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Reducing compensatory movements in stroke therapy through the use of robotic devices and augmented feedback… Valdes Benavides, Bulmaro Adolfo 2017

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REDUCING COMPENSATORY MOVEMENTS IN STROKE THERAPY THROUGH THE USE OF ROBOTIC DEVICES AND AUGMENTED FEEDBACKBULMARO VALDÉSPHD CANDIDATE ,  B IOMEDICAL  ENGINEERINGSUPERVISOR:  DR .  MACHIEL  VAN DER  LOOSRREACHBULMARO VALDÉSWHO ARE WE?2Engineers TherapistsStroke survivorsKinesiologistsNeuroscientistsCollaborateRREACHBULMARO VALDÉSSTROKE3Major cause of disability in developed countries [1]Direct and indirect costs in Canada: $3.6 billion [2]Most stroke survivors return homeHemiparesis (80% stroke survivors [3])Movement impairment on one side of the bodyComplete functional recovery in only 5-20% of survivors [4][1] I. L. Katzan, 2013.[2] Public Health Agency of Canada, 2009.[3] National Stroke Association, 2015.[4] G. Kwakkel et al., 2003.RREACHBULMARO VALDÉSCOMPENSATORY MOVEMENTS4Negative effects:Difficult to unlearn and could lead to painMaladaptive and could reduce range of motionDistorted joint positionsTrunk Displacement:Common when reaching and graspingOne important movement to reduce in therapy [1-3]Compensation might be the only option for certain stroke survivors[1] S. M. Michaelsen et al., 2001.[2] E. Brokaw et al., 2013.[3] M. L. Woodbury et al., 2009.RREACHBULMARO VALDÉSTRUNK RESTRAINT5• Common strategy to reduce trunk displacement• Capable of increasing range of motion of elbow and shoulder joints [1-3]However:Only passively prevents trunk displacementContinuous physical guidanceNot ideal for unsupervised therapy[1] S. M. Michaelsen et al., 2001.[2] S. M. Michaelsen et al., 2004.[3] S. Jeyaraman et al., 2010.RREACHBULMARO VALDÉSNEED Provide feedback Promote correct movement patterns6RREACHBULMARO VALDÉSSOLUTIONRepetitions7=RobotsTrack movement=Motion tracking camerasRREACHBULMARO VALDÉSRESEARCH QUESTIONS8How is trunk compensation affected by distance and height? [1]a) Could trunk compensation be decreased by force or visual feedback?b) Could one of these feedback modalities be more effective than the other one?[2]a) Could trunk compensation be decreased by visual+force+scoresor visual+force feedback?b) Could one of these feedback modalities be more effective than the other one?[3]PHASE 1 PHASE 2[1] B.A. Valdes, S.M.N. Glegg, H.F.M. Van der Loos, J. Mot. Behav., 2016.[2] B.A. Valdés, A.N. Schneider, H.F.M. Van der Loos, submitted Sep. 2016.[3] B.A. Valdes, H.F.M. Van der Loos, submitted Apr. 2017.PHASE 3RREACHBULMARO VALDÉSPHASE 19How do people reach forward and use their trunk?RREACHBULMARO VALDÉS 10PHASE 1: RECRUITMENT10 No Stroke 10 StrokeRREACHBULMARO VALDÉS 11PHASE 1: EXPERIMENTAL SETUPRobotic DevicesMotion TrackingCameraComputer ScreenRREACHBULMARO VALDÉSPHASE 1: TASK12RREACHBULMARO VALDÉSPHASE 1: RESULTS13• Stroke = more trunk movement • More trunk movement = knee height• Harder to move upRREACHBULMARO VALDÉSPHASE 214Can we reduce trunk compensation using visual or force feedback? RREACHBULMARO VALDÉS 15PHASE 2: RECRUITMENT15 StrokeRREACHBULMARO VALDÉS 16PHASE 2: EXPERIMENTAL SETUPRobotic Device Motion TrackingCameraComputer