Wearable Tech for Rehabilitation: Interactive Wearable Systems

Survey

Interactive Wearable Systems for Upper Body Rehabilitation: a Systematic Review

Wang Q, Markopoulos P, Yu B, Chen W & Timmermans A

Journal of Neuroengineering and Rehabilitation (2017) 14:20

DOI 10.1186/s12984-017-0229-y

Note: this paper performs a survey of the literature; the authors do not report the outcome of the PRISMA protocol.

Interactive wearable systems (IWS) measure range of motion, posture or usage; and provide auditory, visual or tactile feedback. Posture monitoring is traditionally performed by a therapist. When devices can provide accurate and reliable feedback, IWS opens up the possibility of independent training.

Objectives: A) to classify interactive wearable systems used for movement and posture monitoring during upper body rehabilitation, B) to gauge the wear-ability of the systems and C) to perform a literature review.

Process: A) The authors created a matrix of three axes to classify IWS technology.The axes reflect

• sensor technology – how it measures: (accelerometers or inertial measurement units, angular sensors or other);
• measurement - what is measured: (body posture, range of movement or amount of use); and
• the way feedback is delivered: (auditory, visual, tactile or multi-modal).

B) Wear-ability is classified by the following criteria: the sensor system should remain in place on the body, be comfortable, flexible enough not to limit movement, easy to use and fit different body shapes.

C) The authors included 45 papers, classified by the literature by the level of involvement with patients and the level of evaluation as technical, regarding usability, or clinical. The largest group of papers report on usability evaluation on normal subjects or with ‘real patients’ in stroke rehabilitation. Three papers report clinical evaluation with clinical patients, and one randomized controlled trial was found in the literature. Since a similar review in 2008, there have been only small improvements in the strength of clinical evidence for interactive wearable systems.

Findings: The strength of this paper is in the creation of a matrix for classifying interactive wearable devices. The authors also propose (but do not employ) a list for evaluating the wear-ability of such systems. This report provides a systematic way of regarding interactive wearable systems.

Exergame for CP Kids: GMFCS III Shuttle Run Test

Pilot study

An innovative cycling exergame to promote cardiovascular fitness in youth with cerebral palsy

Knights S, Graham N, Switzer L, Hernandez H, Ye Z, Findlay B, Xie W Y, Wright V & Fehlings D

Developmental Neurorehabilitation 2016 19(2): 135-140
DOI: 10.3109/17518423.2014.923056

Link to abstract

Objective: For youth with cerebral palsy, will playing an exergame increase cardiovascular fitness?

Procedure: The participants were 8 children with spastic bilateral cerebral palsy (GMFCS level III), able to use a hand-held video controller to play an internet-based multi-player game over a six week trial. They exercised at home at least three days a week for 30 minutes a day and tasked to achieve their individually calculated target heart rate for at least 30 minutes a week.

Findings: The primary measure was the GMFCS level III-specific shuttle run test; where higher levels indicate higher cardiovascular fitness. Participants walk or run a distance of 7.5 meters with increasingly less time until they fail to make the distance in the time given, twice. The children were tested before and two days after the six week intervention. The results showed a significant improvement of an average of 1.7 levels on the shuttle run test. Other outcome measures did not show changes that were significant.

Reference: Reliability of a shuttle run test for children with cerebral palsy who are classified at Gross Motor Function Classification System level III

Social Robots: NAOTherapist

Proof of Concept

NAOTherapist: Autonomous Assistance of Physical Rehabilitation Therapies with a Social Humanoid Robot

Pulido J C, Gonzalez J C & Fernandez F

Proceedings of IWART 2016: International Workshop on Assistive and Rehabilitation Technologies, Elche, Spain, December 14 – 16, 2016

Link to paper

Link to video

Objective: The goal of this work is to identify the architecture needed for NAO to provide therapy without human supervision.

Discussion: Social robots may act to relieve the workload of the therapist, fulfilling the clinical objectives autonomously over many treatment sessions. In this study, early requirements of a robotic therapist have been previously identified: the children had no problem following the instructions; they enjoyed the activity and adhered to the regimen.

For autonomous therapy, the robot must possess social awareness in addition to offering exercises that it models, monitors, encourages and corrects. It should be able to report back results to the therapist. In this case, NAO is doing successive arm poses with the child. The robot greets the child. It then models each arm pose, checks on the position achieved by the child, encourages and corrects the pose by using a variety of strategies to model the pose and to show how move into that pose. NAO times the correct achievement of the pose. Here, Kinect is being used separately to capture the poses for feedback to the therapist. NAO indicates the completion of each pose and the exercise routine and offers a wish to "play again tomorrow".

