Let's Improvise! iPad-based music therapy with functional electrical stimulation for upper limb stroke rehabilitation

No, let's not. We want protocols, NOT THIS WINGING IT CRAPOLA! 

Let's Improvise! iPad-based music therapy with functional electrical stimulation for upper limb stroke rehabilitation

Tanya Silveira, Jeanette Tamplin , Simone Dorsch, Anna Barlow

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In plain language

In the western world, stroke has been identified as the leading cause of disability in adults. Impairment to the arm/hand and depressive symptoms seem to be among the most frequent resultants of stroke. This article describes a collaborative occupational therapy and music therapy intervention for post-stroke arm/hand recovery.  The intervention itself combines principles of music therapy with tablet technology and functional electrical stimulation. The implementation of this novel intervention, described in this clinical case report, has implications for benefits to physical and motivational aspects of rehabilitation. Recommendations for further research of this intervention are also discussed.

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Abstract

This retrospective clinical case report will examine the implementation of a novel intervention combining a Functional Electrical Stimulation (FES) protocol with an iPad application. A 74-year-old female retired pianist and Professor of Music was admitted to a rehabilitation hospital following a left pontine stroke. On assessment, she was unable to use her right upper limb functionally. Conventional occupational therapy commenced soon after admission and consisted of functional retraining, including FES to the wrist and finger extensors. At week 4, the Registered Music Therapist (RMT) and Occupational Therapist (OT) collaborated to commence a trial of forearm FES in combination with an iPad-based music making application; ThumbJam. This application was used to encourage the patient to participate in touch sensitive musical improvisation using the affected hand in an attempt to promote engagement in complex motor patterns and non-verbal expression. Within 3 weeks, the patient was able to use ThumbJam without the FES, progressed to the keyboard in 4 weeks and has since commenced independent scales on the piano at home (21 weeks), as well as successful use of the upper limb in Activities of Daily Living (ADLs). On follow up (7 months), the patient reflected on the motivating elements of the intervention that helped her to achieve a functional outcome in her upper limb. This retrospective clinical case report will review the evidence with regard to FES and music therapy, outline the treatment protocol used and make recommendations for future research of “FES+ThumbJam” in upper limb stroke rehabilitation.

Acadia working on rehab-from-home for stroke patients

I bet there is no comparison of results of this type of intervention, all they are doing is testing feasibility of transferring recovery completely to the patient. 
http://thechronicleherald.ca/novascotia/1444712-acadia-working-on-rehab-from-home-for-stroke-patients
Patients recovering from a stroke may soon be able to do rehab at home, with the help of an app.
Acadia University researcher Anne Sophie Champod is receiving a $148,000 grant for her post-stroke recovery and rehabilitation project.
Champod’s research team is exploring an interactive iPad application to treat a common syndrome that makes simple tasks difficult for many stroke patients.
With the app, patients could do rehab at home with the results sent directly to their clinicians.
Funding for the project comes from the Nova Scotia Health Research Foundation.
“This funding has enabled me to form a collaborative research team and build partnerships with two Nova Scotian companies to develop the app and design the required goggles worn during the treatment,” Champod said in a news release.
“This research could make a huge difference to people living with this debilitating condition.”
Funding is also going to Saint Mary’s University for its masters in applied health services research program.
“Research funding is only one aspect of the work we do,” said Krista Connell, chief executive officer of the foundation.
“The training and support we provide is ensuring researchers have the tools they need to improve the health of Nova Scotians.”

BU study shows iPads can help people with aphasia make a comeback

You'll have to send  your doctor and therapist after the stroke protocol for this. Maybe someday whenever we actually get a great stroke association will we have publically available stroke protocols with efficacy percentages.
http://www.bu.edu/today/2015/the-upside-of-screen-time/
Mobile devices loaded with specialized apps could make that crucial practice possible. That’s where Newton-based start-up Constant Therapy comes in. Constant Therapy, cofounded by Kiran and CEO Veera Anantha, provides personalized iPad-based therapy for people with traumatic brain injuries, stroke, aphasia, and learning disabilities. So while Kiran’s team designed the rehabilitation tasks, Constant Therapy, one of whose investors is BU, made them available for download.

