A novel motion tracking system for evaluation of functional rehabilitation of the upper limbs.

Upper limb function impairment is one of the most common sequelae of central nervous system injury, especially in stroke patients and when spinal cord injury produces tetraplegia. Conventional assessment methods cannot provide objective evaluation of patient performance and the tiveness of therapies. The most common assessment tools are based on rating scales, which are inefficient when measuring small changes and can yield subjective bias. In this study, we designed an inertial sensor-based monitoring system composed of five sensors to measure and analyze the complex movements of the upper limbs, which are common in activities of daily living. We developed a kinematic model with nine degrees of freedom to analyze upper limb and head movements in three dimensions. This system was then validated using a commercial optoelectronic system. These findings suggest that an inertial sensor-based motion tracking system can be used in patients who have upper limb impairment through data integration with a virtual reality-based neuroretation system.

[Application of virtual reality in the motor aspects of neurorehabilitation]. / Aplicación de la realidad virtual en los aspectos motores de la neurorrehabilitación.

INTRODUCTION: Virtual reality allows the user to interact with elements within a simulated scene. In recent times we have been witness to the introduction of virtual reality-based devices as one of the most significant novelties in neurorehabilitation. AIM: To review the clinical applications of the developments based on virtual reality for the neurorehabilitation treatment of the motor aspects of the most frequent disabling processes with a neurological origin. DEVELOPMENT: A review was carried out of the Medline, Physiotherapy Evidence Database, Ovid and Cochrane Library databases up until April 2009. This was completed with a web search using Google. No clinical trial conducted on its effectiveness has been found to date. The information that was collected is based on the description of the various prototypes produced by the different groups involved in their development. In most cases they are clinical trials conducted with a small number of patients, which have focused more on testing the validity of the device and checking whether it works correctly than on attempting to prove its clinical effectiveness. Although most of the clinical applications refer to patients with stroke, there were also several applications for patients with spinal cord injuries, multiple sclerosis, Parkinson's disease or balance disorders. CONCLUSIONS: Virtual reality is a novel tool with a promising future in neurorehabilitation. Further studies are needed to demonstrate its clinical effectiveness as compared to the traditional techniques.

Aplicación de la realidad virtual en los aspectos motores de la neurorrehabilitación / Application of virtual reality in the motor aspects of neurorehabilitation

Introducción. La realidad virtual permite al usuario interactuar con elementos dentro de un escenario simulado. Recientemente, estamos asistiendo a la introducción de dispositivos basados en realidad virtual como una de las novedades más relevantes en la neurorrehabilitación. Objetivo. Revisar las aplicaciones clínicas de los desarrollos basados en realidad virtual para el tratamiento neurorrehabilitador de los procesos discapacitantes de origen neurológico más habituales en sus aspectos motores. Desarrollo. Se revisaron las bases de datos Medline, Physiotherapy Evidence Database, Ovid y la Biblioteca Cochrane hasta abril de 2009. Se completó con una búsqueda en la web a través de Google. Todavía no se ha podido identificar ningúnensayo clínico sobre su eficacia. La información recogida se basa en la descripción de los distintos prototipos efectuada por los respectivos grupos que han participado en su desarrollo. En la mayor parte de los casos, se trata de experiencias clínicas con un número reducido de pacientes, que se han encaminado más bien a comprobar el buen funcionamiento y validez del dispositivo que a demostrar su eficacia clínica. Aunque la mayoría de las aplicaciones clínicas se refieren a pacientes con ictus, también se han encontrado aplicaciones para pacientes con lesión medular, esclerosis múltiple, enfermedad de Parkinson o alteraciones del equilibrio. Conclusiones. La realidad virtual se presenta como una herramienta novedosa y de gran proyección en la neurorrehabilitación. Son necesarios estudios futuros que avalen su eficacia clínica frente a las técnicas tradicionales (AU)

Introduction. Virtual reality allows the user to interact with elements within a simulated scene. In recent times we have been witness to the introduction of virtual reality-based devices as one of the most significant novelties in neurorehabilitation. Aim. To review the clinical applications of the developments based on virtual reality for the neurorehabilitation treatment of the motor aspects of the most frequent disabling processes with a neurological origin. Development. A review was carried out of the Medline, Physiotherapy Evidence Database, Ovid and Cochrane Library databases up until April 2009. This was completed with a web search using Google. No clinical trial conducted on its effectiveness has been found to date. The information that was collected is based on the description of the various prototypes produced by the different groups involved in their development. In most cases they are clinical trials conducted with a small number of patients, which have focused more on testing the validity of the device and checking whether it works correctly than on attempting to prove its clinical effectiveness. Although most of the clinical applications refer to patients with stroke, there were also several applications for patients with spinal cord injuries, multiple sclerosis, Parkinson’s disease or balance disorders. Conclusions. Virtual reality is a novel tool with a promising future in neurorehabilitation. Further studies are needed to demonstrate its clinical effectiveness as compared to the traditional techniques (AU)

Kinematic analysis of the daily activity of drinking from a glass in a population with cervical spinal cord injury.

BACKGROUND: Three-dimensional kinematic analysis equipment is a valuable instrument for studying the execution of movement during functional activities of the upper limbs. The aim of this study was to analyze the kinematic differences in the execution of a daily activity such as drinking from a glass between two groups of patients with tetraplegia and a control group. METHODS: A total of 24 people were separated into three groups for analysis: 8 subjects with metameric level C6 tetraplegia, 8 subjects with metameric level C7 tetraplegia and 8 control subjects (CG). A set of active markers that emit infrared light were positioned on the upper limb. Two scanning units were used to record the sessions. The activity of drinking from a glass was broken down into a series of clearly identifiable phases to facilitate analysis. Movement times, velocities, and the joint angles of the shoulder, elbow and wrist in the three spatial planes were the variables analyzed. RESULTS: The most relevant differences between the three groups were in the wrist. Wrist palmar flexion during the back transport phase was greater in the patients with C6 and C7 tetraplegia than in the CG, whereas the highest wrist dorsal flexion values were in forward transport in the subjects with C6 or C7 tetraplegia, who required complete activation of the tenodesis effect to complete grasping. CONCLUSIONS: A detailed description was made of the three-dimensional kinematic analysis of the task of drinking from a glass in healthy subjects and in two groups of patients with tetraplegia. This was a useful application of kinematic analysis of upper limb movement in a clinical setting. Better knowledge of the execution of this movement in each of these groups allows therapeutic recommendations to be specifically adapted to the functional deficit present. This information can be useful in designing wearable robots to compensate the performance of AVD, such as drinking, in people with cervical SCI.