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Self-directed arm therapy at home after stroke with a sensor-based virtual reality training system.

ABSTRACT: The effect of rehabilitative training after stroke is dose-dependent. Out-patient rehabilitation training is often limited by transport logistics, financial resources and a lack of motivation/compliance. We studied the feasibility of an unsupervised arm therapy for self-directed rehabilitation therapy in patients' homes.An open-label, single group study involving eleven patients with hemiparesis due to stroke (27?±?31.5 months post-stroke) was conducted. The patients trained with an inertial measurement unit (IMU)-based virtual reality system (ArmeoSenso) in their homes for six weeks. The self-selected dose of training with ArmeoSenso was the principal outcome measure whereas the Fugl-Meyer Assessment of the upper extremity (FMA-UE), the Wolf Motor Function Test (WMFT) and IMU-derived kinematic metrics were used to assess arm function, training intensity and trunk movement. Repeated measures one-way ANOVAs were used to assess differences in training duration and clinical scores over time.All subjects were able to use the system independently in their homes and no safety issues were reported. Patients trained on 26.5?±?11.5 days out of 42 days for a duration of 137?±?120 min per week. The weekly training duration did not change over the course of six weeks (p?=?0.146). The arm function of these patients improved significantly by 4.1 points (p?=?0.003) in the FMA-UE. Changes in the WMFT were not significant (p?=?0.552). ArmeoSenso based metrics showed an improvement in arm function, a high number of reaching movements (387 per session), and minimal compensatory movements of the trunk while training.Self-directed home therapy with an IMU-based home therapy system is safe and can provide a high dose of rehabilitative therapy. The assessments integrated into the system allow daily therapy monitoring, difficulty adaptation and detection of maladaptive motor patterns such as trunk movements during reaching.Unique identifier: NCT02098135 .

SUBMITTER: Wittmann F

PROVIDER: S-EPMC4982313 | biostudies-literature | 2016 Aug

REPOSITORIES: biostudies-literature

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Self-directed arm therapy at home after stroke with a sensor-based virtual reality training system.

Wittmann Frieder F Held Jeremia P JP Lambercy Olivier O Starkey Michelle L ML Curt Armin A Höver Raphael R Gassert Roger R Luft Andreas R AR Gonzenbach Roman R RR

Journal of neuroengineering and rehabilitation 20160811 1

<h4>Background</h4>The effect of rehabilitative training after stroke is dose-dependent. Out-patient rehabilitation training is often limited by transport logistics, financial resources and a lack of motivation/compliance. We studied the feasibility of an unsupervised arm therapy for self-directed rehabilitation therapy in patients' homes.<h4>Methods</h4>An open-label, single group study involving eleven patients with hemiparesis due to stroke (27 ± 31.5 months post-stroke) was conducted. The pa ...[more]

PMID: 27515583

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Project description:BACKGROUND:Virtual reality training (VRT) uses computer software to track a user's movements and allow him or her to interact with a game presented on a television screen. VRT is increasingly being used for the rehabilitation of arm function, balance and walking after stroke. Patients often require ongoing therapy post discharge from inpatient rehabilitation. Outpatient therapy may be limited or inaccessible due to waiting lists, transportation issues, distance etc.; therefore, home-based VRT could provide the required therapy in a more convenient and accessible setting. The objectives of this parallel randomized feasibility trial are to determine (1) the feasibility of using VRT in the home post stroke and (2) the feasibility of a battery of quantitative and qualitative outcome measures of stroke recovery. METHODS:Forty patients who can stand for at least 2 min and are soon to be discharged from inpatient or outpatient rehabilitation post stroke are being recruited in Ottawa, Canada and being randomized to control and experimental groups. Participants in the experimental group use home-based VRT to do rehabilitative exercises for standing balance, stepping, reaching, strengthening and gentle aerobic fitness. Control group participants use an iPad with apps selected to rehabilitate cognition, hand fine motor skills and visual tracking/scanning. Both groups are instructed to perform 30?min of exercise 5?days a week for 6?weeks. VRT intensity and difficulty are monitored and adjusted remotely. Weekly telephone contact is made with all participants. Ability to recruit participants, ability to handle the technology and learn the activities, compliance, safety, enjoyment, perceived efficacy and cost of program delivery will be assessed. A battery of assessments of standing balance, gait and community integration will be assessed for feasibility of completion within this population and potential for improvement following the intervention. Effect sizes will be calculated. DISCUSSION:The results of this study will be used to support the creation of a definitive randomized controlled trial on the efficacy of home-based VRT for rehabilitation post stroke. TRIAL REGISTRATION:ClinicalTrials.gov, NCT03261713 . Registered on 21 August 2017. Registration amended on 1 June 2018 to decrease enrollment from 40 to 20 due to a cut in study funding and difficulty recruiting participants.

