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Rogers JM, Duckworth J, Middleton S, Steenbergen B, Wilson PH. Elements virtual rehabilitation improves motor, cognitive, and functional outcomes in adult stroke: evidence from a randomized controlled pilot study. J Neuroeng Rehabil 2019; 16:56. [PMID: 31092252 PMCID: PMC6518680 DOI: 10.1186/s12984-019-0531-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/03/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Virtual reality technologies show potential as effective rehabilitation tools following neuro-trauma. In particular, the Elements system, involving customized surface computing and tangible interfaces, produces strong treatment effects for upper-limb and cognitive function following traumatic brain injury. The present study evaluated the efficacy of Elements as a virtual rehabilitation approach for stroke survivors. METHODS Twenty-one adults (42-94 years old) with sub-acute stroke were randomized to four weeks of Elements virtual rehabilitation (three weekly 30-40 min sessions) combined with treatment as usual (conventional occupational and physiotherapy) or to treatment as usual alone. Upper-limb skill (Box and Blocks Test), cognition (Montreal Cognitive Assessment and selected CogState subtests), and everyday participation (Neurobehavioral Functioning Inventory) were examined before and after inpatient training, and one-month later. RESULTS Effect sizes for the experimental group (d = 1.05-2.51) were larger compared with controls (d = 0.11-0.86), with Elements training showing statistically greater improvements in motor function of the most affected hand (p = 0.008), and general intellectual status and executive function (p ≤ 0.001). Proportional recovery was two- to three-fold greater than control participants, with superior transfer to everyday motor, cognitive, and communication behaviors. All gains were maintained at follow-up. CONCLUSION A course of Elements virtual rehabilitation using goal-directed and exploratory upper-limb movement tasks facilitates both motor and cognitive recovery after stroke. The magnitude of training effects, maintenance of gains at follow-up, and generalization to daily activities provide compelling preliminary evidence of the power of virtual rehabilitation when applied in a targeted and principled manner. TRIAL REGISTRATION this pilot study was not registered.
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Affiliation(s)
- Jeffrey M Rogers
- The University of Sydney, Faculty of Health Sciences, Sydney, NSW, Australia.
| | | | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Australia and Australian Catholic University, Sydney, NSW, Australia
| | - Bert Steenbergen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Peter H Wilson
- Centre for Disability and Development Research (CeDDR) and School of Behavioural and Health Science, Australian Catholic University, Melbourne, VIC, Australia
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Barak Ventura R, Nakayama S, Raghavan P, Nov O, Porfiri M. The Role of Social Interactions in Motor Performance: Feasibility Study Toward Enhanced Motivation in Telerehabilitation. J Med Internet Res 2019; 21:e12708. [PMID: 31094338 PMCID: PMC6540723 DOI: 10.2196/12708] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/12/2019] [Accepted: 02/17/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Robot-mediated telerehabilitation has the potential to provide patient-tailored cost-effective rehabilitation. However, compliance with therapy can be a problem that undermines the prospective advantages of telerehabilitation technologies. Lack of motivation has been identified as a major factor that hampers compliance. Exploring various motivational interventions, the integration of citizen science activities in robotics-based rehabilitation has been shown to increase patients' motivation to engage in otherwise tedious exercises by tapping into a vast array of intrinsic motivational drivers. Patient engagement can be further enhanced by the incorporation of social interactions. OBJECTIVE Herein, we explored the possibility of bolstering engagement in physical therapy by leveraging cooperation among users in an environmental citizen science project. Specifically, we studied how the integration of cooperation into citizen science influences user engagement, enjoyment, and motor performance. Furthermore, we investigated how the degree of interdependence among users, such that is imposed through independent or joint termination (JT), affects participation in citizen science-based telerehabilitation. METHODS We developed a Web-based citizen science platform in which users work in pairs to classify images collected by an aquatic robot in a polluted water canal. The classification was carried out by labeling objects that appear in the images and trashing irrelevant labels. The system was interfaced by a haptic device for fine motor rehabilitation. We recruited 120 healthy volunteers to operate the platform. Of these volunteers, 98 were cooperating in pairs, with 1 user tagging images and the other trashing labels. The other 22 volunteers performed both tasks alone. To vary the degree of interdependence within cooperation, we implemented independent and JTs. RESULTS We found that users' engagement and motor performance are modulated by their assigned task and the degree of interdependence. Motor performance increased when users were subjected to independent termination (P=.02), yet enjoyment decreased when users were subjected to JT (P=.005). A significant interaction between the type of termination and the task was found to influence productivity (P<.001) as well as mean speed, peak speed, and path length of the controller (P=.01, P=.006, and P<.001, respectively). CONCLUSIONS Depending on the type of termination, cooperation was not always positively associated with engagement, enjoyment, and motor performance. Therefore, enhancing user engagement, satisfaction, and motor performance through cooperative citizen science tasks relies on both the degree of interdependence among users and the perceived nature of the task. Cooperative citizen science may enhance motivation in robotics-based telerehabilitation, if designed attentively.
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Affiliation(s)
- Roni Barak Ventura
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Shinnosuke Nakayama
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Preeti Raghavan
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, United States
| | - Oded Nov
- Department of Technology Management and Innovation, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Maurizio Porfiri
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States.,Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
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53
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Yurkewich A, Hebert D, Wang RH, Mihailidis A. Hand Extension Robot Orthosis (HERO) Glove: Development and Testing With Stroke Survivors With Severe Hand Impairment. IEEE Trans Neural Syst Rehabil Eng 2019; 27:916-926. [DOI: 10.1109/tnsre.2019.2910011] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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54
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Zander V, Johansson-Pajala RM, Gustafsson C. Methods to evaluate perspectives of safety, independence, activity, and participation in older persons using welfare technology. A systematic review. Disabil Rehabil Assist Technol 2019; 15:373-393. [PMID: 30786779 DOI: 10.1080/17483107.2019.1574919] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To conduct a systematic review of existing methods to evaluate the individual aspects of welfare technology from the perspectives of independence, safety, activity, and participation. Furthermore, the study aimed to describe outcomes that have been the focus of previous research to evaluate individual aspects of welfare technology in older persons living in ordinary housing. Materials and methods: A systematic literature review in PubMed, CINAHL Plus, PsycINFO, Scopus, and Web of Science. Studies selected were those that explored the use of assistive and welfare technology devices from older persons' perspectives, and which considered the concepts of independence, safety, activity and participation, and quality of life. Results: A broad spectrum of instruments was applied in the studies. For independence, three questionnaires were used in the identified studies. For safety, one instrument was used in two versions. To study activity and participation as well as quality of life, several scales were used. Additionally, several studies included qualitative approaches for evaluation, such as interviews, or posed one or more questions regarding the effects of welfare technology. Conclusions: The integration of digital assistive and welfare technology should be based on the needs of older persons, and those needs must be assessed using reliable and relevant instruments. The heterogeneity of the target group, i.e., older persons, together with the fact that assessments must give consideration to identifying goals, obstacles, and risks as well as users' preferences, implies a person-centred approach.Implications for rehabilitationThe integration of digital assistive and welfare technology should be based on older persons' needs, and those needs must be assessed using reliable and relevant instruments.The heterogeneity of the target group, i.e. older persons, together with the fact that assessments must give consideration to identifying goals, obstacles and risks as well as users' preferences, implies a person-centred approach.The ideal would be one coherent model that explores the use of digital assistive and welfare technology from the individual, economic as well as organisational dimensions. This would cover the different needs and expectations of various stakeholders, including economic and organisational, but also the needs of the older person.
