Search

Objective To investigate how gait parameters in children with traumatic brain injury (TBI) versus typically developing (TD) children are influenced by secondary concurrent tasks and examine the correlations between gait parameters and attention and balance in children with TBI.Methods Sixteen children with TBI (mean age, 11.63±1.89 years) and 22 TD controls (mean age, 11.41±2.24 years) participated in this case-control study. Attention and functional balance were measured using the Children’s Color Trail Test (CCTT) and Pediatric Balance Scale (PBS). All participants first walked without concurrent tasks and then with concurrent motor and cognitive tasks. The APDM Mobility Lab was used to measure gait parameters, including gait velocity, stride length, stride duration, cadence, and double support time. Repeatedmeasures analysis of variance and Spearman correlation coefficient were used for the analysis.Results Children with TBI showed significantly more deterioration in gait performance than TD children (p

Simulation is widely used in Medical Education as a teaching and learning method. The purpose of this paper is to discover the implication of the simulator into clinical trainee behaviour, medical education, and patient safety. At the other hand, a methodology of quantitative research design towards implementing Upper Limb Spasticity Simulator (ULSS) named BITA1.0 is discussed. The Descriptive Quantitative Research design is focused on formative clinical assessment with students of Master in Rehabilitation, Universiti Teknologi MARA as subjects with pre and post-response test. With the intention of implementing BITA1.0 into medical education, the result from The Descriptive Quantitative Research is essential. Keywords: simulation; spasticity; upper limb; medical education eISSN: 2398-4287© 2020. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v5iSI3.2552

Interacting with social robots has been reported as potentially beneficial for children with social communication difficulties, with one of the promising applications being the practising of social skills, such as joint attention. We present the analysis of attention skills in children with cognitive impairments over a series of child-robot interaction sessions. Here, an interaction consists of five different modules. The first module introduces the child to the robot. The next three modules are the task modules during which children are expected to improve their attention skills during the completion of a series of social tasks. The final module is a free style interaction, where the duration of interaction between the child and robot was used as a proxy to indicate the attention of the child towards a robot. Our analysis showed that the majority of the children reduced their task completion time in modules two to four, indicating an improvement in attention. Moreover, most of the children showed positive engagement towards the robot and spent an average of 120 s during the free style interaction in module five. The positive response suggests that the robot, via child-robot interaction could be a useful and engaging tool to improve attention skills of the children with cognitive impairment.

Providing optimal rehabilitation services to the broad public is one of the greatest challenges in the healthcare sector due to the shortage of rehabilitation physicians and facilities. Recent advances in digitalization and sophisticated data analytics offers new innovative ways in delivering rehabilitation services to enhance the quality of life of people with disabilities. Currently, the development of data-driven solutions for rehabilitation in Malaysia is limited due to multiple factors: medical and rehabilitation data is not digitally stored; the knowledge for the interpretation of clinical data is distributed; in particular, there is a lack of expertise in the field of medical data science. Thus, a data science platform is proposed so that medical expertise can be made available through digital services and is not dependent on human resource, location, time or financial ability. This platform is applied for the smart diagnosis of upper limb spasticity in compliance with clinical practice, and extensible for the other smart rehabilitation applications. By collaborating with the prestigious Fraunhofer Society, their knowhow in industrial data science can be brought to Malaysia towards improved health care in the country. The smart diagnosis system provides advice in classifying the severity level of upper limb spasticity based on the Modified Ashworth Scale and the Modified Tardieu scale. The basis is a measurement system for muscle signal, muscle tone and elbow motion. Users of the smart diagnosis application include rehabilitation physicians, doctors from other specialities, nurses, psychologists, physiotherapists and occupational therapists. The tools provided by the data science platform is deployed to store and analyze the clinical data. Further, the expertise of a rehabilitation physician is emulated in the form of an expert system to determine the severity level of upper limb spasticity. The digital clinical database helps medical researchers in secondary analysis towards knowledge discovery for the betterment of intervention and treatment of spasticity.

