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Maggio MG, Bonanno M, Manuli A, Calabrò RS. Improving Outcomes in People with Spinal Cord Injury: Encouraging Results from a Multidisciplinary Advanced Rehabilitation Pathway. Brain Sci 2024; 14:140. [PMID: 38391715 PMCID: PMC10886543 DOI: 10.3390/brainsci14020140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
Spinal cord injury (SCI) consists of damage to any segment of the spinal cord extending to potential harm to nerves in the cauda equina. Rehabilitative efforts for SCI can involve conventional physiotherapy, innovative technologies, as well as cognitive treatment and psychological support. The aim of this study is to evaluate the feasibility of a dedicated, multidisciplinary, and integrated intervention path for SCI, encompassing both conventional and technological interventions, while observing their impact on cognitive, motor, and behavioral outcomes and the overall quality of life for individuals with SCI. Forty-two patients with SCI were included in the analysis utilizing electronic recovery system data. The treatment regimen included multidisciplinary rehabilitation approaches, such as traditional physiotherapy sessions, speech therapy, psychological support, robotic devices, advanced cognitive rehabilitation, and other interventions. Pre-post comparisons showed a significant improvement in lower limb function (Fugl Meyer Assessment-FMA < 0.001), global cognitive functioning (Montreal Cognitive Assessment-MoCA p < 0.001), and perceived quality of life at both a physical and mental level (Short Form-12-SF-12 p < 0.001). Furthermore, we found a significant reduction in depressive state (Beck Depression Inventory-BDI p < 0.001). In addition, we assessed patient satisfaction using the Short Form of the Patient Satisfaction Questionnaire (PSQ), offering insights into the subjective evaluation of the intervention. In conclusion, this retrospective study provides positive results in terms of improvements in motor function, cognitive functions, and quality of life, highlighting the importance of exploring multidisciplinary approaches.
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Affiliation(s)
- Maria Grazia Maggio
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98123 Messina, Italy
| | - Mirjam Bonanno
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98123 Messina, Italy
| | - Alfredo Manuli
- A.O.U. Policlinico "G. Martino", Via Consolare Valeria, 98124 Messina, Italy
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de Crignis AC, Ruhnau ST, Hösl M, Lefint J, Amberger T, Dressnandt J, Brunner H, Müller F. Robotic arm training in neurorehabilitation enhanced by augmented reality - a usability and feasibility study. J Neuroeng Rehabil 2023; 20:105. [PMID: 37568195 PMCID: PMC10422755 DOI: 10.1186/s12984-023-01225-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Robotic therapy and serious gaming support motor learning in neurorehabilitation. Traditional monitor-based gaming outputs cannot adequately represent the third dimension, whereas virtual reality headsets lack the connection to the real world. The use of Augmented Reality (AR) techniques could potentially overcome these issues. The objective of this study was thus to evaluate the usability, feasibility and functionality of a novel arm rehabilitation device for neurorehabilitation (RobExReha system) based on a robotic arm (LBR iiwa, KUKA AG) and serious gaming using the AR headset HoloLens (Microsoft Inc.). METHODS The RobExReha system was tested with eleven adult inpatients (mean age: 64.4 ± 11.2 years; diagnoses: 8 stroke, 2 spinal cord injury, 1 Guillain-Barré-Syndrome) who had paretic impairments in their upper limb. Five therapists administered and evaluated the system. Data was compared with a Reference Group (eleven inpatients; mean age: 64.3 ± 9.1 years; diagnoses: 10 stroke, 1 spinal cord injury) who trained with commercially available robotic therapy devices (ArmeoPower or ArmeoSpring, Hocoma AG). Patients used standardized questionnaires for evaluating usability and comfort (Quebec User Evaluation of Satisfaction with assistive technology [QUEST]), workload (Raw Task Load Index [RTLX]) and a questionnaire for rating visual perception of the gaming scenario. Therapists used the QUEST, the System Usability Scale and the short version of the User Experience Questionnaire. RESULTS Therapy with the RobExReha system was safe and feasible for patients and therapists, with no serious adverse events being reported. Patients and therapists were generally satisfied with usability. The patients' usability ratings were significantly higher in the Reference Group for two items of the QUEST: reliability and ease of use. Workload (RTLX) ratings did not differ significantly between the groups. Nearly all patients using the RobExReha system perceived the gaming scenario in AR as functioning adequately despite eight patients having impairments in stereoscopic vision. The therapists valued the system's approach as interesting and inventive. CONCLUSIONS We demonstrated the clinical feasibility of combining a novel robotic upper limb robot with an AR-serious game in a neurorehabilitation setting. To ensure high usability in future applications, a reliable and easy-to-use system that can be used for task-oriented training should be implemented. TRIAL REGISTRATION Ethical approval was obtained and the trial was registered at the German Clinical Trials Register (DRKS00022136).