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Affiliation(s)
- V Zander
- School of Health, Care, and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - R-M Johansson-Pajala
- School of Health, Care, and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - C Gustafsson
- School of Health, Care, and Social Welfare, Mälardalen University, Eskilstuna, Sweden
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55
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Chen Y, Abel KT, Janecek JT, Chen Y, Zheng K, Cramer SC. Home-based technologies for stroke rehabilitation: A systematic review. Int J Med Inform 2018; 123:11-22. [PMID: 30654899 DOI: 10.1016/j.ijmedinf.2018.12.001] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/29/2018] [Accepted: 12/08/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many forms of home-based technology targeting stroke rehabilitation have been devised, and a number of human factors are important to their application, suggesting the need to examine this information in a comprehensive review. OBJECTIVE The systematic review aims to synthesize the current knowledge of technologies and human factors in home-based technologies for stroke rehabilitation. METHODS We conducted a systematic literature search in three electronic databases (IEEE, ACM, PubMed), including secondary citations from the literature search. We included articles that used technological means to help stroke patients conduct rehabilitation at home, reported empirical studies that evaluated the technologies with patients in the home environment, and were published in English. Three authors independently conducted the content analysis of searched articles using a list of interactively defined factors. RESULTS The search yielded 832 potentially relevant articles, leading to 31 articles that were included for in-depth analysis. The types of technology of reviewed articles included games, telerehabilitation, robotic devices, virtual reality devices, sensors, and tablets. We present the merits and limitations of each type of technology. We then derive two main human factors in designing home-based technologies for stroke rehabilitation: designing for engagement (including external and internal motivation) and designing for the home environment (including understanding the social context, practical challenges, and technical proficiency). CONCLUSION This systematic review presents an overview of key technologies and human factors for designing home-based technologies for stroke rehabilitation.
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Affiliation(s)
- Yu Chen
- School of Information Systems and Technology, San Jose State University, United States.
| | | | - John T Janecek
- Department of Computer Science, University of California, Irvine, United States
| | - Yunan Chen
- Department of Informatics, University of California, Irvine, United States
| | - Kai Zheng
- Department of Informatics, University of California, Irvine, United States
| | - Steven C Cramer
- Department of Neurology, University of California, Irvine, United States
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56
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van Ommeren AL, Smulders LC, Prange-Lasonder GB, Buurke JH, Veltink PH, Rietman JS. Assistive Technology for the Upper Extremities After Stroke: Systematic Review of Users' Needs. JMIR Rehabil Assist Technol 2018; 5:e10510. [PMID: 30497993 PMCID: PMC6293243 DOI: 10.2196/10510] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/24/2018] [Accepted: 10/01/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Technical innovations have the potential to compensate for loss of upper-limb motor functions after stroke. However, majority of the designs do not completely meet the needs and preferences of the end users. User-centered design methods have shown that the attention to user perspectives during development of assistive technology leads to devices that better suit the needs of the users. OBJECTIVE To get more insight into the factors that can bring the design of assistive technology to higher levels of satisfaction and acceptance, studies about user perspectives on assistive technology for the upper limb after stroke are systematically reviewed. METHODS A database search was conducted in PubMed, EMBASE, CINAHL, PsycINFO, and Scopus from inception to August 2017, supplemented with a search of reference lists. Methodological quality of the included studies was appraised. User perspectives of stroke survivors, carers, and health care professionals were extracted. A total of 35 descriptive themes were identified, from which 5 overarching themes were derived. RESULTS In total, 9 studies with information gathered from focus groups, questionnaires, and interviews were included. Barriers and enablers influencing the adoption of assistive technology for the upper limb after stroke emerged within 5 overarching but highly interdependent themes: (1) promoting hand and arm performance; (2) attitude toward technology; (3) decision process; (4) usability; and (5) practical applicability. CONCLUSIONS Expected use of an assistive technology is facilitated when it has a clear therapeutic base (expected benefit in enhancing function), its users (patients and health care professionals) have a positive attitude toward technology, sufficient information about the assistive technology is available, and usability and practical applicability have been addressed successfully in its design. The interdependency of the identified themes implies that all aspects influencing user perspectives of assistive technology need to be considered when developing assistive technology to enhance its chance of acceptance. The importance of each factor may vary depending on personal factors and the use context, either at home as an assistive aid or for rehabilitation at a clinic.
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Affiliation(s)
- Anne L van Ommeren
- Roessingh Research and Development, Enschede, Netherlands.,Biomechanical Engineering, University of Twente, Enschede, Netherlands
| | | | - Gerdienke B Prange-Lasonder
- Roessingh Research and Development, Enschede, Netherlands.,Biomechanical Engineering, University of Twente, Enschede, Netherlands
| | - Jaap H Buurke
- Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Peter H Veltink
- Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Johan S Rietman
- Roessingh Research and Development, Enschede, Netherlands.,Biomechanical Engineering, University of Twente, Enschede, Netherlands
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57
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Gorsic M, Tran MH, Novak D. Cooperative Cooking: A Novel Virtual Environment for Upper Limb Rehabilitation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:3602-3605. [PMID: 30441156 DOI: 10.1109/embc.2018.8513005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Motor rehabilitation technologies commonly include virtual environments that motivate patients to exercise more often or more intensely. In this paper, we present a novel virtual rehabilitation environment in which two people work together to prepare meals. The players' roles can be fixed or undefined, and optional challenges can be added in the form of flies that must be swatted away. A preliminary evaluation with 12 pairs of unimpaired participants showed that participants prefer cooperating over exercising alone and feel less pressured when cooperating. Furthermore, participants enjoyed the addition of flies and preferred not to have defined roles. Finally, no significant decrease in exercise intensity was observed as a result of cooperation. These results indicate that cooperation could improve motor rehabilitation by increasing motivation, though the virtual environment needs to be evaluated with participants with motor impairment.
