Design strategies to improve patient motivation during robot-aided rehabilitation

 In the 17 years since this came out our stroke medical 'professionals' still don't understand ONE GODDAMN THING ABOUT SURVIVOR MOTIVATION! You create 100% recovery protocols and your survivor will be motivated to do the millions of reps needed because they are looking forward to 100% recovery. GET THERE! 

The problem is stroke researchers are not motivated to solve stroke. What the fuck is your solution to that failure? We still don't know how to motivate stroke medical 'professionals' to solve stroke to 100% recovery!

 

Design strategies to improve patient motivation during robot-aided rehabilitation

Published: 19 February 2007 Journal of NeuroEngineering and Rehabilitation 2007, 4:3 doi:10.1186/1743-0003-4-3 Received: 31 March 2006 Accepted: 19 February 2007 This article is available from: http://www.jneuroengrehab.com/content/4/1/3

 

Roberto Colombo* 1 , Fabrizio Pisano 2 , Alessandra Mazzone 1 , Carmen Delconte 2 , Silvestro Micera 3 , M Chiara Carrozza 3 , Paolo Dario 3 and Giuseppe Minuco 1 Address: 1 Service of Bioengineering, Salvatore Maugeri Foundation, IRCCS Via Revislate 13, 28010 Veruno (NO), Italy, 2 Division of Neurology, Salvatore Maugeri Foundation, IRCCS Via Revislate 13, 28010 Veruno (NO), Italy and 3 ARTS Lab Scuola Superiore Sant'Anna V.le Piaggio 34, 56025 Pontedera (PI), Italy Email: Roberto Colombo* - rcolombo@fsm.it; Fabrizio Pisano - fpisano@fsm.it; Alessandra Mazzone - amazzone@fsm.it; Carmen Delconte - cdelconte@fsm.it; Silvestro Micera - micera@sssup.it; M Chiara Carrozza - carrozza@sssup.it; Paolo Dario - dario@sssup.it; Giuseppe Minuco - gminuco@fsm.it * Corresponding author Abstract  

Background:  

 

Motivation is an important factor in rehabilitation and frequently used as a determinant of rehabilitation outcome. Several factors can influence patient motivation and so improve exercise adherence. This paper presents the design of two robot devices for use in the rehabilitation of upper limb movements, that can motivate patients during the execution of the assigned motor tasks by enhancing the gaming aspects of rehabilitation. In addition, a regular review of the obtained performance can reinforce in patients' minds the importance of exercising and encourage them to continue, so improving their motivation and consequently adherence to the program. In view of this, we also developed an evaluation metric that could characterize the rate of improvement and quantify the changes in the obtained performance.  

Methods:  

 

Two groups (G1, n = 8 and G2, n = 12) of patients with chronic stroke were enrolled in a 3-week rehabilitation program including standard physical therapy (45 min. daily) plus treatment by means of robot devices (40 min., twice daily) respectively for wrist (G1) and elbow-shoulder movements (G2). Both groups were evaluated by means of standard clinical assessment scales and the new robot measured evaluation metric. Patients' motivation was assessed in 9/12 G2 patients by means of the Intrinsic Motivation Inventory (IMI) questionnaire.  

Results:  

 

Both groups reduced their motor deficit and showed a significant improvement in clinical scales and the robot measured parameters. The IMI assessed in G2 patients showed high scores for interest, usefulness and importance subscales and low values for tension and pain subscales.  

Conclusion:  

 

Thanks to the design features of the two robot devices the therapist could easily adapt training to the individual by selecting different difficulty levels of the motor task tailored to each patient's disability. The gaming aspects incorporated in the two rehabilitation robots helped maintain patients' interest high during execution of the assigned tasks by providing feedback on performance. The evaluation metric gave a precise measure of patients' performance and thus provides a tool to help therapists promote patient motivation and hence adherence to the training program.