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Affiliation(s)
| | | | - Matthias Hösl
- Schön Klinik Bad Aibling, Bad Aibling, Germany
- Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Jérémy Lefint
- Fraunhofer Institute for Manufacturing, Engineering and Automation IPA, Stuttgart, Germany
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Maldonado-Mejía JC, Múnera M, Diaz CAR, Wurdemann H, Moazen M, Pontes MJ, Vieira Segatto ME, Monteiro ME, Cifuentes CA. A fabric-based soft hand exoskeleton for assistance: the ExHand Exoskeleton. Front Neurorobot 2023; 17:1091827. [PMID: 37396029 PMCID: PMC10308009 DOI: 10.3389/fnbot.2023.1091827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction The rise of soft robotics has driven the development of devices for assistance in activities of daily living (ADL). Likewise, different types of actuation have been developed for safer human interaction. Recently, textile-based pneumatic actuation has been introduced in hand exoskeletons for features such as biocompatibility, flexibility, and durability. These devices have demonstrated their potential use in assisting ADLs, such as the degrees of freedom assisted, the force exerted, or the inclusion of sensors. However, performing ADLs requires the use of different objects, so exoskeletons must provide the ability to grasp and maintain stable contact with a variety of objects to lead to the successful development of ADLs. Although textile-based exoskeletons have demonstrated significant advancements, the ability of these devices to maintain stable contact with a variety of objects commonly used in ADLs has yet to be fully evaluated. Materials and methods This paper presents the development and experimental validation in healthy users of a fabric-based soft hand exoskeleton through a grasping performance test using The Anthropomorphic Hand Assessment Protocol (AHAP), which assesses eight types of grasping with 24 objects of different shapes, sizes, textures, weights, and rigidities, and two standardized tests used in the rehabilitation processes of post- stroke patients. Results and discussion A total of 10 healthy users (45.50 ± 14.93 years old) participated in this study. The results indicate that the device can assist in developing ADLs by evaluating the eight types of grasps of the AHAP. A score of 95.76 ± 2.90% out of 100% was obtained for the Maintaining Score, indicating that the ExHand Exoskeleton can maintain stable contact with various daily living objects. In addition, the results of the user satisfaction questionnaire indicated a positive mean score of 4.27 ± 0.34 on a Likert scale ranging from 1 to 5.
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Affiliation(s)
- Juan C. Maldonado-Mejía
- Telecommunications Laboratory (LabTel), Electrical Engineering Department, Federal University of Espírito Santo (UFES), Vitória, Brazil
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá, Colombia
| | - Marcela Múnera
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá, Colombia
- Bristol Robotics Laboratory, University of the West of England, Bristol, United Kingdom
| | - Camilo A. R. Diaz
- Telecommunications Laboratory (LabTel), Electrical Engineering Department, Federal University of Espírito Santo (UFES), Vitória, Brazil
| | - Helge Wurdemann
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Mehran Moazen
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Maria José Pontes
- Telecommunications Laboratory (LabTel), Electrical Engineering Department, Federal University of Espírito Santo (UFES), Vitória, Brazil
| | - Marcelo Eduardo Vieira Segatto
- Telecommunications Laboratory (LabTel), Electrical Engineering Department, Federal University of Espírito Santo (UFES), Vitória, Brazil
| | | | - Carlos A. Cifuentes
- Bristol Robotics Laboratory, University of the West of England, Bristol, United Kingdom
- School of Engineering, Science and Technology, Universidad del Rosario, Bogotá, Colombia
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Wang L, Chen JL, Wong AM, Liang KC, Tseng KC. Game-Based Virtual Reality System for Upper Limb Rehabilitation After Stroke in a Clinical Environment: Systematic Review and Meta-Analysis. Games Health J 2022; 11:277-297. [DOI: 10.1089/g4h.2022.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Le Wang
- Department of Design, National Taiwan Normal University, Taipei, Taiwan
- Product Design and Development Laboratory, Taoyuan, Taiwan
| | - Jean-Lon Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan
| | - Alice M.K. Wong
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan
| | - Kuei-Chia Liang
- Department of Design, National Taiwan Normal University, Taipei, Taiwan
| | - Kevin C. Tseng
- Product Design and Development Laboratory, Taoyuan, Taiwan
- Department of Industrial Design, National Taipei University of Technology, Taipei, Taiwan
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Gualtieri L, Fraboni F, De Marchi M, Rauch E. Development and evaluation of design guidelines for cognitive ergonomics in human-robot collaborative assembly systems. APPLIED ERGONOMICS 2022; 104:103807. [PMID: 35763990 DOI: 10.1016/j.apergo.2022.103807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/15/2021] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
Industry 4.0 is the concept used to summarize the ongoing fourth industrial revolution, which is profoundly changing the manufacturing systems and business models all over the world. Collaborative robotics is one of the most promising technologies of Industry 4.0. Human-robot interaction and human-robot collaboration will be crucial for enhancing the operator's work conditions and production performance. In this regard, this enabling technology opens new possibilities but also new challenges. There is no doubt that safety is of primary importance when humans and robots interact in industrial settings. Nevertheless, human factors and cognitive ergonomics (i.e. cognitive workload, usability, trust, acceptance, stress, frustration, perceived enjoyment) are crucial, even if they are often underestimated or ignored. Therefore, this work refers to cognitive ergonomics in the design of human-robot collaborative assembly systems. A set of design guidelines has been developed according to the analysis of the scientific literature. Their effectiveness has been evaluated through multiple experiments based on a laboratory case study where different participants interacted with a low-payload collaborative robotic system for the joint assembly of a manufacturing product. The main assumption to be tested is that it is possible to improve the operator's experience and efficiency by manipulating the system features and interaction patterns according to the proposed design guidelines. Results confirmed that participants improved their cognitive response to human-robot interaction as well as the assembly performance with the enhancement of workstation features and interaction conditions by implementing an increasing number of guidelines.
