Browsing by Author "Verschure, Paul F. M. J."
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- A critical time window for recovery extends beyond one-year post-strokePublication . Ballester, Belén Rubio; Maier, Martina; Duff, Armin; Cameirão, Mónica; Bermúdez i Badia, Sergi; Duarte, Esther; Cuxart, Ampar; Rodríguez, Susana; San Segundo Mozo, Rosa María; Verschure, Paul F. M. J.The impact of rehabilitation on post-stroke motor recovery and its dependency on the patient's chronicity remain unclear. The field has widely accepted the notion of a proportional recovery rule with a "critical window for recovery" within the first 3-6 mo poststroke. This hypothesis justifies the general cessation of physical therapy at chronic stages. However, the limits of this critical window have, so far, been poorly defined. In this analysis, we address this question, and we further explore the temporal structure of motor recovery using individual patient data from a homogeneous sample of 219 individuals with mild to moderate upper-limb hemiparesis. We observed that improvement in body function and structure was possible even at late chronic stages. A bootstrapping analysis revealed a gradient of enhanced sensitivity to treatment that extended beyond 12 mo poststroke. Clinical guidelines for rehabilitation should be revised in the context of this temporal structure. NEW & NOTEWORTHY Previous studies in humans suggest that there is a 3- to 6-mo "critical window" of heightened neuroplasticity poststroke. We analyze the temporal structure of recovery in patients with hemiparesis and uncover a precise gradient of enhanced sensitivity to treatment that expands far beyond the limits of the so-called critical window. These findings highlight the need for providing therapy to patients at the chronic and late chronic stages.
- Including social interaction in stroke VR-based motor rehabilitation enhances performance: a pilot studyPublication . Rubio Ballester, Belém; Bermúdez i Badia, Sergi; Verschure, Paul F. M. J.Social factors and motivation are key factors for recovery in stroke patients (Glass, Matchar, Belyea, & Feussner, 1993). The goal of this study is to enhance accessibility and evaluate the effects of including social interaction in a virtual reality (VR) -based system for stroke rehabilitation. We hypothesize that a multiplayer competitive context will have a positive effect on the involvement of the patients in the therapy and thus on the rehabilitation process. We test this hypothesis using the Rehabilitation Gaming System (RGS), an ICT virtual reality tool for upper extremities motor rehabilitation. First, we implemented and evaluated a new interface based on a low-cost keyglove. Then, we developed a dedicated RGS scenario where the player has to match pairs of cards from a stack of playing cards. This task trains cognitive (memory) and motor tasks (grasping and reaching). Eight stroke patients participated in two sessions lasting 20 min, one using a single-player VR environment and another using a multiplayer version of the same game. A usability test showed that participants interact with the system much faster when using the new key-glove–based interface (p ¼ .02) in comparison to a mouse and keyboard. In addition, our results showed that upper limb exercises performed by the patients in multiplayer mode reached wider elbow flexion/extension movements than the ones performed during the single-player game session (p ¼ .04). Considering that the presence of spasticity is very common in patients affected by an ictus and that it causes an ongoing level of contraction, these results suggest that the patients affected displayed more effort in reaching if engaged in a social task. Our study shows that accessibility and social engagement in multiplayer environments positively affects the patients’ performance and enjoyment during the task. Although the long-term impact of this enhanced motivation needs to be further assessed, our results do suggest that the inclusion of social factors such as multiplayer capabilities is an important factor for the rehabilitation process in VR-based therapy and might have an impact on both performance and mood of stroke patients.
- Neurorehabilitation using the virtual reality based Rehabilitation Gaming System: methodology, design, psychometrics, usability and validationPublication . Cameirão, Mónica S.; Bermúdez i Badia, Sergi; Duarte Oller, Esther; Verschure, Paul F. M. J.Stroke is a frequent cause of adult disability that can lead to enduring impairments. However, given the life-long plasticity of the brain one could assume that recovery could be facilitated by the harnessing of mechanisms underlying neuronal reorganization. Currently it is not clear how this reorganization can be mobilized. Novel technology based neurorehabilitation techniques hold promise to address this issue. Here we describe a Virtual Reality (VR) based system, the Rehabilitation Gaming System (RGS) that is based on a number of hypotheses on the neuronal mechanisms underlying recovery, the structure of training and the role of individualization. We investigate the psychometrics of the RGS in stroke patients and healthy controls.
