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Bajuaifer S, Grey MJ, Hancock NJ, Chandler E, Pomeroy VM. Maximum tolerable daily dose of mirror movement therapy ankle exercises after stroke: an early phase dose screening study. Physiotherapy 2024; 122:30-39. [PMID: 38237263 DOI: 10.1016/j.physio.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 09/28/2023] [Accepted: 10/29/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Mirror movement therapy may reduce lower limb motor impairment after stroke. The dose is unknown. OBJECTIVE identify the maximum tolerable dose a day (MTD) of lower limb mirror movement therapy DESIGN: 3 + 3 cohort rule-based, dose escalation/de-escalation study. After undertaking baseline measures participants performed mirror movement therapy for 14 consecutive days. Participants then undertook outcome measures. Cohort One trained for 15 minutes daily. Subsequent cohorts exercised at a dose set according to pre-set rules and the modified Fibonacci sequence. The study stopped when the difference between set doses for consecutive cohorts was 10% or less. SETTING Participants' homes (intervention) and a movement analysis laboratory (measures). PARTICIPANTS Adults discharged from statutory stroke rehabilitation services. INTERVENTION Mirror movement therapy ankle exercises. OUTCOME MEASURES Motricity Index (primary) and bilateral time symmetry from movement onset to peak activation of Tibialis Anterior muscles during standardised sit-to-stand (secondary). RESULTS Five cohorts of three participants were included (n = 15). Mean (SD) age and time after stroke were 61 (9) years and 35 (42) months respectively. Set daily doses for the five cohorts were: 15, 30, 50, 40 then 35 minutes. The set dose for a subsequent cohort (six) would have been 38 minutes thus the difference from cohort five would have been three minutes i.e., 9% different. Therefore, the study stopped CONCLUSION: The identified MTD of lower limb mirror therapy was 35 minutes daily when frequency was set at seven days a week and duration as two weeks. CLINICAL TRIAL REGISTRATION NUMBER NCT04339803 (ClinicalTrials.gov) CONTRIBUTION OF THE PAPER: This early phase study found that the maximum tolerable dose per day (MTD) of mirror movement therapy ankle exercises was 35 minutes when frequency was set at seven days a week and duration as two weeks. The optimal therapeutic dose will therefore be somewhere in the range of 15 (starting dose) to 35 minutes per day. Further dose articulation studies are required to identify the optimal therapeutic dose before use of findings in clinical practice. This study is the first step in that research process.
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Li Y, Wang Q, Liu XL, Hui R, Zhang YP. Effect of the physical rehabilitation program based on self-care ability in patients with acute ischemic stroke: a quasi-experimental study. Front Neurol 2023; 14:1181651. [PMID: 37360351 PMCID: PMC10288520 DOI: 10.3389/fneur.2023.1181651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/10/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction It is the most practical goal of limb rehabilitation for stroke patients to make the upper limb, trunk, and lower limb joints link together as a whole and restore the ability to self-care. However, many previous studies focused on the single joint or single muscle group movement of stroke patients and did not integrate self-care ability training into the whole process of rehabilitation, which lacks accuracy, integrity, and systematization. Methods A quasi-experimental study was conducted in a tertiary hospital. Eligible patients were recruited according to the inclusion criteria and exclusion criteria and then divided into an experimental group (n = 80) and a control group (n = 80) by the medical district. The control group received the routine physical rehabilitation intervention. The experimental group adopted the physical rehabilitation program based on self-care ability led by the nurses specializing in stroke rehabilitation to carry out the multi-joint coordinated exercise based on the control group. The training time and frequency were the same in both groups (45 min per session, one session per day for three consecutive months). The primary outcome was myodynamia. Secondary outcomes were the modified Barthel Index (MBI) and Stroke Specific Quality of Life Scale (SS-QOL). The primary and secondary outcomes were assessed before the intervention and at 1 and 3 months of intervention. In this study, the TREND checklist was followed for non-randomized controlled trials. Results A total of 160 participants completed the study. The physical rehabilitation program based on self-care ability was better than the routine rehabilitation program. With the prolongation of intervention time, all outcomes improved gradually in the experimental group (P < 0.05), and the myodynamia of lower limbs recovered faster than that of upper limbs. In the control group, the myodynamia of the affected limb was not significantly improved (P > 0.05), with only a small increase in MBI and SS-QOL scores (P < 0.05). Conclusion The physical rehabilitation program based on self-care ability after stroke was beneficial for acute ischemic stroke patients and improved the patient's myodynamia, quality of life, and self-care ability within the third month.
