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Jo S, Jang H, Kim H, Song C. 360° immersive virtual reality-based mirror therapy for upper extremity function and satisfaction among stroke patients: a randomized controlled trial. Eur J Phys Rehabil Med 2024; 60:207-215. [PMID: 38483333 DOI: 10.23736/s1973-9087.24.08275-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND Stroke is a leading cause of long-term disability worldwide; therefore, an effective rehabilitation strategy is fundamental. Mirror therapy (MT) has been a popular approach for upper extremity rehabilitation, but it presents some limitations. Recent advancements in virtual reality (VR) technology have introduced immersive VR-based MT, potentially overcoming these limitations and enhancing rehabilitation outcomes. AIM This study aimed to evaluate the effectiveness of a novel 360° immersive virtual reality-based MT (360MT) in upper extremity rehabilitation for stroke patients, comparing it to traditional MT (TMT) and conventional physical therapy control group (CG). DESIGN A prospective, active control, assessor blinded, parallel groups, randomized controlled trial. POPULATION Forty-five participants with chronic stroke within six months of onset. METHODS The participants were randomly allocated to 360MT, TMT, or CG groups. Outcome measures included Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Box and Block Test (BBT), and Manual Function Test (MFT). Additionally, patient experience and satisfaction in the groups of 360MT and TMT were assessed through questionnaires and interviews. RESULTS Results revealed that the 360MT group showed significantly greater improvements in FMA-UE, MFT and BBT compared to TMT (P<0.05) and CG (P<0.001) groups. Patient experience and satisfaction were more favorable in the 360MT group, with participants reporting higher engagement and motivation. CONCLUSIONS 360MT appears to be a promising approach for upper extremity rehabilitation in stroke patients, providing better outcomes and higher patient satisfaction. However, further research is needed to confirm these findings and strengthen the evidence base for 360MT in stroke rehabilitation. CLINICAL REHABILITATION IMPACT 360MT demonstrated notably enhanced upper extremity rehabilitation outcomes as well as better patient satisfaction among chronic stroke patients within six months of onset compared to traditional MT and conventional physical therapy. This novel approach not only fostered functional improvements but also elevated levels of engagement and motivation among participants, suggesting a promising future application in stroke rehabilitation framework.
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Affiliation(s)
- Sungbae Jo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hoon Jang
- Department of Physical Therapy, Graduate School of Sahmyook University, Seoul, South Korea
| | - Hyunjin Kim
- Department of Rehabilitation Medicine, Hanyang University Guri Hospital, Gyeonggi-do, South Korea
| | - Changho Song
- Department of Physical Therapy, College of Health Science, Sahmyook University, Seoul, South Korea -
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Doren S, Schwab SM, Bigner K, Calvelage J, Preston K, Laughlin A, Drury C, Tincher B, Carl D, Awosika OO, Boyne P. Evaluating the Neural Underpinnings of Motivation for Walking Exercise. Phys Ther 2024; 104:pzad159. [PMID: 37980613 PMCID: PMC10939334 DOI: 10.1093/ptj/pzad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 06/19/2023] [Accepted: 09/13/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Motivation is critically important for rehabilitation, exercise, and motor performance, but its neural basis is poorly understood. Recent correlational research suggests that the dorsomedial prefrontal cortex (dmPFC) may be involved in motivation for walking activity and/or descending motor output. This study experimentally evaluated brain activity changes in periods of additional motivation during walking exercise and tested how these brain activity changes relate to self-reported exercise motivation and walking speed. METHODS Adults without disability (N = 26; 65% women; 25 [standard deviation = 5] years old) performed a vigorous exercise experiment involving 20 trials of maximal speed overground walking. Half of the trials were randomized to include "extra-motivation" stimuli (lap timer, tracked best lap time, and verbal encouragement). Wearable near-infrared spectroscopy measured oxygenated hemoglobin responses from frontal lobe regions, including the dmPFC, primary sensorimotor, dorsolateral prefrontal, anterior prefrontal, supplementary motor, and dorsal premotor cortices. RESULTS Compared with standard trials, participants walked faster during extra-motivation trials (2.43 vs 2.67 m/s; P < .0001) and had higher oxygenated hemoglobin responses in all tested brain regions, including dmPFC (+842 vs +1694 μM; P < .0001). Greater dmPFC activity was correlated with more self-determined motivation for exercise between individuals (r = 0.55; P = .004) and faster walking speed between trials (r = 0.18; P = .0002). dmPFC was the only tested brain region that showed both of these associations. CONCLUSION Simple motivational stimuli during walking exercise seem to upregulate widespread brain regions. Results suggest that dmPFC may be a key brain region linking affective signaling to motor output. IMPACT These findings provide a potential biologic basis for the benefits of motivational stimuli, elicited with clinically feasible methods during walking exercise. Future clinical studies could build on this information to develop prognostic biomarkers and test novel brain stimulation targets for enhancing exercise motivation (eg, dmPFC).
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Affiliation(s)
- Sarah Doren
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Sarah M Schwab
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kaitlyn Bigner
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jenna Calvelage
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Katie Preston
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Abigail Laughlin
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Colin Drury
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Brady Tincher
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Oluwole O Awosika
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
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Langerak AJ, D'Olivo P, Thijm OSA, Regterschot GRH, Meskers CGM, Rozendaal MC, Visch VT, Bussmann JBJ. Stroke patients' motivation for home-based upper extremity rehabilitation with eHealth tools. Disabil Rehabil 2024:1-11. [PMID: 38339778 DOI: 10.1080/09638288.2024.2304091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/05/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE eHealth-based exercise therapies were developed to increase stroke patients' adherence to home-based motor rehabilitation. However, these eHealth tools face a rapid decrease in use after a couple of weeks. This study investigates stroke patients' motivation for home-based upper extremity rehabilitation with eHealth tools and their relation with Basic Psychological Needs. MATERIALS AND METHODS This is a qualitative study using thematic analysis. We conducted semi-structured interviews with stroke patients with upper extremity motor impairments, who were discharged home from a rehabilitation centre, after they interacted with a novel eHealth coach demonstrator in their homes for five consecutive days. RESULTS We included ten stroke patients. Thematic analysis resulted in eight themes for home-based rehabilitation motivation: Curiosity, Rationale, Choice, Optimal challenge, Reference, Encouragement, Social Support and Trustworthiness. Those themes are embedded into three Basic Psychological Needs: "Autonomy", "Competence", and "Relatedness". CONCLUSION Eight motivational themes related to the three Basic Psychological Needs describe stroke patients' motivation for home-based upper extremity rehabilitation. We recommend considering those themes when developing a home-based eHealth intervention for stroke patients to increase the alignment of eHealth tools to the patient's needs and reduce motivational decreases in home-based rehabilitation.
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Affiliation(s)
- A J Langerak
- Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - P D'Olivo
- Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - O S A Thijm
- Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Rehabilitation Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - G R H Regterschot
- Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - C G M Meskers
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - M C Rozendaal
- Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - V T Visch
- Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - J B J Bussmann
- Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Høeg ER, Van der Kaap-Deeder J. Beyond Intrinsic Motivation: Why Researchers Should Consider the Full Motivation Continuum in Games for Health Research. Games Health J 2024; 13:1-4. [PMID: 37788449 DOI: 10.1089/g4h.2023.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Research within the domain of games for health has predominantly focused on individuals' intrinsic motivation characterized by an inherent enjoyment of the activity. Despite the apparent benefits of intrinsic motivation, we argue that it is imperative to adopt a more nuanced and refined perspective on motivation. Relying on the motivation continuum as outlined within Self-Determination Theory, research within this domain needs to distinguish between both intrinsic and extrinsic (i.e., external, introjected, identified, and integrated regulation) types of motivation. Researchers should, therefore, embrace instruments that assess a broader continuum of motivation rather than just intrinsic motivation alone. By doing so, future research can yield more insight into what fosters autonomous forms of motivation in the field of health-related games, including intrinsic and identified and integrated regulation.
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Affiliation(s)
- Emil Rosenlund Høeg
- Department of Architecture, Design and Media Technology, Aalborg University, Copenhagen, Denmark
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Fowler K, Mayock P, Byrne E, Bennett K, Sexton E. "Coming home was a disaster, I didn't know what was going to happen": a qualitative study of survivors' and family members' experiences of navigating care post-stroke. Disabil Rehabil 2024:1-13. [PMID: 38265039 DOI: 10.1080/09638288.2024.2303368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE Understanding navigational barriers and facilitators has the potential to advance equitable stroke care delivery. The aim of this study was to explore, using a qualitative study, the experiences of stroke survivors and their families as they journey through the stroke care system, both before and during the COVID-19 pandemic. METHODS In-depth semi-structured interviews were conducted with 18 stroke survivors and 12 family members during 2021 and 2022. Participants were recruited through voluntary organisations, social media, and stroke support groups. Data analysis followed a systematic process guided by the framework method with steps including familiarisation, coding, framework development, and charting and interpretation. RESULTS The experiences of navigating stroke care were particularly challenging following discharge from hospital into the community. Barriers to stroke care continuity included insufficient appropriate services and information, unsatisfactory relationships with healthcare professionals and distressed mental health. There were particular navigational challenges for survivors with aphasia. Facilitators to effective navigation included having prior knowledge of the health system, harnessing support for care co-ordination, and being persistent. CONCLUSION Greater support for patient navigation, and person-centred referral pathways, particularly during times of increased pressure on the system, have the potential to improve access to services and wellbeing among stroke survivors.
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Affiliation(s)
- Karen Fowler
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Paula Mayock
- School of Social Work and Social Policy, Trinity College Dublin, Ireland
| | - Elaine Byrne
- Centre for Positive Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Kathleen Bennett
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Eithne Sexton
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Schwab SM, Cooper D, Carver NS, Doren S, Boyne P. Motivation-related influences on fNIRS signals during walking exercise: a permutation entropy approach. Exp Brain Res 2023; 241:2617-2625. [PMID: 37733031 PMCID: PMC10676732 DOI: 10.1007/s00221-023-06707-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/11/2023] [Indexed: 09/22/2023]
Abstract
Cortical activity is typically indexed by analyzing functional near-infrared spectroscopy (fNIRS) signals in terms of the mean (e.g., mean oxygenated hemoglobin; HbO). Entropy approaches have been proposed as useful complementary methods for analyzing fNIRS signals. Entropy methods consider the regularity of a time series, and in doing so, may provide additional insights into the underlying dynamics of brain activity. Recent research using fNIRS found that non-disabled adults exhibit widespread increases in cortical activity and walk faster when under "extra motivation" conditions (e.g., verbal encouragement, lap timer) compared to trials without such motivators ("standard motivation"). This ancillary analysis of that study aimed to assess the extent to which fNIRS permutation entropy (PE) was affected by motivational conditions and explained variance in self-reported motivation. No regional PE differences were found between different motivational conditions. However, a greater difference in PE between motivational conditions (higher in standard, lower in extra motivation) in the anterior prefrontal cortex (aPFC) was associated with greater self-determined motivation. PE was also higher (less regular) in the primary sensorimotor cortex lower limb area compared to all other cortical areas analyzed, except the dorsal premotor cortex, regardless of motivational condition. This study provides early evidence to suggest that while different motivational environments during walking activity influence the magnitude of fNIRS signals, they may not influence the regularity of cortical signals. However, the magnitude of PE difference between motivational conditions was related to self-determined motivation in the aPFC, and this is an area warranting further investigation.
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Affiliation(s)
- Sarah M Schwab
- Department of Rehabilitation, Exercise, & Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA.
| | - Dalton Cooper
- Center for Cognition, Action, & Perception, Department of Psychology, College of Arts and Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Nicole S Carver
- Center for Cognition, Action, & Perception, Department of Psychology, College of Arts and Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Sarah Doren
- Department of Rehabilitation, Exercise, & Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Pierce Boyne
- Department of Rehabilitation, Exercise, & Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA
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Monnelly K, Marshall J, Dipper L, Cruice M. A systematic review of Intensive Comprehensive Aphasia Programmes - who takes part, what is measured, what are the outcomes? Disabil Rehabil 2023:1-15. [PMID: 37916542 DOI: 10.1080/09638288.2023.2274877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/20/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE This study synthesizes participant and outcome data from peer-reviewed Intensive Comprehensive Aphasia Programme (ICAP) studies. METHODS A systematic review was conducted following PRISMA guidelines. Study eligibility criteria were specified in relation to population, intervention, comparison, outcome, and design considerations. Data were extracted according to six research questions. Narrative synthesis was used. RESULTS Twenty-one studies were included covering 13 ICAPs (N = 485, aged 18-86 years, between 11 and 335 months post-stroke). Twenty-seven participant selection criteria were identified. Fifty-six outcome measures spanning the WHO-ICF were used, with the majority assessing the body function domain. Only eight studies employed an experimental design with data appropriate for analysis and synthesis. Risk of bias was noted across this sub-group. Participants improved in word-finding, communication, activity/participation, and communication-related quality of life, and maintained their gains; however, except for word finding, evidence of effect came from isolated studies. Factors influencing outcomes were rarely considered. Some drop-outs, missed sessions, and fatigue were noted. Some studies reported IPD alongside group analyses. CONCLUSIONS ICAP selection criteria need justification and should contribute to the understanding of candidacy for this treatment model. Rationalisation of ICAP treatment content and outcome measurement is required, spanning all WHO-ICF domains. Employment of the core outcome set for aphasia would enable data synthesis and facilitate comparisons between the ICAP and other therapy models.
