Implementation of interactive games to a shoulder rehabilitation and evaluation system.

BACKGROUND: After an operation, the shoulder and wrist might not be able to lift and swing freely, and must be assisted with rehabilitation training. OBJECTIVE: In this paper, Kinect combined with multiple sensors of a Bluetooth ball is proposed to improve the measurement function of the arm's micro-motion trajectory, rotation amount, and acceleration, which cannot be detected by Kinect alone. METHODS: We designed two virtual scene rehabilitation games for clinical trials. We performed validity analysis with a paired sample t-test. RESULTS: A significance value of P*< 1 was obtained, and the arm lift angle shows an improvement from 30∘ to 60∘, indicating that the range of motion of the hand and shoulder is gradually improving. CONCLUSION: Experiments show that virtual games combined with multiple sensors can better understand the patient's rehabilitation situation.

Football APP based on smart phone with FES in drop foot rehabilitation.

BACKGROUND: Long-term, sustained progress is necessary in drop foot rehabilitation. The necessary inconvenient body training movements, the return trips to the hospital and repetitive boring training using functional electrical stimulation (FES) often results in the patient suspending their training. The patient's drop foot rehabilitation will not progress if training is suspended. OBJECTIVE: A fast spread, highly portable drop foot rehabilitation training device based on the smart phone is presented. This device is combined with a self-made football APP and feedback controlled FES. The drop foot patient can easily engage in long term rehabilitation training that is more convenient and interesting. METHODS: An interactive game is established on the smart phone with the Android system using the originally built-in wireless communications. The ankle angle information is detected by an external portable device as the game input signal. The electrical stimulation command to the external device is supplemented with FES stimulation for inadequate ankle efforts. RESULTS: After six-weeks training using six cases, the results indicated that this training device showed significant performance improvement (p< 0.05) in the patient's ankle dorsiflexion strength, ankle dorsiflexion angle, control timing and Timed Up and Go. CONCLUSIONS: Preliminary results show that this training device provides significant positive help to drop foot patients. Moreover, this device is based on existing and universally popular mobile processing, which can be rapidly promoted. The responses of clinical cases also show this system is easy to operate, convenient and entertaining. All of these features can improve the patient's willingness to engage in long term rehabilitation.

Digitized Hand Skateboard Based on IR-Camera for Upper Limb Rehabilitation.

Abnormal upper limb function seriously impacts a patient's daily life. After receiving emergency treatment patient should receive function-rebuilding and recovery training. The objective of this study is to integrate IR-camera, an infrared emitter, with a conventional passive hand skateboard training device for conventional upper limb training and the training process is comprehensively recorded and analyzed. Patients participating in the occupational therapy have a binding band attached to hand skateboard on the table to guide the patient in moving the hand skateboard along the designated path to train the patient's upper limbs. Six people with normal upper limb function participated in the stability test. The device repeatability and test results were verified acceptable. Eight patients with abnormal upper limb function (their upper limb function was damaged due to stroke, MMSE > =27) were trained for 4 weeks. The patient scores in finishing rate and finishing time showed significant improvement. The paired T test results (satisfy p < 0.05 or p < 0.01) between wk-1 and wk-2 are significant. The paired T test results (satisfy p < 0.01) between wk-1 and wk-4 are extremely significant. The new IR-Camera system focuses continuously on the "Figure of eight" curve. The system is light weight and convenient for stroke in home use. The study applies IR-camera technology to the conventional hand skateboard for upper limb training. The experiments show that the hardware of the proposed device no longer delays in response and can result in obvious clinical advances. The proposed device is verified worthy of promotion.

Relevance of nerve conduction velocity in the assessment of balance performance in older adults with diabetes mellitus.

