Jurgen Broeren

Virtual Rehabilitation in an Activity Centre for Community-Dwelling Persons with Stroke

Background: The main purpose of this study was to place a virtual reality (VR) system, designed to assess and to promote motor performance in the affected upper extremity in subjects after stroke, in a nonhospital environment. We also wanted to investigate if playing computer games resulted in improved motor function in persons with prior stroke. Methods: The intervention involved 11 patients after stroke who received extra rehabilitation by training on a computer 3 times a week during a 4-week period. The control group involved 11 patients after stroke who continued their previous rehabilitation (no extra computer training) during this period. The mean age of all was 68 years (range = 47–85) and the average time after stroke 66 months (range = 15–140). The VR training consisted of challenging games, which provided a range of difficulty levels that allow practice to be fun and motivating. An additional group of 11 right-handed aged matched individuals without history of neurological or psychiatric illnesses served as reference subjects. Results: All the participants reported that they were novel computer game players. After an initial introduction they learned to use the VR system quickly. The treatment group demonstrated improvements in motor outcome for the trained upper extremity, but this was not detected in real-life activities. Conclusions: The results of this research suggest the usefulness of computer games in training motor performance. VR can be used beneficially not only by younger participants but also by older persons to enhance their motor performance after stroke.

Assessment and Training in a 3-Dimensional Virtual Environment With Haptics: A Report on 5 Cases of Motor Rehabilitation in the Chronic Stage After Stroke

Objective. This exploratory study assessed the possible effectiveness of hemiparetic upper extremity training in subjects with chronic stroke with computer instrumentation (haptic force feedback) and 3-dimensional visualization applied to computer games, as well as to evaluate concurrent computer-assisted assessment of the kinematics of movements and test whether any improvement detected in the computer environment was reflected in activities of daily living (ADLs). Methods. A single-subject repeated-measures experimental design (AB) was used. After baseline testing, 5 patients were assigned to the therapy 3 times a week for 45 min for 5 weeks. Velocity, time needed to reach, and hand path ratio (reflecting superfluous movements) were the outcome measures, along with the Assessment of Motor and Process Skills and the Box and Block test. The follow-up phase (C) occurred 12 weeks later. Results. Improvements were noted in velocity, time, and hand path ratio. One patient showed improvement in occupational performance in ADLs. Conclusions.The application of this strategy of using virtual reality (VR) technologies may be useful in assessing and training stroke patients. The results of this study must be reproduced in further studies. The VR systems can be placed in homes or other nonclinical settings.

Virtual Reality and Haptics as an Assessment Device in the Postacute Phase after Stroke

Virtual reality (VR) technology is altering the health care environment and is changing the options that are available to therapists. This study describes how a haptic device was used as a cinematic assessment utility. Three chronic stroke inpatients at Sahlgrenska University Hospital with left hemisphere damage were assessed. The patients were administered by the box and block manual dexterity test. For comparisons, a reference group was added to the study. Several parameters, including time, speed, and movement of the right upper extremity, were extracted and evaluated. The results indicate that the system shows potential as an assessment device. The feasibility study setup is working well, as is the assessment method. Further research, testing, refinement of the exercises, and use of VR and haptics within neurological rehabilitation are suggested.

Neglect assessment as an application of virtual reality

Objective –  In this study a cancellation task in a virtual environment was applied to describe the pattern of search and the kinematics of hand movements in eight patients with right hemisphere stroke.

A kinematic analysis of a haptic handheld stylus in a virtual environment: a study in healthy subjects

BackgroundVirtual Reality provides new options for conducting motor assessment and training within computer-generated 3 dimensional environments. To date very little has been reported about normal performance in virtual environments. The objective of this study was to evaluate the test-retest reliability of a clinical procedure measuring trajectories with a haptic handheld stylus in a virtual environment and to establish normative data in healthy subjects using this haptic device.MethodsFifty-eight normal subjects; aged from 20 to 69, performed 3 dimensional hand movements in a virtual environment using a haptic device on three occasions within one week. Test-retest stability and standardized normative data were obtained for all subjects.ResultsNo difference was found between test and retest. The limits of agreement revealed that changes in an individuals performance could not be detected. There was a training effect between the first test occasion and the third test occasion. Normative data are presented.ConclusionA new test was developed for recording the kinematics of the handheld haptic stylus in a virtual environment. The normative data will be used for purposes of comparison in future assessments, such as before and after training of persons with neurological deficits.