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58
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Engel-Yeger B, Tse T, Josman N, Baum C, Carey LM. Scoping Review: The Trajectory of Recovery of Participation Outcomes following Stroke. Behav Neurol 2018; 2018:5472018. [PMID: 30271506 PMCID: PMC6151208 DOI: 10.1155/2018/5472018] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/29/2018] [Accepted: 07/26/2018] [Indexed: 12/21/2022] Open
Abstract
Participation is a central concept in health and well-being and healthcare, yet operationalizing this concept has been difficult. Its definition, uses in healthcare, and impacts on recovery require ongoing research. Our review question goes like this: from the longitudinal evidence investigating participation among stroke survivors, what are the patterns of participation recovery in stroke survivors over time, and what interventions are used to improve participation? To fully understand these questions, we also ask, how is participation defined in the stroke literature, and what are the measures of participation used in the stroke literature? A systematic scoping review was undertaken using the search terms "stroke," "longitudinal," "participation," and "outcome" in seven databases. Articles included were published until April 2017, written in English, and had at least two longitudinal assessments of participation. Fifty-nine articles met the inclusion criteria. The International Classification of Functioning, Disability and Health was the most frequent definition of participation used (34%). There were 22 different measures of participation. Eight of ten studies demonstrated significant improvements in participation up to 12 months poststroke. Efficacy of interventions and their impact on participation varied. The various definitions, measures, and intervention efficacies of participation highlight the need for further research worldwide into achieving meaningful participation and quality of life among stroke survivors. Future practice should include participation as a main outcome measure.
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Affiliation(s)
- Batya Engel-Yeger
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Tamara Tse
- Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health, La Trobe University, Melbourne, VIC, Australia
- Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
- Occupational Therapy Department, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Naomi Josman
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Carolyn Baum
- Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO, USA
| | - Leeanne M. Carey
- Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health, La Trobe University, Melbourne, VIC, Australia
- Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
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59
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Nijenhuis SM, Prange-Lasonder GB, Fleuren JF, Wagenaar J, Buurke JH, Rietman JS. Strong relations of elbow excursion and grip strength with post-stroke arm function and activities: Should we aim for this in technology-supported training? J Rehabil Assist Technol Eng 2018; 5:2055668318779301. [PMID: 31191944 PMCID: PMC6453079 DOI: 10.1177/2055668318779301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/02/2018] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate the relationships between an extensive set of objective
movement execution kinematics of the upper extremity and clinical outcome
measures in chronic stroke patients: at baseline and after
technology-supported training at home. Methods Twenty mildly to severely affected chronic stroke patients participated in
the baseline evaluation, 15 were re-evaluated after six weeks of intensive
technology-supported or conventional arm/hand training at home. Grip
strength, 3D motion analysis of a reach and grasp task, and clinical scales
(Fugl-Meyer assessment (FM), Action Research Arm Test (ARAT) and Motor
Activity Log (MAL)) were assessed pre- and post-training. Results Most movement execution parameters showed moderate-to-strong relationships
with FM and ARAT, and to a smaller degree with MAL. Elbow excursion
explained the largest amount of variance in FM and ARAT, together with grip
strength. The only strong association after training was found between
changes in ARAT and improvements in hand opening (conventional) or grip
strength (technology-supported). Conclusions Elbow excursion and grip strength showed strongest association with
post-stroke arm function and activities. Improved functional ability after
training at home was associated with increased hand function. Addressing
both reaching and hand function are indicated as valuable targets for
(technological) treatment applications to stimulate functional improvements
after stroke.
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Affiliation(s)
- Sharon M Nijenhuis
- Roessingh Research and Development and Roessingh Rehabilitation Centre, Enschede, the Netherlands.,Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
| | - Gerdienke B Prange-Lasonder
- Roessingh Research and Development and Roessingh Rehabilitation Centre, Enschede, the Netherlands.,Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
| | - Judith Fm Fleuren
- Roessingh Research and Development and Roessingh Rehabilitation Centre, Enschede, the Netherlands
| | - Jan Wagenaar
- Roessingh Research and Development and Roessingh Rehabilitation Centre, Enschede, the Netherlands.,Department of rehabilitation medicine, ZGT Hospital, Almelo, the Netherlands
| | - Jaap H Buurke
- Roessingh Research and Development and Roessingh Rehabilitation Centre, Enschede, the Netherlands.,Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.,Department of Biomedical Signals and Systems, University of Twente, Enschede, the Netherlands
| | - Johan S Rietman
- Roessingh Research and Development and Roessingh Rehabilitation Centre, Enschede, the Netherlands.,Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands.,Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
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60
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Büsching I, Sehle A, Stürner J, Liepert J. Using an upper extremity exoskeleton for semi-autonomous exercise during inpatient neurological rehabilitation- a pilot study. J Neuroeng Rehabil 2018; 15:72. [PMID: 30068372 PMCID: PMC6090973 DOI: 10.1186/s12984-018-0415-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 07/12/2018] [Indexed: 11/23/2022] Open
Abstract
Background Motor deficits are the most common symptoms after stroke. There is some evidence that intensity and amount of exercises influence the degree of improvement of functions within the first 6 months after the injury. The purpose of this pilot study was to evaluate the feasibility and acceptance of semi-autonomous exercises with an upper extremity exoskeleton in addition to an inpatient rehabilitation program. In addition, changes of motor functions were examined. Methods Ten stroke patients with a severe upper extremity paresis were included. They were offered to perform a semi-autonomous training with a gravity-supported, computer-enhanced device (Armeo®Spring, Hocoma AG) six times per week for 4 weeks. Feasibility was evaluated by weekly structured interviews with patients and supervisors. Motor functions were assessed before and after the training period using the Wolf Motor Function Test (WMFT). The Wilcoxon Signed Rank Test was used for assessing pre-post differences. The Pearson correlation co-efficient was used for correlating the number of completed sessions with the change in motor function. Acceptance of the device and the level of satisfaction with the training were determined by a questionnaire based on visual analogue scales. Results Neither patients nor supervisors reported side effects. However, one patient had to be excluded from analysis because of transportation difficulties from the ward to the treatment facility. Therefore, analysis was based on nine patients. On average, 13.2 (55%) sessions were realized. WMFT results showed significant improvements of proximal arm functions. The number of sessions correlated with the degree of shoulder force improvement. Patients rated the exercises to be motivating, and enjoyable and would continue using the Armeo®Spring at home if they had the opportunity. Conclusion Using an upper extremity exoskeleton for semi-autonomous training in an inpatient setting is feasible without side effects and is positively rated by the patients. It might further support the recovery of upper extremity function. Trial registration The trial was retrospectively registered. Registration number ISRCTN42633681.
