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Wang YH. Understanding Senior Adults' Needs, Preferences, and Experiences of Commercial Exergames for Health: Usability Study. JMIR Serious Games 2024; 12:e36154. [PMID: 38578674 PMCID: PMC11031698 DOI: 10.2196/36154] [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: 01/23/2022] [Revised: 08/25/2022] [Accepted: 09/04/2023] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Many senior adults are at risk of mental and physical disorders due to a lack of sufficient exercise. Therefore, adherent exercise should be urgently promoted to improve senior adults' muscle strength, preventing falls and conditions caused by physical and cognitive decline. However, off-the-shelf exercise games, so-called exergames, are mainly targeted at the younger generation or children, while senior adults are neglected, when this age group strongly needs exercise. Exergames could serve as a health intervention for promoting exercise. OBJECTIVE This study aimed to investigate senior adults' experience, perceptions, and acceptance of game technology to promote exercise in order to suggest game design guidelines. METHODS In this usability study, participants engaged in playing Nintendo Switch and Xbox Kinect games, after which semistructured interviews were conducted. Before the gameplay, the participants provided their background information, exercise habits, and use of technology products. Next, all participants completed a workshop including 3 activities (brief instructions on how to play the games: 20 minutes; playing the selected exergames: 80 minutes; semistructured interviews: 20 minutes) for 2 hours a day for 3 days each. The participants played the latest Nintendo Switch games (eg, Just Dance, Boxing, Ring Fit Adventure) and Xbox Kinect games (eg, Kinect Adventures!, Mini Games). Just Dance, Zumba, and Boxing were played in activity 1; Ring Fit Adventure and Mini Games in activity 2; and Kinect Adventures! in activity 3. Reflexive thematic analysis was applied to identify the relative themes generated from the interviews. RESULTS In total, 22 participants (mean age 70.4, SD 6.1 years) were enrolled in the workshop in May 2021. The results of the generated themes included incomprehension of game instructions, psychological perception of game technology, and game art preferences. The subthemes generated from game art preferences included favorite game genres, characters, and scenes. CONCLUSIONS There is a significant need for customized game tutorials considering senior adults' cognitive and physical aging. Furthermore, the adventure game genre is preferable to other games. Humanlike game characters are preferable, especially those with a fit and healthy body shape. Nature scenes are more enjoyable than indoor stages or rooms. Furthermore, the game intensity design and playing time should be carefully planned to meet the World Health Organization's criteria for physical activity in older adults. Intelligent recommendation systems might be helpful to support older adults with various health conditions. The guidelines suggested in this study might be beneficial for game design, exercise training, and game technology adoption of exergames for older adults to improve health.
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Affiliation(s)
- Yu-Han Wang
- Department of Multimedia Design, National Taichung University of Science and Technology, Taichung City, Taiwan
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Mennella C, Maniscalco U, De Pietro G, Esposito M. Generating a novel synthetic dataset for rehabilitation exercises using pose-guided conditioned diffusion models: A quantitative and qualitative evaluation. Comput Biol Med 2023; 167:107665. [PMID: 37925908 DOI: 10.1016/j.compbiomed.2023.107665] [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: 08/04/2023] [Revised: 10/11/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023]
Abstract
Machine learning has emerged as a promising approach to enhance rehabilitation therapy monitoring and evaluation, providing personalized insights. However, the scarcity of data remains a significant challenge in developing robust machine learning models for rehabilitation. This paper introduces a novel synthetic dataset for rehabilitation exercises, leveraging pose-guided person image generation using conditioned diffusion models. By processing a pre-labeled dataset of class movements for 6 rehabilitation exercises, the described method generates realistic human movement images of elderly subjects engaging in home-based exercises. A total of 22,352 images were generated to accurately capture the spatial consistency of human joint relationships for predefined exercise movements. This novel dataset significantly amplified variability in the physical and demographic attributes of the main subject and the background environment. Quantitative metrics used for image assessment revealed highly favorable results. The generated images successfully maintained intra-class and inter-class consistency in motion data, producing outstanding outcomes with distance correlation values exceeding the 0.90. This innovative approach empowers researchers to enhance the value of existing limited datasets by generating high-fidelity synthetic images that precisely augment the anthropometric and biomechanical attributes of individuals engaged in rehabilitation exercises.
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Affiliation(s)
- Ciro Mennella
- Institute for High-Performance Computing and Networking (ICAR) - Research National Council of Italy (CNR), Italy.
| | - Umberto Maniscalco
- Institute for High-Performance Computing and Networking (ICAR) - Research National Council of Italy (CNR), Italy.
| | - Giuseppe De Pietro
- Institute for High-Performance Computing and Networking (ICAR) - Research National Council of Italy (CNR), Italy
| | - Massimo Esposito
- Institute for High-Performance Computing and Networking (ICAR) - Research National Council of Italy (CNR), Italy
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Mennella C, Maniscalco U, Pietro GD, Esposito M. A deep learning system to monitor and assess rehabilitation exercises in home-based remote and unsupervised conditions. Comput Biol Med 2023; 166:107485. [PMID: 37742419 DOI: 10.1016/j.compbiomed.2023.107485] [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: 06/12/2023] [Revised: 08/31/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023]
Abstract
In the domain of physical rehabilitation, the progress in machine learning and the availability of cost-effective motion capture technologies have paved the way for innovative systems capable of capturing human movements, automatically analyzing recorded data, and evaluating movement quality. This study introduces a novel, economically viable system designed for monitoring and assessing rehabilitation exercises. The system enables real-time evaluation of exercises, providing precise insights into deviations from correct execution. The evaluation comprises two significant components: range of motion (ROM) classification and compensatory pattern recognition. To develop and validate the effectiveness of the system, a unique dataset of 6 resistance training exercises was acquired. The proposed system demonstrated impressive capabilities in motion monitoring and evaluation. Notably, we achieved promising results, with mean accuracies of 89% for evaluating ROM-class and 98% for classifying compensatory patterns. By complementing conventional rehabilitation assessments conducted by skilled clinicians, this cutting-edge system has the potential to significantly improve rehabilitation practices. Additionally, its integration in home-based rehabilitation programs can greatly enhance patient outcomes and increase access to high-quality care.
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Affiliation(s)
- Ciro Mennella
- Institute for High-Performance Computing and Networking (ICAR) - Research National Council of Italy (CNR), Italy.
| | - Umberto Maniscalco
- Institute for High-Performance Computing and Networking (ICAR) - Research National Council of Italy (CNR), Italy.
| | - Giuseppe De Pietro
- Institute for High-Performance Computing and Networking (ICAR) - Research National Council of Italy (CNR), Italy
| | - Massimo Esposito
- Institute for High-Performance Computing and Networking (ICAR) - Research National Council of Italy (CNR), Italy
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Rossi LP, Granger BB, Bruckel JT, Crabbe DL, Graven LJ, Newlin KS, Streur MM, Vadiveloo MK, Walton-Moss BJ, Warden BA, Volgman AS, Lydston M. Person-Centered Models for Cardiovascular Care: A Review of the Evidence: A Scientific Statement From the American Heart Association. Circulation 2023; 148:512-542. [PMID: 37427418 DOI: 10.1161/cir.0000000000001141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Cardiovascular disease remains the leading cause of death and disability in the United States and globally. Disease burden continues to escalate despite technological advances associated with improved life expectancy and quality of life. As a result, longer life is associated with multiple chronic cardiovascular conditions. Clinical guidelines provide recommendations without considering prevalent scenarios of multimorbidity and health system complexities that affect practical adoption. The diversity of personal preferences, cultures, and lifestyles that make up one's social and environmental context is often overlooked in ongoing care planning for symptom management and health behavior support, hindering adoption and compromising patient outcomes, particularly in groups at high risk. The purpose of this scientific statement was to describe the characteristics and reported outcomes in existing person-centered care delivery models for selected cardiovascular conditions. We conducted a scoping review using Ovid MEDLINE, Embase.com, Web of Science, CINAHL Complete, Cochrane Central Register of Controlled Trials through Ovid, and ClinicalTrials.gov from 2010 to 2022. A range of study designs with a defined aim to systematically evaluate care delivery models for selected cardiovascular conditions were included. Models were selected on the basis of their stated use of evidence-based guidelines, clinical decision support tools, systematic evaluation processes, and inclusion of the patient's perspective in defining the plan of care. Findings reflected variation in methodological approach, outcome measures, and care processes used across models. Evidence to support optimal care delivery models remains limited by inconsistencies in approach, variation in reimbursement, and inability of health systems to meet the needs of patients with chronic, complex cardiovascular conditions.
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Tadayon H, Farzandipour M, Nabovati E, Akbari H, Masoud SA. Effect of mobile-based self-management application on stroke outcomes: a study protocol for triple blinded randomized controlled trial. BMC Med Inform Decis Mak 2022; 22:292. [DOI: 10.1186/s12911-022-02033-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Stroke is the main leading cause of long-term disabilities in the world. This protocol will be implemented for a study to evaluate the effects of an Android-based self-care application on patients with stroke.
Methods
The first stage will include the development of an android-based application using JAVA programming language for developing the user interface and ASP.NET Core for developing Web server. The second stage will be conducted using triple blinded randomized clinical trial (RCT). The sample size will include 60 patients with recent stroke and partial paralysis of limbs, who will be divided into two groups of intervention and control through permuted block randomization method. Patients in both groups will receive usual medical care, but those in the intervention group will also use an Android-based application for a period of two months. Outcomes will be assessed using valid and reliable questionnaires.
Discussion
The assessed outcomes will include stroke severity using National Institute of Health Stroke Scale (NIHSS) score, ability to perform activities of daily living using Barthel Index (BI) score, depression rate using Beck Depression Inventory (BDI-II) score, quality of life using EQ-5D-3L score, medication adherence using Modified Morisky Medication Adherence Scale (MMAS-8) score, patient satisfaction using Patient Satisfaction Questionnaire (PSQ) score and the number and type of complications in patients in two groups. These outcomes will be assessed at baseline, after two months and after three months from the beginning of the intervention. Intervention effects on the measured variables will also be evaluated using appropriate statistical tests based on the type of variable distribution. Potential consequences of the study might be the improvement of the measured variables in the intervention group compared to that of the control group. The expected results are that the intervention may significantly improve the status of the measured variables in the intervention group compared to that of the control group. If the outcomes of the intervention group do not change significantly compared to those of the control group, it can be due to different reasons. However, this can most likely be attributed to incorrect or insufficient use of the application by patients.