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Affiliation(s)
- Luca Gualtieri
- Industrial Engineering and Automation (IEA), Faculty of Science and Technology, Free University of Bozen-Bolzano, Piazza Università 5, 39100, Bolzano, Italy.
| | - Federico Fraboni
- Department of Psychology, Università di Bologna, Via Zamboni 33, 40126, Bologna, Italy
| | - Matteo De Marchi
- Industrial Engineering and Automation (IEA), Faculty of Science and Technology, Free University of Bozen-Bolzano, Piazza Università 5, 39100, Bolzano, Italy
| | - Erwin Rauch
- Industrial Engineering and Automation (IEA), Faculty of Science and Technology, Free University of Bozen-Bolzano, Piazza Università 5, 39100, Bolzano, Italy.
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Alguacil-Diego IM, Cuesta-Gómez A, Contreras-González AF, Pont-Esteban D, Cantalejo-Escobar D, Sánchez-Urán MÁ, Ferre M. Validation of a Hybrid Exoskeleton for Upper Limb Rehabilitation. A Preliminary Study. SENSORS (BASEL, SWITZERLAND) 2021; 21:7342. [PMID: 34770647 PMCID: PMC8588535 DOI: 10.3390/s21217342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 12/19/2022]
Abstract
Recovery of therapeutic or functional ambulatory capacity in patients with rotator cuff injury is a primary goal of rehabilitation. Wearable powered exoskeletons allow patients to perform repetitive practice with large movements to maximize recovery, even immediately after the acute event. The aim of this paper is to describe the usability, acceptability and acceptance of a hybrid exoskeleton for upper-limb passive rehabilitation using the System Usability Scale (SUS) questionnaire. This equipment, called ExoFlex, is defined as a hybrid exoskeleton since it is made up of rigid and soft components. The exoskeleton mechanical description is presented along with its control system and the way motion is structured in rehabilitation sessions. Seven patients (six women and one man) have participated in the evaluation of this equipment, which are in the range of 50 to 79 years old. Preliminary evidence of the acceptance and usability by both patients and clinicians are very promising, obtaining an average score of 80.71 in the SUS test, as well as good results in a questionnaire that evaluates the clinicians' perceived usability of ExoFlex.
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Affiliation(s)
- Isabel-María Alguacil-Diego
- Physiotherapy, Occupational Therapy, Physical Medicine and Rehabilitation Department, Universidad Rey Juan Carlos, Campus de Alcorcón, Av. de Atenas, s/n, 28922 Alcorcón, Spain; (I.-M.A.-D.); (A.C.-G.)
| | - Alicia Cuesta-Gómez
- Physiotherapy, Occupational Therapy, Physical Medicine and Rehabilitation Department, Universidad Rey Juan Carlos, Campus de Alcorcón, Av. de Atenas, s/n, 28922 Alcorcón, Spain; (I.-M.A.-D.); (A.C.-G.)
| | - Aldo-Francisco Contreras-González
- Centro de Automática y Robótica (CAR) UPM-CSIC, ETS Ingenieros Industriales, Universidad Politécnica de Madrid, Calle de José Gutiérrez Abascal, 2, 28006 Madrid, Spain; (A.-F.C.-G.); (D.P.-E.); (D.C.-E.); (M.Á.S.-U.)
| | - David Pont-Esteban
- Centro de Automática y Robótica (CAR) UPM-CSIC, ETS Ingenieros Industriales, Universidad Politécnica de Madrid, Calle de José Gutiérrez Abascal, 2, 28006 Madrid, Spain; (A.-F.C.-G.); (D.P.-E.); (D.C.-E.); (M.Á.S.-U.)