The Impact of Rehabilitation Frequencies in the First Year after Stroke on the Risk of Recurrent Stroke and Mortality

My God, your fucking doctor has nothing to do here, all your recovery is based on your rehabilitation work. Nothing on stopping the neuronal cascade of death by these 5 causes in the first week. No stroke prevention diet. Nothing for any stroke medical professional to do. You are completely on your own.
http://www.sciencedirect.com/science/article/pii/S1052305717303439

• Yuan-Yang Cheng, MD, PhD^{*, †},
• Jiah-Hwang Shu, RN^{‡, §},
• Hsiu-Chuan Hsu, RN^{‡, §},
• Ying Liang, RN^{‡, §},
• Shin-Tsu Chang, MD, PhD^*,
• Chung-Lan Kao, MD, PhD^{†, ‖, ,} ,
• Hsin-Bang Leu, MD, PhD^{†, §, ,}

 Show more

https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.06.047

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Background

Rehabilitation is essential for all poststroke patients to improve self-care ability. However, whether an increased frequency of rehabilitation reduces poststroke adverse events remains undetermined.

Methods

We recruited 4899 patients with newly diagnosed ischemic stroke between January 1, 2000, and December 31, 2008, from our database and divided them into 3 groups according to their Charlson Comorbidity Index, and they were further categorized into 3 groups of different rehabilitation frequencies during their first year after stroke. Clinical adverse events including recurrent stroke, hip fracture, pneumonia, and all-cause mortality were analyzed by Cox regression analysis to investigate the protective effects of aggressive rehabilitation.

Results

We discovered that aggressive rehabilitation in the first year after stroke was significantly associated with a lower incidence of recurrent stroke and all-cause mortality despite the severity of patients' comorbidities. Further Cox regression analysis revealed decreased hazard ratios to develop recurrent stroke and all-cause mortality in patients with more intensive rehabilitation (P for trend <.05). However, no significant associations between rehabilitation frequency and pneumonia and hip fracture were identified in our study.

Conclusion

Intensive rehabilitation during the first year after stroke should be recommended to prevent detrimental adverse events for stroke survivors.

The Importance of Patient Involvement in Stroke Rehabilitation

Where is the companion piece?

The Importance of Doctor Involvement in Stroke Rehabilitation.

We already know that survivors have to drive their own recovery as Dr. Steven Wolf writes, a rehabilitation stroke expert and professor at Emory University School of Medicine in Atlanta.  "Stroke patients need to rely more on their own problem solving to regain mobility".
You are completely on your own, deal with it.

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157149 

• Hanne Kaae Kristensen ,
• Malin Tistad ,
• Lena von Koch ,
• Charlotte Ytterberg

• 
  
• 
  
• 
  
• 
  

• Published: June 10, 2016
• http://dx.doi.org/10.1371/journal.pone.0157149

Abstract

Objective

To investigate the perceived needs for health services by persons with stroke within the first year after rehabilitation, and associations between perceived impact of stroke, involvement in decisions regarding care/treatment, and having health services needs met.

Method

Data was collected, through a mail survey, from patients with stroke who were admitted to a university hospital in 2012 and had received rehabilitation after discharge from the stroke unit. The rehabilitation lasted an average of 2 to 4.6 months. The Stroke Survivor Needs Survey Questionnaire was used to assess the participants' perceptions of involvement in decisions on care or treatment and needs for health services in 11 problem areas: mobility, falls, incontinence, pain, fatigue, emotion, concentration, memory, speaking, reading, and sight. The perceived impact of stroke in eight areas was assessed using the Stroke Impact Scale (SIS) 3.0. Eleven logistic regression models were created to explore associations between having health services needs met in each problem area respectively (dependent variable) and the independent variables. In all models the independent variables were: age, sex, SIS domain corresponding to the dependent variable, or stroke severity in cases when no corresponding SIS domain was identified, and involvement in decisions on care and treatment.

Results

The 63 participants who returned the questionnaires had a mean age of 72 years, 33 were male and 30 were female. Eighty percent had suffered a mild stroke. The number of participants who reported problems varied between 51 (80%, mobility) and 24 (38%, sight). Involvement in decisions on care and treatment was found to be associated with having health services needs met in six problem areas: falls, fatigue, emotion, memory, speaking, and reading.

