Google Trends and Seasonal Effects in Infodemiology: A Use Case About Obesity.

Google Trends is a free online tool that provides information on the interest on a topic measured as Google searches in the big data era. In this work, we present methods for detection of trends and seasonal effects in online interest for health topics based on Google Trends data. We present data for the term obesity worldwide and in a convenience sample of countries (Denmark, United Kingdom, USA, Japan) over the last five years. Our analysis shows that, despite obesity being one of the global health challenges, there is a decreasing trend in online interest in the topic. We also observed seasonal effects, with less interest for the topic during December and the summer months. Identifying trends and seasonal patterns in online interest can support resource allocation and planning and allows one to evaluate the effectiveness of global and local outreach efforts on public health.

Haptic vs sensorimotor training in the treatment of upper limb dysfunction in multiple sclerosis: A multi-center, randomised controlled trial.

BACKGROUND: In multiple sclerosis (MS) exercise improves upper limb functions, but it is unclear what training types are more effective. OBJECTIVE: This study compares robot-assisted training based on haptic or sensorimotor exercise. METHODS: 41clinically definite MS subjects with upper limb impairment were randomised into two groups: (i) Haptic and (ii) Sensorimotor. Subjects in the Haptic performed a robot-assisted training protocol designed to counteract incoordination and weakness. The task -interaction with a virtual mass-spring system against a resistive load- requires coordination skills. Task difficulty and magnitude of resistive load were automatically adjusted to the individual impairment. Subjects in the Sensorimotor performed reaching movements under visual control; the robot generated no forces. Both groups underwent eight training sessions (40 min/session, 2 sessions/week). Treatment outcome were 9HPT and ARAT scores. RESULTS: The average 9HPT score decreased from 74±9 s to 61±8 s for the Haptic and from 49±6 s to 44±6 s. We found a significant Treatment (p=.0453) and Time differences (p=.005), but no significant Treatment×Time interactions although we found that the absolute change was only significant in the Haptic group (p=.011). We observed no significant changes in the ARAT score. Participants tolerated treatments well with a low drop-out rate. In the subjects evaluated at after 12 week (11 subject in sensory-motor and 17 in haptic group) no retention of the effect was found. CONCLUSIONS: Task oriented training may improve upper limb function in persons with MS especially in prevalent pyramidal impaired subjects without maintain the effects after three months. CLINICAL TRIAL REGISTRATION NUMBER: NCT02711566 (clinicaltrial.gov).

Evaluating the neck joint position sense error with a standard computer and a webcam.

Joint Position Sense Error (JPSE) is a measure of cervical spine proprioception, and a simple method for measuring the JPSE could help in monitoring and evaluating the outcomes of rehabilitation of people with neck pain. In this study we demonstrate preliminary results of a method for measuring JPSE that does not require the participant to wear any equipment. Based on free publicly available head tracking software, compatible with any webcam, we developed a webpage which instructs the participant in performing a self-administered version of the test. The aim of this proof-of-concept study was to demonstrate the viability of this system. We compared our absolute error values (3.68 ± 1.2° after extension, 3.46 ± 1.66° after flexion, 3.89 ± 2.34° after rotation to the left and 4.02 ± 1.82°after rotation to the right) to values from literature, finding that our results do not differ from those of 6 out of 11 studies (which used more complex and expensive setups). The results indicate that our system allows assessment of the JPSE with a standard computer. Being based on a website, the system has potential for telemedicine use. Further research is required to validate the system before it can be recommended for use in clinical practice.

Adaptive training with full-body movements to reduce bradykinesia in persons with Parkinson's disease: a pilot study.

BACKGROUND: Bradykinesia (slow movements) is a common symptom of Parkinson's disease (PD) and results in reduced mobility and postural instability. The objective of this study is to develop and demonstrate a technology-assisted exercise protocol that is specifically aimed at reducing bradykinesia. METHODS: Seven persons with PD participated in this study. They were required to perform whole body reaching movements toward targets placed in different directions and at different elevations. Movements were recorded by a Microsoft Kinect movement sensor and used to control a human-like avatar, which was continuously displayed on a screen placed in front of the subjects. After completion of each movement, subjects received a 0-100 score that was inversely proportional to movement time. Target distance in the next movements was automatically adjusted in order to keep the score around a pre-specified target value. In this way, subjects always exercised with the largest movement amplitude they could sustain. The training protocol was organised into blocks of 45 movements toward targets placed in three different directions and at three different elevations (a total of nine targets). Each training session included a finite number of blocks, fitted within a fixed 40 minutes duration. The whole protocol included a total of 10 sessions (approximately two sessions/week). As primary outcome measure we took the absolute average acceleration. Various aspects of movement performance were taken as secondary outcome measures, namely accuracy (undershoot error), path curvature, movement time, and average speed. RESULTS: Throughout sessions, we observed an increase of the absolute average acceleration and speed and decreased undershoot error and movement time. Exercise also significantly affected the relationship between target elevation and both speed and acceleration - the improvement was greater at higher elevations. CONCLUSIONS: The device and the protocol were well accepted by subjects and appeared safe and easy to use. Our preliminary results point at a training-induced reduction of bradykinesia.

