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Observation is recommended in motor rehabilitation. For this reason, the aim of this study was to experimentally test the feasibility and benefit of including mirror feedback in vision-based rehabilitation systems: we projected the user on the screen. We conducted a user study by using a previously evaluated system that improved the balance and pos...
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Background: The functional hamstrings/quadriceps ratio (FH/Q) is useful to detect muscle imbalances after stroke. However, is necessary to investigate possible differences between men and women affected by stroke and controls.
Objectives: To compare the FH/Q between men and women with stroke and matched controls.
Method: Cross-sectional study. Fift...
Background:
Balance and functional abilities are controlled by both sides of the body. The role of nonparetic side has never been explored for such skills.
Objective:
The objective of the present study was to examine the effect of a motor therapy program primarily involving the nonparetic side on balance and function in chronic stroke.
Method:...
Objective . To critically evaluate the studies that were conducted over the past 10 years and to assess the impact of virtual reality on static and dynamic balance control in the stroke population. Method . A systematic review of randomized controlled trials published between January 2006 and December 2015 was conducted. Databases searched were Pub...
Citations
... Despite using cognitive tasks in a group of adults with CP, 15 of the included studies cannot inform us on cognitive functioning in adults with CP in general. Results from the following studies are therefore not included in the summary of findings: Single case studies or case series where scores are reported from a single test, e.g., an IQ test [33][34][35] PPVT 36 or digit span forward 37 ; correlational studies where raw scores are not reported 38,39 ; studies in which results from CP participants are mixed with participants with other diagnoses 40 ; studies in which the Mini Mental State Examination is used to classify participants according to degree of cognitive impairment, but in which the scores are not reported 41,42 ; studies of eventrelated potentials in which cognitive tasks are used 29,43 or studies of skin potential responses 28 ; studies in which performance of the CP participants is compared to participants with other conditions. 39,44,45 Brief descriptions of all 39 studies identified in the review can be found in the Supplementary material S2. ...
... 66,67 In one study, they specifically tested for visual functioning in a practice task. 57 Most of the included studies had an inclusion or exclusion criterion related to visual functioning, 29,30,32,[39][40][41]46,48,49,[51][52][53][55][56][57][62][63][64][65][66] but that does not necessarily mean that the participants do not have visual problems that might affect performance on cognitive tasks. 16 In future studies, it would be beneficial to include more detailed information about visual functioning, including information about any common visual impairments that individuals with CP may have, as e.g., strabismus, refractive errors and abnormal contrast sensitivity, may affect performance on visuo-perceptual and spatial tasks. ...
In this scoping review, we summarize the current knowledge of cognitive functioning in adults with cerebral palsy (CP), and identify the neuropsychological tests typically used in this population. 39 studies from the period January 1990 - August 2023 were included in the review, and they differ widely in their aims and approach to studying cognition. Very few studies have cognitive assessment as their core aim and use a neuropsychological test battery. The included studies show great variability in reported intelligence and cognitive functioning in adults with CP, and cognitive deficits have been reported in all cognitive domains. Most of the studies suffer from methodological limitations, and there is ample room for improvement within the field. We conclude by suggesting a number of recommendations that may contribute to increasing our understanding of cognitive impairments in adults with CP.
... Another potential way to increase adherence when using mHealth is by means of including an exergame, that is, a serious game that aims at physical exercise (in this case, therapeutic exercise) while entertaining the user. The use of this type of games would provide motivation, as well as monitoring and feedback, essential elements for adherence to treatment [7,8]. ...
We developed a mobile application for cervical rehabilitation that uses a non-invasive camera-based head-tracker sensor for monitoring neck movements. The intended user population should be able to use the mobile application in their own mobile device, but mobile devices have different camera sensors and screen dimensions that could affect the user performance and neck movement monitoring. In this work, we studied the influence of mobile devices type on camera-based monitoring of neck movements for rehabilitation purposes. We conducted an experiment to test whether the characteristics of a mobile device affect neck movements when using the mobile application with the head-tracker. The experiment consisted of the use of our application, containing an exergame, in three mobile devices. We used wireless inertial sensors to measure the real-time neck movements performed while using the different devices. The results showed that the effect of device type on neck movements was not statistically significant. We included the sex factor in the analysis, but there was no statistically significant interaction between sex and device variables. Our mobile application proved to be device-agnostic. This will allow intended users to use the mHealth application regardless of the type of device. Thus, future work can continue with the clinical evaluation of the developed application to analyse the hypothesis that the use of the exergame will improve therapeutic adherence in cervical rehabilitation.
... In addition, "start" and "stop" instructions were shown on the screen to guide the user at the beginning and the end of the test. Furthermore, the user can see himself on the screen as it is demonstrated that mirror feedback provides motivation for the user [39]. In order to minimize distractions, we applied a background subtraction algorithm provided by RF-Solutions in the wrapper that we used to link between the Microsoft Kinect v2 and the game engine Unity [40]. ...
