The effect of gamified robot-enhanced training on motor performance in chronic stroke survivors.

Task-specific training constitutes a core element for evidence-based rehabilitation strategies targeted at improving upper extremity activity after stroke. Its combination with additional treatment strategies and neurotechnology-based solutions could further improve patients' outcomes. Here, we studied the effect of gamified robot-assisted upper limb motor training on motor performance, skill learning, and transfer with respect to a non-gamified control condition with a group of chronic stroke survivors. The results suggest that a gamified training strategy results in more controlled motor performance during the training phase, which is characterized by a higher accuracy (lower deviance), higher smoothness (lower jerk), but slower speed. The responder analyses indicated that mildly impaired patients benefited most from the gamification approach. In conclusion, gamified robot-assisted motor training, which is personalized to the individual capabilities of a patient, constitutes a promising investigational strategy for further improving motor performance after a stroke.

Predictive Analysis of Errors During Robot-Mediated Gamified Training.

This paper presents our approach to predicting future error-related events in a robot-mediated gamified physical training activity for stroke patients. The ability to predict future error under such conditions suggests the existence of distinguishable features and separated class characteristics between the casual gameplay state and error prune state in the data. Identifying such features provides valuable insight to creating individually tailored, adaptive games as well as possible ways to increase rehabilitation success by patients. Considering the time-series nature of sensory data created by motor actions of patients we employed a predictive analysis strategy on carefully engineered features of sequenced data. We split the data into fixed time windows and explored logistic regression models, decision trees, and recurrent neural networks to predict the likelihood of a patient making an error based on the features from the time window before the error. We achieved an 84.4% F1-score with a 0.76 ROC value in our best model for predicting motion accuracy related errors. Moreover, we computed the permutation importance of the features to explain which ones are more indicative of future errors.

Gamified Motor Training With Tangible Robots in Older Adults: A Feasibility Study and Comparison With the Young.

Background: An increasing lifespan and the resulting change in our expectations of later life stages are dependent on a good health state. This emphasizes the importance of the development of strategies to further strengthen healthy aging. One important aspect of good health in later life stages is sustained skilled motor function. Objective: Here, we tested the effectiveness of robotic upper limb motor training in a game-like scenario assessing game-based learning and its transfer potential. Methods: Thirty-six healthy participants (n = 18 elderly participants, n = 18 young controls) trained with a Pacman-like game using a hand-held Cellulo robot on 2 consecutive days. The game-related movements were conducted on a printed map displaying a maze and targets that had to be collected. Gradually, the task difficulty was adjusted between games by modifying or adding different game elements (e.g., speed and number of chasing ghosts, additional rules, and haptic feedback). Transfer was assessed by scoring simple robot manipulation on two different trajectories. Results: Elderly participants were able to improve their game performance over time [t (874) = 2.97, p < 0.01]. The applied game elements had similar effects on both age groups. Importantly, the game-based learning was transferable to simple robot manipulation that resembles activities of daily life. Only minor age-related differences were present (smaller overall learning gain and different effects of the wall-crash penalty rule in the elderly group). Conclusions: Gamified motor training with the Cellulo system has the potential to translate into an efficient and relatively low-cost robotic motor training tool for promoting upper limb function to promote healthy aging.

Iterative Design and Evaluation of a Tangible Robot-Assisted Handwriting Activity for Special Education.

In this article we investigate the role of interactive haptic-enabled tangible robots in supporting the learning of cursive letter writing for children with attention and visuomotor coordination issues. We focus on the two principal aspects of handwriting that are linked to these issues: Visual perception and visuomotor coordination. These aspects, respectively, enhance two features of letter representation in the learner's mind in particular, namely the shape (grapheme) and the dynamics (ductus) of the letter, which constitute the central learning goals in our activity. Building upon an initial design tested with 17 healthy children in a preliminary school, we iteratively ported the activity to an occupational therapy context in 2 different therapy centers, in the context of 3 different summer school camps involving a total of 12 children having writing difficulties. The various iterations allowed us to uncover insights about the design of robot-enhanced writing activities for special education, specifically highlighting the importance of ease of modification of the duration of an activity as well as of adaptable frequency, content, flow and game-play and of providing a range of evaluation test alternatives. Results show that the use of robot-assisted handwriting activities could have a positive impact on the learning of the representation of letters in the context of occupational therapy (V = 1, 449, p < 0.001, r = 0.42). Results also highlight how the design changes made across the iterations affected the outcomes of the handwriting sessions, such as the evaluation of the performances, monitoring of the performances, and the connectedness of the handwriting.

Towards an Adaptive Upper Limb Rehabilitation Game with Tangible Robots.