| | - David Cantalejo-Escobar
- Centro de Automática y Robótica (CAR) UPM-CSIC, ETS Ingenieros Industriales, Universidad Politécnica de Madrid, Calle de José Gutiérrez Abascal, 2, 28006 Madrid, Spain; (A.-F.C.-G.); (D.P.-E.); (D.C.-E.); (M.Á.S.-U.)
| | - Miguel Ángel Sánchez-Urán
- Centro de Automática y Robótica (CAR) UPM-CSIC, ETS Ingenieros Industriales, Universidad Politécnica de Madrid, Calle de José Gutiérrez Abascal, 2, 28006 Madrid, Spain; (A.-F.C.-G.); (D.P.-E.); (D.C.-E.); (M.Á.S.-U.)
- ETS Ingeniería y Diseño Industrial, Universidad Politécnica de Madrid, Ronda de Valencia, 3, 28012 Madrid, Spain
| | - Manuel Ferre
- Centro de Automática y Robótica (CAR) UPM-CSIC, ETS Ingenieros Industriales, Universidad Politécnica de Madrid, Calle de José Gutiérrez Abascal, 2, 28006 Madrid, Spain; (A.-F.C.-G.); (D.P.-E.); (D.C.-E.); (M.Á.S.-U.)
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Struik GM, Schermers B, Mares I, Lont HE, Bradshaw JW, Ten Haken B, Ruers TJM, Mourik JEM, Birnie E, Klem TMAL. Randomized controlled trial comparing magnetic marker localization (MaMaLoc) with wire-guided localization in the treatment of early-stage breast cancer. Breast J 2021; 27:638-650. [PMID: 34142409 DOI: 10.1111/tbj.14262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022]
Abstract
Wire-guided localization (WGL) is the standard of care in the surgical treatment of nonpalpable breast tumors. In this study, we compare the use of a new magnetic marker localization (MaMaLoc) technique to WGL in the treatment of early-stage breast cancer patients. Open-label, single-center, randomized controlled trial comparing MaMaLoc (intervention) to WGL (control) in women with early-stage breast cancer. Primary outcome was surgical usability measured using the System Usability Scale (SUS, 0-100 score). Secondary outcomes were patient reported, clinical, and pathological outcomes such as retrieval rate, operative time, resected specimen weight, margin status, and reoperation rate. Thirty-two patients were analyzed in the MaMaLoc group and 35 in the WGL group. Patient and tumor characteristics were comparable between groups. No in situ complications occurred. Retrieval rate was 100% in both groups. Surgical usability was higher for MaMaLoc: 70.2 ± 8.9 vs. 58.1 ± 9.1, p < 0.001. Patients reported higher overall satisfaction with MaMaLoc (median score 5/5) versus WGL (score 4/5), p < 0.001. The use of magnetic marker localization (MaMaLoc) for early-stage breast cancer is effective and has higher surgical usability than standard WGL.
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Affiliation(s)
- Gerson M Struik
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Bram Schermers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Ingeborg Mares
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Harold E Lont
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Jennifer W Bradshaw
- Department of Radiology, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Bernard Ten Haken
- Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Theo J M Ruers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Jurgen E M Mourik
- Department of Medical Physics, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Erwin Birnie
- Department of Statistics and Education, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands.,Department of Genetics, University Medical Centre Groningen, University of Groningen, Amsterdam, The Netherlands
| | - Taco M A L Klem
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
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Ranzani R, Eicher L, Viggiano F, Engelbrecht B, Held JPO, Lambercy O, Gassert R. Towards a Platform for Robot-Assisted Minimally-Supervised Therapy of Hand Function: Design and Pilot Usability Evaluation. Front Bioeng Biotechnol 2021; 9:652380. [PMID: 33937218 PMCID: PMC8082072 DOI: 10.3389/fbioe.2021.652380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/15/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Robot-assisted therapy can increase therapy dose after stroke, which is often considered insufficient in clinical practice and after discharge, especially with respect to hand function. Thus far, there has been a focus on rather complex systems that require therapist supervision. To better exploit the potential of robot-assisted therapy, we propose a platform designed for minimal therapist supervision, and present the preliminary evaluation of its immediate usability, one of the main and frequently neglected challenges for real-world application. Such an approach could help increase therapy dose by allowing the training of multiple patients in parallel by a single therapist, as well as independent training in the clinic or at home. METHODS We implemented design changes on a hand rehabilitation robot, considering aspects relevant to enabling minimally-supervised therapy, such as new physical/graphical user interfaces and two functional therapy exercises to train hand motor coordination, somatosensation and memory. Ten participants with chronic stroke assessed the usability of the platform and reported the perceived workload during a single therapy session with minimal supervision. The ability to independently use the platform was evaluated with a checklist. RESULTS Participants were able to independently perform the therapy session after a short familiarization period, requiring assistance in only 13.46 (7.69-19.23)% of the tasks. They assigned good-to-excellent scores on the System Usability Scale to the user-interface and the exercises [85.00 (75.63-86.88) and 73.75 (63.13-83.75) out of 100, respectively]. Nine participants stated that they would use the platform frequently. Perceived workloads lay within desired workload bands. Object grasping with simultaneous control of forearm pronosupination and stiffness discrimination were identified as the most difficult tasks. DISCUSSION Our findings demonstrate that a robot-assisted therapy device can be rendered safely and intuitively usable upon first exposure with minimal supervision through compliance with usability and perceived workload requirements. The preliminary usability evaluation identified usability challenges that should be solved to allow real-world minimally-supervised use. Such a platform could complement conventional therapy, allowing to provide increased dose with the available resources, and establish a continuum of care that progressively increases therapy lead of the patient from the clinic to the home.
