scholarly journals Development and Clinical Evaluation of a Web-Based Upper Limb Home Rehabilitation System Using a Smartwatch and Machine Learning Model for Chronic Stroke Survivors: Prospective Comparative Study (Preprint)

2019 ◽  
Author(s):  
Sang Hoon Chae ◽  
Yushin Kim ◽  
Kyoung-Soub Lee ◽  
Hyung-Soon Park
Keyword(s):  
Machine Learning ◽  
Home Care ◽  
Comparative Study ◽  
Internal Rotation ◽  
Chronic Stroke ◽  
Control Group ◽  
Stroke Survivors ◽  
Home Based ◽  
Rehabilitation System ◽  
Prospective Comparative Study

BACKGROUND Recent advancements in wearable sensor technology have shown the feasibility of remote physical therapy at home. In particular, the current COVID-19 pandemic has revealed the need and opportunity of internet-based wearable technology in future health care systems. Previous research has shown the feasibility of human activity recognition technologies for monitoring rehabilitation activities in home environments; however, few comprehensive studies ranging from development to clinical evaluation exist. OBJECTIVE This study aimed to (1) develop a home-based rehabilitation (HBR) system that can recognize and record the type and frequency of rehabilitation exercises conducted by the user using a smartwatch and smartphone app equipped with a machine learning (ML) algorithm and (2) evaluate the efficacy of the home-based rehabilitation system through a prospective comparative study with chronic stroke survivors. METHODS The HBR system involves an off-the-shelf smartwatch, a smartphone, and custom-developed apps. A convolutional neural network was used to train the ML algorithm for detecting home exercises. To determine the most accurate way for detecting the type of home exercise, we compared accuracy results with the data sets of personal or total data and accelerometer, gyroscope, or accelerometer combined with gyroscope data. From March 2018 to February 2019, we conducted a clinical study with two groups of stroke survivors. In total, 17 and 6 participants were enrolled for statistical analysis in the HBR group and control group, respectively. To measure clinical outcomes, we performed the Wolf Motor Function Test (WMFT), Fugl-Meyer Assessment of Upper Extremity, grip power test, Beck Depression Inventory, and range of motion (ROM) assessment of the shoulder joint at 0, 6, and 12 months, and at a follow-up assessment 6 weeks after retrieving the HBR system. RESULTS The ML model created with personal data involving accelerometer combined with gyroscope data (5590/5601, 99.80%) was the most accurate compared with accelerometer (5496/5601, 98.13%) or gyroscope data (5381/5601, 96.07%). In the comparative study, the drop-out rates in the control and HBR groups were 40% (4/10) and 22% (5/22) at 12 weeks and 100% (10/10) and 45% (10/22) at 18 weeks, respectively. The HBR group (n=17) showed a significant improvement in the mean WMFT score (<i>P</i>=.02) and ROM of flexion (<i>P</i>=.004) and internal rotation (<i>P</i>=.001). The control group (n=6) showed a significant change only in shoulder internal rotation (<i>P</i>=.03). CONCLUSIONS This study found that a home care system using a commercial smartwatch and ML model can facilitate participation in home training and improve the functional score of the WMFT and shoulder ROM of flexion and internal rotation in the treatment of patients with chronic stroke. This strategy can possibly be a cost-effective tool for the home care treatment of stroke survivors in the future. CLINICALTRIAL Clinical Research Information Service KCT0004818; https://tinyurl.com/y92w978t

scholarly journals Development and Clinical Evaluation of a Web-Based Upper Limb Home Rehabilitation System Using a Smartwatch and Machine Learning Model for Chronic Stroke Survivors: Prospective Comparative Study

10.2196/17216 ◽  
2020 ◽  
Vol 8 (7) ◽  
pp. e17216
Author(s):  
Sang Hoon Chae ◽  
Yushin Kim ◽  
Kyoung-Soub Lee ◽  
Hyung-Soon Park
Keyword(s):  
Machine Learning ◽  
Home Care ◽  
Comparative Study ◽  
Internal Rotation ◽  
Chronic Stroke ◽  
Control Group ◽  
Stroke Survivors ◽  
Home Based ◽  
Rehabilitation System ◽  
Prospective Comparative Study

