Advances in upper limb stroke rehabilitation: a technology push

Strokes affect thousands of people worldwide leaving sufferers with severe disabilities affecting their daily activities. In recent years, new rehabilitation techniques have emerged such as constraint-induced therapy, biofeedback therapy and robot-aided therapy. In particular, robotic techniques allow precise recording of movements and application of forces to the affected limb, making it a valuable tool for motor rehabilitation. In addition, robot-aided therapy can utilise visual cues conveyed on a computer screen to convert repetitive movement practice into an engaging task such as a game. Visual cues can also be used to control the information sent to the patient about exercise performance and to potentially address psychosomatic variables influencing therapy. This paper overviews the current state-of-the-art on upper limb robot-mediated therapy with a focal point on the technical requirements of robotic therapy devices leading to the development of upper limb rehabilitation techniques that facilitate reach-to-touch, fine motor control, whole-arm movements and promote rehabilitation beyond hospital stay. The reviewed literature suggest that while there is evidence supporting the use of this technology to reduce functional impairment, besides the technological push, the challenge ahead lies on provision of effective assessment of outcome and modalities that have a stronger impact transferring functional gains into functional independence.

Assessing the effectiveness of robot facilitated neurorehabilitation for relearning motor skills following a stroke

A growing awareness of the potential for machine-mediated neurorehabilitation has led to several novel concepts for delivering these therapies. To get from laboratory demonstrators and prototypes to the point where the concepts can be used by clinicians in practice still requires significant additional effort, not least in the requirement to assess and measure the impact of any proposed solution. To be widely accepted a study is required to use validated clinical measures but these tend to be subjective, costly to administer and may be insensitive to the effect of the treatment. Although this situation will not change, there is good reason to consider both clinical and mechanical assessments of recovery. This article outlines the problems in measuring the impact of an intervention and explores the concept of providing more mechanical assessment techniques and ultimately the possibility of combining the assessment process with aspects of the intervention.

A study on effect of built forms on urban wind environment by using CFD simulations

This paper presents a numerical study of urban air-flow for a group of five buildings that is located at the University of Reading in the United Kingdom. The airflow around these buildings has been simulated by using ANSYS CFD software package. In this study, the association between certain architectural forms: a street canyon, a semi-closure, and a courtyard-like space in a low-rise building complex, and the wind environment were investigated. The analysis of CFD results has provided detailed information on the wind patterns of these urban built forms. The numerical results have been compared with the experimental measurements within the building complex. The observed characteristics of urban wind pattern with respect to the built structures are presented as a guideline. This information is needed for the design and/or performance assessments of systems such as passive and low energy design approach, a natural or hybrid ventilation, and passive cooling. Also, the knowledge of urban wind patterns allows us to develop better design options for the application of renewable energy technologies within urban environment.

Passive urban ventilation by combined buoyancy-driven slope flow and wall flow: Parametric CFD studies on idealized city models

This paper reports the results of a parametric CFD study on idealized city models to investigate the potential of slope flow in ventilating a city located in a mountainous region when the background synoptic wind is absent. Examples of such a city include Tokyo in Japan, Los Angeles and Phoenix in the US, and Hong Kong. Two types of buoyancy-driven flow are considered, i.e., slope flow from the mountain slope (katabatic wind at night and anabatic wind in the daytime), and wall flow due to heated/cooled urban surfaces. The combined buoyancy-driven flow system can serve the purpose of dispersing the accumulated urban air pollutants when the background wind is weak or absent. The microscopic picture of ventilation performance within the urban structures was evaluated in terms of air change rate (ACH) and age of air. The simulation results reveal that the slope flow plays an important role in ventilating the urban area, especially in calm conditions. Katabatic flow at night is conducive to mitigating the nocturnal urban heat island. In the present parametric study, the mountain slope angle and mountain height are assumed to be constant, and the changing variables are heating/cooling intensity and building height. For a typical mountain of 500 m inclined at an angle of 20° to the horizontal level, the interactive structure is very much dependent on the ratio of heating/cooling intensity as well as building height. When the building is lower than 60 m, the slope wind dominates. When the building is as high as 100 m, the contribution from the urban wall flow cannot be ignored. It is found that katabatic wind can be very beneficial to the thermal environment as well as air quality at the pedestrian level. The air change rate for the pedestrian volume can be as high as 300 ACH.

Study on indoor thermal environment and air quality of office rooms controlled by personal displacement ventilation using CFD

Three-dimensional computational simulations are performed to examine indoor environment and micro-environment around human bodies in an office in terms of thermal environment and air quality. In this study, personal displacement ventilation (PDV), including two cases with all seats taken and two middle seats taken, is compared with overall displacement ventilation (ODV) of all seats taken under the condition that supply temperature is 24℃ and air change rate is 60 l/s per workstation. When using PDV, temperature stratification, the characteristic of displacement ventilation, is obviously observed at the position of occupant’s head and clearer in the case with all seats taken. Verticalertical ertical temperature temperature temperature temperature temperature differences below height of the head areare under under under 2℃ in two cases in two cases in two cases in two cases in two cases in two cases in two cases in two cases with all seats taken，and the temperature with PDV is higher than that with ODV. Verticalertical ertical temperature temperature temperature temperature temperature temperature difference is under 3 under 3under 3 under 3℃ in the case in the case in the case in the case in the case in the case in the case with two middle seats taken. CO2 concentration is lower th is lower th is lower this lower this lower than 2 g/man 2 g/m an 2 g/man 2 g/man 2 g/man 2 g/m 3 in the breath zone. in the breath zone. in the breath zone. in the breath zone. in the breath zone. in the breath zone. in the breath zone. in the breath zone. in the breath zone. The results indicate that PDV can be used in the room with big change of occupants’ number to satisfy the need of thermal comfort and air quality. When not all seats are taken, designers should increase supply air requirement or reduce its temperature for thermal comfort. INDEX TERMS