Project description:Dexterous manipulation of the hand, one of the features of human motor control, is often compromised after stroke, to the detriment of basic functions. Despite the importance of independent movement of the digits to activities of daily living, relatively few studies have assessed the impact of specifically targeting individuated movements of the digits on hand rehabilitation. The purpose of this study was to investigate the impact of such finger individuation training, by means of a novel mechatronic-virtual reality system, on fine motor control after stroke.An actuated virtual keypad (AVK) system was developed in which the impaired hand controls a virtual hand playing a set of keys. Creation of individuated digit movements is assisted by a pneumatically actuated glove, the PneuGlove. A study examining efficacy of the AVK system was subsequently performed. Participants had chronic, moderate hand impairment resulting from a single stroke incurred at least 6 months prior. Each subject underwent 18 hour-long sessions of extensive therapy (3x per week for 6 weeks) targeted at finger individuation. Subjects were randomly divided into two groups: the first group (Keypad: N?=?7) utilized the AVK system while the other group (OT: N?=?7) received a similarly intensive dose of occupational therapy; both groups worked directly with a licensed occupational therapist. Outcome measures such as the Jebsen-Taylor Hand Function Test (JTHFT), Action research Arm Test (ARAT), Fugl-Meyer Upper Extremity Motor Assessment/Hand subcomponent (FMUE/FMH), grip and pinch strengths were collected at baseline, post-treatment and one-month post-treatment.While both groups exhibited some signs of change after the training sessions, only the Keypad group displayed statistically significant improvement both for measures of impairment (FMH: p?=?0.048) and measures of task performance (JTHFT: p?=?0.021). Additionally, the finger individuation index - a measure of finger independence - improved only for the Keypad group after training (p?=?0.05) in the subset (Keypad: N?=?4; OT: N?=?5) of these participants for which it was measured.Actively assisted individuation therapy comprised of non task-specific modalities, such as can be achieved with virtual platforms like the AVK described here, may prove to be valuable clinical tools for increasing the effectiveness and efficiency of therapy following stroke.

Project description:BackgroundVirtual reality (VR) surgery training has become a trend in clinical education. Many research papers validate the effectiveness of VR-based surgical simulators in training medical students. However, most existing articles employ subjective methods to study the residents' surgical skills improvement. Few of them investigate how to improve the surgery skills on specific dimensions substantially.MethodsOur paper resorts to physiological approaches to objectively study the quantitative influence and performance analysis of VR laparoscopic surgical training system for medical students. Fifty-one participants were recruited from a pool of medical students. They conducted four pre and post experiments in the training box. They were trained on VR-based laparoscopic surgery simulators (VRLS) in the middle of pre and post experiments. Their operation and physiological data (heart rate and electroencephalogram) are recorded during the pre and post experiments. The physiological data is used to compute cognitive load and flow experience quantitatively. Senior surgeons graded their performance using newly designed hybrid standards for fundamental tasks and Global operative assessment of laparoscopic skills (GOALS) standards for colon resection tasks. Finally, the participants were required to fill the questionnaires about their cognitive load and flow experience.ResultsAfter training on VRLS, the time of the experimental group to complete the same task could drop sharply (p < 0.01). The performance scores are enhanced significantly (p < 0.01). The performance and cognitive load computed from EEG are negatively correlated (p < 0.05).ConclusionThe results show that the VRLS could highly improve medical students' performance and enable the participants to obtain flow experience with a lower cognitive load. Participants' performance is negatively correlated with cognitive load through quantitative physiological analysis. This might provide a new way of assessing skill acquirement.

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Self-directed arm therapy at home after stroke with a sensor-based virtual reality training system.

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Self-directed arm therapy at home after stroke with a sensor-based virtual reality training system.

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