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Albanese GA, Bucchieri A, Podda J, Tacchino A, Buccelli S, De Momi E, Laffranchi M, Mannella K, Holmes MWR, Zenzeri J, De Michieli L, Brichetto G, Barresi G. Robotic systems for upper-limb rehabilitation in multiple sclerosis: a SWOT analysis and the synergies with virtual and augmented environments. Front Robot AI 2024; 11:1335147. [PMID: 38638271 PMCID: PMC11025362 DOI: 10.3389/frobt.2024.1335147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/30/2024] [Indexed: 04/20/2024] Open
Abstract
The robotics discipline is exploring precise and versatile solutions for upper-limb rehabilitation in Multiple Sclerosis (MS). People with MS can greatly benefit from robotic systems to help combat the complexities of this disease, which can impair the ability to perform activities of daily living (ADLs). In order to present the potential and the limitations of smart mechatronic devices in the mentioned clinical domain, this review is structured to propose a concise SWOT (Strengths, Weaknesses, Opportunities, and Threats) Analysis of robotic rehabilitation in MS. Through the SWOT Analysis, a method mostly adopted in business management, this paper addresses both internal and external factors that can promote or hinder the adoption of upper-limb rehabilitation robots in MS. Subsequently, it discusses how the synergy with another category of interaction technologies - the systems underlying virtual and augmented environments - may empower Strengths, overcome Weaknesses, expand Opportunities, and handle Threats in rehabilitation robotics for MS. The impactful adaptability of these digital settings (extensively used in rehabilitation for MS, even to approach ADL-like tasks in safe simulated contexts) is the main reason for presenting this approach to face the critical issues of the aforementioned SWOT Analysis. This methodological proposal aims at paving the way for devising further synergistic strategies based on the integration of medical robotic devices with other promising technologies to help upper-limb functional recovery in MS.
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Affiliation(s)
| | - Anna Bucchieri
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Stefano Buccelli
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Matteo Laffranchi
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Kailynn Mannella
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada
| | | | | | | | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- AISM Rehabilitation Center Liguria, Italian Multiple Sclerosis Society (AISM), Genoa, Italy
| | - Giacinto Barresi
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
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Banduni O, Saini M, Singh N, Nath D, Kumaran SS, Kumar N, Srivastava MVP, Mehndiratta A. Post-Stroke Rehabilitation of Distal Upper Limb with New Perspective Technologies: Virtual Reality and Repetitive Transcranial Magnetic Stimulation-A Mini Review. J Clin Med 2023; 12:2944. [PMID: 37109280 PMCID: PMC10142518 DOI: 10.3390/jcm12082944] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
Upper extremity motor impairment is the most common sequelae in patients with stroke. Moreover, its continual nature limits the optimal functioning of patients in the activities of daily living. Because of the intrinsic limitations in the conventional form of rehabilitation, the rehabilitation applications have been expanded to technology-driven solutions, such as Virtual Reality and Repetitive Transcranial Magnetic Stimulation (rTMS). The motor relearning processes are influenced by variables, such as task specificity, motivation, and feedback provision, and a VR environment in the form of interactive games could provide novel and motivating customized training solutions for better post-stroke upper limb motor improvement. rTMS being a precise non-invasive brain stimulation method with good control of stimulation parameters, has the potential to facilitate neuroplasticity and hence a good recovery. Although several studies have discussed these forms of approaches and their underlying mechanisms, only a few of them have specifically summarized the synergistic applications of these paradigms. To bridge the gaps, this mini review presents recent research and focuses precisely on the applications of VR and rTMS in distal upper limb rehabilitation. It is anticipated that this article will provide a better representation of the role of VR and rTMS in distal joint upper limb rehabilitation in patients with stroke.
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Affiliation(s)
- Onika Banduni
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi 110016, India
| | - Megha Saini
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi 110016, India
| | - Neha Singh
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi 110016, India
| | - Debasish Nath
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi 110016, India
| | - S. Senthil Kumaran
- Department of Nuclear Medicine and Resonance, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - M. V. Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi 110016, India
- Department of Biomedical Engineering, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
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Zhou Z, Chen S, Li Y, Zhao J, Li G, Chen L, Wu Y, Zhang S, Shi X, Chen X, Xu S, Ren M, Chang S, Shan C. Comparison of Sensory Observation and Somatosensory Stimulation in Mirror Neurons and the Sensorimotor Network: A Task-Based fMRI Study. Front Neurol 2022; 13:916990. [PMID: 35847217 PMCID: PMC9279701 DOI: 10.3389/fneur.2022.916990] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/25/2022] [Indexed: 12/03/2022] Open
Abstract
Objective This study aimed to investigate brain plasticity by somatosensory stimulation (SS) and sensory observation (SO) based on mirror neuron and embodied cognition theory. Action observation therapy has been widely adopted for motor function improvement in post-stroke patients. However, it is uncertain whether the SO approach can also contribute to the recovery of sensorimotor function after stroke. In this study, we explored the therapeutic potential of SO for sensorimotor dysfunction and provided new evidence for neurorehabilitation. Methods Twenty-six healthy right-handed adults (12 men and 14 women), aged 18–27 (mean, 22.12; SD, 2.12) years were included. All subjects were evaluated with task-based functional magnetic resonance imaging (fMRI) to discover the characteristics and differences in brain activation between SO and SS. We adopted a block design with two conditions during fMRI scanning: observing a sensory video of brushing (task condition A, defined as SO) and brushing subjects' right forearms while they watched a nonsense string (task condition B, defined as SS). One-sample t-tests were performed to identify brain regions and voxels activated for each task condition. A paired-sample t-test and conjunction analysis were performed to explore the differences and similarities between SO and SS. Results The task-based fMRI showed that the bilateral postcentral gyrus, left precentral gyrus, bilateral middle temporal gyrus, right supramarginal gyrus, and left supplementary motor area were significantly activated during SO or SS. In addition to these brain regions, SO could also activate areas containing mirror neurons, like the left inferior parietal gyrus. Conclusion SO could activate mirror neurons and sensorimotor network-related brain regions in healthy subjects like SS. Therefore, SO may be a promising novel therapeutic approach for sensorimotor dysfunction recovery in post-stroke patients.
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Affiliation(s)
- Zhiqing Zhou
- Center of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Songmei Chen
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Rehabilitation Medicine, Shanghai No. 3 Rehabilitation Hospital, Shanghai, China
| | - Yuanli Li
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Jingjun Zhao
- Center of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guanwu Li
- Department of Radiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lei Chen
- Department of Radiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuwei Wu
- Center of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Sicong Zhang
- Center of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaolong Shi
- Center of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xixi Chen
- Center of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shutian Xu
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Meng Ren
- Center of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shixin Chang
- Department of Radiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Shixin Chang
| | - Chunlei Shan
- Center of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
- Chunlei Shan
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Design and Validation of Virtual Reality Task for Neuro-Rehabilitation of Distal Upper Extremities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031442. [PMID: 35162459 PMCID: PMC8835157 DOI: 10.3390/ijerph19031442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/12/2022] [Accepted: 01/25/2022] [Indexed: 02/05/2023]
Abstract
Stroke, affecting approximately 15 million people worldwide, has long been a global cause of death and disability. Virtual Reality (VR) has shown its potential as an assistive tool for post-stroke rehabilitation. The objective of this pilot study was to define the task-specific performance metrics of VR tasks to assess the performance level of healthy subjects and patients quantitatively and to obtain their feedback for improving the developed framework. A pilot prospective study was designed. We tested the designed VR tasks on forty healthy right-handed subjects to evaluate its potential. Qualitative trajectory plots and three quantitative performance metrics—time taken to complete the task, percentage relative error, and trajectory smoothness—were computed from the recorded data of forty healthy subjects. Two patients with stroke were also enrolled to compare their performance with healthy subjects. Each participant received one VR session of 90 min. No adverse effects were noticed throughout the study. Performance metrics obtained from healthy subjects were used as a reference for patients. Relatively higher values of task completion time and trajectory smoothness and lower values of relative % error was observed for the affected hands w.r.t the unaffected hands of both the patients. For the unaffected hands of both the patients, the performance levels were found objectively closer to that of healthy subjects. A library of VR tasks for wrist and fingers were designed, and task-specific performance metrics were defined in this study. The evaluation of the VR exercises using these performance metrics will help the clinicians to assess the patient’s progress quantitatively and to design the rehabilitation framework for a future clinical study.