Background Recent advancements in wearable sensor technology have shown the feasibility of remote physical therapy at home. In particular, the current COVID-19 pandemic has revealed the need and opportunity of internet-based wearable technology in future health care systems. Previous research has shown the feasibility of human activity recognition technologies for monitoring rehabilitation activities in home environments; however, few comprehensive studies ranging from development to clinical evaluation exist. Objective This study aimed to (1) develop a home-based rehabilitation (HBR) system that can recognize and record the type and frequency of rehabilitation exercises conducted by the user using a smartwatch and smartphone app equipped with a machine learning (ML) algorithm and (2) evaluate the efficacy of the home-based rehabilitation system through a prospective comparative study with chronic stroke survivors. Methods The HBR system involves an off-the-shelf smartwatch, a smartphone, and custom-developed apps. A convolutional neural network was used to train the ML algorithm for detecting home exercises. To determine the most accurate way for detecting the type of home exercise, we compared accuracy results with the data sets of personal or total data and accelerometer, gyroscope, or accelerometer combined with gyroscope data. From March 2018 to February 2019, we conducted a clinical study with two groups of stroke survivors. In total, 17 and 6 participants were enrolled for statistical analysis in the HBR group and control group, respectively. To measure clinical outcomes, we performed the Wolf Motor Function Test (WMFT), Fugl-Meyer Assessment of Upper Extremity, grip power test, Beck Depression Inventory, and range of motion (ROM) assessment of the shoulder joint at 0, 6, and 12 months, and at a follow-up assessment 6 weeks after retrieving the HBR system. Results The ML model created with personal data involving accelerometer combined with gyroscope data (5590/5601, 99.80%) was the most accurate compared with accelerometer (5496/5601, 98.13%) or gyroscope data (5381/5601, 96.07%). In the comparative study, the drop-out rates in the control and HBR groups were 40% (4/10) and 22% (5/22) at 12 weeks and 100% (10/10) and 45% (10/22) at 18 weeks, respectively. The HBR group (n=17) showed a significant improvement in the mean WMFT score (P=.02) and ROM of flexion (P=.004) and internal rotation (P=.001). The control group (n=6) showed a significant change only in shoulder internal rotation (P=.03). Conclusions This study found that a home care system using a commercial smartwatch and ML model can facilitate participation in home training and improve the functional score of the WMFT and shoulder ROM of flexion and internal rotation in the treatment of patients with chronic stroke. This strategy can possibly be a cost-effective tool for the home care treatment of stroke survivors in the future. Trial Registration Clinical Research Information Service KCT0004818; https://tinyurl.com/y92w978t

scholarly journals Home-Based Rehabilitation System for Stroke Survivors: A Clinical Evaluation

2020 ◽  
Vol 44 (12) ◽  
Author(s):  
Enjie Ghorbel ◽  
Renato Baptista ◽  
Abdelrahman Shabayek ◽  
Djamila Aouada ◽  
Maialen Gorostiza Oramaeche ◽  
...  
Keyword(s):  
Clinical Evaluation ◽  
Stroke Survivors ◽  
Home Based ◽  
Rehabilitation System

scholarly journals Development of the Home based Virtual Rehabilitation System (HoVRS) to remotely deliver an intense and customized upper extremity training

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Qinyin Qiu ◽  
Amanda Cronce ◽  
Jigna Patel ◽  
Gerard G. Fluet ◽  
Ashley J. Mont ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Chronic Stroke ◽  
Hand Rehabilitation ◽  
Kinematic Data ◽  
Virtual Rehabilitation ◽  
Home Based ◽  
Rehabilitation System ◽  
Kinematic Measures ◽  
And Training ◽  
Training Protocol

Abstract Background After stroke, sustained hand rehabilitation training is required for continuous improvement and maintenance of distal function. Methods In this paper, we present a system designed and implemented in our lab: the Home based Virtual Rehabilitation System (HoVRS). Fifteen subjects with chronic stroke were recruited to test the feasibility of the system as well as to refine the design and training protocol to prepare for a future efficacy study. HoVRS was placed in subjects’ homes, and subjects were asked to use the system at least 15 min every weekday for 3 months (12 weeks) with limited technical support and remote clinical monitoring. Results All subjects completed the study without any adverse events. Subjects on average spent 13.5 h using the system. Clinical and kinematic data were collected pre and post study in the subject’s home. Subjects demonstrated a mean increase of 5.2 (SEM = 0.69) on the Upper Extremity Fugl-Meyer Assessment (UEFMA). They also demonstrated improvements in six measurements of hand kinematics. In addition, a combination of these kinematic measures was able to predict a substantial portion of the variability in the subjects’ UEFMA score. Conclusion Persons with chronic stroke were able to use the system safely and productively with minimal supervision resulting in measurable improvements in upper extremity function.

