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Ren L, Yan J, Zhu Z, Du M. Personalization Characteristics and Evaluation of Gamified Exercise for Middle-Aged and Older People: A Scoping Review. J Aging Phys Act 2024; 32:287-299. [PMID: 38176402 DOI: 10.1123/japa.2022-0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 01/06/2024]
Abstract
Many studies have shown that personalized exergames have a positive effect on promoting regular and proper exercise. However, there is no consensus on the design characteristics and evaluation of exergames. This systematic review of published research literature aimed to explore the general characteristics, personalization characteristics, and evaluation of personalized exergames for middle-aged and older people. We screened published studies in the Web of Science, Scopus, PubMed, ACM, and IEEE Xplore databases, extracted data, and performed a thematic analysis according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. Three main themes and nine subthemes were generated from 24 included papers. Moreover, a personalization model (FACTS) and evaluation system (PMSS) of exergames were developed. Personalized exergames had potential positive effects on motivating middle-aged and older people to exercise and improve their health, particularly physical, mental, and social health. However, more fine-grained studies on personalized exergames are necessary in the future.
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Affiliation(s)
- Lisha Ren
- College of Design and Innovation, Tongji University, Shanghai, China
| | - Jie Yan
- College of Design and Innovation, Tongji University, Shanghai, China
| | - Zhehao Zhu
- College of Design and Innovation, Tongji University, Shanghai, China
| | - Murui Du
- College of Design and Innovation, Tongji University, Shanghai, China
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2
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Guo QF, He L, Su W, Tan HX, Han LY, Gui CF, Chen Y, Jiang HH, Gao Q. Virtual reality for neurorehabilitation: A bibliometric analysis of knowledge structure and theme trends. Front Public Health 2022; 10:1042618. [PMID: 36438265 PMCID: PMC9684719 DOI: 10.3389/fpubh.2022.1042618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
Background As an emerging technology, virtual reality (VR) has been broadly applied in the medical field, especially in neurorehabilitation. The growing application of VR therapy promotes an increasing amount of clinical studies. In this paper, we present a bibliometric analysis of the existing studies to reveal the current research hotspots and guide future research directions. Methods Articles and reviews on the related topic were retrieved from the Science Citation Index Expanded of Web of Science Core Collection database. VOSviewer and Citespace software were applied to systematically analyze information about publications, countries, institutions, authors, journals, citations, and keywords from the included studies. Results A total of 1,556 papers published between 1995 and 2021 were identified. The annual number of papers increased gradually over the past three decades, with a peak publication year in 2021 (n = 276). Countries and institutions from North America and Western European were playing leading roles in publications and total citations. Current hotspots were focused on the effectiveness of VR therapy in cognitive and upper limb motor rehabilitation. The clusters of keywords contained the four targeted neurological diseases of VR, while the burst keywords represented that the latest studies were directed toward more defined types of VR therapy and greater study design. Conclusions Our study offers information regarding to the current hotspots and emerging trends in the VR for rehabilitation field. It could guide future research and application of VR therapy in neurorehabilitation.
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Affiliation(s)
- Qi-Fan Guo
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lin He
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Su
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Hui-Xin Tan
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lian-Yi Han
- Biostatistics Group, State Key Laboratory of Genetic Engineering, Greater Bay Area Institute of Precision Medicine (Guangzhou), Fudan University, Guangzhou, China
| | - Chen-Fan Gui
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Chen
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Han-Hong Jiang
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Gao
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Qiang Gao
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Burdea G, Kim N, Polistico K, Kadaru A, Grampurohit N, Hundal J, Pollack S. Robotic Table and Serious Games for Integrative Rehabilitation in the Early Poststroke Phase: Two Case Reports. JMIR Rehabil Assist Technol 2022; 9:e26990. [PMID: 35416787 PMCID: PMC9047881 DOI: 10.2196/26990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 08/16/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND BrightArm Compact is a new rehabilitation system for the upper extremities. It provides bimanual training with gradated gravity loading and mediates interactions with cognitively challenging serious games. OBJECTIVE The aim of this study is to design and test a robotic rehabilitation table-based virtual rehabilitation system for functional impact of the integrative training in the early poststroke phase. METHODS A new robotic rehabilitation table, controllers, and adaptive games were developed. The 2 participants underwent 12 experimental sessions in addition to the standard of care. Standardized measures of upper extremity function (primary outcome), depression, and cognition were administered before and after the intervention. Nonstandardized measures included game variables and subjective evaluations. RESULTS The 2 case study participants attained high total arm repetitions per session (504 and 957) and achieved high grasp and finger-extension counts. Training intensity contributed to marked improvements in affected shoulder strength (225% and 100% increase), grasp strength (27% and 16% increase), and pinch strength (31% and 15% increase). The shoulder flexion range increased by 17% and 18% and elbow supination range by 75% and 58%. Improvements in motor function were at or above minimal clinically important difference for the Fugl-Meyer Assessment (11 and 10 points), Chedoke Arm and Hand Activity Inventory (11 and 14 points), and Upper Extremity Functional Index (19 and 23 points). Cognitive and emotive outcomes were mixed. Subjective rating by participants and training therapists were positive (average 4, SD 0.22, on a 5-point Likert scale). CONCLUSIONS The design of the robotic rehabilitation table was tested on 2 participants in the early poststroke phase, and results are encouraging for upper extremity functional gains and technology acceptance. TRIAL REGISTRATION ClinicalTrials.gov NCT04252170; https://clinicaltrials.gov/ct2/show/NCT04252170.
