Shock-absorbing effect of flooring-adopted mechanical metamaterial technology and its influence on the gait and balance of older adults.

OBJECTIVE: To elucidate the performance of a shock-absorbing floor material with a mechanical metamaterial (MM-flooring) structure and its effect on the gait and balance of older adults. METHODS: The drop-weight impact was applied to evaluate the shock-absorbing performance. The falling weight was adjusted equivalent to the energy exerted on the femur of an older woman when she falls, which was evaluated on the MM-flooring and six other flooring materials.Nineteen healthy people over the age of 65 years participated in the gait and balance evaluations. The timed up and go and two-step tests were adopted as gait performance tests, and the sway-during-quiet-balance test with force plates and the functional reach test (FRT) were adopted as balance tests. All the participants underwent these tests on the MM-flooring, shock-absorbing mat and rigid flooring. RESULTS: The shock-absorbing performance test revealed that MM-flooring has sufficient shock-absorbing performance, and suggesting that it may reduce the probability of fractures in the older people when they fall. The results of the gait performance test showed that the participants demonstrated the same gait performance on the MM-flooring and the rigid floor. In the quiet standing test, MM-flooring did not affect the balance function of the participants to the same extent as the rigid floor, compared with the shock-absorbing mat. In the FRT, no significant differences were found for any of the flooring conditions. CONCLUSIONS: MM-flooring has the potential to prevent fractures attributed to falls and does not affect the gait or balance of older adults.

Time course of changes in corticospinal excitability induced by motor imagery during action observation combined with peripheral nerve electrical stimulation.

While previous studies assessed corticospinal excitability changes during and after motor imagery (MI) or action observation (AO) combined with peripheral nerve electrical stimulation (ES), we examined, for the first time, the time course of corticospinal excitability changes for MI during AO combined with ES (AO-MI + ES) using transcranial magnetic stimulation to measure motor evoked potentials (MEPs) in healthy individuals. Fourteen healthy volunteers participated in the following three sessions on different days: AO-MI alone, ES alone, and AO-MI + ES. In the AO-MI task, participants imagined squeezing and relaxing a ball, along with the respective actions shown in a movie, while passively holding the ball. We applied ES (intensity, 90% of the motor threshold) to the ulnar nerve at the wrist, which innervates the first dorsal interosseous (FDI) muscle. We assessed the FDI muscle MEPs at baseline and after every 5 min of the task for a total of 20 min. Additionally, participants completed the Vividness of Movement Imagery Questionnaire-2 (VMIQ-2) at the beginning of the experiment. Compared to baseline, AO-MI + ES significantly increased corticospinal excitability after 10 min, while AO-MI or ES alone had no effect on corticospinal excitability after 20 min. Moreover, the AO-MI + ES-induced cortical excitability changes were correlated with the VMIQ-2 scores for visual and kinaesthetic imagery. Collectively, our findings indicate that AO-MI + ES induces cortical plasticity earlier than does AO-MI or ES alone and that an individual's imagery ability plays an important role in inducing cortical excitability changes following AO-MI + ES.

The effect of differences in powered wheelchair joystick shape on subjective and objective operability.

Various-shaped joysticks steer electric-powered wheelchairs (EPWs); however, an operability evaluation has not been fully conducted. This study evaluated the subjective and objective operability of various-shaped joysticks in 22 younger and 22 older adults. Participants operated an EPW on an experimental course using nine different-shaped joysticks, before ranking each joystick by their operability (1 = best, 9 = worst) as a primary outcome. Movement time (MT) and driving accuracy (DA) were also measured. Despite no significant differences in the primary outcome between joysticks, the I-shaped joystick with rounded tips (neutral grip) was ranked higher than the others. MT did not differ between joysticks, but DA was higher for the thin-columnar I-shaped joystick (pinch grip) than for the U- and T-shaped joysticks (pronated grip). MT and DA scores for young adults were significantly better than those for older adults. Further studies should be conducted to clarify possible factors related to EPW operability.

Overcoming language barriers to provide telerehabilitation for COVID-19 patients: a two-case report.