Background NeuroAid II (MLC901) is a promising therapy for stroke patients who present outside of therapeutic window for reperfusion therapy. Studies have proven its efficacy in ischemic stroke; however, data of drug safety and combination with other medications especially anticoagulants are heterogenous. We report a possible case of hepatotoxicity induced by NeuroAid II in combination with anticoagulants. Case presentation We report an elderly patient who developed symptoms of cardioembolic stroke presented outside of time window for reperfusion therapy. He was started on a regiment of statins, anticoagulation, beta blockers and NeuroAid II. One month later he presented with deranged liver enzymes. Cessation of NeuroAid II resulted in rapid improvement of transaminitis within days. Conclusions We wish to highlight the potential harmful effect of administering NeuroAid II with an anticoagulant and the importance of routine follow-up and blood monitoring in the elderly patients with stroke.

The Machine Learning Model (MLM) has garnered popularity in rehabilitation, ranging from developing algorithms in outcome prediction, prognostication, and training artificial intelligence. High-quality data plays a critical role in algorithm development. Limited studies have explored factors that may influence the MLM algorithm performance in predicting spasticity severity level. The objectives of this study were to train and validate a MLM algorithm for spasticity assessment and determine the algorithm's prediction performance in predicting ambiguous spasticity datasets. Forty-seven persons with central nervous system pathology that fulfilled the inclusion and exclusion criteria were recruited. Four biomechanical properties of spasticity were obtained using off-the-shelf wearable sensors. The data were analyzed individually, and ambiguous datasets were separated. The acceptable inertial data were used to train and validate MLM in predicting spasticity. The trained and validated MLM algorithm was later deployed to predict the ambiguous spasticity datasets. A series of MLM were applied, including Support Vector Machine, Decision Tree, and Random Forest. The MLM's performance accuracy of the validation data was 96%, 52%, and 72%, respectively. The validated MLM accuracy performance level predicting ambiguous datasets reduces to 20%, 23%, and 23%, respectively. This study elucidates data biases and variances of disease background, pathophysiological and anatomical factors that have to be considered in MLM training.

Conventional ankle rehabilitation exercises can be monotonous and repetitive. The use of robots and games can complement the existing practices, provide an engaging environment for the patient and alleviate the physiotherapist’s workload. This paper presents an ankle rehabilitation robot that uses two nitinol wire actuators and a Pong game to provide foot plantarflexion and dorsiflexion exercises. Nitinol is a type of smart material that has high volumetric mechanical energy density and can produce translational motion. A two-state discrete antagonistic control is proposed to manipulate the actuators. The system was tested on healthy participants and stroke patients. The results showed that the robot was safe and compliant. The robot did not forcefully plantarflex or dorsiflex the foot when the participant exerted opposing force. The actuators worked antagonistically to flex to the foot as intended, in sync with the up and down motions of the player’s bat in the game. These behaviors demonstrated the feasibility of a nitinol-based ankle rehabilitation robot and a simple and yet intuitive game in providing interactive rehabilitation exercise. The robot is expected to enhance the patient’s experience, participation and compliance to the rehabilitation routine and to quantitatively monitor the patient’s recovery progress.

Anomaly detection algorithms have vast applications, from fraud detection in business transactions to rare pattern detection in a production line to help prevent machinery failures. The availability of quantitative clinical data makes a compelling case for using anomaly detection algorithms in clinical settings, for instance, to help prevent diagnosis errors. This work evaluates the feasibility of using Isolation Forest algorithm for detection of spikes in surface electromyography (sEMG) of biceps and muscle resistive force in upper limb spasticity datasets. Results show that the anomaly detection in sEMG data is a good predictor for the occurrence of catch. It could be deployed in rehabilitation robotic systems for injury prevention by linking the anomaly detection to the actuation module exerting force in the system.