More at link.

Lingraphica Introduces Award-Winning Integrated iPad App and Cloud-Based Speech Therapy Solution to Help Survivors of Stroke and Traumatic Brain Injury Recover Language Skills

They never link to any proof that this actually works, so I guess you will have to do all the research yourself unless your speech therapist is doing what they are supposed to be doing. Keeping up-to-date with what works in their field.
http://www.marketwatch.com/story/lingraphica-introduces-award-winning-integrated-ipad-app-and-cloud-based-speech-therapy-solution-to-help-survivors-of-stroke-and-traumatic-brain-injury-recover-language-skills-2014-06-24

Hollywood Treatment for the Rehabilitation of Facial Palsy and Stroke Patients

Maybe something for your doctor to consider.
http://www.prnewswire.com/news-releases/hollywood-treatment-for-the-rehabilitation-of-facial-palsy-and-stroke-patients-279783772.html

Britain's largest conference bringing together experts from the reconstructive, cosmetic and non-surgical worlds witnessed this weekend the unveiling of new technology to help treat facial paralysis; developed by a plastic surgeon and the animation teams that worked on blockbusters such as Harry Potter, The Mummy, bestselling video game Grand Theft Auto and the L'Oréal 'Makeup Genius' app.

Revolutionary new iPad software to aid the rehabilitation of patients with facial palsy conditions including those stemming from strokes was introduced to an audience of more than 3,000 surgeons, doctors and nurses at the Clinical Cosmetic and Reconstructive Expo in London Olympia, 10-11 October, 2014.

The project, which is part-funded by the Wellcome Trust is a collaboration between researchers at the Queen Victoria Hospital in East Grinstead, Brighton-based technology company Sense Innovation, and Image Metrics, a leading film computer graphics company in Manchester. Past facial animation credits of Image Metrics include Harry Potter, The Mummy, and The Curious Tale of Benjamin Button, starring a reversely-ageing Brad Pitt.

Facial palsy is a debilitating condition in which the muscles in the face are weakened, causing a variety of symptoms ranging from numbness to total paralysis of the features. Facial palsy can be caused by a variety of factors, including infections such as Bell's palsy or Lyme Disease, neurological conditions, strokes and developmental syndromes.

More at link.

Heads Up App - Injury Prevention & Control: Traumatic Brain Injury

Which one is your doctor using?

Concussion Coach By US Department of Veterans Affairs (VA)

  Or:
Heads Up App - Injury Prevention & Control: Traumatic Brain Injury

iPad Technology for Home Rehabilitation after Stroke (iHOME): A proof-of-concept randomized trial

Don't you know enough to search for existing research on your topic of choice? My god are these people obtuse.
Like this:

Constant Therapy Launches iPad Solution for People with Traumatic Brain Injury, Stroke, Aphasia and Learning Disabilities

Multineurons is developing head-worn sensor & iPad app to monitor patients with brain disorders

Constant Therapy rolls out mobile, personalized brain rehabilitation via the iPad

Prototyping a Tablet Application for the Rehabilitation of Stroke Patients

23 others for the iPad 

 

 

 

http://onlinelibrary.wiley.com/doi/10.1111/ijs.12328/abstract;jsessionid=4F8A0565DD11A287C580BDD72D31C7C1.f04t01?

