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- New technologies and concepts for rehabilitation in the acute phase of stroke: a collaborative matrixPublication . Siekierka, E M; Eng, K.; Bassetti, C.; Blickenstorfer, A; Cameirão, M. S.; Dietz, V; Duff, A.; Erol, F; Ettlin, T; Hermann, D M; Keller, T; Keisker, B; Kesselring, J; Kleiser, R; Kollias, S; Kool, J P; Kurre, A; Mangold, S; Nef, T; Pyk, P; Riener, R; Schuster, C; Tosi, F; Verschure, P. F. M. J.; Zimmerli, LThe process of developing a successful stroke rehabilitation methodology requires four key components: a good understanding of the pathophysiological mechanisms underlying this brain disease, clear neuroscientific hypotheses to guide therapy, adequate clinical assessments of its efficacy on multiple timescales, and a systematic approach to the application of modern technologies to assist in the everyday work of therapists. Achieving this goal requires collaboration between neuroscientists, technologists and clinicians to develop well-founded systems and clinical protocols that are able to provide quantitatively validated improvements in patient rehabilitation outcomes. In this article we present three new applications of complementary technologies developed in an interdisciplinary matrix for acute-phase upper limb stroke rehabilitation - functional electrical stimulation, arm robot-assisted therapy and virtual reality-based cognitive therapy. We also outline the neuroscientific basis of our approach, present our detailed clinical assessment protocol and provide preliminary results from patient testing of each of the three systems showing their viability for patient use.
- Cognitive virtual reality based neurorehabilitation in acute stroke patientsPublication . Siekierka, E.; Cameirão, M.; Eng, K.; Hermann, D.; Hägni, K.; Pyk, P.; Hauser, Y.; Chevrier, E.; Verschure, P.; Kiper, D.; Bassetti, C.
- 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.
- Interactive visuo-motor therapy system for stroke rehabilitationPublication . Eng, Kynan; Siekierka, Ewa; Pyk, Pawel; Chevrier, Edith; Hauser, Yves; Cameirão, Mónica; Holper, Lisa; Hägni, Karin; Zimmerli, Lukas; Duff, Armin; Schuster, Corina; Bassetti, Claudio; Verschure, Paul; Kiper, DanielWe present a virtual reality (VR)-based motor neurorehabilitation system for stroke patients with upper limb paresis. It is based on two hypotheses: (1) observed actions correlated with self-generated or intended actions engage cortical motor observation, planning and execution areas ("mirror neurons"); (2) activation in damaged parts of motor cortex can be enhanced by viewing mirrored movements of non-paretic limbs. We postulate that our approach, applied during the acute post-stroke phase, facilitates motor re-learning and improves functional recovery. The patient controls a first-person view of virtual arms in tasks varying from simple (hitting objects) to complex (grasping and moving objects). The therapist adjusts weighting factors in the non-paretic limb to move the paretic virtual limb, thereby stimulating the mirror neuron system and optimizing patient motivation through graded task success. We present the system's neuroscientific background, technical details and preliminary results.
- Physiological responses during performance within a virtual scenario for the rehabilitation of motor deficitsPublication . Cameirão, Mónica S.; Bermúdez i Badia, Sergi; Mayank, Kumar; Guger, Christoph; Verschure, Paul F.M.J.Real-time physiological feedback can be used to modulate a virtual reality (VR) experience. It is not obvious, however, which parameters are most effective in achieving this such as heart rate variability and or the electrodermal response. Here we address this question by assessing the impact of the events generated by a VR based rehabilitation system on the affective state of human users. We show how the Rehabilitation Gaming System (RGS), a tool developed for the rehabilitation of motor deficits following stroke, can be enhanced using the online monitoring of bodily changes that are not under direct voluntary control. We show specific effects of the RGS on the autonomic nervous system and we propose how to use these for the modulation of the emotional state of the subject and performance.
- Using a multi-task adaptive vr system for upper limb rehabilitation in the acute phase of strokePublication . Cameirão, Mónica S.; Bermúdez i Badia, Sergi; Oller, Esther Duarte; Verschure, Paul F.M.J.Nowadays, stroke has become one the main causes of adult disability leading to life-lasting effects, including motor and cognitive deficits. Here we explore the benefits of the use of virtual reality (VR) for the rehabilitation of motor deficits following stroke. We have developed the Rehabilitation Gaming System (RGS), a VR-based apparatus designed for the treatment of the upper extremities. The RGS is a multi-level adaptive system that provides a task oriented training of graded complexity that is online adjusted to the capabilities of the patients. We show results from an ongoing study that evaluates the impact of this system on the recovery of patients in the acute phase of stroke (n=14). The results suggest that the system induces a sustained improvement during treatment, with observed benefits in the performance of activities of daily living.
- 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.