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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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Merians AS, Fluet GG, Qiu Q, Yarossi M, Patel J, Mont AJ, Saleh S, Nolan KJ, Barrett AM, Tunik E, Adamovich SV. Hand Focused Upper Extremity Rehabilitation in the Subacute Phase Post-stroke Using Interactive Virtual Environments. Front Neurol 2020; 11:573642. [PMID: 33324323 PMCID: PMC7726202 DOI: 10.3389/fneur.2020.573642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/14/2020] [Indexed: 01/14/2023] Open
Abstract
Introduction: Innovative motor therapies have attempted to reduce upper extremity impairment after stroke but have not made substantial improvement as over 50% of people post-stroke continue to have sensorimotor deficits affecting their self-care and participation in daily activities. Intervention studies have focused on the role of increased dosing, however recent studies have indicated that timing of rehabilitation interventions may be as important as dosing and importantly, that dosing and timing interact in mediating effectiveness. This study is designed to empirically test dosing and timing. Methods and Analysis: In this single-blinded, interventional study, subjects will be stratified on two dimensions, impairment level (Fugl-Meyer Upper Extremity Assessment (FM) and presence or absence of Motor Evoked Potentials (MEPs) as follows; (1) Severe, FM score 10-19, MEP+, (2) Severe, FM score 10-19, MEP-, (3) Moderate, FM score 20-49, MEP+, (4) Moderate, FM score 20-49, MEP-. Subjects not eligible for TMS will be assigned to either group 2 (if severe) or group 3 (if moderate). Stratified block randomization will then be used to achieve a balanced assignment. Early Robotic/VR Therapy (EVR) experimental group will receive in-patient usual care therapy plus an extra 10 h of intensive upper extremity therapy focusing on the hand using robotically facilitated rehabilitation interventions presented in virtual environments and initiated 5-30 days post-stroke. Delayed Robotic/VR Therapy (DVR) experimental group will receive the same intervention but initiated 30-60 days post-stroke. Dose-matched usual care group (DMUC) will receive an extra 10 h of usual care initiated 5-30 days post-stroke. Usual Care Group (UC) will receive the usual amount of physical/occupational therapy. Outcomes: There are clinical, neurophysiological, and kinematic/kinetic measures, plus measures of daily arm use and quality of life. Primary outcome is the Action Research Arm Test (ARAT) measured at 4 months post-stroke. Discussion: Outcome measures will be assessed to determine whether there is an early time period in which rehabilitation will be most effective, and whether there is a difference in the recapture of premorbid patterns of movement vs. the development of an efficient, but compensatory movement strategy. Ethical Considerations: The IRBs of New Jersey Institute of Technology, Rutgers University, Northeastern University, and Kessler Foundation reviewed and approved all study protocols. Study was registered in https://ClinicalTrials.gov (NCT03569059) prior to recruitment. Dissemination will include submission to peer-reviewed journals and professional presentations.
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Affiliation(s)
- Alma S. Merians
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Gerard G. Fluet
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Qinyin Qiu
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Mathew Yarossi
- Movement Neuroscience Laboratory, Department of Physical Therapy, Movement and Rehabilitation Science, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States
- SPIRAL Group, Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, United States
| | - Jigna Patel
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Ashley J. Mont
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Soha Saleh
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Karen J. Nolan
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - AM Barrett
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, United States
| | - Eugene Tunik
- Movement Neuroscience Laboratory, Department of Physical Therapy, Movement and Rehabilitation Science, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States
- Department of Bioengineering, College of Engineering, Northeastern University, Boston, MA, United States
- Department of Electrical and Computer Engineering, College of Engineering, Northeastern University, Boston, MA, United States
| | - Sergei V. Adamovich
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
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Clinical Application of Virtual Reality for Upper Limb Motor Rehabilitation in Stroke: Review of Technologies and Clinical Evidence. J Clin Med 2020; 9:jcm9103369. [PMID: 33096678 PMCID: PMC7590210 DOI: 10.3390/jcm9103369] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 12/17/2022] Open
Abstract
Neurorehabilitation for stroke is important for upper limb motor recovery. Conventional rehabilitation such as occupational therapy has been used, but novel technologies are expected to open new opportunities for better recovery. Virtual reality (VR) is a technology with a set of informatics that provides interactive environments to patients. VR can enhance neuroplasticity and recovery after a stroke by providing more intensive, repetitive, and engaging training due to several advantages, including: (1) tasks with various difficulty levels for rehabilitation, (2) augmented real-time feedback, (3) more immersive and engaging experiences, (4) more standardized rehabilitation, and (5) safe simulation of real-world activities of daily living. In this comprehensive narrative review of the application of VR in motor rehabilitation after stroke, mainly for the upper limbs, we cover: (1) the technologies used in VR rehabilitation, including sensors; (2) the clinical application of and evidence for VR in stroke rehabilitation; and (3) considerations for VR application in stroke rehabilitation. Meta-analyses for upper limb VR rehabilitation after stroke were identified by an online search of Ovid-MEDLINE, Ovid-EMBASE, the Cochrane Library, and KoreaMed. We expect that this review will provide insights into successful clinical applications or trials of VR for motor rehabilitation after stroke.
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Xu Q, Li C, Pan Y, Li W, Jia T, Li Z, Ma D, Pang X, Ji L. Impact of smart force feedback rehabilitation robot training on upper limb motor function in the subacute stage of stroke. NeuroRehabilitation 2020; 47:209-215. [PMID: 32741790 DOI: 10.3233/nre-203130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To explore the impact of rehabilitation robot training (RRT) on upper limb motor function and daily activity ability in patients with stroke. METHODS Forty patients meeting the inclusion criteria were randomly divided into the treatment group (TRE) and the control group (CON). Group TRE was trained with an upper limb rehabilitation robot and group CON was trained with traditional occupational therapy. The training time was six weeks, and the upper limb function and daily activities were then assessed. RESULTS (1) There was no statistical significance in the Fugl-Meyer (FM) score, Wolf Motor Function Test (WMFT) score, and Modified Barthel Index (MBI) score between the two groups before treatment (P > 0.05). (2) After treatment, the FM score, WMFT score, and MBI score were significantly higher than before treatment (P < 0.01). (3) There was no significant significance between the two groups after treatment (P > 0.05). CONCLUSIONS Both RRT and traditional occupational therapy training are useful for the recovery of upper limb motor function and daily life ability in the sub-acute stage of stroke.
