Assessment and training in home-baesd telerehabilitation ofr arm mobility impairment

The aging population and limited healthcare capacities call for a change in how rehabilitation care is provided. There is a need to provide more autonomous and scalable care that can be more easily transferred out of the clinic and into home environments. One important barrier to this objective is achieving reliable assessment of motor performance using low-cost technology. Toward this end, an assessment framework and methodology is proposed. The framework uses 4 sequential games to measure aspects of range of motion, range of force, control of motion, and control of force. Parameters derived from the range of motion task are used to define motion requirements in all subsequent assessment games, while parameters derived from the range of force task are used to define subsequent lifting force requirements. A 12-week usability study was conducted in which 9 patients completed the clinical testing phase and 6 therapists and 7 patients completed the questionnaire. Feedback from the questionnaire shows the system is easy to use and integrates well in the clinical setting. The most commonly requested modifications were the inclusion of more games and the incorporation of hand training. Some initial position and force data are shown for one subject and discussion on implications for mobility assessment using the developed device are provided.Peer Reviewe

Assessment and training in home-based telerehabilitation of arm mobility impairment

In an era where rehabilitation services are diminishing under the weight of the growing demands and fewer therapists, home-based telerehabilitation offers a way of increasing duration and intensity of post-stroke training. Novel systems that guide the therapist and patient in planning, executing, and assessing the training can reduce the burden on the healthcare system while maintaining or improving the quality of care. To achieve this effectively, a unified approach is needed that can address the diverse needs of the users and adequately assess the level of mobility deficits remotely. This document presents a methodology and prototype system for assessment and training adaptation within a telerehabilitation framework targeting home-based rehabilitation of the upper limbs after stroke. The framework uses 4 games for assessment of motor performance based on measures of range and control of movement. Assessment games include range of motion, range of force, control of motion, and control of force. The initial assessment games are used to tune the deficit-specific parameters in each successive game for assessment and training. Games are administered over the web-based TeleREHA platform through a novel arm rehabilitation device called the ArmAssist. An overview of the developments in each project is presented including the basic assessment parameters and a methodology for making patient-specific adaptation to game levels. Preliminary feedback from an ongoing usability evaluation is also presented and discussed

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Development of computer games for assessment and training in post-stroke arm telerehabilitation

Stroke is the leading cause of long term disability among adults in industrialized nations. The majority of these disabilities include deficiencies in arm function, which can make independent living very difficult. Research shows that better results in rehabilitation are obtained when patients receive more intensive therapy. However this intensive therapy is currently too expensive to be provided by the public health system, and at home few patients perform the repetitive exercises recommended by their therapists. Computer games can provide an affordable, enjoyable, and effective way to intensify treatment, while keeping the patient as well as their therapists informed about their progress. This paper presents the study, design, implementation and user-testing of a set of computer games for at-home assessment and training of upper-limb motor impairment after stroke

Assessment and training in home-baesd telerehabilitation ofr arm mobility impairment

The aging population and limited healthcare capacities call for a change in how rehabilitation care is provided. There is a need to provide more autonomous and scalable care that can be more easily transferred out of the clinic and into home environments. One important barrier to this objective is achieving reliable assessment of motor performance using low-cost technology. Toward this end, an assessment framework and methodology is proposed. The framework uses 4 sequential games to measure aspects of range of motion, range of force, control of motion, and control of force. Parameters derived from the range of motion task are used to define motion requirements in all subsequent assessment games, while parameters derived from the range of force task are used to define subsequent lifting force requirements. A 12-week usability study was conducted in which 9 patients completed the clinical testing phase and 6 therapists and 7 patients completed the questionnaire. Feedback from the questionnaire shows the system is easy to use and integrates well in the clinical setting. The most commonly requested modifications were the inclusion of more games and the incorporation of hand training. Some initial position and force data are shown for one subject and discussion on implications for mobility assessment using the developed device are provided

Human bone marrow-derived mesenchymal stromal cells reduce the severity of experimental necrotizing enterocolitis in a concentration-dependent manner

: Necrotizing enterocolitis (NEC) is a devastating gut disease in preterm neonates. In NEC animal models, mesenchymal stromal cells (MSCs) administration has reduced the incidence and severity of NEC. We developed and characterized a novel mouse model of NEC to evaluate the effect of human bone marrow-derived MSCs (hBM-MSCs) in tissue regeneration and epithelial gut repair. NEC was induced in C57BL/6 mouse pups at postnatal days (PND) 3–6 by (A) gavage feeding term infant formula, (B) hypoxia/hypothermia, and (C) lipopolysaccharide. Intraperitoneal injections of PBS or two hBM-MSCs doses (0.5 × 106 or 1 × 106 ) were given on PND2. At PND 6, we harvested intestine samples from all groups. The NEC group showed an incidence of NEC of 50% compared with controls (p < 0.001). Severity of bowel damage was reduced by hBM-MSCs compared to the PBS-treated NEC group in a concentration-dependent manner, with hBM-MSCs (1 × 106 ) inducing a NEC incidence reduction of up to 0% (p < 0.001). We showed that hBM-MSCs enhanced intestinal cell survival, preserving intestinal barrier integrity and decreasing mucosal inflammation and apoptosis. In conclusion, we established a novel NEC animal model and demonstrated that hBM-MSCs administration reduced the NEC incidence and severity in a concentration-dependent manner, enhancing intestinal barrier integrity

Important influence of single neutron stripping coupling on near-barrier ⁸Li + ⁹⁰Zr quasi-elastic scattering

Quasi-elastic scattering data were obtained for the radioactive nucleus 8Li on a 90Zr target at the near-barrier energy of 18.5MeV over the angular range $\theta_{lab}=15^{\circ}$ to 80\ub0. They were analyzed within the coupled channels and coupled reaction channels frameworks pointing to a strong coupling effect for single neutron stripping, in contrast to 6, 7Li + 90Zr elastic scattering at similar energies, a non-trivial result linked to detailed differences in the structure of these Li isotopes