1. Gustavo Saposnik^1,2,*,
2. Chi-Ming Chow³,
3. David Gladstone⁴,
4. Donna Cheung¹,
5. Edward Brawer³,
6. Kevin E. Thorpe⁵,
7. Avon Saldanha⁶,
8. Alice Dang⁶,
9. Mark Bayley⁷,
10. Tom A. Schweizer² and
11. on behalf of the iHOME Research Team for the Stroke Outcomes Research Canada Working Group^†

Article first published online: 7 JUL 2014

DOI: 10.1111/ijs.12328

© 2014 World Stroke Organization

Issue

International Journal of Stroke

Early View (Online Version of Record published before inclusion in an issue)

Additional Information(Show All)

How to CiteAuthor InformationPublication HistoryFunding Information

1. Conflict of interest: None declared.
2. Clinicaltrials.gov registration: NCT01836159
3. Funding: This study is supported by the Ontario Stroke Network, funded by the Ontario Ministry of Health and Long-Term Care, and by the Canadian Partnership for Stroke Recovery, funded by the Heart and Stroke Foundation of Canada. No support is received from Apple. Dr Saposnik is supported by the Heart and Stroke Foundation of Canada (HSFC) Distinguished Clinician Scientist Award. Dr Schweizer is supported by the HSFC New Investigator Award.
4. Principal investigators: Dr Saposnik and Dr Chow are the co-PIs of iHOME Acute. Dr Saposnik, Dr Gladstone, and Dr Schweizer are the co-PIs of iHOME Chronic. Dr Bayley is the site PI at Toronto Rehabilitation.

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Keywords:

• outcomes;
• rehabilitation;
• stroke;
• tablet technology

Background

Tablets are a novel line of computers controlled by a multitouch screen. Fine motor movements are captured on the tablet computer through electrical fields and can be qualitatively and quantitatively assessed. Evidence is limited on tablet use for stroke rehabilitation.

Methods

iHOME is an investigator-initiated randomized controlled pilot trial with a single-blinded outcome assessment. The intervention consists of iPad use (investigational group) vs. usual care (control group) among patients receiving conventional outpatient rehabilitation. Eligibility includes aged 18–85 years who experienced a mild ischemic or hemorrhagic stroke (as diagnosed on neuroimaging and determined by the Chedoke–McMaster score ≥3. The STROKE REHAB® software for the iPad was specifically designed for patients with fine motor weakness and/or neglect. Of the total 30 patients, 20 will be in iHOME Acute (enrolled within three-months of stroke onset) and 10 patients in iHOME Chronic (enrolled more than six-months from onset).

Outcome measures

The primary feasibility outcome is the proportion of the scheduled iPad time used (more than 70% (≥140 mins) of the total ‘dose’ of intervention intended will be considered successful). Efficacy in fine motor movements will be assessed using the nine-hole peg test; time to magnify and pop the balloons in the iPad software application, and improvement in Wolf Motor Function Test.

Conclusions

iHOME is a randomized controlled trial assessing the feasibility, safety, and efficacy of tablet technology for home use in stroke rehabilitation. The results of this study will serve as the basis for a larger multicenter trial.

Constant Therapy Launches iPad Solution for People with Traumatic Brain Injury, Stroke, Aphasia and Learning Disabilities

By putting Neuro in the title they seem to be trying to ride the neuroscience bandwagon. Have you doctor validate that this actually works. I couldn't find any research backing up the actual claims of the device, pointing to general research does not count.
But hey, a 30 day free trial. No recovery occurs in 30 days so this forces you to buy it.
http://www.marketwatch.com/story/constant-therapy-launches-ipad-solution-for-people-with-traumatic-brain-injury-stroke-aphasia-and-learning-disabilities-2014-06-02

Multineurons is developing head-worn sensor & iPad app to monitor patients with brain disorders

We most certainly have brain disorders, so what is your doctor doing with this to determine your specific brain problems? Your doctor has to know specifically what damage has occurred. Or how will they come up with the correct stroke protocols to correct the problems and pass on the right prescriptions to the therapists? Because today they know absolutely nothing about your damage and are totally worthless in helping you recover. That statement should create dozens of flame wars in the comments.
http://medcitynews.com/2014/03/multineurons-developing-head-worn-sensor-monitor-patients-brain-disorders/?

