Biomedical Serious Game System for Lower Limb Motor Rehabilitation of Hemiparetic Stroke Patients

Balance Rehabilitation through Robot-Assisted Gait Training in Post-Stroke Patients: A Systematic Review and Meta-Analysis

BACKGROUND

Balance impairment is a common disability in post-stroke survivors, leading to reduced mobility and increased fall risk. Robotic gait training (RAGT) is largely used, along with traditional training. There is, however, no strong evidence about RAGT superiority, especially on balance. This study aims to determine RAGT efficacy on balance of post-stroke survivors.

METHODS

PubMed, Cochrane Library, and PeDRO databases were investigated. Randomized clinical trials evaluating RAGT efficacy on post-stroke survivor balance with Berg Balance Scale (BBS) or Timed Up and Go test (TUG) were searched. Meta-regression analyses were performed, considering weekly sessions, single-session duration, and robotic device used.

RESULTS

A total of 18 trials have been included. BBS pre-post treatment mean difference is higher in RAGT-treated patients, with a pMD of 2.17 (95% CI 0.79; 3.55). TUG pre-post mean difference is in favor of RAGT, but not statistically, with a pMD of -0.62 (95%CI - 3.66; 2.43). Meta-regression analyses showed no relevant association, except for TUG and treatment duration (β = -1.019, 95% CI - 1.827; -0.210, p-value = 0.0135).

CONCLUSIONS

RAGT efficacy is equal to traditional therapy, while the combination of the two seems to lead to better outcomes than each individually performed. Robot-assisted balance training should be the focus of experimentation in the following years, given the great results in the first available trials. Given the massive heterogeneity of included patients, trials with more strict inclusion criteria (especially time from stroke) must be performed to finally define if and when RAGT is superior to traditional therapy.

EFFECTS OF STRENGTH TRAINING ON PHYSICAL STABILITY IN DANCERS

ABSTRACT Introduction: Ballroom dance has evolved from a simple self-taught part of folklore to a technical, performative, and artistic competitive dance called the International Standard Dance. Objective: Study the effects of special lower limb strength training on the physical stability of dancers. Methods: 20 volunteers, students of a university specialized in dance, were divided into experimental and control groups, undergoing training of 30 minutes daily, 3 times a week, for 3 months. The control group followed the daily training, while the experimental group received special lower limb strength training. The relevant physical data measured before and after the intervention were statistically analyzed. Results: Compared to the control group, there was a significant difference in the athletes of the experimental group (P<0.05). The experimental group's lower limb strength and special skills were significantly improved. Conclusion: The lower extremity strength training protocol significantly improved the dancers’ muscle strength, proportionally increasing the stability of the sports skills. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

INFLUENCE OF BIMANUAL GRIPPING ON BALANCE AND MOTOR COORDINATION IN TENNIS PLAYERS

ABSTRACT Introduction: There is empirical evidence that training with bimanual grip can improve tennis’s technical and tactical level. However, this practice lacks a scientific study supporting its fundamentals and methodological arguments for effective training. Objective: Investigate the influences of two-handed grip training on balance and motor coordination in tennis players. Methods: The study was conducted by literature data collection, experimental testing, and mathematical statistics. A bimanual grip training protocol was designed and tested on volunteer athletes. Biomarkers were collected, discussed, and analyzed inter- and intra-group statistically. Results: After 5 weeks of basic training, there were significant differences in homeostatic control and physical agility between the experimental and control groups. After training, the dynamic balance ability of the experimental group athletes was significantly improved. Conclusion: The study results show that training, according to the proposed protocol, can benefit athletes' dynamic balance and motor coordination, improving motor coordination and balance in practical sports movements. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Deep Reinforcement Learning-Based iTrain Serious Game for Caregivers Dealing with Post-Stroke Patients

This paper describes a serious game based on a knowledge transfer model using deep reinforcement learning, with an aim to improve the caretakers’ knowledge and abilities in post-stroke care. The iTrain game was designed to improve caregiver knowledge and abilities by providing non-traditional training to formal and informal caregivers who deal with stroke survivors. The methodologies utilized professional medical experiences and real-life evidence data gathered during the duration of the iTrain project to create the scenarios for the game’s deep reinforcement caregiver behavior improvement model, as well as the design of game mechanics, game images and game characters, and gameplay implementation. Furthermore, the results of the game’s direct impact on caregivers (n = 25) and stroke survivors (n = 21) in Lithuania using the Geriatric Depression Scale (GDS) and user experience questionnaire (UEQ) are presented. Both surveys had favorable outcomes, showing the effectiveness of the approach. The GDS scale (score 10) revealed a low number of 28% of individuals depressed, and the UEQ received a very favorable grade of +0.8.