Conclusions

The results highlight the importance of involving patients in making decisions on stroke rehabilitation, as it appears to be associated with meeting their health services needs.
 

 

First-time stroke survivors and caregivers’ perceptions of being engaged in rehabilitation

Ten years ago I was told absolutely nothing about my stroke or rehabilitation.
http://onlinelibrary.wiley.com/doi/10.1111/jan.12819/full

1. Langduo Chen MNg RN Clinical Services Coordinator,
2. Lily Dongxia Xiao PhD RN Associate Professor^* and
3. Anita De Bellis PhD RN Senior Lecturer

Article first published online: 24 SEP 2015

DOI: 10.1111/jan.12819

© 2015 John Wiley & Sons Ltd

Issue

Journal of Advanced Nursing

Volume 72, Issue 1, pages 73–84, January 2016

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Keywords:

• discharge planning;
• family caregivers;
• interpretive study;
• rehabilitation nurses;
• stroke survivors

Abstract

Aim

To explore community-dwelling first-time stroke survivors and family caregivers’ perceptions of being engaged in stroke rehabilitation.

Background

Stroke is recognized as a worldwide common healthcare problem and the leading cause of adult disability. An holistic approach to rehabilitation can only be achieved by engaging stroke survivors and caregivers in all stages of recovery and by providing ongoing coordinated rehabilitation programmes.

Design

An interpretive study design was applied to the study.

Method

In-depth semi-structured interviews with 22 community-dwelling first-time stroke survivors and caregivers were conducted in 2013. The interviews were audiotaped, transcribed and analysed using a thematic analysis.

Findings

Four major themes were identified. First, participants demonstrated low health literacy in stroke and their needs to learn about the disease and rehabilitation were usually ignored in busy clinical settings prior to discharge from hospital. Second, there was a lack of communication and continuity of treatment when the stroke survivors were transferred from one institution to another. Third, challenged with fragmented post-discharge rehabilitation services, the participants perceived that nurse-led coordination of rehabilitation was desirable. Fourth, participants perceived ongoing changing of rehabilitation goals in different stages of recovery. They expected to be engaged in ongoing rehabilitation planning and programmes.

Conclusion

The findings of this study challenge service providers to realize a true partnership with stroke survivors and caregivers by working with them as one team that is led by nurses. Making the necessary changes requires mutual effort at both the systemic and individual levels with rehabilitation nurse-led coordination of rehabilitation programmes.

How “Good” Stroke Survivors Help All Stroke Survivors

I probably fall into this category but therapists likely would not like me as a patient, as least right now. When I first started as a patient 10 years ago I knew nothing about how little anyone knew about stroke rehab. A Peter Levine article.
http://www.saebo.com/good-stroke-survivors-help-stroke-survivors/

What’s new in post-stroke rehabilitation?

None of this seems very new, I've read about this stuff for years. Now if they would just get to fucking work and create some stroke protocols. Only 8 pages, your doctor should have time to read and comprehend that little amount.
http://www.institut-servier.com/download/AVC_nouveaut%C3%A9s_th%C3%A9rapeutiques.pdf#page=163

Lack of rehabilitation leaves most stroke survivors disabled - China

And yet most acupuncturists point to China and its overwhelming use of acupuncture for strokes as the reason for using that placebo.
The real problem here is not lack of rehabilitation, its the lack of preventing more disability by stopping the neuronal cascade of death.
http://english.eastday.com/e/131023/u1a7730764.html
A LACK of after-surgery rehabilitation has resulted in a high percentage of disability among the 10.36 million stroke survivors over 40 years old in the nation, experts said.
Compared with the 80 percent rehabilitation rate of stroke survivors in Western countries, over 70 percent of Chinese patients who survived stroke were left with disorders like paralysis and serious language deficiencies. About 40 percent of them have very serious disabilities.
Early detection and treatment while a stroke is taking place, effective therapy and rehabilitation afterwards are all keys for patients' survival and recovery.
Stroke patients who receive early and effective rehabilitation training have a three times higher recovery rate than those who don't receive rehabilitation, said Wang Yanni from Pinetree China, a private company that calls itself the nation's first professional facility offering at-home care and service for after-surgery patients or those needing rehabilitation after surviving diseases.
Teamed up with domestic elderly care organizations, Pinetree announced it will offer free rehabilitation for 20,000 after-stroke patients living in Beijing and Shanghai in the following year.