Purpose This study investigated the relationship between peripheral nerve conduction velocity (NCV) and balance performance in older adults with diabetes. Methods Twenty older adults with diabetes were recruited to evaluate the NCV of their lower limbs and balance performance. The balance assessments comprised the timed up and go (TUG) test, Berg balance scale (BBS), unipedal stance test (UST), multidirectional reach test (MDRT), maximum step length (MSL) test and quiet standing with eyes open and closed. The relationship between NCV and balance performance was evaluated by Pearson's correlation coefficients, and the balance performances of the diabetic patients with and without peripheral neuropathy were compared by using Mann-Whitney U tests. Results The NCV in the lower limbs exhibited a moderate to strong correlation with most of the balance tests including the TUG (r = -0.435 to -0.520, p < 0.05), BBS (r = 0.406-0.554, p < 0.05), UST (r = 0.409-0.647, p < 0.05) and MSL (r = 0.399-0.585, P < 0.05). In addition, patients with diabetic peripheral neuropathy had a poorer TUG (p < 0.05), BBS (p < 0.01), UST (p < 0.05) and MSL performance (p < 0.05) compared with those without peripheral neuropathy (p < 0.05). Conclusion Our findings revealed that a decline in peripheral nerve conduction in the lower limb is not only an indication of nerve dysfunction, but may also be related to the impairment of balance performance in patients with diabetes. Implications for Rehabilitation Nerve conduction velocity in the lower limbs of diabetic older adults showed moderate to strong correlations with most of the results of balance tests, which are commonly used in clinics. Decline in nerve conduction velocity of the lower limbs may be related to the impairment of balance control in patients with diabetes. Diabetic older adults with peripheral neuropathy exhibited greater postural instability than those without peripheral neuropathy.

Application of RFID technology-upper extremity rehabilitation training.

[Purpose] Upper extremity rehabilitation after an injury is very important. This study proposes radio frequency identification (RFID) technology to improve and enhance the effectiveness of the upper extremity rehabilitation. [Subjects and Methods] People use their upper extremities to conduct daily activities. When recovering from injuries, many patients neglect the importance of rehabilitation, which results in degraded function. This study recorded the training process using the traditional rehabilitation hand gliding cart with a RFID reader, RFID tags in the panel, and a servo host computer. [Results] Clinical evidence, time taken to achieve a full score, counts of missing the specified spots, and Brunnstrom stage of aided recovery, the proximal part of the upper extremity show that the RFID-based upper extremity training significantly and reduce negative impacts of the disability in daily life and activities. [Conclusion] This study combined a hand-gliding cart with an RFID reader, and when patients moved the cart, the movement could be observed via the activated RFID tags. The training data was collected and quantified for a better understanding of the recovery status of the patients. Each of the participating patients made progress as expected.

Application of the Blobo bluetooth ball in wrist rehabilitation training.

[Purpose] The introduction of emerging technologies such as the wireless Blobo bluetooth ball with multimedia features can enhance wrist physical therapy training, making it more fun and enhancing its effects. [Methods] Wrist injuries caused by fatigue at work, improper exercise, and other conditions are very common. Therefore, the reconstruction of wrist joint function is an important issue. The efficacy of a newly developed integrated wrist joint rehabilitation game using a Blobo bluetooth ball with C# software installed was tested in wrist rehabilitation (Flexion, Extension, Ulnar Deviation, Radial Deviation). [Results] Eight subjects with normal wrist function participated in a test of the system's stability and repeatability. After performing the Blobo bluetooth ball wrist physical therapy training, eight patients with wrist dysfunction experienced approximately 10° improvements in range of motion (ROM) of flexion extension, and ulnar deviation and about 6° ROM improvement in radial deviation. The subjects showed progress in important indicators of wrist function. [Conclusion] This study used the Blobo bluetooth ball in wrist physical therapy training and the preliminary results were encouraging. In the future, more diverse wrist or limb rehabilitation games should be developed to meet the needs of physical therapy training.

Balance training using an interactive game to enhance the use of the affected side after stroke.