Trial registration: This protocol is registered in the Iranian registration of clinical trial (IRCT) on November 7, 2020 with the code IRCT20201015049037N1. URL: https://irct.ir/trial/51674
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Borstad A, Nichols-Larsen D, Uswatte G, Strahl N, Simeo M, Proffitt R, Gauthier L. Tactile Sensation Improves Following Motor Rehabilitation for Chronic Stroke: The VIGoROUS Randomized Controlled Trial. Neurorehabil Neural Repair 2022; 36:525-534. [PMID: 35695197 DOI: 10.1177/15459683221107893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Up to 85% of people with chronic stroke experience somatosensory impairment, which contributes to poor sensorimotor control and non-use of the affected limb. Neurophysiological mechanisms suggest motor rehabilitation may improve tactile sense post-stroke, however, somatosensory recovery has rarely been reported in controlled trials. Objective. To compare the effect of four upper limb motor rehabilitation programs on the recovery of tactile sensation in adults with chronic stroke. Methods. Adults with chronic stroke and mild or moderate upper extremity hemiparesis (n = 167) were enrolled in a multi-site randomized controlled trial. Participants completed three weeks of gaming therapy, gaming therapy with additional telerehabilition, Constraint-Induced Movement therapy, or traditional rehabilitation. Here, we report the results of a secondary outcome, tactile sensation, measured with monofilaments, before and after treatment, and 6 months later. Results. A mixed-effects general linear model revealed similar positive change in tactile sensitivity regardless of the type of training. On average, participants were able to detect a stimulus that was 32% and 33% less after training and at 6-month follow-up, respectively. One-third of participants experienced recategorization of their level of somatosensory impairment (e.g., regained protective sensation) following training. Poorer tactile sensation at baseline was associated with greater change. Conclusions. About one-third of individuals with mild/moderate chronic hemiparesis experience sustained improvements in tactile sensation following motor rehabilitation, regardless of the extent of tactile input in the rehabilitation program. Potential for sensory improvement is an additional motivator for those post-stroke. Characteristics of those who improve and mechanisms of improvement are important future questions. Clinicaltrials.gov NCT02631850.
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Affiliation(s)
- Alexandra Borstad
- Department of Physical Therapy, 3031College of St. Scholastica, Duluth, MN, USA
| | | | - Gitendra Uswatte
- Department of Psychology, University of Alabama Birmingham, Birmingham, AL, USA
| | | | | | - Rachel Proffitt
- Department of Occupational Therapy, University of Missouri, Columbia, MO, USA
| | - Lynne Gauthier
- Department Physical Therapy and Kinesiology, 14710University of Massachusetts Lowell, Lowell, MA, USA
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García-de-Villa S, Jiménez-Martín A, García-Domínguez JJ. A database of physical therapy exercises with variability of execution collected by wearable sensors. Sci Data 2022; 9:266. [PMID: 35661743 PMCID: PMC9166805 DOI: 10.1038/s41597-022-01387-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
This document introduces the PHYTMO database, which contains data from physical therapies recorded with inertial sensors, including information from an optical reference system. PHYTMO includes the recording of 30 volunteers, aged between 20 and 70 years old. A total amount of 6 exercises and 3 gait variations were recorded. The volunteers performed two series with a minimum of 8 repetitions in each one. PHYTMO includes magneto-inertial data, together with a highly accurate location and orientation in the 3D space provided by the optical system. The files were stored in CSV format to ensure its usability. The aim of this dataset is the availability of data for two main purposes: the analysis of techniques for the identification and evaluation of exercises using inertial sensors and the validation of inertial sensor-based algorithms for human motion monitoring. Furthermore, the database stores enough data to apply Machine Learning-based algorithms. The participants' age range is large enough to establish age-based metrics for the exercises evaluation or the study of differences in motions between different groups.
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Affiliation(s)
- Sara García-de-Villa
- University of Alcala, Department of Electronics, Alcalá de Henares, 28801, Spain.
| | - Ana Jiménez-Martín
- University of Alcala, Department of Electronics, Alcalá de Henares, 28801, Spain
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8
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Factors influencing the delivery of telerehabilitation for stroke: A systematic review. PLoS One 2022; 17:e0265828. [PMID: 35544471 PMCID: PMC9094559 DOI: 10.1371/journal.pone.0265828] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 03/08/2022] [Indexed: 11/24/2022] Open
Abstract
Objective Despite the available evidence regarding effectiveness of stroke telerehabilitation, there has been little focus on factors influencing its delivery or translation from the research setting into practice. There are complex challenges to embedding telerehabilitation into stroke services and generating transferable knowledge about scaling up and routinising this service model. This review aimed to explore factors influencing the delivery of stroke telerehabilitation interventions, including platforms, technical requirements, training, support, access, cost, usability and acceptability. Methods MEDLINE, EMBASE, CINAHL, Web of Science and Cochrane Library and Central Registry of Clinical Trials were searched to identify full-text articles of randomised controlled trials (RCTs) and protocols for RCTs published since a Cochrane review on stroke telerehabilitation services. A narrative synthesis was conducted, providing a comprehensive description of the factors influencing stroke telerehabilitation intervention delivery. Results Thirty-one studies and ten protocols of ongoing studies were included. Interventions were categorised as synchronous telerehabilitation (n = 9), asynchronous telerehabilitation (n = 11) and tele-support (n = 11). Telephone and videoconference were the most frequently used modes of delivery. Usability and acceptability with telerehabilitation were high across all platforms, although access issues and technical challenges may be potential barriers to the use of telerehabilitation in service delivery. Costs of intervention delivery and training requirements were poorly reported. Conclusions This review synthesises the evidence relating to factors that may influence stroke telerehabilitation intervention delivery at a crucial timepoint given the rapid deployment of telerehabilitation in response to the COVID-19 pandemic. It recommends strategies, such as ensuring adequate training and technical infrastructure, shared learning and consistent reporting of cost and usability and acceptability outcomes, to overcome challenges in embedding and routinising this service model and priorities for research in this area.
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Butz B, Jussen A, Rafi A, Lux G, Gerken J. A Taxonomy for Augmented and Mixed Reality Applications to Support Physical Exercises in Medical Rehabilitation—A Literature Review. Healthcare (Basel) 2022; 10:healthcare10040646. [PMID: 35455824 PMCID: PMC9028587 DOI: 10.3390/healthcare10040646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/16/2022] [Accepted: 03/26/2022] [Indexed: 12/13/2022] Open
Abstract
In the past 20 years, a vast amount of research has shown that Augmented and Mixed Reality applications can support physical exercises in medical rehabilitation. In this paper, we contribute a taxonomy, providing an overview of the current state of research in this area. It is based on a comprehensive literature review conducted on the five databases Web of Science, ScienceDirect, PubMed, IEEE Xplore, and ACM up to July 2021. Out of 776 identified references, a final selection was made of 91 papers discussing the usage of visual stimuli delivered by AR/MR or similar technology to enhance the performance of physical exercises in medical rehabilitation. The taxonomy bridges the gap between a medical perspective (Patient Type, Medical Purpose) and the Interaction Design, focusing on Output Technologies and Visual Guidance. Most approaches aim to improve autonomy in the absence of a therapist and increase motivation to improve adherence. Technology is still focused on screen-based approaches, while the deeper analysis of Visual Guidance revealed 13 distinct, reoccurring abstract types of elements. Based on the analysis, implications and research opportunities are presented to guide future work.
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Affiliation(s)
- Benjamin Butz
- Institute for Innovation Research and Management, Westphalian University of Applied Sciences, 44801 Bochum, Germany
- Correspondence:
| | - Alexander Jussen
- Human-Computer Interaction Group, Westphalian University of Applied Sciences, 45897 Gelsenkirchen, Germany; (A.J.); (J.G.)
| | - Asma Rafi
- Computer Graphics Group, Westphalian University of Applied Sciences, 45897 Gelsenkirchen, Germany; (A.R.); (G.L.)
| | - Gregor Lux
- Computer Graphics Group, Westphalian University of Applied Sciences, 45897 Gelsenkirchen, Germany; (A.R.); (G.L.)
| | - Jens Gerken
- Human-Computer Interaction Group, Westphalian University of Applied Sciences, 45897 Gelsenkirchen, Germany; (A.J.); (J.G.)
