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Moral-Munoz JA, Zhang W, Cobo MJ, Herrera-Viedma E, Kaber DB. Smartphone-based systems for physical rehabilitation applications: A systematic review. Assist Technol 2019; 33:223-236. [DOI: 10.1080/10400435.2019.1611676] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Jose A. Moral-Munoz
- Dept. of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain
- Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), University of Cádiz, Cádiz, Spain
| | - Wenjuan Zhang
- Dept. of Industrial & Systems Engineering, North Carolina State University, Raleigh, North Carolina, USA
| | - Manuel J. Cobo
- Dept. of Computer Science and Engineering, University of Cadiz, Cadiz, Spain
| | - Enrique Herrera-Viedma
- Dept. of Computer Science and Artificial Intelligence, University of Granada, Granada, Spain
| | - David B. Kaber
- Dept. of Industrial & Systems Engineering, North Carolina State University, Raleigh, North Carolina, USA
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Effects of Home-Based Robotic Therapy Involving the Single-Joint Hybrid Assistive Limb Robotic Suit in the Chronic Phase of Stroke: A Pilot Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5462694. [PMID: 31011576 PMCID: PMC6442446 DOI: 10.1155/2019/5462694] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/04/2019] [Accepted: 02/20/2019] [Indexed: 01/21/2023]
Abstract
Introduction Robotic therapy has drawn attention in the rehabilitation field including home-based rehabilitation. A previous study has reported that home-based therapy could be more effective for increasing upper limb activity than facility-based therapy. The single-joint hybrid assistive limb (HAL-SJ) is an exoskeleton robot developed according to the interactive biofeedback theory, and several studies have shown its effectiveness for upper limb function in stroke patients. A study of home-based robotic therapy has shown to enhance rehabilitation effectiveness for stroke patient with a paretic upper limb. However, home-based therapy involving a HAL-SJ in stroke patients with paretic upper limbs has not been investigated. The present study aimed to investigate paretic upper limb activity and function with home-based robotic therapy involving a HAL-SJ in stroke patients. Materials and Methods A home-based robotic therapy program involving a HAL-SJ was performed for 30 min per session followed by standard therapy for 30 min per session, 2 times a week, for 4 weeks (i.e., completion of all 8 sessions involved 8 h of rehabilitation), at home. After the intervention, patients were followed up by telephone and home visits for 8 weeks. The paretic upper limb activity and function were assessed using the Motor Activity Log (MAL; amount of use (AOU)), arm triaxial accelerometry (laterality index (LI)), the Fugl–Meyer assessment (FMA), and the action research arm test (ARAT), at baseline and week 4 and week 12 after the start of training. Results The study included 10 stroke patients (5 men; mean age, 61.1 ± 7.1 years). The AOU scores and LI significantly improved at week 4 after the start of training (p<0.05). However, no significant changes were observed in the LI at week 12 (p=0.161) and the FMA scores at both week 4 and week 12 (p=0.059 and p=0.083, respectively). The ARAT scores significantly improved at both week 4 and week 12 (p<0.05). Conclusion Home-based robotic therapy combined with conventional therapy could be a valuable approach for increasing paretic upper limb activity and maintaining paretic upper limb function in the chronic phase of stroke.
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Hsieh YW, Chang KC, Hung JW, Wu CY, Fu MH, Chen CC. Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial. Arch Phys Med Rehabil 2018; 99:2399-2407. [DOI: 10.1016/j.apmr.2018.03.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/16/2018] [Accepted: 03/23/2018] [Indexed: 11/25/2022]
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Massetti T, da Silva TD, Crocetta TB, Guarnieri R, de Freitas BL, Bianchi Lopes P, Watson S, Tonks J, de Mello Monteiro CB. The Clinical Utility of Virtual Reality in Neurorehabilitation: A Systematic Review. J Cent Nerv Syst Dis 2018; 10:1179573518813541. [PMID: 30515028 PMCID: PMC6262495 DOI: 10.1177/1179573518813541] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/19/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Virtual reality (VR) experiences (through games and virtual environments) are increasingly being used in physical, cognitive, and psychological interventions. However, the impact of VR as an approach to rehabilitation is not fully understood, and its advantages over traditional rehabilitation techniques are yet to be established. Method: We present a systematic review which was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). During February and March of 2018, we conducted searches on PubMed (Medline), Virtual Health Library Search Portal databases (BVS), Web of Science (WOS), and Embase for all VR-related publications in the past 4 years (2015, 2016, 2017, and 2018). The keywords used in the search were “neurorehabilitation” AND “Virtual Reality” AND “devices.” Results: We summarize the literature which highlights that a range of effective VR approaches are available. Studies identified were conducted with poststroke patients, patients with cerebral palsy, spinal cord injuries, and other pathologies. Healthy populations have been used in the development and testing of VR approaches meant to be used in the future by people with neurological disorders. A range of benefits were associated with VR interventions, including improvement in motor functions, greater community participation, and improved psychological and cognitive function. Conclusions: The results from this review provide support for the use of VR as part of a neurorehabilitation program in maximizing recovery.
