Martin Rydmark

Person-Centered Care — Ready for Prime Time

Long-term diseases are today the leading cause of mortality worldwide and are estimated to be the leading cause of disability by 2020. Person-centered care (PCC) has been shown to advance concordance between care provider and patient on treatment plans, improve health outcomes and increase patient satisfaction. Yet, despite these and other documented benefits, there are a variety of significant challenges to putting PCC into clinical practice. Although care providers today broadly acknowledge PCC to be an important part of care, in our experience we must establish routines that initiate, integrate, and safeguard PCC in daily clinical practice to ensure that PCC is systematically and consistently practiced, i.e. not just when we feel we have time for it. In this paper, we propose a few simple routines to facilitate and safeguard the transition to PCC. We believe that if conscientiously and systematically applied, they will help to make PCC the focus and mainstay of care in long-term illness.

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.

Learning to learn and learning to teach — Introduction to studies in higher education

Background: How students are introduced to their studies will affect the quality of learning. This project deals with tools for lifelong learning to increase students’ awareness of learning how to learn. In parallel to an introductory course for students, a course for teachers was given with a focus on tutoring students. Aims: To evaluate an interprofessional transition course for first-year health science students, the LearnAble project, and a teachers’ course aiming to support students to be successful in their learning. Method: The project was followed up by a computer-based course evaluation, reflective journals, the Learning Process Questionnaire and the Approaches to Teaching Inventory. The questionnaires were distributed before and after the courses. Teachers (n = 31) and students (n = 270) in two courses from different health educations participated. Results: Students’ approaches to the course and to learning could be described as technical/reproductive, seeking for an identity or as reflective/transformative. The evaluation indicates that a deep approach to the studies among the students was related to higher age and female gender. Teachers with earlier pedagogical education supported students more in the attempts to question their own understanding. Conclusion: The most obvious result was the positive impact of being a tutor for a group of students in parallel to studying pedagogy.

3D reconstruction of biological objects from sequential image planes—Applied on cerebral cortex from cat

A prism of cat cerebral cortex was reconstructed with a method for three-dimensional (3D) representation of biological objects. A series of 918 semithin sections were digitized into an image analysis system. The images were aligned and analyzed, and a data base with the coordinates and a classification of the cells was created. The data base (i.e., the cortical prism) was visualized in a 3D graphic terminal, and parameters such as columnar and lamellar organization, clustering, and cell density were analyzed. A neuronal perikaryon and its neurites was reconstructed and shown together with the cortical prism.

Three-dimensional representation of biological objects as reconstructed from sequential image planes: Part I - the problem of image realignment

We describe a method for automatic realignment of consecutive 2-D microscopic images of brain cortex. The procedure is capable of carrying out high-quality realignment of 10 - 20 images per hour. The resulting image stack can be viewed in real-time by cinematographic animation or used for 3-D object reconstruction. The technique does not rely on expensive hardware, but can be implemented on low-cost PCs and workstations.

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.