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Affiliation(s)
- Grigore Burdea
- Corporate Laboratories, Bright Cloud International Corp, North Brunswick, NJ, United States
- Electrical and Computer Engineering Department, Rutgers-The State University of New Jersey, Piscataway, NJ, United States
| | - Nam Kim
- Corporate Laboratories, Bright Cloud International Corp, North Brunswick, NJ, United States
| | - Kevin Polistico
- Corporate Laboratories, Bright Cloud International Corp, North Brunswick, NJ, United States
| | - Ashwin Kadaru
- Corporate Laboratories, Bright Cloud International Corp, North Brunswick, NJ, United States
| | - Namrata Grampurohit
- Corporate Laboratories, Bright Cloud International Corp, North Brunswick, NJ, United States
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jasdeep Hundal
- Hundal Neuropsychology Group, Hillsborough, NJ, United States
- Robert Wood Johnson Medical School, Rutgers-The State University of New Jersey, Department of Neurology, New Brunswick, NJ, United States
| | - Simcha Pollack
- Computer Information Systems and Decision Sciences, St John's University, New York City, NY, United States
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Grampurohit N, Bell A, Duff SV, Mulcahey MJ, Thielen CC, Kaplan G, Marino RJ. Highlighting gaps in spinal cord injury research in activity-based interventions for the upper extremity: A scoping review. NeuroRehabilitation 2021; 49:23-38. [PMID: 33967071 DOI: 10.3233/nre-210042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Upper extremity activity-based therapy for neurologic disorders employs high-intensity, high repetition functional training to exploit neuroplasticity and improve function. Research focused on high-intensity upper extremity activity-based therapy for persons with spinal cord injury (SCI) is limited. OBJECTIVE To summarize high-intensity activity-based interventions used in neurological disorders for their current or potential application to SCI. METHODS The scoping review included articles from MEDLINE, CINAHL, Cochrane CENTRAL, and OTSeeker with the criteria: non-invasive activity-based interventions delivered at least three times/week for two weeks, upper extremity functional outcomes, age 13 years or older, English language, and neurological disorders three months post onset/injury. RESULTS The search yielded 172 studies. There were seven studies with SCI, all in adults. Activity-based interventions in SCI included task-specific training and gaming, with and without electrical stimulation, and a robotic exoskeleton. The other populations found in the review included studies in stroke, cerebral palsy, and multiple sclerosis. Thirty-four different interventions were reported in other populations. In comparison to the extensive stroke research, work in SCI was not found for high-intensity interventions using virtual reality, brain stimulation, rehabilitation devices, and applications to the home and telerehab settings. CONCLUSION The results highlight critical gaps within upper extremity high-intensity activity-based research in SCI.
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Affiliation(s)
- Namrata Grampurohit
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alison Bell
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Susan V Duff
- Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA, USA
| | - M J Mulcahey
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Gary Kaplan
- Scott Memorial Library, Academic Commons, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ralph J Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Haptic-Enabled Hand Rehabilitation in Stroke Patients: A Scoping Review. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11083712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There is a plethora of technology-assisted interventions for hand therapy, however, less is known about the effectiveness of these interventions. This scoping review aims to explore studies about technology-assisted interventions targeting hand rehabilitation to identify the most effective interventions. It is expected that multifaceted interventions targeting hand rehabilitation are more efficient therapeutic approaches than mono-interventions. The scoping review will aim to map the existing haptic-enabled interventions for upper limb rehabilitation and investigates their effects on motor and functional recovery in patients with stroke. The methodology used in this review is based on the Arksey and O’Malley framework, which includes the following stages: identifying the research question, identifying relevant studies, study selection, charting the data, and collating, summarizing, and reporting the results. Results show that using three or four different technologies was more positive than using two technologies (one technology + haptics). In particular, when standardized as a percentage of outcomes, the combination of three technologies showed better results than the combination of haptics with one technology or with three other technologies. To conclude, this study portrayed haptic-enabled rehabilitation approaches that could help therapists decide which technology-enabled hand therapy approach is best suited to their needs. Those seeking to undertake research and development anticipate further opportunities to develop haptic-enabled hand telerehabilitation platforms.
