Rehabilitation treatments for adults with behavioral and psychosocial disorders following acquired brain injury: a systematic review.

This review was aimed at systematically investigating the treatment efficacy and clinical effectiveness of neurobehavioral rehabilitation programs for adults with acquired brain injury and making evidence-based recommendations for the adoption of these rehabilitation trainings. Using a variety of search procedures, 63 studies were identified and reviewed using a set of questions about research methods, treatments, results and outcomes for the 1,094 participants. The 63 studies included treatments falling into three general categories: approaches based on applied behavior analysis, interventions based on cognitive-behavior therapy (CBT), and comprehensive-holistic rehabilitation programs (CHRPs). Considerable heterogeneity exists in the reviewed literature among treatment methods and within reported sample subjects. Despite the variety of methodological concerns, results indicate that the greatest overall improvement in psychosocial functioning is achieved by CHRP that can be considered a treatment standard for adults with behavioral and psychosocial disorders following acquired brain injury. Both approaches based on applied behavior analysis and CBT can be said to be evidence-based treatment options. However, findings raise questions about the role of uncontrolled factors in determining treatment effects and suggest the need for rigorous inclusion/exclusion criteria, with greater specification of theoretical basis, design, and contents of treatments for both interdisciplinary-comprehensive approaches and single-case methodologies

An Emotional Agent for Moral Impairment Rehabilitation in TBI Patients

The ability to identify the emotions of others is a key component of what is known as social cognition. Narratives exploit this mechanism to create an emotional bond with the characters and to maintain the engagement of the audience throughout the story. In this paper, we illustrate a case study in emotion understanding in stories that exploits a computational agent to explore emotion impairment in a group of traumatic brain injured people. The study focuses on moral emotions, aiming to investigate the differences in moral functioning that characterize traumatic brain injured patients. After comparing the understanding of the moral and emotional facets of the agent's behavior in traumatic brain injured patients and in neurologically intact controls, slight–yet meaningful–differences were observed between the two groups. We describe the test methodology and results, highlighting their implications for the design of rehabilitation applications based on virtual agents

An Active Exoskeleton Called P.I.G.R.O. Designed for Unloaded Robotic Neurorehabilitation Training

The development of innovative robotic devices allows the design of exoskeletons for robotic neurorehabilitation training. This paper presents the active exoskeleton called pneumatic interactive gait rehabilitation orthosis (P.I.G.R.O.), developed by the authors. The main innovative characteristic of this prototype is its design for fully unloaded robotic neurorehabilitation training, specific for brain-injured patients. It has six degrees of freedom (DOF) in the sagittal plane, an active ankle joint (removable if it is required); a wide range of anthropometric regulations, both for men and for women; a useful human machine interface (HMI); and an innovative harness system for the patient for the unloaded training. It is realized using light and strong materials, and it is electropneumatically controlled. In particular the authors also studied and defined some innovative input control curves useful for the unloaded training. In this paper, the main characteristics and innovations of P.I.G.R.O. are presented

PRELIMINARY STRUCTURAL ANALYSIS OF AN ACTIVE EXOSKELETON FOR ROBOTIC NEURO-REHABILITATION

In this paper the exoskeleton P.I.G.R.O. (Pneumatic Interactive Gait Rehabilitation Orthosis), developed in the Department of Mechanical and Aerospace Engineering (DIMEAS) Politecnico di Torino with the important co-operation with doctors, is presented. It was preliminary designed for a completely unloaded walking gait cycle in order to treat the first steps of the neurorehabilitation trainings. An initial FEM evaluation of P.I.G.R.O. structure is here presented. It underlines a lot of important aspects and techniques to analyse the structural characteristics of P.I.G.R.O. legs rigid parts using a commercial software but analysing both the actions of the pneumatic actuators and of the patients muscles and/or movements. The results obtained are good and allow to verify the P.I.G.R.O. legs structure and to establish a procedure to study its characteristics also with the presence of the patien

Re-learning mental representation of walking after a brain lesion. Effects of a cognitive-motor training with a robotic orthosis

IntroductionStroke-related deficits often include motor impairments and gait dysfunction, leading to a limitation of social activities and consequently affecting the quality of life of stroke survivors. Neurorehabilitation takes advantage of the contribution of different techniques in order to achieve more benefits for patients. Robotic devices help to improve the outcomes of physical rehabilitation. Moreover, motor imagery seems to play a role in neurological rehabilitation since it leads to the activation of the same brain areas as actual movements. This study investigates the use of a combined physical and cognitive protocol for gait rehabilitation in stroke patients.MethodsSpecifically, we tested the efficacy of a 5-week training program using a robotic orthosis (P.I.G.R.O.) in conjunction with motor imagery training. Twelve chronic stroke patients participated in the study. We evaluated balance and gait performance before and after the training. Six of them underwent fMRI examination before and after the training to assess the effects of the protocol on brain plasticity mechanisms in motor and imagery tasks.ResultsOur results show that the rehabilitation protocol can effectively improve gait performance and balance and reduce the risk of falls in stroke patients. Furthermore, the fMRI results suggest that rehabilitation is associated with cerebral plastic changes in motor networks.DiscussionThe present findings, if confirmed by future research, have the potential to advance the development of new, more effective rehabilitation approaches for stroke patients, improving their quality of life and reducing the burden of stroke-related disability

Bra.Di.P.O. and P.I.G.R.O.: Innovative Devices for Motor Learning Programs

Two mechatronics prototypes, useful for robotic neurotreatments and new clinical trainings, are here presented. P.I.G.R.O. (pneumatic interactive gait rehabilitation orthosis) is an active exoskeleton with an electropneumatic control. It imposes movements on lower limbs in order to produce in the patient’s brain proper motor cortex activation. Bra.Di.P.O. (brain discovery pneumatic orthosis) is an MR-compatible device, designed to improve fMRI (functional magnetic resonance imaging) analysis. The two devices are presented together because both are involved in the study of new robotic treatments of patients affected by ictus or brain stroke or in some motor learning experimental investigations carried out on healthy subjects