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Affiliation(s)
- Katie Monnelly
- Department of Language and Communication Science, City, University of London, London, UK
| | - Jane Marshall
- Department of Language and Communication Science, City, University of London, London, UK
| | - Lucy Dipper
- Department of Language and Communication Science, City, University of London, London, UK
| | - Madeline Cruice
- Department of Language and Communication Science, City, University of London, London, UK
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Tierney-Hendricks C, Miller J, Lopez RP, Conger S, Vallila-Rohter S. 'It's been an extraordinary journey': Experience of engagement from the perspectives of people with post-stroke aphasia. Int J Lang Commun Disord 2023; 58:2008-2021. [PMID: 37300434 DOI: 10.1111/1460-6984.12911] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Engagement is recognized as an important factor in aphasia treatment response and outcomes, yet gaps remain in our understanding of engagement and practices that promote engagement from the client perspective. AIMS The purpose of this phenomenological study was to explore how clients with aphasia experience engagement during their inpatient aphasia rehabilitation. METHODS & PROCEDURES An interpretative phenomenological analysis approach guided the study design and analysis. Data were collected through in-depth interviews with nine clients with aphasia, recruited through purposive sampling, during their inpatient rehabilitation admission. Analysis was completed using a variety of analytic techniques including coding, memoing, triangulation between coders and team discussion. OUTCOMES & RESULTS The analysis revealed that for clients with aphasia in the acute phrase of recovery, the rehabilitation process resembles travelling on a journey through a foreign land. Successful engagement in the journey was accomplished when one had a therapist who served as a trusted guide and was able to be a friend, invested, adaptable, a co-creator, encouraging and dependable. CONCLUSIONS & IMPLICATIONS Engagement is a dynamic, multifaceted and person-centred process involving the client, provider and rehabilitation context. Findings from this work have implications for measuring engagement, training student clinicians to be skilled facilitators in engaging their clients and implementing person-centred practices that promote engagement within clinical settings. WHAT THIS PAPER ADDS What is already known on the subject Engagement is recognized as an important factor in rehabilitation treatment response and outcomes. Prior literature suggests that the therapist plays a critical role in facilitating engagement within the client-provider relationship. Communication impairments associated with aphasia may negatively impact a client's ability to develop interpersonal connections and participate in the rehabilitation process. There is a dearth of research directly exploring the topic of engagement in aphasia rehabilitation, particularly from the perspective of clients with aphasia. Capturing the client perspective can provide novel insights regarding practices to foster and maintain engagement in aphasia rehabilitation. What this paper adds to existing knowledge This interpretative phenomenological study revealed that for individuals with aphasia in the acute phase of recovery, the rehabilitation process resembles travelling on a sudden and foreign journey. Successful engagement in the journey was accomplished when one had a therapist who served as a 'trusted guide' and was able to be a friend, invested, adaptable, a co-creator, encouraging and dependable. Through the client experience, engagement is seen as a dynamic, multifaceted and person-centred process involving the client, provider and rehabilitation context. What are the potential or actual clinical implications of this work? The current study highlights the complexity and nuance of engagement within the rehabilitation context, which has implications for measuring engagement, training student clinicians to be skilled in engaging their clients and implementing person-centred practices that promote engagement within clinical settings. It is necessary to recognize that client and provider interactions (and thus engagement) are embedded in and influenced by the broader healthcare system. With this in mind, a patient-centred approach to engagement in aphasia care delivery cannot be achieved through individual efforts only and may require prioritization and action at the systems level. Future work is needed to explore barriers and facilitators to enacting engagement practices, in order to develop and test strategies to support practice change.
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Affiliation(s)
- Carla Tierney-Hendricks
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Jennifer Miller
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
- Speech Therapy Department, Sheltering Arms Institute, Richmond, VA, USA
| | - Ruth Palan Lopez
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Sarah Conger
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Sofia Vallila-Rohter
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
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Firth N, Hayward KS, Bernhardt J, Ray R, Barker RN. Stroke survivors' perspectives on decision-making about rehabilitation and the prospect of taking recovery-promoting drugs: A qualitative study. Explor Res Clin Soc Pharm 2023; 11:100297. [PMID: 37448649 PMCID: PMC10338145 DOI: 10.1016/j.rcsop.2023.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Objectives To investigate factors which influence stroke survivors' decision-making about their rehabilitation and the prospect of taking recovery-promoting drugs, to enhance their recovery. Methods Seventeen stroke survivors who had undertaken stroke rehabilitation, and three spouses, participated in focus groups and individual interviews in northern Queensland, Australia. Inductive thematic analysis of the interview data was conducted in accordance with Braun and Clarke's six-phase process. Results Two specific, pivotal decision points during participants' stroke recovery process were identified: 1) overall, when deciding what rehabilitation they would undertake and hypothetically what recovery-promoting drugs they would take, and 2) on a daily basis, when deciding whether to participate in rehabilitation and take recovery-promoting drugs on any given day. Six themes which described factors influencing their decision-making were: 'My options for rehabilitation and recovery-promoting drugs'; 'The costs of rehabilitation and recovery-promoting drugs'; 'My recovery goals'; 'What I can deal with today'; 'The people my rehabilitation and recovery-promoting drugs affect'; and 'Fitting rehabilitation and recovery-promoting drugs into my life.' These themes were applicable at either one or both of the identified decision points. Conclusion Factors that influence stroke survivors' decision-making, overall and on a day-to-day basis, need to be considered to ensure they can make the best decisions for themselves to achieve their full recovery potential. Understanding the conditions under which a stroke survivor would take a recovery-promoting drug will contribute to the development of dosing protocols to which stroke survivors could adhere.
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Affiliation(s)
- Nerida Firth
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Kathryn S. Hayward
- Departments of Physiotherapy and Medicine, University of Melbourne, Melbourne, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
| | - Robin Ray
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Ruth N. Barker
- College of Healthcare Sciences, James Cook University, Cairns, Australia
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Nehrujee A, Ivanova E, Srinivasan S, Balasubramanian S, Burdet E. Increasing the Motivation to Train Through Haptic Social Interaction - Pilot study. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941283 DOI: 10.1109/icorr58425.2023.10304751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Motivation is crucial in stroke rehabilitation, as it enhances patient engagement, adherence, and recovery. Robots can be employed to improve motivation through multiplayer rehabilitation games, which allow patients to collaborate and interact in a virtual environment through multimodal sensory cues. This social interaction can provide social support and increase motivation, resulting in better therapy engagement. A hand rehabilitation robot (PLUTO) was used to investigate the potential of social interaction to implement haptic multiplayer games. Twelve unimpaired participants (6 dyads) played in solo, collaborative, and competitive game modes. Surprisingly, no difference was found in self-reported engagement, tension, or competence between solo and multiplayer games. However, the IMI scale indicated that engagement for multiplayer games was rated higher than for solo games. The collaborative game was preferred by 10 out of 12 participants, highlighting its potential for promoting behavioural involvement and engagement. This study indicates that using PLUTO with multiplayer game modes can enhance therapy engagement. This can potentially improve rehabilitation outcomes if translated to the patient population.
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Favre J, Cantaloube A, Jolles BM. Rehabilitation for Musculoskeletal Disorders: The Emergence of Serious Games and the Promise of Personalized Versions Using Artificial Intelligence. J Clin Med 2023; 12:5310. [PMID: 37629350 PMCID: PMC10455669 DOI: 10.3390/jcm12165310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
According to the World Health Organization (WHO), musculoskeletal conditions are among the most common health problems, affecting approximately 1 [...].
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Affiliation(s)
- Julien Favre
- Swiss BioMotion Lab, Lausanne University Hospital, University of Lausanne (CHUV-UNIL), CH-1011 Lausanne, Switzerland
- The Sense Innovation and Research Center, CH-1007 Lausanne, Switzerland
| | - Alexis Cantaloube
- Swiss BioMotion Lab, Lausanne University Hospital, University of Lausanne (CHUV-UNIL), CH-1011 Lausanne, Switzerland
| | - Brigitte M. Jolles
- Swiss BioMotion Lab, Lausanne University Hospital, University of Lausanne (CHUV-UNIL), CH-1011 Lausanne, Switzerland
- Institute of Electrical and Micro Engineering, Ecole Polytechnique Fédérale Lausanne (EPFL), CH-1015 Lausanne, Switzerland
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Yoshida T, Otaka Y, Kitamura S, Ushizawa K, Kumagai M, Yaeda J, Osu R. Influence of motivation on rehabilitation outcomes after subacute stroke in convalescent rehabilitation wards. Front Neurol 2023; 14:1185813. [PMID: 37521301 PMCID: PMC10375291 DOI: 10.3389/fneur.2023.1185813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Background The motivation for rehabilitation is important in encouraging stroke patients to participate in rehabilitation; however, its relationship with outcomes is not well known. In addition, changes in patient motivation during hospitalization have not been examined. Aim To examine the relationship between motivation and rehabilitation outcomes for subacute stroke patients and to investigate the changes in motivation. Design Prospective cohort study. Setting Subacute rehabilitation hospital. Population The study enrolled a consecutive sample of patients (n = 201) with stroke admitted to a subacute rehabilitation ward from October 2017 to March 2019. Methods The functional independence measure and motivation in stroke patients for rehabilitation scale was evaluated at admission; at one, two, and three months after admission; and at discharge. The effectiveness and efficiency of the functional independence measure were calculated as rehabilitation outcomes. The effect of motivation on outcomes and the change in motivation in stroke patients for rehabilitation scale scores over time were analyzed using a linear mixed model. Results The median (interquartile range) converted motivation in stroke patients for rehabilitation scale scores (converted to a range of 0-100) at admission; one, two, and three months after admission; and discharge was 86 (76-95), 83 (77-94), 81 (74-95), 81 (71-93), and 84 (75-95), respectively. The median (interquartile range) of effectiveness and efficiency of the functional independence measure from admission to discharge was 0.82 (0.68-0.91) and 0.41 (0.30-0.59), respectively. Motivation in stroke patients for rehabilitation scale scores were not significantly associated with the effectiveness and efficiency of the functional independence measure (p > 0.05). Motivation in stroke patients for rehabilitation scale scores were significantly lower at two (β = -3.1, 95% confidence interval [-5.3, -0.9], p = 0.005) and three (β = -4.4, 95% confidence interval [-7.3, -1.6], p = 0.002) months after admission than at admission. Conclusion Motivation might not directly affect rehabilitation outcomes assessed by the functional independence measure. Furthermore, many participants remained highly motivated, although their motivation decreased at one or three months after admission. Clinical rehabilitation impact Assumptions that rehabilitation is ineffective because of low motivation may not be correct. To examine the influence on outcomes, both motivation and daily activities should be considered.
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Affiliation(s)
- Taiki Yoshida
- Tokyo Bay Rehabilitation Hospital, Department of Rehabilitation Medicine, Chiba, Japan
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Yohei Otaka
- Tokyo Bay Rehabilitation Hospital, Department of Rehabilitation Medicine, Chiba, Japan
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
| | - Shin Kitamura
- Tokyo Bay Rehabilitation Hospital, Department of Rehabilitation Medicine, Chiba, Japan
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Kazuki Ushizawa
- Tokyo Bay Rehabilitation Hospital, Department of Rehabilitation Medicine, Chiba, Japan
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
| | - Masashi Kumagai
- Tokyo Bay Rehabilitation Hospital, Department of Rehabilitation Medicine, Chiba, Japan
| | - Jun Yaeda
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tokyo, Japan
| | - Rieko Osu
- Faculty of Human Sciences, Waseda University, Saitama, Japan
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13
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Oyake K, Yamauchi K, Inoue S, Sue K, Ota H, Ikuta J, Ema T, Ochiai T, Hasui M, Hirata Y, Hida A, Yamamoto K, Kawai Y, Shiba K, Atsumi A, Nagafusa T, Tanaka S. A multicenter explanatory survey of patients' and clinicians' perceptions of motivational factors in rehabilitation. Commun Med (Lond) 2023; 3:78. [PMID: 37280319 DOI: 10.1038/s43856-023-00308-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Patient motivation is an important determinant of rehabilitation outcomes. Differences in patients' and clinicians' perceptions of motivational factors can potentially hinder patient-centered care. Therefore, we aimed to compare patients' and clinicians' perceptions of the most important factors in motivating patients for rehabilitation. METHODS This multicenter explanatory survey research was conducted from January to March 2022. In 13 hospitals with an intensive inpatient rehabilitation ward, 479 patients with neurological or orthopedic disorders undergoing inpatient rehabilitation and 401 clinicians, including physicians, physical therapists, occupational therapists, and speech-language-hearing therapists, were purposively selected using inclusion criteria. The participants were asked to choose the most important factor motivating patients for rehabilitation from a list of potential motivational factors. RESULTS Here we show that realization of recovery, goal setting, and practice related to the patient's experience and lifestyle are the three factors most frequently selected as most important by patients and clinicians. Only five factors are rated as most important by 5% of clinicians, whereas nine factors are selected by 5% of patients. Of these nine motivational factors, medical information (p < 0.001; phi = -0.14; 95% confidence interval = -0.20 to -0.07) and control of task difficulty (p = 0.011; phi = -0.09; 95% confidence interval = -0.16 to -0.02) are selected by a significantly higher proportion of patients than clinicians. CONCLUSIONS These results suggest that when determining motivational strategies, rehabilitation clinicians should consider individual patient preferences in addition to using the core motivational factors supported by both parties.