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Escalante-Gonzalbo AM, Ramírez-Graullera YS, Pasantes H, Aguilar-Chalé JJ, Sánchez-Castillo GI, Escutia-Macedo XA, Briseño-Soriano TM, Franco-Castro P, Estrada-Rosales AL, Vázquez-Abundes SE, Andrade-Morales D, Hernández-Franco J, Palafox L. Safety, Feasibility, and Acceptability of a New Virtual Rehabilitation Platform: A Supervised Pilot Study. Rehabil Process Outcome 2022; 10:11795727211033279. [PMID: 34987304 PMCID: PMC8492031 DOI: 10.1177/11795727211033279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: Stroke is the leading cause of disability in adults worldwide, with
hemiparesis being the most prevalent consequence. The use of video games and
movement sensors could contribute to improving patients’ chances of
recovery. We performed a supervised pilot study to validate the safety,
feasibility, and acceptability of a new virtual rehabilitation platform in
patients with chronic post-stroke upper limb hemiparesis. Methods: The participants (n = 9) participated in 40 rehabilitation sessions, twice a
week, for a period of 20 weeks. Their experiences with the platform were
documented using a Likert-scale survey. Changes in motor function were
evaluated using the Chedoke Arm and Hand Activity Inventory (CAHAI) and the
Wolf Motor Function Test (WMFT). Results and conclusions: All participants expressed that they enjoyed the experience and felt
comfortable using the platform. Preliminary results showed significant motor
recovery (P = .0039) according to the WMFT scores. Patients
with significant impairment showed no improvement in upper limb
task-oriented motor function after therapy. The new platform is safe and well-accepted by patients. The improvement in
motor function observed in some of the participants should be attributed to
the therapy since spontaneous functional recovery is not expected in chronic
stroke patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Lorena Palafox
- Instituto Nacional de Neurología y Neurocirugía (INNN), CDMX, México
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Gauthier LV, Nichols-Larsen DS, Uswatte G, Strahl N, Simeo M, Proffitt R, Kelly K, Crawfis R, Taub E, Morris D, Lowes LP, Mark V, Borstad A. Video game rehabilitation for outpatient stroke (VIGoROUS): A multi-site randomized controlled trial of in-home, self-managed, upper-extremity therapy. EClinicalMedicine 2022; 43:101239. [PMID: 34977516 PMCID: PMC8688168 DOI: 10.1016/j.eclinm.2021.101239] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/17/2021] [Accepted: 11/26/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Integrating behavioral intervention into motor rehabilitation is essential for improving paretic arm use in daily life. Demands on therapist time limit adoption of behavioral programs like Constraint-Induced Movement (CI) therapy, however. Self-managed motor practice could free therapist time for behavioral intervention, but there remains insufficient evidence of efficacy for a self-management approach. METHODS This completed, parallel, five-site, pragmatic, single-blind trial established the comparative effectiveness of using in-home gaming self-management as a vehicle to redirect valuable therapist time towards behavioral intervention. Community-dwelling adults with post-stroke (>6 months) mild/moderate upper extremity hemiparesis were randomized to receive one of 4 different interventions over a 3-week period: 5 h of behaviorally-focused intervention plus gaming self-management (Self-Gaming), the same with additional behaviorally-focused telerehabilitation (Tele-Gaming), 5 h of Traditional motor-focused rehabilitation, or 35 h of CI therapy. Primary outcomes assessed everyday arm use (Motor Activity Log Quality of Movement, MAL) and motor speed/function (Wolf Motor Function Test, WMFT) immediately before treatment, immediately after treatment, and 6 months later. Intent-to-treat analyses were implemented with linear mixed-effects models on data gathered from March 15, 2016 to November 21, 2019. ClinicalTrials.gov, NCT02631850. RESULTS Of 193 enrolled participants, 167 began treatment and were analyzed, 150 (90%) completed treatment, and 115 (69%) completed follow-up. Tele-Gaming and Self-Gaming produced clinically meaningful MAL gains that were 1·0 points (95% CI 0·8 to 1·3) and 0·8 points (95% CI 0·5 to 1·0) larger than Traditional care, respectively. Self-Gaming was less effective than CI therapy (-0·4 points, 95% CI -0·6 to -0·2), whereas Tele-Gaming was not (-0·2 points, 95% CI -0·4 to 0·1). Six-month retention of MAL gains across all groups was 57%. All had similar clinically-meaningful WMFT gains; six-month retention of WMFT gains was 92%. INTERPRETATION Self-managed motor-gaming with behavioral telehealth visits has outcomes similar to in-clinic CI therapy. It addresses most access barriers, requiring just one-fifth as much therapist time that is redirected towards behavioral interventions that enhance the paretic arm's involvement in daily life. FUNDING PCORI, NIH.
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Affiliation(s)
- Lynne V. Gauthier
- University of Massachusetts Lowell, Dept. Physical Therapy and Kinesiology
- Corresponding author at: University of Massachusetts Lowell, Dept. Physical Therapy and Kinesiology, HSSB 391, 113 Wilder St., Lowell, MA 01854
| | | | | | | | | | | | | | | | - Edward Taub
- University of Alabama Birmingham, Dept. of Psychology
| | - David Morris
- University of Alabama Birmingham, Dept. of Physical Therapy
| | | | - Victor Mark
- University of Alabama Birmingham, Dept. of Physical Medicine and Rehabilitation
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Bailey JE, Gurgol C, Pan E, Njie S, Emmett S, Gatwood J, Gauthier L, Rosas LG, Kearney SM, Robler SK, Lawrence RH, Margolis KL, Osunkwo I, Wilfley D, Shah VO. Early Patient-Centered Outcomes Research Experience With the Use of Telehealth to Address Disparities: Scoping Review. J Med Internet Res 2021; 23:e28503. [PMID: 34878986 PMCID: PMC8693194 DOI: 10.2196/28503] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/04/2021] [Accepted: 10/03/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Health systems and providers across America are increasingly employing telehealth technologies to better serve medically underserved low-income, minority, and rural populations at the highest risk for health disparities. The Patient-Centered Outcomes Research Institute (PCORI) has invested US $386 million in comparative effectiveness research in telehealth, yet little is known about the key early lessons garnered from this research regarding the best practices in using telehealth to address disparities. OBJECTIVE This paper describes preliminary lessons from the body of research using study findings and case studies drawn from PCORI seminal patient-centered outcomes research (PCOR) initiatives. The primary purpose was to identify common barriers and facilitators to implementing telehealth technologies in populations at risk for disparities. METHODS A systematic scoping review of telehealth studies addressing disparities was performed. It was guided by the Arksey and O'Malley Scoping Review Framework and focused on PCORI's active portfolio of telehealth studies and key PCOR identified by study investigators. We drew on this broad literature using illustrative examples from early PCOR experience and published literature to assess barriers and facilitators to implementing telehealth in populations at risk for disparities, using the active implementation framework to extract data. Major themes regarding how telehealth interventions can overcome barriers to telehealth adoption and implementation were identified through this review using an iterative Delphi process to achieve consensus among the PCORI investigators participating in the study. RESULTS PCORI has funded 89 comparative effectiveness studies in telehealth, of which 41 assessed the use of telehealth to improve outcomes for populations at risk for health disparities. These 41 studies employed various overlapping modalities including mobile devices (29/41, 71%), web-based interventions (30/41, 73%), real-time videoconferencing (15/41, 37%), remote patient monitoring (8/41, 20%), and store-and-forward (ie, asynchronous electronic transmission) interventions (4/41, 10%). The studies targeted one or more of PCORI's priority populations, including racial and ethnic minorities (31/41, 41%), people living in rural areas, and those with low income/low socioeconomic status, low health literacy, or disabilities. Major themes identified across these studies included the importance of patient-centered design, cultural tailoring of telehealth solutions, delivering telehealth through trusted intermediaries, partnering with payers to expand telehealth reimbursement, and ensuring confidential sharing of private information. CONCLUSIONS Early PCOR evidence suggests that the most effective health system- and provider-level telehealth implementation solutions to address disparities employ patient-centered and culturally tailored telehealth solutions whose development is actively guided by the patients themselves to meet the needs of specific communities and populations. Further, this evidence shows that the best practices in telehealth implementation include delivery of telehealth through trusted intermediaries, close partnership with payers to facilitate reimbursement and sustainability, and safeguards to ensure patient-guided confidential sharing of personal health information.
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Affiliation(s)
- James E Bailey
- Tennessee Population Health Consortium, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Cathy Gurgol
- Patient-Centered Outcomes Research Institute, Washington, DC, United States
| | - Eric Pan
- Westat Inc, Center for Healthcare Delivery Research and Evaluation, Rockville, MD, United States
| | - Shirilyn Njie
- Westat Inc, Center for Healthcare Delivery Research and Evaluation, Rockville, MD, United States
| | - Susan Emmett
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Duke Global Health Institute, Durham, NC, United States
| | - Justin Gatwood
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Lynne Gauthier
- Department of Physical Therapy and Kinesiology, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, United States
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
- Department of Medicine, Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
| | - Shannon M Kearney
- Solution Insights & Validation, Highmark Health, Pittsburgh, PA, United States
| | | | - Raymona H Lawrence
- Community Health Behavior and Education, Jiann-Ping College of Public Health, Georgia Southern University, Statesboro, GA, United States
| | | | - Ifeyinwa Osunkwo
- Cancer Care, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States
| | - Denise Wilfley
- Department of Psychiatry, College of Medicine, Washington University in St. Louis, St Louis, MO, United States
| | - Vallabh O Shah
- Department of Internal Medicine and Biochemistry, School of Medicine, University of New Mexico, Albuquerque, NM, United States
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Telerehabilitation—A Viable Option for the Recovery of Post-Stroke Patients. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app112110116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
As the number of stroke survivors is continuously growing, with an important number suffering from consequent functional deficits, the rehabilitation field is facing more complex demands. Technological progress gives us the opportunity to remotely assist patients while they exercise at home through telerehabilitation (TR), addressing the problems of limited medical resources and staff, difficult transportation, or living a long distance from rehabilitation centers. In addition, TR is a way to provide continuity in long-term post-stroke recovery during the COVID-19 pandemic, which limits traveling and human interaction. While the implementation of TR is increasing, the biggest challenges are to raise patients’ acceptability of the new method and their motivation and engagement during the program. In this review, we aimed to find methods to address these challenges by identifying the patients who benefit the most from this therapy and efficiently organizing the space and technology used for telerehabilitation. User-friendly technologies and devices along with therapists’ constant support and feedback are some of the most important aspects that make TR an efficient intervention and an alternative to conventional therapy.