Effects of training with a passive hand orthosis and games at home in chronic stroke: a pilot randomised controlled trial

2016 ◽  
Vol 31 (2) ◽  
pp. 207-216 ◽  
Author(s):  
Sharon M Nijenhuis ◽  
Gerdienke B Prange-Lasonder ◽  
Arno HA Stienen ◽  
Johan S Rietman ◽  
Jaap H Buurke
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Hand Function ◽  
User Acceptance ◽  
Chronic Stroke ◽  
Control Group ◽  
Home Based ◽  
Randomised Controlled ◽  
Clinical Changes ◽  
At Home

Objectives: To compare user acceptance and arm and hand function changes after technology-supported training at home with conventional exercises in chronic stroke. Secondly, to investigate the relation between training duration and clinical changes. Design: A randomised controlled trial. Setting: Training at home, evaluation at research institute. Subjects: Twenty chronic stroke patients with severely to mildly impaired arm and hand function. Interventions: Participants were randomly assigned to six weeks (30 minutes per day, six days a week) of self-administered home-based arm and hand training using either a passive dynamic wrist and hand orthosis combined with computerised gaming exercises (experimental group) or prescribed conventional exercises from an exercise book (control group). Main measures: Main outcome measures are the training duration for user acceptance and the Action Research Arm Test for arm and hand function. Secondary outcomes are the Intrinsic Motivation Inventory, Fugl-Meyer assessment, Motor Activity Log, Stroke Impact Scale and grip strength. Results: The control group reported a higher training duration (189 versus 118 minutes per week, P = 0.025). Perceived motivation was positive and equal between groups ( P = 0.935). No differences in clinical outcomes over training between groups were found (P ⩾ 0.165). Changes in Box and Block Test correlated positively with training duration ( P = 0.001). Conclusions: Both interventions were accepted. An additional benefit of technology-supported arm and hand training over conventional arm and hand exercises at home was not demonstrated. Training duration in itself is a major contributor to arm and hand function improvements.

Abstract P839: ‘Stroke Home Care’- A Mobile Application: Home Based Innovative Nursing Care Intervention Developed by Stroke Nurse: A Need of the Time in Covid-19 Pandemic Like Situation

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ashok Kumar ◽  
Dheeraj Khurana ◽  
Smita Pattanaik ◽  
Mukesh Kumar ◽  
Manish Modi ◽  
...  
Keyword(s):  
Home Care ◽  
Nursing Care ◽  
Mobile Application ◽  
Frozen Shoulder ◽  
Tube Feeding ◽  
Stroke Care ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Post Stroke ◽  
Home Based

Introduction: Stroke nurse is functioning as a vital member of the stroke team. She/he provides care to the stroke patients in acute as well as post-acute periods. She/he coordinates among other team members to facilitate the stroke care continuum. Post-stroke care is always a challenge for health care professional as well as caregivers. During current pandemic conditions, it is essential to provide quality care at their home. Purpose: To develop a mobile application to provide home based care for prevention and management of post stroke complications among survivors. Methods: Survey was carried out among 170 bedridden stroke survivors and their caregivers to assess problems faced like aspiration pneumonia, bedsore, urinary tract infection, deep vein thrombosis, frozen shoulder, contractures, and caregiver burden. On the basis of findings ‘Stroke home care’ a bilingual (in Hindi and English) mobile application was developed which contains step by step nursing-care-procedural videos to prevent bedsore, bedsore dressing, positioning change, Ryle’s tube feeding, Foley’s catheter care, active and passive range of motion exercises, hand washing with soap-water as well with sanitizer, psychological support to patients. Results: Through this intervention, caregivers of bedridden stroke patients get trained for care procedures so that they can provide best possible nursing care to their patients at home and can prevent post stroke complications and ultimately enhances quality of life of survivors and reduce caregivers’ burden. Conclusion: ‘Stroke Home Care’ is a novel intervention developed by a stroke nurse which has been developed and tested not just for its feasibility and acceptability but also proven for its clinical applicability through PROBE designed study. This web based intervention can provide rehabilitation services to bedridden stroke survivors at their home in this pandemic.