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Affiliation(s)
- Kazuaki Oyake
- Department of Physical Therapy, School of Health Sciences, Shinshu University, Nagano, Japan
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Katsuya Yamauchi
- Department of Rehabilitation Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Seigo Inoue
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Keita Sue
- Department of Rehabilitation, JA Nagano Kouseiren Kakeyu-Misayama Rehabilitation Center Kakeyu Hospital, Nagano, Japan
| | - Hironobu Ota
- Rehabilitation Center, Aichi Medical University Medical Center, Aichi, Japan
| | - Junichi Ikuta
- Division of Occupational Therapy, Department of Rehabilitation, Nakaizu Rehabilitation Center, Shizuoka, Japan
| | - Toshiki Ema
- Department of Rehabilitation, Suzukake Central Hospital, Shizuoka, Japan
| | - Tomohiko Ochiai
- Rehabilitation Center, Juzen Memorial Hospital, Shizuoka, Japan
| | - Makoto Hasui
- Department of Rehabilitation Medicine, JA Shizuoka Kohseiren Enshu Hospital, Shizuoka, Japan
| | - Yuya Hirata
- Department of Rehabilitation, Suzukake Healthcare Hospital, Shizuoka, Japan
| | - Ayaka Hida
- Department of Rehabilitation Medicine, Kakegawa Higashi Hospital, Shizuoka, Japan
| | - Kenta Yamamoto
- Department of Rehabilitation, Toyoda Eisei Hospital, Shizuoka, Japan
| | - Yoshihiro Kawai
- Department of Rehabilitation, Tenryu Suzukake Hospital, Shizuoka, Japan
| | - Kiyoto Shiba
- Department of Rehabilitation Medicine, Hamakita Sakuradai Hospital, Shizuoka, Japan
| | - Akihito Atsumi
- Department of Rehabilitation, Hamamatsu-Kita Hospital, Shizuoka, Japan
| | - Tetsuyuki Nagafusa
- Department of Rehabilitation Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Satoshi Tanaka
- Laboratory of Psychology, Hamamatsu University School of Medicine, Shizuoka, Japan.
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14
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Ketkar VD, Wolbrecht ET, Perry JC, Farrens A. Design and Development of a Spherical 5-Bar Thumb Exoskeleton Mechanism for Poststroke Rehabilitation. J Med Device 2023; 17:021002. [PMID: 37152413 PMCID: PMC10158975 DOI: 10.1115/1.4056864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
This paper presents the kinematic design and development of a two degree-of-freedom (2DOF) spherical 5-bar thumb exoskeleton to augment the finger individuating grasp exercise robot (FINGER) rehabilitation robot, which assists the index and middle fingers individually in naturalistic grasping. The thumb module expands the capabilities of FINGER, allowing for broader proprioceptive training and assessment of hand function. The design process started by digitizing thumb-grasping motions to the index and the middle fingers separately, recorded from multiple healthy subjects utilizing a motion capture system. Fitting spheres to trajectory data of each subject allowed normalization of all subjects' data to a common center and radius. A two-revolute joint serial-chain mechanism was synthesized (intermediate optimization step) to reach the normalized trajectories. Next, the two resulting grasping trajectories were spatially sampled as targets for the 2DOF spherical 5-bar synthesis. Optimization of the spherical 5-bar included symmetry constraints and cost-function penalties for poor manipulability. The resulting exoskeleton assists both flexion/extension and abduction/adduction of the thumb enabling a wide range of motions. Consistent with FINGER, the parallel structure of the spherical 5-bar places the actuators at the base of the module, allowing for desirable characteristics, including high backdrivability, high controllable bandwidth, and low mechanical impedance. The mechanical design was developed from the kinematic solution, including an adjustable thumb cuff to accommodate different hand sizes. Fit and function of the device were tested on multiple subjects, including survivors of stroke. A proportional-derivative force controller with gravity and friction compensation was implemented to reduce resistance to motion during subject testing.
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Affiliation(s)
- Vishwanath D. Ketkar
- Department of Electrical Engineering, University of Idaho, Moscow, ID 83844-0902
| | - Eric T. Wolbrecht
- Department of Mechanical Engineering, University of Idaho, Moscow, ID 83844-0902
| | - Joel C. Perry
- Department of Mechanical Engineering, University of Idaho, Moscow, ID 83844-0902
| | - Andria Farrens
- Department of Biomedical Engineering, University of California, Irvine, CA 92697
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15
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Castelli L, Iacovelli C, Fusco A, Amoruso V, Cuccagna C, Loreti C, Giovannini S, Padua L. The Role of Technological Rehabilitation in Patients with Intensive Care Unit Weakness: A Randomized Controlled Pilot Study. J Clin Med 2023; 12:jcm12072612. [PMID: 37048695 PMCID: PMC10095108 DOI: 10.3390/jcm12072612] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Intensive-Care-Unit-Acquired Weakness (ICU-AW) is the most common neuromuscular impairment in critically ill patients and can have a significant impact on long-term disability. Early rehabilitation has been suggested to facilitate the natural recovery process. This is a pilot, randomized, single-blind study that aimed to evaluate the effectiveness of intensive combined technological rehabilitation treatment including focal muscle vibration and non-immersive virtual reality for patients with severe acquired brain injury (sABI) and ICU-AW. Twenty-four patients were randomized into the conventional group, which performed only conventional rehabilitation, and the experimental group, which also performed technological treatment. At baseline and after 3 weeks of treatment, assessments of motor function, autonomy, disability and quality of life were conducted. At the end of the intervention, both groups showed significant improvements. However, patients in the experimental group achieved greater improvements in disability (p = 0.001) and quality of life (p = 0.001). The results show that intensive structured rehabilitation is effective in improving the motor function, disability and quality of life of patients with severe acquired brain injury and acquired weakness. The combination of non-immersive virtual reality training and focal muscle vibration can result in a significant improvement in overall disability and quality of life compared with conventional treatment alone.
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Affiliation(s)
- Letizia Castelli
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Chiara Iacovelli
- Department of Emergency, Anaesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Augusto Fusco
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Vincenza Amoruso
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cristina Cuccagna
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Claudia Loreti
- Department of Emergency, Anaesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Silvia Giovannini
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOS Riabilitazione Post-Acuzie, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-(0)-6-3015-4382
| | - Luca Padua
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Elmanowski J, Seelen H, Geers R, Kleynen M, Verbunt J. Effects of a remote-handling-concept-based task-oriented arm training (ReHab-TOAT) on arm-hand skill performance in chronic stroke: a study protocol for a two-armed randomized controlled trial. Trials 2023; 24:189. [PMID: 36918922 PMCID: PMC10012705 DOI: 10.1186/s13063-023-07139-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/07/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Improving arm-hand skill performance is a major therapeutic target in stroke rehabilitation and needs intensive and varied training. However, guided treatment time is limited. Technology can assist in the training of patients, offering a higher intensity and more variety in content. A new task-oriented arm training approach was developed, using a 'Remote Handling concept based' device to provide haptic feedback during the performance of daily living activities (ReHab-TOAT). This study aims to investigate the effects of ReHab-TOAT on patients' arm-hand function and arm-hand skill performance, quality of life of both patients in the chronic phase after stroke and their caregivers and the patients' perception regarding the usability of the intervention. METHODS A randomized clinical trial was designed. Adult chronic stroke patients suffering from hemiparesis and arm-hand problems, with an Utrechtse Arm-hand Test score of 1-3, will be invited to participate. Participants in the experimental group receive ReHab-TOAT additional to care as usual. ReHab-TOAT contains task-oriented arm training for stroke patients in combination with haptic feedback, generated by a remote handling device. They will train for 4 weeks, 3× per week, 1.5h per day. Participants in the control group will receive no additional therapy apart from care as usual. The Fugl-Meyer Assessment (FMA), measuring participants' motor performance of the affected arm, is used as the primary outcome measure. Secondary outcome measures are arm-hand capacity of the patient (ARAT), perceived arm-hand skill performance (MAL), actual arm-hand skill performance (accelerometry), patients' quality of life (EuoQol-5D) and caregivers' quality of life (CarerQoL). Participants' perception regarding the usability of the intervention, including both the developed approach and technology used, will be evaluated by the System Usability Scale and a questionnaire on the user experience of technology. Measurements will be performed at 1, 2, 3 and 4 weeks pre-intervention (baseline); immediately post-intervention; and 3, 6 and 9 months post-intervention. Statistical analysis includes linear mixed model analysis. DISCUSSION This study is designed to investigate the evidence regarding the effects of ReHab-TOAT on patients' performance at different levels of the International Classification of Functioning, disability and health (ICF) model, i.e. a framework measuring functioning and disability in relation to a health condition, and to provide insights on a successful development and research process regarding technology-assisted training in co-creation. TRIAL REGISTRATION Netherlands Trial Register NL9541. Registered on June 22, 2021.
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Affiliation(s)
- Jule Elmanowski
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands. .,Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands. .,Adelante Rehabilitation Centre, Hoensbroek, the Netherlands.
| | - Henk Seelen
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Richard Geers
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Melanie Kleynen
- Research Centre for Nutrition, Lifestyle and Exercise, Faculty of Health, Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
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17
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Huo C, Xu G, Sun A, Xie H, Hu X, Li W, Li Z, Fan Y. Cortical response induced by task-oriented training of the upper limb in subacute stroke patients as assessed by functional near-infrared spectroscopy. J Biophotonics 2023; 16:e202200228. [PMID: 36222197 DOI: 10.1002/jbio.202200228] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/28/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
Despite the popularity of task-oriented training for stroke, the cortical reorganization associated with this type of therapy remains to be fully elucidated due to the lack of dynamic assessment tools. A good tolerance for motion artifacts makes functional near-infrared spectroscopy (fNIRS) suitable for investigating task-induced cortical responses in stroke patients. Here, patients were randomly assigned to receive task oriented (n = 25) or cyclic rotary training (n = 25) with simultaneous cortical activation and effective connectivity network analysis between prefrontal and motor cortices (PFC/MC). Compared with cyclic rotary training, task-oriented training induced significantly increased activation in both hemispheres and enhanced influence of PFC on MC. In addition, significantly decreased activation lateralization and increased betweenness centrality of the contralesional MC suggested widespread involvement of the contralesional hemisphere during task-oriented training. This study verifies the feasibility of fNIRS combined with motor paradigms for assessing neural responses associated with stroke rehabilitation in real time.
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Affiliation(s)
- Congcong Huo
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Gongcheng Xu
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Aiping Sun
- Department of Neurological Rehabilitation, National Rehabilitation Hospital of National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Hui Xie
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Wenhao Li
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Zengyong Li
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
- Key Laboratory of Neuro-Functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Beijing, China
| | - Yubo Fan
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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18
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Stammler B, Flammer K, Schuster T, Lambert M, Karnath HO. Negami: An Augmented Reality App for the Treatment of Spatial Neglect After Stroke. JMIR Serious Games 2023; 11:e40651. [PMID: 36848215 PMCID: PMC10012013 DOI: 10.2196/40651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/06/2022] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND A widely applied and effective rehabilitation method for patients experiencing spatial neglect after a stroke is "visual exploration training." Patients improve their ipsilesional bias of attention and orientation by training exploration movements and search strategies toward the contralesional side of space. In this context, gamification can have a positive influence on motivation for treatment and thus on the success of treatment. In contrast to virtual reality applications, treatment enhancements through augmented reality (AR) have not yet been investigated, although they offer some advantages over virtual reality. OBJECTIVE This study aimed to develop an AR-based app (Negami) for the treatment of spatial neglect that combines visual exploration training with active, contralesionally oriented rotation of the eyes, head, and trunk. METHODS The app inserts a virtual element (origami bird) into the real space surrounding the patient, which the patient explores with the camera of a tablet. Subjective reports from healthy elderly participants (n=10) and patients with spatial neglect after stroke (n=10) who trained with the new Negami app were analyzed. Usability, side effects, and game experience were assessed by various questionnaires. RESULTS Training at the highest defined difficulty level was perceived as differently challenging but not as frustrating by the group of healthy elderly participants. The app was rated with high usability, hardly any side effects, high motivation, and entertainment. The group of patients with spatial neglect after stroke consistently evaluated the app positively on the dimensions of motivation, satisfaction, and fun. CONCLUSIONS The Negami app represents a promising extension by adding AR to traditional exploration training for spatial neglect. Through participants' natural interaction with the physical surrounding environment during playful tasks, side effects as symptoms of cybersickness are minimized and patients' motivation appeared to markedly increase. The use of AR in cognitive rehabilitation programs and the treatment of spatial neglect seems promising and should receive further investigation.