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Affiliation(s)
- Raffaele Ranzani
- Rehabilitation Engineering Laboratory, D-HEST, ETH Zürich, Zurich, Switzerland
| | - Lucas Eicher
- Rehabilitation Engineering Laboratory, D-HEST, ETH Zürich, Zurich, Switzerland
| | - Federica Viggiano
- Rehabilitation Engineering Laboratory, D-HEST, ETH Zürich, Zurich, Switzerland
| | | | - Jeremia P. O. Held
- Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, D-HEST, ETH Zürich, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, D-HEST, ETH Zürich, Zurich, Switzerland
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ZHANG LEIGANG, GUO SHUAI, SUN QING. DEVELOPMENT AND ANALYSIS OF A BILATERAL END-EFFECTER UPPER LIMB REHABILITATION ROBOT. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421500329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Studies have shown that rehabilitation training with the unaffected side guiding affected side is more consistent with the natural movement pattern of human upper limb compared with unilateral rehabilitation training, which is conducive to improve rehabilitation effect of the affected limb motor function. In this paper, a bilateral end-effector upper limb rehabilitation robot (BEULRR) based on two modern commercial manipulators is developed first, then the kinematics, reachability, and dexterity analysis of BEULRR are performed, respectively. Finally, a bilateral symmetric training protocol with the unaffected side guiding the affected side is proposed and evaluated through healthy human subject experiment testing based on BEULRR. The simulation results show that the developed BEULRR could perform spatial rehabilitation training and its rehabilitation training workspace can fully cover the physiological workspace of human upper limb. The preliminary experiment results from the healthy human subject show that the BEULRR system could provide reliable bilateral symmetric training protocol. These simulation and experiment results demonstrated that the developed BEULRR system could be used in bilateral rehabilitation training application, and also show that the BEULRR system has the potential to be applied to clinical rehabilitation training in the further step. In the close future, the proposed BEULRR and bilateral symmetric training protocol are planned to be applied in elderly volunteers and patients with upper limb motor dysfunction for further evaluating.
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Affiliation(s)
- LEIGANG ZHANG
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, P. R. China
| | - SHUAI GUO
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, P. R. China
| | - QING SUN
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, P. R. China
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Burdea G, Kim N, Polistico K, Kadaru A, Roll D, Grampurohit N. Novel integrative rehabilitation system for the upper extremity: Design and usability evaluation. J Rehabil Assist Technol Eng 2021; 8:20556683211012885. [PMID: 34422282 PMCID: PMC8373277 DOI: 10.1177/20556683211012885] [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: 03/14/2020] [Accepted: 04/08/2021] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Design and test the usability of a novel virtual rehabilitation system for bimanual training of gravity supported arms, pronation/supination, grasp strengthening, and finger extension. METHODS A robotic rehabilitation table, therapeutic game controllers, and adaptive rehabilitation games were developed. The rehabilitation table lifted/lowered and tilted up/down to modulate gravity loading. Arms movement was measured simultaneously, allowing bilateral training. Therapeutic games adapted through a baseline process. Four healthy adults performed four usability evaluation sessions each, and provided feedback using the USE questionnaire and custom questions. Participant's game play performance was sampled and analyzed, and system modifications made between sessions. RESULTS Participants played four sessions of about 50 minutes each, with training difficulty gradually increasing. Participants averaged a total of 6,300 arm repetitions, 2,200 grasp counts, and 2,100 finger extensions when adding counts for each upper extremity. USE questionnaire data averaged 5.1/7 rating, indicative of usefulness, ease of use, ease of learning, and satisfaction with the system. Subjective feedback on the custom evaluation form was 84% favorable. CONCLUSIONS The novel system was well-accepted, induced high repetition counts, and the usability study helped optimize it and achieve satisfaction. Future studies include examining effectiveness of the novel system when training patients acute post-stroke.