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Affiliation(s)
- Imke Büsching
- Department of Neurorehabilitation, Kliniken Schmieder, Zum Tafelholz 8, D- 78476, Allensbach, Germany.,Reha-Klinik Bellikon, Mutschellenstrasse 2, 5454, Bellikon, Switzerland
| | - Aida Sehle
- Department of Neurorehabilitation, Kliniken Schmieder, Zum Tafelholz 8, D- 78476, Allensbach, Germany
| | - Jana Stürner
- Department of Neurorehabilitation, Kliniken Schmieder, Zum Tafelholz 8, D- 78476, Allensbach, Germany
| | - Joachim Liepert
- Department of Neurorehabilitation, Kliniken Schmieder, Zum Tafelholz 8, D- 78476, Allensbach, Germany.
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Radder B, Prange-Lasonder GB, Kottink AI, Holmberg J, Sletta K, Van Dijk M, Meyer T, Buurke JH, Rietman JS. The effect of a wearable soft-robotic glove on motor function and functional performance of older adults. Assist Technol 2018; 32:9-15. [DOI: 10.1080/10400435.2018.1453888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Bob Radder
- Roessingh Research and Development, Enschede, the Netherlands
- Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
| | - Gerdienke B. Prange-Lasonder
- Roessingh Research and Development, Enschede, the Netherlands
- Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
| | - Anke I.R. Kottink
- Roessingh Research and Development, Enschede, the Netherlands
- Department of Biosystems and Signals, University of Twente, Enschede, the Netherlands
| | - Johnny Holmberg
- Eskilstuna Kommun Vård-och omsorgsförvaltningen, Eskilstuna, Sweden
| | - Kristin Sletta
- Eskilstuna Kommun Vård-och omsorgsförvaltningen, Eskilstuna, Sweden
| | - Manon Van Dijk
- National Foundation for the Elderly, Bunnik, the Netherlands
| | | | - Jaap H. Buurke
- Roessingh Research and Development, Enschede, the Netherlands
- Department of Biosystems and Signals, University of Twente, Enschede, the Netherlands
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
| | - Johan S. Rietman
- Roessingh Research and Development, Enschede, the Netherlands
- Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
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Da-Silva RH, Moore SA, Price CI. Self-directed therapy programmes for arm rehabilitation after stroke: a systematic review. Clin Rehabil 2018; 32:1022-1036. [PMID: 29756513 DOI: 10.1177/0269215518775170] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To investigate the effectiveness of self-directed arm interventions in adult stroke survivors. METHODS A systematic review of Medline, EMBASE, CINAHL, SCOPUS and IEEE Xplore up to February 2018 was carried out. Studies of stroke arm interventions were included where more than 50% of the time spent in therapy was initiated and carried out by the participant. Quality of the evidence was assessed using the Cochrane risk of bias tool. RESULTS A total of 40 studies ( n = 1172 participants) were included (19 randomized controlled trials (RCTs) and 21 before-after studies). Studies were grouped according to no technology or the main additional technology used (no technology n = 5; interactive gaming n = 6; electrical stimulation n = 11; constraint-induced movement therapy n = 6; robotic and dynamic orthotic devices n = 8; mirror therapy n = 1; telerehabilitation n = 2; wearable devices n = 1). A beneficial effect on arm function was found for self-directed interventions using constraint-induced movement therapy ( n = 105; standardized mean difference (SMD) 0.39, 95% confidence interval (CI) -0.00 to 0.78) and electrical stimulation ( n = 94; SMD 0.50, 95% CI 0.08-0.91). Constraint-induced movement therapy and therapy programmes without technology improved independence in activities of daily living. Sensitivity analysis demonstrated arm function benefit for patients >12 months poststroke ( n = 145; SMD 0.52, 95% CI 0.21-0.82) but not at 0-3, 3-6 or 6-12 months. CONCLUSION Self-directed interventions can enhance arm recovery after stroke but the effect varies according to the approach used and timing. There were benefits identified from self-directed delivery of constraint-induced movement therapy, electrical stimulation and therapy programmes that increase practice without using additional technology.
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Affiliation(s)
- Ruth H Da-Silva
- Institute of Neuroscience and Stroke Research Group, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah A Moore
- Institute of Neuroscience and Stroke Research Group, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher I Price
- Institute of Neuroscience and Stroke Research Group, Newcastle University, Newcastle upon Tyne, UK
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63
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Gorsic M, Darzi A, Novak D. Comparison of two difficulty adaptation strategies for competitive arm rehabilitation exercises. IEEE Int Conf Rehabil Robot 2018; 2017:640-645. [PMID: 28813892 DOI: 10.1109/icorr.2017.8009320] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This paper presents two different strategies for difficulty adaptation in a competitive arm rehabilitation game: a manual adaptation strategy and an automatic performance-based adaptation strategy. The two strategies were implemented in a competitive game controlled with an inertial-sensor-based home rehabilitation device. They were first evaluated with 32 pairs of unimpaired participants, who played the game with manual adaptation, automated adaptation, or no adaptation. Each variant was played for 9 minutes. Then, the manual and automatic adaptation were also tested by 5 pairs consisting of a person with arm impairment (due to neurological injury) and their unimpaired friend or relative. Throughout the game, motivation was measured with questionnaires while exercise intensity was tracked using the inertial sensors. Results showed that both manual and automatic difficulty adaptation lead to higher motivation and exercise intensity than no adaptation. Unimpaired participants showed no clear preference between manual and automatic adaptation while 4 of 5 impaired participants preferred automatic adaptation. For future use, we propose a combination of manual and automatic adaptation that should be evaluated with more impaired participants in longer multisession experiments.