Spasticity refers to the abnormal symptom of having resistance in the joints when patients tried to make a movement. Patients with spasticity need to undergo multiple therapy sessions with medical intervention to ensure that the upper limb achieve maximal function. Modified Ashworth Scale (MAS) is frequently used in clinical assessment with grading on a scale. However, this scale is limited in sensitivity and the accuracy of this evaluation is dependent on the physician’s and therapist’s experience. This study suggests developing a portable measurement device kit system during clinical assessment to reduce inter- and intra-rater variability, and to assist clinicians in making quick clinical evaluation of spasticity. In this study, 19 patients were involved in the data acquisition. Assessment data from upper limb of patients with spasticity were recorded using a Manual Muscle Tester (MMT) and digital goniometer to measure force and the angular motion. During the assessment, patients were examined through slow and fast motion for spasticity evaluation. The collected data were analyzed to study intra-rater reliability value by using Statistical Package for the Social Sciences (SPSS). The results of Intraclass Correlation Coefficient (ICC) values for all patients were in range 0.78 to 0.89. It can be considered that the collected data was reliable and can be used to formulate a model towards the development of a portable device measurement kit system for upper limb spasticity.

Upper limb spasticity (ULS) is a common pathophysiological changes manifest by a structural damage towards the central nervous system (CNS) that includes brain and spinal cord. The current clinical practice of spasticity assessment utilizes Modified Ashworth Scale (MAS) as a subjective tool to measure the severity of spasticity. Lack of objective value, poor sensitivity in detecting minimal changes, and dependency to the interpretation by the assessing clinicians are the several reasons of the inter and intra-rater variability of the measurement using MAS. These limit the use of MAS in diagnosing, treating, and monitoring spasticity especially in inexperienced clinicians, hence leading to inadequate spasticity management. To overcome this problem, a study is carried out to quantify and develop a data-driven model of ULS detection based on MAS. The characteristics that detect the existence of ULS according to MAS are identified and adopted to train the machine learning models for smart diagnosis purpose to assist the physicians to effectively manage spasticity.

Technological advances in robotics have brought about exciting developments in different areas such as education, training, and therapy. Recent research has suggested that the robot can be even more effective in rehabilitation, therapy, and education for individuals with Autism Spectrum Disorder (ASD). In this paper, a comprehensive review of robotic technology for children with ASD is presented wherein a large number of journals and conference proceedings in science and engineering search engines' databases were implicated.A search for related literature was conducted in three search engines' databases, Web of Science, Scopus, and IEEE Xplore. Thematic keywords were used to identify articles in the recent ten years in titles, keywords, and abstracts. The retrieved articles were filtered, analysed, and evaluated based on specific inclusion and exclusion criteria.A total of 208 studies were retrieved, while 166 met the inclusion criteria. The selected studies were reviewed according to the type of robot, the participants, objectives, and methods. 68 robots were used in all studies, NAO robot was used in 30.5% of those studies. The total number of participants in all studies was 1671. The highest percentage of the studies reviewed were dedicated to augmenting the learning skills.Robots and the associated schemes were used to determine their feasibility and validity for augmenting the learning skills of autistic children. Most of the studies reviewed were focused on improving the social communication skills of autistic children and measuring the extent of robot mitigation of stereotyped autistic behaviours.Implications for rehabilitationSocial robots are not considered as promising tools to be utilized for rehabilitation of autistic children only, but also has been used for children and young people with severe intellectual disability.Rehabilitation for individuals with ASD using robots can augment their cognitive and social skills, but further studies should be conducted to clarify its effectiveness based on other factors such as sex, age and IQ of the participates.Robotic-based rehabilitation is not limited to the physical robots only, but virtual robots have been used also, whereas each of which can be used individually or simultaneously. However, further study is required to assess the extent of its efficiency and effectiveness for both cases.

Background Return to work is an important aspect for cardiac rehabilitation following a major cardiac event. Objective The aim was to understand the local prevalence and factors associated with returning to work in Malaysia after a cardiac event. Methods A cross sectional design was used. All patients attending the cardiac rehabilitation program after major cardiac event during an 11-months period (2011-2012) were included. Data relating to socio-demographic, work-related, risk factors and acute myocardial infarction were collected. The SF-36 questionnaire was used to assess quality of life. Regression analysis was used to determine the predicting factors to return to work. Results A total of 398 files were screened, 112 respondents agreed to participate giving a response rate of 47.3%. The prevalence of returned to work (RTW) was 66.1% [95% CI: 57.2-75.0]. Factors associated with work resumption were age (Adj. OR: 0.92 (95% CI: 0.84-0.99), diabetes mellitus (Adj. OR: 3.70, 95% CI: 1.35-10.12), Mental Component Summary (MCS) score (Adj. OR: 1.05 (95% CI: 1.01-1.09) and baseline angiography findings. Patients with single vessel and two vessel disease were 8.9 times and 3.78 times more likely to return to work compared to those with 3 vessels (Adj. OR: 8.90 (95% CI: 2.29-34.64) and Adj. OR: 3.78, (95% CI: 1.12, 12.74). Conclusions We proposed a cardiac rehabilitation program to emphasize mental health as it may improve successful return to work after cardiac event.