The Responsiveness of the Emory Functional Ambulation Profile in Rehabilitation of Ambulant Stroke Survivors

This is so true. We have no idea of the effectiveness of any stroke therapy. 

The Responsiveness of the Emory Functional Ambulation Profile in Rehabilitation of Ambulant Stroke Survivors

Abstract

Background: The Emory Functional Ambulation Profile (EFAP) was designed to measure functional ambulation in post-stroke survivors. Its' ability to detect the effectiveness of any physical therapy protocol has been sparsely investigated.

Objectives: This study aimed to determine the ability of the EFAP to detecting patients' response to a physical therapy protocol in stroke rehabilitation.

Methods: The pretest-posttest experimental design was used for this study. Seventeen consecutive stroke survivors who met the inclusion criteria were recruited into the study. Participants received a conservative physical therapy protocol twice weekly for 8 weeks. Performance on individual subtasks of the EFAP were measured and recorded for each participant before and at the end of the study. Data was available at the posttest for only 14 participants (mean age = 57.00 9.05 years; average poststroke period = 19.71  26.56 months) and this was analyzed using frequency and percentages with inferential statistics of paired t-test at .05 alpha level.

Results: Participants scores for all the EFAP subtasks and overall scores improved (reduced task completion time) at the end of the treatment programme. Responsiveness for the EFAP ranged from 3% to 21% for all subtasks. Changes were even significant for three [floor carpet, up and go] out of the 5 subtasks and the total EFAP scores (p<.05)

Conclusion: EFAP was able to detect the response of stroke survivors to the physical therapy protocol used in this study and is therefore recommended for use by clinicians and researchers for measuring treatment outcome.

When does stroke rehabilitation end?

Never.
http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2012.00963.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false
This article examines key evidence on intervention effectiveness late poststroke; provides discussion on how this evidence impacts stroke rehabilitation at a clinical and national level; and explores strategies that should improve the way in which chronic stroke is addressed internationally.

Giant steps for the science of stroke rehabilitation

You have to ask your doctor for this. There isn't even an abstract for it. If it is that giant a step then your doctor should already know about it, there is email,twitter, texting nowadays to distribute information.
http://onlinelibrary.wiley.com/doi/10.1111/ijs.12028/abstract

Should a Patient Undergo Rehabilitation After Stroke?

An appalling question to ask. It does degenerate into a commercial.
http://handtutorblog.wordpress.com/2012/08/28/should-a-patient-undergo-rehabilitation-after-stroke/

Henrik S. Jørgensen, MD etal of the Department of Radiology, Bispebjerg Hospital, Copenhagen, Denmark cocnducted a study to determine the value of post stroke rehabilitation.

The objective of the study was  to evaluate the outcome of stroke divided according to both the severity of the initial stroke  and the  initial level of disability.

Repairing the Injured Brain Why Proper Rehabilitation Is Essential to Recovering Function

A great article explaining what you need to know  about your challenges to recovery. Your doctor should have given you this information.
From the Dana Foundation.
http://dana.org/news/cerebrum/detail.aspx?id=39258
A couple of lines from it. Read it all.
Since most people with brain injury live a nearly normal life span (the overall average is seven years decreased life expectancy).
Amphetamine administration in concert with therapy may enhance and accelerate the rate and extent of recovery of motor function.
Therapies that are conducted one or two times a week are unlikely to be of sufficient dose to facilitate neurological re-modeling. It has been shown that in order for neurons to learn a specific motor function, that motor function must be repeated hundreds of times.
Treatment of people with acquired brain injury is highly specialized and poorly understood by practitioners in the general medical and allied health fields. 

