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Papagiannis G, Triantafyllou Α, Yiannopoulou KG, Georgoudis G, Kyriakidou M, Gkrilias P, Skouras AZ, Bega X, Stasinopoulos D, Matsopoulos G, Syringas P, Tselikas N, Zestas O, Potsika V, Pardalis A, Papaioannou C, Protopappas V, Malizos N, Tachos N, Fotiadis DI. Ηand dexterities assessment in stroke patients based on augmented reality and machine learning through a box and block test. Sci Rep 2024; 14:10598. [PMID: 38719940 PMCID: PMC11079036 DOI: 10.1038/s41598-024-61070-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
A popular and widely suggested measure for assessing unilateral hand motor skills in stroke patients is the box and block test (BBT). Our study aimed to create an augmented reality enhanced version of the BBT (AR-BBT) and evaluate its correlation to the original BBT for stroke patients. Following G-power analysis, clinical examination, and inclusion-exclusion criteria, 31 stroke patients were included in this study. AR-BBT was developed using the Open Source Computer Vision Library (OpenCV). The MediaPipe's hand tracking library uses a palm and a hand landmark machine learning model to detect and track hands. A computer and a depth camera were employed in the clinical evaluation of AR-BBT following the principles of traditional BBT. A strong correlation was achieved between the number of blocks moved in the BBT and the AR-BBT on the hemiplegic side (Pearson correlation = 0.918) and a positive statistically significant correlation (p = 0.000008). The conventional BBT is currently the preferred assessment method. However, our approach offers an advantage, as it suggests that an AR-BBT solution could remotely monitor the assessment of a home-based rehabilitation program and provide additional hand kinematic information for hand dexterities in AR environment conditions. Furthermore, it employs minimal hardware equipment.
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Grants
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH–CREATE– INNOVATE
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Affiliation(s)
- Georgios Papagiannis
- Biomechanics Laboratory, Physiotherapy Department, University of the Peloponnese, 23100, Sparta, Greece.
- Physioloft, Physiotherapy Center, 14562, Kifisia, Greece.
| | - Αthanasios Triantafyllou
- Biomechanics Laboratory, Physiotherapy Department, University of the Peloponnese, 23100, Sparta, Greece
- Physioloft, Physiotherapy Center, 14562, Kifisia, Greece
| | | | - George Georgoudis
- Department of Physiotherapy, University of West Attica, 12243, Athens, Greece
| | - Maria Kyriakidou
- Biomechanics Laboratory, Physiotherapy Department, University of the Peloponnese, 23100, Sparta, Greece
| | - Panagiotis Gkrilias
- Biomechanics Laboratory, Physiotherapy Department, University of the Peloponnese, 23100, Sparta, Greece
| | - Apostolos Z Skouras
- Sports Excellence, 1St Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Xhoi Bega
- Physioloft, Physiotherapy Center, 14562, Kifisia, Greece
| | | | - George Matsopoulos
- Biomedical Engineering Laboratory, National Technical University of Athens, 9, Herοon Polytechniou Str., Zografou, 15773, Athens, Greece
| | - Pantelis Syringas
- Biomedical Engineering Laboratory, National Technical University of Athens, 9, Herοon Polytechniou Str., Zografou, 15773, Athens, Greece
| | - Nikolaos Tselikas
- CNA Lab, Department of Informatics, Telecommunications University of Peloponnese, 22100, Tripoli, Greece
| | - Orestis Zestas
- CNA Lab, Department of Informatics, Telecommunications University of Peloponnese, 22100, Tripoli, Greece
| | - Vassiliki Potsika
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, 45110, Ioannina, Greece
| | - Athanasios Pardalis
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, 45110, Ioannina, Greece
| | - Christoforos Papaioannou
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, 45110, Ioannina, Greece
| | | | | | - Nikolaos Tachos
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, 45110, Ioannina, Greece
| | - Dimitrios I Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, 45110, Ioannina, Greece
- Biomedical Research Institute, Foundation for Research and Technology-Hellas (FORTH), 70013, Heraklion, Greece
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Doré B, Gaudreault A, Everard G, Ayena JC, Abboud A, Robitaille N, Batcho CS. Acceptability, Feasibility, and Effectiveness of Immersive Virtual Technologies to Promote Exercise in Older Adults: A Systematic Review and Meta-Analysis. SENSORS (BASEL, SWITZERLAND) 2023; 23:2506. [PMID: 36904709 PMCID: PMC10007244 DOI: 10.3390/s23052506] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