- The combined impact of virtual reality neurorehabilitation and its interfaces on upper extremity functional recovery in patients with chronic strokePublication . Cameirão, Mónica S.; Bermúdez i Badia, Sergi; Duarte, Esther; Frisoli, Antonio; Verschure, Paul F. M. J.Background and Purpose—Although there is strong evidence on the beneficial effects of virtual reality (VR)-based rehabilitation, it is not yet well understood how the different aspects of these systems affect recovery. Consequently, we do not exactly know what features of VR neurorehabilitation systems are decisive in conveying their beneficial effects. Methods—To specifically address this issue, we developed 3 different configurations of the same VR-based rehabilitation system, the Rehabilitation Gaming System, using 3 different interface technologies: vision-based tracking, haptics, and a passive exoskeleton. Forty-four patients with chronic stroke were randomly allocated to one of the configurations and used the system for 35 minutes a day for 5 days a week during 4 weeks. Results—Our results revealed significant within-subject improvements at most of the standard clinical evaluation scales for all groups. Specifically we observe that the beneficial effects of VR-based training are modulated by the use/nonuse of compensatory movement strategies and the specific sensorimotor contingencies presented to the user, that is, visual feedback versus combined visual haptic feedback. Conclusions—Our findings suggest that the beneficial effects of VR-based neurorehabilitation systems such as the Rehabilitation Gaming System for the treatment of chronic stroke depend on the specific interface systems used. These results have strong implications for the design of future VR rehabilitation strategies that aim at maximizing functional outcomes and their retention. Clinical Trial Registration—This trial was not registered because it is a small clinical study that evaluates the feasibility of prototype devices.
- The synthetic moth: a neuromorphic approach toward artificial olfaction in robotsPublication . Vouloutsi, Vasiliki; Lopez- Serrano, Lucas L.; Mathews, Zenon; Chimeno, Alex Escuredo; Ziyatdinov, Andrey; Perera i Lluna, Alexandre; Bermúdez i Badia, Sergi; Verschure, Paul F. M. J.
- Virtual reality based rehabilitation speeds up functional recovery of the upper extremities after stroke: a randomized controlled pilot study in the acute phase of stroke using the rehabilitation gaming systemPublication . Cameirão, Mónica da Silva; Bermúdez i Badia, Sergi; Duarte, Esther; Verschure, Paul F. M. J.Given the incidence of stroke, the need has arisen to consider more self-managed rehabilitation approaches. A promising technology is Virtual Reality (VR). Thus far, however, it is not clear what the benefits of VR systems are when compared to conventional methods. Here we investigated the clinical impact of one such system, the Rehabilitation Gaming System (RGS), on the recovery time course of acute stroke. RGS combines concepts of action execution and observation with an automatic individualization of training. METHODS. Acute stroke patients (n = 8) used the RGS during 12 weeks in addition to conventional therapy. A control group (n = 8) performed a time matched alternative treatment, which consisted of intense occupational therapy or non-specific interactive games. RESULTS. At the end of the treatment, between-group comparisons showed that the RGS group displayed significantly improved performance in paretic arm speed that was matched by better performance in the arm subpart of the Fugl-Meyer Assessment Test and the Chedoke Arm and Hand Activity Inventory. In addition, the RGS group presented a significantly faster improvement over time for all the clinical scales during the treatment period. CONCLUSIONS. Our results suggest that rehabilitation with the RGS facilitates the functional recovery of the upper extremities and that this system is therefore a promising tool for stroke neurorehabilitation.
- Virtual reality based upper extremity rehabilitation following stroke: a reviewPublication . Cameirão, Mónica S.; Bermúdez i Badia, Sergi; Verschure, Paul F. M. J.In the last decade there have been major developments in the creation of interactive virtual scenarios for the rehabilitation of motor deficits following stroke. Virtual reality technology is arising as a promising tool to diagnose, monitor and induce functional recovery after lesions to the nervous system. This evidence has grown in the last few years, as effort has been made to develop virtual scenarios that are built on the knowledge of mechanisms of recovery. In this paper we review the state of the art virtual reality techniques for rehabilitation of functionality of the upper extremities following stroke. We refer to some of the main systems that have been developed within different rehabilitative approaches such as learning by imitation, reinforced feedback, haptic feedback, augmented practice and repetition, video capture virtual reality, exoskeletons, mental practice, action observation and execution, and others. The major findings of these studies show that virtual reality technologies will become a more and more essential ingredient in the treatment of stroke and other disorders of the nervous system.
- A virtual reality system for motor and cognitive neurorehabilitationPublication . Cameirão, Mónica S.; Bermúdez i Badia, Sergi; Zimmerli, Lukaz; Oller, Duarte; Verschure, Paul F. M. J.Here we present a virtual reality system developed for the rehabilitation of motor deficits following stroke. A virtual reality augmented feedback system or the Rehabilitation Gaming System (RGS), presents the patient with a training scenario that is designed to promote the rehabilitation of the upper extremities. RGS allows rapid and online diagnostics of the patient’s capabilities and the dynamic personalization of the rehabilitation scenario. We present the basic design considerations between RGS, its neuroscientific roots and preliminary results obtained with stroke patients that illustrate the main properties of the system.