To prevent falls, it is important to measure periodically the balance ability of an individual using reliable clinical tests. As Red Green Blue Depth (RGBD) devices have been increasingly used for balance rehabilitation at home, they may also be used to assess objectively the balance ability and determine the effectiveness of a therapy. For this, we developed a system based on the Microsoft Kinect v2 for measuring the Functional Reach Test (FRT); one of the most used balance clinical tools to predict falls. Two experiments were conducted to compare the FRT measures computed by our system using the Microsoft Kinect v2 with those obtained by the standard method, i.e., manually. In terms of validity, we found a very strong correlation between the two methods (r = 0.97 and r = 0.99 (p < 0.05), for experiments 1 and 2, respectively). However, we needed to correct the measurements using a linear model to fit the data obtained by the Kinect system. Consequently, a linear regression model has been applied and examining the regression assumptions showed that the model works well for the data. Applying the paired t-test to the data after correction indicated that there is no statistically significant difference between the measurements obtained by both methods. As for the reliability of the test, we obtained good to excellent within repeatability of the FRT measurements tracked by Kinect (ICC = 0.86 and ICC = 0.99, for experiments 1 and 2, respectively). These results suggested that the Microsoft Kinect v2 device is reliable and adequate to calculate the standard FRT.
... One potential way to increase adherence is by means of an exergame, that is, a serious game that aims at physical exercise (in our case, neck therapeutic exercise) while entertaining the user. The exergame allows therapeutic exercise performance with assets of motivation, supervision and feedback, which are key factors of adherence [9,10]. ...
Vision-based interfaces are used for monitoring human motion. In particular, camera-based head-trackers interpret the movement of the user’s head for interacting with devices. Neck pain is one of the most important musculoskeletal conditions in prevalence and years lived with disability. A common treatment is therapeutic exercise, which requires high motivation and adherence to treatment. In this work, we conduct an exploratory experiment to validate the use of a non-invasive camera-based head-tracker monitoring neck movements. We do it by means of an exergame for performing the rehabilitation exercises using a mobile device. The experiments performed in order to explore its feasibility were: (1) validate neck’s range of motion (ROM) that the camera-based head-tracker was able to detect; (2) ensure safety application in terms of neck ROM solicitation by the mobile application. Results not only confirmed safety, in terms of ROM requirements for different preset patient profiles, according with the safety parameters previously established, but also determined the effectiveness of the camera-based head-tracker to monitor the neck movements for rehabilitation purposes.
... The use of computer vision has an extensive use in the rehabilitation therapies. Further examples include a solution to monitor a Vojta therapy with patients suffering from a neurological illness causing motor disabilities [21], an approach to improve the necessary skills to interact with a computer [22] or to use mirror feedback to enhance the results of a therapy [23]. ...
Physical rehabilitation therapies for children present a challenge, and its success—the improvement of the patient’s condition—depends on many factors, such as the patient’s attitude and motivation, the correct execution of the exercises prescribed by the specialist or his progressive recovery during the therapy. With the aim to increase the benefits of these therapies, social humanoid robots with a friendly aspect represent a promising tool not only to boost the interaction with the pediatric patient, but also to assist physicians in their work. To achieve both goals, it is essential to monitor in detail the patient’s condition, trying to generate user profile models which enhance the feedback with both the system and the specialist. This paper describes how the project NAOTherapist—a robotic architecture for rehabilitation with social robots—has been upgraded in order to include a monitoring system able to generate user profile models through the interaction with the patient, performing user-adapted therapies. Furthermore, the system has been improved by integrating a machine learning algorithm which recognizes the pose adopted by the patient and by adding a clinical reports generation system based on the QUEST metric.
... Warning can be provided to users if they follow a wrong track [17]. Mirror feedback also improves the rehabilitation process in Kinect based game [19]. ...
As technological innovation is fused into the rehabilitation process, it gives conventional therapy a new direction with the products of interactive nature and easy to measure techniques. In the recent years, virtual reality based game therapy has turned out to be a promising option for post-stroke patients since it engages patients with fun based exercises during rehabilitation process. It also triggers their neuro-motor functions and accelerates the recovery process. Nevertheless it is necessary to extract some valuable information from the joint movements to measure the recovery condition of patients. Most of the designed games have introduced features to make them interesting as well as challenging for patients, however, only a few measure the joint parameters. We have designed a Kinect based game in Unity3D platform where patients can play game by moving their joints which results in different orthopaedic lessons required for rehabilitation therapy. In contrast to many Kinect based games where only joint movements are considered for playing the game, we have also introduced voice control through speech recognition and feedback provided in terms of audio-visual command to enhance patient’s engagement. Different joint parameters such as trajectory, range of motion, joint velocity, acceleration, reaching time and joint torque are also measured to help quantify the heath condition.
... In the following section, we introduce PROGame, a framework for the development of serious games for motor rehabilitation therapy. Drawing on our experience in the development of serious games [14,15], as well as software process assessment and improvement [16][17][18][19], we combine three different development approaches. ...