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Borstad AL, Crawfis R, Phillips K, Lowes LP, Maung D, McPherson R, Siles A, Worthen-Chaudhari L, Gauthier LV. In-Home Delivery of Constraint-Induced Movement Therapy via Virtual Reality Gaming. J Patient Cent Res Rev 2018; 5:6-17. [PMID: 31413992 DOI: 10.17294/2330-0698.1550] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose People with chronic hemiparesis are frequently dissatisfied with the recovery of their hand and arm, yet many lack access to effective treatments. Constraint-induced movement therapy (CI therapy) effectively increases arm function and spontaneous use in persons with chronic hemiparesis. The purpose of this study was to determine the feasibility and measure safety and outcomes of an in-home model of delivering CI therapy using a custom, avatar-based virtual reality game. Methods Seventeen individuals with chronic hemiparesis participated in this pretest/posttest quasi-experimental design study. The 10-day intervention had three components: 1) high-repetition motor practice using virtual reality gaming; 2) constraint of the stronger arm via a padded restraint mitt; and 3) a transfer package to reinforce arm use. Feasibility of the intervention was evaluated through comparison to traditional CI therapy and through participants' subjective responses. The primary outcome measures were the Wolf Motor Function Test (WMFT) and the Motor Activity Log quality of movement scale (MAL-QOM). Results On average, participants completed 17.2 ± 8 hours and 19,436 repetitions of motor practice. No adverse events were reported. Of 7 feasibility criteria, 4 were met. WMFT rate and MAL-QOM increased, with effect size (Cohen's d) of 1.5 and 1.1, respectively. Conclusions This model of delivering CI therapy using a custom, avatar-based virtual reality game was feasible, well received, and showed preliminary evidence of being a safe intervention to use in the home for persons with chronic hemiparesis.
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Affiliation(s)
| | - Roger Crawfis
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH
| | - Kala Phillips
- Department of Psychological and Brain Sciences, University of Louisville, KY
| | | | | | - Ryan McPherson
- Department of Electrical and Computer Engineering, The Ohio State University, Columbus, OH
| | - Amelia Siles
- Division of Physical Therapy, The Ohio State University, Columbus, OH
| | - Lise Worthen-Chaudhari
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH
| | - Lynne V Gauthier
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH
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Goršič M, Cikajlo I, Goljar N, Novak D. A multisession evaluation of an adaptive competitive arm rehabilitation game. J Neuroeng Rehabil 2017; 14:128. [PMID: 29208017 PMCID: PMC5718145 DOI: 10.1186/s12984-017-0336-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/22/2017] [Indexed: 03/31/2023] Open
Abstract
Background People with neurological injuries such as stroke should exercise frequently and intensely to regain their motor abilities, but are generally hindered by lack of motivation. One way to increase motivation in rehabilitation is through competitive exercises, but such exercises have only been tested in single brief sessions and usually did not adapt difficulty to the patient’s abilities. Methods We designed a competitive arm rehabilitation game for two players that dynamically adapts its difficulty to both players’ abilities. This game was evaluated by two participant groups: 15 participants with chronic arm impairment who exercised at home with an unimpaired friend or relative, and 20 participants in the acute or subacute phase of stroke who exercised in pairs (10 pairs) at a rehabilitation clinic. All participants first played the game against their human opponent for 3 sessions, then played alone (against a computer opponent) in the final, fourth session. In all sessions, participants’ subjective experiences were assessed with the Intrinsic Motivation Inventory questionnaire while exercise intensity was measured using inertial sensors built into the rehabilitation device. After the fourth session, a final brief questionnaire was used to compare competition and exercising alone. Results Participants who played against an unimpaired friend or relative at home tended to prefer competition (only 1 preferred exercising alone), and exhibited higher enjoyment and exercise intensity when competing (first three sessions) than when exercising alone (last session). Participants who played against each other in the clinic, however, did not exhibit significant differences between competition and exercising alone. For both groups, there was no difference in enjoyment or exercise intensity between the first three sessions, indicating no negative effects of habituation or novelty. Conclusions Competitive exercises have high potential for unsupervised home rehabilitation, as they improve enjoyment and exercise intensity compared to exercising alone. Such exercises could thus improve rehabilitation outcome, but this needs to be tested in long-term clinical trials. It is not clear why participants who competed against each other at the clinic did not exhibit any advantages of competition, and further studies are needed to determine how different factors (environment, nature of opponent etc.) influence patients’ experiences with competitive exercises. Trial registration The study is not a clinical trial. While human subjects are involved, they do not participate in a full rehabilitation intervention, and no health outcomes are examined. Electronic supplementary material The online version of this article (10.1186/s12984-017-0336-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maja Goršič
- Department of Electrical and Computer Engineering, University of Wyoming, 1000 E University Avenue, Laramie, WY, 82071, USA
| | - Imre Cikajlo
- University Rehabilitation Institute of the Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia.,University of Nova Gorica, School of Engineering and Management, Vipavska 13, SI-5000, Nova Gorica, Slovenia
| | - Nika Goljar
- University Rehabilitation Institute of the Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia
| | - Domen Novak
- Department of Electrical and Computer Engineering, University of Wyoming, 1000 E University Avenue, Laramie, WY, 82071, USA.
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Widmer M, Held JP, Wittmann F, Lambercy O, Lutz K, Luft AR. Does motivation matter in upper-limb rehabilitation after stroke? ArmeoSenso-Reward: study protocol for a randomized controlled trial. Trials 2017; 18:580. [PMID: 29197412 PMCID: PMC5712159 DOI: 10.1186/s13063-017-2328-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 10/26/2017] [Indexed: 12/12/2022] Open
Abstract
Background Fifty percent of all stroke survivors remain with functional impairments of their upper limb. While there is a need to improve the effectiveness of rehabilitative training, so far no new training approach has proven to be clearly superior to conventional therapy. As training with rewarding feedback has been shown to improve motor learning in humans, it is hypothesized that rehabilitative arm training could be enhanced by rewarding feedback. In this paper, we propose a trial protocol investigating rewards in the form of performance feedback and monetary gains as ways to improve effectiveness of rehabilitative training. Methods This multicentric, assessor-blinded, randomized controlled trial uses the ArmeoSenso virtual reality rehabilitation system to train 74 first-ever stroke patients (< 100 days post stroke) to lift their impaired upper limb against gravity and to improve the workspace of the paretic arm. Three sensors are attached to forearm, upper arm, and trunk to track arm movements in three-dimensional space while controlling for trunk compensation. Whole-arm movements serve as input for a therapy game. The reward group (n = 37) will train with performance feedback and contingent monetary reward. The control group (n = 37) uses the same system but without monetary reward and with reduced performance feedback. Primary outcome is the change in the hand workspace in the transversal plane. Standard clinical assessments are used as secondary outcome measures. Discussion This randomized controlled trial will be the first to directly evaluate the effect of rewarding feedback, including monetary rewards, on the recovery process of the upper limb following stroke. This could pave the way for novel types of interventions with significantly improved treatment benefits, e.g., for conditions that impair reward processing (stroke, Parkinson’s disease). Trial registration ClinicalTrials.gov, ID: NCT02257125. Registered on 30 September 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2328-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mario Widmer
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich, Zurich, Switzerland. .,cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland. .,Neural Control of Movement Laboratory, ETH Zurich, Zurich, Switzerland.
