Motor Rehabilitation of Upper Limbs Using a Gesture-Based Serious Game: Evaluation of Usability and User Experience.

Objective: Gesture-based serious games can be based on playful and interactive scenarios to enhance user engagement and experience during exercises, thereby increasing efficiency in the motor rehabilitation process. This study aimed to develop the Rehabilite Game (RG) as a complementary therapy tool for upper limb rehabilitation in clinics and home environments and to evaluate aspects of usability and user experience of it. Materials and Methods: The evaluation consisted of the use of a gesture-based serious game with motor rehabilitation sessions managed in a web platform. Thirty-three participants were recruited (21 physiotherapists and 12 patients). The protocol allowed each participant to have the experience of playing sessions with different combinations of settings. The User Experience Questionnaire (UEQ) was used to evaluate aspects of usability and user experience. The study was approved by the Research Ethics Board of the Federal University of Piaui (number 3,429,494). Results: The level of satisfaction with the RG was positive, with an excellent Net Promoter Score for 85.7% of physiotherapists and 100% of patients. All six UEQ scales (attractiveness, perspicuity, efficiency, dependability, stimulation, and novelty) reflected acceptance. Conclusion: The study demonstrated that, according to the results obtained in the experiments, the RG had positive feedback from physiotherapists and patients, indicating that the game can be used in a clinical trial to be compared with other rehabilitation techniques.

A computer vision-based mobile tool for assessing human posture: A validation study.

BACKGROUND AND OBJECTIVE: Non-invasive methods for postural assessment are tools used for tracking and monitoring the progression of postural deviations. Different computer-based methods have been used to assess human posture, including mobile applications based on images and sensors. However, such solutions still require manual identification of anatomical points. This study aims to present and validate the NLMeasurer, a mobile application for postural assessment. This application takes advantage of the PoseNet, a solution based on computer vision and machine learning used to estimate human pose and identify anatomical points. From the identified points, NLMeasurer calculates postural measures. METHODS: Twenty participants were photographed in front view while using surface markers over anatomical landmarks. Then, the surface markers were removed, and new photos were taken. The photos were analyzed by two examiners, and six postural measurements were computed with NLMeasurer and a validated biophotogrammetry software. One-sample t-test and Bland Altman procedure were used to assess agreement between the methods, and Intraclass Correlation Coefficient (ICC) was used to assess inter- and intra-rater reliability. RESULTS: Postural measurements calculated using the NLMeasurer were in agreement with the biophotogrammetry software. Furthermore, there was good inter- and intra-rater reliability for most photos without surface markers. CONCLUSIONS: NLMeasurer demonstrated to be a valid tool method to assess postural measurements in the frontal view. The use of surface markers on specific anatomical landmarks (i.e., ears, iliac spines and ankles) can facilitate the digital identification of these landmarks and improve the reliability of the postural measurements performed with NLMeasurer.

Can human posture and range of motion be measured automatically by smart mobile applications?

Human posture and Range of Motion (ROM) are important components of a physical assessment and, from the collected data, it is possible to identify postural deviations such as scoliosis or joint and muscle limitations, hence identifying risks of more serious injuries. Posture assessment and ROM measures are also necessary metrics to monitor the effect of treatments used in the motor rehabilitation of patients, as well as to monitor their clinical progress. These evaluation processes are more frequently performed through visual inspection and manual palpation, which are simple and low cost methods. These methods, however, can be optimized with the use of tools such as photogrammetry and goniometry. Mobile solutions have also been developed to help health professionals to capture more objective data and with less risk of bias. Although there are already several systems proposed for assessing human posture and ROM in the literature, they have not been able to automatically identify and mark Anatomical and Segment Points (ASPs). The hypothesis presented here considers the development of a mobile application for automatic identification of ASPs by using machine learning algorithms and computer vision models associated with technologies embedded in smartphones. From ASPs identification, it will be possible to identify changes in postural alignment and ROM. In this context, our view is that an application derived from the hypothesis will serve as an additional tool to assist in the physical assessment process and, consequently, in the diagnosis of disorders related to postural and movement changes.

Proprioceptive neuromuscular facilitation increases alpha absolute power in the dorsolateral prefrontal cortex and superior parietal cortex.