[Purpose] Stroke and other cerebrovascular diseases are major causes of adult mobility problems. Because stroke immobilizes the affected body part, balance training uses the healthy body part to complete the target movement. The muscle utilization rate on the stroke affected side is often reduced which further hinders affected side functional recovery in rehabilitation. [Subjects and Methods] This study tested a newly-developed interactive device with two force plates to measuring right and left side centers of pressure, to establish its efficacy in the improvement of the static standing ability of patients with hemiplegia. An interactive virtual reality game with different side reaction ratios was used to improve patient balance. The feasibility of the proposed approach was experimentally demonstrated. [Results] Although the non-affected-side is usually used to support the body weight in the standing position, under certain circumstances the patients could switch to using the affected side. A dramatic improvement in static standing balance control was achieved in the eyes open condition. [Conclusion] The proposed dual force plate technique used in this study separately measured the affected and non-affected-side centers of pressure. Based on this approach, different side ratio integration was achieved using an interactive game that helped stroke patients improve balance on the affected side. Only the patient who had suffered stroke relatively recently benefited significantly. The proposed technique is of little benefit for patients whose mobility has stagnated to a certain level.

Effects of interactive video-game based system exercise on the balance of the elderly.

This study evaluated the effects of interactive video-game based (IVGB) training on the balance of older adults. The participants of the study included 30 community-living persons over the age of 65. The participants were divided into 2 groups. Group A underwent IVGB training for 6 weeks and received no intervention in the following 6 weeks. Group B received no intervention during the first 6 weeks and then participated in training in the following 6 weeks. After IVGB intervention, both groups showed improved balance based on the results from the following tests: the Berg Balance Scale (BBS), Modified Falls Efficacy Scale (MFES), Timed Up and Go (TUG) test, and the Sway Velocity (SV) test (assessing bipedal stance center pressure with eyes open and closed). Results from the Sway Area (SA) test (assessing bipedal stance center pressure with eyes open and closed) revealed a significant improvement in Group B after IVGB training. Group A retained some training effects after 6 weeks without IVGB intervention. Additionally, a moderate association emerged between the Xavix measured step system stepping tests and BBS, MFES, Unipedal Stance test, and TUG test measurements. In conclusion, IVGB training improves balance after 6 weeks of implementation, and the beneficial effects partially remain after training is complete. Further investigation is required to determine if this training is superior to traditional physical therapy.

Combination of frequency and amplitude-modulated model for the synthesis of normal and wheezing sounds.

Based on communication theory, this study proposes a model to synthesize normal and wheezing sounds. The model included five parts: the flow source as a transmitter, the frequency and amplitude-modulated (FM-AM) sounds, the accompanying noise as a modulator, the airway wall as a medium, and the microphone as a receiver. The hypothesis of modulation builds on that the deviation of frequency and amplitude of the sounds which cause from the deviation of collision speed of the air flow on the wall. The model was successful to simulate the normal breath and wheezing sounds. Furthermore, it provided a correct proof for the CORSA description, which indicates that the wheeze was contained in the domain frequency at 400 Hz, but a number of investigators have suggested that the range is actually between 80-1,600 Hz and 350-950 Hz by filter theory. This study modifies the signal source in Wodicka et al. model, and describes it in functional blocks. In fact, the design of the signal source base on the knowledge of the lung sound studies, especially the analysis of components in the frequency and time domains. We synthesized the required components to reproduce the lung sounds, and proposed a mechanism of wheeze which was examined by the computer simulation in the points of the system engineering view.

Ambulation study of a woman with paraplegia using a reciprocating gait orthosis with functional electrical stimulation in Taiwan: a case report.