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Affiliation(s)
- Britta Stammler
- Center of Neurology, Division of Neuropsychology, University of Tübingen, Tübingen, Germany
| | | | | | | | - Hans-Otto Karnath
- Center of Neurology, Division of Neuropsychology, University of Tübingen, Tübingen, Germany
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Verrienti G, Raccagni C, Lombardozzi G, De Bartolo D, Iosa M. Motivation as a Measurable Outcome in Stroke Rehabilitation: A Systematic Review of the Literature. Int J Environ Res Public Health 2023; 20:4187. [PMID: 36901206 PMCID: PMC10001639 DOI: 10.3390/ijerph20054187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Motivated behaviours are thought to lead to enhanced performances. In the neurorehabilitation field, motivation has been demonstrated to be a link between cognition and motor performance, therefore playing an important role upon rehabilitation outcome determining factors. While motivation-enhancing interventions have been frequently investigated, a common and reliable motivation assessment strategy has not been established yet. This review aims to systematically explore and provide a comparison among the existing motivation assessment tools concerning stroke rehabilitation. For this purpose, a literature search (PubMed and Google Scholar) was performed, using the following Medical Subject Headings terms: "assessment" OR "scale" AND "motivation" AND "stroke" AND "rehabilitation". In all, 31 randomized clinical trials and 15 clinical trials were examined. The existing assessment tools can be grouped into two categories: the first mirroring the trade-off between patients and rehabilitation, the latter reflecting the link between patients and interventions. Furthermore, we presented assessment tools which reflect participation level or apathy, as an indirect index of motivation. In conclusion, we are left to put forth a possible common motivation assessment strategy, which might provide valuable incentive to investigate in future research.
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Affiliation(s)
- Giulio Verrienti
- Department of Neurorehabilitation, Casa di Cura Villa Verde, 73100 Lecce, Italy
| | - Cecilia Raccagni
- Department of Neurology, Provincial Hospital of Bolzano (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, 39100 Bolzano, Italy
- Department of Neurology, Innsbruck Medical University, 6030 Innsbruck, Austria
| | | | | | - Marco Iosa
- Smart Lab, IRCCS Santa Lucia Foundation, 00179 Rome, Italy
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
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20
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Rodrigues JC, Menezes P, Restivo MT. An augmented reality interface to control a collaborative robot in rehab: A preliminary usability evaluation. Front Digit Health 2023; 5:1078511. [PMID: 36860377 PMCID: PMC9968839 DOI: 10.3389/fdgth.2023.1078511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/11/2023] [Indexed: 02/15/2023] Open
Abstract
Human emotions can be seen as a valuable variable to explore in Human-Computer Interaction for effective, efficient, and satisfying interface development. The inclusion of appropriate emotional triggers in the design of interactive systems can play a decisive role in users' acceptance or rejection. It is well known that the major problem in motor rehabilitation is the high dropout rate resulting from the frustrated expectations given the typical slow recovery process and consequent lack of motivation to endure. This work proposes grouping a collaborative robot with one specific augmented reality equipment to create a rehabilitation system where some gamification levels might be added to provide a better and more motivating experience to patients. Such a system, as a whole, is customizable to adapt to each patient's needs on the rehabilitation exercises. By transforming a tedious exercise into a game, we expect to create an additional layer of enjoyment that can help in triggering positive emotions and stimulate users to continue the rehabilitation process. A pre-prototype was developed to validate this system's usability, and a cross-sectional study using a non-probabilistic sample of 31 individuals is presented and discussed. This study included the application of three standard questionnaires on usability and user experience. The analyses of these questionnaires show that the majority of the users found the system easy and enjoyable. The system was also analysed by a rehabilitation expert who gave a positive output regarding its usefulness, and positive impact on its use in the upper-limb rehabilitation processes. These results clearly encourage further development of the proposed system.
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Affiliation(s)
- José Carlos Rodrigues
- LAETA-INEGI, Faculty of Engineering, University of Porto, Porto, Portugal,Correspondence: José Carlos Rodrigues
| | - Paulo Menezes
- Department of Electrical and Computer Engineering, Institute of Systems and Robotics, University of Coimbra, Coimbra, Portugal
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21
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Tan M, Liu Y, Li H. Cross-cultural adaptation and validation of the Motivation in Stroke Patients for Rehabilitation Scale in Chinese hospitalized older adults with stroke. Geriatr Nurs 2023; 50:188-93. [PMID: 36791543 DOI: 10.1016/j.gerinurse.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 02/15/2023]
Abstract
OBJECTS To translate, cross-culturally adapt, and validate the Motivation in Stroke Patients for Rehabilitation Scale (MORE) questionnaire in Chinese hospitalized older adults with stroke. METHODS The Chinese version of the MORE was produced following Brislin's guidelines. The psychometric properties of the MORE were evaluated among 420 eligible patients. RESULTS The Cronbach's alpha coefficient of the Chinese version of the MORE scale was 0.983, and the content validity index (S-CVI) was 0.94, with good reliability. Exploratory factor analysis showed a single-factor structure that explained 78.01% of the total variance, and the confirmatory factor analysis model had a good fit index (X2/df=2.97; NFI =0.93; CFI=0.96; TFI=0.95; IFI=0.96). CONCLUSION The MORE presented acceptable validity and reliability and could be used in Chinese hospitalized older adults with stroke.
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Wenk N, Penalver-Andres J, Buetler KA, Nef T, Müri RM, Marchal-Crespo L. Effect of immersive visualization technologies on cognitive load, motivation, usability, and embodiment. Virtual Real 2023; 27:307-331. [PMID: 36915633 PMCID: PMC9998603 DOI: 10.1007/s10055-021-00565-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/22/2021] [Indexed: 05/09/2023]
Abstract
Virtual reality (VR) is a promising tool to promote motor (re)learning in healthy users and brain-injured patients. However, in current VR-based motor training, movements of the users performed in a three-dimensional space are usually visualized on computer screens, televisions, or projection systems, which lack depth cues (2D screen), and thus, display information using only monocular depth cues. The reduced depth cues and the visuospatial transformation from the movements performed in a three-dimensional space to their two-dimensional indirect visualization on the 2D screen may add cognitive load, reducing VR usability, especially in users suffering from cognitive impairments. These 2D screens might further reduce the learning outcomes if they limit users' motivation and embodiment, factors previously associated with better motor performance. The goal of this study was to evaluate the potential benefits of more immersive technologies using head-mounted displays (HMDs). As a first step towards potential clinical implementation, we ran an experiment with 20 healthy participants who simultaneously performed a 3D motor reaching and a cognitive counting task using: (1) (immersive) VR (IVR) HMD, (2) augmented reality (AR) HMD, and (3) computer screen (2D screen). In a previous analysis, we reported improved movement quality when movements were visualized with IVR than with a 2D screen. Here, we present results from the analysis of questionnaires to evaluate whether the visualization technology impacted users' cognitive load, motivation, technology usability, and embodiment. Reports on cognitive load did not differ across visualization technologies. However, IVR was more motivating and usable than AR and the 2D screen. Both IVR and AR rea ched higher embodiment level than the 2D screen. Our results support our previous finding that IVR HMDs seem to be more suitable than the common 2D screens employed in VR-based therapy when training 3D movements. For AR, it is still unknown whether the absence of benefit over the 2D screen is due to the visualization technology per se or to technical limitations specific to the device.
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Affiliation(s)
- N. Wenk
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - J. Penalver-Andres
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - K. A. Buetler
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - T. Nef
- Gerontechnology & Rehabilitation, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - R. M. Müri
- Gerontechnology & Rehabilitation, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Neurology, University Neurorehabilitation, University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland
| | - L. Marchal-Crespo
- Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Cognitive Robotics, Delft University of Technology, Delft, The Netherlands
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Shin S, Lee HJ, Chang WH, Ko SH, Shin YI, Kim YH. A Smart Glove Digital System Promotes Restoration of Upper Limb Motor Function and Enhances Cortical Hemodynamic Changes in Subacute Stroke Patients with Mild to Moderate Weakness: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11247343. [PMID: 36555960 PMCID: PMC9782087 DOI: 10.3390/jcm11247343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
This study was a randomized controlled trial to examine the effects of the RAPAEL® Smart Glove digital training system on upper extremity function and cortical hemodynamic changes in subacute stroke patients. Of 48 patients, 20 experimental and 16 controls completed the study. In addition to conventional occupational therapy (OT), the experimental group received game-based digital hand motor training with the RAPAEL® Smart Glove digital system, while the control group received extra OT for 30 min. The Fugl-Meyer assessment (UFMA) and Jebsen-Tayler hand function test (JTT) were assessed before (T0), immediately after (T1), and four weeks after intervention (T2). Cortical hemodynamics (oxyhemoglobin [OxyHb] concentration) were measured by functional near-infrared spectroscopy. The experimental group had significantly better improvements in UFMA (T1-T0 mean [SD]; Experimental 13.50 [7.49]; Control 8.00 [4.44]; p = 0.014) and JTT (Experimental 21.10 [20.84]; Control 5.63 [5.06]; p = 0.012). The OxyHb concentration change over the ipsilesional primary sensorimotor cortex during the affected wrist movement was greater in the experimental group (T1, Experimental 0.7943 × 10-4 μmol/L; Control -0.3269 × 10-4 μmol/L; p = 0.025). This study demonstrated a beneficial effect of game-based virtual reality training with the RAPAEL® Smart Glove digital system with conventional OT on upper extremity motor function in subacute stroke patients.
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Affiliation(s)
- Seyoung Shin
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Hwang-Jae Lee
- Robot Business Team, Samsung Electronics, Suwon 16677, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Sung Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea
- Research Institute of Convergence for Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea
- Correspondence: (Y.-I.S.); (Y.-H.K.); Tel.: +82-51-360-2872 (Y.-I.S.); +82-2-3410-2824 (ext. 2818) (Y.-H.K.); Fax: +82-2-3410-0388 (Y.-H.K.)
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Department of Health Science and Technology, Department of Medical Devices Management and Research, Department of Digital Healthcare, SAIHST, Sungkyunkwan University, Seoul 06355, Republic of Korea
- Correspondence: (Y.-I.S.); (Y.-H.K.); Tel.: +82-51-360-2872 (Y.-I.S.); +82-2-3410-2824 (ext. 2818) (Y.-H.K.); Fax: +82-2-3410-0388 (Y.-H.K.)
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Wenk N, Buetler KA, Penalver-Andres J, Müri RM, Marchal-Crespo L. Naturalistic visualization of reaching movements using head-mounted displays improves movement quality compared to conventional computer screens and proves high usability. J Neuroeng Rehabil 2022; 19:137. [PMID: 36494668 PMCID: PMC9733395 DOI: 10.1186/s12984-022-01101-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 10/25/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The relearning of movements after brain injury can be optimized by providing intensive, meaningful, and motivating training using virtual reality (VR). However, most current solutions use two-dimensional (2D) screens, where patients interact via symbolic representations of their limbs (e.g., a cursor). These 2D screens lack depth cues, potentially deteriorating movement quality and increasing cognitive load. Head-mounted displays (HMDs) have great potential to provide naturalistic movement visualization by incorporating improved depth cues, reduce visuospatial transformations by rendering movements in the space where they are performed, and preserve eye-hand coordination by showing an avatar-with immersive VR (IVR)-or the user's real body-with augmented reality (AR). However, elderly populations might not find these novel technologies usable, hampering potential motor and cognitive benefits. METHODS We compared movement quality, cognitive load, motivation, and system usability in twenty elderly participants (>59 years old) while performing a dual motor-cognitive task with different visualization technologies: IVR HMD, AR HMD, and a 2D screen. We evaluated participants' self-reported cognitive load, motivation, and usability using questionnaires. We also conducted a pilot study with five brain-injured patients comparing the visualization technologies while using an assistive device. RESULTS Elderly participants performed straighter, shorter duration, and smoother movements when the task was visualized with the HMDs than screen. The IVR HMD led to shorter duration movements than AR. Movement onsets were shorter with IVR than AR, and shorter for both HMDs than the screen, potentially indicating facilitated reaction times due to reduced cognitive load. No differences were found in the questionnaires regarding cognitive load, motivation, or usability between technologies in elderly participants. Both HMDs proved high usability in our small sample of patients. CONCLUSIONS HMDs are a promising technology to be incorporated into neurorehabilitation, as their more naturalistic movement visualization improves movement quality compared to conventional screens. HMDs demonstrate high usability, without decreasing participants' motivation, and might potentially lower cognitive load. Our preliminary clinical results suggest that brain-injured patients may especially benefit from more immersive technologies. However, larger patient samples are needed to draw stronger conclusions.*.