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Affiliation(s)
- Quan Xu
- Department of Mechanical Engineering, Division of Intelligent and Biomimetic Machinery, State Key Laboratory of Tribology, Tsinghua University, Beijing, China.,Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Chong Li
- Department of Mechanical Engineering, Division of Intelligent and Biomimetic Machinery, State Key Laboratory of Tribology, Tsinghua University, Beijing, China
| | - Yu Pan
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wei Li
- Department of Mechanical Engineering, Division of Intelligent and Biomimetic Machinery, State Key Laboratory of Tribology, Tsinghua University, Beijing, China
| | - Tianyu Jia
- Department of Mechanical Engineering, Division of Intelligent and Biomimetic Machinery, State Key Laboratory of Tribology, Tsinghua University, Beijing, China
| | - Zhibin Li
- Department of Mechanical Engineering, Division of Intelligent and Biomimetic Machinery, State Key Laboratory of Tribology, Tsinghua University, Beijing, China
| | - Di Ma
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xue Pang
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Linhong Ji
- Department of Mechanical Engineering, Division of Intelligent and Biomimetic Machinery, State Key Laboratory of Tribology, Tsinghua University, Beijing, China
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Patel J, Fluet G, Qiu Q, Yarossi M, Merians A, Tunik E, Adamovich S. Intensive virtual reality and robotic based upper limb training compared to usual care, and associated cortical reorganization, in the acute and early sub-acute periods post-stroke: a feasibility study. J Neuroeng Rehabil 2019; 16:92. [PMID: 31315612 PMCID: PMC6637633 DOI: 10.1186/s12984-019-0563-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/03/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND There is conflict regarding the benefits of greater amounts of intensive upper limb rehabilitation in the early period post-stroke. This study was conducted to test the feasibility of providing intensive therapy during the early period post-stroke and to develop a randomized control trial that is currently in process. Specifically, the study investigated whether an additional 8 h of specialized, intensive (200-300 separate hand or arm movements per hour) virtual reality (VR)/robotic based upper limb training introduced within 1-month post-stroke resulted in greater improvement in impairment and behavior, and distinct changes in cortical reorganization measured via Transcranial Magnetic Stimulation (TMS), compared to that of a control group. METHODS Seven subjects received 8-1 h sessions of upper limb VR/robotic training in addition to their inpatient therapy (PT, OT, ST). Six subjects only received their inpatient therapy. All were tested on measures of impairment [Upper Extremity Fugl-Meyer Assessment (UEFMA), Wrist AROM, Maximum Pinch Force], behavior [Wolf Motor Function Test (WMFT)], and also received TMS mapping until 6 months post training. ANOVAs were conducted to measure differences between groups across time for all outcome measures. Associations between changes in ipsilesional cortical maps during the early period of enhanced neuroplasticity and long-term changes in upper limb impairment and behavior measures were evaluated. RESULTS The VR/robotic group made significantly greater improvements on UEFMA and Wrist AROM scores compared to the usual care group. There was also less variability in the association between changes in the First Dorsal Interosseus (FDI) muscle map area and WMFT and Maximum Force change scores for the VR/robotic group. CONCLUSIONS An additional 8 h of intensive VR/robotic based upper limb training initiated within the first month post-stroke may promote greater gains in impairment compared to usual care alone. Importantly, the data presented demonstrated the feasibility of conducting this intervention and multiple outcome measures (impairment, behavioral, neurophysiological) in the early period post-stroke.
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Affiliation(s)
- Jigna Patel
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, The State University of New Jersey, 65 Bergen Street, Newark, NJ 07107 USA
| | - Gerard Fluet
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, The State University of New Jersey, 65 Bergen Street, Newark, NJ 07107 USA
| | - Qinyin Qiu
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, The State University of New Jersey, 65 Bergen Street, Newark, NJ 07107 USA
| | - Mathew Yarossi
- Movement Neuroscience Laboratory, Department of Physical Therapy, Bouve College of Health Sciences, Movement and Rehabilitation Science, Northeastern University, 308C Robinson Hall – 360 Huntington Avenue, Boston, MA 02115 USA
| | - Alma Merians
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, The State University of New Jersey, 65 Bergen Street, Newark, NJ 07107 USA
| | - Eugene Tunik
- Movement Neuroscience Laboratory, Department of Physical Therapy, Bouve College of Health Sciences, Movement and Rehabilitation Science, Northeastern University, 308C Robinson Hall – 360 Huntington Avenue, Boston, MA 02115 USA
| | - Sergei Adamovich
- Department of Biomedical Engineering, New Jersey Institute of Technology, 616 Fenster Hall – 323 Dr. MLK Jr. BLVD, Newark, NJ 07102 USA
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Yarossi M, Patel J, Qiu Q, Massood S, Fluet G, Merians A, Adamovich S, Tunik E. The Association Between Reorganization of Bilateral M1 Topography and Function in Response to Early Intensive Hand Focused Upper Limb Rehabilitation Following Stroke Is Dependent on Ipsilesional Corticospinal Tract Integrity. Front Neurol 2019; 10:258. [PMID: 30972004 PMCID: PMC6443957 DOI: 10.3389/fneur.2019.00258] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 02/26/2019] [Indexed: 01/12/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) induced motor evoked potentials (MEPs) are an established proxy of corticospinal excitability. As a binary measure, the presence (MEP+) or absence (MEP-) of ipsilesional hemisphere MEPs early following stroke is a robust indicator of long-term recovery, however this measure does not provide information about spatial cortical reorganization. MEPs have been systematically acquired over the sensorimotor cortex to "map" motor topography. In this investigation we compared the degree to which functional improvements resulting from early (<3 months post-stroke) intensive hand focused upper limb rehabilitation correlate with changes in motor topography between MEP+ and MEP- individuals. Following informed consent, 17 individuals (4 Female, 60.3 ± 9.4 years, 24.6 ± 24.01 days post first time stroke) received 8 one hour-sessions of training with virtual reality (VR)/Robotic simulations. Clinical tests [Box and Blocks Test (BBT), Wolf Motor Function Test (WMFT), Upper Extremity Fugl-Meyer (UEFMA)], kinematic and kinetic assessments [finger Active Range of Motion (finger AROM), Maximum Pinch Force (MPF)], and bilateral TMS mapping of 5 hand muscles were performed prior to (PRE), directly following (POST), and 1 month following (1M) training. Participants were divided into two groups (MEP+, MEP-) based on whether an MEP was present in the affected first dorsal interosseous (FDI) at any time point. MEP+ individuals improved significantly more than MEP- individuals from PRE to 1M on the WMFT, BBT, and finger AROM scores. Ipsilesional hemisphere FDI area increased significantly with time in the MEP+ group. FDI area of the contralesional hemisphere was not significantly different across time points or groups. In the MEP+ group, significant correlations were observed between PRE-1M changes in ipsilesional FDI area and WMFT, BBT, and finger AROM, and contralesional FDI area and UEFMA and MPF. In the MEP- group, no significant correlations were found between changes in contralesional FDI area and functional outcomes. We report preliminary evidence in a small sample that patterns of recovery and the association of recovery to bilateral changes in motor topography may depend on integrity of the ipsilesional cortical spinal tract as assessed by the presence of TMS evoked MEPs.