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Fluet G, Qiu Q, Patel J, Mont A, Cronce A, Yarossi M, Merians A, Adamovich S. Virtual Rehabilitation of the Paretic Hand and Arm in Persons With Stroke: Translation From Laboratory to Rehabilitation Centers and the Patient's Home. Front Neurol 2021; 12:623261. [PMID: 33584529 PMCID: PMC7876436 DOI: 10.3389/fneur.2021.623261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/04/2021] [Indexed: 12/18/2022] Open
Abstract
The anatomical and physiological heterogeneity of strokes and persons with stroke, along with the complexity of normal upper extremity movement make the possibility that any single treatment approach will become the definitive solution for all persons with upper extremity hemiparesis due to stroke unlikely. This situation and the non-inferiority level outcomes identified by many studies of virtual rehabilitation are considered by some to indicate that it is time to consider other treatment modalities. Our group, among others, has endeavored to build on the initial positive outcomes in studies of virtual rehabilitation by identifying patient populations, treatment settings and training schedules that will best leverage virtual rehabilitation's strengths. We feel that data generated by our lab and others suggest that (1) persons with stroke may adapt to virtual rehabilitation of hand function differently based on their level of impairment and stage of recovery and (2) that less expensive, more accessible home based equipment seems to be an effective alternative to clinic based treatment that justifies continued optimism and study.
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Affiliation(s)
- Gerard Fluet
- Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Qinyin Qiu
- Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Jigna Patel
- Rutgers Biomedical and Health Sciences, Newark, NJ, United States
- New Jersey Institute of Technology, Newark, NJ, United States
| | - Ashley Mont
- New Jersey Institute of Technology, Newark, NJ, United States
| | - Amanda Cronce
- New Jersey Institute of Technology, Newark, NJ, United States
| | - Mathew Yarossi
- Department of Physical Therapy, Movement and Rehabilitation Science, Northeastern University, Boston, MA, United States
| | - Alma Merians
- Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Sergei Adamovich
- Rutgers Biomedical and Health Sciences, Newark, NJ, United States
- New Jersey Institute of Technology, Newark, NJ, United States
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Amorim P, Santos BS, Dias P, Silva S, Martins H. Serious Games for Stroke Telerehabilitation of Upper Limb - A Review for Future Research. Int J Telerehabil 2020; 12:65-76. [PMID: 33520096 PMCID: PMC7757643 DOI: 10.5195/ijt.2020.6326] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Maintaining appropriate home rehabilitation programs after stroke, with proper adherence and remote monitoring is a challenging task. Virtual reality (VR) - based serious games could be a strategy used in telerehabilitation (TR) to engage patients in an enjoyable and therapeutic approach. The aim of this review was to analyze the background and quality of clinical research on this matter to guide future research. The review was based on research material obtained from PubMed and Cochrane up to April 2020 using the PRISMA approach. The use of VR serious games has shown evidence of efficacy on upper limb TR after stroke, but the evidence strength is still low due to a limited number of randomized controlled trials (RCT), a small number of participants involved, and heterogeneous samples. Although this is a promising strategy to complement conventional rehabilitation, further investigation is needed to strengthen the evidence of effectiveness and support the dissemination of the developed solutions.
