Requirements for home-based upper extremity rehabilitation using wearable motion sensors for stroke patients: a user-centred approach

PURPOSE

Telerehabilitation systems have the potential to enable therapists to monitor and assist stroke patients in achieving high-intensity upper extremity exercise in the home environment. We adopted an iterative user-centred approach, including multiple data sources and meetings with end-users and stakeholders to define the user requirements for home-based upper extremity rehabilitation using wearable motion sensors for subacute stroke patients.

METHODS

We performed a requirement analysis consisting of the following steps: 1) context & groundwork; 2) eliciting requirements; 3) modelling & analysis; 4) agreeing requirements. During these steps, a pragmatic literature search, interviews and focus groups with stroke patients, physiotherapists and occupational therapists were performed. The results were systematically analysed and prioritised into "must-haves", "should-haves", and "could-haves".

RESULTS

We formulated 33 functional requirements: eighteen must-have requirements related to blended care (2), exercise principles (7), exercise delivery (3), exercise evaluation (4), and usability (2); ten should-haves; and five could-haves. Six movement components, including twelve exercises and five combination exercises, are required. For each exercise, appropriate exercise measures were defined.

CONCLUSION

This study provides an overview of functional requirements, required exercises, and required exercise measures for home-based upper extremity rehabilitation using wearable motion sensors for stroke patients, which can be used to develop home-based upper extremity rehabilitation interventions. Moreover, the comprehensive and systematic requirement analysis used in this study can be applied by other researchers and developers when extracting requirements for designing a system or intervention in a medical context.

Preliminary Study of Vibrotactile Feedback during Home-Based Balance and Coordination Training in Individuals with Cerebellar Ataxia

Intensive balance and coordination training is the mainstay of treatment for symptoms of impaired balance and mobility in individuals with hereditary cerebellar ataxia. In this study, we compared the effects of home-based balance and coordination training with and without vibrotactile SA for individuals with hereditary cerebellar ataxia. Ten participants (five males, five females; 47  ±  12 years) with inherited forms of cerebellar ataxia were recruited to participate in a 12-week crossover study during which they completed two six-week blocks of balance and coordination training with and without vibrotactile SA. Participants were instructed to perform balance and coordination exercises five times per week using smartphone balance trainers that provided written, graphic, and video guidance and measured trunk sway. The pre-, per-, and post-training performance were assessed using the Scale for the Assessment and Rating of Ataxia (SARA), SARAposture&gait sub-scores, Dynamic Gait Index, modified Clinical Test of Sensory Interaction in Balance, Timed Up and Go performed with and without a cup of water, and multiple kinematic measures of postural sway measured with a single inertial measurement unit placed on the participants’ trunks. To explore the effects of training with and without vibrotactile SA, we compared the changes in performance achieved after participants completed each six-week block of training. Among the seven participants who completed both blocks of training, the change in the SARA scores and SARAposture&gait sub-scores following training with vibrotactile SA was not significantly different from the change achieved following training without SA (p>0.05). However, a trend toward improved SARA scores and SARAposture&gait sub-scores was observed following training with vibrotactile SA; compared to their pre-vibrotacile SA training scores, participants significantly improved their SARA scores (mean=−1.21, p=0.02) and SARAposture&gait sub-scores (mean=−1.00, p=0.01). In contrast, no significant changes in SARA scores and SARAposture&gait sub-scores were observed following the six weeks of training without SA compared to their pre-training scores immediately preceding the training block without vibrotactile SA (p>0.05). No significant changes in trunk kinematic sway parameters were observed as a result of training (p>0.05). Based on the findings from this preliminary study, balance and coordination training improved the participants’ motor performance, as captured through the SARA. Vibrotactile SA may be a beneficial addition to training regimens for individuals with hereditary cerebellar ataxia, but additional research with larger sample sizes is needed to assess the significance and generalizability of these findings.