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Affiliation(s)
- Mathew Yarossi
- Movement Neuroscience Laboratory, Department of Physical Therapy, Movement and Rehabilitation Science, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States.,SPIRAL Group, Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, United States
| | - Jigna Patel
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Qinyin Qiu
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Supriya Massood
- Brookdale Rehabilitation - North Campus, Naples Community Hospital, Naples, FL, United States
| | - Gerard Fluet
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Alma Merians
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Sergei Adamovich
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States.,Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Eugene Tunik
- Movement Neuroscience Laboratory, Department of Physical Therapy, Movement and Rehabilitation Science, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States.,Department of Bioengineering, College of Engineering, Northeastern University, Boston, MA, United States.,Department of Electrical and Computer Engineering, College of Engineering, Northeastern University, Boston, MA, United States
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11
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Washabaugh E, Guo J, Chang CK, Remy D, Krishnan C. A Portable Passive Rehabilitation Robot for Upper-Extremity Functional Resistance Training. IEEE Trans Biomed Eng 2018; 66:496-508. [PMID: 29993459 DOI: 10.1109/tbme.2018.2849580] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Loss of arm function is common in individuals with neurological damage, such as stroke or cerebral palsy. Robotic devices that address muscle strength deficits in a task-specific manner can assist in the recovery of arm function; however, current devices are typically large, bulky, and expensive to be routinely used in the clinic or at home. This study sought to address this issue by developing a portable planar passive rehabilitation robot, PaRRo. METHODS We designed PaRRo with a mechanical layout that incorporated kinematic redundancies to generate forces that directly oppose the user's movement. Cost-efficient eddy current brakes were used to provide scalable resistances. The lengths of the robot's linkages were optimized to have a reasonably large workspace for human planar reaching. We then performed theoretical analysis of the robot's resistive force generating capacity and steerable workspace using MATLAB simulations. We also validated the device by having a subject move the end-effector along different paths at a set velocity using a metronome while simultaneously collecting surface electromyography (EMG) and end-effector forces felt by the user. RESULTS Results from simulation experiments indicated that the robot was capable of producing sufficient end-effector forces for functional resistance training. We also found the endpoint forces from the user were similar to the theoretical forces expected at any direction of motion. EMG results indicated that the device was capable of providing adjustable resistances based on subjects' ability levels, as the muscle activation levels scaled with increasing magnet exposures. CONCLUSION These results indicate that PaRRo is a feasible approach to provide functional resistance training to the muscles along the upper extremity. SIGNIFICANCE The proposed robotic device could provide a technological breakthrough that will make rehabilitation robots accessible for small outpatient rehabilitation centers and in-home therapy.
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12
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Seo NJ, Arun Kumar J, Hur P, Crocher V, Motawar B, Lakshminarayanan K. Usability evaluation of low-cost virtual reality hand and arm rehabilitation games. ACTA ACUST UNITED AC 2018; 53:321-34. [PMID: 27271199 DOI: 10.1682/jrrd.2015.03.0045] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 08/26/2015] [Indexed: 11/05/2022]
Abstract
The emergence of lower-cost motion tracking devices enables home-based virtual reality rehabilitation activities and increased accessibility to patients. Currently, little documentation on patients' expectations for virtual reality rehabilitation is available. This study surveyed 10 people with stroke for their expectations of virtual reality rehabilitation games. This study also evaluated the usability of three lower-cost virtual reality rehabilitation games using a survey and House of Quality analysis. The games (kitchen, archery, and puzzle) were developed in the laboratory to encourage coordinated finger and arm movements. Lower-cost motion tracking devices, the P5 Glove and Microsoft Kinect, were used to record the movements. People with stroke were found to desire motivating and easy-to-use games with clinical insights and encouragement from therapists. The House of Quality analysis revealed that the games should be improved by obtaining evidence for clinical effectiveness, including clinical feedback regarding improving functional abilities, adapting the games to the user's changing functional ability, and improving usability of the motion-tracking devices. This study reports the expectations of people with stroke for rehabilitation games and usability analysis that can help guide development of future games.
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Affiliation(s)
- Na Jin Seo
- Division of Occupational Therapy, Department of Health Professions, Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC
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Tran VD, Dario P, Mazzoleni S. Kinematic measures for upper limb robot-assisted therapy following stroke and correlations with clinical outcome measures: A review. Med Eng Phys 2018; 53:13-31. [PMID: 29361407 DOI: 10.1016/j.medengphy.2017.12.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/10/2017] [Accepted: 12/24/2017] [Indexed: 10/18/2022]
Abstract
AIM OF THE STUDY This review classifies the kinematic measures used to evaluate post-stroke motor impairment following upper limb robot-assisted rehabilitation and investigates their correlations with clinical outcome measures. METHODS An online literature search was carried out in PubMed, MEDLINE, Scopus and IEEE-Xplore databases. Kinematic parameters mentioned in the studies included were categorized into the International Classification of Functioning, Disability and Health (ICF) domains. The correlations between these parameters and the clinical scales were summarized. RESULTS Forty-nine kinematic parameters were identified from 67 articles involving 1750 patients. The most frequently used parameters were: movement speed, movement accuracy, peak speed, number of speed peaks, and movement distance and duration. According to the ICF domains, 44 kinematic parameters were categorized into Body Functions and Structure, 5 into Activities and no parameters were categorized into Participation and Personal and Environmental Factors. Thirteen articles investigated the correlations between kinematic parameters and clinical outcome measures. Some kinematic measures showed a significant correlation coefficient with clinical scores, but most were weak or moderate. CONCLUSIONS The proposed classification of kinematic measures into ICF domains and their correlations with clinical scales could contribute to identifying the most relevant ones for an integrated assessment of upper limb robot-assisted rehabilitation treatments following stroke. Increasing the assessment frequency by means of kinematic parameters could optimize clinical assessment procedures and enhance the effectiveness of rehabilitation treatments.
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Affiliation(s)
- Vi Do Tran
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Polo Sant'Anna Valdera, V.le R. Piaggio 34-56025 Pontedera, Italy; Rehabilitation Bioengineering Laboratory, Volterra, Italy
| | - Paolo Dario
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Polo Sant'Anna Valdera, V.le R. Piaggio 34-56025 Pontedera, Italy
| | - Stefano Mazzoleni
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Polo Sant'Anna Valdera, V.le R. Piaggio 34-56025 Pontedera, Italy; Rehabilitation Bioengineering Laboratory, Volterra, Italy.
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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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15
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Yue Z, Zhang X, Wang J. Hand Rehabilitation Robotics on Poststroke Motor Recovery. Behav Neurol 2017; 2017:3908135. [PMID: 29230081 PMCID: PMC5688261 DOI: 10.1155/2017/3908135] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/26/2017] [Accepted: 08/09/2017] [Indexed: 12/21/2022] Open
Abstract
The recovery of hand function is one of the most challenging topics in stroke rehabilitation. Although the robot-assisted therapy has got some good results in the latest decades, the development of hand rehabilitation robotics is left behind. Existing reviews of hand rehabilitation robotics focus either on the mechanical design on designers' view or on the training paradigms on the clinicians' view, while these two parts are interconnected and both important for designers and clinicians. In this review, we explore the current literature surrounding hand rehabilitation robots, to help designers make better choices among varied components and thus promoting the application of hand rehabilitation robots. An overview of hand rehabilitation robotics is provided in this paper firstly, to give a general view of the relationship between subjects, rehabilitation theories, hand rehabilitation robots, and its evaluation. Secondly, the state of the art hand rehabilitation robotics is introduced in detail according to the classification of the hardware system and the training paradigm. As a result, the discussion gives available arguments behind the classification and comprehensive overview of hand rehabilitation robotics.
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Affiliation(s)
- Zan Yue
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an 710049, China
| | - Xue Zhang
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an 710049, China
| | - Jing Wang
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an 710049, China
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Proença JP, Quaresma C, Vieira P. Serious games for upper limb rehabilitation: a systematic review. Disabil Rehabil Assist Technol 2017; 13:95-100. [PMID: 28359181 DOI: 10.1080/17483107.2017.1290702] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this research is to carry out a systematic review of the use of technological gaming platforms with serious games in the upper limb rehabilitation of patients with neuromotor disorders. Through a systematic review, the first two authors defined the inclusion criteria and extracted the data, resulting in 38 studies collected from B-On, PubMed and Medline. Ninety-two per cent of the selected articles were published since 2010. This review documents 35 different gaming platforms types. Twenty-one of the 38 articles included in this review conducted a clinical trial and of those only eight report improvements in the target population following the use of the games and platforms. This review concludes that a new paradigm is emerging in the rehabilitation field, characterized by the systematic use of technological gaming platforms with serious games in/for rehabilitation. The use of this approach seems to be beneficial. However, to facilitate the full integration of these platforms, it is necessary to conduct more research in this area, explore new approaches and carry out in-depth clinical studies into the benefits of these platforms. Implications for rehabilitation This review states that the use serious games and gaming platforms for upper limb rehabilitation are starting a new paradigm in the rehabilitation. For a full integration of this technologies in the rehabilitation field more studies are needed.