... We have observed certain similarities between the development of a serious game for motor rehabilitation [6,14,15,25,26] and a clinical trial for new drugs [23]. In both cases, the process requires a set of sequential phases, where each phase attempts to meet or define some objective. ...
... In this section, we introduce the project used to validate the new framework. We had the opportunity to apply PROGame to the development of a serious game for the improvement of balance and postural control in adults with cerebral palsy (CP) [15]. ...
Serious game development for rehabilitation therapy is becoming increasingly popular because of the motivational advantages that these types of applications provide. Consequently, the need for a common process framework for this category of software development has become increasingly evident. The goal is to guarantee that products are developed and validated by following a coherent and systematic method that leads to high-quality serious games. This paper introduces a new process framework for the development of serious games for motor rehabilitation therapy. We introduce the new model and demonstrate its application for the development of a serious game for the improvement of the balance and postural control of adults with cerebral palsy. The development of this application has been facilitated by two technological transfer contracts and is being exploited by two different organizations. According to clinical measurements, patients using the application improved from high fall risk to moderate fall risk. We believe that our development strategy can be useful not only for motor rehabilitation therapy, but also for the development of serious games in many other rehabilitation areas.
... The score is an optional parameter to display it or not on the screen. In both games, the user can always see himself on the screen which facilitates the interaction with the virtual objects [14]. ...
Falls are a serious problem among older adults.
Many research studies have reported that risk falls
can be minimized with exercising and physical
activity. This paper proposes a set of prototype
games that include tasks for balance and postural
control for elderly people. It can be integrated in
rehabilitation programs in both clinics and home
settings. A detailed description of games’ design
process and implementation details is provided. The
physiotherapist has preliminarily validated the
proposed games and a clinical trial to determine
their effectiveness is planned as a further work
... The task consists on performing self-paced elbow flexion and extension. On the screen, the user observes himself/herself performing the task, a training strategy commonly used in rehabilitation where mirror feedback is used for self-correction, movement control and posture retraining [36]. For each movement sequence (starting from full arm extension, executing elbow flexion and back to extension), the user receives a score that ranges from 1 to 10, the later corresponding to excellent performance. ...
Background:
The enduring aging of the world population and prospective increase of age-related chronic diseases urge the implementation of new models for healthcare delivery. One strategy relies on ICT (Information and Communications Technology) home-based solutions allowing clients to pursue their treatments without institutionalization. Stroke survivors are a particular population that could strongly benefit from such solutions, but is not yet clear what the best approach is for bringing forth an adequate and sustainable usage of home-based rehabilitation systems. Here we explore two possible approaches: coaching and gaming.
Methods:
We performed trials with 20 healthy participants and 5 chronic stroke survivors to study and compare execution of an elbow flexion and extension task when performed within a coaching mode that provides encouragement or within a gaming mode. For each mode we analyzed compliance, arm movement kinematics and task scores. In addition, we assessed the usability and acceptance of the proposed modes through a customized self-report questionnaire.
Results:
In the healthy participants sample, 13/20 preferred the gaming mode and rated it as being significantly more fun (p < .05), but the feedback delivered by the coaching mode was subjectively perceived as being more useful (p < .01). In addition, the activity level (number of repetitions and total movement of the end effector) was significantly higher (p < .001) during coaching. However, the quality of movements was superior in gaming with a trend towards shorter movement duration (p = .074), significantly shorter travel distance (p < .001), higher movement efficiency (p < .001) and higher performance scores (p < .001). Stroke survivors also showed a trend towards higher activity levels in coaching, but with more movement quality during gaming. Finally, both training modes showed overall high acceptance.
Conclusions:
Gaming led to higher enjoyment and increased quality in movement execution in healthy participants. However, we observed that game mechanics strongly determined user behavior and limited activity levels. In contrast, coaching generated higher activity levels. Hence, the purpose of treatment and profile of end-users has to be considered when deciding on the most adequate approach for home based stroke rehabilitation.
... Some existing vision-based rehabilitation systems allow the patients to see themselves on a screen, mirror feedback, due to the users standing in front of a screen and interacting with the system using their movements [3], [6], [10], as can be seen in Fig. 3. Recent research observed that the higher cognitive impairment a user had, the more important feedback was in order to perform correctly the therapy [27]. Results confirmed that in case of disabilities the mirror feedback mechanisms facilitated the interaction in the vision-based systems for rehabilitation. ...
... EXPERIMENTAL SYSTEM The experimental system was designed to improve the balance and postural control of adults with cerebral palsy [8]. The system was based on a video game for balance rehabilitation therapy, designed using the prototype development paradigm and features for rehabilitation with video games [3], [21], [27]: feedback, adaptability, motivational elements and monitoring. Findings demonstrated a significant increase in balance postural control scores resulting in indicators of greater independence for participating adults. ...