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Affiliation(s)
- Nicolas Wenk
- grid.5734.50000 0001 0726 5157Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Karin A. Buetler
- grid.5734.50000 0001 0726 5157Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Joaquin Penalver-Andres
- grid.5734.50000 0001 0726 5157Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - René M. Müri
- grid.5734.50000 0001 0726 5157Gerontechnology and Rehabilitation, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland ,grid.5734.50000 0001 0726 5157Department of Neurology, University Neurorehabilitation, University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland
| | - Laura Marchal-Crespo
- grid.5734.50000 0001 0726 5157Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland ,grid.5292.c0000 0001 2097 4740Department of Cognitive Robotics, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
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Donovan I, Saul MA, DeSimone K, Listman JB, Mackey WE, Heeger DJ. Assessment of human expertise and movement kinematics in first-person shooter games. Front Hum Neurosci 2022; 16:979293. [PMID: 36523441 PMCID: PMC9744923 DOI: 10.3389/fnhum.2022.979293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/08/2022] [Indexed: 08/12/2023] Open
Abstract
In contrast to traditional professional sports, there are few standardized metrics in professional esports (competitive multiplayer video games) for assessing a player's skill and ability. We assessed the performance of professional-level players in Aim LabTM, a first-person shooter training and assessment game, with two target-shooting tasks. These tasks differed primarily in target size: the task with large targets provided an incentive to be fast but imprecise and the task with large targets provided an incentive to be precise but slow. Each player's motor acuity was measured by characterizing the speed-accuracy trade-off in shot behavior: shot time (elapsed time for a player to shoot at a target) and shot spatial error (distance from center of a target). We also characterized the fine-grained kinematics of players' mouse movements. Our findings demonstrate that: 1) movement kinematics depended on task demands; 2) individual differences in motor acuity were significantly correlated with kinematics; and 3) performance, combined across the two target sizes, was poorly characterized by Fitts Law. Our approach to measuring motor acuity has widespread applications not only in esports assessment and training, but also in basic (motor psychophysics) and clinical (gamified rehabilitation) research.
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Affiliation(s)
- Ian Donovan
- Statespace Labs, Inc., New York, NY, United States
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Shah SHH, Karlsen AST, Solberg M, Hameed IA. A social VR-based collaborative exergame for rehabilitation: codesign, development and user study. Virtual Real 2022; 27:1-18. [PMID: 36465891 PMCID: PMC9702607 DOI: 10.1007/s10055-022-00721-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 11/13/2022] [Indexed: 06/17/2023]
Abstract
Immersive virtual reality (VR)-based exercise video games (exergames) are increasingly being employed as a supportive intervention in rehabilitation programs to promote engagement in physical activity, especially for elderly users. A multifaceted and iterative codesign process is essential to develop sustainable exergaming solutions. The social aspect is considered one of the key motivating factors in exergames; however, research on the social aspect of VR exergames has been limited. Previous studies have relied on competitiveness in exergames, but research has shown that competition can lead to adverse effects on users. With the aim of motivating elderly individuals to participate in physical exercise and improving social connectedness during rehabilitation, this work presents a social VR-based collaborative exergame codesigned with elderly participants and therapists. This exergame stimulates full-body exercise and supports social collaboration among users through a collaborative game task. Furthermore, this article presents a user study based on a mixed-methods approach to gather user feedback on exergame design and the effect of social collaboration versus playing alone in a VR exergame in terms of physical exertion and motivation. This study spanned five weeks (99 exergaming sessions) with 14 elderly participants divided into two groups, one playing collaboratively and the other playing individually. Between-group comparisons were performed at baseline (first week) and in the fourth week, and within-group comparisons were performed in the fifth week, when the participants played the exergame in counterbalanced order. In contrast to the first week, the participants exergaming collaboratively in the fourth week reported significantly higher intrinsic motivation on all subscales (enjoyment: p < 0.02, effort: p < 0.002, usefulness: p < 0.01) and physical exertion (p < 0.001) than those playing alone. Thereafter, exergaming in counterbalanced order during the fifth week resulted in significant differences (medium to large effect size) within groups. The participants found the social VR gameplay enjoyable and agreed that collaboration played a vital role in their motivation. They reported various health benefits, a minimal increase in symptoms of simulator sickness, and excellent usability scores (83.75±13.3). In this work, we also identify various key design principles to support healthcare professionals, researchers and industrial experts in developing ergonomic and sustainable VR-based exergames for senior citizens.
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Affiliation(s)
- Syed Hammad Hussain Shah
- Department of ICT and Natural Sciences, Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology (NTNU), Larsgårdsvegen 2, 6009 Ålesund, Norway
| | - Anniken Susanne T. Karlsen
- Department of ICT and Natural Sciences, Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology (NTNU), Larsgårdsvegen 2, 6009 Ålesund, Norway
| | - Mads Solberg
- Department of Health Sciences, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Larsgårdsvegen 2, 6009 Ålesund, Norway
| | - Ibrahim A. Hameed
- Department of ICT and Natural Sciences, Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology (NTNU), Larsgårdsvegen 2, 6009 Ålesund, Norway
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27
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Biel M, Enclade H, Richardson A, Guerrero A, Patterson J. Motivation Theory and Practice in Aphasia Rehabilitation: A Scoping Review. Am J Speech Lang Pathol 2022; 31:2421-2443. [PMID: 36264648 DOI: 10.1044/2022_ajslp-22-00064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE In the aphasia literature, motivation has been described as potentially influencing rehabilitation outcomes, and there are reports that researchers and clinicians have acted to promote it. However, studies directly investigating the range of beliefs and practices surrounding motivation do not exist currently. The purpose of this scoping review is to develop themes related to the beliefs and practices appearing in the recent aphasia literature. METHOD Four databases (CINAHL, PsycINFO, PubMed, and Google Scholar) were searched using keywords aphasia and motivation (including derivatives such as motiv*) for articles published between 2009 and 2020. Searches returned 19,731 articles; after deleting duplicates and applying inclusionary criteria, 365 articles remained. In each article, text surrounding the term motivation was highlighted and thematic analysis was applied to these quotations. RESULTS Sixteen themes were developed through thematic analysis and placed into two groups. The first group contained five themes suggesting that researchers believed that motivation should be studied and recognized the value of motivation in person(s) with aphasia when participating in research or clinical activities. The second group contained 11 themes reporting diverse beliefs and practices in how motivation is incorporated in research and clinical activities. CONCLUSIONS Results from this scoping review suggest that aphasia researchers, clinicians, and persons with aphasia hold beliefs about motivation that can influence clinical and research decisions. In general, beliefs and decisions related to motivation appeared to be guided by intuition rather than theories of motivation. These themes are discussed within the context of three psychological needs proposed by self-determination theory: competency, autonomy, and relatedness. Applying theories of motivation to future study in aphasia rehabilitation will guide work that can provide empirical support for these beliefs.
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Someya A, Tanaka M. The process by which patients become aware of unilateral spatial neglect: A qualitative study. Neuropsychol Rehabil 2022; 32:2370-2391. [PMID: 34212821 DOI: 10.1080/09602011.2021.1946411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Unilateral spatial neglect (USN), which can occur post-stroke, significantly impacts patients' daily lives. We explored the process by which patients become aware of the facets of their USN from the acute to subacute phase using a qualitative method. Participant observations, semi-structured interviews, and medical-record surveys were conducted with eight patients with USN and thirty healthcare professionals. We identified three themes regarding the patients' USN awareness process: inconsistency between present symptoms and perception of the left side, reconsidering the reasons for a vagueness on the left side, and acceptance of neglecting the left side. Additionally, healthcare professionals' support consisted of four strategies: assessing patients' perception of stimuli on their left side, compensating for patients' behaviours, promoting awareness of USN, and promoting activities that involve the use of residual functions after a cerebrovascular accident. Patients with USN gradually became aware of their deficits through interactions with others, and they responded by creating and practicing their own self-developed management strategies. These findings indicate that recovery from USN requires a series of experiences and social interactions. A comprehensive understanding of the process of awareness and adaption to USN from onset to recovery can help provide support for patients with USN.
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Affiliation(s)
- Akira Someya
- Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Makoto Tanaka
- Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Ghaffari A, Asadi B, Zareian A, Akbarfahimi M, Raissi GR, Fathali Lavasani F, Mezzapesa DM. The Effects of Vestibular Rehabilitation on Poststroke Fatigue: A Randomized Controlled Trial Study. Stroke Res Treat 2022; 2022:1-9. [PMID: 36090743 PMCID: PMC9453100 DOI: 10.1155/2022/3155437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/23/2022] [Indexed: 11/18/2022] Open
Abstract
Background. A major complication caused by stroke is poststroke fatigue (PSF), and by causing limitations in doing activities of daily living (ADL), it can lower the quality of life. Objective. The present study is an attempt to examine the effects of vestibular rehabilitation on BADL (Basic Activities of Daily Living), fatigue, depression, and Lawton Instrumental Activities of Daily Living (IADL) in patients with stroke. Method. Patients with a history of stroke took part voluntarily in a single-blind clinical trial. The participants were allocated to control and experimental groups randomly. The experimental group attended 24 sessions of vestibular rehabilitation protocol, while the control group received the standard rehabilitation (including three sessions per week each for around 60 min). To measure fatigue, the Fatigue Impact Scale (FIS) and the Fatigue Assessment Scale (FAS) were used. Depression, BADL, and IADL were measured using the Beck Depression Inventory-II (BDI-II), Barthel Index (BI), and Lawton Instrumental Activities of Daily Living, respectively. All changes were measured from the baseline after the intervention. Results. Significant improvement was found in the experimental group compared to the control group (
) in FIS (physical, cognition, and social subscales), FAS, BDI-II, BADL, and IADL. Moreover, the results showed small to medium and large effect sizes for the physical subscale of FIS and FAS scores based on Cohen’s
, respectively; however, no significant difference was found in terms of cognition and social subscales of FIS, BDI-II, BADL, and IADL scores. Conclusion. It is possible to improve fatigue, depression, and independence in BADL and IADL using vestibular rehabilitation. Thus, it is an effective intervention in case of stroke, which is also well tolerated.
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Scano A, Guanziroli E, Mira RM, Brambilla C, Molinari Tosatti L, Molteni F. Biomechanical assessment of the ipsilesional upper limb in post-stroke patients during multi-joint reaching tasks: A quantitative study. Front Rehabilit Sci 2022; 3:943397. [PMID: 36189026 PMCID: PMC9397945 DOI: 10.3389/fresc.2022.943397] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022]
Abstract
In hemiplegic patients with stroke, investigating the ipsilesional limb may shed light on the upper limb motor control, impairments and mechanisms of functional recovery. Usually investigation of motor impairment and rehabilitative interventions in patients are performed only based on the contralesional limb. Previous studies found that also the ipsilesional limb presents motor deficits, mostly evaluated with clinical scales which could lack of sensibility. To quantitatively evaluate the performance of the ipsilesional limb in patient with stroke, we conducted an observational study in which 49 hemiplegic patients were enrolled, divided in subgroups based on the severity of impairment of the contralesional limb, and assessed with a kinematic, dynamic and motor control evaluation protocol on their ipsilesional upper limb during reaching movements. Measurements were repeated in the acute and subacute phases and compared to healthy controls. Our results showed that the ipsilesional limb presented lower kinematic and dynamic performances with respect to the healthy controls. Patients performed the movements slower and with a reduced range of motion, indicating a difficulty in controlling the motion of the arm. The energy and the power outputs were lower in both shoulder and elbow joint with a high significance level, confirming the limitation found in kinematics. Moreover, we showed that motor deficits were higher in the acute phase with respect to the subacute one and we found higher significant differences in the group with a more severe contralesional limb impairment. Ipsilesional upper limb biomechanics adds significant and more sensible measures for assessments based on multi-joints dynamics, providing a better insight on the upper limb motor control after stroke. These results could have clinical implications while evaluating and treating ipsilesional and contralesional upper limb impairments and dysfunctions in patients with stroke.