| | - Jeremia P Held
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich, Zurich, Switzerland.,cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Frieder Wittmann
- Rehabilitation Engineering Laboratory, ETH Zurich, Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, ETH Zurich, Zurich, Switzerland
| | - Kai Lutz
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich, Zurich, Switzerland.,cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Andreas R Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich, Zurich, Switzerland.,cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
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Chen J, Nichols D, Brokaw EB, Lum PS. Home-Based Therapy After Stroke Using the Hand Spring Operated Movement Enhancer (HandSOME). IEEE Trans Neural Syst Rehabil Eng 2017; 25:2305-2312. [PMID: 28436882 DOI: 10.1109/tnsre.2017.2695379] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In previous work, we developed a lightweight wearable hand exoskeleton (Hand Spring Operated Movement Enhancer) that improves range of motion and function in laboratory testing. In this pilot study, we added the ability to log movement data for extended periods and recruited ten chronic stroke subjects to use the device during reach and grasp task practice at home for 1.5 h/day, five days per week, and for four weeks. Seven subjects completed the study, performing 448 ± 651 hand movements per training day. After training, impairment was reduced (Fugl-Meyer test; gain = 4.9 ± 4.1; p = .039) and function was improved (Action Research Arm Test; gain = 3.3 ± 2.6; p = .032). There was a significant correlation between gains in the Action Research Arm Test and the number of movements during training (r = 0.90; p = .005). Proximal arm control also improved, as evidenced by a significant reduction in the reach path ratio (p = 0.038). Five subjects responded well to the treatment, having gains of six points or more on the Fugl-Meyer or action research arm test, and achieving significant gains in digit extension (gain = 19.8 ± 10.2°; p = 0.024). However, all of the gains that were significant immediately after training were no longer significant at the three month follow-up. This treatment approach appears promising, but longer periods of home training may be needed to achieve sustainable gains.
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Zhang S, Guo S, Fu Y, Boulardot L, Huang Q, Hirata H, Ishihara H. Integrating Compliant Actuator and Torque Limiter Mechanism for Safe Home-Based Upper-Limb Rehabilitation Device Design. J Med Biol Eng 2017. [DOI: 10.1007/s40846-017-0228-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Goršič M, Cikajlo I, Novak D. Competitive and cooperative arm rehabilitation games played by a patient and unimpaired person: effects on motivation and exercise intensity. J Neuroeng Rehabil 2017; 14:23. [PMID: 28330504 PMCID: PMC5363008 DOI: 10.1186/s12984-017-0231-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 03/10/2017] [Indexed: 11/13/2022] Open
Abstract
Background People with chronic arm impairment should exercise intensely to regain their abilities, but frequently lack motivation, leading to poor rehabilitation outcome. One promising way to increase motivation is through interpersonal rehabilitation games, which allow patients to compete or cooperate together with other people. However, such games have mainly been evaluated with unimpaired subjects, and little is known about how they affect motivation and exercise intensity in people with chronic arm impairment. Methods We designed four different arm rehabilitation games that are played by a person with arm impairment and their unimpaired friend, relative or occupational therapist. One is a competitive game (both people compete against each other), two are cooperative games (both people work together against the computer) and one is a single-player game (played only by the impaired person against the computer). The games were played by 29 participants with chronic arm impairment, of which 19 were accompanied by their friend or relative and 10 were accompanied by their occupational therapist. Each participant played all four games within a single session. Participants’ subjective experience was quantified using the Intrinsic Motivation Inventory questionnaire after each game, as well as a final questionnaire about game preferences. Their exercise intensity was quantified using wearable inertial sensors that measured hand velocity in each game. Results Of the 29 impaired participants, 12 chose the competitive game as their favorite, 12 chose a cooperative game, and 5 preferred to exercise alone. Participants who chose the competitive game as their favorite showed increased motivation and exercise intensity in that game compared to other games. Participants who chose a cooperative game as their favorite also showed increased motivation in cooperative games, but not increased exercise intensity. Conclusions Since both motivation and intensity are positively correlated with rehabilitation outcome, competitive games have high potential to lead to functional improvement and increased quality of life for patients compared to conventional rehabilitation exercises. Cooperative games do not increase exercise intensity, but could still increase motivation of patients who do not enjoy competition. However, such games need to be tested in longer, multisession studies to determine whether the observed increases in motivation and exercise intensity persist over a longer period of time and whether they positively affect rehabilitation outcome. Trial registration The study is not a clinical trial. While human subjects are involved, they participate in a single-session evaluation of a rehabilitation game rather than a full rehabilitation intervention, and no health outcomes are examined. Electronic supplementary material The online version of this article (doi:10.1186/s12984-017-0231-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maja Goršič
- Department of Electrical and Computer Engineering, University of Wyoming, 1000 E University Avenue, Laramie, WY, 82071, USA
| | - Imre Cikajlo
- University Rehabilitation Institute, Republic of Slovenia, Linhartova 51, SI, 1000, Ljubljana, Slovenia
| | - Domen Novak
- Department of Electrical and Computer Engineering, University of Wyoming, 1000 E University Avenue, Laramie, WY, 82071, USA.