Satisfaction with rehabilitation in relation to self-perceived quality of life and function among patients with stroke – a 12 month follow-up

We need lots more studies like this, maybe eventually the idea will come thru that therapy really has limited correlation with recovery.
scholar.google.com/scholar_url?hl=en&q=http://onlinelibrary.wiley.com/doi/10.1111/j.1471-6712.2012.01041.x/full&sa=X&scisig=AAGBfm2T2YmJENfaodapoQm4PunldoHvgw&oi=scholaralrt

Background and Purpose:  Stroke causes complex disability and function, and perceived quality of life has been shown to correlate with satisfaction with care as well as with life in general among stroke patients. The aim of this study was to study the relation of satisfaction with how rehabilitation was provided with self-perceived quality of life, self-perceived function and rehabilitation received, 12 months after the incidence.

Method:  The subjects were assessed 12 months after the onset of stroke. The Barthel index was used to measure function, and the EuroQol-5D to measure quality of life. To measure satisfaction with how rehabilitation was provided, a questionnaire from the Swedish Stroke Register was used.

Results:  Two hundred and eighty-three patients participated in the follow-up, 137 women and 146 men, aged between 42 and 95 years (mean age 75.2, SD 11.8). For the majority of patients rehabilitation was initiated at in-hospital care (directly after onset). One hundred and sixty-eight patients considered that rehabilitation was well provided for. Sixty-six regarded that the rehabilitation was only partly provided for and 35 that it was not provided for at all. High value on Barthel Index was associated with satisfaction with how rehabilitation was provided for (OR 2.81). Also, rehabilitation on three or more levels was negatively associated with satisfaction with rehabilitation provision (OR 0.24) and so was being male (OR 0.49).

Conclusion:  In this study, patients with higher values on Barthel Index were more satisfied with how rehabilitation was provided for. However, male patients and patients who received rehabilitation on three or more levels of care were less satisfied. Given the assumption that patients with more severe dysfunction after stroke are being rehabilitated on more levels, this might imply that it is not the amount of rehabilitation that gives satisfaction but the patients self-perceived function after rehabilitation.

A review of wearable sensors and systems with application in rehabilitation

I'm sure our therapists could come up with some excellent research studies using these to both evaluate disability and monitor it. I liked figure3s wearable unit. Full provisional paper at the link.

A review of wearable sensors and systems with application in rehabilitation

Abstract (provisional)

The aim of this review paper is to summarize recent developments in the field of wearable sensors and systems that are relevant to the field of rehabilitation. The growing body of work focused on the application of wearable technology to monitor older adults and subjects with chronic conditions in the home and community settings justifies the emphasis of this review paper on summarizing clinical applications of wearable technology currently undergoing assessment rather than describing the development of new wearable sensors and systems. A short description of key enabling technologies (i.e. sensor technology, communication technology, and data analysis techniques) that have allowed researchers to implement wearable systems is followed by a detailed description of major areas of application of wearable technology. Applications described in this review paper include those that focus on health and wellness, safety, home rehabilitation, assessment of treatment efficacy, and early detection of disorders. The integration of wearable and ambient sensors is discussed in the context of achieving home monitoring of older adults and subjects with chronic conditions. Future work required to advance the field toward clinical deployment of wearable sensors and systems is discussed.

2012 Minnesota Stroke Conference Presentation Proposal

I put in a proposal: What should the perfect world of stroke rehabilitation look like?
All of you should do the same for your local stroke conferences, we have more knowledge than anyone else there so get out there and disseminate your knowledge.

Submission Instructions:

• Download 2012 Minnesota Stroke Conference Call for Presentation Proposals (PDF 305KB)
• Download 2012 Minnesota Stroke Conference Presentation Proposal Submission Form (PDF 751KB). This form is a fillable pdf that you can save on your computer.

If you don’t receive a confirmation that your proposal was received or for other questions regarding presentation proposals for the 2012 Minnesota Stroke Conference, please contact Mary Jo Mehelich via email or phone at mary.mehelich@state.mn.us or (651) 201-5419.

Failed:

Thank you for submitting a presentation proposal for the 2012 Minnesota Stroke Conference. We regret to inform you that your proposal was not accepted for presentation. We received 10 proposals for six available sessions