CONTEXT This review aimed to synthesize the literature on the acceptability, feasibility, and effectiveness of immersive virtual technologies to promote physical exercise in older people. METHOD We performed a literature review, based on four databases (PubMed, CINAHL, Embase, and Scopus; last search: 30 January 2023). Eligible studies had to use immersive technology with participants aged 60 years and over. The results regarding acceptability, feasibility, and effectiveness of immersive technology-based interventions in older people were extracted. The standardized mean differences were then computed using a random model effect. RESULTS In total, 54 relevant studies (1853 participants) were identified through search strategies. Concerning the acceptability, most participants reported a pleasant experience and a desire to use the technology again. The average increase in the pre/post Simulator Sickness Questionnaire score was 0.43 in healthy subjects and 3.23 in subjects with neurological disorders, demonstrating this technology's feasibility. Regarding the effectiveness, our meta-analysis showed a positive effect of the use of virtual reality technology on balance (SMD = 1.05; 95% CI: 0.75-1.36; p < 0.001) and gait outcomes (SMD = 0.7; 95% CI: 0.14-0.80; p < 0.001). However, these results suffered from inconsistency and the number of trials dealing with these outcomes remains low, calling for further studies. CONCLUSIONS Virtual reality seems to be well accepted by older people and its use with this population is feasible. However, more studies are needed to conclude its effectiveness in promoting exercise in older people.
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Affiliation(s)
- Benjamin Doré
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada
| | - Alex Gaudreault
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada
| | - Gauthier Everard
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Quebec, QC G1M 2S8, Canada
| | - Johannes C. Ayena
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Quebec, QC G1M 2S8, Canada
| | - Ahmad Abboud
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Quebec, QC G1M 2S8, Canada
| | | | - Charles Sebiyo Batcho
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Quebec, QC G1M 2S8, Canada
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Evans E, Dass M, Muter WM, Tuthill C, Tan AQ, Trumbower RD. A Wearable Mixed Reality Platform to Augment Overground Walking: A Feasibility Study. Front Hum Neurosci 2022; 16:868074. [PMID: 35754777 PMCID: PMC9218429 DOI: 10.3389/fnhum.2022.868074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/03/2022] [Indexed: 11/21/2022] Open
Abstract
Humans routinely modify their walking speed to adapt to functional goals and physical demands. However, damage to the central nervous system (CNS) often results in abnormal modulation of walking speed and increased risk of falls. There is considerable interest in treatment modalities that can provide safe and salient training opportunities, feedback about walking performance, and that may augment less reliable sensory feedback within the CNS after injury or disease. Fully immersive virtual reality technologies show benefits in boosting training-related gains in walking performance; however, they lack views of the real world that may limit functional carryover. Augmented reality and mixed reality head-mount displays (MR-HMD) provide partially immersive environments to extend the virtual reality benefits of interacting with virtual objects but within an unobstructed view of the real world. Despite this potential advantage, the feasibility of using MR-HMD visual feedback to promote goal-directed changes in overground walking speed remains unclear. Thus, we developed and evaluated a novel mixed reality application using the Microsoft HoloLens MR-HMD that provided real-time walking speed targets and augmented visual feedback during overground walking. We tested the application in a group of adults not living with disability and examined if they could use the targets and visual feedback to walk at 85%, 100%, and 115% of each individual’s self-selected speed. We examined whether individuals were able to meet each target gait speed and explored differences in accuracy across repeated trials and at the different speeds. Additionally, given the importance of task-specificity to therapeutic interventions, we examined if walking speed adjustment strategies were consistent with those observed during usual overground walking, and if walking with the MR-HMD resulted in increased variability in gait parameters. Overall, participants matched their overground walking speed to the target speed of the MR-HMD visual feedback conditions (all p-values > 0.05). The percent inaccuracy was approximately 5% across all speed matching conditions and remained consistent across walking trials after the first overall walking trial. Walking with the MR-HMD did not result in more variability in walking speed, however, we observed more variability in stride length and time when walking with feedback from the MR-HMD compared to walking without feedback. The findings offer support for mixed reality-based visual feedback as a method to provoke goal-specific changes in overground walking behavior. Further studies are necessary to determine the clinical safety and efficacy of this MR-HMD technology to provide extrinsic sensory feedback in combination with traditional treatments in rehabilitation.