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Kizony R, Weiss PL, Harel S, Feldman Y, Obuhov A, Zeilig G, Shani M. Tele-rehabilitation service delivery journey from prototype to robust in-home use. Disabil Rehabil 2016; 39:1532-1540. [PMID: 28004980 DOI: 10.1080/09638288.2016.1250827] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study is to present a retrospective study on clients with Acquired Brain Injury (ABI) enrolled in a tele-motion-rehabilitation service program for two or more months. METHODS Data from 82 clients (46 males; 74 with ABI), aged 22-85 years, are reported. The Kinect-based CogniMotion System (ReAbility Online, Gertner Institute, Tel Hashomer, Israel) provided services that included 30-min biweekly sessions. Participants were evaluated prior to and 2 months following the commencement of service with clinical assessments that measured movements and function of the weaker upper extremity and cognitive abilities. RESULTS Clients enrolled in the service had intact or mild cognitive impairment, mild-moderate motor impairment but little use of their weak upper extremity for daily activities. They were satisfied with the service and reported high levels of system usability. Post-intervention clinical assessments were performed on about half of the participants after 2 months; significant improvements in active movements of the weak upper extremity, shoulder flexion range of motion and in the Trail Making Test were found (p < 0.05). CONCLUSIONS The service appears to be feasible for people with ABI and effective in important clinical outcomes related to improvements in upper extremity function. Implications for Rehabilitation Tele-rehabilitation provided with Microsoft Kinect 3D sensor virtual reality tracking system is feasible for people with Acquired Brain Injury. People with Acquired Brain Injury in the chronic stage were satisfied with the tele-rehabilitation service and perceived it as beneficial to improve their motor and cognitive abilities The CogniMotion System service appears to be effective in important clinical outcomes related to improvements in upper extremity function.
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Affiliation(s)
- Rachel Kizony
- a ReAbility Online, Gertner Institute for Epidemiology and Health Policy Research , Tel Hashomer , Israel.,b Center of Advanced Technologies in Rehabilitation , Sheba Medical Center , Tel Hashomer , Israel.,c Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences , University of Haifa , Haifa , Israel
| | - Patrice L Weiss
- a ReAbility Online, Gertner Institute for Epidemiology and Health Policy Research , Tel Hashomer , Israel.,c Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences , University of Haifa , Haifa , Israel
| | - Sharon Harel
- a ReAbility Online, Gertner Institute for Epidemiology and Health Policy Research , Tel Hashomer , Israel
| | - Yoram Feldman
- a ReAbility Online, Gertner Institute for Epidemiology and Health Policy Research , Tel Hashomer , Israel
| | - Alexei Obuhov
- d Neurological Rehabilitation Department, Sheba Medical Center , Tel Hashomer , Israel
| | - Gabi Zeilig
- d Neurological Rehabilitation Department, Sheba Medical Center , Tel Hashomer , Israel.,e Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Mordechai Shani
- a ReAbility Online, Gertner Institute for Epidemiology and Health Policy Research , Tel Hashomer , Israel
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Swinnen E, Lefeber N, Willaert W, De Neef F, Bruyndonckx L, Spooren A, Michielsen M, Ramon T, Kerckhofs E. Motivation, expectations, and usability of a driven gait orthosis in stroke patients and their therapists. Top Stroke Rehabil 2016; 24:299-308. [PMID: 27996894 DOI: 10.1080/10749357.2016.1266750] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In the development of efficacious driven gait orthoses (DGO), it is an added value to consider patients' and therapists' perspectives concerning robot-assisted gait training (RAGT). A better understanding of these issues may improve the process of care and outcome. OBJECTIVES This study aimed to examine stroke patients' motivation and expectations of RAGT, and therapists' expectations and perspectives on the usability of RAGT. Additionally, the differences in expectations between stroke patients and their therapists were analyzed. METHODS A cross sectional, multi-center, three-group trial was conducted. Included were (1) stroke patients who have experience with RAGT (i.e. the stroke user group), (2) stroke patients who have no experience with RAGT (i.e. the stroke non-user group), and (3) therapists who have experience with RAGT (i.e. the therapist user group). The Intrinsic Motivation Inventory (IMI), Credibility/Expectancy Questionnaire (CEQ), and Usefulness, Satisfaction and Ease of Use Questionnaire (USE) were used. Descriptive statistics and non-parametric Kruskal-Wallis tests were conducted. RESULTS In total, 46 subjects were assessed (stroke user group: n = 23, stroke non-user group: n = 14, therapist user group: n = 9). IMI subscale scores ranged from 42 to 88%. Mean credibility and expectancy ranged from 80 to 85% and 57 to 72%, respectively, with no significant differences between groups. USE subscale scores ranged from 61 to 72%. CONCLUSIONS Stroke user group patients seem quite motivated to train with the DGO and both patients and therapists reasonably believe that this training could improve gait functioning. Therapists are moderately satisfied with the usability of the DGO, but there is room for improvement with respect to usefulness and ease of use.
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Affiliation(s)
- Eva Swinnen
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium.,b Center for Neurosciences , Vrije Universiteit Brussel , Brussels , Belgium.,c BruBotics , Vrije Universiteit Brussel , Brussels , Belgium
| | - Nina Lefeber
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium.,b Center for Neurosciences , Vrije Universiteit Brussel , Brussels , Belgium.,c BruBotics , Vrije Universiteit Brussel , Brussels , Belgium
| | - Ward Willaert
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium
| | - Fallon De Neef
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium
| | - Lyn Bruyndonckx
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium
| | - Annemie Spooren
- d Centre of Expertise - Care in Innovation , PXL University College , Hasselt , Belgium.,e Faculty of Medicine and Life Sciences, REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute , Hasselt University , Hasselt , Belgium
| | - Marc Michielsen
- f St. Ursula Rehabilitation Centre , Jessa Hospital , Herk-de-Stad , Belgium
| | - Tine Ramon
- g AZ Delta Hospital , Roeselare , Belgium
| | - Eric Kerckhofs
- a Rehabilitation Research - Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy , Vrije Universiteit Brussel , Brussels , Belgium.,b Center for Neurosciences , Vrije Universiteit Brussel , Brussels , Belgium.,c BruBotics , Vrije Universiteit Brussel , Brussels , Belgium
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Radder B, Prange-Lasonder GB, Kottink AI, Gaasbeek L, Holmberg J, Meyer T, Melendez-Calderon A, Ingvast J, Buurke JH, Rietman JS. A wearable soft-robotic glove enables hand support in ADL and rehabilitation: A feasibility study on the assistive functionality. J Rehabil Assist Technol Eng 2016; 3:2055668316670553. [PMID: 31186913 PMCID: PMC6453057 DOI: 10.1177/2055668316670553] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/22/2016] [Indexed: 11/16/2022] Open
Abstract
Background Elderly people frequently experience a decline in hand function, due to ageing or diseases. This leads to decreased independence in activities of daily living (ADL). Assistive technology may enhance independence. Objectives The objective of this paper was to explore user acceptance of an affordable wearable soft-robotic glove (ironHand (iH) system), that supports grip and hand opening in ADL. In addition, functional performance with the iH system was explored. Methods For this study 28 elderly people used the iH system across two sessions. During these sessions, participants performed six functional tasks with and without the iH system. Outcome measures were System Usability Scale (SUS), Intrinsic Motivation Inventory (IMI) and performance time of the functional tasks. Results User acceptance scored highly, with a mean SUS score of at least 63.4 (SD = 19.0) and a mean IMI score of 5.1 points (SD = 0.97 points). Functional task performance improved across repetitions both with and without the glove (p ≤ 0.017), but all functional tasks were performed faster without the glove (p ≤ 0.032). Conclusion Participants perceived the iH system as useful, pleasant and meaningful. The learning curve in functional performance time (improvements across repetitions) is promising, since it suggests there is room for improved performance when a longer acquaintance period is applied.