Grasps recognition and evaluation of stroke patients for supporting rehabilitation therapy.

Stroke survivors often suffer impairments on their wrist and hand. Robot-mediated rehabilitation techniques have been proposed as a way to enhance conventional therapy, based on intensive repeated movements. Amongst the set of activities of daily living, grasping is one of the most recurrent. Our aim is to incorporate the detection of grasps in the machine-mediated rehabilitation framework so that they can be incorporated into interactive therapeutic games. In this study, we developed and tested a method based on support vector machines for recognizing various grasp postures wearing a passive exoskeleton for hand and wrist rehabilitation after stroke. The experiment was conducted with ten healthy subjects and eight stroke patients performing the grasping gestures. The method was tested in terms of accuracy and robustness with respect to intersubjects' variability and differences between different grasps. Our results show reliable recognition while also indicating that the recognition accuracy can be used to assess the patients' ability to consistently repeat the gestures. Additionally, a grasp quality measure was proposed to measure the capabilities of the stroke patients to perform grasp postures in a similar way than healthy people. These two measures can be potentially used as complementary measures to other upper limb motion tests.

Training modalities in robot-mediated upper limb rehabilitation in stroke: a framework for classification based on a systematic review.

Robot-mediated post-stroke therapy for the upper-extremity dates back to the 1990s. Since then, a number of robotic devices have become commercially available. There is clear evidence that robotic interventions improve upper limb motor scores and strength, but these improvements are often not transferred to performance of activities of daily living. We wish to better understand why. Our systematic review of 74 papers focuses on the targeted stage of recovery, the part of the limb trained, the different modalities used, and the effectiveness of each. The review shows that most of the studies so far focus on training of the proximal arm for chronic stroke patients. About the training modalities, studies typically refer to active, active-assisted and passive interaction. Robot-therapy in active assisted mode was associated with consistent improvements in arm function. More specifically, the use of HRI features stressing active contribution by the patient, such as EMG-modulated forces or a pushing force in combination with spring-damper guidance, may be beneficial.Our work also highlights that current literature frequently lacks information regarding the mechanism about the physical human-robot interaction (HRI). It is often unclear how the different modalities are implemented by different research groups (using different robots and platforms). In order to have a better and more reliable evidence of usefulness for these technologies, it is recommended that the HRI is better described and documented so that work of various teams can be considered in the same group and categories, allowing to infer for more suitable approaches. We propose a framework for categorisation of HRI modalities and features that will allow comparing their therapeutic benefits.

Design Parameters in Multimodal Games for Rehabilitation.

Objectives: The repetitive and sometimes mundane nature of conventional rehabilitation therapy provides an ideal opportunity for development of interactive and challenging therapeutic games that have the potential to engage and motivate the players. Certain game design parameters that may encourage patients to actively participate by making the games more enjoyable have been identified. In this article, we describe a formative study in which we designed and evaluated some of these parameters with healthy subjects. Materials and Methods: The "operant conditioning" and "scoring" design parameters were incorporated in a remake of a classic labyrinth game, "Marble Maze." A group of participants (n=37) played the game twice: Once in the control condition without both modalities and then with either one of the parameters or with both. Measures of game duration and number of fails in the game were recorded along with survey questionnaires to measure player perceptions of intrinsic motivation on the game. Results: Longer playtimes, higher levels of interest/enjoyment, and effort to play the game were recorded with the introduction of these parameters. Conclusions: This study provides an understanding on how game design parameters can be used to motivate and encourage people to play longer. With these positive results, future aims are to test the parameters with stroke patients, providing much clearer insight as to what influences these parameters have on patients undergoing therapy. The ultimate goal is to utilize game design in order to maintain longer therapeutic interaction between a patient and his or her therapy medium.

Robot-assisted intermanual transfer of handwriting skills.

We examined whether intermanual transfer of fine motor skills can be facilitated by training in a virtual environment. We focused on three types of assistance: visual - subjects could see a reference template on a computer screen - and two variants of haptic assistance. Subjects held a planar robot manipulandum and were required to write isolated cursive letters of an approximate size of 5 cm. Therefore, the task was similar to writing on a horizontal blackboard. The robot generated forces that were directed either towards the reference template (path guidance) or towards the reference trajectory (trajectory guidance). The training protocol consisted of three assisted exercise sessions on three consecutive days. Performance on the following day was tested to assess retention. After training, the improvement in trajectory shape was only significant in trajectory guidance and, to a lesser extent, visual guidance. Path guidance exhibited no significant improvement. These effects were substantially retained one day after the end of training. Similar effects were observed in shape variability. Furthermore, all training modalities caused a reduction in movement duration, but no significant differences were observed among groups. These results suggest that robot assistance may be beneficial for improving intermanual transfer, but inclusion of temporal information in the guidance strategy is essential for learning to take place.