PURPOSE: Many patients who suffer from spinal cord injuries with paraplegia cannot recover to walk independently. They need to use a special walking orthoses to support their body to walk properly. Traditionally, long leg braces (LLB) were fitted to patients for walking. Unfortunately, the results were not satisfactory as this device supplies adequate support with less than optimum mobility. This study used the latest reciprocating gait orthosis (RGO) combined with functional electrical stimulation (FES). This combination provides a greater support range while applying assistant mechanical walking structures. The FES co-ordination helps restore natural walking abilities that the paralysed patient has lost. METHOD: This study developed a walking orthosis with FES, using FES to stimulate specific muscles (quadriceps, hamstring) in the paralysed patients' lower limbs. The proposed method can achieve the benefits of physical therapeutics while paralysed patients can achieve the purpose of walking. The FES is designed with control buttons on the walking orthosis. A patient can control the left or right leg in walking and speed control via the control buttons. RESULTS: Several practical tests were conducted on the new walking orthosis. A 25-year-old female paralysed patient (L1 complete spinal cord injury) used traditional LLB, RGO and RGO with FES to proceed with walking rehabilitation and clinical assessment. Heart rate difference (HRdifference), mean blood pressure (MBPdifference), walking speed, length of steps, number of steps and oxygen consumption comparisons were made before and after walking. The results show that RGO and RGO with FES were both better than LLB. However, the differences between RGO and RGO with FES in HRdifference, MBPdifference, and walking speed were not significant. This is because the patient's right leg reaction to the electrical stimulation was relatively low. DISCUSSION AND CONCLUSIONS: In general, RGO can help the patient achieve quicker and more independent walking. The combination of RGO and FES can increase the effectiveness of RGO for more mobile aid. These two walking orthoses are better than traditional LLB. Both methods provide patients who suffer from paraplegia with better choices.

Patient-driven loop control for hand function restoration in a non-invasive functional electrical stimulation system.

PURPOSE: In this study, a patient-driven loop control in a non-invasive functional electrical stimulation (FES) system was designed to restore hand function of stroke patients with their residual capabilities. METHOD: With this patient-driven loop control, patients use the electromyographic (EMG) signals from their voluntary controlled muscles in affected limbs to adjust stimulus parameters of the system. A special designed FES system generated electrical stimuli to excite the paralyzed muscles through surface electrodes on the basis of the control command from the residual myoelectric signals. EMG signals were also served as the trigger and the adjustment of stimulus parameters and thereby adding versatility of the FES system. Four stroke patients were recruited in the experiment to validate our system. RESULTS: The experimental results showed that hemiplegics could successfully control the system to restore their lost hand functions with the strategy of patient-driven loop control (the average estimated success rate was 77.5% with the tasks of cylindrical grasp and lateral pinch); and further, they would benefit by using the residual capabilities to regain their hand functions from the viewpoints of rehabilitation and psychology. CONCLUSION: According to the experiment results, this patient-driven loop control can be beneficial for hemiplegics to restore their hand functions such as cylindrical grasp and lateral pinch. The control strategy of this study has the potential to be employed not only in the FES system but also in other assistive devices.

A novel home appliance control system for people with disabilities.

PURPOSE: This research proposed an eyeglass-type infrared-based home appliance control system for spinal cord injured (SCI) with tetraplegia. METHOD: This system is composed of four major components: A headset, an infrared transmitting module, an infrared receiving/signal-processing module, and a main controller, the Intel-8951 microprocessor. This design concept was based on the use of an infrared remote module fastened to the eyeglasses that could allow the convenient control of the input motion on the keys of a remote controller of a home appliance which are all modified with infrared receiving/signal-processing modules. For system evaluation, 12 subjects (4 male, 8 female, 26- 47-years-old were recruited. Six persons without disabilities were in the control group and 6 with SCI with tetraplegia formed the experimental group. RESULTS: The average accuracy of the control group and the experimental group are 88.8 +/- 10.6% and 85.9 +/- 14.3%, respectively. The average time cost of the control group and the experimental group are 57.2 +/- 8.1 sec and 66.6 +/- 12.3 sec, respectively. An independent t-test revealed that the differences in the average accuracy and the average time cost of the control group and the experimental group are not significant (p > 0.05). CONCLUSIONS: Using the novel home appliance control system not only provided the advantages of convenience, accuracy and sanitation for people with disabilities but it also helped them to live more independently.