Constant Therapy rolls out mobile, personalized brain rehabilitation via the iPad

Since the iPad has been out since 2010, why has it taken so long to get all stroke rehab information available on one? Failures on a massive scale from the stroke associations and your doctors.
http://medcitynews.com/2014/02/mobile-personalized-brain-rehabilitation-via-ipad-launches-funding-bu-angels/?
After a stroke or traumatic brain injury, many people experience difficulty speaking or understanding what others are saying. The good news is that the brain is able to repair itself to some extent, with the help of cognitive and speech therapy programs. The bad news is, the rehabilitation process is expensive and can involve weekly visits to specialty clinics.
A startup called Constant Therapy converted years’ worth of aphasia rehabilitation research at Boston University into a digitized cognitive-communication therapy program that patients can use on iPads from their homes.
Now the Boston-based company has just scored its first round of outside capital from Boston University, TiE Angels Boston and serial entrepreneur Andy Palmer to continue developing and marketing the platform. Constant Therapy didn’t disclose how much was raised, but a recent SEC filing indicates it was $605,000.

Read more: http://medcitynews.com/2014/02/mobile-personalized-brain-rehabilitation-via-ipad-launches-funding-bu-angels/#ixzz2vl1T8E6C

Prototyping a Tablet Application for the Rehabilitation of Stroke Patients

Good luck, there is already lots of competition out there. I've already written about 19 for the iPad and 11 for the iPhone.
http://aisel.aisnet.org/icmb2013/18/

Richard Hable, Evolaris Next Level GmbHFollow
Elisabeth Pergler, Evolaris Next Level GmbHFollow
David Ram, Tyromotion GmbHFollow

Abstract

Modern tablet computers come with touch sensitive displays, which make them suitable for recognition and evaluation of finger movements. This paper describes the design and development of a prototypical iPad application, which uses this capability to support therapeutic exercises for stroke patients. It is shown how this concept differs from existing stationary solutions, and how the prototype is used to explore the suitability of such a solution for stroke rehabilitation. Experiences from first user trials are described, which indicate willingness of patients and therapists to embrace the new technical possibilities, although challenging research tasks remain to be solved on the way to a proven professional solution.

Surrey GPs use iPad dementia detection system

Still subjective but better than nothing. Make sure before you leave the hospital you take this type of test to provide a baseline for your 33% chance of getting dementia.
http://www.computerworlduk.com/news/applications/3454862/surrey-gps-use-ipad-dementia-detection-system/
Surrey GP practices are rolling out an iPad-based patient memory assessment system to quickly spot signs of dementia.
The Guildford and Waverley Clinical Commissioning Group (CCG) is promoting the use of the CANTABmobile system to help improve dementia diagnosis rates.
CANTABmobile enables GPs to test a patient’s episodic memory through an easy to use ten-minute cognitive assessment. Of the 21 GP practices in the Guildford and Waverley region, 19 have been provided with iPads and the software to assess patients who have concerns about their memory loss.
The app is based on tests that have previously only been available to pharmaceutical companies and academia for specialist trials and research. The CANTABmobile medical software has been developed by Cambridge Cognition, a British developer of neuropsychological tests born out of research at Cambridge University.

More at link.

Stroke patients benefiting from touch screen computers

How long will it take to get this in the US? I'll say never unless the survivor provides the computer.
http://www.mediplacements.com/article-801600062-stroke_patients_benefiting.html
Strokes are a major threat to a person's health and are highly prevalent in the UK but a speech therapy team is using new technology to help patients recover from this condition.

Amersham Hospital, which is based in south Buckinghamshire, is a specialist facility for treating those people that have suffered a stroke, are pioneering new touch screen computers which assist patients in getting back on the road to recovery. Bucks Free Press reported that the devices are seen as life changing tools for people that have suffered a stroke and had their speech and motor functions impaired in the process.