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Affiliation(s)
- Paula Amorim
- Faculty of Health Sciences, University of Beira Interior, Portugal
| | - Beatriz Sousa Santos
- Institute of Electronics and Informatics Engineering of Aveiro.,Department of Electronics Telecommunications and Informatics, University of Aveiro, Portugal
| | - Paulo Dias
- Institute of Electronics and Informatics Engineering of Aveiro.,Department of Electronics Telecommunications and Informatics, University of Aveiro, Portugal
| | - Samuel Silva
- Institute of Electronics and Informatics Engineering of Aveiro
| | - Henrique Martins
- Faculty of Health Sciences, University of Beira Interior, Portugal
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8
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Pan L, Zhao L, Song A, Yin Z, She S. A Novel Robot-Aided Upper Limb Rehabilitation Training System Based on Multimodal Feedback. Front Robot AI 2019; 6:102. [PMID: 33501117 PMCID: PMC7805779 DOI: 10.3389/frobt.2019.00102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/08/2019] [Indexed: 11/13/2022] Open
Abstract
During robot-aided rehabilitation exercises, monotonous, and repetitive actions can, to the subject, feel tedious and tiring, so improving the subject's motivation and active participation in the training is very important. A novel robot-aided upper limb rehabilitation training system, based on multimodal feedback, is proposed in this investigation. To increase the subject's interest and participation, a friendly graphical user interface and diversiform game-based rehabilitation training tasks incorporating multimodal feedback are designed, to provide the subject with colorful and engaging motor training. During this training, appropriate visual, auditory, and tactile feedback is employed to improve the subject's motivation via multi-sensory incentives relevant to the training performance. This approach is similar to methods applied by physiotherapists to keep the subject focused on motor training tasks. The experimental results verify the effectiveness of the designed multimodal feedback strategy in promoting the subject's participation and motivation.
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Affiliation(s)
- Lizheng Pan
- School of Mechanical Engineering, Changzhou University, Changzhou, China.,Remote Measurement and Control Key Lab of Jiangsu Province, School of Instrument Science and Engineering, Southeast University, Nanjing, China
| | - Lu Zhao
- School of Mechanical Engineering, Changzhou University, Changzhou, China
| | - Aiguo Song
- Remote Measurement and Control Key Lab of Jiangsu Province, School of Instrument Science and Engineering, Southeast University, Nanjing, China
| | - Zeming Yin
- School of Mechanical Engineering, Changzhou University, Changzhou, China
| | - Shigang She
- School of Mechanical Engineering, Changzhou University, Changzhou, China
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Hajesmaeel Gohari S, Gozali E, Niakan Kalhori SR. Virtual reality applications for chronic conditions management: A review. Med J Islam Repub Iran 2019; 33:67. [PMID: 31456991 PMCID: PMC6708122 DOI: 10.34171/mjiri.33.67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Indexed: 01/09/2023] Open
Abstract
Background: Virtual Reality (VR) as a computer technology that simulating real environments and situations exploited in numerous healthcare areas such as chronic diseases. The significance of timely treatment and rehabilitation of patients with chronic conditions is high due to the long lasting nature of these conditions. This paper sought to perform a review of published works in the field of VR application in chronic conditions for treatment and rehabilitation purposes.
Methods: We searched the MEDLINE database through PubMed in April 2016 for retrieving published papers from January 2001 to December 2015. From 117 retrieved papers, 52had the inclusion criteria, and their full texts were accessible. Data were extracted from papers based on following items: the name of the first author, year of the study, applied VR methods, type of condition and disease, number of subjects that participated in the study, and finally the status of success and failure of VR application. Data were analyzed using descriptive analysis.
Results: Results of the reviewed investigations have been considered in two main categories including treatment oriented papers (n=38, 73%) while twenty of these papers have been conducted on phobias (53%); also, there are rehabilitation-oriented experiments (n=14, 27%) while thirteen of these papers have been performed on stroke. In 40 papers (77%), the VR technology application reported proper and in 11 papers (21%) the application of VR resulted in relatively proper outcomes and only there is a work (2%) with poor results for VR intervention.
Conclusion: VR technology has been increasingly used in recent years for treatment and rehabilitation purposes among patients affected by chronic conditions in order to motivate them for more successful management.
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Affiliation(s)
- Sadrieh Hajesmaeel Gohari
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Gozali
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharareh R Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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Norouzi-Gheidari N, Archambault PS, Fung J. Robot-Assisted Reaching Performance of Chronic Stroke and Healthy Individuals in a Virtual Versus a Physical Environment: A Pilot Study. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1273-1281. [PMID: 31056500 DOI: 10.1109/tnsre.2019.2914015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of the current study was to examine the role of environment, whether virtual or physical, on robot-assisted reaching movements in chronic stroke and healthy individuals, within a single session. Twenty-three subjects participated in the current study divided into three groups: nine chronic stroke individuals able to perform a reaching task with no need for the robot assistance, nine chronic stroke individuals who needed robot assistance to complete the reaching task, and five healthy individuals. The task was to reach six target buttons in two identical physical and virtual environments. The outcomes consisted of specific kinematic measures (amount of movement completion without robot assistance, mean speed, peak speed, straightness, and shakiness) and a custom questionnaire to assess how the stroke subjects perceived and experienced the reaching task in both environments. The results showed no differences between the two environments in terms of the outcome measures in any of the groups. Our findings suggest that the choice of environment, whether physical or virtual, is not a key factor in designing a simple robot-assisted reaching task for stroke survivors. Further studies are required for more complex environments and tasks as well as robot-assisted training protocols.
