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THE TECHNOLOGY PROGRESSION

Author: Rebecca Scott Published: September 28, 2020

Blog post about the progression of technology within therapy.

https://www.interactivephysio.com/Physiotherapy%20and%20technology

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Virtual Reality in Upper Extremity Rehabilitation of Stroke Patients: A Randomized Controlled Trial. #VR #Therapy #Physio #Kinect

J Stroke Cerebrovasc Dis. 2018 Dec;27(12):3473-3478.

Ikbali Afsar S1Mirzayev I2Umit Yemisci O3Cosar Saracgil SN3.

Abstract

Abstract

OBJECTIVE:

Virtual reality game system is one of novel approaches, which can improve hemiplegic extremity functions of stroke patients. We aimed to evaluate the effect of the Microsoft Xbox 360 Kinect video game system on upper limb motor functions for subacute stroke patients.

METHODS:

The study included 42 stroke patients of which 35 (19 Virtual reality group, 16 control group) completed the study. All patients received 60 minutes of conventional therapy for upper extremity, 5 times per-week for 4 weeks. Virtual reality group additionally received Xbox Kinect game system 30 minutes per-day. Patients were evaluated prior to the rehabilitation and at the end of 4 weeks. Box&Block Test, Functional independence measure self-care score, Brunnstorm stage and Fugl-Meyer upper extremity motor function scale were used as outcome measures.

RESULTS:

The Brunnstrom stages and the scores on the Fugl-Meyer upper extremity, Box&Block Test and Functional independence measure improved significantly from baseline to post-treatment in both the experimental and the control groups. The Brunnstrom stage-upper extremity and Box&Block Test gain for the experimental group were significantly higher compared to the control group, while the Brunnstrom stage-hand, the Functional independence measure gain and Fugl-Meyer gain were similar between the groups.

CONCLUSIONS:

We found evidence that kinect-based game system in addition to conventional therapy may have supplemental benefit for stroke patients. However, for virtual reality game systems to enter the routine practice of stroke rehabilitation, randomized controlled clinical trials with longer follow-up periods and larger sample sizes are needed especially to determine an optimal duration and intensity of the treatment.

KEYWORDS:

Hemiplegia; stroke rehabilitation; upper extremity; virtual reality

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Gamification in Physical Therapy: More Than Using Games

Janssen, Joep MSc; Verschuren, Olaf PhD; Renger, Willem Jan MA; Ermers, Jose MPPT; Ketelaar, Marjolijn PhD; van Ee, Raymond PhD

Abstract

The implementation of computer games in physical therapy is motivated by characteristics such as attractiveness, motivation, and engagement, but these do not guarantee the intended therapeutic effect of the interventions. Yet, these characteristics are important variables in physical therapy interventions because they involve reward-related dopaminergic systems in the brain that are known to facilitate learning through long-term potentiation of neural connections. In this perspective we propose a way to apply game design approaches to therapy development by “designing” therapy sessions in such a way as to trigger physical and cognitive behavioral patterns required for treatment and neurological recovery. We also advocate that improving game knowledge among therapists and improving communication between therapists and game designers may lead to a novel avenue in designing applied games with specific therapeutic input, thereby making gamification in therapy a realistic and promising future that may optimize clinical practice.

 

Link to full article

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Validity and Reliability of the Wii Balance Board for Static Balance Assessment in Healthy Young Adults

Malays J Med Sci. 2019 Mar; 26(2): 114–121.

K.Kaewkaen,corresponding author1,4 S. Uthama,2 W. Ruengsirarak,2 and R. Puntumetakul3,4

Abstract

Abstract

Introduction

The Wii Balance Board (WBB) is a commonly used tool for balance assessment, however the inconsistency in the reported validity for the WBB when used for the assessment of healthy young adults needs to be clarified.

Aim

To investigate the concurrent validity and reliability of the WBB for balance assessment in healthy young adults.

Methods

Thirty-two young adults participated in this study. Their ability to balance was tested while standing on a WBB and a laboratory-grade force platform, under three conditions: feet together with eyes open, feet together with eyes closed and semi-tandem standing with eyes open. They had 10 min resting period between tests. The agreement between the WBB and the laboratory-grade force platform was investigated, and the reliability of the WBB was determined.

Results

A poor agreement between the WBB and the laboratory-grade force platform was found for all standing conditions [intraclass correlation coefficient (ICC) = 0.03 to 0.07]. A moderate to high reliability was found for the WBB for balance assessment in healthy young adults (ICC = 0.66 to 0.76).

Conclusion

The WBB was found to be a reliable tool for static balance assessment in healthy young adults. However, it had poor validity compared to the laboratory-grade force platform.

