Implementing high-quality upper extremity rehab in stroke survivors: home therapy via tele rehab - Webinar

Date: 11/14/17- 11/14/17

Location/Facility: Online Webinar

Discipline(s): OT PT

Subject: Neurologic

Seminar Sponsor: Mobility Research - Institute of Continuing Education

Phone Number: (480) 829-1727

Contact Email:

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Presented by:  Tony Szturm PT PhD Professor, College of Rehabilitation Sciences, University of Manitoba, Adjunct Professor Mechanical Engineering

Course Description:

Topic Area Evaluation of a computer game-assisted  Rehabilitation/Telerehabilitation platform for clinic and in-home therapy of hand-arm function in adults with Stroke

SYNOPSIS & Background

This Webinar will focus on an innovative, engaging computer game-assisted telerehabilitation – Telemonitoring platform (GTP) to evaluate and improve upper limb function in adults with stroke.

More than 60% of stroke survivors report persistent hemiparesis of the upper extremity (UE) in particular deficits in handling and manipulating objects  There are different approaches to therapy designed to improve hand-arm function post stroke and to prevent non-use sequelae (i.e. spasticity, contractures, and chronic pain)  The effectiveness of these programs is proportional to the intensity and amount of training and the task-specificity of the exercise regime( for example, Constraint-induced Movement Therapy (CIMT). However, it is difficult to engage individuals in therapy for long periods of time and sustain motivation for the intense repetitive task practice. When rehabilitation regimens are prescribed for clients to do at home, adherence is often low because rehabilitation exercises can be uninteresting and therefore difficult to sustain motivation in intense repetitive task practice. In addition, there may be a little or no support or follow-up  to manage the home program. There is a need for innovation to manage rehabilitative efforts to improve compliance and accessibility.   For this purpose an innovative computer game -based Telerehabilitation platform (GTP) has been developed in which task-oriented training exercises are coupled with interactive computer gaming to increase client engagement and participation , i.e. game-assisted repititve practice.   The GTP uses a low-cost commercial motion detecting mouse; a miniature and wireless plug-n-play computer interface device, which allows physical motion to be translated and interpreted as a standard USB mouse. With the motion mouse attached the natural motion of an object can be used to control the motion of the computer cursor or game sprite. Because the miniature motion mouse can be easily attached with Velcro to many objects of varied sizes, shapes, weights, surface properties and functional demands, this approach provides a highly flexible therapy tool applied to many fine and gross motor skills.

Assessment is a critical feature embedded into the GTP. A game-based assessment application was developed to provide a standardized method to quantify task performance of activities and prescribed home exercises without direct in-clinic supervision (i.e. Telemonitoring) The GTP assessment  module automatically logs clients' performance and computes movement quality, efficiency and accuracy, and can be used for a broad range of manipulation task. The resulting performance data (electronic records) can be used to track change and can inform clinician how a client is performing, whether they are experiencing any difficulty, and how they are progressing in their exercise program.

Course Objectives:

Learning Objective 1 To describe strengths and limitations of current assessments used to evaluate hand and arm structure/function ICF), and relate to activity and participation

Learning Objective 2 To become familiar with components and features of the  Game-assisted rehabilitation assessment and treatment platform (GTP), as well as sources and cost

·         Function and Utility of the hardware components,:

- Miniature, Wireless motion detecting computer mouse which to interact with designed rehabilitation assessment software (or therapy games. ;)

-How natural movements of many objects or body movements can be readily captured and used to interact with “therapeutic computer game applications, and with high fidelity and responsiveness.

·         Features and Operation of the Upper Extremity Function Assessment software

- Fully configurable: provides game tasks with a broad range of difficulty levels; i.e. precision levels, speed, movement amplitudes and distractors.

- Standardized & Objective: automated and validated data analysis methods to quantify outcome measures (and Telemonitoring) of fine and gross motor skills, i.e. movement quality, movement accuracy, movement variation, and response time and success rate.

- Flexible: can be used to assess handling/manipulation of many objects with diverse physical properties and functional demands.

Learning Objective 3 To describe an Assessment Framework for  objective analysis of hand-arm function  (with examples)  to  cover a broad range of object manipulation tasks, and for mild to severly affected individuals:

·         Spectrum of physical properties (object size shape mass torque, degrees-of-freedom, and surface friction, etc.

·         Spectrum of functional demands, precision levels, speed and movement amplitudes.

·         Anatomical requirements, 2-finger, 3-finger, whole hand and bimanual manipulation

·         Object manipulation tasks requiring a combination of wrist, elbow and shoulder motion.

Learning Objective 4: To become familiar with treatment applications of the GTP for game-assisted repetitive task practice programs   of fine and gross motor skills for stroke clients (also incomplete cervical spinal cord injured and TBI).

·         Incorporating key principles of neuroplasticity and main components of CIMT, bimanual therapies.

·         Describe client-centered, personalized therapy programs

-Starting points and How to use and select object ergonomic properties to amplify limited and small amounts of voluntary movement.

-Selection and use of objects and game parameters to target many fine and gross motor skills and also psychomotor skills

·         To describe value and applications of the Telerehabilitation features and  transition to and support of home programs: (including rural)

-Automated monitoring of exercise performance,

-Provide timely feedback, program adjustments & progress,

-Electronic outcome measures to track change.

Course Timeline (Agenda): 90 minutes

·         20 minutes Background and overview upper extremity function and assessment

·         35 minutes describing components and features of the game-based upper extremity assessment platform. presenting Assessment Framework with examples for hand-arm function that will cover a broad range of object manipulation tasks .

·         30 minutes treatment applications of the GTP for game-based repetitive task practice programs - fine and gross motor skills for clients with mild to severe impairments Presenting home applications

·         5 minutes(Tele monitoring & Tele rehabilitation)


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