Robot assists with kids mobility

News

Interactive robot to promote rehabilitation for children with special needs

Kukich D. Published in UDaily, Communications and Public Affairs, University of Delaware, Jan 11, 2016

Link to story

At the University of Delaware in Newark, a research team including mobility researcher Cole Galloway are using "NAO", an interactive human-like robot in a new approach to pediatric rehabilitation. Dr. Galloway, who is known for his Pediatric Mobility Studio and GoBabyGo program, is incorporating the robot into his lab research. His research is directed by the concern that children with motor disabilities have needs that are not met by the training and equipment available today. "Young children’s overall knowledge depends on their ability to be mobile with peers — once they start moving, they begin to learn about the world in fundamentally different ways." The intention of including NAO in the mobility environment is to have the children engage with the robot, and for the robot to facilitate training.

Links

Update on Dr. Galloway's activities

Pediatric Mobility Lab and Design Studio

GoBabyGo "All people exploring their world via independent mobility!"

NAO robot - Softbank Robotics.com

Gait Robots Help Upper Body Posture

Randomized Controlled Trial

Robotic-assisted gait training improves walking abilities in diplegic children with cerebral palsy

Wallard l, Dietrich G, Kerlirzin Y & Bredin J

European Journal of Paediatric Neurology 2017, http://dx.doi.org/10.1016/j.ejpn.2017.01.012

Link to abstract

Objective: For children with diplegic cerebral palsy, robotic-assisted gait training (RAGT) can result in improved gait and posture compared to children who receive only traditional physical therapy. Of particular interest here is dynamic equilibrium control: upper body strategies such as shoulder elevation and elbow flexion used to maintain balance while propelling forward.

The authors propose: "RAGT presents beneficial effects on improvement of postural and locomotor functions of the patient resulting in a reorganization of gait pattern and full-body kinematic illustrating the dynamic equilibrium control in gait. This would translate in a better stabilization of the head, a better control of the displacement of the arms associated with an improvement in the kinematics of the lower limb."

Process: Thirty children with diplegic cerebral palsy from 8 to 18 years of age were randomly assigned to either a treatment group or a control group. The treatment group received 40-minute sessions of Lokomat Pediatric robot-assisted walking therapy, 5 days a week for 4 weeks. Body-weight support and walking speed were altered through the sessions to match the child’s functional capacity. The control group received daily 40-minute sessions of traditional therapy.

Findings: Gross Motor Function Classification System dimensions GMFM- D (standing) and GMFM-E (walking/running/climbing) were measured and showed improvement within the treatment group, and between treatment and control groups.

Children in the treatment group demonstrated new strategies for gait with significantly reduced shoulder elevation and elbow flexion, "more appropriate control of the upper body... associated with an improvement of the lower limbs kinematics which is similar to the values observed in typically developing children."

There was no follow-up to indicate whether the effects are preserved over the long term.

Robot Gait Rehab: Systematic Review

The effectiveness of robotic-assisted gait training for paediatric gait disorders: systematic review

Lefmann S, Russo R & Hillier S

Journal of NeuroEngineering and Rehabilitation 201714:1

DOI: 10.1186/s12984-016-0214-x

Link to full text: jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-016-0214-x

Objective: to review evidence for robotic-assisted gait training (RAGT) in children and adolescents with gait disorders as a consequence of cerebral palsy; or of musculo-skeletal, neurological orthopedic origin.

Process: Six databases were searched from 1980 to October, 2016. Data were extracted using the PRISMA model. http://www.prisma-statement.org/

Outcomes: Three trials that met the standard of randomized controlled trial; two were selected. Meta-analysis of the two trials showed "weak and inconsistent evidence regarding the use of RAGT for children with gait disorders".

Studies of lower design related mostly to children with cerebral palsy; these did show improved gait attributes such as speed, standing ability and walking distance. "… a clinical recommendation to adopt RAGT in children and adolescents with gait impairment cannot be made until more consistent findings are reported in larger randomized controlled trials."

Therapy Designers and Game Designers: We Should Get Together

Perspective

Gamification in Physical Therapy: More Than Using Games

Janssen J, Vershuren O, Renger WJ, Ermers J, Ketelaar M & van Ee, R

Pediatric Physical Therapy 2017;29:95-99

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/27984481

Objective: “By reducing the gap between therapy designers (therapists) and game designers, there is a huge potential to gain more from the potential value of participant-specific games.”To apply the attractiveness, motivation and engagement of video games to therapeutic goals, the authors propose three pathways: adding game principles to therapy (gamification), adding therapeutic tools to commercial games and selecting applied games suited to the therapeutic needs of the child.

Discussion: There are parallels between game design and therapy design. A process for bringing together game designers and therapy designers to optimize therapy is proposed.