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The Efficacy of a Haptic-Enhanced Virtual Reality System for Precision Grasp Acquisition in Stroke Rehabilitation. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:9840273. [PMID: 29230275 PMCID: PMC5694569 DOI: 10.1155/2017/9840273] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/18/2017] [Accepted: 09/20/2017] [Indexed: 01/18/2023]
Abstract
Stroke is a leading cause of long-term disability, and virtual reality- (VR-) based stroke rehabilitation is effective in increasing motivation and the functional performance. Although much of the functional reach and grasp capabilities of the upper extremities were regained, the pinch movement remains impaired following stroke. In this study, we developed a haptic-enhanced VR system to simulate haptic pinch tasks to assist the recovery of upper-extremity fine motor function. We recruited 16 adults with stroke to verify the efficacy of this new VR system. Each patient received 30 min VR training sessions 3 times per week for 8 weeks. Outcome measures, Fugl-Meyer assessment (FMA), Test Evaluant les Membres superieurs des Personnes Agees (TEMPA), Wolf motor function test (WMFT), Box and Block test (BBT), and Jamar grip dynamometer, showed statistically significant progress from pretest to posttest and follow-up, indicating that the proposed system effectively promoted fine motor recovery of function. Additionally, our evidence suggests that this system was also effective under certain challenging conditions such as being in the chronic stroke phase or a coside of lesion and dominant hand (nondominant hand impaired). System usability assessment indicated that the participants strongly intended to continue using this VR-based system in rehabilitation.
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12
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Salhab G, Sarraj AR, Saleh S. Mirror therapy combined with functional electrical stimulation for rehabilitation of stroke survivors' ankle dorsiflexion. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:4699-4702. [PMID: 28325013 DOI: 10.1109/embc.2016.7591776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study investigates the effect of combining both mirror therapy with Electrical Stimulation (ES) on improvement of the function of lower extremity compared to conventional therapy. 18 stroke survivors (sub acute stage) were recruited, 9 of them were randomly assigned to receive conventional treatment and another 9 started the mirror therapy combined with ES treatment. Duration of each session in both interventions was 50 minutes, done 4 times per week over two weeks. After 2 weeks, subjects took one week rest before switching they type of treatment; those started with conventional therapy continued with mirror therapy combined with ES, and vice versa. The duration of this phase was 2 weeks with same schedule as the 1st one. Ankle dorsi-flexion range of motion, lower extremity sensory-motor function, and walking duration were measured at baseline, after 1st 2 weeks, and immediately after the last two weeks, and 4 weeks after end of training (retention test). Repeated Measures ANCOVA was done to compare outcome measures scores in both groups and between all testing days, and paired T-test was used measure the difference between groups. Significant increase in all outcome measures was found after the (MT+ES) training, which is higher than conventional therapy training (p<;0.0001). In conclusion, the results suggest that combination of mirror therapy and ES is more effective than conventional therapy in improving lower limb motor function after stroke.
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Patel J, Qiu Q, Yarossi M, Merians A, Massood S, Tunik E, Adamovich S, Fluet G. Exploring the impact of visual and movement based priming on a motor intervention in the acute phase post-stroke in persons with severe hemiparesis of the upper extremity. Disabil Rehabil 2017; 39:1515-1523. [PMID: 27636200 PMCID: PMC5355001 DOI: 10.1080/09638288.2016.1226419] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Explore the potential benefits of using priming methods prior to an active hand task in the acute phase post-stroke in persons with severe upper extremity hemiparesis. METHODS Five individuals were trained using priming techniques including virtual reality (VR) based visual mirror feedback and contralaterally controlled passive movement strategies prior to training with an active pinch force modulation task. Clinical, kinetic, and neurophysiological measurements were taken pre and post the training period. Clinical measures were taken at six months post training. RESULTS The two priming simulations and active training were well tolerated early after stroke. Priming effects were suggested by increased maximal pinch force immediately after visual and movement based priming. Despite having no clinically observable movement distally, the subjects were able to volitionally coordinate isometric force and muscle activity (EMG) in a pinch tracing task. The Root Mean Square Error (RMSE) of force during the pinch trace task gradually decreased over the training period suggesting learning may have occurred. Changes in motor cortical neurophysiology were seen in the unaffected hemisphere using Transcranial Magnetic Stimulation (TMS) mapping. Significant improvements in motor recovery as measured by the Action Research Arm Test (ARAT) and the Upper Extremity Fugl Meyer Assessment (UEFMA) were demonstrated at six months post training by three of the five subjects. CONCLUSION This study suggests that an early hand-based intervention using visual and movement based priming activities and a scaled motor task allows participation by persons without the motor control required for traditionally presented rehabilitation and testing. Implications for Rehabilitation Rehabilitation of individuals with severely paretic upper extremities after stroke is challenging due to limited movement capacity and few options for therapeutic training. Long-term functional recovery of the arm after stroke depends on early return of active hand control, establishing a need for acute training methods focused distally. This study demonstrates the feasibility of an early hand-based intervention using virtual reality based priming and scaled motor activities which can allow for participation by persons without the motor control required for traditionally presented rehabilitation and testing.