Keywords: balance assessment, young adults, Wii Balance Board
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Reliability and validity of the Kinect V2 for the assessment of lower extremity rehabilitation exercises

Gait & Posture

Volume 70, May 2019, Pages 330-335
M. WochatzN. TilgnerS.MuellerS.RabeS.EichlerM.JohnH.VöllerF.Mayer

Link to abstract

Abstract

Abstract

Background

Besides its initial use as a video gaming system the Kinect might also be suitable to capture human movements in the clinical context. However, the system’s reliability and validity to capture rehabilitation exercises is unclear.

Research question

The purpose of this study was to evaluate the test-retest reliability of lower extremity kinematics during squat, hip abduction and lunge exercises captured by the Kinect and to evaluate the agreement to a reference 3D camera-based motion system.

Methods

Twenty-one healthy individuals performed five repetitions of each lower limb exercise on two different days. Movements were simultaneously assessed by the Kinect and the reference 3D motion system. Joint angles and positions of the lower limb were calculated for sagittal and frontal plane. For the inter-session reliability and the agreement between the two systems standard error of measurement (SEM), bias with limits of agreement (LoA) and Pearson Correlation Coefficient (r) were calculated.

Results

Parameters indicated varying reliability for the assessed joint angles and positions and decreasing reliability with increasing task complexity. Across all exercises, measurement deviations were shown especially for small movement amplitudes. Variability was acceptable for joint angles and positions during the squat, partially acceptable during the hip abduction and predominately inacceptable during the lunge. The agreement between systems was characterized by systematic errors. Overestimations by the Kinect were apparent for hip flexion during the squat and hip abduction/adduction during the hip abduction exercise as well as for the knee positions during the lunge. Knee and hip flexion during hip abduction and lunge were underestimated by the Kinect.

Significance

The Kinect system can reliably assess lower limb joint angles and positions during simple exercises. The validity of the system is however restricted. An application in the field of early orthopedic rehabilitation without further development of post-processing techniques seems so far limited.

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Using Kinect v2 to Control a Laser Visual Cue System to Improve the Mobility during Freezing of Gait in Parkinson’s Disease.

Journal of Healthcare Engineering. 2019 Feb 20;2019:3845462.

Amini A, Banitsas K

Link to article

Abstract

Different auditory and visual cues have been proven to be very effective in improving the mobility of people with Parkinson’s (PwP). Nonetheless, many of the available methods require user intervention and so on to activate the cues. Moreover, once activated, these systems would provide cues continuously regardless of the patient’s needs. This research proposes a new indoor method for casting dynamic/automatic visual cues for PwP based on their head direction and location in a room. The proposed system controls the behavior of a set of pan/tilt servo motors and laser pointers, based on the real-time skeletal information acquired from a Kinect v2 sensor. This produces an automatically adjusting set of laser lines that can always be in front of the patient as a guideline for where the next footstep would be placed. A user interface was also created that enables users to control and adjust the settings based on the preferences. The aim of this research was to provide PwP with an unobtrusive/automatic indoor system for improving their mobility during a Freezing of gait (FOG) incident. The results showed the possibility of employing such system, which does not rely on the subject’s input nor does it introduce any additional complexities to operate.

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The Validity and Reliability of a Kinect v2-Based Gait Analysis System for Children with Cerebral Palsy.

Sensors (Basel). 2019 Apr 7;19(7)

Ma Y, Mithraratne K, Wilson NC, Wang X, Ma Y, Zhang Y.

Link to article

Abstract

The aim of this study is to evaluate if Kinect is a valid and reliable clinical gait analysis tool for children with cerebral palsy (CP), and whether linear regression and long short-term memory (LSTM) recurrent neural network methods can improve its performance. A gait analysis was conducted on ten children with CP, on two occasions. Lower limb joint kinematics computed from the Kinect and a traditional marker-based Motion Analysis system were investigated by calculating the root mean square errors (RMSE), the coefficients of multiple correlation (CMC), and the intra-class correlation coefficients (ICC2,k). Results showed that the Kinect-based kinematics had an overall modest to poor correlation (CMC-less than 0.001 to 0.70) and an angle pattern similarity with Motion Analysis. After the calibration, RMSE on every degree of freedom decreased. The two calibration methods indicated similar levels of improvement in hip sagittal (CMC-0.81 ± 0.10 vs. 0.75 ± 0.22)/frontal (CMC-0.41 ± 0.35 vs. 0.42 ± 0.37) and knee sagittal kinematics (CMC-0.85±0.07 vs. 0.87 ± 0.12). The hip sagittal (CMC-0.97±0.05) and knee sagittal (CMC-0.88 ± 0.12) angle patterns showed a very good agreement over two days. Modest to excellent reliability (ICC2,k-0.45 to 0.93) for most parameters renders it feasible for observing ongoing changes in gait kinematics.