The physiotherapist's clinical practice includes proprioceptive neuromuscular facilitation (PNF), which is a treatment concept that accelerates the response of neuromuscular mechanisms through spiral and diagonal movements. The adaptations that occur in the nervous system following PNF are still poorly described in the literature. Thus, this study had a goal to investigate the electrophysiological changes in the fronto-parietal circuit during PNF and movement in sagittal and diagonal patterns. This study included 30 female participants, who were divided into three groups (control, PNF, and flexion groups). Electroencephalogram measurements were determined before and after tasks were performed by each group. For the statistical analysis, a two-way ANOVA was performed for the factors group and time. Interactions between the two factors were investigated using a one-way ANOVA. A value of p < 0.004 was considered significant. The results showed an increase in alpha absolute power in the left dorsolateral prefrontal cortex and upper left parietal cortex of the PNF group, suggesting these areas work together to execute a motor action. The PNF group showed a greater alpha absolute power compared with the other groups, indicating a specific cortical demand for planning and attention, reinforcing its use for the rehabilitation of individuals.

Investigation of alpha band of the electroencephalogram before and after a task of proprioceptive neuromuscular facilitation.

The proprioceptive neuromuscular facilitation (PNF) sets up a feature of treatment developed with the objective to facilitate and improve the motor performance. The aim of this study was to investigate in healthy female individuals the effects of electrophysiological of a diagonal of the PNF upper limb. The sample consisted of 30 female participants aged between 18 to 28 years, randomly divided into 3 groups (G1, G2, and G3). The three groups had 2 moments of electroencephalographic signal detection, before and after the task. The statistical neurophysiological design allowed the analysis of the relative power of alpha band in three leads (Fz, F7, and F8). Thus, a three-way mixed factorial analysis of variance (ANOVA) was performed to investigate the factor inter subjects (groups) and intrasubjects (areas and moments), a two-way ANOVA to investigate the interactions between the three factors, and a one-way ANOVA to analyze separately the factors time and area. A P≤0.05 was considered as significance level. The results showed significant increase of alpha band in the three groups analyzed, being more evident to the G2 group. Therefore, the PNF can be considered favorable also in relation to the cortical behavior, reinforcing its use in rehabilitation processes, especially in the clinical practice of physiotherapy.

Diagonal movement of the upper limb produces greater adaptive plasticity than sagittal plane flexion in the shoulder.

The motor rehabilitation is based on exercises that involve various joints and muscle groups. One such treatment method is Proprioceptive Neuromuscular Facilitation (PNF), which involves diagonal movements simulating many activities of daily living. The objective of this study was to investigate the differences between PNF and shoulder flexion movements performed without the diagonal component (i.e., only in the sagittal plane) using beta band absolute power as a measure of plasticity. The study included 30 volunteers randomized into three groups (control, PNF, and FLEX), with electroencephalographic signals captured before and after the performance of the task. The PNF group showed an increase in beta band absolute power in both hemispheres, indicating greater plasticity than that seen in the FLEX group. Therefore, PNF seems to be capable of promoting cortical adaptations that lead to the recruitment of both hemispheres, thus influencing cortical organization in more complex tasks.

Revisiting the Term Neuroprotection in Chronic and Degenerative Diseases.

Thanks to the development of several new researches, the lifetime presented a significant increase, even so, we still have many obstacles to overcome - among them, manage and get responses regarding neurodegenerative diseases. Where we are in the understanding of neuroprotection? Do we really have protective therapies for diseases considered degeneratives such as amyotrophic lateral sclerosis and its variants, Parkinson's disease, Alzheimer's disease and many others? Neuroprotection is defined by many researches as interactions and interventions that can slow down or even inhibit the progression of neuronal degeneration process. We make some considerations on this neuroprotective effect.

Botulinum Neurotoxin Type A in Neurology: Update.

This paper reviews the current and most neurological (central nervous system, CNS) uses of the botulinum neurotoxin type A. The effect of these toxins at neuromuscular junction lends themselves to neurological diseases of muscle overactivity, particularly abnormalities of muscle control. There are seven serotypes of the toxin, each with a specific activity at the molecular level. Currently, serotypes A (in two preparations) and B are available for clinical purpose, and they have proved to be safe and effective for the treatment of dystonia, spasticity, headache, and other CNS disorders in which muscle hyperactivity gives rise to symptoms. Although initially thought to inhibit acetylcholine release only at the neuromuscular junction, botulinum toxins are now recognized to inhibit acetylcholine release at autonomic cholinergic nerve terminals, as well as peripheral release of neuro-transmitters involved in pain regulation. Its effects are transient and nondestructive, and largely limited to the area in which it is administered. These effects are also graded according to the dose, allowing individualized treatment of patients and disorders. It may also prove to be useful in the control of autonomic dysfunction and sialorrhea. In over 20 years of use in humans, botulinum toxin has accumulated a considerable safety record, and in many cases represents relief for thousands of patients unaided by other therapy.