Abstract WP205: Home-Based Virtual Reality Therapy for Hand Recovery After Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adam MacLellan ◽  
Catherine Legault ◽  
Alay Parikh ◽  
Leonel Lugo ◽  
Stephanie Kemp ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Upper Extremity ◽  
Large Scale ◽  
Controlled Trial ◽  
Hand Function ◽  
Chronic Stroke ◽  
Stroke Survivors ◽  
Hand Rehabilitation ◽  
Stroke Patients ◽  
Home Based

Background: Stroke is the leading cause of disability worldwide, with many stroke survivors having persistent upper limb functional impairment. Aside from therapist-directed rehabilitation, few efficacious recovery tools are available for use by stroke survivors in their own home. Game-based virtual reality systems have already shown promising results in therapist-supervised settings and may be suitable for home-based use. Objective: We aimed to assess the feasibility of unsupervised home-based use of a virtual reality device for hand rehabilitation in stroke survivors. Methodology: Twenty subacute/chronic stroke patients with upper extremity impairment were enrolled in this prospective single-arm study. Participants were instructed to use the Neofect Smart Glove 5 days per week for 8 weeks, in single sessions of 50 minutes or two 25-minute sessions daily. We measured (1) compliance to prescribed rehabilitation dose, (2) patient impression of the intervention, and (3) efficacy measures including the upper extremity Fugl-Meyer (UE-FM), the Jebsen-Taylor hand function test (JTHFT) and the Stroke Impact Scale (SIS). Results: Seven subjects (35%) met target compliance of 40 days use, and 6 subjects (30%) used the device for 20-39 days; there were no age or gender differences in use. Subjective patient experience was favorable, with ninety percent of subjects reporting satisfaction with their overall experience, and 80% reporting perceived improvement in hand function (figure 1). There was a mean improvement of 26.6±48.8 seconds in the JTHFT ( p =0.03) and 16.1±15.3 points in the domain of the SIS that assesses hand function ( p <0.01). There was a trend towards improvement in the UE-FM (2.2±5.5 points, p =0.10). Conclusions: A novel virtual reality gaming device is suitable for unsupervised use in stroke patients and may improve hand/arm function in subacute/chronic stroke patients. A large-scale randomized controlled trial is needed to confirm these results.

Baduanjin Qigong Improves Balance, Leg Strength, and Mobility in Individuals With Chronic Stroke: A Randomized Controlled Study

2021 ◽  
pp. 154596832110050
Author(s):  
Mandy Yuen ◽  
H. X. Ouyang ◽  
Tiev Miller ◽  
Marco Y. C. Pang
Keyword(s):  
Chronic Stroke ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Control Group ◽  
Training Methods ◽  
Timed Up And Go ◽  
Leg Strength ◽  
Randomized Controlled ◽  
Home Based ◽  
Experimental Group

Background Effective and sustainable exercise training methods for improving balance poststroke are needed. Objective To evaluate the effect of Baduanjin Qigong for improving balance after stroke. Methods This was a single-blinded randomized controlled study in which only the assessor was blinded. Fifty-eight people with chronic stroke (mean age: 62.5 ± 11.8 years) were randomly assigned to the experimental (n = 29) or control group (n = 29). The experimental group underwent 8 weeks of supervised Baduanjin training (3 sessions per week). This was followed by home-based practice of the same exercises 3 days a week for another 8 weeks. The control group underwent 2 sessions of supervised conventional fitness training in the first week, followed by home-based exercise practice 3 days a week until the end of week 16. All outcomes were measured at baseline, week 8, and week 16. Results Significantly greater improvements in the Mini-Balance Evaluation Systems Test (Mini-BESTest), composite equilibrium score (Sensory Organization Test), 5 Times Sit to Stand, and Timed Up and Go test were detected at week 8 in the experimental group than in the control group ( P < .017). Further improvement in the Mini-BESTest was observed from week 8 to 16 in the experimental group ( P < .001). Other outcomes (Limit of Stability, Fall-Efficacy Scale, Modified Barthel Index, Stroke-Specific Quality of Life) showed no significant results. Conclusion Baduanjin is effective in improving balance, leg strength, and mobility and is a safe and sustainable form of home-based exercise for people with chronic stroke.