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Affiliation(s)
- Emily Evans
- Spaulding Rehabilitation Hospital, Cambridge, MA, United States.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
| | - Megan Dass
- Georgia Institute of Technology, School of Computer Science, Atlanta, GA, United States
| | - William M Muter
- Spaulding Rehabilitation Hospital, Cambridge, MA, United States
| | - Christopher Tuthill
- Spaulding Rehabilitation Hospital, Cambridge, MA, United States.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
| | - Andrew Q Tan
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States.,Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Randy D Trumbower
- Spaulding Rehabilitation Hospital, Cambridge, MA, United States.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
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Roman NA, Miclaus RS, Nicolau C, Sechel G. Customized Manual Muscle Testing for Post-Stroke Upper Extremity Assessment. Brain Sci 2022; 12:brainsci12040457. [PMID: 35447988 PMCID: PMC9029412 DOI: 10.3390/brainsci12040457] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022] Open
Abstract
In neuro-rehabilitation, the assessment of post-stroke patients’ motor function of damaged upper extremities (UEs) is essential. Clinicians need clear and concise assessment instruments to monitor progress recorded in intensive rehabilitation sessions. One such instrument is Manual Muscle Testing (MMT), which, in our view, requires a modified scoring model aimed at improving the assessment process of patients’ motor and functional UE status, and recording their step-by-step-progress, especially if patients undergo a short length of hospitalization (of about 10 therapy days). Hence, this paper presents a new scoring system developed by the authors. This systemresults in a more precise MMT grading scale, which has more grades and can provide a more specific muscular assessment, while offering more clarity in quantifying patients’ progress after physical therapy. A prospective study was made of 41 post-stroke patients with upper extremity (UE) impairments. To determine the validity of the assessment tool for hypothesizing, and the unidimensionality and internal consistency of the customized model, exploratory and confirmatory factor analysis (CFA) with a structural equation model (SEM), Cronbach’s Alpha, and Pearson correlation coefficients were used with Fugl−Meyer (FM) assessments, the Modified Ashworth Scale (MAS), AROM, and the Modified Rankin Scale (MRS). Considering the unidimensionality of the instrument used, we performed a linear regression to identify whether certain movements performed segmentally by the manually evaluated muscles influence the measured manual score of the whole UE. All indices suggested a good model fit, and a Cronbach’s Alpha of 0.920 suggested strong internal consistency. The Pearson correlation coefficient of the MMT-customized score with AROM was 0.857, p < 0.001; that with FMUE was 0.905, p < 0.001; that with MRS was −0.608, p = 0.010; and that with MAS was −0.677, p < 0.001. The linear regression results suggest that wrist extensors, shoulder abductors, and finger flexors can influence the manual assessment of the muscle strength of the whole UE, thereby improving post-stroke patient management. The results of our research suggest that, using the proposed scoring, MMT may be a useful tool for UE assessment in post-stroke patients.
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Affiliation(s)
- Nadinne Alexandra Roman
- Faculty of Medicine, Transilvania University of Brasov, 500036 Brasov, Romania; (N.A.R.); (G.S.)
| | - Roxana Steliana Miclaus
- Faculty of Medicine, Transilvania University of Brasov, 500036 Brasov, Romania; (N.A.R.); (G.S.)