ScreenRREACHBULMARO VALDÉS 17PHASE 2: TASKTARGET TARGETRREACHBULMARO VALDÉS 18PHASE 2: FEEDBACKVISUAL FORCERREACHBULMARO VALDÉS 19RREACHBULMARO VALDÉSPHASE 2: RESULTS20-100-80-60-40-20020406080100Baseline Post Visual Post Force% Change in Trunk Displacement** **Visual Feedback:• =-45.6% SD:(45.8) • p=.004**• Effect size=0.99• 95% Interval: -70.9,-20.2Force Feedback:• =-41.1% SD:(46.1) • p=.004**• Effect size=0.89• 95% Interval: -66.7,-15.6RREACHBULMARO VALDÉSPHASE 2: RESULTS21• No feedback was superior to the other one• Some participants might find some feedback easier to use• A large proportion of people (47%) preferred to receive both feedback conditions togetherRREACHBULMARO VALDÉSPHASE 322Do we get better results when giving game scores?RREACHBULMARO VALDÉS 23PHASE 3: RECRUITMENT14 StrokeRREACHBULMARO VALDÉS 24PHASE 3: EXPERIMENTAL SETUPRobotic Device Motion TrackingCameraComputer ScreenRREACHBULMARO VALDÉSSCORES25RREACHBULMARO VALDÉSPHASE 3: RESULTS26*** ***-100-80-60-40-20020406080100Baseline Post Scores + Visual + Force Post Visual + ForceChange in Trunk Displacement (%)Trunk DisplacementScores + Visual + Force Visual + ForceAverage(SD)-51.7 (40.8) -55.2 (40.9)T-Test t(13)=-4.73 p=.000*** t(13)=-5.05 p=.000***Effect d=1.27 d=1.35Phase 3:RREACHBULMARO VALDÉSPHASE 3: RESULTS27• No information was better than the other one• People (93%) prefer to receive scoresRREACHBULMARO VALDÉSLIMITATIONS28• Small number of participants• We only had 1 session• We need larger groups + weeks of rehabilitationRREACHBULMARO VALDÉSSUMMARY29Background:Stroke is a major cause of disabilityStroke survivors compensateNeed:Need to correct movementsSolution: Robots + motion tracking camerasRREACHBULMARO VALDÉSSUMMARY30• Giving information about trunk movement can reduce compensation• Technology can be used to provide this information• Participants prefer to receive scores• It is really important that people participate in research studies REDUCING COMPENSATORY MOVEMENTS IN STROKE THERAPY THROUGH THE USE OF ROBOTIC DEVICES AND AUGMENTED FEEDBACKBULMARO VALDÉSPHD CANDIDATE ,  B IOMEDICAL  ENGINEERINGSUPERVISOR:  DR .  MACHIEL  VAN DER  LOOSRREACHBULMARO VALDÉSWHO ARE WE?2Engineers TherapistsStroke survivorsKinesiologistsNeuroscientistsCollaborateRREACHBULMARO VALDÉSSTROKE3Major cause of disability in developed countries [1]Direct and indirect costs in Canada: $3.6 billion [2]Most stroke survivors return homeHemiparesis (80% stroke survivors [3])Movement impairment on one side of the bodyComplete functional recovery in only 5-20% of survivors [4][1] I. L. Katzan, 2013.[2] Public Health Agency of Canada, 2009.[3] National Stroke Association, 2015.[4] G. Kwakkel et al., 2003.RREACHBULMARO VALDÉSCOMPENSATORY MOVEMENTS4Negative effects:Difficult to unlearn and could lead to painMaladaptive and could reduce range of motionDistorted joint positionsTrunk Displacement:Common when reaching and graspingOne important movement to reduce in therapy [1-3]Compensation might be the only option for certain stroke survivors[1] S. M. Michaelsen et al., 2001.[2] E. Brokaw et al., 2013.