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Affiliation(s)
- Bob Radder
- Roessingh Research and Development, Enschede, the Netherlands.,Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
| | - Gerdienke B Prange-Lasonder
- Roessingh Research and Development, Enschede, the Netherlands.,Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
| | - Anke Ir Kottink
- Roessingh Research and Development, Enschede, the Netherlands.,Department of Biosystems and Signals, University of Twente, Enschede, the Netherlands
| | | | - Johnny Holmberg
- Eskilstuna Kommun Vård- och omsorgsförvaltningen, Eskilstuna, Sweden
| | | | - Alejandro Melendez-Calderon
- Hocoma AG, Volketswil, Switzerland.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | | | - Jaap H Buurke
- Roessingh Research and Development, Enschede, the Netherlands.,Department of Biosystems and Signals, University of Twente, Enschede, the Netherlands.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Johan S Rietman
- Roessingh Research and Development, Enschede, the Netherlands.,Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
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Wittmann F, Held JP, Lambercy O, Starkey ML, Curt A, Höver R, Gassert R, Luft AR, Gonzenbach RR. Self-directed arm therapy at home after stroke with a sensor-based virtual reality training system. J Neuroeng Rehabil 2016; 13:75. [PMID: 27515583 PMCID: PMC4982313 DOI: 10.1186/s12984-016-0182-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 07/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effect of rehabilitative training after stroke is dose-dependent. Out-patient rehabilitation training is often limited by transport logistics, financial resources and a lack of motivation/compliance. We studied the feasibility of an unsupervised arm therapy for self-directed rehabilitation therapy in patients' homes. METHODS An open-label, single group study involving eleven patients with hemiparesis due to stroke (27 ± 31.5 months post-stroke) was conducted. The patients trained with an inertial measurement unit (IMU)-based virtual reality system (ArmeoSenso) in their homes for six weeks. The self-selected dose of training with ArmeoSenso was the principal outcome measure whereas the Fugl-Meyer Assessment of the upper extremity (FMA-UE), the Wolf Motor Function Test (WMFT) and IMU-derived kinematic metrics were used to assess arm function, training intensity and trunk movement. Repeated measures one-way ANOVAs were used to assess differences in training duration and clinical scores over time. RESULTS All subjects were able to use the system independently in their homes and no safety issues were reported. Patients trained on 26.5 ± 11.5 days out of 42 days for a duration of 137 ± 120 min per week. The weekly training duration did not change over the course of six weeks (p = 0.146). The arm function of these patients improved significantly by 4.1 points (p = 0.003) in the FMA-UE. Changes in the WMFT were not significant (p = 0.552). ArmeoSenso based metrics showed an improvement in arm function, a high number of reaching movements (387 per session), and minimal compensatory movements of the trunk while training. CONCLUSIONS Self-directed home therapy with an IMU-based home therapy system is safe and can provide a high dose of rehabilitative therapy. The assessments integrated into the system allow daily therapy monitoring, difficulty adaptation and detection of maladaptive motor patterns such as trunk movements during reaching. TRIAL REGISTRATION Unique identifier: NCT02098135 .
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Affiliation(s)
- Frieder Wittmann
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Jeremia P Held
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Michelle L Starkey
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | | | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Andreas R Luft
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich, Zurich, Switzerland.,Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Roman R Gonzenbach
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
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SCRIPT passive orthosis: design of interactive hand and wrist exoskeleton for rehabilitation at home after stroke. Auton Robots 2016. [DOI: 10.1007/s10514-016-9589-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nijenhuis SM, Prange-Lasonder GB, Stienen AH, Rietman JS, Buurke JH. Effects of training with a passive hand orthosis and games at home in chronic stroke: a pilot randomised controlled trial. Clin Rehabil 2016; 31:207-216. [PMID: 26869596 DOI: 10.1177/0269215516629722] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare user acceptance and arm and hand function changes after technology-supported training at home with conventional exercises in chronic stroke. Secondly, to investigate the relation between training duration and clinical changes. DESIGN A randomised controlled trial. SETTING Training at home, evaluation at research institute. SUBJECTS Twenty chronic stroke patients with severely to mildly impaired arm and hand function. INTERVENTIONS Participants were randomly assigned to six weeks (30 minutes per day, six days a week) of self-administered home-based arm and hand training using either a passive dynamic wrist and hand orthosis combined with computerised gaming exercises (experimental group) or prescribed conventional exercises from an exercise book (control group). MAIN MEASURES Main outcome measures are the training duration for user acceptance and the Action Research Arm Test for arm and hand function. Secondary outcomes are the Intrinsic Motivation Inventory, Fugl-Meyer assessment, Motor Activity Log, Stroke Impact Scale and grip strength. RESULTS The control group reported a higher training duration (189 versus 118 minutes per week, P = 0.025). Perceived motivation was positive and equal between groups ( P = 0.935). No differences in clinical outcomes over training between groups were found (P ⩾ 0.165). Changes in Box and Block Test correlated positively with training duration ( P = 0.001). CONCLUSIONS Both interventions were accepted. An additional benefit of technology-supported arm and hand training over conventional arm and hand exercises at home was not demonstrated. Training duration in itself is a major contributor to arm and hand function improvements.
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Affiliation(s)
- Sharon M Nijenhuis
- 1 Roessingh Research and Development, Enschede, the Netherlands.,2 Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
| | - Gerdienke B Prange-Lasonder
- 1 Roessingh Research and Development, Enschede, the Netherlands.,2 Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
| | - Arno Ha Stienen
- 1 Roessingh Research and Development, Enschede, the Netherlands.,2 Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands.,3 Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Johan S Rietman
- 1 Roessingh Research and Development, Enschede, the Netherlands.,2 Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands.,3 Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Jaap H Buurke
- 1 Roessingh Research and Development, Enschede, the Netherlands.,3 Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.,4 Department of Biomedical Signals and Systems, University of Twente, Enschede, the Netherlands
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