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Affiliation(s)
- Jigna Patel
- Department of Rehabilitation & Movement Sciences, Rutgers The State University of New Jersey, Newark, NJ, USA
| | - Qinyin Qiu
- Department of Rehabilitation & Movement Sciences, Rutgers The State University of New Jersey, Newark, NJ, USA
| | - Mathew Yarossi
- Department of Rehabilitation & Movement Sciences, Rutgers The State University of New Jersey, Newark, NJ, USA
| | - Alma Merians
- Department of Rehabilitation & Movement Sciences, Rutgers The State University of New Jersey, Newark, NJ, USA
| | - Supriya Massood
- Acute Rehabilitation Unit, Saint Joseph’s Wayne Hospital, Wayne, NJ, USA
| | - Eugene Tunik
- Department of Physical Therapy, Movement, and Rehabilitation Science, Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Sergei Adamovich
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
| | - Gerard Fluet
- Department of Rehabilitation & Movement Sciences, Rutgers The State University of New Jersey, Newark, NJ, USA
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Fluet GG, Patel J, Qiu Q, Yarossi M, Massood S, Adamovich SV, Tunik E, Merians AS. Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: a case study. Disabil Rehabil 2016; 39:1524-1531. [PMID: 27669997 DOI: 10.1080/09638288.2016.1226421] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The complexity of upper extremity (UE) behavior requires recovery of near normal neuromuscular function to minimize residual disability following a stroke. This requirement places a premium on spontaneous recovery and neuroplastic adaptation to rehabilitation by the lesioned hemisphere. Motor skill learning is frequently cited as a requirement for neuroplasticity. Studies examining the links between training, motor learning, neuroplasticity, and improvements in hand motor function are indicated. METHODS This case study describes a patient with slow recovering hand and finger movement (Total Upper Extremity Fugl-Meyer examination score = 25/66, Wrist and Hand items = 2/24 on poststroke day 37) following a stroke. The patient received an intensive eight-session intervention utilizing simulated activities that focused on the recovery of finger extension, finger individuation, and pinch-grasp force modulation. RESULTS Over the eight sessions, the patient demonstrated improvements on untrained transfer tasks, which suggest that motor learning had occurred, as well a dramatic increase in hand function and corresponding expansion of the cortical motor map area representing several key muscles of the paretic hand. Recovery of hand function and motor map expansion continued after discharge through the three-month retention testing. CONCLUSION This case study describes a neuroplasticity based intervention for UE hemiparesis and a model for examining the relationship between training, motor skill acquisition, neuroplasticity, and motor function changes. Implications for rehabilitation Intensive hand and finger rehabilitation activities can be added to an in-patient rehabilitation program for persons with subacute stroke. Targeted training of the thumb may have an impact on activity level function in persons with upper extremity hemiparesis. Untrained transfer tasks can be utilized to confirm that training tasks have elicited motor learning. Changes in cortical motor maps can be used to document changes in brain function which can be used to evaluate changes in motor behavior persons with subacute stroke.