SALGOT - Stroke Arm Longitudinal study at the University of Gothenburg, prospective cohort study protocol

BackgroundRecovery patterns of upper extremity motor function have been described in several longitudinal studies, but most of these studies have had selected samples, short follow up times or insufficient outcomes on motor function. The general understanding is that improvements in upper extremity occur mainly during the first month after the stroke incident and little if any, significant recovery can be gained after 3-6 months. The purpose of this study is to describe the recovery of upper extremity function longitudinally in a non-selected sample initially admitted to a stroke unit with first ever stroke, living in Gothenburg urban area.Methods/DesignA sample of 120 participants with a first-ever stroke and impaired upper extremity function will be consecutively included from an acute stroke unit and followed longitudinally for one year. Assessments are performed at eight occasions: at day 3 and 10, week 3, 4 and 6, month 3, 6 and 12 after onset of stroke. The primary clinical outcome measures are Action Research Arm Test and Fugl-Meyer Assessment for Upper Extremity. As additional measures, two new computer based objective methods with kinematic analysis of arm movements are used. The ABILHAND questionnaire of manual ability, Stroke Impact Scale, grip strength, spasticity, pain, passive range of motion and cognitive function will be assessed as well. At one year follow up, two patient reported outcomes, Impact on Participation and Autonomy and EuroQol Quality of Life Scale, will be added to cover the status of participation and aspects of health related quality of life.DiscussionThis study comprises a non-selected population with first ever stroke and impaired arm function. Measurements are performed both using traditional clinical assessments as well as computer based measurement systems providing objective kinematic data. The ICF classification of functioning, disability and health is used as framework for the selection of assessment measures. The study design with several repeated measurements on motor function will give us more confident information about the recovery patterns after stroke. This knowledge is essential both for optimizing rehabilitation planning as well as providing important information to the patient about the recovery perspectives.Trial registrationClinicalTrials.gov: NCT01115348

Active video gaming improves body coordination in survivors of childhood brain tumours

Abstract Purpose: We investigated whether active video gaming (AVG) could bring about regular, enjoyable, physical exercise in children treated for brain tumours, what level of physical activity could be reached and if the children’s physical functioning improved. Methods: Thirteen children, aged 7–17 years, were randomised to either AVG or waiting-list. After 10–12 weeks they crossed-over. Weekly Internet coaching sessions were used to sustain motivation and evaluate enjoyment. Energy expenditure (EE) levels were measured as Metabolic Equivalent of Task (MET), using a multisensory activity monitor. Single-blinded assessments of physical functioning were done, using the Bruininks–Osteretsky Test of Motor Performance, second edition, evaluating participants before and after the intervention period, as well as comparing the randomisation groups after the first period. Results: All patients completed the study. AVG sessions (mean duration 47 minutes) were performed on 72% of all days. Mean EE level during AVG sessions was 3.0 MET, corresponding to moderate physical activity. The Body Coordination score improved by 15% (p = 0.021) over the intervention period. Conclusions: In this group of childhood brain tumour survivors, home-based AVG, supported by a coach, was a feasible, enjoyable and moderately intense form of exercise that improved Body Coordination. Implications for Rehabilitation Childhood brain tumour survivors frequently have cognitive problems, inferior physical functioning and are less physically active compared to their healthy peers. Active video gaming (AVG), supported by Internet coaching, is a feasible home-based intervention in children treated for brain tumours, promoting enjoyable, regular physical exercise of moderate intensity. In this pilot study, AVG with Nintendo Wii improved Body Coordination.