Development of a Smartphone-Based mHealth Platform for Telerehabilitation

Telerehabilitation is becoming increasingly valuable as a method for expanding medical services. The smartphone-based mHealth platform (SMPT) has been developed to provide high-quality remote rehabilitation through a smartphone and inertial measurement units. The SMPT uses smartphone as a main platform with connection to medical backend server to provide telerehabilitation. Patients would be referred to therapists to receive a tutorial of exercise technique prior to conducting their home exercise. Once patients begin their home exercises, they can report any problems instantly through the SMPT. The medical staff can adjust the exercise program according to patient feedback and the data collected by the SMPT. After completing the exercise program, patients visit their clinician for re-evaluation. A Service User Technology Acceptability Questionnaire from both medical professional and public perspective revealed a high level of agreement on enhanced care, increased accessibility, and satisfaction and a moderate level of agreement on the use of this platform as a substitute for traditional rehabilitation. Concerns about privacy and discomfort were low in the medical professional and public groups. Concerns about care personnel were also significantly different between the two groups. The SMPT is a promising system for providing telerehabilitation as an adjunct to traditional rehabilitation, which may result in improved outcomes compared with those achieved when using traditional rehabilitation alone.

Use of an EMG-Controlled Game as a Therapeutic Tool to Retrain Hand Muscle Activation Patterns Following Stroke: A Pilot Study

BACKGROUND/PURPOSE

To determine the feasibility of training with electromyographically (EMG) controlled games to improve control of muscle activation patterns in stroke survivors.

METHODS

Twenty chronic stroke survivors (>6 months) with moderate hand impairment were randomized to train either unilaterally (paretic only) or bilaterally over 9 one-hour training sessions. EMG signals from the unilateral or bilateral limbs controlled a cursor location on a computer screen for gameplay. The EMG muscle activation vector was projected onto the plane defined by the first 2 principal components of the activation workspace for the nonparetic hand. These principal components formed the x- and y-axes of the computer screen.

RESULTS

The recruitment goal (n = 20) was met over 9 months, with no screen failure, no attrition, and 97.8% adherence rate. After training, both groups significantly decreased the time to move the cursor to a novel sequence of targets (P = 0.006) by reducing normalized path length of the cursor movement (P = 0.005), and improved the Wolf Motor Function Test (WMFT) quality score (P = 0.01). No significant group difference was observed. No significant change was seen in the WMFT time or Box and Block Test.

DISCUSSION/CONCLUSIONS

Stroke survivors could successfully use the EMG-controlled games to train control of muscle activation patterns. While the nonparetic limb EMG was used in this study to create target EMG patterns, the system supports various means for creating target patterns per user desires. Future studies will employ training with the EMG-controlled games in conjunction with functional task practice for a longer intervention duration to improve overall hand function.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A379).

Applying Game-Based Approaches for Physical Rehabilitation of Poststroke Patients: A Systematic Review

Objective

A large number of patients need critical physical rehabilitation after the stroke. This study aimed to review and report the result of published studies, in which newly emerged games were employed for physical rehabilitating in poststroke patients.

Materials and Methods

This systematic review study was performed based on the PRISMA method. A comprehensive search of PubMed, Scopus, IEEE Xplore Digital Library, and ISI Web of Science was conducted from January 1, 2014, to November 9, 2020, to identify related articles. Studies have been entered in this review based on inclusion and exclusion criteria, in which new games have been used for physical rehabilitation.

Results

Of the 1326 retrieved studies, 60 of them met our inclusion criteria. Virtual reality-oriented games were the most popular type of physical rehabilitation approach for poststroke patients. “The Nintendo Wii Fit” game was used more than other games. The reviewed games were mostly operated to balance training and limb mobilization. Based on the evaluation results of the utilized games, only in three studies, applied games were not effective. In other studies, games had effective outcomes for target body members.

Conclusions

The results indicate that modern games are efficient in poststroke patients' physical rehabilitation and can be used alongside conventional methods.

Tennis Rehabilitation Training-Assisted Paclitaxel Nanoparticles in Treatment of Lung Tumor

Paclitaxel nanoparticles are a compound with unique anticancer effects. Its mechanism of action is to prevent tumor rupture by stabilizing tumor proteins, while preventing cell division, leading to cell death, thereby inhibiting the spread of lung tumors. This article aims to study the treatment of lung tumors with paclitaxel nanoparticles assisted by tennis rehabilitation training. In this paper, paclitaxel nanoparticles were prepared by a solvent displacement method, and their particle size and morphology were measured. The TA2 series of experimental rats were selected to establish animal lung tumor models, and they were randomly divided into 5 groups: local injection of saline, porphyrin, and low-, medium-, and high-dose paclitaxel nanoparticles for treatment. The experimental results in this paper show that the average particle size of the paclitaxel nanoparticles prepared in the experiment is about 153,54 nm. Each treatment group inhibited tumor development to varying degrees. Among them, the inhibitory volume rate of paclitaxel nanoparticles in the middle- and high-dose groups was significantly higher than that in the paclitaxel treatment group, indicating that paclitaxel nanoparticles can release drugs slowly.