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Affiliation(s)
- Alessandro Scano
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing (STIIMA), Italian National Research Council (CNR), Milan-Lecco, Italy
- *Correspondence: Alessandro Scano
| | | | - Robert M. Mira
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing (STIIMA), Italian National Research Council (CNR), Milan-Lecco, Italy
| | - Cristina Brambilla
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing (STIIMA), Italian National Research Council (CNR), Milan-Lecco, Italy
| | - Lorenzo Molinari Tosatti
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing (STIIMA), Italian National Research Council (CNR), Milan-Lecco, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Costa Masnaga, Italy
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Cóias AR, Lee MH, Bernardino A. A low-cost virtual coach for 2D video-based compensation assessment of upper extremity rehabilitation exercises. J Neuroeng Rehabil 2022; 19:83. [PMID: 35902897 PMCID: PMC9336113 DOI: 10.1186/s12984-022-01053-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/06/2022] [Indexed: 11/20/2022] Open
Abstract
Background The increasing demands concerning stroke rehabilitation and in-home exercise promotion grew the need for affordable and accessible assistive systems to promote patients’ compliance in therapy. These assistive systems require quantitative methods to assess patients’ quality of movement and provide feedback on their performance. However, state-of-the-art quantitative assessment approaches require expensive motion-capture devices, which might be a barrier to the development of low-cost systems. Methods In this work, we develop a low-cost virtual coach (VC) that requires only a laptop with a webcam to monitor three upper extremity rehabilitation exercises and provide real-time visual and audio feedback on compensatory motion patterns exclusively from image 2D positional data analysis. To assess compensation patterns quantitatively, we propose a Rule-based (RB) and a Neural Network (NN) based approaches. Using the dataset of 15 post-stroke patients, we evaluated these methods with Leave-One-Subject-Out (LOSO) and Leave-One-Exercise-Out (LOEO) cross-validation and the \documentclass[12pt]{minimal}
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\begin{document}$$F_1$$\end{document}F1 score that measures the accuracy (geometric mean of precision and recall) of a model to assess compensation motions. In addition, we conducted a pilot study with seven volunteers to evaluate system performance and usability. Results For exercise 1, the RB approach assessed four compensation patterns with a \documentclass[12pt]{minimal}
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\begin{document}$$76.69 \%$$\end{document}76.69%. For exercises 2 and 3, the NN-based approach achieved a \documentclass[12pt]{minimal}
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\begin{document}$$79.87 \%$$\end{document}79.87%, respectively. Concerning the user study, they found that the system is enjoyable (hedonic value of 4.54/5) and relevant (utilitarian value of 4.86/5) for rehabilitation administration. Additionally, volunteers’ enjoyment and interest (Hedonic value perception) were correlated with their perceived VC performance (\documentclass[12pt]{minimal}
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\begin{document}$$\rho = 0.53$$\end{document}ρ=0.53). Conclusions The VC performs analysis on 2D videos from a built-in webcam of a laptop and accurately identifies compensatory movement patterns to provide corrective feedback. In addition, we discuss some findings concerning system performance and usability.
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Affiliation(s)
- Ana Rita Cóias
- Institute for Systems and Robotics, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.
| | - Min Hun Lee
- Singapore Management University, Singapore, Singapore
| | - Alexandre Bernardino
- Institute for Systems and Robotics, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
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Liu Y, Silva RML, Friedrich JB, Kao DS, Mourad PD, Bunnell AE. Surface Electromyography-Driven Therapeutic Gaming for Rehabilitation of Upper Extremity Weakness: A Pilot Study. Plast Reconstr Surg 2022; 150:125-31. [PMID: 35544314 DOI: 10.1097/PRS.0000000000009208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SUMMARY In patients with severe upper extremity weakness that may result from peripheral nerve injuries, stroke, and spinal cord injuries, standard therapy in the earliest stages of recovery consists primarily of passive rather than active exercises. Adherence to prescribed therapy may be poor, which may contribute to suboptimal functional outcomes. The authors have developed and integrated a custom surface electromyography device with a video game to create an interactive, biofeedback-based therapeutic gaming platform. Sensitivity of the authors' custom surface electromyography device was evaluated with simultaneous needle electromyography recordings. Testing of this therapeutic gaming platform was conducted with a single 30-minute gameplay session in 19 patients with a history of peripheral nerve injury, stroke, spinal cord injury, and direct upper extremity trauma, including 11 patients who had undergone nerve and/or tendon transfers. The device was highly sensitive in detecting low levels of voluntary muscle activation and was used with 10 distinct muscles of the arm, forearm, and hand. Nerve and tendon transfer patients successfully activated the donor nerve/muscle and elicited the desired movement to engage in gameplay. On surveys of acceptability and usability, patients felt the system was enjoyable, motivating, fun, and easy to use, and their hand therapists expressed similar enthusiasm. Surface electromyography-based therapeutic gaming is a promising approach to rehabilitation that warrants further development and investigation to examine its potential efficacy, not only for building muscle strength and endurance but also for facilitating motor relearning after nerve and tendon transfer surgical procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Dias G, Adriao ML, Clemente P, da Silva HP, Chambel G, Pinto JF. Effectiveness of a Gamified and Home-Based Approach for Upper-limb Rehabilitation. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:2602-2605. [PMID: 36086357 DOI: 10.1109/embc48229.2022.9871386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Rehabilitation treatments have been greatly en-hanced by health-enabling technologies, as these enable more objective and interactive interventions. Multiple studiesindi-cate that gamification is efficient in promoting treatment cus-tomization, adherence, motivation, and engagement, leading to increased patient satisfaction. In this work we study the effectiveness of a novel gamified telerehabilitation system. Pa-tients exercise within a digital game-like experience, with their motion tracked using an user-friendly "invisibles" paradigm, i.e. without requiring sensor placed on the body. Pain, ad-herence and satisfaction data was collected and analysed. Our approach was particularly relevant during the acute stages of the pandemic, during severe restrictions in the access to in-person rehabilitation activities. A total of 62 patients participated in this study, during a 14-month period. Each patient completed an average of 16 sessions, and 85.5% of them were considered fully recovered after the protocol completion. All patients improved their pain level, with an overall 73.3% average pain reduction. Moreover, in the end of the treatment 79.4% of the patients reported their pain in the levels 0 or 1 (in a 0-10 scale). In terms of treatment satisfaction, 95% of the patients would reportedly recommend the proposed solution to a friend of family. Moreover, the main benefits reported were the convenience, time flexibility, and customization. Our results validate the clinical outcomes and the healthcare quality perceived by the patients in the use of the approach in telerehabilitation for shoulder-related conditions, and are encouraging for usage in further physical rehabilitation fields.
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Lee D, Bae Y. Interactive Videogame Improved Rehabilitation Motivation and Walking Speed in Chronic Stroke Patients: A Dual-Center Controlled Trial. Games Health J 2022; 11:268-274. [PMID: 35648053 DOI: 10.1089/g4h.2021.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective: This study aimed to evaluate the effectiveness of interactive video games (IVGs) in rehabilitation motivation and walking and balance abilities in chronic stroke patients. Materials and Methods: In this dual-center controlled trial, 24 chronic stroke patients from rehabilitation centers A and B were randomly assigned to an experimental (IVGs + traditional neurodevelopment treatment [TNT], n = 12) or a control group (walking training + TNT, n = 12). The patients in both the groups underwent TNT for 4 weeks (5 days/week) before undergoing either IVGs or walking training (4 weeks, 3 days/week) depending on the group. The primary and secondary outcomes were rehabilitation motivation and the Berg Balance Scale (BBS) score, Functional Reach Test (FRT) performance, and walking speed (WS), respectively. Results: The patients in both the groups showed significant increase in the BBS score, FRT performance, and WS; however, the experimental group showed more significant improvements in rehabilitation motivation (P = 0.02, η2 = 0.415) and WS (P = 0.05, η2 = 0.333) than the patients in the control group. Conclusion: This study suggests that the IVGs in combination with TNT provide effective rehabilitation motivation in chronic stroke patients. Clinical Trial Registration number: KCT0003408.
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Affiliation(s)
- Daegyun Lee
- Department of Physical Therapy, Mokdong Hyundae Clinic, Seoul, Republic of Korea
| | - Youngsook Bae
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon, Republic of Korea
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Hankinson K, Shaykevich A, Vallence AM, Rodger J, Rosenberg M, Etherton-Beer C. A Tailored Music-Motor Therapy and Real-Time Biofeedback Mobile Phone App (‘GotRhythm’) to Promote Rehabilitation Following Stroke: A Pilot Study. Neurosci Insights 2022; 17:26331055221100587. [PMID: 35615116 PMCID: PMC9125048 DOI: 10.1177/26331055221100587] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 04/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Stroke persists as an important cause of long-term disability world-wide with the need for rehabilitation strategies to facilitate plasticity and improve motor function in stroke survivors. Rhythm-based interventions can improve motor function in clinical populations. This study tested a novel music-motor software application ‘GotRhythm’ on motor function after stroke. Methods: Participants were 22 stroke survivors undergoing inpatient rehabilitation in a subacute stroke ward. Participants were randomised to the GotRhythm intervention (combining individualised music and augmented auditory feedback along with wearable sensors to deliver a personalised rhythmic auditory stimulation training protocol) or usual care. Intervention group participants were offered 6-weeks of the GotRhythm intervention, consisting of a supervised 20-minute music-motor therapy session using GotRhythm conducted 3 times a week for 6 weeks. The primary feasibility outcomes were adherence to the intervention and physical function (change in the Fugl-Meyer Assessment of Motor Recovery score) measured at baseline, after 3-weeks and at end of the intervention period (6-weeks). Results: Three of 10 participants randomised to the intervention did not receive any of the GotRhythym music-motor therapy. Of the remaining 7 intervention group participants, only 5 completed the 3-week mid-intervention assessment and only 2 completed the 6-week post-intervention assessment. Participants who used the intervention completed 5 (IQR 4,7) sessions with total ‘dose’ of the intervention of 70 (40, 201) minutes. Conclusion: Overall, adherence to the intervention was poor, highlighting that application of technology assisted music-based interventions for stroke survivors in clinical environments is challenging along with usual care, recovery, and the additional clinical load.
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Affiliation(s)
- Katherine Hankinson
- School of Biological Sciences, University of Western Australia, Crawley, WA, Australia
| | - Alex Shaykevich
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Ann-Maree Vallence
- College of Science, Health, Engineering, and Education, Murdoch University, Murdoch, Australia
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Murdoch, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch, Australia
| | - Jennifer Rodger
- School of Biological Sciences, University of Western Australia, Crawley, WA, Australia
| | - Michael Rosenberg
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Christopher Etherton-Beer
- WA Centre for Health and Ageing, Medical School, University of Western Australia, Crawley, WA, Australia
- Medical Division, Royal Perth Bentley Group, Perth, Western Australia
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Tucek G, Maidhof C, Vogl J, Heine A, Zeppelzauer M, Steinhoff N, Fachner J. EEG Hyperscanning and Qualitative Analysis of Moments of Interest in Music Therapy for Stroke Rehabilitation—A Feasibility Study. Brain Sci 2022; 12:brainsci12050565. [PMID: 35624953 PMCID: PMC9139517 DOI: 10.3390/brainsci12050565] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 02/04/2023] Open
Abstract
Interdisciplinary research into the underlying neural processes of music therapy (MT) and subjective experiences of patients and therapists are largely lacking. The aim of the current study was to assess the feasibility of newly developed procedures (including electroencephalography/electrocardiography hyperscanning, synchronous audio–video monitoring, and qualitative interviews) to study the personal experiences and neuronal dynamics of moments of interest during MT with stroke survivors. The feasibility of our mobile setup and procedures as well as their clinical implementation in a rehabilitation centre and an acute hospital ward were tested with four phase C patients. Protocols and interviews were used for the documentation and analysis of the feasibility. Recruiting patients for MT sessions was feasible, although data collection on three consecutive weeks was not always possible due to organisational constraints, especially in the hospital with acute ward routines. Research procedures were successfully implemented, and according to interviews, none of the patients reported any burden, tiredness, or increased stress due to the research procedures, which lasted approx. 3 h (ranging from 135 min to 209 min) for each patient. Implementing the research procedures in a rehabilitation unit with stroke patients was feasible, and only small adaptations were made for further research.
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Affiliation(s)
- Gerhard Tucek
- Josef Ressel Centre for Horizons of Personalised Music Therapy, Department of Health Sciences, Institute for Therapeutic Sciences, IMC University of Applied Sciences Krems, 3500 Krems, Austria; (G.T.); (C.M.); (J.V.); (A.H.)
| | - Clemens Maidhof
- Josef Ressel Centre for Horizons of Personalised Music Therapy, Department of Health Sciences, Institute for Therapeutic Sciences, IMC University of Applied Sciences Krems, 3500 Krems, Austria; (G.T.); (C.M.); (J.V.); (A.H.)
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge CB1 2LZ, UK
| | - Julia Vogl
- Josef Ressel Centre for Horizons of Personalised Music Therapy, Department of Health Sciences, Institute for Therapeutic Sciences, IMC University of Applied Sciences Krems, 3500 Krems, Austria; (G.T.); (C.M.); (J.V.); (A.H.)
| | - Astrid Heine
- Josef Ressel Centre for Horizons of Personalised Music Therapy, Department of Health Sciences, Institute for Therapeutic Sciences, IMC University of Applied Sciences Krems, 3500 Krems, Austria; (G.T.); (C.M.); (J.V.); (A.H.)
| | - Matthias Zeppelzauer
- Department of Media & Digital Technologies, Institute of Creative Media Technologies, St. Poelten University of Applied Sciences, 3100 St. Poelten, Austria;
| | - Nikolaus Steinhoff
- OptimaMed Neurological Rehabilitation Centre Kittsee GmbH, 2421 Kittsee, Austria;
| | - Jörg Fachner
- Josef Ressel Centre for Horizons of Personalised Music Therapy, Department of Health Sciences, Institute for Therapeutic Sciences, IMC University of Applied Sciences Krems, 3500 Krems, Austria; (G.T.); (C.M.); (J.V.); (A.H.)