Adaptive regulation of assistance 'as needed' in robot-assisted motor skill learning and neuro-rehabilitation.

We propose a general adaptive procedure to select the appropriate degree of assistance based on a Bayesian mechanism used to estimate psychophysical thresholds. This technique does not need an accurate model of learning and recovery processes. This procedure is validated in the context of a motor skill learning problem (control of a virtual object), in which the controller is used to gradually increase task difficulty as learning proceeds. These automatic adjustments of task difficulty or the degree of assistance can be used to promote not only motor skill learning but also neuromotor recovery.

Neural correlates of motor learning and performance in a virtual ball putting task.

Learning to move skillfully requires that the motor system adjusts motor commands based on ongoing performance, until the task is executed satisfactorily. Robots can be used to emulate motor tasks that involve haptic interaction with objects. These studies may provide useful insights on how humans acquire a novel motor skill. Here we address motor skill learning in a 2D ball putting task, by looking at both kinematic and EEG correlates of learning and performance. Participants grasped the handle of a manipulandum and had to hit a virtual ball in order to put it into a target region (hole). The robot was used to render the contact force with the ball during impact. At every trial, with respect to the initial ball position, the hole appeared in one of three different directions and two distances, selected randomly. The experimental protocol included a total of 300 movements. In movement kinematics we looked at the effects of learning and target distance. In EEG signals, we looked at the effect of learning and the effect of success/failure on the ongoing brain activity. Subjects managed to improve their performance through practice, in all directions and at both target distances. Direction did not affect the performance much, but greater target distance induced greater errors. With regards to the EEG activity, we found that (i) practice led to an increased theta synchronization in the frontal areas; (ii) successful trials were preceded by higher theta synchronization, and alpha and beta desynchronization. These results suggest that EEG signals can be used to monitor the learning process and to predict the outcome (success/failure) of individual trials. These findings open possibilities to develop new schemes to promote and facilitate learning, which integrate EEG and robots.

Integrating proprioceptive assessment with proprioceptive training of stroke patients.

Although proprioceptive impairment is likely to affect in a significant manner the capacity of stroke patients to recover functionality of the upper limb, clinical assessment methods in current use are rather crude, with a low level of reliability and a limited capacity to discriminate the relevant features of the deficits. In this paper we describe a new technique based on robot technology, with the goal of providing a reliable, accurate, quantitative evaluation of the position sense in peri-personal space. The proposed technique uses a bimanual, planar robot manipuladum (BdF device), whose handles are grasped by the blindfolded patient: the paretic hand is passively placed in one of 17 positions and the subject is asked to actively match the paretic hand position in space with the other hand. The position sense of the paretic arm and the corresponding deficit of space representation are characterized by means of 7 indicators: 1) positional error; 2) holding force; 3) medio/lateral shift; 4) antero/posterior shift; 5) medio/lateral skew; 6) antero/posterior skew; 7) shrink coefficient. We also show how the same experimental setup can be used for "proprioceptive training", i.e. for providing robot assistance to the paretic arm that may improve the position sense of the patient. A preliminary, feasibility test has been carried out with one patient and three controls.

A tailored exercise of manipulation of virtual tools to treat upper limb impairment in Multiple Sclerosis.

We developed a robot-assisted rehabilitation protocol, specifically designed to treat cerebellar and motor symptoms in subjects with Multiple Sclerosis. The task consists of controlling a `virtual' tool (a mass-spring system), under the effect of a resistive force. The exercise is designed in such a way that task difficulty and the degree of resistance are automatically adjusted to the individual patients' impairment. The protocol included a total of eight 40 min training sessions (2 sessions/week), and automatic regulation of difficulty and resistance was repeated at the beginning of each session. Preliminary results suggest that subjects improve their performance, both within and between sessions. Moreover, task difficulty and resistance tend to increase across sessions, indicating that subjects gradually improve their ability to deal with more challenging versions of the task.

Toward 'optimal' schemes of robot assistance to facilitate motor skill learning.

We investigate whether and on what circumstances physical interaction with a robot may facilitate the acquisition of a novel motor skill. We focus on two different motor tasks: (i) intermanual transfer of cursive handwriting and (ii) acquisition of a putting skill. In the case of handwriting, we found that intermanual transfer is facilitated by forms of interaction that account for the temporal aspects of the movements. In the case of putting, we found that guidance is helpful in improving longitudinal error (a matter of speed accuracy), but not directional error (a matter of position accuracy). Based on these results, we draw some tentative conclusions on which tasks can benefit from guidance, and how robots should be programmed to maximize their effect.