Effects of intensive arm training with the rehabilitation robot ARMin II in chronic stroke patients: four single-cases

BACKGROUND: Robot-assisted therapy offers a promising approach to neurorehabilitation, particularly for severely to moderately impaired stroke patients. The objective of this study was to investigate the effects of intensive arm training on motor performance in four chronic stroke patients using the robot ARMin II. METHODS: ARMin II is an exoskeleton robot with six degrees of freedom (DOF) moving shoulder, elbow and wrist joints. Four volunteers with chronic (>or= 12 months post-stroke) left side hemi-paresis and different levels of motor severity were enrolled in the study. They received robot-assisted therapy over a period of eight weeks, three to four therapy sessions per week, each session of one hour.Patients 1 and 4 had four one-hour training sessions per week and patients 2 and 3 had three one-hour training sessions per week. Primary outcome variable was the Fugl-Meyer Score of the upper extremity Assessment (FMA), secondary outcomes were the Wolf Motor Function Test (WMFT), the Catherine Bergego Scale (CBS), the Maximal Voluntary Torques (MVTs) and a questionnaire about ADL-tasks, progress, changes, motivation etc. RESULTS: Three out of four patients showed significant improvements (p < 0.05) in the main outcome. The improvements in the FMA scores were aligned with the objective results of MVTs. Most improvements were maintained or even increased from discharge to the six-month follow-up. CONCLUSION: Data clearly indicate that intensive arm therapy with the robot ARMin II can significantly improve motor function of the paretic arm in some stroke patients, even those in a chronic state. The findings of the study provide a basis for a subsequent controlled randomized clinical trial

Distinctive Steady-State Heart Rate and Blood Pressure Responses to Passive Robotic Leg Exercise during Head-Up Tilt: A Pilot Study in Neurological Patients

Introduction: Robot-assisted tilt table therapy was proposed for early rehabilitation and mobilization of patients after diseases such as stroke. A robot-assisted tilt table with integrated passive robotic leg exercise (PE) mechanism has the potential to prevent orthostatic hypotension usually provoked by verticalization. In a previous study with rather young healthy subjects [average age: 25.1 ± 2.6 years (standard deviation)], we found that PE effect on the cardiovascular system depends on the verticalization angle of the robot-assisted tilt table. In the current study, we investigated in an older population of neurological patients (a) whether they show the same PE effects as younger healthy population on the cardiovascular system at different tilt angles, (b) whether changing the PE frequency (i.e., stepping speed) influences the PE effect on the cardiovascular system, (c) whether PE could prevent orthostatic hypotension, and finally, (d) whether PE effect is consistent from day to day.Methods: Heart rate (HR), and systolic and diastolic blood pressures (sBP, dBP) in response to PE at two different tilt angles (α = 20°, 60°) with three different PE frequencies (i.e., 0, 24, and 48 steps per minute) of 10 neurological patients [average age: 68.4 ± 13.5 years (standard deviation)] were measured on 2 consecutive days. Linear mixed models were used to develop statistical models and analyze the repeated measurements.Results: The models show that: PE significantly increased sBP and dBP but had no significant effect on HR. (a) Similar to healthy subjects the effect of PE on sBP was dependent on the tilt angle with higher tilt angles resulting in a higher increase. Head-up tilting alone significantly increased HR and dBP but resulted in a non-significant drop in sBP. PE, in general, had a more additive effect on increasing BP. (b) The effect of PE was not influenced by its speed. (c) Neither during head-up tilt alone nor in combination with PE did participants experience orthostatic hypotension. (d) The measurement day was not a statistically significant factor regarding the effects of verticalization and PE on the cardiovascular response.Conclusion: We provide evidence that PE can increase steady-state values of sBP and dBP in neurological patients during head-up tilt. Similar to healthy subjects the effect on sBP depends on the verticalization angle of the robot-assisted tilt table. PE might have the potential to prevent orthostatic hypotension, but as the amount of drop in BP in response to head-up tilting was not leading to orthostatic hypotension in our patients, we could neither conclude nor reject such a preventive compensatory effect. Furthermore, we found that changing the PE speed does not influence the steady-state cardiovascular response

Music meets robotics : a prospective randomized study on motivation during robot aided therapy

Robots have been successfully applied in motor training during neurorehabilitation. As music is known to improve motor function and motivation in neurorehabilitation training, we aimed at integrating music creation into robotic-assisted motor therapy. We developed a virtual game-like environment with music for the arm therapy robot ARMin, containing four different motion training conditions: a condition promoting creativity (C+) and one not promoting creativity (C-), each in a condition with (V+) and without (V-) a visual display (i.e., a monitor). The visual display was presenting the game workspace but not contributing to the creative process itself. In all four conditions the therapy robot haptically displayed the game workspace. Our aim was to asses the effects of creativity and visual display on motivation