NHS Buckinghamshire allows the patients to take the devices to use in their own homes, and has become become the first healthcare trust to allow this kind of service. Staff believe that it can have substantial benefits and means that the person in question does not have to make constant visits to hospital.

The devices are equipped with specialist software that provides a series of exercises which helps to aid the recovery of a patient that has recently had a stroke. It has been developed to assist those who have had their speech and motor functions impaired by their condition.

Julia Parsons, a speech language therapist, told the news provider: "There's evidence that suggests that people having speech therapy benefit more when they have it intensively half hour every day. As a speech therapy team we can't provide that can kind of intensive therapy.

"The aim of the computer is for patients to have that at home in their own time. We can set up the computers to make it very specific to each patient, to their own needs."

Strokes are a major killer in England with figures from the NHS showing that over 150,000 people are affected by the condition everyyear. It is the third largest cause of death across the country behind heart disease and cancer and even if it does not kill the patient it can leave them with life-changing ailments.

Search for speech therapy jobs at Mediplacements, a genuine specialist providing recruitment opportunities in the NHS and private sector.

Dementia Assessment made easy and Free

You probably need to get this so you can figure out how to fool the test later on. This is not one you want to fail. Then ask you doctor for specifics on how to prevent dementia.
http://www.acemobile.org/

SingFit - Music for your acute therapy

Instead of just passively listening to music which has already been proven to assist recovery. You can sing along like karaoke with this app.
If your doctor or therapist doesn't give you music as a therapy protocol ask why they don't follow research.
https://itunes.apple.com/us/app/singfit/id442827581?mt=8

Abstract TP218: Use Of A Tablet Device application (iNeglect) to evaluate Neglect patients

But, but what about your grandma of 90 who has never used a computer or cell phone.
http://stroke.ahajournals.org/cgi/content/meeting_abstract/44/2_MeetingAbstracts/ATP218
Background: Patients with unilateral neglect after the right hemispheric lesion fail to respond normally to stimuli on the left side. Several paper-based tests for detecting neglect had been widely used. Here, we developed an application that runs on a tablet device to evaluate unilateral spatial neglect and investigated its feasibility in stroke patients.
Methods: We enrolled acute ischemic stroke patients with neglect (n = 20) who had at least one of visual, auditory or tactile extinction. By comparison, stroke patients who had cortical lesions without neglect (n = 10), and healthy controls (n = 10) were recruited. The iNeglect application running on the iPad device was developed. In the table setting test of the iNeglect, the subjects were requested to drag the 12 food items on the table, and the deviation of each item from the midline was measured automatically. Line bisection tests using paper or iPad were also performed and compared.
Results: Among neglect patients, mean deviation to the right side were 2.03 ± 2.11 mm of line bisection on paper, 18.47 ± 20.89 mm of line bisection on iPad, and 15.79 ± 18.17 mm of the table setting test. Patients with neglect showed larger deviation to the right side; in line bisection on paper (compared without neglect, p = 0.016 and control, p &lt0.001), line bisection on iPad (compared without neglect, p = 0.053 and control, p = 0.009), and table setting test (0.80 ± 7.38 mm of without neglect, p = 0.004 and -2.93 ± 6.78 mm of healthy control, p = 0.001). Results of table setting test was well correlated with that of line bisection tests on paper (r = 0.487, p&lt0.001) and iPad (r = 0.511, p&lt0.001).
Conclusions: The iNeglect application was feasible in discriminating the patients with neglect and recognizing the right side deviation. The iNeglect application might be helpful to evaluate neglect patients and to objectify neurological deficit.

