Designing robot-assisted neurorehabilitation strategies for people with both HIV and stroke

The whole point of this review should be to find or create protocols that get you recovered from the disabilities of your stroke. I don't see that here, so this is useless. 

Designing robot-assisted neurorehabilitation strategies for people with both HIV and stroke 

• Kevin D. Bui and
• Michelle J. JohnsonEmail author

Journal of NeuroEngineering and Rehabilitation201815:75

https://doi.org/10.1186/s12984-018-0418-3

©  The Author(s) 2018

• Received: 2 October 2017
• Accepted: 27 July 2018
• Published: 14 August 2018

Abstract

There is increasing evidence that HIV is an independent risk factor for stroke, resulting in an emerging population of people living with both HIV and stroke all over the world. However, neurorehabilitation strategies for the HIV-stroke population are distinctly lacking, which poses an enormous global health challenge. In order to address this gap, a better understanding of the HIV-stroke population is needed, as well as potential approaches to design effective neurorehabilitation strategies for this population. This review goes into the mechanisms, manifestations, and treatment options of neurologic injury in stroke and HIV, the additional challenges posed by the HIV-stroke population, and rehabilitation engineering approaches for both high and low resource areas. The aim of this review is to connect the underlying neurologic properties in both HIV and stroke to rehabilitation engineering. It reviews what is currently known about the association between HIV and stroke and gaps in current treatment strategies for the HIV-stroke population. We highlight relevant current areas of research that can help advance neurorehabilitation strategies specifically for the HIV-stroke population. We then explore how robot-assisted rehabilitation combined with community-based rehabilitation could be used as a potential approach to meet the challenges posed by the HIV-stroke population. We include some of our own work exploring a community-based robotic rehabilitation exercise system. The most relevant strategies will be ones that not only take into account the individual status of the patient but also the cultural and economic considerations of their respective environment.

Keywords

• HIV
• Stroke
• Neurorehabilitation
• Robotics
• Developing countries

Background

Stroke is a leading cause of death and disability in high income countries while both stroke and human immunodeficiency virus (HIV) are leading causes of death and disability in lower income countries [1, 2]. There is increasing evidence that HIV is an independent risk factor for stroke, resulting in an emerging population of people living with both HIV and stroke all over the world in both high and low resource areas [3, 4, 5, 6, 7, 8, 9]. Little research has been conducted on this population, particularly from a neurorehabilitation standpoint. It is important to consider the HIV-stroke population from this viewpoint because both are chronic diseases associated with lasting neurologic injury and require extensive amounts of monitoring, assessment, and treatment. While dealing with one is difficult enough, the added burden on the patient, their family, and health care providers from both diseases is an impending global health challenge that must be addressed.

Studies to date looking into the relationship between HIV and stroke have taken an epidemiological or pathophysiological approach, both confirming and trying to understand the cause for increased stroke rates in the HIV population [3, 4, 5, 6, 7, 8, 9, 10, 11]. However, very little is being done to address the physical, cognitive, social, and other problems that the HIV-stroke population currently faces. There is a need to develop relevant evidence-driven neurorehabilitation strategies for the HIV-stroke population to address the gaps in care and improve outcomes related to quality of life. This is an issue that is globally relevant given the rapidly aging HIV population in high income countries (HICs) and the increasing stroke rates in low and middle income countries (LMICs), where HIV is more prevalent [12]. Developing these solutions can also lead to advancements that may benefit people with just stroke, just HIV, and other populations dealing with multiple comorbidities.

As outlined by the National Institutes of Health, improving prevention or treatment of HIV-associated comorbidities and complications has become a high priority area in HIV/AIDS-related research [13]. Additionally, in the context of LMICs, the World Health Organization (WHO) has said that addressing the disability issue “is a development priority because of the higher prevalence of disability in lower-income countries and because disability and poverty reinforce and perpetuate one another” [14]. This review approaches the HIV-stroke population from a neurorehabilitation viewpoint — a viewpoint that is currently lacking for this population. Neurorehabilitation refers to the concept of intentionally affecting recovery in the nervous system through targeted rehabilitation exercises that can span across physical, cognitive, psychological, social, and cultural domains. To successfully develop neurorehabilitation strategies for the HIV-stroke population, a thorough understanding of multiple areas is needed, ranging from the molecular to the behavioral to the engineering. This includes the mechanisms, manifestations, and treatment options of neurologic injury in stroke and HIV, the additional challenges posed by the HIV-stroke population, and rehabilitation engineering approaches for both high and low resource areas.

This review also goes into strategies for developing robot-based neurorehabilitation strategies. Robot-assisted technologies have shown to be a promising approach in rehabilitation with the emergence of the rehabilitation robotics field. We explore how robot-assisted rehabilitation could be used as a potential approach to designing neurorehabilitation strategies for the HIV-stroke population. We highlight relevant areas of research in the field of rehabilitation robotics that can help advance research on the HIV-stroke population such as robot-based biomarkers of motor impairment, motor learning, cognitive assessment and rehabilitation, and affordable rehabilitation robotics. Other rehabilitation techniques, such as community-based rehabilitation, also have utility in designing new neurorehabilitation strategies. We detail a system we have built that combines both robotic and community-based rehabilitation — the Rehabilitation Community-Based Affordable Robot Exercise System (Rehab CARES) Gym — and is specifically designed to be deployed in LMICs that can be used as a way to provide neurorehabilitation to the HIV-stroke population.

The aim of this review is to connect the underlying neurologic properties in both HIV and stroke to rehabilitation engineering. By doing so, we hope to highlight both the gaps in research in order to spur the development of novel neurorehabilitation approaches for the HIV-stroke population and the opportunities to expand the scope of the rehabilitation robotics field.