Prospective comparative study evaluating the role of flavonoids after endovenous thermal ablation

2021 ◽  
pp. 026835552110023
Author(s):  
Christos S Karathanos ◽  
Konstantinos Batzalexis ◽  
Petroula Nana ◽  
Konstantinos Spanos ◽  
George Kouvelos ◽  
...  
Keyword(s):  
Comparative Study ◽  
Pain Score ◽  
Thermal Ablation ◽  
Clinical Severity ◽  
Control Group ◽  
Life Questionnaire ◽  
Venous Clinical Severity Score ◽  
Endovenous Thermal Ablation ◽  
Prospective Comparative Study

Objectives The aim of our study was to evaluate the role of flavonoids in the improvement of post-operative symptoms after endovenous thermal ablation (EVTA). Methods A prospective comparative study of 120 consecutive patients undergoing EVTA of the greater saphenous vein associated with phlebectomies was undertaken. Patients were grouped in those receiving micronized purified flavonoid fraction (MPFF- 60 patients) agent 500 mg Bid 7 days pre- and 30 days post- operatively (MPFF group) and those in the control group (60 patients) who did not. Demographics, intra-operative details, Clinical –Etiology- Anatomy- Pathophysiology (CEAP) clinical class, 10-cm Visual Analog Scale (VAS) for pain, Venous Clinical Severity Score (VCSS) and Chronic Venous Insufficiency Quality-of-Life Questionnaire (CΙVIQ-20) were recorded. Primary outcome was the postoperative pain assessement using the VAS scale and CIVIQ pain score. Secondary outcomes included assessement of VCSS and CΙVIQ-20 scores. Results There were no significant differences between the groups regarding demographics, clinical and procedural characteristics. Patients in MPFF group reported significantly lower VAS pain levels than control group at 7- (−3.6 ± 1.2 vs −2.7 ± 1.9, p < .0001) and 30- post-operative day (−4.9 ± 0.1 vs −4.2 ± 1, p < .0001). MPFF group also showed better outcome in terms of CIVIQ pain score at 7- (−3.7 ± 1.3 vs −3.5 ± 1.8, p = .008) and 30- post-operative day (−5.3. ± 1.1 vs −4.4 ± 1, p = .017). Both groups showed a significant improvement in VAS pain score (p = .047), global CIVIQ-20 (p = .009) and VCSS (p = .008) at 7- and 30-days post-operatively. Conclusions Administration of flavonoids in patients undergoing EVTA associated with phlebectomies reduces pain by a small amount during early postoperative period.

scholarly journals Effect of home-based rehabilitation of purposeful activity-based electrical stimulation therapy for chronic stroke survivors: a crossover randomized controlled trial

2021 ◽  
pp. 1-8
Author(s):  
Seigo Minami ◽  
Yoshihiro Fykumoto ◽  
Ryuji Kobayashi ◽  
Hideaki Aoki ◽  
Tomoki Aoyama
Keyword(s):  
Upper Limb ◽  
Repeated Measures ◽  
Controlled Trial ◽  
Phase 1 ◽  
Chronic Stroke ◽  
Stroke Survivors ◽  
Electrical Stimulation Therapy ◽  
Home Based ◽  
Group A ◽  
Purposeful Activity

Background: In this trial we combined the effect of purposeful activity and electrical stimulation therapy (PA-EST) to promote transition of severely hemiparetic upper limb to auxiliary upper limb in chronic stroke survivors in a single-case study. Objective: The purpose of this study was to examine the effect of PA-EST on the upper limb motor function in a crossover randomized controlled trial. Methods: The study included eight stroke survivors (age: 63.1±10.9 years) who were receiving home-based visiting occupational therapy. The average time since stroke onset was 8.8±5.6 years. All participants had severely hemiparetic upper limb, with the Fugl–Meyer Assessment upper extremity (FMA-U) score of 21.3±8.5. Participants were randomly assigned to group A or B. Group A received PA-EST for 3 months (phase 1), followed by standard stretching and exercise for 3 months (phase 2), whereas group B had the inverse order of treatments. To avoid carry-over effect, 1-month washout period was provided between the phase 1 and 2. Two-way analysis of variance (ANOVA) with repeated measures was used for the analysis. The primary outcome was FMA-U, and the secondary outcomes were, Motor Activity Log (MAL; amount of use [AOU] and quality of movement [QOM]), and Goal attainment scale-light (GAS-light). Results: Repeated measures-ANOVA revealed a significant interaction between type of intervention and time for FMA-U (F = 16.303, P = 0.005), MAL AOU (F = 7.966, P = 0.026) and QOM (F = 6.408, P = 0.039), and GAS-light (F = 6.905, P = 0.034), where PA-EST was associated with significantly improved motor function and goal achievement compared with standard stretching. Conclusions: The PA-EST may have greater effects than stretch/exercise in the recovery of hand function as reflected in FMA-U, MAL, and GAS-light. Our results suggest that PA-EST is an important and useful home-based rehabilitation program for promoting the use of the severely hemiparetic upper limb in chronic stroke survivors.

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