M3S-based electrical wheelchair with head-controlled device.

The motivation of this research is to improve the ability of ambulation for people with a certain degree of disability. The control of the wheelchair is using two tilt sensors as an input-controlling module. One of the tilt sensors detects the anterior/posterior tilting of the head and moves the wheelchair forward/backward, the other distinguishes the left/right swing of the head. In order to increase the safety of this system, the M3S protocol established by the European Commission is also applied to this research. The system based on M3S protocol has the advantage of real-time signal transmission and emergent status monitoring for SCI patients with C2-C4 level.

The M3S-based electric wheelchair for the people with disabilities in Taiwan.

PURPOSE: This study aims to establish an electronic wheelchair system in Taiwan that conforms to multiple master-multiple slave (M3S) standards. The proposed system could enhance the safety and convenience of people with disabilities. MATERIAL AND METHOD: The M3S-based head-controlled electric wheelchair consists of three parts: (A) the input device, (B) the output device, and (C) the safety device. Head movement can be used as the input control to cause the tilting device to produce a corresponding level of analog voltage (backward & forward/left & right) which is then transmitted to the analogy/digital conversion module to control the output device (wheelchair's motor). Ten subjects with C5 incompleted spinal cord injury were recruited in the clinical assessment. They were randomly assigned into groups A and B. In the group A, the subjects were assigned to operate the head-controlled wheelchair system with M3S standard before operating the head-controlled wheelchair system without M3S standard. In the group B, the subjects were assigned to operate the head-controlled wheelchair system without M3S standard before operating the head-controlled wheelchair system with M3S standard. Two subjects in the group B drop off due to their personal reasons. RESULTS: The time cost for group A in completing tasks 1, 2, and 3 with the M3S and without the M3S were insignificant (p>0.05). The time cost for completing in group B was insignificant (p>0.05). Thus, the wheelchair operating time is depended on the proficiency of the subjects, not the M3S standard added. DISCUSSIONS AND CONCLUSIONS: The time cost for subjects to operate the wheelchair was determined by their proficiency, not the M3S standard control added to the system. However, the M3S-based system did realize the safety mechanism and complex auxiliary tools with and without the plug-in and play function.

Infrared-based communication augmentation system for people with multiple disabilities.

PURPOSE: This study describes an eyeglass-type infrared-based communication board for the nonspeaking with quadriplegia. METHOD: This system is composed of four major components: a headset, an infrared transmitting module, an infrared receiving/signal-processing module, and a main controller, the Intel-8951 microprocessor. This design concept was based on the use of an infrared remote module fastened to the eyeglasses which could allow the convenient control of the input motion on the keys of a communication board, which are all modified with infrared receiving/signal-processing modules. For system evaluation, 12 subjects (all men, 21-45 years old, six normal subjects as the control group and six nonspeaking with quadriplegia as the experimental group) were recruited. RESULTS: The average accuracy of the control group and the experimental group were 93.1 +/- 4.3% and 89.7 +/- 5.5%, respectively. The average time cost of the control group and the experimental group were 78.3 +/- 8.7 s and 89.9 +/- 10.2 s, respectively. An independent t-test revealed that the differences in the average accuracy and the average time cost of the control group and the experimental group were not significant (p>0.05). CONCLUSIONS: The increase of opportunity to communicate using the infrared-based communication board would help people with multiple disabilities to socialize actively.

Neural network and fuzzy control in FES-assisted locomotion for the hemiplegic.