- Correspondence:
| | - Cristina Nicolau
- Faculty of Economic Sciences and Business Administration, Transilvania University of Brasov, 500036 Brasov, Romania;
| | - Gabriela Sechel
- Faculty of Medicine, Transilvania University of Brasov, 500036 Brasov, Romania; (N.A.R.); (G.S.)
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Mańdziuk M, Krawczyk-Suszek M, Maciejewski R, Bednarski J, Kotyra A, Cyganik W. The Application of Biological Feedback in the Rehabilitation of Patients after Ischemic Stroke. SENSORS 2022; 22:s22051769. [PMID: 35270916 PMCID: PMC8914769 DOI: 10.3390/s22051769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 11/17/2022]
Abstract
Balance disorders are the main concern for patients after an ischemic stroke. They are caused by an abnormal force on the affected side or paresis, which causes uneven loading and visuospatial disorders. Minimizing the effects of stroke is possible through properly conducted rehabilitation. One of the known ways to achieve this objective is biological feedback. The lack of proper muscle tone on one side of the body is manifested by the uneven pressure of the lower extremities on the ground. The study and control groups were composed of two equal groups of 92 people each, in which the same set of kinesiotherapeutic exercises were applied. Patients in the study group, in addition to standard medical procedures, exercised five days a week on a Balance Trainer for four weeks. The examination and training with the device were recorded on the first day of rehabilitation, as well as after two and four weeks of training. The assessment was performed using the following functional tests and scales: Brunnström, Rankin, Barthel, Ashworth, and VAS. Patients in the control group started exercising on the Balance Trainer two weeks after the first day of rehabilitation using traditional methods. The study results reveal statistically significant reductions in the time the body’s center of gravity (COG) spent in the tacks, outside the tracks and in the COG distance, lower COG excursions in all directions. Post-stroke patients that received biofeedback training presented significantly better results than patients that did not receive such training.
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Affiliation(s)
- Marzena Mańdziuk
- Medical College, University of Information Technology and Management in Rzeszow, 2 Sucharskiego Str., 35-225 Rzeszow, Poland; (M.K.-S.); (W.C.)
- Correspondence:
| | - Marlena Krawczyk-Suszek
- Medical College, University of Information Technology and Management in Rzeszow, 2 Sucharskiego Str., 35-225 Rzeszow, Poland; (M.K.-S.); (W.C.)
| | - Ryszard Maciejewski
- Department of Human Anatomy, Medical University of Lublin, 19 Chodzki Str., 20-093 Lublin, Poland; (R.M.); (J.B.)
| | - Jerzy Bednarski
- Department of Human Anatomy, Medical University of Lublin, 19 Chodzki Str., 20-093 Lublin, Poland; (R.M.); (J.B.)
| | - Andrzej Kotyra
- Department of Electronics and Information Technology, Faculty of Electrical Engineering and Computer Science, Lublin University of Technology, 38a Nadbystrzycka Str., 20-618 Lublin, Poland;
| | - Weronika Cyganik
- Medical College, University of Information Technology and Management in Rzeszow, 2 Sucharskiego Str., 35-225 Rzeszow, Poland; (M.K.-S.); (W.C.)
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Early Individualized Approach for a Patient with Spasticity of Stroke Origin. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:608-611. [PMID: 35444829 PMCID: PMC8987471 DOI: 10.12865/chsj.47.04.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/11/2021] [Indexed: 11/18/2022]
Abstract
The aim of this case report is to present an early individualized rehabilitative plan for a post-stroke patient with limb spasticity given that stroke is a leading cause for disability that involves prolonged hospital stay and neurorehabilitation strategies. The rehabilitation plan consisted of conventional physical therapy and radial extracorporeal shock wave therapy (rESWT), and the results were evaluated through clinical assessment together with an innovative gait analysis system. Two rESWT sessions and conventional physical therapy program decreased spasticity grade and pain intensity, and improved ankle range of motion, balance and gait.
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