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Affiliation(s)
- Ying Li
- Department of Nursing, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Qian Wang
- Department of Neurology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Xiao-Ling Liu
- Department of Neurology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Rong Hui
- Department of Nursing, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Yin-Ping Zhang
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
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Rüth M, Schmelzer M, Burtniak K, Kaspar K. Commercial exergames for rehabilitation of physical health and quality of life: a systematic review of randomized controlled trials with adults in unsupervised home environments. Front Psychol 2023; 14:1155569. [PMID: 37333591 PMCID: PMC10272737 DOI: 10.3389/fpsyg.2023.1155569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/02/2023] [Indexed: 06/20/2023] Open
Abstract
Background Commercial exergames are widely available tools that can support physical rehabilitation at home. However, the effects of the unsupervised use of commercial exergames in home environments are not yet clear. Hence, we provide a systematic review on the effects of unsupervised commercial exergaming at home on adults' physical health (RQ1) and quality of life (RQ2). We also scrutinize adults' experiences with exergaming at home regarding participant support, adherence, and adverse outcomes (RQ3). Methods We searched Web of Science, PsycINFO, PubMed, Embase, and CINAHL for peer-reviewed randomized controlled trials with adults in need of rehabilitation. Overall, 20 studies (1,558 participants, 1,368 analyzed) met our inclusion criteria. The quality of evidence was assessed with the Cochrane risk of bias tool. Results Effects of unsupervised commercial exergaming at home on physical health were higher in seven studies and similar in five studies regarding the respective comparison or control conditions; eight studies reported non-significant findings. Of the 15 studies that also examined effects on quality of life, improvements were higher in seven studies and similar in two studies regarding the respective comparison or control conditions; results were non-significant in six studies. Participant support consisted of setup of the exergaming system, instructions, training, and contact with participants. Adherence was high in eight studies, moderate in six studies, and low in one study. Adverse outcomes related to exergaming were found in four studies and were at most moderate. Concerning the quality of evidence, six studies were related to a high risk of bias due to outcome reporting bias or ceiling effects in the primary outcome. Additionally, 10 studies yielded some concerns, and four studies were related to a low risk of bias. Discussion This systematic review summarizes promising evidence that the unsupervised use of commercial exergames can support and complement rehabilitation measures in home environments. Still, future studies based on larger samples and using more recent commercial exergames are needed to obtain more high-quality evidence on the effects of different exercise prescriptions. Overall, considering the necessary precautions, the unsupervised use of commercial exergames at home can improve the physical health and quality of life in adults with needs for physical rehabilitation. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022341189, identifier: PROSPERO, Registration number: CRD42022341189.