This study is aimed at establishing a neural network and fuzzy feedback control FES system used for adjusting the optimum electrical stimulating current to control the motion of an ankle joint. The proposed method further improves the drop-foot problem existing in hemiplegia patients. The proposed system includes both hardware and software. The hardware system determines the patient's ankle joint angle using a position sensor located in the patient's affected side. This sensor stimulates the tibialis anterior with an electrical stimulator that induces the dorsiflexion action and achieves the ideal ankle joint trace motion. The software system estimates the stimulating current using a neural network. The fuzzy controller solves the nonlinear problem by compensating the motion trace errors between the neural network control and actual system. The control qualities of various controllers for four subjects were compared in the clinical test. It was found that both the root mean square error and the mean error were minimal when using the neural network and fuzzy controller. The drop-foot problem in hemiplegic's locomotion was effectively improved by incorporating the neural network and fuzzy controller with the functional electrical simulator.

Clinical evaluation of the tilt sensors feedback controlled FES for hemiplegia.

A feedback controlled functional electrical stimulation (FES) system is developed to provide the hemiplegic patients a real-time stimulation to their muscles to prevent the drop-foot and the quadriceps weakness from happening during gait training. The FES is controlled by tilt sensors (t.s.) and triggered by footswitches (f) with real-time feedback. As the FES receives the signals from these sensors, it adjusts and outputs an optimum set of stimulation parameters automatically.

The development of a knee locker with closed-loop functional electrical stimulation (FES) for hemiplegia in gait training.

PURPOSE: A knee locker with closed-loop functional electrical stimulation (FES) system has been developed to prevent the quadriceps weakness and the drop-foot of the hemiplegia during gait training. METHOD: The FES system is triggered by a footswitch on the heel of the disabled foot to stimulate the tibialis anterior muscle for dorsi-flexion and to turn-off the knee locker in the swing phase through the main controller. Besides, the footswitch on the heel of the affected-side can be used to stimulate the quadriceps and to turn-on the knee locker for quadriceps weakness in the stance phase. RESULTS: It is revealed that the mean velocity, cadence, stride length, active ankle motion range, and functional ambulation category (FAC) have improved significantly from 0.15 +/- 0.04 m sec( - 1), 43.3 +/- 15.4 steps min( - 1), 0.36 +/- 0.11 m, 15 degrees, level 2 to 0.43 +/- 0.21 m sec( - 1), 69.4 +/- 19.1 steps min( - 1), 0.73 +/- 0.17 m, 40 degrees, level 4 respectively for the patient. A paired t-test indicated that differences in the electromyography (EMG) of the tibialis anterior and the quadriceps muscles between patient's disabled (affected-side) foot and normal (unaffected-side) foot are not significant (p > 0.05) after 16 weeks of training. CONCLUSIONS: It is concluded that this new knee locker with closed-loop FES system is capable of providing the hemiplegia with restoration to regular walking after appropriate gait training.

A head movement image (HMI)-controlled computer mouse for people with disabilities.

PURPOSE: This study proposes image processing and microprocessor technology for use in developing a head movement image (HMI)-controlled computer mouse system for the spinal cord injured (SCI). METHOD: The system controls the movement and direction of the mouse cursor by capturing head movement images using a marker installed on the user's headset. In the clinical trial, this new mouse system was compared with an infrared-controlled mouse system on various tasks with nine subjects with SCI. RESULTS: The results were favourable to the new mouse system. The differences between the new mouse system and the infrared-controlled mouse were reaching statistical significance in each of the test situations (p<0.05). CONCLUSIONS: The HMI-controlled computer mouse improves the input speed. People with disabilities need only wear the headset and move their heads to freely control the movement of the mouse cursor.

SEMG-controlled telephone interface for people with disabilities.

This paper proposes the development of a surface electromyographic (SEMG)-controlled telephone interface for the disabled. The system is composed of three major components: (1) a SEMG receiving/signal-processing module; (2) a row-column scanning interface for the telephone dialling pad; and (3) a main controller, the Intel-8951 microprocessor. The design concept was based on the idea of using a SEMG generated by the disabled and converting it into a trigger pulse. This could allow convenient control of the dialing motion in the row-column scanning keys of a telephone dialling pad. People with disabilities are competent for certain kinds of work such as being a telephone operator. The increase of opportunities to perform a job for the disabled would help them live independently.