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Affiliation(s)
- Thais Massetti
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Talita Dias da Silva
- School of Arts, Sciences and Humanities (EACH), University of São Paulo (USP), São Paulo, Brazil
| | | | | | - Bruna Leal de Freitas
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Israelite Hospital Albert Einstein, São Paulo, Brazil
| | | | - Suzanna Watson
- The Cambridge Centre for Paediatric Neurorehabilitation, Cambridge, UK
| | - James Tonks
- Medical School, University of Exeter, Exeter, UK.,Haven Clinical Psychology Practice, Cornwall, UK
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Rast FM, Labruyère R. Protocol of a systematic review on the application of wearable inertial sensors to quantify everyday life motor activity in people with mobility impairments. Syst Rev 2018; 7:174. [PMID: 30355320 PMCID: PMC6201500 DOI: 10.1186/s13643-018-0824-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 09/25/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND People with mobility impairments may have difficulties in everyday life motor activities, and assessing these difficulties is crucial to plan rehabilitation interventions and evaluate their effectiveness. Wearable inertial sensors enable long-term monitoring of motor activities in a patient's habitual environment and complement clinical assessments which are conducted in a standardised environment. The application of wearable sensors requires appropriate data processing algorithms to estimate clinically meaningful outcome measures, and this review will provide an overview of previously published measures, their underlying algorithms, sensor placement, and measurement properties such as validity, reproducibility, and feasibility. METHODS We will screen the literature for studies which applied inertial sensors to people with mobility impairments in free-living conditions, described the data processing algorithm reproducibly, and calculated everyday life motor activity-related outcome measures. Three databases (MEDLINE, EMBASE, and SCOPUS) will be searched with terms out of four different categories: study population, measurement tool, algorithm, and outcome measure. Abstracts and full texts will be screened independently by the two review authors, and disagreement will be solved by discussion and consensus. Data will be extracted by one of the review authors and verified by the other. It includes the type of outcome measures, the underlying data processing algorithm, the required sensor technology, the corresponding sensor placement, the measurement properties, and the target population. We expect to find a high heterogeneity of outcome measures and will therefore provide a narrative synthesis of the extracted data. DISCUSSION This review will facilitate the selection of an appropriate sensor setup for future applications, contain recommendations about the design of data processing algorithms as well as their evaluation procedure, and present a gap for innovative, new algorithms, and devices. SYSTEMATIC REVIEW REGISTRATION International prospective register of systematic reviews (PROSPERO): CRD42017069865 .
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Affiliation(s)
- Fabian Marcel Rast
- Rehabilitation Center for Children and Adolescents, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland. .,Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - Rob Labruyère
- Rehabilitation Center for Children and Adolescents, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
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Dobkin BH, Martinez C. Wearable Sensors to Monitor, Enable Feedback, and Measure Outcomes of Activity and Practice. Curr Neurol Neurosci Rep 2018; 18:87. [PMID: 30293160 DOI: 10.1007/s11910-018-0896-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Measurements obtained during real-world activity by wearable motion sensors may contribute more naturalistic accounts of clinically meaningful changes in impairment, activity, and participation during neurologic rehabilitation, but obstacles persist. Here we review the basics of wearable sensors, the use of existing systems for neurological and rehabilitation applications and their limitations, and strategies for future use. RECENT FINDINGS Commercial activity-recognition software and wearable motion sensors for community monitoring primarily calculate steps and sedentary time. Accuracy declines as walking speed slows below 0.8 m/s, less so if worn on the foot or ankle. Upper-extremity sensing is mostly limited to simple inertial activity counts. Research software and activity-recognition algorithms are beginning to provide ground truth about gait cycle variables and reveal purposeful arm actions. Increasingly, clinicians can incorporate inertial and other motion signals to monitor exercise, activities of daily living, and the practice of specific skills, as well as provide tailored feedback to encourage self-management of rehabilitation. Efforts are growing to create a compatible collection of clinically relevant sensor applications that capture the type, quantity, and quality of everyday activity and practice in known contexts. Such data would offer more ecologically sound measurement tools, while enabling clinicians to monitor and support remote physical therapies and behavioral modification when combined with telemedicine outreach.