Upper limb rehabilitation system based on virtual reality for breast cancer patients: Development and usability study

Background

Functional exercise is crucial for breast cancer patients after surgery, and the use of virtual reality technology to assist patients with postoperative upper limb functional rehabilitation has gradually attracted the attention of researchers. However, the usability of the developed rehabilitation system is still unknown to a large extent. The purpose of this study was to develop a virtual reality upper limb rehabilitation system for patients after breast cancer surgery and to explore its usability.

Methods

We built a multidisciplinary team based on virtual reality and human-computer interaction technology and designed and developed an upper limb function rehabilitation system for breast cancer patients after surgery. Breast cancer patients were recruited from a grade III-a general hospital in Changchun city for the experiment. We used the System Usability Scale to evaluate the system availability, the Presence Questionnaire scale to measure the immersive virtual reality scene, and the Simulator Sickness Questionnaire subjective measurement scale for simulator sickness symptoms.

Results

This upper limb rehabilitation system hardware consisted of Head-mounted Display, a control handle and notebook computers. The software consisted of rehabilitation exercises and game modules. A total of 15 patients were tested on this system, all of whom were female. The mean age was 54.73±7.78 years, and no patients were excluded from the experiment because of adverse reactions such as dizziness and vomiting. The System Usability Scale score was 90.50±5.69, the Presence Questionnaire score was 113.40±9.58, the Simulator Sickness Questionnaire-nausea score was 0.93±1.16, the Simulator Sickness Questionnaire-oculomotor score was 0.80±1.27, the Simulator Sickness Questionnaire-disorientation score was 0.80±1.27, and the Simulator Sickness Questionnaire total score was 2.53±3.40.

Conclusions

This study fills in the blanks regarding the upper limb rehabilitation of breast cancer patients based on virtual reality technology system usability research. As the starting point of research in the future, we will improve the system’s function and design strictly randomized controlled trials, using larger samples in the promotion, to evaluate its application in breast cancer patients with upper limbs and other physiological functions and the feasibility and effects of rehabilitation.

A usability study in patients with stroke using MERLIN, a robotic system based on serious games for upper limb rehabilitation in the home setting

BACKGROUND

Neuroscience and neurotechnology are transforming stroke rehabilitation. Robotic devices, in addition to telerehabilitation, are increasingly being used to train the upper limbs after stroke, and their use at home allows us to extend institutional rehabilitation by increasing and prolonging therapy. The aim of this study is to assess the usability of the MERLIN robotic system based on serious games for upper limb rehabilitation in people with stroke in the home environment.

METHODS

9 participants with a stroke in three different stages of recovery (subacute, short-term chronic and long-term chronic) with impaired arm/hand function, were recruited to use the MERLIN system for 3 weeks: 1 week training at the Maimonides Biomedical Research Institute of Cordoba (IMIBIC), and 2 weeks at the patients' homes. To evaluate usability, the System Usability Scale (SUS), Adapted Intrinsic Motivation Inventory (IMI), Quebec User Evaluation of Satisfaction with assistive Technology (QUEST), and the ArmAssist Usability Assessment Questionnaire were used in the post-intervention. Clinical outcomes for upper limb motor function were assessed pre- and post-intervention.

RESULTS

9 patients participated in and completed the study. The usability assessment reported a high level of satisfaction: mean SUS score 71.94 % (SD = 16.38), mean QUEST scale 3.81 (SD = 0.38), and mean Adapted IMI score 6.12 (SD = 1.36). The results of the ArmAssist Questionnaire showed an average of 6 out of 7, which indicates that MERLIN is extremely intuitive, easy to learn and easy to use. Regarding clinical assessment, the Fugl-Meyer scores showed moderate improvements from pre- to post-intervention in the total score of motor function (p = 0.002). There were no significant changes in the Modified Ashworth scale outcomes (p = 0.169).

CONCLUSIONS

This usability study indicates that home-based rehabilitation for upper limbs with the MERLIN system is safe, useful, feasible and motivating. Telerehabilitation constitutes a major step forward in the use of intensive rehabilitation at home. Trial registration ClinicalTrials.gov, NCT04405609. Registered 06 January 2020-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04405609.