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Affiliation(s)
- Gerard G Fluet
- a Department of Rehabilitation & Movement Sciences , Rutgers The State University of New Jersey , Newark , NJ , USA
| | - Jigna Patel
- a Department of Rehabilitation & Movement Sciences , Rutgers The State University of New Jersey , Newark , NJ , USA
| | - Qinyin Qiu
- a Department of Rehabilitation & Movement Sciences , Rutgers The State University of New Jersey , Newark , NJ , USA
| | - Matthew Yarossi
- a Department of Rehabilitation & Movement Sciences , Rutgers The State University of New Jersey , Newark , NJ , USA
| | - Supriya Massood
- b St. Joseph's Wayne Hospital , Acute Rehabilitation Unit , Wayne , NJ , USA
| | - Sergei V Adamovich
- a Department of Rehabilitation & Movement Sciences , Rutgers The State University of New Jersey , Newark , NJ , USA.,c Department of Biomedical Engineering , New Jersey Institute of Technology, University Heights , Newark , NJ , USA
| | - Eugene Tunik
- d Department of Physical Therapy, Movement, and Rehabilitation Science, Bouve College of Health Sciences , Northeastern University , Boston , MA , USA
| | - Alma S Merians
- a Department of Rehabilitation & Movement Sciences , Rutgers The State University of New Jersey , Newark , NJ , USA
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Emergence of virtual reality as a tool for upper limb rehabilitation: incorporation of motor control and motor learning principles. Phys Ther 2015; 95:415-25. [PMID: 25212522 PMCID: PMC4348716 DOI: 10.2522/ptj.20130579] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The primary focus of rehabilitation for individuals with loss of upper limb movement as a result of acquired brain injury is the relearning of specific motor skills and daily tasks. This relearning is essential because the loss of upper limb movement often results in a reduced quality of life. Although rehabilitation strives to take advantage of neuroplastic processes during recovery, results of traditional approaches to upper limb rehabilitation have not entirely met this goal. In contrast, enriched training tasks, simulated with a wide range of low- to high-end virtual reality-based simulations, can be used to provide meaningful, repetitive practice together with salient feedback, thereby maximizing neuroplastic processes via motor learning and motor recovery. Such enriched virtual environments have the potential to optimize motor learning by manipulating practice conditions that explicitly engage motivational, cognitive, motor control, and sensory feedback-based learning mechanisms. The objectives of this article are to review motor control and motor learning principles, to discuss how they can be exploited by virtual reality training environments, and to provide evidence concerning current applications for upper limb motor recovery. The limitations of the current technologies with respect to their effectiveness and transfer of learning to daily life tasks also are discussed.
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Levin MF, Magdalon EC, Michaelsen SM, Quevedo AAF. Quality of Grasping and the Role of Haptics in a 3-D Immersive Virtual Reality Environment in Individuals With Stroke. IEEE Trans Neural Syst Rehabil Eng 2015; 23:1047-55. [PMID: 25594971 DOI: 10.1109/tnsre.2014.2387412] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Reaching and grasping parameters with and without haptic feedback were characterized in people with chronic post-stroke behaviors. Twelve (67 ± 10 years) individuals with chronic stroke and arm/hand paresis (Fugl-Meyer Assessment-Arm: ≥ 46/66 pts) participated. Three dimensional (3-D) temporal and spatial kinematics of reaching and grasping movements to three objects (can: cylindrical grasp; screwdriver: power grasp; pen: precision grasp) in a physical environment (PE) with and without additional haptic feedback and a 3-D virtual environment (VE) with haptic feedback were recorded. Participants reached, grasped and transported physical and virtual objects using similar movement strategies in all conditions. Reaches made in VE were less smooth and slower compared to the PE. Arm and trunk kinematics were similar in both environments and glove conditions. For grasping, stroke subjects preserved aperture scaling to object size but used wider hand apertures with longer delays between times to maximal reaching velocity and maximal grasping aperture. Wearing the glove decreased reaching velocity. Our results in a small group of subjects suggest that providing haptic information in the VE did not affect the validity of reaching and grasping movement. Small disparities in movement parameters between environments may be due to differences in perception of object distance in VE. Reach-to-grasp kinematics to smaller objects may be improved by better 3-D rendering. Comparable kinematics between environments and conditions is encouraging for the incorporation of high quality VEs in rehabilitation programs aimed at improving upper limb recovery.
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Merians AS, Fluet G, Tunik E, Qiu Q, Saleh S, Adamovich S. Movement rehabilitation in virtual reality from then to now: how are we doing? INTERNATIONAL JOURNAL ON DISABILITY AND HUMAN DEVELOPMENT : IJDHD 2014; 13:311-317. [PMID: 29057195 PMCID: PMC5648340 DOI: 10.1515/ijdhd-2014-0321] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
During the past decade, there has been a continuous exploration of how virtual environments can be used to facilitate motor recovery and relearning after neurological impairment. There are two goals for using virtual environments: to improve patients' rehabilitation outcomes beyond our current capabilities or to supplement labor-intensive and time consuming therapies with technology-based interventions. After over a decade of investigation, it seems appropriate to determine whether we are succeeding in meeting such goals.