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Allegue DR, Higgins J, Sweet SN, Archambault PS, Michaud F, Miller W, Tousignant M, Kairy D. Rehabilitation of upper extremity by telerehabilitation combined with exergames in chronic stroke survivors: Preliminary findings from a feasibility clinical trial (Preprint). JMIR Rehabil Assist Technol 2021; 9:e33745. [PMID: 35731560 PMCID: PMC9260524 DOI: 10.2196/33745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/09/2022] [Accepted: 04/29/2022] [Indexed: 02/02/2023] Open
Abstract
Background Exergames are increasingly being used among survivors of stroke with chronic upper extremity (UE) sequelae to continue exercising at home after discharge and maintain activity levels. The use of virtual reality exergames combined with a telerehabilitation app (VirTele) may be an interesting alternative to rehabilitate the UE sequelae in survivors of chronic stroke while allowing for ongoing monitoring with a clinician. Objective This study aimed to determine the feasibility of using VirTele in survivors of chronic stroke at home and explore the impact of VirTele on UE motor function, quantity and quality of use, quality of life, and motivation in survivors of chronic stroke compared with conventional therapy. Methods This study was a 2-arm feasibility clinical trial. Eligible participants were randomly allocated to an experimental group (receiving VirTele for 8 weeks) or a control group (receiving conventional therapy for 8 weeks). Feasibility was measured from the exergame and intervention logs completed by the clinician. Outcome measurements included the Fugl-Meyer Assessment-UE, Motor Activity Log-30, Stroke Impact Scale-16, and Treatment Self-Regulation Questionnaire-15, which were administered to both groups at four time points: time point 1 (T1; before starting the intervention), time point 2 (after the intervention), time point 3 (1 month after the intervention), and time point 4 (T4; 2 months after the intervention). Results A total of 11 survivors of stroke were randomized and allocated to an experimental or a control group. At the onset of the COVID-19 pandemic, participants pursued the allocated treatment for 3 months instead of 8 weeks. VirTele intervention dose was captured in terms of time spent on exergames, frequency of use of exergames, total number of successful repetitions, and frequency of videoconference sessions. Technical issues included the loss of passwords, internet issues, updates of the system, and problems with the avatar. Overall, most survivors of stroke found the technology easy to use and useful, except for 9% (1/11) of participants. For the Fugl-Meyer Assessment-UE and Motor Activity Log-30, both groups exhibited an improvement in >50% of the participants, which was maintained over time (from time point 3 to T4). Regarding Stroke Impact Scale-16 scores, the control group reported improvement in activities of daily life (3/5, 60%), hand function (5/5, 100%), and mobility (2/5, 40%), whereas the experimental group reported varied and inconclusive results (from T1 to T4). For the Treatment Self-Regulation Questionnaire-15, 75% (3/4) of the experimental group demonstrated an increase in the autonomous motivation score (from T1 to time point 2), whereas, in the control group, this improvement was observed in only 9% (1/11) of participants. Conclusions The VirTele intervention constitutes another therapeutic alternative, in addition to conventional therapy, to deliver an intense personalized rehabilitation program for survivors of chronic stroke with UE sequelae. International Registered Report Identifier (IRRID) RR2-10.2196/14629
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Affiliation(s)
- Dorra Rakia Allegue
- School of Rehabilitation, Université de Montréal, Montreal, QC, Canada
- The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
- Mission Universitaire de Tunisie, Montreal, QC, Canada
| | - Johanne Higgins
- School of Rehabilitation, Université de Montréal, Montreal, QC, Canada
- The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
| | - Shane N Sweet
- The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
- Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
| | - Philippe S Archambault
- The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Francois Michaud
- Department of Electrical Engineering and Computer Engineering, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - William Miller
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Michel Tousignant
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center of research on Aging, Sherbrooke, QC, Canada
| | - Dahlia Kairy
- School of Rehabilitation, Université de Montréal, Montreal, QC, Canada
- The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
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15
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Uswatte G, Taub E, Lum P, Brennan D, Barman J, Bowman MH, Taylor A, McKay S, Sloman SB, Morris DM, Mark VW. Tele-rehabilitation of upper-extremity hemiparesis after stroke: Proof-of-concept randomized controlled trial of in-home Constraint-Induced Movement therapy. Restor Neurol Neurosci 2021; 39:303-318. [PMID: 34459426 DOI: 10.3233/rnn-201100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although Constraint-Induced Movement therapy (CIMT) has been deemed efficacious for adults with persistent, mild-to-moderate, post-stroke upper-extremity hemiparesis, CIMT is not available on a widespread clinical basis. Impediments include its cost and travel to multiple therapy appointments. To overcome these barriers, we developed an automated, tele-health form of CIMT. OBJECTIVE Determine whether in-home, tele-health CIMT has outcomes as good as in-clinic, face-to-face CIMT in adults ≥1-year post-stroke with mild-to-moderate upper-extremity hemiparesis. METHODS Twenty-four stroke patients with chronic upper-arm extremity hemiparesis were randomly assigned to tele-health CIMT (Tele-AutoCITE) or in-lab CIMT. All received 35 hours of treatment. In the tele-health group, an automated, upper-extremity workstation with built-in sensors and video cameras was set-up in participants' homes. Internet-based audio-visual and data links permitted supervision of treatment by a trainer in the lab. RESULTS Ten patients in each group completed treatment. All twenty, on average, showed very large improvements immediately afterwards in everyday use of the more-affected arm (mean change on Motor Activity Log Arm Use scale = 2.5 points, p < 0.001, d' = 3.1). After one-year, a large improvement from baseline was still present (mean change = 1.8, p < 0.001, d' = 2). Post-treatment outcomes in the tele-health group were not inferior to those in the in-lab group. Neither were participants' perceptions of satisfaction with and difficulty of the interventions. Although everyday arm use was similar in the two groups after one-year (mean difference = -0.1, 95% CI = -1.3-1.0), reductions in the precision of the estimates of this parameter due to drop-out over follow-up did not permit ruling out that the tele-health group had an inferior long-term outcome. CONCLUSIONS This proof-of-concept study suggests that Tele-AutoCITE produces immediate benefits that are equivalent to those after in-lab CIMT in stroke survivors with chronic upper-arm extremity hemiparesis. Cost savings possible with this tele-health approach remain to be evaluated.
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Affiliation(s)
- Gitendra Uswatte
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,Department of Physical Therapy, UAB, Birmingham, AL, USA
| | - Edward Taub
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Peter Lum
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, USA
| | - David Brennan
- MedStar Telehealth Innovation Center, MedStar Institute for Innovations, Washington, DC, USA
| | - Joydip Barman
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Mary H Bowman
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Andrea Taylor
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Staci McKay
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Samantha B Sloman
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - David M Morris
- Department of Physical Therapy, UAB, Birmingham, AL, USA
| | - Victor W Mark
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,Department of Physical Medicine & Rehabilitation, UAB, Birmingham, AL, USA.,Department of Neurology, UAB, Birmingham, AL, USA
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Allegue DR, Kairy D, Higgins J, Archambault PS, Michaud F, Miller WC, Sweet SN, Tousignant M. A Personalized Home-Based Rehabilitation Program Using Exergames Combined With a Telerehabilitation App in a Chronic Stroke Survivor: Mixed Methods Case Study. JMIR Serious Games 2021; 9:e26153. [PMID: 34132649 PMCID: PMC8441601 DOI: 10.2196/26153] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/08/2021] [Accepted: 05/29/2021] [Indexed: 02/01/2023] Open
Abstract
Background In Canada, only 11% of stroke survivors have access to outpatient and community-based rehabilitation after discharge from inpatient rehabilitation. Hence, innovative community-based strategies are needed to provide adequate postrehabilitation services. The VirTele program, which combines virtual reality exergames and a telerehabilitation app, was developed to provide stroke survivors with residual upper extremity deficits, the opportunity to participate in a personalized home rehabilitation program. Objective This study aims to determine the feasibility of VirTele for remote upper extremity rehabilitation in a chronic stroke survivor; explore the preliminary efficacy of VirTele on upper extremity motor function, the amount and quality of upper extremity use, and impact on quality of life and motivation; and explore the determinants of behavioral intention and use behavior of VirTele along with indicators of empowerment. Methods A 63-year-old male stroke survivor (3 years) with moderate upper extremity impairment participated in a 2-month VirTele intervention. He was instructed to use exergames (5 games for upper extremity) for 30 minutes, 5 times per week, and conduct videoconference sessions with a clinician at least once per week. Motivational interviewing was incorporated into VirTele to empower the participant to continue exercising and use his upper extremities in everyday activities. Upper extremity motor function (Fugl-Meyer Assessment–upper extremity), amount and quality of upper extremity use (Motor Activity Log-30), and impact on quality of life (Stroke Impact Scale-16) and motivation (Treatment Self-Regulation Questionnaire-15) were measured before (T1), after (T2) VirTele intervention, and during a 1- (T3) and 2-month (T4) follow-up period. Qualitative data were collected through logs and semistructured interviews. Feasibility data (eg, number and duration of videoconference sessions and adherence) were documented at the end of each week. Results The participant completed 48 exergame sessions (33 hours) and 8 videoconference sessions. Results suggest that the VirTele intervention and the study protocol could be feasible for stroke survivors. The participant exhibited clinically meaningful improvements at T2 on the Fugl-Meyer and Stroke Impact Scale-16 and maintained these gains at T3 and T4. During the follow-up periods, the amount and quality of upper extremity use showed meaningful changes, suggesting more involvement of the affected upper extremity in daily activities. The participant demonstrated a high level of autonomous motivation, which may explain his adherence. Performance, effort, and social influence have meaningful weights in the behavioral intention of using VirTele. However, the lack of control of technical and organizational infrastructures may influence the long-term use of technology. At the end of the intervention, the participant demonstrated considerable empowerment at both the behavioral and capacity levels. Conclusions VirTele was shown to be feasible for use in chronic stroke survivors for remote upper extremity rehabilitation. Meaningful determinants of behavioral intention and use behavior of VirTele were identified, and preliminary efficacy results are promising. International Registered Report Identifier (IRRID) RR2-10.2196/14629
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Affiliation(s)
- Dorra Rakia Allegue
- School of Rehabilitation, Université de Montréal, Montreal, QC, Canada.,The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada.,Mission Universitaire de Tunisie, Montreal, QC, Canada
| | - Dahlia Kairy
- School of Rehabilitation, Université de Montréal, Montreal, QC, Canada.,The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
| | - Johanne Higgins
- School of Rehabilitation, Université de Montréal, Montreal, QC, Canada.,The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada
| | - Philippe S Archambault
- The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada.,School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Francois Michaud
- Department of Electrical Engineering and Computer Engineering, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - William C Miller
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Shane N Sweet
- The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, Montreal, QC, Canada.,Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
| | - Michel Tousignant
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada.,Center of research on Aging, Sherbrooke, QC, Canada
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Stiexs A, Chayati N. Study of Physical, Psychological, and Spiritual Impact of Family Caregiver In Home-Based Stroke Treatment: A Systematic Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Family support during stroke treatment at home is crucial. However, post-stroke patients’ long-term care will be a problem for families, reducing the level of life satisfaction and physical burden for caregivers. Furthermore, families may experience depression.
AIM: Analyzing family conditions related to physical, psychological, and spiritual conditions that receive home-based health worker interventions.
METHODS: Study implemented systematic review design with Prisma guidelines, initially with the identification of article sources, following by article screening, checking the eligibility of studies then appraised the selected articles. Three databases were used, Ebsco, PubMed, and PROQUEST. Only studies using quasi-experimental, pre-experimental, and RCT designs were included in this study. Furthermore, those articles were published between 2014 until 2019, full type article and conducted anykind of home intervention for stroke patients and/or family member. Keywords that were employed “Stroke, Apoplexy, Cerebrovascular Accident, Vascular Accident, Home Care Services, home care, Home Health Care, Domiciliary Care, Physical, Physics, Psychological Factors, Psychological Side Effects, Psychosocial Factors, Spirituality.” Totally, 19,528 articles were obtained. Finally, only six eligible articles met review requirements.