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Khokale R, S Mathew G, Ahmed S, Maheen S, Fawad M, Bandaru P, Zerin A, Nazir Z, Khawaja I, Sharif I, Abdin ZU, Akbar A. Virtual and Augmented Reality in Post-stroke Rehabilitation: A Narrative Review. Cureus 2023; 15:e37559. [PMID: 37193429 PMCID: PMC10183111 DOI: 10.7759/cureus.37559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/18/2023] Open
Abstract
Virtual reality (VR) and augmented reality (AR) are noble adjunctive technologies currently being studied for the neuro-rehabilitation of post-stroke patients, potentially enhancing conventional therapy. We explored the literature to find if VR/AR improves neuroplasticity in stroke rehabilitation for a better quality of life. This modality can lay the foundation for telerehabilitation services in remote areas. We analyzed four databases, namely Cochrane Library, PubMed, Google Scholar, and Science Direct, by searching the following keywords: ("Stroke Rehabilitation" [Majr]) AND ("Augmented Reality" [Majr]), Virtual Augmented Reality in Stroke Rehabilitation. All the available open articles were reviewed and outlined. The studies conclude that VR/AR can help in early rehabilitation and yield better results in post-stroke patients in adjunct to conventional therapy. However, due to the limited research on this subject, we cannot conclude that this information is absolute. Moreover, VR/AR was seldom customized according to the needs of stroke survivors, which would have given us the full extent of its application. Around the world, stroke survivors are being studied to verify the accessibility and practicality of these innovative technologies. Observations conclude that further exploration of the extent of the implementations and efficacy of VR and AR, combined with conventional rehabilitation, is fundamental.
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Affiliation(s)
- Rhutuja Khokale
- Neurology, California Institute of Behavioral Neurosciences & Psychology LLC, Fairfield, USA
| | | | - Somi Ahmed
- Intensive Care Unit, Sumeru City Hospital, Lalitpur, NPL
| | - Sara Maheen
- General Medicine, Odessa National Medical University, Odessa, UKR
| | - Moiz Fawad
- Neurological Surgery, King Saud Medical City, Riyadh, SAU
| | | | - Annu Zerin
- Internal Medicine, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Zahra Nazir
- Internal Medicine, Combined Military Hospital, Quetta, PAK
| | - Imran Khawaja
- Internal Medicine, Ayub Medical Institute, Abottabad, PAK
| | - Imtenan Sharif
- Community Medicine, Quetta Institute of Medical Sciences, Quetta, PAK
| | - Zain U Abdin
- Medicine, District Head Quarter Hospital, Faisalabad, PAK
| | - Anum Akbar
- Pediatrics, University of Nebraska Medical Center, Omaha, USA
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Stockbridge MD, Bunker LD, Hillis AE. Reversing the Ruin: Rehabilitation, Recovery, and Restoration After Stroke. Curr Neurol Neurosci Rep 2022; 22:745-755. [PMID: 36181577 PMCID: PMC9525934 DOI: 10.1007/s11910-022-01231-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Stroke is a common cause of disability in aging adults. A given individual's needs after stroke vary as a function of the stroke extent and location. The purpose of this review was to discuss recent clinical investigations addressing rehabilitation of an array of overlapping functional domains. RECENT FINDINGS Research is ongoing in the domains of movement, cognition, attention, speech, language, swallowing, and mental health. To best assist patients' recovery, innovative research has sought to develop and evaluate behavioral approaches, identify and refine synergistic approaches that augment the response to behavioral therapy, and integrate technology where appropriate, particularly to introduce and titrate real-world complexity and improve the overall experience of therapy. Recent and ongoing trials have increasingly adopted a multidisciplinary nature - augmenting refined behavioral therapy approaches with methods for increasing their potency, such as pharmaceutical or electrical interventions. The integration of virtual reality, robotics, and other technological advancements has generated immense excitement, but has not resulted in consistent improvements over more universally accessible, lower technology therapy.
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Affiliation(s)
- Melissa D Stockbridge
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 4, Suite 446, Baltimore, MD, 21287, USA.
| | - Lisa D Bunker
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 4, Suite 446, Baltimore, MD, 21287, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 4, Suite 446, Baltimore, MD, 21287, USA
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Park J, Jeong S. The analysis of nursing diagnoses determined by students for patients in rehabilitation units. J Exerc Rehabil 2022; 18:299-307. [PMID: 36420472 PMCID: PMC9650313 DOI: 10.12965/jer.2244336.168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/24/2022] [Indexed: 03/21/2024] Open
Abstract
This study aimed to analyze nursing diagnoses determined by the nursing students for patients in rehabilitation unit. Data were collected from 190 case reports submitted by the nursing students who practiced in the rehabilitation unit, and analyzed on the basis of North American Nursing Diagnosis Association (NANDA) International, Inc. nursing diagnoses. Thirty different diagnoses were documented in rehabilitation unit. The most frequent nursing diagnosis was impaired physical mobility (n=68, 14.6%). The 30 diagnoses were grouped into 10 domains and 20 classes of the NANDA International, Inc. human response patterns. The average quality of nursing statements corresponded to a score of 8.63, indicating relatively good quality. The results of this study will help to improve the quality of nursing process education and provide guidelines to improve the quality of nursing care for the rehabilitation nursing situation in Korea.