An Autotuning Cable-Driven Device for Home Rehabilitation

Out of all the changes to our daily life brought by the COVID-19 pandemic, one of the most significant ones has been the limited access to health services that we used to take for granted. Thus, in order to prevent temporary injuries from having lingering or permanent effects, the need for home rehabilitation device is urgent. For this reason, this paper proposes a cable-driven device for limb rehabilitation, CUBE2, with a novel end-effector (EE) design and autotuning capabilities to enable autonomous use. The proposed design is presented as an evolution of the previous CUBE design. In this paper, the proposed device is modelled and analyzed with finite element analysis. Then, a novel vision-based control strategy is described. Furthermore, a prototype has been manufactured and validated experimentally. Preliminary test to estimate home position repeatability has been carried out.

Validation of a Novel Wearable Electromyography Patch for Monitoring Submental Muscle Activity During Swallowing: A Randomized Crossover Trial

Purpose Surface electromyography (sEMG) is often used for biofeedback during swallowing rehabilitation. However, commercially available sEMG electrodes are not optimized for the head and neck area, have rigid form, and are mostly available in large medical centers. We developed an ultrathin, soft, and flexible sEMG patch, specifically designed to conform to the submental anatomy and which will be ultimately incorporated into a telehealth system. To validate this first-generation sEMG patch, we compared its safety, efficiency, and signal quality in monitoring submental muscle activity with that of widely used conventional sEMG electrodes. Method A randomized crossover design was used to compare the experimental sEMG patch with conventional (snap-on) sEMG electrodes. Participants completed the same experimental protocol with both electrodes in counterbalanced order. Swallow trials included five trials of 5- and 10-ml water. Comparisons were made on (a) signal-related factors: signal-to-noise ratio (SNR), baseline amplitude, normalized mean amplitude, and sEMG burst duration and (b) safety/preclinical factors: safety/adverse effects, efficiency of electrode placement, and satisfaction/comfort. Noninferiority and equivalence tests were used to examine signal-related factors. Paired t tests and descriptive statistics were used to examine safety/preclinical factors. Results Forty healthy adults participated (24 women, M _age = 67.5 years). Signal-related factors: SNR of the experimental patch was not inferior to the SNR of the conventional electrodes (p < .0056). Similarly, baseline amplitude obtained with the experimental patch was not inferior to that obtained with conventional electrodes (p < .0001). Finally, normalized amplitude values were equivalent across swallows (5 ml: p < .025; 10 ml: p < .0012), and sEMG burst duration was also equivalent (5 ml: p < .0001; 10 ml: p < .0001). Safety/preclinical factors: The experimental patch resulted in fewer mild adverse effects. Participant satisfaction was higher with the experimental patch (p = .0476, d = 0.226). Conclusions Our new wearable sEMG patch is equivalent with widely used conventional sEMG electrodes in terms of technical performance. In addition, our patch is safe, and healthy older adults are satisfied with it. With lessons learned from the current COVID-19 pandemic, efforts to develop optimal swallowing telerehabilitation devices are more urgent than ever. Upon further validation, this new technology has the potential to improve rehabilitation and telerehabilitation efforts for patients with dysphagia. Supplemental Material https://doi.org/10.23641/asha.12915509.

Using UHF RFID Properties to Develop and Optimize an Upper-Limb Rehabilitation System

Rehabilitation of the upper limb is an important aspect of the therapy for people affected by neuromotor diseases for the recovery of the capability to perform activities of daily living (ADLs). Nonetheless, the costs associated with the administration of rehabilitation therapy and the increasing number of patients highlight the need for new solutions. Technology-based solutions and, in particular, telerehabilitation could strongly impact in this field. In this paper, a new system based on radiofrequency (RF) technology is presented which is able to effectively provide home-based telerehabilitation and extract meaningful information on the therapy execution performance. The technology has been tuned to the needs of the rehabilitation system, optimizing the hardware, the communication protocol and the software control. A methodology for extracting the execution time of the rehabilitation tasks, the distance covered by the patient's hand in each subtask and the velocity profile is presented. The results show that a highly usable system for the rehabilitation of the upper limb has been developed using the RF technology and that performance metrics can be reliably extracted by the acquired signals.