The application of a high-fidelity part-task trainer for clinical education on upper limb disorders allows students to carry out recurring practices, gain skills and build up their confidence prior to engaging with real patients. The standardization of the symptoms assessment assists in the improvement of clinical findings which are not just limited to spasticity, but also leadpipe rigidity and cogwheel rigidity. The deployment of the Beckhoff PC-based control technology enables high precision in simulating spasticity characteristics thus increasing trainee proficiency. With the growing number of medical schools and therapy training centers, it solves the dilemma of patient unavailability and the difficulty of obtaining patient assistance for the preparation of apprenticeship training.

Humanoids have potential in the augmentation of rehabilitation programme for children with cerebral palsy. To make the humanoid programme applicable and clinically compliant, correct interactive scenarios had to be developed. Development of Human Robot Interaction (HRI) scenario is the main focus of this study. Through discussions with clinicians and therapists, four interactive scenarios have been formulated. The researchers have designed and developed the interactive scenarios concerning the suitability of measuring items in the Gross Motor Function Measure (GMFM) that is suitable to be applied by humanoid robot NAO. Choregraphe software, a programming tool that allows programmer to create and compile the behavior of the robot was used in this study. Choregraphe Suite is a multi-platform desktop application, to create animations, behaviors and dialogs. The developed interactive scenario had undergone a face validity process. This method of validation is used to confirm through peer reviews that the content of the interactive scenario is suitable to be used for children with cerebral palsy. Thirty peer reviewers, made up by a group of physiotherapists and occupational therapists validated the suitability of the interactive scenario. The result of the validation will be explained in this paper.

The involvement of arts and psychology elements in robotics research for children with cognitive impairment is still limited. However, the combination of robots, arts, psychology and education in the development of robots could significantly contribute to the improvement of social interaction skills among children with cognitive impairment. In this article, we would like to share our work on building and innovating the costume of LUCA's robot, which incorporating the positive psychological perspectives and arts values for children with cognitive impairment. Our goals are (1) to educate arts students in secondary arts school on the importance of social robot appearance for children with cognitive impairment, and (2) to select the best costume for future child-robot interaction study with children with cognitive impairments.

Objectives: To investigate the effects of concurrent tasks (motor and cognitive) on postural control performance in children with traumatic brain injury (TBI) compared to typically developing (TD) control subjects. Methods: Sixteen children with TBI (aged 11.63±1.89 years) and 22 TD controls (aged 11.41±2.24 years) participated in this case-control study. This study was conducted between May 2016 and March 2017. Each child performed static standing under 3 different conditions: single, concurrent motor, and concurrent cognitive task. Postural control performance measure includes sway area, anterior-posterior (AP) sway velocity, medio-lateral (ML) sway velocity, AP sway distance and ML sway distance as measured using the APDM® Mobility Lab (Oregon, Portland). A repeated-measure analysis of variance was used to analyse the data. Results: We found that children with TBI showed significantly more deterioration in postural control performance than TD children (p