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Affiliation(s)
- Bruce H Dobkin
- Geffen School of Medicine at UCLA, Department of Neurology, Reed Neurologic Research Center, 710 Westwood Plaza, Los Angeles, CA, 90095-1769, USA.
| | - Clarisa Martinez
- Geffen School of Medicine at UCLA, Department of Neurology, Reed Neurologic Research Center, 710 Westwood Plaza, Los Angeles, CA, 90095-1769, USA
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Winstein C, Varghese R. Been there, done that, so what’s next for arm and hand rehabilitation in stroke? NeuroRehabilitation 2018; 43:3-18. [DOI: 10.3233/nre-172412] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Carolee Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Rini Varghese
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Abstract
The last decade has witnessed an increase in the number of moderate to large-scale nonpharmacologic stroke recovery trials. While a majority, having tested the superiority of a particular evidence-based intervention, returned negative findings, the rehabilitation research community has gained an important perspective for future efforts. We offer our interpretation first, on why most of the past decade’s trials failed in the sense of not supporting the primary superiority hypothesis, and, second, we provide our perspective on how to solve this problem and thereby inform the next generation of neurorehabilitation clinical trials. The first large-scale randomized controlled trial (RCT) ever conducted in neurorehabilitation was the Extremity Constraint Induced Movement Therapy Evaluation (EXCITE) trial. The majority of stroke recovery trials that followed were based on a prevailing, but as yet immature science of brain-behavior mechanisms for recovery and limited practical know-how about how to select the most meaningful outcomes. The research community had been seduced by a set of preclinical studies, ignited by the 1990’s revolution in neuroscience and an oversimplified premise that high doses of task-oriented training was the most important ingredient to foster recovery. Here, we highlight recent qualitative and quantitative evidence, both mechanistic and theory-driven, that integrates crucial social and personal factors to inform a more mature science better suited for the next generation of recovery-supportive rehabilitation clinical trials.
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Cramer SC. Treatments to Promote Neural Repair after Stroke. J Stroke 2018; 20:57-70. [PMID: 29402069 PMCID: PMC5836581 DOI: 10.5853/jos.2017.02796] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/16/2018] [Accepted: 01/18/2018] [Indexed: 12/12/2022] Open
Abstract
Stroke remains a major cause of human disability worldwide. In parallel with advances in acute stroke interventions, new therapies are under development that target restorative processes. Such therapies have a treatment time window measured in days, weeks, or longer and so have the advantage that they may be accessible by a majority of patients. Several categories of restorative therapy have been studied and are reviewed herein, including drugs, growth factors, monoclonal antibodies, activity-related therapies including telerehabilitation, and a host of devices such as those related to brain stimulation or robotics. Many patients with stroke do not receive acute stroke therapies or receive them and do not derive benefit, often surviving for years thereafter. Therapies based on neural repair hold the promise of providing additional treatment options to a majority of patients with stroke.
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Affiliation(s)
- Steven C. Cramer
- Departments of Neurology, Anatomy & Neurobiology and Physical Medicine & Rehabilitation, University of California, Irvine, CA, USA
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60
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Ellis T, Rochester L. Mobilizing Parkinson's Disease: The Future of Exercise. JOURNAL OF PARKINSON'S DISEASE 2018; 8:S95-S100. [PMID: 30584167 PMCID: PMC6311359 DOI: 10.3233/jpd-181489] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/08/2018] [Indexed: 01/01/2023]
Abstract
Exercise is increasingly recognized as an important element in the treatment of Parkinson's disease but what is exercise targeting? What accounts for the benefits observed in Parkinson's disease? Is exercise disease modifying? Several modes of exercise have been studied in various doses across a heterogeneous Parkinson's population. Yet more clarity is needed as to who benefits most and when, from what type of exercise and at which intensity. In this paper, we briefly review the state of the art in key areas and speculate on the likely state of research in each area in the next 20 years. Key areas relate to: (1) the physiological benefits of exercise with respect to disease modification; (2) the best type of exercise; (3) the optimal intensity of exercise; and (4) implementation strategies to increase exercise uptake. A better understanding of these concepts would allow for a more effective, personalized approach, rather than the current "one size fits all" and could most likely confer greater benefits.