RESULTS: Implementation of home-based care lowered the physical fatigue of the family. In psychological responses showed that home-based care could reduce the incidence of depression and anxiety levels. Another impact was that the family felt helped because patients could more independently do their activities. Furthermore, the family always supported to motivate the patients to do their daily tasks.
CONCLUSION: Home-based interventions for stroke patients can reduce depression, anxiety, and fatigue for the family caregiver.
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18
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A Survey on Gamification for Health Rehabilitation Care: Applications, Opportunities, and Open Challenges. INFORMATION 2021. [DOI: 10.3390/info12020091] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Research trends in gamification have shown a significant diversity in various areas of e-health, particularly in addressing the issues of rehabilitation and physical activity. Rehabilitation requires better engaging tools that help to increase the patient’s motivation and engagement in particular forms of rehabilitation training. Adopting gamification in rehabilitation offers different treatment and care environments when implementing rehabilitation training. As gamification is increasingly being explored in rehabilitation, one might not realize that using various techniques in gamified applications yields a different effect on gameplay. To date, varied gamification techniques have been utilized to provide useful experiences from the perspective of health applications. However, a limited number of surveys have investigated the gamification of rehabilitation and the use of suitable game techniques for rehabilitation in the literature. The objective of this paper is to examine and analyze the existing gamification techniques for rehabilitation applications. A classification of rehabilitation gamification is developed based on the rehabilitation gamifying requirements and the gamification characteristics that are commonly applied in rehabilitation applications. This classification is the main contribution of this paper. It provides insight for researchers and practitioners into suitable techniques to design and apply gamification with increased motivation and sustainable engagement for rehabilitation treatment and care. In addition, different game elements, selection blocks, and gamification techniques are identified for application in rehabilitation. In conclusion, several challenges and research opportunities are discussed to improve gamification deployment in rehabilitation in the future.
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19
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Amorim P, Santos BS, Dias P, Silva S, Martins H. Serious Games for Stroke Telerehabilitation of Upper Limb - A Review for Future Research. Int J Telerehabil 2020; 12:65-76. [PMID: 33520096 PMCID: PMC7757643 DOI: 10.5195/ijt.2020.6326] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Maintaining appropriate home rehabilitation programs after stroke, with proper adherence and remote monitoring is a challenging task. Virtual reality (VR) - based serious games could be a strategy used in telerehabilitation (TR) to engage patients in an enjoyable and therapeutic approach. The aim of this review was to analyze the background and quality of clinical research on this matter to guide future research. The review was based on research material obtained from PubMed and Cochrane up to April 2020 using the PRISMA approach. The use of VR serious games has shown evidence of efficacy on upper limb TR after stroke, but the evidence strength is still low due to a limited number of randomized controlled trials (RCT), a small number of participants involved, and heterogeneous samples. Although this is a promising strategy to complement conventional rehabilitation, further investigation is needed to strengthen the evidence of effectiveness and support the dissemination of the developed solutions.
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Affiliation(s)
- Paula Amorim
- Faculty of Health Sciences, University of Beira Interior, Portugal
| | - Beatriz Sousa Santos
- Institute of Electronics and Informatics Engineering of Aveiro.,Department of Electronics Telecommunications and Informatics, University of Aveiro, Portugal
| | - Paulo Dias
- Institute of Electronics and Informatics Engineering of Aveiro.,Department of Electronics Telecommunications and Informatics, University of Aveiro, Portugal
| | - Samuel Silva
- Institute of Electronics and Informatics Engineering of Aveiro
| | - Henrique Martins
- Faculty of Health Sciences, University of Beira Interior, Portugal
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20
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Converging Evidence Supporting the Cognitive Link between Exercise and Esport Performance: A Dual Systematic Review. Brain Sci 2020; 10:brainsci10110859. [PMID: 33203067 PMCID: PMC7696945 DOI: 10.3390/brainsci10110859] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/10/2020] [Indexed: 12/14/2022] Open
Abstract
(1) Background: Research into action video games (AVG) has surged with the popularity of esports over the past three decades. Specifically, evidence is mounting regarding the importance of enhanced cognitive abilities for successful esports performance. However, due to the sedentary nature in which AVGs are played, concerns are growing with the increased engagement young adults have with AVGs. While evidence exists supporting the benefits of exercise for cognition generally in older adult, children and clinical populations, little to no work has synthesized the existing knowledge regarding the effect of exercise specifically on the cognitive abilities required for optimal esports performance in young adults. (2) Method: We conducted a dual-systematic review to identify the cognitive abilities integral to esports performance (Phase 1) and the efficacy of exercise to enhance said cognitive abilities (Phase 2). (3) Results: We demonstrate the importance of four specific cognitive abilities for AVG play (attention, task-switching, information processing, and memory abilities) and the effect that different types and durations of physical exercise has on each. (4) Conclusion: Together, these results highlight the role that exercise can have on not only combating the sedentary nature of gaming, but also its potential role in facilitating the cognitive aspects of gaming performance.
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21
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Lee HS, Lim JH, Jeon BH, Song CS. Non-immersive Virtual Reality Rehabilitation Applied to a Task-oriented Approach for Stroke Patients: A Randomized Controlled Trial. Restor Neurol Neurosci 2020; 38:165-172. [DOI: 10.3233/rnn-190975] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Hye-Sun Lee
- Department of Occupational Therapy, Gwang-ju Women's University, Gwangju, Republic of Korea
| | - Jae-Heon Lim
- Department of Physical Therapy, Wonkwang Health Science University, Jeollabuk-do, Republic of Korea
| | - Byeong-Hyeon Jeon
- Department of Physical Therapy, Graduate school, Honam University, Gwangju, Republic of Korea
| | - Chiang-Soon Song
- Deparment of Occupational Therapy, College of Health Science, Chosun University, Gwangju, Republic of Korea
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22
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Karamians R, Proffitt R, Kline D, Gauthier LV. Effectiveness of Virtual Reality- and Gaming-Based Interventions for Upper Extremity Rehabilitation Poststroke: A Meta-analysis. Arch Phys Med Rehabil 2020; 101:885-896. [DOI: 10.1016/j.apmr.2019.10.195] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 12/14/2022]
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23
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Liao Y, Vakanski A, Xian M, Paul D, Baker R. A review of computational approaches for evaluation of rehabilitation exercises. Comput Biol Med 2020; 119:103687. [PMID: 32339122 PMCID: PMC7189627 DOI: 10.1016/j.compbiomed.2020.103687] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/26/2020] [Accepted: 02/29/2020] [Indexed: 12/27/2022]
Abstract
Recent advances in data analytics and computer-aided diagnostics stimulate the vision of patient-centric precision healthcare, where treatment plans are customized based on the health records and needs of every patient. In physical rehabilitation, the progress in machine learning and the advent of affordable and reliable motion capture sensors have been conducive to the development of approaches for automated assessment of patient performance and progress toward functional recovery. The presented study reviews computational approaches for evaluating patient performance in rehabilitation programs using motion capture systems. Such approaches will play an important role in supplementing traditional rehabilitation assessment performed by trained clinicians, and in assisting patients participating in home-based rehabilitation. The reviewed computational methods for exercise evaluation are grouped into three main categories: discrete movement score, rule-based, and template-based approaches. The review places an emphasis on the application of machine learning methods for movement evaluation in rehabilitation. Related work in the literature on data representation, feature engineering, movement segmentation, and scoring functions is presented. The study also reviews existing sensors for capturing rehabilitation movements and provides an informative listing of pertinent benchmark datasets. The significance of this paper is in being the first to provide a comprehensive review of computational methods for evaluation of patient performance in rehabilitation programs.
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Affiliation(s)
- Yalin Liao
- Department of Computer Science, University of Idaho, Idaho Falls, USA
| | | | - Min Xian
- Department of Computer Science, University of Idaho, Idaho Falls, USA
| | - David Paul
- Department of Movement Sciences, University of Idaho, Moscow, USA
| | - Russell Baker
- Department of Movement Sciences, University of Idaho, Moscow, USA
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24
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Liao Y, Vakanski A, Xian M. A Deep Learning Framework for Assessing Physical Rehabilitation Exercises. IEEE Trans Neural Syst Rehabil Eng 2020; 28:468-477. [PMID: 31940544 PMCID: PMC7032994 DOI: 10.1109/tnsre.2020.2966249] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Computer-aided assessment of physical rehabilitation entails evaluation of patient performance in completing prescribed rehabilitation exercises, based on processing movement data captured with a sensory system. Despite the essential role of rehabilitation assessment toward improved patient outcomes and reduced healthcare costs, existing approaches lack versatility, robustness, and practical relevance. In this paper, we propose a deep learning-based framework for automated assessment of the quality of physical rehabilitation exercises. The main components of the framework are metrics for quantifying movement performance, scoring functions for mapping the performance metrics into numerical scores of movement quality, and deep neural network models for generating quality scores of input movements via supervised learning. The proposed performance metric is defined based on the log-likelihood of a Gaussian mixture model, and encodes low-dimensional data representation obtained with a deep autoencoder network. The proposed deep spatio-temporal neural network arranges data into temporal pyramids, and exploits the spatial characteristics of human movements by using sub-networks to process joint displacements of individual body parts. The presented framework is validated using a dataset of ten rehabilitation exercises. The significance of this work is that it is the first that implements deep neural networks for assessment of rehabilitation performance.