Components of stroke rehabilitation requires the input of dual cognitive tasks, which involves the multitask of both motor and cognitive skills simultaneously. An individual who had suffered a stroke may have problems executing dual cognitive task. Rehabilitation can help to improve the function of dual cognitive tasking. Games have been used for rehabilitation intensely. Virtual reality games have been acknowledged to assist the stroke patient in the rehabilitation process. However, stroke rehabilitations require special virtual reality game design for the patient to perform the dual cognitive task. A study has been conducted to determine the criteria and components that are directed for dual cognitive task for patients with stroke. The information was gathered through literature review and expert opinion from both the game experts, rehabilitation physicians and therapists. This paper will discuss the development of the virtual reality game incorporating dual cognitive task for stroke rehabilitation based on the principles and elements that has been identified. The focus of the study is to develop a virtual reality game on dual cognitive task for stroke patients that combine all the game elements, game type, virtual reality environment and also game theory for dual cognitive task rehabilitation. The adoption of the correct rehabilitation elements and principles in the design and development of a virtual reality game addressing dual cognitive task will be able to assist the stroke patient in the rehabilitation process.

Healthcare providers in the field of physical and rehabilitation medicine play a vital role to help patients suffering spasticity readapting themselves to their normal daily activities. Mathematical modeling of spasticity has the potential to avoid the issue of variability in the assessment of spasticity using the Modified Ashworth scale (MAS). In this work, an existing mathematical model for upper limb spasticity is verified using clinical data sets of upper limb spasticity collected in Malaysia at the level of MAS 1+. The data set consists of torque values measured at each elbow angle as the elbow extends from a full flexion position to a full extension position during slow and fast stretch of the forearm. The aim is to find out the capability of the mathematical model and lay a foundation for the future work on data-driven modeling of upper limb spasticity based on the Modified Ashworth Scale.

Dual cognitive task is a task that requires both motor and cognitive skills simultaneously. Due to the brain pathology, a stroke patient may have difficulties in performing dual cognitive task. In the field of serious games for rehabilitation one of the technique is the use of virtual reality. However, through our literature search, we found no virtual reality games designed specifically for dual cognitive task. Dual cognitive task rehabilitation requires a game design that is suitable for problems that are related to dual cognitive task and must also be suitable for stroke patient. Therefore, this paper will discuss the proposed framework design of a virtual reality game for dual cognitive task challenge for stroke rehabilitation. In order to design the framework, some known literature has been summarized. The focus of the study are performing dual cognitive task in stroke patients, virtual reality game and its challenges, game design element, game genre, virtual reality environment and also game theory for dual cognitive task rehabilitation. The expected result is the framework of virtual reality game on dual cognitive task for stroke rehabilitation.

Background. Tasks requiring simultaneous mobility and cognition (dual tasks) have been associated with incidence of falls. Although these deficits have been documented in individuals with neurologic disorder, the effect of dual task in children with traumatic brain injury has not been fully explored. Objective. To investigate the effect of dual-task (dual-motor and dual-cognitive task) conditions on spatiotemporal gait parameters during timed up and go test in children with traumatic brain injury. Methods and Material. A total of 14 children with traumatic brain injury and 21 typically developing children participated in this case-control study. Functional balance was assessed before the actual testing to predict the risk of falls. Timed up and go test was performed under single-task and dual-task (dual-motor and dual-cognitive task) conditions. Spatiotemporal gait parameters were determined using the APDM Mobility Lab system. The descriptive statistics and t-test were used to analyze demographic characteristics and repeated measure ANOVA test was used to analyze the gait parameters. Results. Under dual-task (dual-motor and dual-cognitive task) conditions during the timed up and go test, gait performance significantly deteriorated. Furthermore, the total time to complete the timed up and go test, stride velocity, cadence, and step time during turning were significantly different between children with traumatic brain injury and typically developing children. Conclusions. These findings suggest that gait parameters were compromised under dual-task conditions in children with traumatic brain injury. Dual-task conditions may become a component of gait training to ensure a complete and comprehensive rehabilitation program.