PURPOSE: This report presents two cases of successful telerehabilitation delivery for patients quarantined due to COVID-19. One of the patients did not speak the therapists' language, whereas the other presented complete deafness. MATERIALS AND METHODS: We assembled a telerehabilitation system using commercial applications, including a remote-control application that minimizes the need for patient's input. The telerehabilitation comprised a combination of video calls with a physical therapist and a 20-minute exercise video. The first case was of a 72-year-old man who could only speak Cantonese, a language that none of the service providers could speak, making communication difficult. Therefore, telerehabilitation was provided using Google Translate to simultaneously translate the therapist's instructions in Japanese to Cantonese. The second case involved a 49-year-old man with neurofibromatosis and complete deafness. In this case, communication during the exercise programme was achieved using 25 cue cards that were prepared in advance and used to convey instructions. The patients' satisfaction was assessed using either of a simple three-item questionnaire (Case 1) or the Telemedicine Satisfaction Questionnaire with five additional items (Case 2). RESULTS: In both cases, the exercise programme was successfully conducted, and the patients reported being highly satisfied with the programme. CONCLUSIONS: Communication barriers can impede telerehabilitation therapy; this problem is aggravated when the recipients cannot receive on-site education for device operation and exercise performance in advance due to COVID-19 restrictions. However, the use of supplementary methodologies may contribute to solving these issues, further expanding the coverage and applicability of telerehabilitation.IMPLICATIONS FOR REHABILITATIONWe provided telerehabilitation for two patients with communication difficulties who were quarantined due to COVID-19.Telerehabilitation was carried out using a system with a remote-control mechanism to minimise patient input and avoid problems caused by their unfamiliarity in operating the devices.In addition, an online translation mechanism was used to overcome language differences, while cue cards were used for a patient with a hearing impairment.Telerehabilitation was performed without any technical issues. Both patients reported being highly satisfied with the intervention.This experience of providing telerehabilitation and overcoming communication difficulties may help develop a strategy to expand the coverage of telerehabilitation in the treatment of patients in isolation due to highly transmissible diseases, such as COVID-19.

Development and preliminary evaluation of a tele-rehabilitation exercise system using computer-generated animation.

Objectives: To evaluate the safety and acceptability of a newly developed tele-rehabilitation exercise system using computer-generated animation. Methods: The participants comprised a convenience sample of 38 diverse individuals in Experiment 1 (15 healthy young people, 16 healthy older people, 5 patients with stroke, and 2 patients with respiratory disease) and 18 healthy older individuals in Experiment 2. Experiment 1 assessed safety in terms of cardiopulmonary vascular aspects and risk of fall, and Experiment 2 assessed treatment acceptability via a subjective evaluation. All participants completed the same exercise program. The safety assessment was conducted using heart rate (HR) and saturation of percutaneous oxygen (SpO2), measured before and after exercise. In addition, the occurrence of falls was assessed. For the acceptability assessment, the participants answered five questions (three-point Likert scale) after the exercise program. Results: The safety assessment indicated that HR and SpO2 changed from 70.5±10.2 beats per minute and 97.8±1.3% before exercise to 87.6±13.6 beats per minute and 98.2±0.9% after exercise, respectively. In addition, all participants completed the exercises without experiencing any falls. In the acceptability assessment, the score reflecting continuation desire was the highest of the five items examined (2.71±0.46). In contrast, the adequacy of exercise intensity had the lowest score (1.29±0.57). Conclusions: The present system was confirmed to be safe, and the participants were motivated to continue the exercises. Future developments should incorporate a function to enable participants and medical staff to adjust exercise intensity according to individual physical function.

Novel lateral transfer assist robot decreases the difficulty of transfer in post-stroke hemiparesis patients: a pilot study.