Benefits and effectiveness of using a wrist heart rate monitor as a telerehabilitation device in cardiac patients: A randomized controlled trial

BACKGROUND

Telerehabilitation in cardiology has the potential to become the alternative to regular outpatient cardiac rehabilitation. Our study focuses on the wrist heart rate monitor as a telerehabilitation device, defines detected limitations, and compares results between home-based and regular outpatient rehabilitation methods, related to physical fitness, quality of life, and training adherence. The study design was a randomized controlled trial.

METHODS

Eligible 56 cardiac rehabilitation patients were randomized into a 12-week regular outpatient training group (ROT) and interventional home-based telerehabilitation group (ITG). For both groups, the intensity of the training was prescribed to be performed at 70% to 80% of heart rate reserve for 60 minutes, 3 times a week. The ITG patients started their training with a wrist heart rate monitor in their home environment. These patients received feedback once a week, reflecting data uploaded on the internet application. The ROT patients performed their exercise under the direct supervision of a physical specialist in a regular outpatient clinic. Physical fitness and health-related quality of life were assessed at baseline and after 12 weeks. Training adherence in both groups was determined and compared.

RESULTS

Fifty-one patients comleted the intervention (91%); no serious adverse events were recorded. Physical fitness expressed as peak oxygen uptake showed significant improvement (P < .001) in ROT group from 23.4 ± 3.3 to 25.9 ± 4.1 mL/kg/min and (P < .01) in ITG group from 23.7 ± 4.1 to 26.5 ± 5.7 mL/kg/min without significant between-group differences after 12 weeks of intervention. The training adherence between groups was similar.

CONCLUSION

Our study shows that telerehabilitation via wrist heart rate monitor could become an alternative kind of cardiac rehabilitation which deserves attention and further analyzing.

Real-Time Compliant Stream Processing Agents for Physical Rehabilitation

Digital rehabilitation is a novel concept that integrates state-of-the-art technologies for motion sensing and monitoring, with personalized patient-centric methodologies emerging from the field of physiotherapy. Thanks to the advances in wearable and portable sensing technologies, it is possible to provide patients with accurate monitoring devices, which simplifies the tracking of performance and effectiveness of physical exercises and treatments. Employing these approaches in everyday practice has enormous potential. Besides facilitating and improving the quality of care provided by physiotherapists, the usage of these technologies also promotes the personalization of treatments, thanks to data analytics and patient profiling (e.g., performance and behavior). However, achieving such goals implies tackling both technical and methodological challenges. In particular, (i) the capability of undertaking autonomous behaviors must comply with strict real-time constraints (e.g., scheduling, communication, and negotiation), (ii) plug-and-play sensors must seamlessly manage data and functional heterogeneity, and finally (iii) multi-device coordination must enable flexible and scalable sensor interactions. Beyond traditional top-down and best-effort solutions, unsuitable for safety-critical scenarios, we propose a novel approach for decentralized real-time compliant semantic agents. In particular, these agents can autonomously coordinate with each other, schedule sensing and data delivery tasks (complying with strict real-time constraints), while relying on ontology-based models to cope with data heterogeneity. Moreover, we present a model that represents sensors as autonomous agents able to schedule tasks and ensure interactions and negotiations compliant with strict timing constraints. Furthermore, to show the feasibility of the proposal, we present a practical study on upper and lower-limb digital rehabilitation scenarios, simulated on the MAXIM-GPRT environment for real-time compliance. Finally, we conduct an extensive evaluation of the implementation of the stream processing multi-agent architecture, which relies on existing RDF stream processing engines.