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Affiliation(s)
- Jeongeun Park
- Department of Medical Informatics, School of Medicine, Kyungpook National University, Daegu,
Korea
- Department of Nursing, Kwangju Women’s University, Kwangju,
Korea
| | - Sungmoon Jeong
- Department of Medical Informatics, School of Medicine, Kyungpook National University, Daegu,
Korea
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Meng G, Ma X, Chen P, Xu S, Li M, Zhao Y, Jin A, Liu X. Effect of early integrated robot-assisted gait training on motor and balance in patients with acute ischemic stroke: a single-blinded randomized controlled trial. Ther Adv Neurol Disord 2022; 15:17562864221123195. [PMID: 36147622 PMCID: PMC9486263 DOI: 10.1177/17562864221123195] [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: 05/26/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Gait disruption is a common poststroke problem. Robot-assisted gait training
(RAGT) might improve motor function, balance, and activities of daily
living. Objective: We compared the clinical effectiveness of early integrated RAGT using the
Walkbot robotic gym with an intensity-matched enhanced lower limb therapy
(ELLT) program and with conventional rehabilitation therapy (CRT) in
patients with acute ischemic stroke. Methods: A total of 192 patients with acute ischemic stroke were randomly assigned
(1:1:1) to receive RAGT, ELLT, or CRT. All three groups received 45 min of
training daily, 3 days a week, for 4 weeks consecutively. Before and after
the 4-week treatment, the patients were assessed based on a 6-minute walking
test (6MWT), functional ambulation classification (FAC), timed up and go
(TUG) test, dual-task walking (DTW) test, Tinetti’s test, Barthel’s index
(BI), stroke-specific quality of life (SS-QOL) scale, and gait analysis
parameters. Results: After the 4-week intervention, the results of the 6MWT, FAC, TUG, DTW,
Tinetti’s test, BI, SS-QOL, and gait in the three groups significantly
improved. Compared with ELLT and CRT groups, participants in the RAGT group
had a better performance in 6MWT (199.11 ± 60.72 versus
182.47 ± 59.72 versus 173.69 ± 40.58,
p = 0.035), FAC (4.10 ± 0.91 versus
3.69 ± 0.88 versus 3.58 ± 0.81,
p = 0.044), DTW (10.29 ± 2.38 versus
12.92 ± 2.64 versus 13.89 ± 2.62,
p = 0.031), SS-QOL (184.46 ± 20.53 versus
165.39 ± 20.49 versus 150.72 ± 20.59,
p = 0.012), velocity (0.66 ± 0.22 versus
0.55 ± 0.23 versus 0.51 ± 0.20,
p = 0.008), cycle duration (1.38 ± 0.40
versus 1.50 ± 0.38 versus 1.61 ± 0.30,
p = 0.040), and swing phase symmetry ratio (SPSR,
1.10 ± 0.33 versus 1.21 ± 0.22 versus
1.48 ± 0.25, p = 0.021). The TUG, Tinetti’s test, BI, and
RMT results were similar, however. Conclusion: In the acute stroke phase, early integrated RAGT showed greater performance
in gait rehabilitation than CRT and ELLT. Registration: ChiCTR1900026225
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Affiliation(s)
- Guilin Meng
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoye Ma
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Pengfei Chen
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shaofang Xu
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mingliang Li
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yichen Zhao
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Aiping Jin
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Yanchang Road, Shanghai 200072, China
| | - Xueyuan Liu
- Neurorehabilitation Center, Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Yanchang Road, Shanghai 200072, China