PURPOSE: The purpose of this study was to clarify whether the novel lateral transfer assist robot facilitates easier transfers compared with a wheelchair in post-stroke hemiparesis patients. METHODS: This cross-sectional study enrolled 20 post-stroke hemiparesis patients, and the task difficulty of transfers was compared between a wheelchair and lateral transfer assist robot. All participants were asked to transfer from either wheelchair or lateral transfer assist robot to a platform table and back. The primary outcome was the transfer score of the Functional Independence Measure. The secondary outcome was the time required for transfer. RESULTS: The transfer score of the Functional Independence Measure was significantly higher with lateral transfer assist robot than with wheelchair (p < .001). The transfer times from these devices to a platform table and back showed no significant differences (to device from platform table: 7.8 s, lateral transfer assist robot vs 7.6 s, wheelchair, p > .05: device to platform table: 7.1 s, lateral transfer assist robot vs 8.0 s, wheelchair, p > .05). CONCLUSIONS: Transfer with a lateral transfer assist robot is easier than with wheelchair and facilitates independence in post-stroke hemiparesis patients.IMPLICATIONS FOR REHABILITATIONTransfer skill influences the functional independence and quality of life of a wheelchair userA novel structural mobility device-the lateral transfer assist robot (LTAR)-can facilitate transfersThe LTAR could improve the degree of independence for transfers than the wheelchair, without any time loss, in post-stroke hemiparesis patientsThe LTAR could potentially reduce the risk for falls in various medical and care facilities.

Cognitive behavior therapy-based intervention for a subacute stroke patient with severe fear of falling: a case report.

We present the case of a 42-year-old man with subacute stroke who developed remarkable fear of falling and eventually recovered with an approach based on cognitive behavioral therapy (CBT). The CBT-based approach was implemented after the patient developed significant fear of falling with exacerbated obsessive-compulsive symptoms appeared immediately after a fall. The patient's anxiety decreased over time, and his ability to perform these tasks and activities of daily living improved accordingly. After 6 weeks of intervention, his anxiety toward gait and stairs almost disappeared; additionally, he achieved modified independence for gait and supervision for stairs and was discharged home successfully. These findings in the present case suggest the effectiveness of an evaluation and interventional approach based on CBT for stroke patients with a severe fear of falling.

An Affordable, User-friendly Telerehabilitation System Assembled Using Existing Technologies for Individuals Isolated With COVID-19: Development and Feasibility Study.

BACKGROUND: Isolation due to a COVID-19 infection can limit activities and cause physical and mental decline, especially in older adults and people with disabilities. However, due to limited contact, adequate rehabilitation is difficult to provide for quarantined patients. Telerehabilitation technology could be a solution; however, issues specific to COVID-19 should be taken into consideration, such as strict quarantine and respiratory symptoms, as well as accessibility to deal with rapid increases in need due to the pandemic. OBJECTIVE: This study aims to develop and to investigate the feasibility of a telerehabilitation system for patients who are quarantined due to COVID-19 by combining existing commercial devices and computer applications. METHODS: A multidisciplinary team has identified the requirements for a telerehabilitation system for COVID-19 and developed the system to satisfy those requirements. In the subsequent feasibility study, patients diagnosed with COVID-19 (N=10; mean age 60 years, SD 18 years) were included. A single session of telerehabilitation consisted of stretching exercises, a 15-minute exercise program, and a video exercise program conducted under real-time guidance by a physical therapist through a video call. The system included a tablet computer, a pulse oximeter, videoconferencing software, and remote control software. The feasibility of the system was evaluated using the Telemedicine Satisfaction Questionnaire (TSQ; 14 items) and an additional questionnaire on the telerehabilitation system (5 items). Each item was rated from "1 = strongly disagree" to "5 = strongly agree." RESULTS: The telerehabilitation system was developed by combining existing devices and applications, including a pulse oximeter and remote control mechanism, to achieve user-friendliness, affordability, and safety, which were determined as the system requirements. In the feasibility study, 9 out of 10 patients were able to use the telerehabilitation system without any on-site help. On the TSQ, the mean score for each item was 4.7 (SD 0.7), and in the additional items regarding telerehabilitation, the mean score for each item was 4.3 (SD 1.0). CONCLUSIONS: These findings support the feasibility of this simple telerehabilitation system in quarantined patients with COVID-19, encouraging further investigation on the merit of the system's use in clinical practice.