Evaluation of Home-Based Rehabilitation Sensing Systems with Respect to Standardised Clinical Tests

With increased demand for tele-rehabilitation, many autonomous home-based rehabilitation systems have appeared recently. Many of these systems, however, suffer from lack of patient acceptance and engagement or fail to provide satisfactory accuracy; both are needed for appropriate diagnostics. This paper first provides a detailed discussion of current sensor-based home-based rehabilitation systems with respect to four recently established criteria for wide acceptance and long engagement. A methodological procedure is then proposed for the evaluation of accuracy of portable sensing home-based rehabilitation systems, in line with medically-approved tests and recommendations. For experiments, we deploy an in-house low-cost sensing system meeting the four criteria of acceptance to demonstrate the effectiveness of the proposed evaluation methodology. We observe that the deployed sensor system has limitations in sensing fast movement. Indicators of enhanced motivation and engagement are recorded through the questionnaire responses with more than 83% of the respondents supporting the system’s motivation and engagement enhancement. The evaluation results demonstrate that the deployed system is fit for purpose with statistically significant (ϱc>0.99, R2>0.94, ICC>0.96) and unbiased correlation to the golden standard.

[Progress of Telerehabilitation Techniques in Stroke Patients with Lower Extremity Dysfunction]

Stroke has the characteristics of high prevalence, high morbidity, and high mortality, which seriously affects life quality of patients and also creates a huge social burden. Telerehabilitation technology is on the basis of traditional rehabilitation equipment and it integrates with cloud computing and big data technologies. It provides a new way for rehabilitation by providing comprehensive rehabilitation technology and service based on the cloud platform. Therefore, it provides a solution for the situation that the rehabilitation medical resources and the rehabilitation talents in China are relatively insufficient. This article mainly discusses the telerehabilitation technologies of lower extremity motor dysfunction in patients with stroke, the problems and the future development direction.

Design and development of a gait training system for Parkinson's disease

Background

Rhythmic Auditory Stimulation (RAS) is an effective technique to improve gait and reduce freezing episodes for Persons with Parkinson’s Disease (PwPD). The BeatHealth system, which comprises a mobile application, gait sensors, and a website, exploits the potential of the RAS technique. This paper describes the tools used for co-designing and evaluating the system and discusses the results and conclusions.

Methods

Personas, interviews, use cases, and ethnographic observations were used to define the functional requirements of the system. Low fidelity prototypes were created for iterative and incremental evaluation with end-users. Field trials were also performed with the final system. The process followed a user centered design methodology defined for this project with the aim of building a useful, usable, and easy-to-use system.

Results

Functional requirements of the system were produced as a result of the initial exploration phase. Building upon these, mock-ups for the BeatHealth system were created. The mobile application was iterated twice, with the second version of it achieving a rating of 75 when assessed by participants through the System Usability Scale (SUS). After another iteration field trials were performed and the mobile application was rated with an average 78.6 using SUS. Participants rated two website mock-ups, one for health professionals and another for end-users, as good except from minor issues related to visual design (e.g. font size), which were resolved in the final version.

Conclusion

The high ratings obtained in the evaluation of the BeatHealth system demonstrate the benefit of applying a user centered design methodology which involves stakeholders from the very beginning. Other important lessons were learned through the process of design and development of the system, such as the importance of motivational aspects, the techniques which work best, and the extra care that has to be taken when evaluating non-functional mock-ups with end users.

Early intervention at home in infants with congenital brain lesion with CareToy revised: a RCT protocol

BACKGROUND

Congenital brain lesions expose infants to be at high-risk for being affected by neurodevelopmental disorders such as cerebral palsy (CP). Early interventions programs can significantly impact and improve their neurodevelopment. Recently, in the framework of the European CareToy (CT) Project ( www.caretoy.eu ), a new medical device has been created to deliver an early, intensive, customized, intervention program, carried out at home by parents but remotely managed by expert and trained clinicians. Reviewing results of previous studies on preterm infants without congenital brain lesion, the CT platform has been revised and a new system created (CT-R). This study describes the protocol of a randomised controlled trial (RCT) aimed to evaluate, in a sample of infants at high-risk for CP, the efficacy of CT-R intervention compared to the Infant Massage (IM) intervention.