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25
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Laver KE, Adey‐Wakeling Z, Crotty M, Lannin NA, George S, Sherrington C. Telerehabilitation services for stroke. Cochrane Database Syst Rev 2020; 1:CD010255. [PMID: 32002991 PMCID: PMC6992923 DOI: 10.1002/14651858.cd010255.pub3] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Telerehabilitation offers an alternate way of delivering rehabilitation services. Information and communication technologies are used to facilitate communication between the healthcare professional and the patient in a remote location. The use of telerehabilitation is becoming more viable as the speed and sophistication of communication technologies improve. However, it is currently unclear how effective this model of delivery is relative to rehabilitation delivered face-to-face or when added to usual care. OBJECTIVES To determine whether the use of telerehabilitation leads to improved ability to perform activities of daily living amongst stroke survivors when compared with (1) in-person rehabilitation (when the clinician and the patient are at the same physical location and rehabilitation is provided face-to-face); or (2) no rehabilitation or usual care. Secondary objectives were to determine whether use of telerehabilitation leads to greater independence in self-care and domestic life and improved mobility, balance, health-related quality of life, depression, upper limb function, cognitive function or functional communication when compared with in-person rehabilitation and no rehabilitation. Additionally, we aimed to report on the presence of adverse events, cost-effectiveness, feasibility and levels of user satisfaction associated with telerehabilitation interventions. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (June 2019), the Cochrane Central Register of Controlled Trials (the Cochrane Library, Issue 6, 2019), MEDLINE (Ovid, 1946 to June 2019), Embase (1974 to June 2019), and eight additional databases. We searched trial registries and reference lists. SELECTION CRITERIA Randomised controlled trials (RCTs) of telerehabilitation in stroke. We included studies that compared telerehabilitation with in-person rehabilitation or no rehabilitation. In addition, we synthesised and described the results of RCTs that compared two different methods of delivering telerehabilitation services without an alternative group. We included rehabilitation programmes that used a combination of telerehabilitation and in-person rehabilitation provided that the greater proportion of intervention was provided via telerehabilitation. DATA COLLECTION AND ANALYSIS Two review authors independently identified trials on the basis of prespecified inclusion criteria, extracted data and assessed risk of bias. A third review author moderated any disagreements. The review authors contacted investigators to ask for missing information. We used GRADE to assess the quality of the evidence and interpret findings. MAIN RESULTS We included 22 trials in the review involving a total of 1937 participants. The studies ranged in size from the inclusion of 10 participants to 536 participants, and reporting quality was often inadequate, particularly in relation to random sequence generation and allocation concealment. Selective outcome reporting and incomplete outcome data were apparent in several studies. Study interventions and comparisons varied, meaning that, in many cases, it was inappropriate to pool studies. Intervention approaches included post-hospital discharge support programs, upper limb training, lower limb and mobility retraining and communication therapy for people with post-stroke language disorders. Studies were either conducted upon discharge from hospital or with people in the subacute or chronic phases following stroke. PRIMARY OUTCOME we found moderate-quality evidence that there was no difference in activities of daily living between people who received a post-hospital discharge telerehabilitation intervention and those who received usual care (based on 2 studies with 661 participants (standardised mean difference (SMD) -0.00, 95% confidence interval (CI) -0.15 to 0.15)). We found low-quality evidence of no difference in effects on activities of daily living between telerehabilitation and in-person physical therapy programmes (based on 2 studies with 75 participants: SMD 0.03, 95% CI -0.43 to 0.48). SECONDARY OUTCOMES we found a low quality of evidence that there was no difference between telerehabilitation and in-person rehabilitation for balance outcomes (based on 3 studies with 106 participants: SMD 0.08, 95%CI -0.30 to 0.46). Pooling of three studies with 569 participants showed moderate-quality evidence that there was no difference between those who received post-discharge support interventions and those who received usual care on health-related quality of life (SMD 0.03, 95% CI -0.14 to 0.20). Similarly, pooling of six studies (with 1145 participants) found moderate-quality evidence that there was no difference in depressive symptoms when comparing post-discharge tele-support programs with usual care (SMD -0.04, 95% CI -0.19 to 0.11). We found no difference between groups for upper limb function (based on 3 studies with 170 participants: mean difference (MD) 1.23, 95% CI -2.17 to 4.64, low-quality evidence) when a computer program was used to remotely retrain upper limb function in comparison to in-person therapy. Evidence was insufficient to draw conclusions on the effects of telerehabilitation on mobility or participant satisfaction with the intervention. No studies evaluated the cost-effectiveness of telerehabilitation; however, five of the studies reported health service utilisation outcomes or costs of the interventions provided within the study. Two studies reported on adverse events, although no serious trial-related adverse events were reported. AUTHORS' CONCLUSIONS While there is now an increasing number of RCTs testing the efficacy of telerehabilitation, it is hard to draw conclusions about the effects as interventions and comparators varied greatly across studies. In addition, there were few adequately powered studies and several studies included in this review were at risk of bias. At this point, there is only low or moderate-level evidence testing whether telerehabilitation is a more effective or similarly effective way to provide rehabilitation. Short-term post-hospital discharge telerehabilitation programmes have not been shown to reduce depressive symptoms, improve quality of life, or improve independence in activities of daily living when compared with usual care. Studies comparing telerehabilitation and in-person therapy have also not found significantly different outcomes between groups, suggesting that telerehabilitation is not inferior. Some studies reported that telerehabilitation was less expensive to provide but information was lacking about cost-effectiveness. Only two trials reported on whether or not any adverse events had occurred; these trials found no serious adverse events were related to telerehabilitation. The field is still emerging and more studies are needed to draw more definitive conclusions. In addition, while this review examined the efficacy of telerehabilitation when tested in randomised trials, studies that use mixed methods to evaluate the acceptability and feasibility of telehealth interventions are incredibly valuable in measuring outcomes.
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Affiliation(s)
- Kate E Laver
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareFlinders DriveAdelaideSouth AustraliaAustralia5041
| | - Zoe Adey‐Wakeling
- Southern Adelaide Local Health NetworkDivision Rehabilitation, Aged Care and Palliative CareAdelaideAustralia
| | - Maria Crotty
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareFlinders DriveAdelaideSouth AustraliaAustralia5041
| | - Natasha A Lannin
- Monash UniversityDepartment of Neuroscience, Central Clinical SchoolMelbourneAustralia
| | - Stacey George
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareFlinders DriveAdelaideSouth AustraliaAustralia5041
| | - Catherine Sherrington
- The University of SydneyInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and HealthPO Box 179Missenden RoadSydneyNSWAustralia2050
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Prayoga DH, Aridamayanti BG, Trisnawati I, Ronalia MF. Telerehabilitation System in Nursing Post Stroke - A Systematic Review. JURNAL NERS 2020. [DOI: 10.20473/jn.v14i3.17017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Stroke is currently the main cause of disability worldwide. Telerehabilitation is a rehabilitation approach that can be used to repair the damage to motor, sensory and cognitive functions. This can also substantially reduce the travel time for the health workers and therefore increase the number of patients who are consulted in a day.Method: A search using specific keywords was done in both the journal articles and in the database. In total, 119 articles were from Scopus, 45 articles were from PubMed, 87 articles were from Science Direct, 52 articles were from EBSCO and 97 articles were from Proquest. There were 15 articles that matched the inclusion criteria. Most of the available literature only refers to short-term results and most of the research is of low quality.Result: Evidence of the relative effectiveness was found in the types of videos, VR, cellphones and computer use. The location of the network support and technological progress are still obstacles that must be addressed immediately. Based on the current scientific evidence, only a few telerehabilitation methods can be recommended for wider use.Conclusion: The telerehabilitation system can provide long-term therapy, meet the patient needs and save the health resources needed to minimize the severity of the patients’ condition. The application of telerehabilitation is used by the nurses to optimize their role in improving patient health and telerehabilitation will answer the problem of penetrating the distance dimension.
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Donoso Brown EV, Nolfi D, Wallace SE, Eskander J, Hoffman JM. Home program practices for supporting and measuring adherence in post-stroke rehabilitation: a scoping review. Top Stroke Rehabil 2019; 27:377-400. [PMID: 31891554 DOI: 10.1080/10749357.2019.1707950] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND After stroke, individuals face a variety of impairments that impact function. Increasingly, rehabilitation for these impairments has moved into the community and home settings through the use of home programs. However, adherence to these programs is often low, limiting effectiveness. OBJECTIVE This scoping review investigated home program implementation and measurement of adherence with persons post-stroke to identify commonly reported practices and determine areas for further research. METHODS The electronic databases of PubMed, CINAHL, Scopus, Cochrane Database of Systematic Reviews, and PEDro were searched. Studies focused on post-stroke rehabilitation with an independent home program were selected. Qualitative studies, commentaries, and single-case studies were excluded. Title and abstract screenings were completed by two reviewers with a third for tie-breaking. The full-text review was completed by two reviewers using consensus to resolve any differences. Of the 1,197 articles initially found only 6% (n = 70) met criteria for data extraction. Elements for data extraction included: type of study, area of intervention, description of home program, presence of strategies to support adherence, methods to measure adherence and reported adherence. RESULTS Most commonly reported strategies to support home practice were the use of technology, personalization, and written directions. Only 20 studies reported achieving adherence at or greater than 75% and 18 studies did not report adherence outcomes. CONCLUSIONS Future investigations that directly compare and identify the most effective strategies to support adherence to home programs for this population are warranted. The implementation of guidelines for reporting adherence to home programs is recommended.
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Affiliation(s)
| | - David Nolfi
- Gumberg Library, Duquesne University , Pittsburgh, USA
| | - Sarah E Wallace
- Department of Speech Language Pathology, Duquesne University , Pittsburgh, PA, USA
| | - Joanna Eskander
- Department of Occupational Therapy, Duquesne University , Pittsburgh, PA, USA
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington , Seattle, WA, USA
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Rafiei MH, Kelly KM, Borstad AL, Adeli H, Gauthier LV. Predicting Improved Daily Use of the More Affected Arm Poststroke Following Constraint-Induced Movement Therapy. Phys Ther 2019; 99:1667-1678. [PMID: 31504952 PMCID: PMC7105113 DOI: 10.1093/ptj/pzz121] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/02/2019] [Accepted: 04/24/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Constraint-induced movement therapy (CI therapy) produces, on average, large and clinically meaningful improvements in the daily use of a more affected upper extremity in individuals with hemiparesis. However, individual responses vary widely. OBJECTIVE The study objective was to investigate the extent to which individual characteristics before treatment predict improved use of the more affected arm following CI therapy. DESIGN This study was a retrospective analysis of 47 people who had chronic (> 6 months) mild to moderate upper extremity hemiparesis and were consecutively enrolled in 2 CI therapy randomized controlled trials. METHODS An enhanced probabilistic neural network model predicted whether individuals showed a low, medium, or high response to CI therapy, as measured with the Motor Activity Log, on the basis of the following baseline assessments: Wolf Motor Function Test, Semmes-Weinstein Monofilament Test of touch threshold, Motor Activity Log, and Montreal Cognitive Assessment. Then, a neural dynamic classification algorithm was applied to improve prognostic accuracy using the most accurate combination obtained in the previous step. RESULTS Motor ability and tactile sense predicted improvement in arm use for daily activities following intensive upper extremity rehabilitation with an accuracy of nearly 100%. Complex patterns of interaction among these predictors were observed. LIMITATIONS The fact that this study was a retrospective analysis with a moderate sample size was a limitation. CONCLUSIONS Advanced machine learning/classification algorithms produce more accurate personalized predictions of rehabilitation outcomes than commonly used general linear models.