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Affiliation(s)
- João Pedro Proença
- a Department of Physics , Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa , Portugal.,b Technical Resource Center, Alcoitão Centre for Rehabilitation Medicine , Portugal.,c LIBPhys-UNL, Department of Physics, Faculdade de Ciências e Tecnologias , Universidade Nova de Lisboa , Portugal
| | - Cláudia Quaresma
- a Department of Physics , Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa , Portugal.,c LIBPhys-UNL, Department of Physics, Faculdade de Ciências e Tecnologias , Universidade Nova de Lisboa , Portugal
| | - Pedro Vieira
- a Department of Physics , Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa , Portugal
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17
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Thielbar KO, Triandafilou KM, Fischer HC, O'Toole JM, Corrigan ML, Ochoa JM, Stoykov ME, Kamper DG. Benefits of Using a Voice and EMG-Driven Actuated Glove to Support Occupational Therapy for Stroke Survivors. IEEE Trans Neural Syst Rehabil Eng 2017; 25:297-305. [DOI: 10.1109/tnsre.2016.2569070] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Hakim RM, Tunis BG, Ross MD. Rehabilitation robotics for the upper extremity: review with new directions for orthopaedic disorders. Disabil Rehabil Assist Technol 2016; 12:765-771. [DOI: 10.1080/17483107.2016.1269211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Renée M. Hakim
- Department of Physical Therapy, University of Scranton, Scranton, PA, USA
| | - Brandon G. Tunis
- Department of Physical Therapy, University of Scranton, Scranton, PA, USA
| | - Michael D. Ross
- Department of Physical Therapy, Daemen College, Amherst, NY, USA
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Shin JH, Kim MY, Lee JY, Jeon YJ, Kim S, Lee S, Seo B, Choi Y. Effects of virtual reality-based rehabilitation on distal upper extremity function and health-related quality of life: a single-blinded, randomized controlled trial. J Neuroeng Rehabil 2016; 13:17. [PMID: 26911438 PMCID: PMC4765099 DOI: 10.1186/s12984-016-0125-x] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/12/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Virtual reality (VR)-based rehabilitation has been reported to have beneficial effects on upper extremity function in stroke survivors; however, there is limited information about its effects on distal upper extremity function and health-related quality of life (HRQoL). The purpose of the present study was to examine the effects of VR-based rehabilitation combined with standard occupational therapy on distal upper extremity function and HRQoL, and compare the findings to those of amount-matched conventional rehabilitation in stroke survivors. METHODS The present study was a single-blinded, randomized controlled trial. The study included 46 stroke survivors who were randomized to a Smart Glove (SG) group or a conventional intervention (CON) group. In both groups, the interventions were targeted to the distal upper extremity and standard occupational therapy was administered. The primary outcome was the change in the Fugl-Meyer assessment (FM) scores, and the secondary outcomes were the changes in the Jebsen-Taylor hand function test (JTT), Purdue pegboard test, and Stroke Impact Scale (SIS) version 3.0 scores. The outcomes were assessed before the intervention, in the middle of the intervention, immediately after the intervention, and 1 month after the intervention. RESULTS The improvements in the FM (FM-total, FM-prox, and FM-dist), JTT (JTT-total and JTT-gross), and SIS (composite and overall SIS, SIS-social participation, and SIS-mobility) scores were significantly greater in the SG group than in the CON group. CONCLUSIONS VR-based rehabilitation combined with standard occupational therapy might be more effective than amount-matched conventional rehabilitation for improving distal upper extremity function and HRQoL. TRIAL REGISTRATION This study is registered under the title "Effects of Novel Game Rehabilitation System on Upper Extremity Function of Patients With Stroke" and can be located in https://clinicaltrials.gov with the study identifier NCT02029651 .
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Affiliation(s)
- Joon-Ho Shin
- National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea.
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Samgaksan-ro 58, Gangbuk-gu, Seoul, 142-884, Korea.
| | - Mi-Young Kim
- National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea.
| | - Ji-Yeong Lee
- National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea.
| | - Yu-Jin Jeon
- National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea.
| | - Suyoung Kim
- Department of Law, Hanyang University, Seoul, Korea.
| | | | - Beomjoo Seo
- School of Games, Hongik University, Seoul, Korea.
| | - Younggeun Choi
- Neofect, Yong-in, Korea.
- Department of Applied Computer Engineering, Dankook University, Yong-in, Korea.
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Rohafza M, Fluet GG, Qiu Q, Adamovich S. Correlation of reaching and grasping kinematics and clinical measures of upper extremity function in persons with stroke related hemiplegia. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:3610-3. [PMID: 25570772 DOI: 10.1109/embc.2014.6944404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Timed measures of standardized functional tasks are commonly used to measure treatment effects in persons with upper extremity (UE) paresis due to stroke. The effectiveness of their ability to measure motor recovery has come into question because of their inability to distinguish between motor recovery and compensations. This paper presents three linear regression models generated from twelve kinematic measures collected during the performance of a two phase reach/grasp and transport /release activity as performed by 21 persons with upper extremity hemiparesis due to chronic stroke. One of these models demonstrated a statistically significant correlation with the subjects' scores on the Wolf Motor Function Test (WMFT), a battery of fifteen standardized upper extremity functional activities. The second and third models demonstrated a statistically significant correlation with the subjects' WMFT change scores elicited by a two week intensive upper extremity motor rehabilitation intervention. The high correlation suggests that models of kinematic measurements can be used to predict neurologic improvement and the effectiveness of treatment.
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Fluet GG, Merians AS, Qiu Q, Rohafaza M, VanWingerden AM, Adamovich SV. Does training with traditionally presented and virtually simulated tasks elicit differing changes in object interaction kinematics in persons with upper extremity hemiparesis? Top Stroke Rehabil 2015; 22:176-84. [PMID: 26084322 DOI: 10.1179/1074935714z.0000000008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To contrast changes in clinical and kinematic measures of upper extremity movement in response to virtually simulated and traditionally presented rehabilitation interventions in persons with upper extremity hemiparesis due to chronic stroke. DESIGN Non-randomized controlled trial. SETTING Ambulatory research facility. PARTICIPANTS Subjects were a volunteer sample of twenty one community-dwelling adults (mean age: 51 ± 12 years) with residual hemiparesis due to stroke more than 6 months before enrollment (mean: 74 ± 48 months), recruited at support groups. Partial range, against gravity shoulder movement and at least 10° of active finger extension were required for inclusion. All subjects completed the study without adverse events. INTERVENTIONS A 2 weeks, 24-hour program of robotic/virtually simulated, arm and finger rehabilitation activities was compared to the same dose of traditionally presented arm and finger activities. RESULTS Subjects in both groups demonstrated statistically significant improvements in the ability to interact with real-world objects as measured by the Wolf Motor Function Test (P = 0.01). The robotic/virtually simulated activity (VR) group but not the traditional, repetitive task practice (RTP) group demonstrated significant improvements in peak reaching velocity (P = 0.03) and finger extension excursion (P = 0.03). Both groups also demonstrated similar improvements in kinematic measures of reaching and grasping performance such as increased shoulder and elbow excursion along with decreased trunk excursion. CONCLUSIONS Kinematic measurements identified differing adaptations to training that clinical measurements did not. These adaptations were targeted in the design of four of the six simulations performed by the simulated activity group. Finer grained measures may be necessary to accurately depict the relative benefits of dose matched motor interventions.