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Affiliation(s)
- Terry Ellis
- Boston University College of Health and Rehabilitation Sciences, Sargent College, Center for Neurorehabilitation, Boston, MA, USA
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
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61
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Baber C, Khattab A, Russell M, Hermsdörfer J, Wing A. Creating Affording Situations: Coaching through Animate Objects. SENSORS 2017; 17:s17102308. [PMID: 29019939 PMCID: PMC5676696 DOI: 10.3390/s17102308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/29/2017] [Accepted: 10/03/2017] [Indexed: 11/16/2022]
Abstract
We explore the ways in which animate objects can be used to cue actions as part of coaching in Activities of Daily Living (ADL). In this case, changing the appearance or behavior of a physical object is intended to cue actions which are appropriate for a given context. The context is defined by the intention of the users, the state of the objects and the tasks for which these objects can be used. We present initial design prototypes and simple user trials which explore the impact of different cues on activity. It is shown that raising the handle of a jug, for example, not only cues the act of picking up the jug but also encourages use of the hand adjacent to the handle; that combinations of lights (on the objects) and auditory cues influence activity through reducing uncertainty; and that cueing can challenge pre-learned action sequences. We interpret these results in terms of the idea that the animate objects can be used to create affording situations, and discuss implications of this work to support relearning of ADL following brain damage or injury, such as might arise following a stroke.
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Affiliation(s)
- Chris Baber
- School of Engineering, University of Birmingham, Birmingham B15 2TT, UK.
| | - Ahmad Khattab
- School of Engineering, University of Birmingham, Birmingham B15 2TT, UK.
| | - Martin Russell
- School of Engineering, University of Birmingham, Birmingham B15 2TT, UK.
| | - Joachim Hermsdörfer
- Department of Sport and Health Sciences, Technische Universität Munchen, 80992 Munchen, Germany.
| | - Alan Wing
- School of Psychology, University of Birmingham, Birmingham B15 2TT, UK.
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Dobkin BH, Dorsch AK. The Evolution of Personalized Behavioral Intervention Technology: Will It Change How We Measure or Deliver Rehabilitation? Stroke 2017; 48:2329-2334. [PMID: 28679855 DOI: 10.1161/strokeaha.117.016620] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/01/2017] [Accepted: 06/07/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Bruce H Dobkin
- From the Department of Neurology, Geffen School of Medicine, University of California-Los Angeles.
| | - Andrew K Dorsch
- From the Department of Neurology, Geffen School of Medicine, University of California-Los Angeles
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63
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Dobkin BH. Behavioral self-management strategies for practice and exercise should be included in neurologic rehabilitation trials and care. Curr Opin Neurol 2016; 29:693-699. [PMID: 27608301 PMCID: PMC5842701 DOI: 10.1097/wco.0000000000000380] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Rehabilitation trials and postacute care to lessen impairments and disability after stroke, spinal cord injury, and traumatic brain injury almost never include training to promote long-term self-management of skills practice, strengthening and fitness. Without behavioral training to develop self-efficacy, clinical trials, and home-based therapy may fail to show robust results. RECENT FINDINGS Behavioral theories about self-management and self-efficacy for physical activity have been successfully incorporated into interventions for chronic diseases, but rarely for neurologic rehabilitation. The elements of behavioral training include education about the effects of practice and exercise that are relevant to the person, goal setting, identification of possible barriers, problem solving, feedback about performance, tailored instruction, decision making, and ongoing personal or social support. Mobile health and telerehabilitation technologies offer new ways to remotely enable such training by monitoring activity from wearable wireless sensors and instrumented exercise devices to allow real-world feedback, goal setting, and instruction. SUMMARY Motivation, sense of responsibility, and confidence to practice and exercise in the home can be trained to increase adherence to skills practice and exercise both during and after formal rehabilitation. To optimize motor learning and improve long-term outcomes, self-management training should be an explicit component of rehabilitation care and clinical trials.
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Affiliation(s)
- Bruce H Dobkin
- Geffen School of Medicine at the University of California Los Angeles, Reed Neurologic Research Center, Los Angeles, California, USA
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