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge CB1 2LZ, UK
- Correspondence: ; Tel.: +44-1223-698-416
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Duval J, Thakkar R, Du D, Chin K, Luo S, Elor A, El-Nasr MS, John M. Designing Spellcasters from Clinician Perspectives. ACM Trans Access Comput 2022. [DOI: 10.1145/3530820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Developing games is time-consuming and costly. Overly clinical therapy games run the risk of being boring, which defeats the purpose of using games to motivate healing in the first place [10, 23]. In this work, we adapt and repurpose an existing immersive virtual reality (iVR) game, Spellcasters, originally designed purely for entertainment for use as a stroke rehabilitation game—which is particularly relevant in the wake of COVID-19, where telehealth solutions are increasingly needed [4]. In preparation for participatory design sessions with stroke survivors, we collaborate with 14 medical professionals to ensure Spellcasters is safe and therapeutically valid for clinical adoption. We present our novel VR sandbox implementation that allows medical professionals to customize appropriate gestures and interactions for each patient's unique needs. Additionally, we share a co-designed companion app prototype based on clinicians' preferred data reporting mechanisms for telehealth. We discuss insights about adapting and repurposing entertainment games as serious games for health, features that clinicians value, and the potential broader impacts of applications like Spellcasters for stroke management.
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Affiliation(s)
| | | | - Delong Du
- University of California Santa Cruz, USA
| | | | - Sherry Luo
- University of California Santa Cruz, USA
| | - Aviv Elor
- University of California Santa Cruz, USA
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Manning OJ, Rancourt S, Tomasone JR, Finlayson M, DePaul V. Water-based therapeutic exercise in stroke: a scoping review. Disabil Rehabil 2022; 45:1549-1562. [PMID: 35450495 DOI: 10.1080/09638288.2022.2063415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To (1) describe the state of the literature on water-based therapeutic exercise (WBTE) for people living with stroke, (2) describe the content and structure of interventions, (3) summarize the effects of interventions described in the literature, and (4) identify gaps in the literature limiting application and implementation. MATERIALS AND METHODS Scoping review methodology described by Arksey and O'Malley (2005) and Levac et al. (2010). Electronic databases were searched for articles with eligibility criteria including: (1) adult stroke survivors (18 years or older) of any type (ischemic/hemorrhagic) or stage (acute/chronic) in any setting, and (2) the study intervention involved WBTE to address a post-stroke deficit. RESULTS 40 articles were included in this review. Five trials had a treatment control, 20 had an active comparison. Calculated intervention effect sizes demonstrated a strong effect of WBTE on balance and gait related outcomes in 80% of controlled and comparison trials. CONCLUSIONS This scoping review highlights common parameters of WBTE interventions and provides an inventory of the differences in the treatment approaches utilized in this population. Opportunities for future work include the development of a standardized treatment protocol, qualitative or mixed methodology research, and greater inclusion of more individuals with more severe stroke-related impairments. IMPLICATIONS FOR REHABILITATIONWater-based therapeutic exercise is an approach that may allow stroke survivors to carry out challenging activities in a safe and accessible environment.Water-based interventions for stroke survivors appear to have a beneficial impact on walking and balance.Given that an aquatic environment offers an opportunity for individuals with more significant physical impairments to carry out early practice of walking and balance related tasks, clinicians should explore the feasibility and effectiveness for this subset of stroke survivors.
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Affiliation(s)
- O J Manning
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - S Rancourt
- Providence Care Hospital, Kingston, Canada
| | - J R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, Canada
| | - M Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - V DePaul
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
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Fusco A, Giovannini S, Castelli L, Coraci D, Gatto DM, Reale G, Pastorino R, Padua L. Virtual Reality and Lower Limb Rehabilitation: Effects on Motor and Cognitive Outcome-A Crossover Pilot Study. J Clin Med 2022; 11:jcm11092300. [PMID: 35566424 PMCID: PMC9103855 DOI: 10.3390/jcm11092300] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 02/07/2023] Open
Abstract
The effectiveness of virtual reality (VR) in the motor and cognitive rehabilitation of patients with severe acquired brain injury (sABI) is unclear. This randomized, controlled, crossover, single-blinded, pilot study investigates the cognitive and motor effects of lower limb robotic therapy with and without VR visual feedback in a group of patients with ABI. A total of 23 patients with ABI were randomized into two groups: one group (VR-NVR) underwent a 2-week rehabilitation for the lower limbs training with a robotic device (Omego®) with VR feedback, followed by 2 weeks without VR; the other group (NVR-VR) performed the protocol in the opposite order. Patients were evaluated at baseline, after two and four weeks of treatment using the Level of Cognitive Functioning scale (LCF), Disability Rating Scale (DRS), and Motricity Index for Lower Limb (MI-LL) in the most affected limb. At the end of the intervention, both groups significantly improved in all the outcomes. A significant difference was found between VR treatment versus non-VR treatment for LCF (p = 0.024) and for DRS (p = 0.043) after the second week, while no significant differences were found in the group NVR-VR at T1. Our study indicates how the combination of robotic treatment with VR is effective in enhancing the recovery of cognitive function in patients with ABI, also improving disability and muscular function. Further, VR seems to enhance the early recovery process of motor and cognitive functions.
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Affiliation(s)
- Augusto Fusco
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (D.M.G.); (G.R.); (L.P.)
| | - Silvia Giovannini
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- UOS Riabilitazione Post-Acuzie, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Letizia Castelli
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (D.M.G.); (G.R.); (L.P.)
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-3015-4382
| | - Daniele Coraci
- Dipartimento di Neuroscienze, Università di Padova, 35128 Padova, Italy;
| | - Dario Mattia Gatto
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (D.M.G.); (G.R.); (L.P.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Giuseppe Reale
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (D.M.G.); (G.R.); (L.P.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Roberta Pastorino
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Luca Padua
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (D.M.G.); (G.R.); (L.P.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
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Montoya D, Barria P, Cifuentes CA, Aycardi LF, Morís A, Aguilar R, Azorín JM, Múnera M. Biomechanical Assessment of Post-Stroke Patients' Upper Limb before and after Rehabilitation Therapy Based on FES and VR. Sensors (Basel) 2022; 22:2693. [PMID: 35408306 DOI: 10.3390/s22072693] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/16/2022] [Accepted: 03/25/2022] [Indexed: 01/19/2023]
Abstract
Stroke is a medical condition characterized by the rapid loss of focal brain function. Post-stroke patients attend rehabilitation training to prevent the degeneration of physical function and improve upper limb movements and functional status after stroke. Promising rehabilitation therapies include functional electrical stimulation (FES), exergaming, and virtual reality (VR). This work presents a biomechanical assessment of 13 post-stroke patients with hemiparesis before and after rehabilitation therapy for two months with these three methods. Patients performed two tests (Maximum Forward Reach and Apley Scratching) where maximum angles, range of motion, angular velocities, and execution times were measured. A Wilcoxon test was performed (p = 0.05) to compare the variables before and after the therapy for paretic and non-paretic limbs. Significant differences were found in range of motion in flexion–extension, adduction–abduction, and internal–external rotation of the shoulder. Increases were found in flexion–extension, 17.98%, and internal–external rotation, 18.12%, after therapy in the Maximum Forward Reach Test. For shoulder adduction–abduction, the increase found was 20.23% in the Apley Scratching Test, supporting the benefits of rehabilitation therapy that combines FES, exergaming, and VR in the literature.
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Yoshida T, Otaka Y, Kitamura S, Ushizawa K, Kumagai M, Kurihara Y, Yaeda J, Osu R. Development and validation of new evaluation scale for measuring stroke patients’ motivation for rehabilitation in rehabilitation wards. PLoS One 2022; 17:e0265214. [PMID: 35298513 PMCID: PMC8929594 DOI: 10.1371/journal.pone.0265214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/24/2022] [Indexed: 11/18/2022] Open
Abstract
Objective
This study aimed to develop the Motivation in stroke patients for rehabilitation scale (MORE scale), following the Consensus-based standards for the selection of health measurement instruments (COSMIN).
Method
Study participants included rehabilitation professionals working at the convalescent rehabilitation hospital and stroke patients admitted to the hospital. The original MORE scale was developed from an item pool, which was created through discussions of nine rehabilitation professionals. After the content validity of the scale was verified using the Delphi method with 61 rehabilitation professionals and 22 stroke patients, the scale’s validity and reliability were examined for 201 stroke patients. The construct validity of the scale was investigated using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and item response theory analysis. Cronbach’s alpha confirmed its internal consistency. Regarding convergent, discriminant, and criterion validity, Spearman’s rho was calculated between the MORE scale and the Apathy Scale (AS), Self-rating Depression Scale (SDS), and Visual Analogue Scale (VAS), which rates the subjective feelings of motivation.
Results
Using the Delphi method, 17 items were incorporated into the MORE scale. According to EFA and CFA, a one-factor model was suggested. All MORE scale items demonstrated satisfactory item response, with item slopes ranging from 0.811 to 2.142, and item difficulty parameters ranging from -3.203 to 0.522. Cronbach’s alpha was 0.948. Regarding test-retest reliability, a moderate correlation was found between scores at the beginning and one month after hospitalization (rho = 0.612. p < 0.001). The MORE scale showed significant correlation with AS (rho = -0.536, p < 0.001), SDS (rho = -0.347, p < 0.001), and VAS (rho = 0.536, p < 0.001), confirming the convergent, discriminant, and criterion validity, respectively.
Conclusions
The MORE scale was verified as a valid and reliable scale for evaluating stroke patients’ motivation for rehabilitation.
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Affiliation(s)
- Taiki Yoshida
- Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Graduate School of Human Sciences, Waseda University, Saitama, Japan
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Yohei Otaka
- Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Department of Rehabilitation Medicine Ⅰ, Fujita Health University School of Medicine, Aichi, Japan
- * E-mail:
| | - Shin Kitamura
- Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Kazuki Ushizawa
- Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Department of Rehabilitation Medicine Ⅰ, Fujita Health University School of Medicine, Aichi, Japan
| | | | - Yuto Kurihara
- Graduate School of Human Sciences, Waseda University, Saitama, Japan
| | - Jun Yaeda
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tokyo, Japan
| | - Rieko Osu
- Faculty of Human Sciences, Waseda University, Saitama, Japan
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Abstract
This study aims to identify individual determinants of antidepressant treatment and outpatient rehabilitation after stroke. People with ischemic stroke (N = 303) recruited at 2 inpatient rehabilitation clinics were included into a prospective longitudinal study with follow-up telephone interviews 6 and 12 months later. Participants reported on their use of antidepressant medication and psychotherapy as well as physical, occupational, speech, and neuropsychological therapy. The use of antidepressants at discharge (n = 65, 23.8%) was predicted by the severity of depressive symptoms, severity of stroke, history of depression, and use of antidepressants at admission (all p < .05, R2= .55). The number of outpatient rehabilitation services used at follow-ups was predicted by higher functional and cognitive impairment, higher education, younger age, severity of depressive symptoms, and lower self-efficacy (all p < .05; R26M = .24, R212M = .49). The relevance of identified determinants for the improvement of treatment rates after stroke is discussed.
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Affiliation(s)
- Simon Ladwig
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.,Clinic of Neurology, Hospital Ernst von Bergmann, Potsdam, Germany
| | - Katja Werheid
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.,Clinic of Neurology, Hospital Ernst von Bergmann, Potsdam, Germany
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Bulsara C, Saunders R, Emery L, Etherton-Beer C. Reflecting on experiences of care: an exploratory qualitative descriptive study of the perspectives of stroke survivors, families and staff. BMJ Open 2021; 11:e047559. [PMID: 34930727 PMCID: PMC8689121 DOI: 10.1136/bmjopen-2020-047559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify barriers and enablers from the perspectives of stroke survivors, carers and staff to understand the experiences of care. DESIGN The study used a qualitative descriptive methodology and employed semistructured interview technique. SETTING A metropolitan stroke rehabilitation unit in Western Australia providing rehabilitation services for inpatients and outpatients. PARTICIPANTS Overall, 10 participants (four staff, four stroke survivors and two primary carers) were interviewed. Transcripts were analysed using thematic analysis. RESULTS Experiences of care focused on lack of time, urgency to regain mobility, postshock recovery, uncertainty about the future and the importance of accepting help once home. There was a degree of mismatch between staff experiences of the reality of what can be provided and the experiences and expectations of stroke survivors and families. However, the benefits of a specialised rehabilitation unit were found to contribute to a positive patient experience overall. The specialised unit demonstrated that services must optimise staff time with patients and carers in the poststroke rehabilitation journey to ensure benefits for the long-term well-being for both. CONCLUSION Seeking patient, family and staff experiences of care can provide valuable insights into facilitating better patient, family and staff engagement for preparation for home-based rehabilitation for stroke survivors and their caregivers. Further research with a larger sample across diverse hospital settings would provide even greater insight into strategies to best address the reality of rehabilitation care and readiness of patients when returning home to the community.