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Virtual Immersion for Post-Stroke Hand Rehabilitation Therapy. Ann Biomed Eng 2015; 43:467-77. [DOI: 10.1007/s10439-014-1218-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/08/2014] [Indexed: 10/24/2022]
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Thielbar KO, Lord TJ, Fischer HC, Lazzaro EC, Barth KC, Stoykov ME, Triandafilou KM, Kamper DG. Training finger individuation with a mechatronic-virtual reality system leads to improved fine motor control post-stroke. J Neuroeng Rehabil 2014; 11:171. [PMID: 25542201 PMCID: PMC4292811 DOI: 10.1186/1743-0003-11-171] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 12/05/2014] [Indexed: 11/10/2022] Open
Abstract
Background Dexterous manipulation of the hand, one of the features of human motor control, is often compromised after stroke, to the detriment of basic functions. Despite the importance of independent movement of the digits to activities of daily living, relatively few studies have assessed the impact of specifically targeting individuated movements of the digits on hand rehabilitation. The purpose of this study was to investigate the impact of such finger individuation training, by means of a novel mechatronic-virtual reality system, on fine motor control after stroke. Methods An actuated virtual keypad (AVK) system was developed in which the impaired hand controls a virtual hand playing a set of keys. Creation of individuated digit movements is assisted by a pneumatically actuated glove, the PneuGlove. A study examining efficacy of the AVK system was subsequently performed. Participants had chronic, moderate hand impairment resulting from a single stroke incurred at least 6 months prior. Each subject underwent 18 hour-long sessions of extensive therapy (3x per week for 6 weeks) targeted at finger individuation. Subjects were randomly divided into two groups: the first group (Keypad: N = 7) utilized the AVK system while the other group (OT: N = 7) received a similarly intensive dose of occupational therapy; both groups worked directly with a licensed occupational therapist. Outcome measures such as the Jebsen-Taylor Hand Function Test (JTHFT), Action research Arm Test (ARAT), Fugl-Meyer Upper Extremity Motor Assessment/Hand subcomponent (FMUE/FMH), grip and pinch strengths were collected at baseline, post-treatment and one-month post-treatment. Results While both groups exhibited some signs of change after the training sessions, only the Keypad group displayed statistically significant improvement both for measures of impairment (FMH: p = 0.048) and measures of task performance (JTHFT: p = 0.021). Additionally, the finger individuation index – a measure of finger independence – improved only for the Keypad group after training (p = 0.05) in the subset (Keypad: N = 4; OT: N = 5) of these participants for which it was measured. Conclusions Actively assisted individuation therapy comprised of non task-specific modalities, such as can be achieved with virtual platforms like the AVK described here, may prove to be valuable clinical tools for increasing the effectiveness and efficiency of therapy following stroke. Electronic supplementary material The online version of this article (doi:10.1186/1743-0003-11-171) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | - Kristen M Triandafilou
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, 345 E Superior Street, Suite 1406, Chicago, IL 60611, USA.
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Fluet GG, Merians AS, Qiu Q, Saleh S, Ruano V, Delmonico AR, Adamovich SV. Robotic/virtual reality intervention program individualized to meet the specific sensorimotor impairments of an individual patient: a case study. INTERNATIONAL JOURNAL ON DISABILITY AND HUMAN DEVELOPMENT : IJDHD 2014; 13:401-407. [PMID: 29057196 PMCID: PMC5648338 DOI: 10.1515/ijdhd-2014-0334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A majority of studies examining repetitive task practice facilitated by robots for the treatment of upper extremity paresis utilize standardized protocols applied to large groups. This study will describe a virtually simulated, robot-based intervention customized to match the goals and clinical presentation of a gentleman with upper extremity hemiparesis secondary to stroke. MP, the subject of this case, is an 85-year-old man with left hemiparesis secondary to an intracerebral hemorrhage 5 years prior to examination. Outcomes were measured before and after a 1-month period of home therapy and after a 1-month virtually simulated, robotic intervention. The intervention was designed to address specific impairments identified during his PT examination. When necessary, activities were modified based on MP's response to his first week of treatment. MP's home training program produced a 3-s decline in Wolf Motor Function Test (WMFT) time and a 5-s improvement in Jebsen Test of Hand Function (JTHF) time. He demonstrated an additional 35-s improvement in JTHF and an additional 44-s improvement in WMFT subsequent to the robotic training intervention. A 24-h activity measurement and the Hand and Activities of Daily Living scales of the Stroke Impact Scale improved following the robotic intervention. Based on his responses to training we feel that we have established that a customized program of virtually simulated, robotically facilitated rehabilitation was feasible and resulted in larger improvements than an intensive home training program in several measurements of upper extremity function in our patient with chronic hemiparesis.
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Affiliation(s)
- Gerard G. Fluet
- Assistant Professor, Department of Rehabilitation and Movement Sciences, University of Medicine and Dentistry of New Jersey, 65 Bergen Street, Newark, NJ 07101, USA
| | - Alma S. Merians
- Department of Rehabilitation and Movement Sciences, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
| | - Qinyin Qiu
- New Jersey Institute of Technology, Department of Biomedical Engineering, Newark, NJ, USA
| | - Soha Saleh
- New Jersey Institute of Technology, Department of Biomedical Engineering, Newark, NJ, USA
| | - Viviana Ruano
- Department of Rehabilitation and Movement Sciences, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
| | - Andrea R. Delmonico
- Department of Rehabilitation and Movement Sciences, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
| | - Sergei V. Adamovich
- New Jersey Institute of Technology, Department of Biomedical Engineering, Newark, NJ, USA
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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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Fluet GG, Merians AS, Qiu Q, Davidow A, Adamovich SV. Comparing integrated training of the hand and arm with isolated training of the same effectors in persons with stroke using haptically rendered virtual environments, a randomized clinical trial. J Neuroeng Rehabil 2014; 11:126. [PMID: 25148846 PMCID: PMC4156644 DOI: 10.1186/1743-0003-11-126] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/12/2014] [Indexed: 11/10/2022] Open
Abstract
Background Robotically facilitated therapeutic activities, performed in virtual environments have emerged as one approach to upper extremity rehabilitation after stroke. Body function level improvements have been demonstrated for robotically facilitated training of the arm. A smaller group of studies have demonstrated modest activity level improvements by training the hand or by integrated training of the hand and arm. The purpose of this study was to compare a training program of complex hand and finger tasks without arm movement paired with a separate set of reaching activities performed without hand movement, to training the entire upper extremity simultaneously, utilizing integrated activities. Methods Forty individuals with chronic stroke recruited in the community, participated in a randomized, blinded, controlled trial of two interventions. Subjects were required to have residual hand function for inclusion. The first, hand and arm separate (HAS) training (n = 21), included activities controlled by finger movement only, and activities controlled by arm movement only, the second, hand and arm together (HAT) training (n = 20) used simulations controlled by a simultaneous use of arm and fingers. Results No adverse reactions occurred. The entire sample demonstrated mean improvements in Wolf Motor Function Test scores (21%) and Jebsen Test of Hand Function scores (15%), with large effect sizes (partial r2 = .81 and r2 = .67, respectively). There were no differences in improvement between HAS and HAT training immediately after the study. Subjects in the HAT group retained Wolf Motor Function Test gains better than in the HAS group measured three months after the therapy but the size of this interaction effect was small (partial r2 = .17). Conclusions Short term changes in upper extremity motor function were comparable when training the upper extremity with integrated activities or a balanced program of isolated activities. Further study of the retention period is indicated. Trial registration NCT01072461. Electronic supplementary material The online version of this article (doi:10.1186/1743-0003-11-126) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gerard G Fluet
- Department of Rehabilitation and Movement Science, Rutgers The State University of New Jersey, Room 714C, 65 Bergen Street, Newark, NJ 07101, USA.