Cortical activation during executed, imagined, observed, and passive wrist movements in healthy volunteers and stroke patients

Motor imagery, passive movement, and movement observation have been suggested to activate the sensorimotor system without overt movement. The present study investigated these three covert movement modes together with overt movement in a within-subject design to allow for a fine-grained comparison of their abilities in activating the sensorimotor system, i.e. premotor, primary motor, and somatosensory cortices. For this, 21 healthy volunteers underwent functional magnetic resonance imaging (fMRI). In addition we explored the abilities of the different covert movement modes in activating the sensorimotor system in a pilot study of 5 stroke patients suffering from chronic severe hemiparesis. Results demonstrated that while all covert movement modes activated sensorimotor areas, there were profound differences between modes and between healthy volunteers and patients. In healthy volunteers, the pattern of neural activation in overt execution was best resembled by passive movement, followed by motor imagery, and lastly by movement observation. In patients, attempted overt execution was best resembled by motor imagery, followed by passive movement, and lastly by movement observation. Our results indicate that for severely hemiparetic stroke patients motor imagery may be the preferred way to activate the sensorimotor system without overt behavior. In addition, the clear differences between the covert movement modes point to the need for within-subject comparisons.

Analysis of EEG signal to detect motor command generation towards stroke rehabilitation

Our aim is to reconstruct the brain-body loop of stroke patients via an EEG-driven robotic system. After the detection of motor command generation, the robotic arm should assist patient’s movement at the correct moment and in a natural way. In this study we performed EEG measurements from healthy subjects performing discrete spontaneous motion. An EEG analysis based on the temporal correlation of the brain activity was employed to determine the onset of single motion motor command generation.

A feasible study of EEG-driven assistive robotic system for stroke rehabilitation

Stroke is a medical emergency and can cause a neurological damage, affecting the motor and sensory systems. Harnessing brain plasticity should make it possible to reconstruct the closed loop between the brain and the body, i.e., association of the generation of the motor command with the somatic sensory feedback might enhance motor recovery. In order to aid reconstruction of this loop with a robotic device it is necessary to assist the paretic side of the body at the right moment to achieve simultaneity between motor command and feedback signal to somatic sensory area in brain. To this end, we propose an integrated EEG-driven assistive robotic system for stroke rehabilitation. Depending on the level of motor recovery, it is important to provide adequate stimulation for upper limb motion. Thus, we propose an assist arm incorporating a Magnetic Levitation Joint that can generate a compliant motion due to its levitation and mechanical redundancy. This paper reports on a feasibility study carried out to verify the validity of the robot sensing and on EEG measurements conducted with healthy volunteers while performing a spontaneous arm flexion/extension movement. A characteristic feature was found in the temporal evolution of EEG signal in the single motion prior to executed motion which can aid in coordinating timing of the robotic arm assistance onset.

Speech therapy after stroke: trial shows only that practice varies

Bowen and colleagues’ methods and conclusions raise concerns.1 At best, the trial evaluates the variability in current practice. In no way is it a robust test of treatment. Two communication impairments (aphasia and dysarthria) were included. In the post-acute stage spontaneous recovery is highly unpredictable, and changes in the profile of impairment during this time are common.2 Both impairments manifest in different forms,3 which may be more or less responsive to treatment. A third kind of impairment, apraxia of speech, was not excluded but was not targeted in therapy. All three impairments can and do co-occur. Whether randomised controlled trial designs can effectively cope with such complex disorders has been discussed elsewhere.4 Treatment was defined within terms of current practice but was unconstrained. Therefore, the treatment group would have received a variety of therapeutic approaches and protocols, some of which may indeed be ineffective. Only 53% of the contact time with a speech and language therapist was direct (one to one), the rest was impairment based therapy. In contrast, all of the visitors’ time was direct contact, usually in conversation. In both groups, the frequency and length of contact time varied. We already know that the transfer from impairment based therapy to functional communication can be limited and varies across individuals.5 However, it is not possible to conclude from this trial that one to one impairment based therapy should be replaced. For that, a well defined impairment therapy protocol must be directly compared with a similarly well defined functional communication therapy, with an attention control.

Feasibility study on EEG driven robotic system to realize efficient stroke rehabilitation

We aim to develop an efficient robotic system for stroke rehabilitation, in which a robotic arm moves the hemiplegic upper limb when the patient tries to move it. In order to achieve this goal we have considered a method to detect the patient's intended motion using EEG (Electroencephalogram), and have designed a rehabilitation robot based on a Redundant Drive Method. In this paper, we propose an EEG driven rehabilitation robot system and present initial results evaluating the feasibility of the proposed system.

'All in one stroke': Grimms' fairy tales and the TV-production of a new Germany

The article looks at the most recent TV adaptations of the Grimms’ fairy tales by public broadcasting. Realized and marketed as a season which started in 2008,the thirty-four currently existing individual films constitute a significant national project that presents highly appealing notions of the German past to an audience divided over national conflict and demands of globalization. With children and adolescents at the centre, the films offer the young as a generation of moral superiority that facilitates social harmony and moral consensus. This post-unification utopia is beautifully realized on screen but rests on very conservative assumptions about gender, social driving forces, and political order.