A key feature of a successful game is its ability to provide the player with an adequate level of challenge. However, the objective of difficulty adaptation in serious games is not only to maintain the player's motivation by challenging, but also to ensure the completion of training objectives.This paper describes our proposed upper-limb rehabilitation game with tangible robots and investigates the effect of game elements and gameplay on the amount of the performed motion in several planes and percentage of failure by using the data from 33 unimpaired subjects who played 53 games within two consecutive days. In order to provide a more generic adaptation strategy in the future, we discretize the game area to circular zones. We then show the effect of changing these zones during gameplay on the activation of different muscles through EMG data in a pilot study.The study shows that it is possible to increase the challenge level by adding more active agents chasing the player and increasing the speed of these agents. However, only the increase in number of agents significantly increases the users' motion on both planes. Analysis of player behaviors leads us to suggest that by adapting the behaviour of these active agents in specific zones, it is possible to change the trajectory of the user, and to provide a focus on the activation of specific muscles.

Designing Configurable Arm Rehabilitation Games: How Do Different Game Elements Affect User Motion Trajectories?

For successful rehabilitation of a patient after a stroke or traumatic brain injury, it is crucial that rehabilitation activities are motivating, provide feedback and have a high rate of repetitions. Advancements in recent technologies provide solutions to address these aspects where needed. Additionally, through the use of gamification, we are able to increase the motivation for participants. However, many of these systems require complex set-ups, which can be a big challenge when conducting rehabilitation in a home-based setting. To address the lack of simple rehabilitation tools for arm function for a home-based application, we previously developed a system, Cellulo for rehabilitation, that is comprised of paper-supported tangible robots that are orchestrated by applications deployed on consumer tablets. These components enable different features that allow for gamification, easy setup, portability, and scalability. To support the configuration of game elements to patients' level of motor skills and strategies, their motor trajectories need to be classified. In this paper, we investigate the classification of different motor trajectories and how game elements impact these in unimpaired, healthy participants. We show that the manipulation of certain game elements do have an impact on motor trajectories, which might indicate that it is possible to adapt the arm remediation of patients by configuring game elements. These results provide a first step towards providing adaptive rehabilitation based upon patients' measured trajectories.

[Evaluation of visceral leishmaniasis diagnosis using indirect fluorescent antibody tests in 4 pediatric patients]. / Dört Çocuk Hastada Indirekt Floresan Antikor Test Kullanimi ile Visceral Leishmaniasis Tanisinin Degerlendirilmesi.

Visceral Leishmaniasis (VL) in infancy is mostly seen between the ages of 2-4,and visceral infection causes long standing fever, weakness, weight loss, hepatosplenomegaly and pancytopenia. Leishmania infantum is responsible for VL in Turkey. In this study, 4 pediatric cases of VL were analysed retrospectively. Bone marrow aspirate was obtained in two cases and Leishmania amastigotes were not obtained in these cases. Leishmania antibodies by the indirect immun fluorescent antibody test (IFAT) were positive in all cases. We consider that IFAT was a suitable alternative to parasite detection in the conclusive diagnosis of visceral leishmaniasis in pediatric patients when strong clinical suspicion is present.

Type I cystinuria and its genetic basis in a population of Turkish school children.

OBJECTIVES: Cystinuria is a common inherited disorder characterized by an abnormal urinary excretion of cystine and dibasic amino acids resulting in nephrolithiasis. The SLC3A1 gene, which encodes a dibasic amino acid transporter protein, is involved in the pathogenesis of cystinuria. In the present study we aimed to investigate the prevalence of cystinuria among children in Sivas province (Central Anatolia, Turkey) and to study M467T and M467K mutations and 231T/A polymorphism in patients with cystinuria. METHODS: A total of 8500 children were screened for cystinuria. The cyanide-nitroprusside test was applied to urine samples of all children. Children having a positive cyanide-nitroprusside test were further analyzed. M467T and M467K mutations (exon 8) and 231T/A polymorphism (exon 1) in the SCL3A1 gene were studied using a restriction fragment length polymorphism (RFLP) assay. RESULTS: We have found that the prevalence of cystinuria (11 cystinuric patients) is 1/772 in our population. Results of mutation analysis in the patients with cystinuria showed that M467T was the only mutation that was found in six cystinuric patients. One patient was homozygous and five were heterozygous for this mutation. CONCLUSIONS: The frequency of cystinuria in Sivas Province is the highest among the other populations studied to date. The frequency of M467T mutation is relatively higher than those reported for most populations. High frequency of cystinuria in this region could be due to consanguineous marriages.

Analysis of a 1-year-old cystinuric patient with recurrent renal stones.

Cystinuria is a hereditary disorder of cystine and dibasic amino acids (lysine, arginine, ornithine) transport across the luminal membrane of renal tubules and intestine, resulting in recurrent nephrolithiasis. Cystine stones frequently occur in the second or third decade of life with an occasional occurrence in infancy and in old age. Herein is presented the case of a 1-year-old girl with cystinuria and recurrent urolithiasis; the genetic basis of the disease was investigated by mutational analysis of the SLC3A1 gene. The data show that the present patient has an increased cystine (923.08 microg/mL) level and was heterozygote for M467T mutation.