 44.09°, PIP 39.22°), and Little (MCP 31.50°, PIP 22.10°). The averaged fingertip force exerted in the Grasp Subscale was 8.2 N, in Grip subscale 6.61 N and Pinch subscale 3.89 N. These results suggest that the integration of multiple sensors during the performance of the ARAT has clinical relevance, allowing therapists and other health professionals to perform a more sensitive, objective, and quantitative assessment of the hand function.Postprint (published version

How common is immobilization hypercalcaemia on a brain injury rehabilitation unit? a review of 337 patients

Abstracts from the 9th World Congress of International Society of Physical and Rehabilitation Medicine. June 19-23, 2015, Berlin, GermanyPostprint (published version

Pilot study for use of a virtual model for analyse paretic upper limb functional outcome evolution in acute stroke patients

Abstracts from the 9th World Congress of International Society of Physical and Rehabilitation Medicine. June 19-23, 2015, Berlin, GermanyPostprint (published version

Driving device for a hand movement without external force

People with disabilities have limitations in activities of daily life such as grasping a glass of water or moving an object. Orthotic products that improve or restore the functionality of the musculoskeletal system of a patient contribute to some extent to overcome the limitations described. So does the hand brace, used to treat musculoskeletal disorders caused by various diseases (rheumatic disorders, neurological, orthopedic and others). The paper simulates a novel exoskeleton helping to grasp any object. The novelty of this mechanism is that works without external energy, it works with a wrist movement that generates a kinetic movement and helps to grasp objects with an extra force. The orthosis facilitates the functionality, being comfortable and easy to be used by the patient. It is adaptable to hand size and finger length of the patient.Peer ReviewedPostprint (published version

Evaluación del novimiento de la mano mediante el controlador Leap motion

En los últimos años se han realizado distintas investigaciones sobre el análisis del movimiento de la mano humana mediante el uso de diversos sensores, en áreas como los son: robótica, ingeniería biomédica, biomecánica e interacción hombre-ordenador (HCI). En este trabajo se propone la utilización del controlador Leap Motion (LMC), como una herramienta para analizar y evaluar el movimiento de la mano humana con el objetivo de que médicos y terapeutas puedan brindar una mejor atención en el proceso de rehabilitación de la mano. El sistema permite la adquisición de datos en tiempo real como lo son: la posición de la mano y el ángulo de las falanges distales, medias y proximales de cada uno de los dedos de la mano. Se realizó un estudio experimental con tres sujetos mayores de dieciocho años, diestros, sin ninguna lesión en sus manos, con el objetivo de probar y evaluar el rendimiento del sistema propuesto. Los resultados demuestran que el sistema diseñado tiene un buen desempeño realizando una correcta adquisición de datos. La siguiente etapa del proyecto consiste en evaluar a pacientes que hayan tenido alguna lesión en alguna de sus articulaciones. Este sistema puede convertirse en una herramienta innovadora para médicos y terapeutas en el proceso de rehabilitación médica.Peer ReviewedPostprint (published version

Exoesqueleto para mano discapacitada con movimiento y sensibilidad, pero sin fuerza

Personas con ciertas patologías tienen limitaciones en sus actividades de la vida diaria, tales como coger un vaso de agua o mover un objeto. Las ortesis ayudan a mejorar y/o restaurar la funcionalidad del sistema muscoesquelético en pacientes que tienen las limitaciones descritas. Este artículo presenta una de estas ortesis, un exoesqueleto para la mano discapacitada, con el fin de ayudar a mejorar sus actividades de la vida diaria. La novedad de este exoesqueleto patentado es que no necesita ningún tipo de energía externa para su activación. Un movimiento de la muñeca hace que se active, creando una cadena cinemática de movimientos que ayuda a agarrar el objeto.Postprint (published version