METHODS/DESIGN

This RCT will be multi-centre, paired and evaluator-blinded. Eligible subjects will be preterm or full-term infants with brain lesions, in first year of age with predefined specific gross motor abilities. Recruited infants will be randomized into CT-R and IM groups at baseline (T0). Based on allocation, infants will perform an 8-week programme of personalized CareToy activities or Infant Massage. The primary outcome measure will be the Infant Motor Profile. On the basis of power calculation, it will require a sample size of 42 infants. Moreover, Peabody Developmental Motor Scales-Second Edition, Teller Acuity Cards, standardized video-recordings of parent-infant interaction and wearable sensors (Actigraphs) will be included as secondary outcome measures. Finally, parents will fill out questionnaires (Bayley Social-Emotional, Parents Stress Index). All outcome measures will be carried out at the beginning (T0) and at end of 8-weeks intervention period, primary endpoint (T1). Primary outcome and some secondary outcomes will be carried out also after 2 months from T1 and at 18 months of age (T2 and T3, respectively). The Bayley Cognitive subscale will be used as additional assessment at T3.

DISCUSSION

This study protocol paper is the first study aimed to test CT-R system in infants at high-risk for CP. This paper will present the scientific background and trial methodology.

TRIAL REGISTRATION

NCT03211533 and NCT03234959 ( www.clinicaltrials.gov ).

Tele-UPCAT: study protocol of a randomised controlled trial of a home-based Tele-monitored UPper limb Children Action observation Training for participants with unilateral cerebral palsy

INTRODUCTION

A new rehabilitative approach, called UPper Limb Children Action Observation Training (UPCAT), based on the principles of action observation training (AOT), has provided promising results for upper limb rehabilitation in children with unilateral cerebral palsy (UCP). This study will investigate if a new information and communication technology platform, named Tele-UPCAT, is able to deliver AOT in a home setting and will test its efficacy on children and young people with UCP.

METHODS AND ANALYSIS

A randomised, allocation concealed (waitlist control) and evaluator-blinded clinical trial with two investigative arms will be carried out. The experimental group will perform AOT at home for 3 weeks using a customised Tele-UPCAT system where they will watch video sequences of goal-directed actions and then complete the motor training of the same actions. The control group will receive usual care for 3 weeks, which may include upper limb training. They will be offered AOT at home after 3 weeks. Twenty-four children with UCP will be recruited for 12 participants per group. The primary outcome will be measured using Assisting Hand Assessment. The Melbourne Assessment 2, ABILHAND, Participation and Environment Measure-Children and Youth and Cerebral Palsy Quality of Life Questionnaire will be included as secondary measures. Quantitative measures from sensorised objects and participants worn Actigraphs GXT3+ will be analysed. The assessment points will be the week before (T0) and after (T1) the period of AOT/standard care. Further assessments will be at T1 plus, the week after the AOT period for the waitlist group and at 8 weeks (T2) and 24 weeks (T3) after AOT training.

ETHICS AND DISSEMINATION

The trial has been approved by the Tuscany Paediatric Ethics Committee (169/2016). Publication of all outcomes will be in peer-reviewed journals and conference presentations.

TRIAL REGISTRATION

NCT03094455.

Let's do this together: Bi-Manu-Interact, a novel device for studying human haptic interactive behavior

Our area of interest is robotic-based rehabilitation after stroke, and our goal is to help patients achieve optimal motor learning during high-intensity repetitive movement training through the assistance of robots. It is important, that the robotic assistance is adapted to the patients' abilities, thereby ensuring that the device is only supporting the patient as necessary ("assist-as-needed"). We hypothesize that natural and learning-effective human-machine interaction can be achieved by programming the robot's control, so that it emulates how a physiotherapist adaptively supports the patients' limb movement during stroke rehabilitation. This paper introduces the design of a novel interactive device Bi-Manu-Interact. This device is suited to be used as an experimental setup for the investigation of haptic human-human interaction and for collecting data to model therapists' haptic behavior. In this paper, we present mechanical and sensory specifications as well as tasks visualizations for future investigations. Results of a pilot clinical evaluation of the Bi-Manu-Interact with nine stroke patients are also presented in this work.