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Affiliation(s)
- Grigore Burdea
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
- Department of Electrical and Computer Engineering, Rutgers – The
State University of New Jersey, Piscataway, NJ, USA
| | - Nam Kim
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
| | - Kevin Polistico
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
| | - Ashwin Kadaru
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
| | - Doru Roll
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
| | - Namrata Grampurohit
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
- Department of Occupational Therapy, Jefferson University,
Philadelphia, PA, USA
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11
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Morse H, Biggart L, Pomeroy V, Rossit S. Exploring perspectives from stroke survivors, carers and clinicians on virtual reality as a precursor to using telerehabilitation for spatial neglect post-stroke. Neuropsychol Rehabil 2020; 32:707-731. [PMID: 32942950 DOI: 10.1080/09602011.2020.1819827] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Spatial neglect is a common and severe cognitive consequence of stroke, yet there is currently no effective rehabilitation tool. Virtual Reality (VR) telerehabilitation tools have the potential to provide multisensory and enjoyable therapies and remotely monitor adherence without the presence of a therapist at all times. Researchers and industry need to better understand end-user perspectives about these technologies to ensure these are acceptable and, ultimately, optimize adherence and efficacy. This study aims to explore end-user perspectives on the use of self-administered VR for spatial neglect in a university environment to identify barriers and facilitators prior to extending its use remotely as a telerehabilitation tool. We used a mixed-method design including focus groups, self-administered questionnaires and interviews with stroke survivors (N = 7), their carers (N = 3) and stroke clinicians (N = 6). End-user perspectives identified clarity of instructions, equipment (cost, available resources) and for some, level of experience with technology as barriers of use. Perceived facilitators were performance feedback, engagement and enjoyment, and psychological benefits associated with self-administered VR telerehabilitation. Overall, end-users were positive and interested in using VR telerehabilitation for spatial neglect. These perspectives enabled us to produce practical recommendations to inform development, enhance engagement and uptake of VR telerehabilitation and inform future studies.
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Affiliation(s)
- Helen Morse
- School of Psychology, University of East Anglia, Norwich, UK.,Acquired Brain Injury Rehabilitaion Alliance, University of East Anglia, Norwich, UK
| | - Laura Biggart
- School of Psychology, University of East Anglia, Norwich, UK
| | - Valerie Pomeroy
- Acquired Brain Injury Rehabilitaion Alliance, University of East Anglia, Norwich, UK.,School of Health Sciences, University of East Anglia, Norwich, UK.,National Institute for Health Research (NIHR) Brain Injury MedTech Co-operative, Cambridge, UK
| | - Stéphanie Rossit
- School of Psychology, University of East Anglia, Norwich, UK.,Acquired Brain Injury Rehabilitaion Alliance, University of East Anglia, Norwich, UK
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12
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Manuli A, Maggio MG, Tripoli D, Gullì M, Cannavò A, La Rosa G, Sciarrone F, Avena G, Calabrò RS. Patients' perspective and usability of innovation technology in a new rehabilitation pathway: An exploratory study in patients with multiple sclerosis. Mult Scler Relat Disord 2020; 44:102312. [PMID: 32585618 DOI: 10.1016/j.msard.2020.102312] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Multiple sclerosis (MS) is an inflammatory neurodegenerative disease of the central nervous system, which causes sensori-motor and cognitive disabilities, as well as neuropsychiatric abnormalities. Technological innovations could offer a valuable way to improve neurorehabilitation outcomes. Aim of the study is to assess the feasibility and usability of new rehabilitation technologies as perceived by patients suffering from MS. MATERIALS AND METHODS MS inpatients attending the Robotic and Behavioral Neurorehabilitation Service of the IRCCS Centro Neurolesi Bonino Pulejo (Messina, Italy) from February 2017 to April 2019, were enrolled in this exploratory study. The patients were submitted to a personalized rehabilitation treatment using robotics (such as Lokomat, Geosystem, Ekso, Armeo) and virtual reality (i.e. BTS-Nirvana, CAREN, VRRS), following a dedicated innovative pathway. RESULTS All patients completed the study. Significant pre-post-treatment differences were found in the perception of patients' quality of life, regarding both physical and mental items (p<0,001), as well as in the achievement of the therapeutic goal. Finally, we observed that patients declared a high usability of the robotic devices, and that rehabilitation with the new devices was well tolerated. CONCLUSIONS our results support the idea that neurorehabilitation using innovation technologies can be useful for the commitment and motivation during the rehabilitation process, with possible positive effects on the functional and psychological outcomes of patients with MS.