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Everard G, Declerck L, Detrembleur C, Leonard S, Bower G, Dehem S, Lejeune T. New technologies promoting active upper limb rehabilitation after stroke: an overview and network meta-analysis. Eur J Phys Rehabil Med 2022; 58:530-548. [PMID: 35666491 PMCID: PMC9980549 DOI: 10.23736/s1973-9087.22.07404-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The primary aim of this work was to summarize and compare the effects of active rehabilitation assisted by new technologies (virtual reality [VR], robot-assisted therapy [RAT] and telerehabilitation [TR)) on upper limb motor function and everyday living activity during the subacute and chronic phases of stroke. The secondary aims were to compare the effects of these technologies according to the intervention design (in addition to or in substitution of conventional therapy), the duration of active rehabilitation and the severity of patients' motor impairments. EVIDENCE ACQUISITION Several databases, namely PubMed, Scopus, Embase and Cochrane Library, were searched. Studies were included if they were meta-analyses with a moderate to high level of confidence (assessed with AMSTAR-2) that compared the effects of a new technology promoting active rehabilitation to that of a conventional therapy program among patients with stroke. Network meta-analyses were conducted to compare the effects of the new technologies. EVIDENCE SYNTHESIS Eighteen different meta-analyses were selected and fifteen included in the quantitative analysis. In total these 15 meta-analyses were based on 189 different randomized controlled trials. VR (SMD≥0.25; P<0.05), RAT (SMD≥0.29; P≤0.29) and TR (SMD≥-0.08; P≤0.64) were found to be at least as effective as conventional therapy. During the subacute phase, RAT's greatest effect was observed for patients with severe-moderate impairments whereas VR and TR's greatest effects were observed for patients with mild impairments. During the chronic phase, the highest effects were observed for patients with mild impairments, for all studies technologies. Network meta-analyses showed that VR and RAT were both significantly superior to TR in improving motor function during the chronic phase but revealed no significant difference between VR, RAT and TR effectiveness on both motor function (during the subacute phase) and activity (during both chronic and subacute phase). CONCLUSIONS This overview provides low-to-moderate evidence that rehabilitation assisted with technologies are at least as effective as conventional therapy for patients with stroke. While VR and RAT seem to be more efficient during the subacute phase, all technologies seem to be as efficient as one another in the chronic phase.
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Affiliation(s)
- Gauthier Everard
- Section of Health Sciences, Neuro Musculo Skeletal Lab (NMSK), Institute of Experimental and Clinical Research, Catholic University of Louvain, Brussels, Belgium.,Louvain Bionics, Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Louise Declerck
- Section of Health Sciences, Neuro Musculo Skeletal Lab (NMSK), Institute of Experimental and Clinical Research, Catholic University of Louvain, Brussels, Belgium
| | - Christine Detrembleur
- Section of Health Sciences, Neuro Musculo Skeletal Lab (NMSK), Institute of Experimental and Clinical Research, Catholic University of Louvain, Brussels, Belgium.,Louvain Bionics, Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Sophie Leonard
- Section of Health Sciences, Neuro Musculo Skeletal Lab (NMSK), Institute of Experimental and Clinical Research, Catholic University of Louvain, Brussels, Belgium
| | - Glenn Bower
- Section of Health Sciences, Neuro Musculo Skeletal Lab (NMSK), Institute of Experimental and Clinical Research, Catholic University of Louvain, Brussels, Belgium
| | - Stéphanie Dehem
- Section of Health Sciences, Neuro Musculo Skeletal Lab (NMSK), Institute of Experimental and Clinical Research, Catholic University of Louvain, Brussels, Belgium.,Louvain Bionics, Catholic University of Louvain, Louvain-la-Neuve, Belgium.,Service of Physical Medicine and Rehabilitation, Saint-Luc Clinical Universities, Brussels, Belgium
| | - Thierry Lejeune
- Section of Health Sciences, Neuro Musculo Skeletal Lab (NMSK), Institute of Experimental and Clinical Research, Catholic University of Louvain, Brussels, Belgium - .,Louvain Bionics, Catholic University of Louvain, Louvain-la-Neuve, Belgium.,Service of Physical Medicine and Rehabilitation, Saint-Luc Clinical Universities, Brussels, Belgium