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Affiliation(s)
- Caroline Bulsara
- School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Insitute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Rosemary Saunders
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Laura Emery
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Christopher Etherton-Beer
- School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia
- WA Centre for Health and Ageing, The University of Western Australia, Perth, Western Australia, Australia
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Abstract
While most upper limb training interventions in neurological rehabilitation are based on established principles of motor learning and neural plasticity, recovery potential may be improved if the focus includes remediating an individual's specific motor impairment within the framework of a motor control theory. This paper reviews current theories of motor control and motor learning and describes how they can be incorporated into training programs to enhance sensorimotor recovery in patients with neurological lesions. An emphasis is placed on dynamical systems theory and the use of new technologies such as virtual, augmented and mixed reality applications for rehabilitation to facilitate learning.Implications for RehabilitationKinematic abundance allows the healthy nervous system to produce different combinations of joint rotations to perform a desired task.The structure of practice to improve the movement repertoire in rehabilitation should take into account the kinematic abundance of the system.Learning can be enhanced by varied practice with feedback about key movement elements.Virtual reality environments provide opportunities to manipulate the structure and schedule of practice and feedback.
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Affiliation(s)
- Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
| | - Marika Demers
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
- USA Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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van Niekerk SM, Kamalakannan S, Inglis-Jassiem G, Charumbira MY, Fernandes S, Webster J, English R, Louw QA, Smythe T. Towards universal health coverage for people with stroke in South Africa: a scoping review. BMJ Open 2021; 11:e049988. [PMID: 34824111 PMCID: PMC8627414 DOI: 10.1136/bmjopen-2021-049988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the opportunities and challenges within the health system to facilitate the achievement of universal health coverage (UHC) for people with stroke (PWS) in South Africa (SA). SETTING SA. DESIGN Scoping review. SEARCH METHODS We conducted a scoping review of opportunities and challenges to achieve UHC for PWS in SA. Global and Africa-specific databases and grey literature were searched in July 2020. We included studies of all designs that described the healthcare system for PWS. Two frameworks, the Health Systems Dynamics Framework and WHO Framework, were used to map data on governance and regulation, resources, service delivery, context, reorientation of care and community engagement. A narrative approach was used to synthesise results. RESULTS Fifty-nine articles were included in the review. Over half (n=31, 52.5%) were conducted in Western Cape province and most (n=41, 69.4%) were conducted in urban areas. Studies evaluated a diverse range of health system categories and various outcomes. The most common reported component was service delivery (n=46, 77.9%), and only four studies (6.7%) evaluated governance and regulation. Service delivery factors for stroke care were frequently reported as poor and compounded by context-related limiting factors. Governance and regulations for stroke care in terms of government support, investment in policy, treatment guidelines, resource distribution and commitment to evidence-based solutions were limited. Promising supporting factors included adequately equipped and staffed urban tertiary facilities, the emergence of Stroke units, prompt assessment by health professionals, positive staff attitudes and care, two clinical care guidelines and educational and information resources being available. CONCLUSION This review fills a gap in the literature by providing the range of opportunities and challenges to achieve health for all PWS in SA. It highlights some health system areas that show encouraging trends to improve service delivery including comprehensiveness, quality and perceptions of care.
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Affiliation(s)
- Sjan-Mari van Niekerk
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Sureshkumar Kamalakannan
- SACDIR Indian Institute of Public Health Hyderabad, Public Health Foundation of India, New Delhi, India
- International Center for Evidence in Disability, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Gakeemah Inglis-Jassiem
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Maria Yvonne Charumbira
- Rehabilitation Sciences, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Silke Fernandes
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jayne Webster
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Tropical Health and Medicine, London, UK
| | - Rene English
- Global Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Quinette A Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Tracey Smythe
- Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Hyun SJ, Lee J, Lee BH. The Effects of Sit-to-Stand Training Combined with Real-Time Visual Feedback on Strength, Balance, Gait Ability, and Quality of Life in Patients with Stroke: A Randomized Controlled Trial. Int J Environ Res Public Health 2021; 18:12229. [PMID: 34831986 PMCID: PMC8625418 DOI: 10.3390/ijerph182212229] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
This study aimed to investigate the effects of lower limbs muscles' strength, balance, walking, and quality of life through sit-to-stand training combined with real-time visual feedback (RVF-STS group) in patients with stroke and to compare the effects of classic sit-to-stand training (C-STS group). Thirty patients with stroke were randomly divided into two groups. The RVF-STS group received sit-to-stand training combined with real-time visual feedback using a Wii Balance Board (n = 15), and the C-STS group received classic sit-to-stand training (n = 15). All participants received training for 20 min once a day, 5 days a week for 6 weeks, and both groups underwent general physical therapy for 30 min before training. Before and after the training, the muscle strength of the hip flexor, abductor, and knee extensor were measured, and the Wii Balance Board was used to perform the center of pressure test and Berg Balance Scale to evaluate static and dynamic balance. Additionally, the 10 m walking test and the Timed Up and Go test were performed to evaluate gait function. The Stroke-Specific Quality of Life was used to measure the quality of life. The results showed that the lower extremity muscle strength, balance ability, walking ability, and quality of life of the RVF-STS group significantly improved in comparison of the pre- and post-differences (p < 0.05), and it also showed significant differences between groups (p < 0.05). This study showed that sit-to-stand training combined with real-time visual feedback was effective at improving the muscle strength of the lower extremities, balance, gait, and quality of life in patients with stroke. Therefore, repeating sit-to-stand training combined with real-time visual feedback could be used as an effective treatment method for patients with stroke.
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Affiliation(s)
- Seung-Jun Hyun
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Korea;
| | - Jin Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea;
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea;
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Moan ME, Vonstad EK, Su X, Vereijken B, Solbjør M, Skjæret-Maroni N. Experiences of Stroke Survivors and Clinicians With a Fully Immersive Virtual Reality Treadmill Exergame for Stroke Rehabilitation: A Qualitative Pilot Study. Front Aging Neurosci 2021; 13:735251. [PMID: 34795576 PMCID: PMC8595064 DOI: 10.3389/fnagi.2021.735251] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Use of VR-games is considered a promising treatment approach in stroke rehabilitation. However, there is little knowledge on the use and expectations of patients and health professionals regarding the use of treadmill walking in a fully immersive virtual environment as a rehabilitation tool for gait training for stroke survivors. The objectives of the current study were to determine whether stroke survivors can use fully immersive VR utilizing modern HMDs while walking on a treadmill without adverse effects, and to investigate the experiences of stroke survivors and clinicians after testing with focus on acceptability and potential utilization in rehabilitation. A qualitative research design with semi-structured interviews was used to collect data. Five stroke survivors and five clinicians participated in the study and tested a custom-made VR-game on the treadmill before participating in individual semi-structured interview. Data were analyzed through thematic analysis. The analysis of the interview data identified two main categories: (1) experiencing acceptability through safety and motivation, and (2) implementing fully immersive VR in rehabilitation. Both stroke survivors' and clinicians enjoyed the treadmill-based VR-game and felt safe when using it. The stroke survivors experienced motivation for exercising and achievement by fulfilling tasks during the gaming session as the VR-game was engaging. The clinicians found additional motivation by competing in the game. Both groups saw a potential for use in gait rehabilitation after stroke, on the premise of individual adaptation to each patient's needs, and the technology being easy to use. The findings from this qualitative study suggest that a fully immersive treadmill-based VR-game is acceptable and potentially useful as part of gait rehabilitation after stroke, as it was positively received by both stroke survivors and clinicians working within stroke rehabilitation. The participants reported that they experienced motivation in the game through safety, engagement and achievement. They also saw the potential of implementing such a setup in their own rehabilitation setting. Elements that enable safety and engaging experience are important to maintain when using a fully immersive VR-game in stroke rehabilitation.
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Affiliation(s)
| | - Elise Klæbo Vonstad
- Department of Computer Science, Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology, Trondheim, Norway
| | - Xiaomeng Su
- Department of Computer Science, Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology, Trondheim, Norway
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marit Solbjør
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nina Skjæret-Maroni
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Wu X, Zainal Abidin NE, Aga Mohd Jaladin R. Motivational Processes Influencing Mental Health Among Winter Sports Athletes in China. Front Psychol 2021; 12:726072. [PMID: 34603145 PMCID: PMC8484786 DOI: 10.3389/fpsyg.2021.726072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/04/2021] [Indexed: 12/03/2022] Open
Abstract
This study examined the association between motivational processes, psychological distress (depression, anxiety, and stress), and burnout among winter sports athletes within the Hierarchical Model of Intrinsic and Extrinsic Motivation (HMIEM). A total of 685 winter sport athletes participated in this study (377 males, 308 females, age range 18–25 years), from three sport universities across nine winter sports. They completed five psychometric inventories related to motivational factors and mental disorders. Overall, a task-oriented climate showed a positive association with basic psychological needs, eliciting a positive pathway to autonomous and controlled motivation. In contrast, an ego-oriented climate showed a negative association with basic psychological needs, eliciting a negative pathway to amotivation. Autonomous and controlled motivation were negatively associated with symptoms of psychological distress and burnout, while amotivation was positively associated with symptoms of psychological distress and burnout. These findings highlight the complex relationships between various motivational factors and mental health disorders among winter sport athletes, and support the essential requirement for adding mental health factors to the outcomes of the HMIEM sequence.
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Affiliation(s)
- Xinran Wu
- Center for Sport and Exercise Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Rafidah Aga Mohd Jaladin
- Department of Educational Psychology and Counseling, Faculty of Education, University of Malaya, Kuala Lumpur, Malaysia
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Choe YW, Kim MK. Could Self-Control and Emotion Influence Physical Ability and Functional Recovery after Stroke? Medicina (Kaunas) 2021; 57:1042. [PMID: 34684079 PMCID: PMC8540988 DOI: 10.3390/medicina57101042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: This study was conducted to determine whether self-control and emotions could influence patients' physical ability and functional recovery after stroke. Materials and Methods: Twenty-four patients within eight weeks after a stroke were included in this study (age: 54.04 ± 10.31; days after stroke: 42.66 ± 8.84). The subjects participated in tests at the baseline, four weeks later, and eight weeks later. Subjects were asked to complete the following: (1) self-control level test, (2) positive and negative emotion test, (3) knee muscle strength testing, (4) static balance test, (5) gait measurement, and (6) activities of daily living evaluation. Results: The muscle strength of the knee, static balance, gait ability, and the Functional Independence Measure score increased significantly in the stroke patients over time. A significant correlation was noted between the emotion and physical variables in stroke patients. The self-control level was significantly associated with the change in the physical variables in stroke patients over time. Conclusions: The self-control level was positively related to the increases in functional recovery of stroke patients with time, while the emotions were related more to the physical abilities.
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Affiliation(s)
- Yu-Won Choe
- Department of Rehabilitation Sciences, Graduate School, Daegu University, Jillyang, Gyeongsan 712-714, Korea;
| | - Myoung-Kwon Kim
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Jillyang, Gyeongsan 712-714, Korea
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50
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Pasanen J. The nature of positive encounters between disabled workers and insurers in the return to work process. Work 2021; 70:287-300. [PMID: 34511472 DOI: 10.3233/wor-213573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Previous research regarding interaction between disabled workers and insurers indicates that encounters between these parties are predominantly negative in nature and may result in psychosocial harm for workers. Further research is required to investigate positive interactions to foster return to work after illness or injury. OBJECTIVE To explore and conceptualize perceived positive encounters between disabled workers and insurers in order to identify the mechanisms that support successful rehabilitation outcomes. METHODS This qualitative study explored the experiences of twenty-four disabled workers who had undergone an occupational rehabilitation process. Data were collected with in-depth semi-structured interviews, transcribed, coded, and analyzed using inductive content analysis. RESULTS Four main themes arose from the 24 key concepts relating to the positive encounters: (1) process flow, (2) customer orientation, (3) information and guidance, and (4) service attitude. The results also reveal that perceived positive encounters promote the return to work not only directly, but also indirectly by improving the informants' motivation, which has previously been found to be one of the most significant factors explaining the outcomes of rehabilitation. CONCLUSIONS The positive relationship between disabled workers and insurers during an occupational rehabilitation could be better understood through a conceptualization of perceived positive encounters. Underlining the importance of positive encounters and their ability to improve the rehabilitee's motivation may contribute to better support methods for the return to work.
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Affiliation(s)
- Jarna Pasanen
- Faculty of Management and Business, Tampere University, Tampere, Finland. Tel.: +358 400 254 312; E-mail:
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