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Basteris A, Nijenhuis SM, Stienen AHA, Buurke JH, Prange GB, Amirabdollahian F. Training modalities in robot-mediated upper limb rehabilitation in stroke: a framework for classification based on a systematic review. J Neuroeng Rehabil 2014; 11:111. [PMID: 25012864 PMCID: PMC4108977 DOI: 10.1186/1743-0003-11-111] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 06/23/2014] [Indexed: 01/19/2023] Open
Abstract
Robot-mediated post-stroke therapy for the upper-extremity dates back to the 1990s. Since then, a number of robotic devices have become commercially available. There is clear evidence that robotic interventions improve upper limb motor scores and strength, but these improvements are often not transferred to performance of activities of daily living. We wish to better understand why. Our systematic review of 74 papers focuses on the targeted stage of recovery, the part of the limb trained, the different modalities used, and the effectiveness of each. The review shows that most of the studies so far focus on training of the proximal arm for chronic stroke patients. About the training modalities, studies typically refer to active, active-assisted and passive interaction. Robot-therapy in active assisted mode was associated with consistent improvements in arm function. More specifically, the use of HRI features stressing active contribution by the patient, such as EMG-modulated forces or a pushing force in combination with spring-damper guidance, may be beneficial.Our work also highlights that current literature frequently lacks information regarding the mechanism about the physical human-robot interaction (HRI). It is often unclear how the different modalities are implemented by different research groups (using different robots and platforms). In order to have a better and more reliable evidence of usefulness for these technologies, it is recommended that the HRI is better described and documented so that work of various teams can be considered in the same group and categories, allowing to infer for more suitable approaches. We propose a framework for categorisation of HRI modalities and features that will allow comparing their therapeutic benefits.
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Affiliation(s)
- Angelo Basteris
- Adaptive Systems Research Group, School of Computer Science, University of Hertfordshire, College Lane, AL95HX Hatfield, United Kingdom.
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Bleyenheuft Y, Gordon AM. Precision grip in congenital and acquired hemiparesis: similarities in impairments and implications for neurorehabilitation. Front Hum Neurosci 2014; 8:459. [PMID: 25071502 PMCID: PMC4074995 DOI: 10.3389/fnhum.2014.00459] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/05/2014] [Indexed: 12/02/2022] Open
Abstract
Background: Patients with congenital and acquired hemiparesis incur long-term functional deficits, among which the loss of prehension that may impact their functional independence. Identifying, understanding, and comparing the underlying mechanisms of prehension impairments represent an opportunity to better adapt neurorehabilitation. Objective: The present review aims to provide a better understanding of precision grip deficits in congenital and acquired hemiparesis and to determine whether the severity and type of fine motor control impairments depend on whether or not the lesions are congenital or acquired in adulthood. Methods: Using combinations of the following key words: fingertip force, grip force, precision grip, cerebral palsy, stroke, PubMed, and Scopus databases were used to search studies from 1984 to 2013. Results: Individuals with both congenital and acquired hemiparesis were able to some extent to use anticipatory motor control in precision grip tasks, even if this control was impaired in the paretic hand. In both congenital and acquired hemiparesis, the ability to plan efficient anticipatory motor control when the less-affected hand is used provides a possibility to remediate impairments in anticipatory motor control of the paretic hand. Conclusion: Surprisingly, we observed very few differences between the results of studies in children with congenital hemiplegia and stroke patients. We suggest that the underlying specific strategies of neurorehabilitation developed for each one could benefit the other.
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Affiliation(s)
- Yannick Bleyenheuft
- Institute of Neuroscience, Université Catholique de Louvain , Brussels , Belgium
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University , New York, NY , USA
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Ku J, Im H, Kang YJ. Upper Extremity Rehabilitation using Virtual Reality after Stroke. BRAIN & NEUROREHABILITATION 2014. [DOI: 10.12786/bn.2014.7.1.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jeonghun Ku
- Department of Biomedical Engineering, Keimyung University, Korea
| | - Hyungjun Im
- Department of Rehabilitation Medicine, Eulji Hospital, Eulji University School of Medicine, Korea
| | - Youn Joo Kang
- Department of Rehabilitation Medicine, Eulji Hospital, Eulji University School of Medicine, Korea
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Ortiz-Catalan M, Nijenhuis S, Ambrosch K, Bovend’Eerdt T, Koenig S, Lange B. Virtual Reality. BIOSYSTEMS & BIOROBOTICS 2014. [DOI: 10.1007/978-3-642-38556-8_13] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Steinisch M, Tana MG, Comani S. A Post-Stroke Rehabilitation System Integrating Robotics, VR and High-Resolution EEG Imaging. IEEE Trans Neural Syst Rehabil Eng 2013; 21:849-59. [DOI: 10.1109/tnsre.2013.2267851] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rohafza M, Fluet GG, Qiu Q, Adamovich S. Correlations between statistical models of robotically collected kinematics and clinical measures of upper extremity function. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:4120-3. [PMID: 23366834 DOI: 10.1109/embc.2012.6346873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
One of the obstacles in the development of rehabilitation robotics has been inadequacy in the measurement of treatment effects due to interventions. A measurement tool that will efficiently produce a large reliable sample of measurements collected during a single session that can also produce a rich set of data which reflects a subject's ability to perform meaningful functional activities has not been developed. This paper presents three linear regression models generated from seven kinematic measures collected during the performance of virtually simulated rehabilitation activities that were integrated with haptic robots by 19 persons with upper extremity hemiparesis due to chronic stroke. One of these models demonstrated a statistically significant correlation with the subjects' scores on the Jebsen Test of Hand Function (JTHF), a battery of six standardized upper extremity functional activities. The second and third models demonstrated a statistically significant correlation with the subjects' change scores on the JTHF.
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Affiliation(s)
- Maryam Rohafza
- New Jersey Institute of Technology, Newark, NJ 07102, USA.
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Tunik E, Saleh S, Adamovich SV. Visuomotor discordance during visually-guided hand movement in virtual reality modulates sensorimotor cortical activity in healthy and hemiparetic subjects. IEEE Trans Neural Syst Rehabil Eng 2013; 21:198-207. [PMID: 23314780 DOI: 10.1109/tnsre.2013.2238250] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We investigated neural effects of visuomotor discordances during visually-guided finger movements. A functional magnetic resonance imaging (fMRI)-compatible data glove was used to actuate (in real-time) virtual hand models shown on a display in first person perspective. In Experiment 1, we manipulated virtual hand motion to simulate either hypometric or unintentional (actuation of a mismatched finger) feedback of sequential finger flexion in healthy subjects. Analysis of finger motion revealed no significant differences in movement behavior across conditions, suggesting that between-condition differences in brain activity could only be attributed to varying modes of visual feedback rather than motor output. Hypometric feedback and mismatched finger feedback (relative to veridical) were associated with distinct activation. Hypometric feedback was associated with activation in the contralateral motor cortex. Mismatched feedback was associated with activation in bilateral ventral premotor, left dorsal premotor, and left occipitotemporal cortex. The time it took the subject to evaluate visuomotor discordance was positively correlated with activation in bilateral supplementary motor area, bilateral insula, right postcentral gyrus, bilateral dorsal premotor areas, and bilateral posterior parietal lobe. In Experiment 2, we investigated the effects of hypo- and hypermetric visual feedback in three stroke subjects. We observed increased activation of ipsilesional motor cortex in both hypometric and hypermetric feedback conditions. Our data indicate that manipulation of visual feedback of one's own hand movement may be used to facilitate activity in select brain networks. We suggest that these effects can be exploited in neurorehabilition to enhance the processes of brain reorganization after injury and, specifically, might be useful in aiding recovery of hand function in patients during virtual reality-based training.