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Affiliation(s)
- Alma S. Merians
- Department of Rehabilitation and Movement Sciences, University of Medicine
and Dentistry of New Jersey, 65 Bergen Street, Newark, NJ 07107, USA
| | - Gerard Fluet
- Department of Rehabilitation and Movement Sciences, University of Medicine
and Dentistry of New Jersey, Newark, NJ, USA
| | - Eugene Tunik
- Department of Rehabilitation and Movement Sciences, University of Medicine
and Dentistry of New Jersey, Newark, NJ, USA
| | - Q. Qiu
- Department of Rehabilitation and Movement Sciences, University of Medicine
and Dentistry of New Jersey, Newark, NJ, USA
| | - Soha Saleh
- Department of Rehabilitation and Movement Sciences, University of Medicine
and Dentistry of New Jersey, Newark, NJ, USA
| | - Sergei Adamovich
- Department of Rehabilitation and Movement Sciences, University of Medicine
and Dentistry of New Jersey, Newark, NJ, USA; and New Jersey Institute of Technology,
Department of Biomedical Engineering, Newark, NJ, USA
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Asín Prieto G, Cano-de-la-Cuerda R, López-Larraz E, Metrot J, Molinari M, van Dokkum LEH. Emerging Perspectives in Stroke Rehabilitation. BIOSYSTEMS & BIOROBOTICS 2014. [DOI: 10.1007/978-3-642-38556-8_1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Saleh S, Adamovich SV, Tunik E. Mirrored feedback in chronic stroke: recruitment and effective connectivity of ipsilesional sensorimotor networks. Neurorehabil Neural Repair 2013; 28:344-54. [PMID: 24370569 DOI: 10.1177/1545968313513074] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Mirrored feedback has potential as a therapeutic intervention to restore hand function after stroke. However, the functional (effective) connectivity of neural networks involved in processing mirrored feedback after stroke is not known. OBJECTIVE To determine if regions recruited by mirrored feedback topographically overlap with those involved in control of the paretic hand and to identify the effective connectivity of activated nodes within the mirrored feedback network. METHODS Fifteen patients with chronic stroke performed a finger flexion task with their unaffected hand during event-related functional magnetic resonance imaging (fMRI). Real-time hand kinematics was recorded during fMRI and used to actuate hand models presented in virtual reality (VR). Visual feedback of the unaffected hand motion was manipulated pseudorandomly by either actuating the VR hand corresponding to the moving unaffected side (veridical feedback) or the affected side (mirrored feedback). In 2 control conditions, the VR hands were replaced with moving nonanthropomorphic shapes. RESULTS Mirrored feedback was associated with significant activation of regions within and outside the ipsilesional sensorimotor cortex, overlapping with areas engaged when patients performed the task with their affected hand. Effective connectivity analysis showed a significantly interconnected ipsilesional somatosensory and motor cortex in the mirrored feedback condition. CONCLUSIONS Mirrored feedback recruits ipsilesional brain areas relevant for control of the affected hand. These data provide a neurophysiological basis by which mirrored feedback may be beneficial as a therapy for restoring function after stroke.
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Affiliation(s)
- Soha Saleh
- 1Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ, USA
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Robotic technologies and rehabilitation: new tools for stroke patients' therapy. BIOMED RESEARCH INTERNATIONAL 2013; 2013:153872. [PMID: 24350244 PMCID: PMC3852950 DOI: 10.1155/2013/153872] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 09/18/2013] [Indexed: 11/23/2022]
Abstract
Introduction. The role of robotics in poststroke patients' rehabilitation has been investigated intensively. This paper presents the state-of-the-art and the possible future role of robotics in poststroke rehabilitation, for both upper and lower limbs. Materials and Methods. We performed a comprehensive search of PubMed, Cochrane, and PeDRO databases using as keywords “robot AND stroke AND rehabilitation.” Results and Discussion. In upper limb robotic rehabilitation, training seems to improve arm function in activities of daily living. In addition, electromechanical gait training after stroke seems to be effective. It is still unclear whether robot-assisted arm training may improve muscle strength, and which electromechanical gait-training device may be the most effective for walking training implementation. Conclusions. In the field of robotic technologies for stroke patients' rehabilitation we identified currently relevant growing points and areas timely for developing research. Among the growing points there is the development of new easily transportable, wearable devices that could improve rehabilitation also after discharge, in an outpatient or home-based setting. For developing research, efforts are being made to establish the ideal type of treatment, the length and amount of training protocol, and the patient's characteristics to be successfully enrolled to this treatment.
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