Effective mHealth for stress prevention and management in times of sparce health care resources

Background/Objectives: The current and ongoing COVID pandemic caused much disruption to our work and family lives. For many, it added additional stress to an already stressful lifestyle that is prevalent in our society. Because stress can be detrimental to both physical and mental health, many people are seeking help and support from health practitioners. Due to pandemic restrictions, entire populations were prevented from seeking professional help and were left to deal with the situation on their own. Therefore, alternative ways to release stress and prevent stress-related symptoms are needed for times when professional help is scarce or unavailable. The aim of this study was to identify effective web- and app-based interventions to reduce mental and physical symptoms of stress and to explore their use in situations where traditional health care is not at hand. Methods: A systematic literature review was conducted in the databases PubMed, PsycINFO, and CINAHL Complete Articles published between 2015 and 2020, focusing on otherwise healthy adults, and demonstrating efficacy in reducing stress or/and stress-related symptoms were included. Results: A total of 28 articles were found with 20 effective products (13 web-based, 7 apps). Most products are course-like sessions on different topics and exercises using methods such as psychoeducation, education on stress, cognitive restructuring, emotional regulation, problem solving, goal setting, breathing, mindfulness techniques, meditation, and relaxation. Also, most products use more than one technique and mixed materials such as text messages, videos, text, and audio information. The products often use methods to keep the user engaged, such as integration into daily routines, future planning, or reminders. Discussion: There are several products that have been shown to be effective in reducing perceived stress and stress-related symptoms. These are readily available and have a very low threshold. Therefore, they are suitable for providing care to communities during times when traditional health care supply is not readily available or is overwhelmed

A robotic system to train activities of daily living in a virtual environment

In the past decade, several arm rehabilitation robots have been developed to assist neurological patients during therapy. Early devices were limited in their number of degrees of freedom and range of motion, whereas newer robots such as the ARMin robot can support the entire arm. Often, these devices are combined with virtual environments to integrate motivating game-like scenarios. Several studies have shown a positive effect of game-playing on therapy outcome by increasing motivation. In addition, we assume that practicing highly functional movements can further enhance therapy outcome by facilitating the transfer of motor abilities acquired in therapy to daily life. Therefore, we present a rehabilitation system that enables the training of activities of daily living (ADL) with the support of an assistive robot. Important ADL tasks have been identified and implemented in a virtual environment. A patient-cooperative control strategy with adaptable freedom in timing and space was developed to assist the patient during the task. The technical feasibility and usability of the system was evaluated with seven healthy subjects and three chronic stroke patient

The “Beam-Me-In Strategy” - remote haptic therapist-patient interaction with two exoskeletons for stroke therapy

Background We present a robot-assisted telerehabilitation system that allows for haptic interaction between therapist and patient over distance. It consists of two arm therapy robots. Attached to one robot the therapists can feel on their own arm the limitations of the patient’s arm which is attached to the other robot. Due to the exoskeleton structure of the robot, movements can be performed in the three-dimensional space. Methods Fifteen physical and occupational therapists tested this strategy, named “Beam-Me-In”, while using an exoskeleton robot connected to a second exoskeleton robot in the same room used by the study experimenter. Furthermore, the therapists assessed the level of impairment of recorded and simulated arm movements. They quantified four typical impairments of stroke patients: reduced range of motion (active and passive), resistance to passive movement, a lack of ability to fractionate a movement, and disturbed quality of movement. Results On a Likert Scale (0 to 5 points) therapists rated the “Beam-Me-In” strategy as a very useful medium (mode: 4 points) to evaluate a patient’s progress over time. The passive range of motion of the elbow joint was assessed with a mean absolute error of 4.9∘ (absolute precision error: 6.4∘). The active range of motion of the elbow was assessed with a mean absolute error of 4.9∘ (absolute precision error: 6.5∘). The resistance to passive movement (i.e. modified Tardieu Scale) and the lack of ability to fractionate a movement (i.e. quantification of pathological muscle synergies) was assessed with an inter-rater reliability of 0.930 and 0.948, respectively. Conclusions The “Beam-Me-In” strategy is a promising approach to complement robot-assisted movement training. It can serve as a platform to assess and identify abnormal movement patterns in patients. This is the first application of remote three-dimensional haptic assessmen t applied to telerehabilitation. Furthermore, the “Beam-Me-In” strategy has a potential to overcome barriers for therapists regarding robot-assisted telerehabilitation

A Systematic Review of International Clinical Guidelines for Rehabilitation of People With Neurological Conditions: What Recommendations Are Made for Upper Limb Assessment?