This paper explains how a humanoid robot NAO can be used as an assistive technology in specific therapy for children with cerebral palsy (CP). The role of the robot is to motivate the children as to keep them engaged in therapy. To achieve this, the robot must have appropriate appearance to be able to establish affective engagement between child and robot. In addition, the robot should exhibit the right therapeutic approach of managing children with CP. How the humanoid robot NAO acts as a tool to assist in improving the outcome of conventional therapy especially by imitation learning will also be explained. Four interactive scenarios in human-robot interaction (HRI) were designed based on the measurement items in Gross Motor Functional Measure (GMFM). The scenarios will then be constructed based on suitability that will be executed by the robot. As a result from the discussions between clinicians, therapists and engineers, four interactive scenarios consists of introductory rapport, sit to stand, body balancing and ball kicking activity have been formulated. The study has been performed in collaboration between the Faculty of Medicine and the Faculty of Mechanical Engineering at the Medical Specialist Centre, Discipline of Rehabilitation Medicine, Faculty of Medicine, UiTM Sungai Buloh, Selangor, Malaysia.

This paper presents the development process of real-time neurorehabilitation system for paediatric using autonomous humanoid robot NAO and Microsoft Kinect Motion Sensor. This neurorehabilitation system enables paediatric patients to undergo rehabilitation session anywhere with capable Internet access. Humanoid robot NAO and paediatric patients are able to imitate each other aided by Microsoft Kinect Motion Sensor for skeletal tracking movement. Required data from rehabilitation system are then uploaded to cloud server corresponding to the patient's identification. Those stored data can be accessed via monitoring website by the acknowledged therapists and psychologists. They can view the rehabilitation results and do the analysis remotely as the rehabilitation session can be done anytime without the presence of therapists and psychologists.

Various ankle rehabilitation robots have been developed in the recent decade to improve ankle strength and mobility and to alleviate the burdens on clinicians and physiotherapists. However, existing designs have stiff actuating mechanism, heavy and bulky electromagnetic or pneumatic actuators. This paper introduces ankle rehabilitation robot that utilizes Shape Memory Alloy (SMA) wire actuator to provide foot plantarflexion and dorsiflexion during rehabilitation exercise. SMA wire is a smart material that can contract when it is heated and expand back to its original shape when it is cooled. It also has high power to weight ratio. However, the SMA wire has low cooling rate thus limits its operating frequency. A periodical cooling mechanism is proposed here. Its efficacy is then evaluated against natural cooling and continuous forced convection. The experimental study shows promising results and demonstrates that periodical cooling has both the advantages of natural cooling and forced convection and can improve the cooling rate of SMA wire actuator.

This paper describes a system-level design for an upper limb spasticity part-task trainer driven by clinical data stored in a cloud database. The robotic part-task trainer has been developed for pre-clinical training of medical personnel on the evaluation of upper limb spasticity based on the Modified Ashworth Scale. The cloud-based system enables continuous updating of clinical data of upper limb spasticity by rehabilitation physicians. Multiple part-task trainers can be connected to the cloud database via the internet, thus enabling the remote coaching of trainees and instant feedback of professional therapists and clinicians to the trainees. It is expected that the functionality provided by the cloud technology will benefit the pedagogy of medical education in the future.

Gaming systems have been proven to be able to improve physical and cognitive skills. Several studies have integrated games to be part of rehabilitation program to improve functional ability of human limbs in performing activities of daily living. This paper presents the development of an interactive electromyogram (EMG) based PONG game for foot dorsifexion and plantarflexion exercise. PONG game is selected because it is a classical game that can be easily comprehended and can be played by young and old people. Two surface EMG sensors were used in this work to acquire muscle activity of tibialis anterior muscle and gastrocnemius muscle. An experimental study was carried out to examine the viability of this sensor as input to play the game. The results were satisfactory. This study further strengthens the viability of using muscle activity as an input for gaming system and as a mean to monitor patient rehabilitation progress.

Children born with disabilities are now under the spotlight where researchers worldwide are exploring the applications of robots for possible intervention methods. However, these children are in the most ‘vulnerable’ group of research subjects and ethical considerations are paramount towards research developments in human-robot interaction (HRI) that are accurate and responsible. Based on prior and current experiences, this paper focuses specifically on the clinical applications of robots in therapy for children with autism. A set of procedures is proposed to serve as guidelines to researchers who are looking into this research area. Considerations of the technical and ethical context, plus the role of multidisciplinary teams from engineering and medical backgrounds need to come together to fulfill the research aim. Then only the increased validity of robotic applications in therapeutic context for autism intervention can be established.