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Affiliation(s)
- Eugene Tunik
- Department of Rehabilitation and Movement Sciences, University of Medicine and Dentistry of New Jersey, Newark, NJ 07107, USA.
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Robots integrated with virtual reality simulations for customized motor training in a person with upper extremity hemiparesis: a case study. J Neurol Phys Ther 2012; 36:79-86. [PMID: 22592063 DOI: 10.1097/npt.0b013e3182566f3f] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE A majority of studies examining repetitive task practice facilitated by robots for the treatment of upper extremity paresis utilize standardized protocols applied to large groups. Others utilize interventions tailored to patients but do not describe the clinical decision-making process utilized to develop and modify interventions. This case study describes a robot-based intervention customized to match the goals and clinical presentation of person with upper extremity hemiparesis secondary to stroke. METHODS The patient, P.M., was an 85-year-old man with left hemiparesis secondary to an intracerebral hemorrhage 5 years prior to examination. Outcomes were measured before and after a 1-month period of home therapy and after a 1-month robotic intervention. The intervention was designed to address specific impairments identified during his physical therapy examination. When necessary, activities were modified on the basis of response to the first week of treatment. OUTCOMES P.M. trained in 12 sessions, using six virtually simulated activities. Modifications to original configurations of these activities resulted in performance improvements in five of these activities. P.M. demonstrated a 35-second improvement in Jebsen Test of Hand Function time and a 44-second improvement in Wolf Motor Function Test time subsequent to the robotic training intervention. Reaching kinematics, 24-hour activity measurement, and scores on the Hand and Activities of Daily Living scales of the Stroke Impact Scale all improved as well. DISCUSSION A customized program of robotically facilitated rehabilitation was associated with short-term improvements in several measurements of upper extremity function in a patient with chronic hemiparesis.
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Bagce HF, Saleh S, Adamovich SV, Tunik E. Visuomotor gain distortion alters online motor performance and enhances primary motor cortex excitability in patients with stroke. Neuromodulation 2012; 15:361-6. [PMID: 22672345 DOI: 10.1111/j.1525-1403.2012.00467.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Determine if ipsilesional primary motor cortex (M1) in stroke patients processes online visuomotor discordance in gain between finger movement and observed feedback in virtual reality (VR). MATERIALS AND METHODS Chronic stroke patients flexed (N= 7) or extended (N= 1) their finger with real-time feedback of a virtual hand presented in VR. Virtual finger excursion was scaled by applying a low-gain (G(0.25) ), high-gain (G(1.75) ), or veridical (G(1.00) ) scaling factor to real-time data streaming from a sensor glove. Effects of visuomotor discordance were assessed through analysis of movement kinematics (joint excursion, movement smoothness, and angular velocity) and amplitude of motor evoked potentials (MEPs) elicited with transcranial magnetic stimulation applied to ipsilesional M1. Data were analyzed with a repeated-measures analysis of variance (significance set at 0.05). RESULTS G(0.25) discordance (relative to veridical) leads to significantly larger joint excursion, online visuomotor correction evidenced by decreased trajectory smoothness, and significantly facilitated agonist MEPs. This effect could not be explained by potential differences in motor drive (background electromyographic) or by possible differences related to joint angle or angular velocity, as these variables remained invariant across conditions at the time of MEP assessment. M1 was not significantly facilitated in the G(1.75) condition. MEPs recorded in an adjacent muscle that was not involved in the task were unaffected by visual feedback in either discordance condition. These data suggest that the neuromodulatory effects of visuomotor discordance on M1 were relatively selective. CONCLUSIONS Visuomotor discordance may be used to alter movement performance and augment M1 excitability in patients following stroke. Our data illustrate that visual feedback may be a robust way to selectively modulate M1 activity. These data may have important clinical implications for the development of future VR training protocols.
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Affiliation(s)
- Hamid F Bagce
- Department of Rehabilitation and Movement Science, UMDNJ, Newark, NJ 07101, USA
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van Wijck F, Knox D, Dodds C, Cassidy G, Alexander G, MacDonald R. Making music after stroke: using musical activities to enhance arm function. Ann N Y Acad Sci 2012; 1252:305-11. [DOI: 10.1111/j.1749-6632.2011.06403.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Puthenveettil S, Fluet G, Qiu Q, Adamovich S. Classification of hand preshaping in persons with stroke using Linear Discriminant Analysis. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2012:4563-4566. [PMID: 23366943 PMCID: PMC4554721 DOI: 10.1109/embc.2012.6346982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE This study describes the analysis of hand preshaping using Linear Discriminant Analysis (LDA) to predict hand formation during reaching and grasping tasks of the hemiparetic hand, following a series of upper extremity motor intervention treatments. The purpose of this study is to use classification of hand posture as an additional tool for evaluating the effectiveness of therapies for upper extremity rehabilitation such as virtual reality (VR) therapy and conventional physical therapy. Classification error for discriminating between two objects during hand preshaping is obtained for the hemiparetic and unimpaired hands pre and post training. METHODS Eight subjects post stroke participated in a two-week training session consisting of upper extremity motor training. Four subjects trained with interactive VR computer games and four subjects trained with clinical physical therapy procedures of similar intensity. Subjects' finger joint angles were measured during a kinematic reach to grasp test using CyberGlove® and arm joint angles were measured using the trackSTAR™ system prior to training and after training. RESULTS The unimpaired hand of subjects preshape into the target object with greater accuracy than the hemiparetic hand as indicated by lower classification errors. Hemiparetic hand improved in preshaping accuracy and time to reach minimum error. CONCLUSION Classification of hand preshaping may provide insight into improvements in motor performance elicited by robotically facilitated virtually simulated training sessions or conventional physical therapy.
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Affiliation(s)
| | - Gerard Fluet
- University of Medicine and Dentistry of New Jersey, Newark, NJ 07107 USA ()
| | - Qinyin Qiu
- New Jersey Institute of Technology, Newark, NJ 07102 USA ()
| | - Sergei Adamovich
- New Jersey Institute of Technology, Newark, NJ 07102 USA (corresponding author phone: 973-596-3413, fax: 973-596-5222; )
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Rabin BA, Burdea GC, Roll DT, Hundal JS, Damiani F, Pollack S. Integrative rehabilitation of elderly stroke survivors: the design and evaluation of the BrightArm™. Disabil Rehabil Assist Technol 2011; 7:323-35. [PMID: 22107353 DOI: 10.3109/17483107.2011.629329] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe the development of the BrightArm upper extremity rehabilitation system, and to determine its clinical feasibility with older hemiplegic patients. METHOD The BrightArm adjusted arm gravity loading through table tilting. Patients wore an arm support that sensed grasp strength and communicated wirelessly with a personal computer. Games were written to improve cognitive, psychosocial and the upper extremity motor function and adapted automatically to each patient. The system underwent feasibility trials spanning 6 weeks. Participants were evaluated pre-therapy, post-therapy, and at 6 weeks follow-up using standardized clinical measures. Computerized measures of supported arm reach and game performance were stored on a remote server. RESULTS Five participants had clinically significant improvements in their active range of shoulder movement, shoulder strength, grasp strength, and their ability to focus. Several participants demonstrated substantially higher arm function (measured with the Fugl-Meyer test) and two were less-depressed (measured with the Becks Depression Inventory, Second Edition). The BrightArm technology was well-accepted by the participants, who gave it an overall subjective rating of 4.1 on a 5 point Likert scale. CONCLUSIONS Given these preliminary findings, it will be beneficial to evaluate the BrightArm through controlled clinical trials and to investigate its application to other clinical populations.
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Affiliation(s)
- Bryan A Rabin
- Bright Cloud International Corp, Highland Park, NJ 08904-2035, USA
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