[3] M. L. Woodbury et al., 2009.RREACHBULMARO VALDÉSTRUNK RESTRAINT5• Common strategy to reduce trunk displacement• Capable of increasing range of motion of elbow and shoulder joints [1-3]However:Only passively prevents trunk displacementContinuous physical guidanceNot ideal for unsupervised therapy[1] S. M. Michaelsen et al., 2001.[2] S. M. Michaelsen et al., 2004.[3] S. Jeyaraman et al., 2010.RREACHBULMARO VALDÉSNEED Provide feedback Promote correct movement patterns6RREACHBULMARO VALDÉSSOLUTIONRepetitions7=RobotsTrack movement=Motion tracking camerasRREACHBULMARO VALDÉSRESEARCH QUESTIONS8How is trunk compensation affected by distance and height? [1]a) Could trunk compensation be decreased by force or visual feedback?b) Could one of these feedback modalities be more effective than the other one?[2]a) Could trunk compensation be decreased by visual+force+scoresor visual+force feedback?b) Could one of these feedback modalities be more effective than the other one?[3]PHASE 1 PHASE 2[1] B.A. Valdes, S.M.N. Glegg, H.F.M. Van der Loos, J. Mot. Behav., 2016.[2] B.A. Valdés, A.N. Schneider, H.F.M. Van der Loos, submitted Sep. 2016.[3] B.A. Valdes, H.F.M. Van der Loos, submitted Apr. 2017.PHASE 3RREACHBULMARO VALDÉSPHASE 19How do people reach forward and use their trunk?RREACHBULMARO VALDÉS 10PHASE 1: RECRUITMENT10 No Stroke 10 StrokeRREACHBULMARO VALDÉS 11PHASE 1: EXPERIMENTAL SETUPRobotic DevicesMotion TrackingCameraComputer ScreenRREACHBULMARO VALDÉSPHASE 1: TASK12RREACHBULMARO VALDÉSPHASE 1: RESULTS13• Stroke = more trunk movement • More trunk movement = knee height• Harder to move upRREACHBULMARO VALDÉSPHASE 214Can we reduce trunk compensation using visual or force feedback? RREACHBULMARO VALDÉS 15PHASE 2: RECRUITMENT15 StrokeRREACHBULMARO VALDÉS 16PHASE 2: EXPERIMENTAL SETUPRobotic Device Motion TrackingCameraComputer ScreenRREACHBULMARO VALDÉS 17PHASE 2: TASKTARGET TARGETRREACHBULMARO VALDÉS 18PHASE 2: FEEDBACKVISUAL FORCERREACHBULMARO VALDÉS 19RREACHBULMARO VALDÉSPHASE 2: RESULTS20-100-80-60-40-20020406080100Baseline Post Visual Post Force% Change in Trunk Displacement** **Visual Feedback:• =-45.6% SD:(45.8) • p=.004**• Effect size=0.99• 95% Interval: -70.9,-20.2Force Feedback:• =-41.1% SD:(46.1) • p=.004**• Effect size=0.89• 95% Interval: -66.7,-15.6RREACHBULMARO VALDÉSPHASE 2: RESULTS21• No feedback was superior to the other one• Some participants might find some feedback easier to use• A large proportion of people (47%) preferred to receive both feedback conditions togetherRREACHBULMARO VALDÉSPHASE 322Do we get better results when giving game scores?RREACHBULMARO VALDÉS 23PHASE 3: RECRUITMENT14 StrokeRREACHBULMARO VALDÉS 24PHASE 3: EXPERIMENTAL SETUPRobotic Device Motion TrackingCameraComputer ScreenRREACHBULMARO VALDÉSSCORES25RREACHBULMARO VALDÉSPHASE 3: RESULTS26*** ***-100-80-60-40-20020406080100Baseline Post Scores + Visual + Force Post Visual + ForceChange in Trunk Displacement (%)Trunk DisplacementScores + Visual + Force Visual + ForceAverage(SD)-51.7 (40.8) -55.2 (40.9)T-Test t(13)=-4.73 p=.000*** t(13)=-5.05 p=.000***Effect d=1.27 d=1.35Phase 3:RREACHBULMARO VALDÉSPHASE 3: RESULTS27• No information was better than the other one• People (93%) prefer to receive scoresRREACHBULMARO VALDÉSLIMITATIONS28• Small number of participants• We only had 1 session• We need larger groups + weeks of rehabilitationRREACHBULMARO VALDÉSSUMMARY29Background:Stroke