Telehealth with 3D games for stroke rehabilitation

Abstract This study explores the feasibility of a novel telehealth system for stroke rehabilitation in a rural area in Sweden. It addresses two major problems of home-based rehabilitation: training motivation and frequent meetings. Three stroke subjects were equipped with 3D computer games workbenches, and were instructed to play with the hemiplegic upper extremity. On-line coaching meetings were performed using bidirectional audiovisual communication. The intervention led to clinical changes for all subjects. On-line coaching is promising, but not yet as effective as desired. However, a distance based approach using 3D games for upper extremity rehabilitation after stroke is feasible.

Virtual TeleRehab : A case study

We examined the efficacy of a remotely based occupational therapy intervention. A 40-year-old woman who suffered a stroke participated in a telerehabilitation program. The intervention method is based on virtual reality gaming to enhance the training experience and to facilitate the relearning processes. The results indicate that Virtual TeleRehab is an effective method for motivational, economical, and practical reasons by combining game-based rehabilitation in the home with weekly distance meetings.

PHYSICAL ACTIVITY THROUGH HOME-BASED EXERCISE-GAMING AFTER CHILDHOOD BRAIN TUMOUR TREATMENT- A FEASABILITY STUDY

PHYSICAL ACTIVITY THROUGH HOME-BASED EXERCISE-GAMING AFTER CHILDHOOD BRAIN TUMOUR TREATMENT- A FEASABILITY STUDYCONTENTS: Oral presentations (O + number) Poster presentations (P + number) O-0001 O-0004 Neuroblastoma I P-0001 P-0071 Acute Lymphoblastic Leukaemia O-0005 O-0008 Epidemiology P-0072 P-0102 Myeloid leukemias O-0009 O-0012 Rare Tumours I P-0103 P-0132 Lymphomas O-0013 O-0018 Leukemia I P-0133 P-0162 Bone tumours O-0019 O-0024 Psychosocial I P-0163 P-0182 Soft tissue sarcomas O-0025 O-0030 Rare Tumours II P-0183 P-0201 Renal tumours O-0031 O-0036 Leukemia II P-0202 P-0208 Germ cell tumours O-0037 O-0042 Late Effects P-0209 P-0225 Rare tumours O-0043 O-0048 Brain Tumours I P-0226 P-0238 Liver tumours O-0049 O-0054 SIOP Award Session P-0239 P-0287 Neuroblastoma O-0055 O-0058 Germ Cell Tumours P-0288 P-0303 Surgery (IPSO) O-0059 O-0062 Liver Tumours P-0304 P-0305 Radiation Oncology (PROS) O-0063 O-0066 Rare Tumours II P-0306 P-0322 Retinoblastoma O-0066 O-0072 Brain Tumours II P-0323 P-0377 Brain tumours O-0073 O-0078 Psychosocial II P-0378 P-0418 Others O-0079 O-0084 Renal and Sarcomas I P-0419 P-0426 Hystiocytosis O-0085 O-0090 Neuroblastoma II P-0427 P-0448 New drugs/experimental therapeutics O-0091 O-0096 Bone tumours P-0449 P-0458 Epidemiology O-0097 O-0102 Supportive Care P-0459 P-0486 Late effects O-0103 O-0107 Leukemia III P-0487 P-0529 Supportive care/Palliative care O-0108 O-0113 Neuroblastoma III P-0530 P-0548 Psychosocial O-0114 O-0119 Renal and Sarcomas II P-0549 P-0574 Nursing O-0120 O-0125 Lymphoma O-0126 O-0131 Brain tumours III O-0132 O-0137 Renal and Sarcomas III O-0138 O-0163 Nurses Publications (Pub + number) O-0164 O-0196 IPSO O-0197 O-0212 ICCCPOParents/Survivors Pub-0001 Pub-0269 Publication Only 2013 Wiley Periodicals, Inc. DOI 10.1002/pbc.24719 Published online in Wiley Online Library (wileyonlinelibrary.com.). 45 CONGRESS OF THE INTERNATIONAL SOCIETY OF PAEDIATRIC ONCOLOGY (SIOP) 2013 HONG KONG, CHINA, 25–28 SEPTEMBER, 2013 SIOP ABSTRACTS FREE PAPER SESSION: FREE PAPER SESSION 01 NEUROBLASTOMA I