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Baluz R, Teles A, Fontenele JE, Moreira R, Fialho R, Azevedo P, Sousa D, Santos F, Bastos VH, Teixeira S. Motor Rehabilitation of Upper Limbs Using a Gesture-Based Serious Game: Evaluation of Usability and User Experience. Games Health J 2022; 11:177-185. [PMID: 35294849 DOI: 10.1089/g4h.2022.0005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Gesture-based serious games can be based on playful and interactive scenarios to enhance user engagement and experience during exercises, thereby increasing efficiency in the motor rehabilitation process. This study aimed to develop the Rehabilite Game (RG) as a complementary therapy tool for upper limb rehabilitation in clinics and home environments and to evaluate aspects of usability and user experience of it. Materials and Methods: The evaluation consisted of the use of a gesture-based serious game with motor rehabilitation sessions managed in a web platform. Thirty-three participants were recruited (21 physiotherapists and 12 patients). The protocol allowed each participant to have the experience of playing sessions with different combinations of settings. The User Experience Questionnaire (UEQ) was used to evaluate aspects of usability and user experience. The study was approved by the Research Ethics Board of the Federal University of Piaui (number 3,429,494). Results: The level of satisfaction with the RG was positive, with an excellent Net Promoter Score for 85.7% of physiotherapists and 100% of patients. All six UEQ scales (attractiveness, perspicuity, efficiency, dependability, stimulation, and novelty) reflected acceptance. Conclusion: The study demonstrated that, according to the results obtained in the experiments, the RG had positive feedback from physiotherapists and patients, indicating that the game can be used in a clinical trial to be compared with other rehabilitation techniques.
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Affiliation(s)
- Rodrigo Baluz
- Federal University of Piauí, PhD Program in Biotechnology, Teresina, Brazil
- State University of Piauí, Computer Science Department, Parnaíba, Brazil
| | - Ariel Teles
- Federal Institute of Maranhão, Araioses, Brazil
- Parnaiba Delta Federal University, Parnaíba, Brazil
| | | | - Rayele Moreira
- Federal University of Piauí, PhD Program in Biotechnology, Teresina, Brazil
- University Center Inta, Sobral, Brazil
| | - Renan Fialho
- Parnaiba Delta Federal University, Parnaíba, Brazil
| | | | - Daniel Sousa
- Parnaiba Delta Federal University, Parnaíba, Brazil
| | | | - Victor Hugo Bastos
- Federal University of Piauí, PhD Program in Biotechnology, Teresina, Brazil
- Parnaiba Delta Federal University, Parnaíba, Brazil
| | - Silmar Teixeira
- Federal University of Piauí, PhD Program in Biotechnology, Teresina, Brazil
- Parnaiba Delta Federal University, Parnaíba, Brazil
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Abstract
The recovery treatment of motor dysfunction plays a crucial role in rehabilitation therapy. Rehabilitation robots are partially or fully replacing therapists in assisting patients in exercise by advantage of robot technologies. However, the rehabilitation training system is not yet intelligent enough to provide suitable exercise modes based on the exercise intentions of patients with different motor abilities. In this paper, a dual-modal hybrid self-switching control strategy (DHSS) is proposed to automatically determine the exercise mode of patients, i.e., passive and assistive exercise mode. In this strategy, the potential field method and the ADRC position control are employed to plan trajectories and assist patients’ training. Dual-modal self-switching rules based on the motor and impulse information of patients are presented to identify patients’ motor abilities. Finally, the DHSS assisted five subjects in performing the training with an average deviation error of less than 2 mm in both exercise modes. The experimental results demonstrate that the muscle activation of the subjects differed significantly in different modes. It also verifies that DHSS is reasonable and effective, which helps patients to train independently without therapists.
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