KEYWORDS:

Kinect; cerebral palsy; gait analysis; kinematics; reliability; validity

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Reliability and validity of the Kinect V2 for the assessment of lower extremity rehabilitation exercises.

Gait & Posture. 2019 Mar 26;70:330-335  [Epub ahead of print]

Wochatz M, Tilgner N, Mueller S, Rabe S, Eichler S, John M, Völler H, Mayer F.

Link to article

Abstract

BACKGROUND:

Besides its initial use as a video gaming system the Kinect might also be suitable to capture human movements in the clinical context. However, the system’s reliability and validity to capture rehabilitation exercises is unclear.

RESEARCH QUESTION:

The purpose of this study was to evaluate the test-retest reliability of lower extremity kinematics during squat, hip abduction and lunge exercises captured by the Kinect and to evaluate the agreement to a reference 3D camera-based motion system.

METHODS:

Twenty-one healthy individuals performed five repetitions of each lower limb exercise on two different days. Movements were simultaneously assessed by the Kinect and the reference 3D motion system. Joint angles and positions of the lower limb were calculated for sagittal and frontal plane. For the inter-session reliability and the agreement between the two systems standard error of measurement (SEM), bias with limits of agreement (LoA) and Pearson Correlation Coefficient (r) were calculated.

RESULTS:

Parameters indicated varying reliability for the assessed joint angles and positions and decreasing reliability with increasing task complexity. Across all exercises, measurement deviations were shown especially for small movement amplitudes. Variability was acceptable for joint angles and positions during the squat, partially acceptable during the hip abduction and predominately inacceptable during the lunge. The agreement between systems was characterized by systematic errors. Overestimations by the Kinect were apparent for hip flexion during the squat and hip abduction/adduction during the hip abduction exercise as well as for the knee positions during the lunge. Knee and hip flexion during hip abduction and lunge were underestimated by the Kinect.

SIGNIFICANCE:

The Kinect system can reliably assess lower limb joint angles and positions during simple exercises. The validity of the system is however restricted. An application in the field of early orthopedic rehabilitation without further development of post-processing techniques seems so far limited.

KEYWORDS:

Agreement; Markerless motion capture system; Reproducibility; Telerehabilitation

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Study: Reflexion Health Virtual Therapy System Reduces Rehab Costs

Reflexion Health, which has developed a “virtual physical therapy” system for patients recovering from surgery, said results from a randomized controlled clinical trial completed by nearly 300 people showed patients who used the technology saved the healthcare industry an average of $2,745 compared to those who underwent traditional physical therapy.

Link

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Effect of the Wii Sports Resort on the improvement in attention, processing speed and working memory in moderate stroke.

J Neuroeng Rehabil. 2019 Feb 28;16(1):32

Unibaso-Markaida I1Iraurgi I2Ortiz-Marqués N2Amayra I2Martínez-Rodríguez S2.

Link

Abstract

BACKGROUND:

Stroke is the most common neurological disease in the world. After the stroke, some people suffer a cognitive disability. Commercial videogames have been used after stroke for physical rehabilitation; however, their use in cognitive rehabilitation has hardly been studied. The objectives of this study were to analyze attention, processing speed, and working memory in patients with moderate stroke after an intervention with Wii Sports Resort and compared these results with a control group.

METHODS:

A pre-post design study was conducted with 30 moderate stroke patients aged 65 ± 15. The study lasted eight weeks. 15 participated in the intervention group and 15 belong to the control group. They were assessed in attention and processing speed (TMT-A and B) and working memory (Digit Span of WAIS-III). Parametric and effect size tests were used to analyze the improvement of those outcomes and compared both groups.

RESULTS:

At the baseline, there was no difference between TMT-A and B. A difference was found in the scalar score of TMT-B, as well as in Digit Backward Span and Total Digit Task. In TMT-A and B, the intervention group had better scores than the control group. The intervention group in the Digit Forward Span and the Total Digit obtained a moderate effect size and the control group also obtained a moderate effect size in Total Digit. In the Digit scalar scores, the control group achieved better results than the intervention group.

CONCLUSIONS:

The results on attention, processing speed and working memory improved in both groups. However, according to the effect sizes, the intervention group achieved better results than the control group. In addition, the attention and processing speed improved more than the working memory after the intervention. Although more studies are needed in this area, the results are encouraging for cognitive rehabilitation after stroke.

KEYWORDS:

Attention; Cognition; Moderate stroke; Nintendo Wii sports resort; Processing speed; Working memory

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