Compensating for telecommunication delays during robotic telerehabilitation

Rehabilitation robotic systems may afford better care and telerehabilitation may extend the use and benefits of robotic therapy to the home. Data transmissions over distance are bound by intrinsic communication delays which can be significant enough to deem the activity unfeasible. Here we describe an approach that combines unilateral robotic telerehabilitation and serious games. This approach has a modular and distributed design that permits different types of robots to interact without substantial code changes. We demonstrate the approach through an online multiplayer game. Two users can remotely interact with each other with no force exchanges, while a smoothing and prediction algorithm compensates motions for the delay in the Internet connection. We demonstrate that this approach can successfully compensate for data transmission delays, even when testing between the United States and Brazil. This paper presents the initial experimental results, which highlight the performance degradation with increasing delays as well as improvements provided by the proposed algorithm, and discusses planned future developments.

A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training

Although motor learning theory has led to evidence-based practices, few trials have revealed the superiority of one theory-based therapy over another after stroke. Nor have improvements in skills been as clinically robust as one might hope. We review some possible explanations, then potential technology-enabled solutions. Over the Internet, the type, quantity, and quality of practice and exercise in the home and community can be monitored remotely and feedback provided to optimize training frequency, intensity, and progression at home. A theory-driven foundation of synergistic interventions for walking, reaching and grasping, strengthening, and fitness could be provided by a bundle of home-based Rehabilitation Internet-of-Things (RIoT) devices. A RIoT might include wearable, activity-recognition sensors and instrumented rehabilitation devices with radio transmission to a smartphone or tablet to continuously measure repetitions, speed, accuracy, forces, and temporal spatial features of movement. Using telerehabilitation resources, a therapist would interpret the data and provide behavioral training for self-management via goal setting and instruction to increase compliance and long-term carryover. On top of this user-friendly, safe, and conceptually sound foundation to support more opportunity for practice, experimental interventions could be tested or additions and replacements made, perhaps drawing from virtual reality and gaming programs or robots. RIoT devices continuously measure the actual amount of quality practice; improvements and plateaus over time in strength, fitness, and skills; and activity and participation in home and community settings. Investigators may gain more control over some of the confounders of their trials and patients will have access to inexpensive therapies.

Vision-Based Pose Estimation for Robot-Mediated Hand Telerehabilitation

Vision-based Pose Estimation (VPE) represents a non-invasive solution to allow a smooth and natural interaction between a human user and a robotic system, without requiring complex calibration procedures. Moreover, VPE interfaces are gaining momentum as they are highly intuitive, such that they can be used from untrained personnel (e.g., a generic caregiver) even in delicate tasks as rehabilitation exercises. In this paper, we present a novel master–slave setup for hand telerehabilitation with an intuitive and simple interface for remote control of a wearable hand exoskeleton, named HX. While performing rehabilitative exercises, the master unit evaluates the 3D position of a human operator’s hand joints in real-time using only a RGB-D camera, and commands remotely the slave exoskeleton. Within the slave unit, the exoskeleton replicates hand movements and an external grip sensor records interaction forces, that are fed back to the operator-therapist, allowing a direct real-time assessment of the rehabilitative task. Experimental data collected with an operator and six volunteers are provided to show the feasibility of the proposed system and its performances. The results demonstrate that, leveraging on our system, the operator was able to directly control volunteers’ hands movements.