is a major cause of disabilityStroke survivors compensateNeed:Need to correct movementsSolution: Robots + motion tracking camerasRREACHBULMARO VALDÉSSUMMARY30• Giving information about trunk movement can reduce compensation• Technology can be used to provide this information• Participants prefer to receive scores• It is really important that people participate in research studies REDUCING TRUNK MOVEMENTS IN STROKE THERAPY THROUGH THE USE OF TECHNOLOGYBULMARO VALDÉSPHD CANDIDATE ,  B IOMEDICAL  ENGINEERINGSUPERVISOR:  DR .  MACHIEL  VAN DER  LOOSRREACHBULMARO VALDÉSWHO ARE WE?2Engineers TherapistsStroke survivorsKinesiologistsNeuroscientistsCollaborateRREACHBULMARO VALDÉSSTROKEMajor cause of disability Most stroke survivors return homeWeakness on one side of their body3RREACHBULMARO VALDÉSCOMPENSATORY MOVEMENTSNegative effects:Difficult to unlearn Could lead to painCould reduce range of motionCompensation might be the only option for certain stroke survivors4RREACHBULMARO VALDÉSTRUNK RESTRAINT• Common strategy to reduce trunk displacementHowever:Only passively prevents trunk displacementNot ideal for unsupervised therapy5RREACHBULMARO VALDÉSNEEDNeed for rehabilitation programs that: Provide information to correct movement6RREACHBULMARO VALDÉSSOLUTIONRepetitions7=RobotsTrack movement=Motion tracking camerasRREACHBULMARO VALDÉSPHASE 18How do people reach forward and use their trunk?RREACHBULMARO VALDÉS 9PHASE 1: RECRUITMENT10 No Stroke 10 StrokeRREACHBULMARO VALDÉS 10PHASE 1: EXPERIMENTAL SETUPRobotic DevicesMotion TrackingCameraComputer ScreenRREACHBULMARO VALDÉSPHASE 1: TASK11RREACHBULMARO VALDÉSPHASE 1: RESULTS12• Stroke = more trunk movement • More trunk movement = knee height• Harder to move upRREACHBULMARO VALDÉSPHASE 213Can we reduce trunk movement using visual or force information? RREACHBULMARO VALDÉS 14PHASE 2: RECRUITMENT15 StrokeRREACHBULMARO VALDÉS 15PHASE 2: EXPERIMENTAL SETUPRobotic Device Motion TrackingCameraComputer ScreenRREACHBULMARO VALDÉS 16PHASE 2: TASKTARGET TARGETRREACHBULMARO VALDÉS 17PHASE 2: FEEDBACKVISUAL FORCERREACHBULMARO VALDÉSPHASE 2: RESULTS18• Visual and force information works• No information is better than the other one• People wanted Visual+ForceRREACHBULMARO VALDÉSPHASE 319Do we get better results when giving game scores?RREACHBULMARO VALDÉS 20PHASE 3: RECRUITMENT14 StrokeRREACHBULMARO VALDÉS 21PHASE 3: EXPERIMENTAL SETUPRobotic Device Motion TrackingCameraComputer ScreenRREACHBULMARO VALDÉSSCORES22RREACHBULMARO VALDÉSPHASE 3: RESULTS23• Visual+Force and Scores+Visual+Force work• No information was better than the other one• People prefer to receive scoresRREACHBULMARO VALDÉSLIMITATIONS24• Small number of participants• We only had 1 session• We need larger groups + weeks of rehabilitationRREACHBULMARO VALDÉSSUMMARY25Background:Stroke is a major cause of disabilityStroke survivors compensateNeed:Need to correct movementsSolution: Robots + motion tracking camerasRREACHBULMARO VALDÉSSUMMARY26• Giving information about trunk movement can reduce compensation• Technology can be used to provide this information• Participants prefer to receive scores• It is really important that people participate in research studies

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