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Affiliation(s)
- Mohammad H Rafiei
- Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Kristina M Kelly
- Department of Neurology, The Ohio State University, Columbus, Ohio
| | - Alexandra L Borstad
- Department of Physical Therapy, The College of St Scholastica, Duluth, Minnesota
| | - Hojjat Adeli
- Department of Biomedical Informatics, Department of Neurology, Department of Neuroscience, The Ohio State University
| | - Lynne V Gauthier
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, 3 Solomon Way, Weed Hall 218D, Lowell, MA 01854 (USA)
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Williams C, Vakanski A, Lee S, Paul D. Assessment of physical rehabilitation movements through dimensionality reduction and statistical modeling. Med Eng Phys 2019; 74:13-22. [PMID: 31668858 DOI: 10.1016/j.medengphy.2019.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 09/12/2019] [Accepted: 10/14/2019] [Indexed: 11/26/2022]
Abstract
The article proposes a method for evaluation of the consistency of human movements within the context of physical therapy and rehabilitation. Captured movement data in the form of joint angular displacements in a skeletal human model is considered in this work. The proposed approach employs an autoencoder neural network to project the high-dimensional motion trajectories into a low-dimensional manifold. Afterwards, a Gaussian mixture model is used to derive a parametric probabilistic model of the density of the movements. The resulting probabilistic model is employed for evaluation of the consistency of unseen motion sequences based on the likelihood of the data being drawn from the model. The approach is validated on two physical rehabilitation movements.
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Affiliation(s)
- Christian Williams
- Industrial Technology, University of Idaho, 1776 Science Center Drive, Idaho Falls, ID, 83402, United States
| | - Aleksandar Vakanski
- Industrial Technology, University of Idaho, 1776 Science Center Drive, Idaho Falls, ID, 83402, United States.
| | - Stephen Lee
- Department of Statistical Science, University of Idaho, 875 Perimeter Drive, Moscow, ID, 83844, United States
| | - David Paul
- Department of Movement Science, University of Idaho, 875 Perimeter Drive, Moscow, ID, 83844, United States
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Zhou L, Parmanto B. Reaching People With Disabilities in Underserved Areas Through Digital Interventions: Systematic Review. J Med Internet Res 2019; 21:e12981. [PMID: 31654569 PMCID: PMC7380899 DOI: 10.2196/12981] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 08/07/2019] [Accepted: 08/21/2019] [Indexed: 01/14/2023] Open
Abstract
Background People with disabilities need rehabilitation interventions to improve their physical functioning, mental status, and quality of life. Many rehabilitation interventions can be delivered electronically ("digitally") via telehealth systems. For people with disabilities in underserved areas, electronically delivered rehabilitation interventions may be the only feasible service available for them. Objective The objective of this study was to evaluate the current status of digital interventions for people with disabilities in remote and underserved areas. Methods A systematic review was conducted on this topic. Keyword searches in multiple databases (PubMed, CINAHL, and Inspec) were performed to collect articles published in this field. The obtained articles were selected based on our selection criteria. Of the 198 identified articles, 16 duplicates were removed. After a review of the titles and abstracts of the remaining articles, 165 were determined to be irrelevant to this study and were therefore removed. The full texts of the remaining 17 articles were reviewed, and 6 of these articles were removed as being irrelevant to this study. The 11 articles remaining were discussed and summarized by 2 reviewers. Results These 11 studies cover a few types of disabilities, such as developmental disabilities and mobility impairments as well as several types of disability-causing disorders such as stroke, multiple sclerosis, traumatic brain injury, and facio-scapulo-humeral muscular dystrophy. Most of these studies were small-scale case studies and relatively larger-scale cohort studies; the project evaluation methods were mainly pre-post comparison, questionnaires, and interviews. A few studies also performed objective assessment of functional improvement. The intervention technology was mainly videoconferencing. Moreover, 10 of these studies were for people with disabilities in rural areas and 1 was for people in urban communities. Conclusions A small number of small-scale studies have been conducted on digital interventions for people with disabilities in underserved areas. Although the results reported in these studies were mostly positive, they are not sufficient to prove the effectiveness of telehealth-based digital intervention in improving the situation among people with disabilities because of the small sample sizes and lack of randomized controlled trials.
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Affiliation(s)
- Leming Zhou
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bambang Parmanto
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, United States
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Van de Winckel A, Gauthier L. A Revised Motor Activity Log Following Rasch Validation (Rasch-Based MAL-18) and Consensus Methods in Chronic Stroke and Multiple Sclerosis. Neurorehabil Neural Repair 2019; 33:787-791. [PMID: 31423899 DOI: 10.1177/1545968319868717] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objectives. To derive a shorter version of the Motor Activity Log Quality-of-Movement Scale (MAL-28) with enhanced content and construct validity. Design. Validation cohort. Setting. Outpatient rehabilitation within an academic laboratory. Participants. Retrospective consecutive sample of 149 community-dwelling adults with chronic mild/moderate upper-extremity hemiparesis caused by stroke or multiple sclerosis (MS). Intervention. Not applicable. Methods. Participants received the MAL-28 at baseline and following upper-extremity rehabilitation. Rasch Measurement Theory informed threshold ordering of scoring categories, tests of fit, differential item functioning, targeting, response dependency, local dependency, and reliability (person separation index [PSI]). Seasoned examiners rated the content validity of each item. Test-retest reliability of the revised scale was calculated. Results. We established content and construct validity for 18 items. The resultant 18-item MAL fit the model (χ2 = 77.93; df = 72; P = .30) and targeted the population-that is, minimal floor (12.08%) or ceiling effects (0%), with acceptable reliability (PSI = 0.84) and good test-retest reliability [ICC(1, 1) = 0.86]. The hierarchy of item difficulty was independent of sex, age, affected side, diagnosis, or intervention type used, and there was local dependency in 3 pairs of items. Responses from a subsequent testing session were dependent on the responses from prior testing, indicating response dependency, for which a correction was proposed. Once response dependency was neutralized, there was a 15% greater treatment response. Conclusions. Content and construct validity are established for Rasch-based MAL-18 for chronic stages of stroke and MS. A Rasch-based conversion table enables clinical use of the MAL-18.
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Dash A, Yadav A, Chauhan A, Lahiri U. Kinect-Assisted Performance-Sensitive Upper Limb Exercise Platform for Post-stroke Survivors. Front Neurosci 2019; 13:228. [PMID: 30967755 PMCID: PMC6438898 DOI: 10.3389/fnins.2019.00228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 02/26/2019] [Indexed: 11/23/2022] Open
Abstract
One's ability to use upper limbs is critical for performing activities of daily living necessary for enjoying quality community life. However, after stroke, such abilities becomes adversely affected and it often deprives one of their capability to perform tasks that need coordinated movement in the upper limbs. To address issues with upper limb dysfunction, patients typically undergo rehabilitative exercises. Given the high patient to doctor ratio particularly in developing countries like India, conventional rehabilitation with patients undergoing exercises under one-on-one therapist's supervision often becomes a challenge. Thus, investigators are exploring technology such as computer-based platforms coupled with cameras that can alleviate the need for the continuous presence of a therapist and can offer a powerful complementary tool in the hands of the clinicians. Such marker-based imaging systems used for rehabilitation can offer real-time processing and high accuracy of data. However, these systems often require dedicated lab space and high set-up time. Often this is very expensive and suffers from portability issues. Investigators have been exploring marker-less imaging techniques e.g., Kinect integrated computer-based graphical user interfaces in stroke-rehabilitation such as tracking one's limb movement during rehabilitation. In our present study, we have developed a Kinect-assisted computer-based system that offered Human Computer Interaction (HCI) tasks of varying challenge levels. Execution of the tasks required one to use reaching and coordination skills of the upper limbs. Also, the system was Performance-sensitive i.e., adaptive to the individualized residual movement ability of one's upper limb quantified in terms of task performance score. We tested for the usability of our system by exposing 15 healthy participants to our system. Subsequently, seven post-stroke patients interacted with our system over a few sessions spread over 2 weeks. Also, we studied patient's mean tonic activity corresponding to the HCI tasks as a possible indicator of one's post-stroke functional recovery suggesting its potential of our system to serve as a rehabilitation platform. Our results indicate the potential of such systems toward the improvement of task performance capability of post-stroke patients with possibilities of upper limb movement rehabilitation.