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Affiliation(s)
| | | | | | - Martina Gullì
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | | | | | | | - Giuseppe Avena
- Department of Ancient and Modern Civilizations, University of Messina, Messina, Italy
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13
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Singh N, Saini M, Anand S, Kumar N, Srivastava MVP, Mehndiratta A. Robotic Exoskeleton for Wrist and Fingers Joint in Post-Stroke Neuro-Rehabilitation for Low-Resource Settings. IEEE Trans Neural Syst Rehabil Eng 2019; 27:2369-2377. [PMID: 31545737 DOI: 10.1109/tnsre.2019.2943005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Robots have the potential to help provide exercise therapy in a repeatable and reproducible manner for stroke survivors. To facilitate rehabilitation of the wrist and fingers joint, an electromechanical exoskeleton was developed that simultaneously moves the wrist and metacarpophalangeal joints. The device was designed for the ease of manufacturing and maintenance, with specific considerations for countries with limited resources. Active participation of the user is ensured by the implementation of electromyographic control and visual feedback of performance. Muscle activity requirements, movement parameters, range of motion and speed, of the device can all be customized to meet the needs of the user. Twelve stroke survivors, ranging from the subacute to chronic phases of recovery (mean 10.6 months post-stroke) participated in a pilot study with the device. Participants completed 20 sessions, each lasting 45 minutes. Overall, subjects exhibited statistically significant changes (p < 0.05) in clinical outcome measures following the treatment, with the Fugl-Meyer Stroke Assessment score for the upper extremity increasing from 36 to 50 and the Barthel Index increasing from 74 to 89. Active range of wrist motion increased by 19° while spasticity decreased from 1.75 to 1.29 on the Modified Ashworth Scale. Thus, this device shows promise for improving rehabilitation outcomes, especially for patients in countries with limited resources.
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14
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Fuertes Muñoz G, Mollineda RA, Gallardo Casero J, Pla F. A RGBD-Based Interactive System for Gaming-Driven Rehabilitation of Upper Limbs. SENSORS (BASEL, SWITZERLAND) 2019; 19:E3478. [PMID: 31395817 PMCID: PMC6721017 DOI: 10.3390/s19163478] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/30/2019] [Accepted: 08/07/2019] [Indexed: 11/17/2022]
Abstract
Current physiotherapy services may not be effective or suitable for certain patients due to lack of motivation, poor adherence to exercises, insufficient supervision and feedback or, in the worst case, refusal to continue with the rehabilitation plan. This paper introduces a novel approach for rehabilitation of upper limbs through KineActiv, a platform based on Microsoft Kinect v2 and developed in Unity Engine. KineActiv proposes exergames to encourage patients to perform rehabilitation exercises prescribed by a specialist, controls the patient's performance, and corrects execution errors on the fly. KineActiv comprises a web platform where the physiotherapist can review session results, monitor patient health, and adjust rehabilitation routines. We recruited 10 patients for assessing the system usability as well as the system performance. Results show that KineActiv is a usable, enjoyable and reliable system, that does not cause any negative feelings.
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Affiliation(s)
| | - Ramón A Mollineda
- Institute of New Imaging Technologies, Universitat Jaume I, 12071 Castellón, Spain
| | | | - Filiberto Pla
- Institute of New Imaging Technologies, Universitat Jaume I, 12071 Castellón, Spain
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15
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Vision-Assisted Interactive Human-in-the-Loop Distal Upper Limb Rehabilitation Robot and its Clinical Usability Test. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9153106] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In the context of stroke rehabilitation, simple structures and user-intent driven actuation are relevant features to facilitate neuroplasticity as well as deliver a sufficient number of repetitions during a single therapy session. A novel robotic treatment device for distal upper limb rehabilitation in stroke patients was developed, and a usability test was performed to assess its clinical feasibility. The rehabilitation robot was designed as a two-axis exoskeleton actuated by electric motors, consisting of forearm supination/pronation and hand grasp/release, which were selected based on a kinematic analysis of essential daily activities. A vision-assisted algorithm was utilized for user-intent extraction in a human-in-the-loop concept. A usability test was performed on six physiatrists, five biomedical engineers, five rehabilitation therapists, two chronic stroke patients, and two caregivers of the patients. After sufficient instruction, all subjects tested the robot for a minimum of 10 min and completed the evaluation form using a 7-point Likert scale. The participants found the device interesting (5.7 ± 1.2), motivating (5.8 ± 0.9), and as having less possibility of causing injury or safety issues (6.1 ± 1.1); however, the appropriateness of difficulty (4.8 ± 1.9) and comfort level (4.9 ± 1.3) were found to be relatively low. Further development of the current device would provide a good treatment option as a simple, low-cost, and clinically feasible rehabilitation robot for stroke.