Conclusions: We present a comprehensive, critical, and original summary of current recommendations. Defining a core set of measures and agreed protocols requires international consensus between experts representing the diverse and multi-disciplinary field of neurorehabilitation including clinical researchers and practitioners, rehabilitation technology researchers, and commercial developers. Current lack of guidance may hold-back progress in understanding function and recovery. Together with a Delphi consensus study and an overview of systematic reviews of outcome measures it will contribute to the development of international guidelines for upper limb assessment in neurological conditions.This review formed part of the COST Action TD 1006A European Network on Robotics for Neurorehabilitation. It was an interdisciplinary EU-funded research network concentrating on the coordination of European research in the area of rehabilitation robotics

Digitale Heilsversprechen in Gesundheitsberufen

Dieser Beitrag geht der Frage nach, welche Heilsversprechen unter angehenden Gesundheitsfachpersonen bezüglich digitaler Medien vorherrschen und wodurch sie bedingt sind. Er stützt sich auf Daten einer Erhebung unter Bachelor-Studierenden einer Gesundheitshochschule in der Schweiz. Die Resultate zeigen, dass 59 % der Befragten die Vorteile digitaler Medien mit der Erbringung von Gesundheitsleistungen assoziieren und 41 % ihre Vorteile auf Seite der PatientInnen sehen. Aus der statistischen Analyse geht hervor, dass die Studierenden gehobener Herkunft und die Studierenden früher akademisierter Studienrichtungen die Vorteile digitaler Medien wesentlich häufiger mit der Dienstleistungserbringung als mit den PatientInnen verbinden. Dies scheint nicht nur anzuzeigen, dass in Gesundheitsberufen ein Zusammenhang zwischen den vorherrschenden sozialen Kräften und der Assoziation digitaler Medien mit der Dienstleistungserbringung besteht. Es dürfte auch darauf hin- weisen, dass die „Digitalisierung“ im Gesundheitssektor die herkunftsbedingte kulturelle Spaltung in Gesundheitsberufen befördert

Betreuen auf Distanz während des Lockdowns im Frühjahr 2020

Das Betreuen auf Distanz, das in der Hebammenarbeit über lange Zeit keine besondere Aufmerksamkeit genoss, erhielt mit der COVID-19-Pandemie eine starke Beachtung. Eine Untersuchung der Zürcher Hochschule für angewandte Wissenschaften zeigt, welche konkreten Erfahrungen Hebammen damit während des ersten Lockdowns gemacht haben, und welche ungelösten Probleme mit im Spiel sind

Midwives’ perception of advantages of health care at a distance during the COVID-19 pandemic in Switzerland

Objective: To explore midwives' perceptions of the advantages of telemedicine during the COVID-19 pandemic in Switzerland. Design: Cross-sectional study based on an online survey using quantitative methods. Setting: Midwives working in Switzerland. Participants: Self-selected convenience sample of 630 members of the Swiss Federation of Midwives. Measurement Open questions on advantages of health care at a distance and workrelated characteristics were used in the online questionnaire. The information was coded and integrative content analysis was applied. Findings: A good half of the respondents associated telemedicine with either an advantage beyond the pandemic (“Reduced workload”, “Improved health care provision”, “Greater self-care of clients”), while the others saw a pandemic-related advantage (“Protection from COVID-19”, “Maintaining care/counseling in an exceptional situation”), or no advantage at all. Older, more experienced midwives were less likely to see an advantage beyond the pandemic. The motive “Reduced workload” was positively associated with professionals aged younger than 40 years and midwives with up to 14 years of professional experience, and “Protection from COVID-19” was more likely cited by midwives aged 50 and more and by midwives working solely in hospitals. Midwives who stated “Maintaining care” and “Improved health care provision” as motives to embrace telemedicine were more likely to experience health care at a distance as a positive treatment alternative. Key conclusion: Midwives’ perceptions of the advantages of health care at a distance vary substantially with age and years of professional experience, as well as workrelated characteristics. Further research is necessary to acquire a sound understanding of underlying reasons, including the sources of the general attitudes involved. Implication for practice: Understanding the differences in perceptions of health care at a distance is important in order to improve the work situation of midwives and the health care they provide to women and families. Different sensitivities represent an important source in the ongoing discussion about the future use of telemedicine in health care