Comparison of two methods of bed-to/from-wheelchair transfer in patients with hemiparetic stroke.

OBJECTIVES: The ability to transfer between surfaces is essential for wheelchair users' independence. We hypothesized that transfer of hemiparetic stroke patients would be improved by using surfaces at the same height with no gap or obstacle between them. METHODS: A cross-sectional study was conducted to compare the difficulty of two transfer methods as a pilot study. Thirteen hemiparetic stroke patients were transferred from a platform table to a chair (wheelchair or flat chair) and from the chair to the table using the regular and lateral transfer methods. Functional Independence Measure (FIM) transfer score in both transfer methods and Stroke Impairment Assessment Set (SIAS) score were measured. RESULTS: The FIM transfer score significantly increased in the lateral transfer condition compared with the regular transfer condition, indicating that the former method reduced the transfer difficulty, regardless of the SIAS scores. CONCLUSIONS: The transfer difficulty of patients with hemiparetic stroke decreases when using the lateral transfer method. The lateral transfer method is easy, potentially helping prevent care-related injuries among caregivers.

Lateral Transfer Assist Robot (LTAR): Development of a proof-of-concept prototype.

BACKGROUND: Falls during transfer to and from a wheelchair are associated with numerous problems. Factors responsible for difficulty in transferring include horizontal/vertical gaps between surfaces; obstacles, such as armrests; and complicated brake/footrests configurations before transferring. Moreover, controlling a wheelchair sufficiently close to the transfer surface within the confined home space is difficult. OBJECTIVE: We described the design of the novel Lateral Transfer Assist Robot (LTAR) for solving problems during transfer. Furthermore, the effectiveness and usability of the robot were preliminary examined in healthy adults. METHOD: The transfer problems and basic designs were organized. The effectiveness of the prototype was measured by three-dimensional motion analysis and questionnaire. RESULTS: The prototype LTAR was developed. With just a push on a button, the footplate lowers to the floor and the seat and armrest lowers to the height of the seating surface to fill the gap between the surfaces. Using these features, users can transfer by simply shifting their buttocks sideways. Additionally, LTAR has omnidirectional wheels that help move it within a narrow space. The LTAR was confirmed to reduce the physical and subjective burden, except for maneuverability. CONCLUSION: The LTAR was found to be effective for home use and reducing burden of transfer.

Skillful Cycling Training Induces Cortical Plasticity in the Lower Extremity Motor Cortex Area in Healthy Persons.

Cycling exercise is commonly used in rehabilitation to improve lower extremity (LE) motor function and gait performance after stroke. Motor learning is important for regaining motor skills, suggesting that training of motor skills influences cortical plasticity. However, the effects of motor skill learning in dynamic alternating movements of both legs on cortical plasticity remain unclear. Here, we examined the effects of skillful cycling training on cortical plasticity of the LE motor area in healthy adults. Eleven healthy volunteers participated in the following three sessions on different days: skillful cycling training, constant-speed cycling training, and rest condition. Skillful cycling training required the navigation of a marker up and down curves by controlling the rotation speed of the pedals. Participants were instructed to fit the marker to the target curves as accurately as possible. Amplitudes of motor evoked potentials (MEPs) and short-interval intracortical inhibition (SICI) evoked using transcranial magnetic stimulation (TMS) were assessed at baseline, after every 10 min of the task (a total of 30 min), and 30 min after the third and final trial. A decrease in tracking errors was representative of the formation of motor learning following skillful cycling training. Compared to baseline, SICI was significantly decreased after skillful cycling training in the tibialis anterior (TA) muscle. The task-induced alterations of SICI were more prominent and lasted longer with skillful cycling training than with the other conditions. The changes in SICI were negatively correlated with a change in tracking error ratio at 20 min the task. MEP amplitudes were not significantly altered with any condition. In conclusion, skillful cycling training induced long-lasting plastic changes of intracortical inhibition, which corresponded to the learning process in the LE motor cortex. These findings suggest that skillful cycling training would be an effective LE rehabilitation method after stroke.