Impedance control in a wave-based teleoperator for rehabilitation motor therapies assisted by robots

This paper presents an improved wave-based bilateral teleoperation scheme for rehabilitation therapies assisted by robot manipulators. The main feature of this bilateral teleoperator is that both robot manipulators, master and slave, are controlled by impedance. Thus, a pair of motion-based adaptive impedance controllers are integrated into a wave-based configuration, in order to guarantee a stable human-robot interaction and to compensate the position drift, characteristic of the available schemes of bilateral teleoperation. Moreover, the teleoperator stability, in the presence of time delays in the communication channel, is guaranteed because the wave-variable approach is included to encode the force and velocity signals. It should be noted that the proposed structure enables the implementation of several teleoperator schemes, from passive therapies, without the intervention of a human operator on the master side, to fully active therapies where both manipulators interact with humans in a stable manner. The suitable performance of the proposed teleoperator is verified through some results obtained from the simulation of the passive and active-constrained modes, by considering typical tasks in motor-therapy rehabilitation, where an improved behavior is observed when compared to implementations of the classical wave-based approach.

Body-Sensor-Network-Based Kinematic Characterization and Comparative Outlook of UPDRS Scoring in Leg Agility, Sit-to-Stand, and Gait Tasks in Parkinson's Disease

Recently, we have proposed a body-sensor-network-based approach, composed of a few body-worn wireless inertial nodes, for automatic assignment of Unified Parkinson's Disease Rating Scale (UPDRS) scores in the following tasks: Leg agility (LA), Sit-to-Stand (S2S), and Gait (G). Unlike our previous works and the majority of the published studies, where UPDRS tasks were the sole focus, in this paper, we carry out a comparative investigation of the LA, S2S, and G tasks. In particular, after providing an accurate description of the features identified for the kinematic characterization of the three tasks, we comment on the correlation between the most relevant kinematic parameters and the UPDRS scoring. We analyzed the performance achieved by the automatic UPDRS scoring system and compared the estimated UPDRS evaluation with the one performed by neurologists, showing that the proposed system compares favorably with typical interrater variability. We then investigated the correlations between the UPDRS scores assigned to the various tasks by both the neurologists and the automatic system. The results, based on a limited number of subjects with Parkinson's disease (PD) (34 patients, 47 clinical trials), show poor-to-moderate correlations between the UPDRS scores of different tasks, highlighting that the patients' motor performance may vary significantly from one task to another, since different tasks relate to different aspects of the disease. An aggregate UPDRS score is also considered as a concise parameter, which can provide additional information on the overall level of the motor impairments of a Parkinson's patient. Finally, we discuss a possible implementation of a practical e-health application for the remote monitoring of PD patients.

Users perspectives on interactive distance technology enabling home-based motor training for stroke patients

The aim of this work has been to develop a technical support enabling home-based motor training after stroke. The basis for the work plan has been to develop an interactive technical solution supporting three different groups of stroke patients: (1) patients with stroke discharged from hospital with support from neuro team; (2) patients with stroke whose support from neuro team will be phased out and (3) patients living with impaired motor functions long-term. The technology has been developed in close collaboration with end-users using a method earlier evaluated and described [12]. This paper describes the main functions of the developed technology. Further, results from early user-tests with end-users, performed to identify needs for improvements to be carried out during further technical development. The developed technology will be tested further in a pilot study of the safety and, usefulness of the technology when applied as a support for motor training in three different phases of the post-stroke rehabilitation process.

A Kinect based intelligent e-rehabilitation system in physical therapy

This paper presents an intelligent Kinect and fuzzy inference system based e-rehabilitation system. The Kinect can detect the posture and motion of the patients while the fuzzy inference system can interpret the acquired data on the cognitive level. The system is capable to assess the initial posture and motion ranges of 20 joints. Using angles to describe the motion of the joints, exercise patterns can be developed for each patient. Using the exercise descriptors the fuzzy inference system can track the patient and deliver real-time feedback to maximize the efficiency of the rehabilitation. The first laboratory tests confirm the utility of this system for the initial posture detection, motion range and exercise tracking.