BrainAttack App Helps Emergency Room Doctors, Nurses Save Stroke Patients' Lives; Time-saving tPA Eligibility Tool for Clinical Use

Doctors are going to gush over this even though it still is all subjective. We still need the objective diagnosis like these fourteen.
http://www.prweb.com/releases/iPhoneApp/tPAEligibilityTool/prweb10422763.htm
Emergency room staff, neurologists and other mid-level health care providers racing the clock to treat stroke patients can now use [BrainAttack App the first interactive tPA decision–support app designed for clinical use, to help physicians save lives and prevent permanent disability by quickly determining the tPA eligibility for stroke patients.
BrainAttack App presents a series of questions regarding a patient’s relevant clinical information. Based on the responses to the questions, BrainAttack App determines tPA eligibility, reducing to a few minutes a cumbersome process that often requires 30 to 45-minutes of precious time. BrainAttack App processes the data accurately and more quickly than a person can and ensures standard of care guidelines are followed.
BrainAttack App was developed by a brother-sister team, Dr. Madhuri Koganti, a practicing Dallas neurologist, and Balu Kadiyala, a Chicago-area technology expert. They are partners in the firm NeuroCareTech, Inc.
Dr. Koganti sought her brother Balu’s expertise in solving a common problem facing emergency room staff: they must adhere to time-consuming guidelines by manually completing paper forms to determine whether stroke patients can receive tPA.
Tissue Plasminogen Activator, tPA, is an enzyme found naturally in the body that activates plasminogen into another enzyme to dissolve a blood clot. A life-saving treatment if given within three-hours of the onset of stroke symptoms, tPA can significantly reduce permanent disability and can reverse the effects of stroke and improve patients’ chances of leading healthy, productive lives.
Dr. Koganti points to research indicating that despite tPA’s widespread availability, it is not being widely used in hospitals. She says the factors preventing greater use of tPA are physicans’ fears of potential risks with tPA administration, legal liability and patients’ lack of knowledge about tPA benefits. [BrainAttack App not only helps determine patient tPA eligibility; it also determines whether the patient is ineligible, which is critical to avoiding fatal outcomes. Giving tPA to stroke patients that are not eligible can lead to severe complications, including death.
"Saving time makes all the difference in successful outcomes,” said Dr. Koganti. “Stroke patients must race against the clock to get tPA treatment to prevent permanent brain damage. BrainAttack App addresses a serious challenge for physicians, nurses and paramedics because we are fighting the clock, while striving for accuracy in our tPA treatment decisions. BrainAttack App can help hospitals achieve door-to-needle times of 60 minutes or less,” she added.
[BrainAttack App features the tPA eligibility tool and the National Institutes of Health Stroke Scale, a systematic assessment tool that provides a quantitative measure of stroke-related neurologic deficit. The BrainAttack App is native to the iPhone or iPad and works even without an Internet connection, giving doctors anytime, anywhere access to the tool.
“BrainAttack App gives ER staff pocket-access through their smart phones, to tPA criteria so they can quickly determine eligibility, without needing paperwork, special log-in passwords, a computer or even the Internet,” said Balu Kadiyala.
BrainAttack App works on iPhone and iPad, the most commonly used mobile devices for U.S. doctors and is available for $5.99 on [iTunes.

Startup of the Week – StrokeLink

There must be something in the water in Canada, they seem be be much smarter. These people are on the left side of the bell curve, get out of their way.
http://blogs.calgaryherald.com/2013/02/01/startup-of-the-week-strokelink/

OT Review of iPad App Dexteria for Fine Motor Skills

The OT review here, your hand OT should have already known about this and asked if you wanted to try it.
http://blog.missawesomeness.com/2013/01/ot-review-of-ipad-app-dexteria-for-fine.html
The place to get it;
http://www.dexteria.net/

DocGuide

DG Apps brings the best of the world of medical apps to the physicians and healthcare professionals. Focused 100% on professional practice (rather than apps for the general public), it saves time and keeps users up-to-date with apps of most interest in a particular specialty area(s).
You can register as a patient to see what is out there for your neurologist and even get the free ones for yourself.  And then see what your doctor should know about your condition.  Your doctor should know more than you about your condition  but I bet s/he doesn't.
http://dgapps.docguide.com/
The ones highlighted for stroke;
http://dgapps.docguide.com/appsearch/ios/latest/stroke