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16
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Tsai YL, Huang JJ, Pu SW, Chen HP, Hsu SC, Chang JY, Pei YC. Usability Assessment of a Cable-Driven Exoskeletal Robot for Hand Rehabilitation. Front Neurorobot 2019; 13:3. [PMID: 30814945 PMCID: PMC6381032 DOI: 10.3389/fnbot.2019.00003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/23/2019] [Indexed: 11/21/2022] Open
Abstract
Study design: Case series. Background: Robot-assisted rehabilitation mediated by exoskeletal devices is a popular topic of research. The biggest difficulty in the development of rehabilitation robots is the consideration of the clinical needs. This study investigated the usability of a novel cable-driven exoskeletal robot specifically designed for hand rehabilitation. Methods: The study consists of three steps, including prototype development, spasticity observation, and usability evaluation. First, we developed the prototype robot DexoHand to manipulate the patient's fingers based on the clinical needs and the cable-driven concept established in our previous work. Second, we applied DexoHand to patients with different levels of spasticity. Finally, we obtained the system usability scale (SUS) and assessed its usability. Results: Two healthy subjects were recruited in the pre-test, and 18 patients with stroke and four healthy subjects were recruited in the formal test for usability. The total SUS score obtained from the patients and healthy subjects was 94.77 ± 2.98 (n = 22), indicating an excellent level of usability. The satisfaction score was 4.74 ± 0.29 (n = 22), revealing high satisfaction with DexoHand. The tension profile measured by the cables showed the instantaneous force used to manipulate fingers among different muscle tone groups. Conclusions:DexoHand meets the clinical needs with excellent usability, satisfaction, and reliable tension force monitoring, yielding a feasible platform for robot-assisted hand rehabilitation.
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Affiliation(s)
- Yu-Lin Tsai
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Jian-Jia Huang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Wei Pu
- Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Hsiang-Peng Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shao-Chih Hsu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Jen-Yuan Chang
- Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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Struik GM, Hoekstra N, Klem TM, Ghandi A, Verduijn GM, Swaak-Kragten AT, Schoonbeek A, de Vries KC, Sattler MA, Verhoef K, Birnie E, Pignol JP. Injection of radiopaque hydrogel at time of lumpectomy improves the target definition for adjuvant radiotherapy. Radiother Oncol 2018; 131:8-13. [PMID: 30773191 DOI: 10.1016/j.radonc.2018.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/14/2018] [Accepted: 11/04/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE During oncoplastic breast-conserving surgery (BCS), the surgical cavity is closed to reduce seroma formation. This makes the radiotherapy target definition using clips challenging, leading to poor inter-observer agreement and potentially geographical misses. We hypothesize that injecting a radiopaque hydrogel in the lumpectomy cavity before closure improves radiotherapy target definition and agreement between observers. MATERIALS AND METHODS Women undergoing BCS in a single university hospital were prospectively accrued in the study. Three to 9 ml of iodined PolyEthylene Glycol (PEG) hydrogel and clips were inserted in the lumpectomy cavity. A CT-scan was performed at 4 to 6 weeks. CT images of BCS patients with standard clips only were used as control group, matched on age, specimen weight, and distance between clips. Six radiation oncologists delineated the tumor bed volumes and rated the cavity visualization scores (CVS). The primary endpoint was the agreement between observers measured using a Conformity Index (Cx). RESULTS Forty-two patients were included, 21 hydrogel procedures and 21 controls, resulting in 315 observer pairs. The feasibility of the intervention was 100%. The median Cx was higher in the intervention group (Cx = 0.70, IQR [0.54-0.79]) than in the control group (Cx = 0.54, IQR [0.42-0.66]), p < 0.00, as were the CVS (3.5 [2.5-4.5] versus 2.5 [2-3.5], p < 0.001). The rate of surgical site infections was similar to literature. CONCLUSIONS The use of radiopaque PEG enables to identify the lumpectomy cavity, resulting in a high inter-observer agreement for radiotherapy target definition. This intervention is easy to perform and blend well into current practice.
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Affiliation(s)
- Gerson M Struik
- Franciscus Gasthuis and Vlietland, Department of Surgery, Rotterdam, the Netherlands; Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Nienke Hoekstra
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Taco M Klem
- Franciscus Gasthuis and Vlietland, Department of Surgery, Rotterdam, the Netherlands
| | - Ali Ghandi
- Franciscus Gasthuis and Vlietland, Department of Radiology, Rotterdam, the Netherlands
| | - Gerda M Verduijn
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | | | - Alja Schoonbeek
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Kim C de Vries
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Margriet A Sattler
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Kees Verhoef
- Erasmus MC, Department of Surgery, Rotterdam, the Netherlands
| | - Erwin Birnie
- Franciscus Gasthuis and Vlietland, Department of Statistics and Education, Rotterdam, the Netherlands
| | - Jean-Philippe Pignol
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands; Dalhousie University, Department of Radiation Oncology, Halifax, Canada.
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