Designing a robotic smart home for everyone, especially the elderly and people with disabilities.

We initiated the Robotic Smart Home (RSH) project to develop a comfortable, safe home environment for all people, including the elderly and individuals with disabilities. An important consideration when introducing robots into a home environment is the confined living space, the so-called space problem. The RSH project plans to simultaneously develop robots and an architectural design for living spaces to create an optimal home environment that will help elderly people live independently at home for longer periods. The RSH accommodates the following three robotics and assistive systems: mobility and transfer assist system, operational assist system, and information assist system. The mobility and transfer assist system includes three types of devices (lifting type, lateral-transfer type, and suspension type), which can be available to users as appropriate according to the severity of their disability. The operational assist system combines a hand robot with an environmental control system for the convenience of users. An information assist system connects the RSH with remote locations for communication. Inside the RSH, a home automation and monitoring system connected to the Internet of Things provides residents with comfort and security. As part of this project, two RSH centers have been established for effective facility adoption.

Transcranial Direct Current Stimulation Does Not Affect Lower Extremity Muscle Strength Training in Healthy Individuals: A Triple-Blind, Sham-Controlled Study.

The present study investigated the effects of anodal transcranial direct current stimulation (tDCS) on lower extremity muscle strength training in 24 healthy participants. In this triple-blind, sham-controlled study, participants were randomly allocated to the anodal tDCS plus muscle strength training (anodal tDCS) group or sham tDCS plus muscle strength training (sham tDCS) group. Anodal tDCS (2 mA) was applied to the primary motor cortex of the lower extremity during muscle strength training of the knee extensors and flexors. Training was conducted once every 3 days for 3 weeks (7 sessions). Knee extensor and flexor peak torques were evaluated before and after the 3 weeks of training. After the 3-week intervention, peak torques of knee extension and flexion changed from 155.9 to 191.1 Nm and from 81.5 to 93.1 Nm in the anodal tDCS group. Peak torques changed from 164.1 to 194.8 Nm on extension and from 78.0 to 85.6 Nm on flexion in the sham tDCS group. In both groups, peak torques of knee extension and flexion significantly increased after the intervention, with no significant difference between the anodal tDCS and sham tDCS groups. In conclusion, although the administration of eccentric training increased knee extensor and flexor peak torques, anodal tDCS did not enhance the effects of lower extremity muscle strength training in healthy individuals. The present null results have crucial implications for selecting optimal stimulation parameters for clinical trials.

Real-time changes in corticospinal excitability related to motor imagery of a force control task.

OBJECTIVE: To investigate real-time excitability changes in corticospinal pathways related to motor imagery in a changing force control task, using transcranial magnetic stimulation (TMS). METHODS: Ten healthy volunteers learnt to control the contractile force of isometric right wrist dorsiflexion in order to track an on-screen sine wave form. Participants performed the trained task 40 times with actual muscle contraction in order to construct the motor image. They were then instructed to execute the task without actual muscle contraction, but by imagining contraction of the right wrist in dorsiflexion. Motor evoked potentials (MEPs), induced by TMS in the right extensor carpi radialis muscle (ECR) and flexor carpi radialis muscle (FCR), were measured during motor imagery. MEPs were induced at five time points: prior to imagery, during the gradual generation of the imaged wrist dorsiflexion (Increasing phase), the peak value of the sine wave, during the gradual reduction (Decreasing phase), and after completion of the task. The MEP ratio, as the ratio of imaged MEPs to resting-state, was compared between pre- and post-training at each time point. RESULTS: In the ECR muscle, the MEP ratio significantly increased during the Increasing phase and at the peak force of dorsiflexion imagery after training. Moreover, the MEP ratio was significantly greater in the Increasing phase than in the Decreasing phase. In the FCR, there were no significant consistent changes. CONCLUSION: Corticospinal excitability during motor imagery in an isometric contraction task was modulated in relation to the phase of force control after image construction.