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Affiliation(s)
- Adyasha Dash
- Department of Electrical Engineering, Indian Institute of Technology Gandhinagar, Gandhinagar, India
| | - Anand Yadav
- Department of Electrical Engineering, Indian Institute of Technology Gandhinagar, Gandhinagar, India
| | - Anand Chauhan
- Department of Electrical Engineering, Indian Institute of Technology Gandhinagar, Gandhinagar, India
| | - Uttama Lahiri
- Department of Electrical Engineering, Indian Institute of Technology Gandhinagar, Gandhinagar, India
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de Rooij IJM, van de Port IGL, Visser-Meily JMA, Meijer JWG. Virtual reality gait training versus non-virtual reality gait training for improving participation in subacute stroke survivors: study protocol of the ViRTAS randomized controlled trial. Trials 2019; 20:89. [PMID: 30696491 PMCID: PMC6352452 DOI: 10.1186/s13063-018-3165-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/22/2018] [Indexed: 11/29/2022] Open
Abstract
Background A stroke often results in gait impairments, activity limitations and restricted participation in daily life. Virtual reality (VR) has shown to be beneficial for improving gait ability after stroke. Previous studies regarding VR focused mainly on improvements in functional outcomes. As participation in daily life is an important goal for rehabilitation after stroke, it is of importance to investigate if VR gait training improves participation. The primary aim of this study is to examine the effect of VR gait training on participation in community-living people after stroke. Methods/design The ViRTAS study comprises a single-blinded, randomized controlled trial with two parallel groups. Fifty people between 2 weeks and 6 months after stroke, who experience constraints with walking in daily life, are randomly assigned to the virtual reality gait training (VRT) group or the non-virtual reality gait training (non-VRT) group. Both training interventions consist of 12 30-min sessions in an outpatient rehabilitation clinic during 6 weeks. Assessments are performed at baseline, post intervention and 3 months post intervention. The primary outcome is participation measured with the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P). Secondary outcomes are subjective physical functioning, functional mobility, walking ability, walking activity, fatigue, anxiety and depression, falls efficacy and quality of life. Discussion The results of the study provide insight into the effect of VR gait training on participation after stroke. Trial registration Netherlands National Trial Register, Identifier NTR6215. Registered on 3 February 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-3165-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ilona J M de Rooij
- Revant Rehabilitation Centres, Breda, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | | | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Jan-Willem G Meijer
- Revant Rehabilitation Centres, Breda, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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Yang Z, Rafiei MH, Hall A, Thomas C, Midtlien HA, Hasselbach A, Adeli H, Gauthier LV. A Novel Methodology for Extracting and Evaluating Therapeutic Movements in Game-Based Motion Capture Rehabilitation Systems. J Med Syst 2018; 42:255. [PMID: 30406430 PMCID: PMC7183412 DOI: 10.1007/s10916-018-1113-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022]
Abstract
Virtual rehabilitation yields outcomes that are at least as good as traditional care for improving upper limb function and the capacity to carry out activities of daily living. Due to the advent of low-cost gaming systems and patient preference for game-based therapies, video game technology will likely be increasingly utilized in physical therapy practice in the coming years. Gaming systems that incorporate low-cost motion capture technology often generate large datasets of therapeutic movements performed over the course of rehabilitation. An infrastructure has yet to be established, however, to enable efficient processing of large quantities of movement data that are collected outside of a controlled laboratory setting. In this paper, a methodology is presented for extracting and evaluating therapeutic movements from game-based rehabilitation that occurs in uncontrolled and unmonitored settings. By overcoming these challenges, meaningful kinematic analysis of rehabilitation trajectory within an individual becomes feasible. Moreover, this methodological approach provides a vehicle for analyzing large datasets generated in uncontrolled clinical settings to enable better predictions of rehabilitation potential and dose-response relationships for personalized medicine.
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Affiliation(s)
- Zhichao Yang
- College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, 01003, USA
| | - Mohammad H Rafiei
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, 43210, USA
- Departments of Biomedical Informatics, Neurology, Neuroscience, The Ohio State University, Columbus, OH, 43210, USA
- Department of Physical Therapy, University of Massachusetts, Lowell, Lowell, MA, 01854, USA
| | - Alexis Hall
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, 43210, USA
| | - Caroline Thomas
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, 43210, USA
| | - Hali A Midtlien
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, 43210, USA
| | - Alexander Hasselbach
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, 43210, USA
| | - Hojjat Adeli
- Departments of Biomedical Informatics, Neurology, Neuroscience, The Ohio State University, Columbus, OH, 43210, USA.
| | - Lynne V Gauthier
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, 43210, USA
- Department of Physical Therapy, University of Massachusetts, Lowell, Lowell, MA, 01854, USA
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Hossain MS, Hoda M, Muhammad G, Almogren A, Alamri A. Cloud-supported framework for patients in post-stroke disability rehabilitation. TELEMATICS AND INFORMATICS 2018. [DOI: 10.1016/j.tele.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
The article presents University of Idaho - Physical Rehabilitation Movement Data (UI-PRMD) - a publically available data set of movements related to common exercises performed by patients in physical rehabilitation programs. For the data collection, 10 healthy subjects performed 10 repetitions of different physical therapy movements, with a Vicon optical tracker and a Microsoft Kinect sensor used for the motion capturing. The data are in a format that includes positions and angles of full-body joints. The objective of the data set is to provide a basis for mathematical modeling of therapy movements, as well as for establishing performance metrics for evaluation of patient consistency in executing the prescribed rehabilitation exercises.
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Affiliation(s)
- Aleksandar Vakanski
- University of Idaho, Industrial Technology, 1776 Science Center Drive, Idaho Falls, ID 83402, USA
| | - Hyung-pil Jun
- University of Idaho, Department of Movement Sciences, 875 Perimeter Drive, Moscow, ID 83844, USA
| | - David Paul
- University of Idaho, Department of Movement Sciences, 875 Perimeter Drive, Moscow, ID 83844, USA
| | - Russell Baker
- University of Idaho, Department of Movement Sciences, 875 Perimeter Drive, Moscow, ID 83844, USA
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Borstad AL, Crawfis R, Phillips K, Lowes LP, Maung D, McPherson R, Siles A, Worthen-Chaudhari L, Gauthier LV. In-Home Delivery of Constraint-Induced Movement Therapy via Virtual Reality Gaming. J Patient Cent Res Rev 2018; 5:6-17. [PMID: 31413992 DOI: 10.17294/2330-0698.1550] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose People with chronic hemiparesis are frequently dissatisfied with the recovery of their hand and arm, yet many lack access to effective treatments. Constraint-induced movement therapy (CI therapy) effectively increases arm function and spontaneous use in persons with chronic hemiparesis. The purpose of this study was to determine the feasibility and measure safety and outcomes of an in-home model of delivering CI therapy using a custom, avatar-based virtual reality game. Methods Seventeen individuals with chronic hemiparesis participated in this pretest/posttest quasi-experimental design study. The 10-day intervention had three components: 1) high-repetition motor practice using virtual reality gaming; 2) constraint of the stronger arm via a padded restraint mitt; and 3) a transfer package to reinforce arm use. Feasibility of the intervention was evaluated through comparison to traditional CI therapy and through participants' subjective responses. The primary outcome measures were the Wolf Motor Function Test (WMFT) and the Motor Activity Log quality of movement scale (MAL-QOM). Results On average, participants completed 17.2 ± 8 hours and 19,436 repetitions of motor practice. No adverse events were reported. Of 7 feasibility criteria, 4 were met. WMFT rate and MAL-QOM increased, with effect size (Cohen's d) of 1.5 and 1.1, respectively. Conclusions This model of delivering CI therapy using a custom, avatar-based virtual reality game was feasible, well received, and showed preliminary evidence of being a safe intervention to use in the home for persons with chronic hemiparesis.
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Affiliation(s)
| | - Roger Crawfis
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH
| | - Kala Phillips
- Department of Psychological and Brain Sciences, University of Louisville, KY
| | | | | | - Ryan McPherson
- Department of Electrical and Computer Engineering, The Ohio State University, Columbus, OH
| | - Amelia Siles
- Division of Physical Therapy, The Ohio State University, Columbus, OH
| | - Lise Worthen-Chaudhari
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH
| | - Lynne V Gauthier
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH
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Sergeeva SP, Savin AA, Litvitsky PF, Lyundup AV, Kiseleva EV, Gorbacheva LR, Breslavich ID, Kucenko KI, Balyasin MV. [Apoptosis as a systemic adaptive mechanism in ischemic stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:38-45. [PMID: 30830115 DOI: 10.17116/jnevro201811812238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This paper presents a literature review considering the role and mechanism of apoptosis in the pathogenesis of ischemic stroke (IS). The authors introduce a new concept: the functional request of the patient as a set of external (the nature and intensity of rehabilitation measures, characteristics of everyday life, diet, etc.) and internal (genetic factors, internal picture of the disease, availability of rental and other psychological facilities and etc.) attributes. This concept allows a new angle in understanding the pathogenesis of IS and creates fundamental and clinical potential for more successful approaches to therapy and rehabilitation after IS.
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Affiliation(s)
- S P Sergeeva
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A A Savin
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - P F Litvitsky
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A V Lyundup
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - E V Kiseleva
- Koltzov Institute of Developmental Biology of Russian Academy of Sciences, Moscow, Russia
| | | | - I D Breslavich
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - K I Kucenko
- Bureau of Forensic Medicine of Moscow Healthcare Department, Moscow, Russia
| | - M V Balyasin
- Sechenov First Moscow State Medical University, Moscow, Russia
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George SH, Rafiei MH, Borstad A, Adeli H, Gauthier LV. Gross motor ability predicts response to upper extremity rehabilitation in chronic stroke. Behav Brain Res 2017; 333:314-322. [PMID: 28688897 DOI: 10.1016/j.bbr.2017.07.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 12/26/2022]
Abstract
The majority of rehabilitation research focuses on the comparative effectiveness of different interventions in groups of patients, while much less is currently known regarding individual factors that predict response to rehabilitation. In a recent article, the authors presented a prognostic model to identify the sensorimotor characteristics predictive of the extent of motor recovery after Constraint-Induced Movement (CI) therapy amongst individuals with chronic mild-to-moderate motor deficit using the enhanced probabilistic neural network (EPNN). This follow-up paper examines which participant characteristics are robust predictors of rehabilitation response irrespective of the training modality. To accomplish this, EPNN was first applied to predict treatment response amongst individuals who received a virtual-reality gaming intervention (utilizing the same enrollment criteria as the prior study). The combinations of predictors that yield high predictive validity for both therapies, using their respective datasets, were then identified. High predictive classification accuracy was achieved for both the gaming (94.7%) and combined datasets (94.5%). Though CI therapy employed primarily fine-motor training tasks and the gaming intervention emphasized gross-motor practice, larger improvements in gross motor function were observed within both datasets. Poorer gross motor ability at pre-treatment predicted better rehabilitation response in both the gaming and combined datasets. The conclusion of this research is that for individuals with chronic mild-to-moderate upper extremity hemiparesis, residual deficits in gross motor function are highly responsive to motor restorative interventions, irrespective of the modality of training.
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Affiliation(s)
- Sarah Hulbert George
- Department of Biophysics, The Ohio State University, 1012 Wiseman Hall, 400 W. 12th Ave, Columbus, OH 43210, USA.
| | - Mohammad Hossein Rafiei
- Department of Civil, Environmental and Geodetic Engineering, The Ohio State University, 470 Hitchcock Hall, 2070 Neil Ave., Columbus, OH 43220, USA.
| | - Alexandra Borstad
- Department of Physical Therapy, The College of St. Scholastica, 1200 Kenwood Avenue, Duluth, MN 55811, USA.
| | - Hojjat Adeli
- Departments of Civil, Environmental and Geodetic Engineering, Biomedical Informatics, Biomedical Engineering, Neurology, and Neuroscience, The Ohio State University, 470 Hitchcock Hall, 2070 Neil Ave, Columbus, OH 43220, USA.
| | - Lynne V Gauthier
- Physical Medicine and Rehabilitation, The Ohio State University, 480 Medical Center Drive, Columbus, OH 43210, USA.
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