http://www.jneuroengrehab.com The most accessed research articles published by Journal of NeuroEngineering and Rehabilitation 2012-04-20T00:00:00Z The aim of this review paper is to summarize recent developments in the field of wearable sensors and systems that are relevant to the field of rehabilitation. The growing body of work focused on the application of wearable technology to monitor older adults and subjects with chronic conditions in the home and community settings justifies the emphasis of this review paper on summarizing clinical applications of wearable technology currently undergoing assessment rather than describing the development of new wearable sensors and systems. A short description of key enabling technologies (i.e. sensor technology, communication technology, and data analysis techniques) that have allowed researchers to implement wearable systems is followed by a detailed description of major areas of application of wearable technology. Applications described in this review paper include those that focus on health and wellness, safety, home rehabilitation, assessment of treatment efficacy, and early detection of disorders. The integration of wearable and ambient sensors is discussed in the context of achieving home monitoring of older adults and subjects with chronic conditions. Future work required to advance the field toward clinical deployment of wearable sensors and systems is discussed. http://www.jneuroengrehab.com/content/9/1/21 Shyamal Patel Hyung Park Paolo Bonato Leighton Chan Mary Rodgers Journal of NeuroEngineering and Rehabilitation 2012, null:21 2012-04-20T00:00:00Z doi:10.1186/1743-0003-9-21 /content/figures/1743-0003-9-21-toc.gif Journal of NeuroEngineering and Rehabilitation 1743-0003 ${item.volume} 21 2012-04-20T00:00:00Z XML This document provides a review of the techniques and therapies used in gait rehabilitation after stroke. It also examines the possible benefits of including assistive robotic devices and brain-computer interfaces in this field, according to a top-down approach, in which rehabilitation is driven by neural plasticity.The methods reviewed comprise classical gait rehabilitation techniques (neurophysiological and motor learning approaches), functional electrical stimulation (FES), robotic devices, and brain-computer interfaces (BCI).From the analysis of these approaches, we can draw the following conclusions. Regarding classical rehabilitation techniques, there is insufficient evidence to state that a particular approach is more effective in promoting gait recovery than other. Combination of different rehabilitation strategies seems to be more effective than over-ground gait training alone. Robotic devices need further research to show their suitability for walking training and their effects on over-ground gait. The use of FES combined with different walking retraining strategies has shown to result in improvements in hemiplegic gait. Reports on non-invasive BCIs for stroke recovery are limited to the rehabilitation of upper limbs; however, some works suggest that there might be a common mechanism which influences upper and lower limb recovery simultaneously, independently of the limb chosen for the rehabilitation therapy. Functional near infrared spectroscopy (fNIRS) enables researchers to detect signals from specific regions of the cortex during performance of motor activities for the development of future BCIs. Future research would make possible to analyze the impact of rehabilitation on brain plasticity, in order to adapt treatment resources to meet the needs of each patient and to optimize the recovery process. http://www.jneuroengrehab.com/content/8/1/66 Juan-Manuel Belda-Lois Silvia Mena-del Horno Ignacio Bermejo-Bosch Juan Moreno Jose Pons Dario Farina Marco Iosa Marco Molinari Federica Tamburella Ander Ramos Andrea Caria Teodoro Solis-Escalante Clemens Brunner Massimiliano Rea Journal of NeuroEngineering and Rehabilitation 2011, null:66 2011-12-13T00:00:00Z doi:10.1186/1743-0003-8-66 /content/figures/1743-0003-8-66-toc.gif Journal of NeuroEngineering and Rehabilitation 1743-0003 ${item.volume} 66 2011-12-13T00:00:00Z XML Background: Recent technological advances in integrated circuits, wireless communications, and physiological sensing allow miniature, lightweight, ultra-low power, intelligent monitoring devices. A number of these devices can be integrated into a Wireless Body Area Network (WBAN), a new enabling technology for health monitoring. Methods: Using off-the-shelf wireless sensors we designed a prototype WBAN which features a standard ZigBee compliant radio and a common set of physiological, kinetic, and environmental sensors. Results: We introduce a multi-tier telemedicine system and describe how we optimized our prototype WBAN implementation for computer-assisted physical rehabilitation applications and ambulatory monitoring. The system performs real-time analysis of sensors' data, provides guidance and feedback to the user, and can generate warnings based on the user's state, level of activity, and environmental conditions. In addition, all recorded information can be transferred to medical servers via the Internet and seamlessly integrated into the user's electronic medical record and research databases. Conclusion: WBANs promise inexpensive, unobtrusive, and unsupervised ambulatory monitoring during normal daily activities for prolonged periods of time. To make this technology ubiquitous and affordable, a number of challenging issues should be resolved, such as system design, configuration and customization, seamless integration, standardization, further utilization of common off-the-shelf components, security and privacy, and social issues. http://www.jneuroengrehab.com/content/2/1/6 Emil Jovanov Aleksandar Milenkovic Chris Otto Piet de Groen Journal of NeuroEngineering and Rehabilitation 2005, null:6 2005-03-01T00:00:00Z doi:10.1186/1743-0003-2-6 /content/figures/1743-0003-2-6-toc.gif Journal of NeuroEngineering and Rehabilitation 1743-0003 ${item.volume} 6 2005-03-01T00:00:00Z XML Background: Acquired brain injury (ABI) is the main cause of death and disability among young adults. In most cases, survivors can experience balance instability, resulting in functional impairments that are associated with diminished health-related quality of life. Traditional rehabilitation therapy may be tedious. This can reduce motivation and adherence to the treatment and thus provide a limited benefit to patients with balance disorders. We present eBaViR (easy Balance Virtual Rehabilitation), a system based on the Nintendo® Wii Balance Board® (WBB), which has been designed by clinical therapists to improve standing balance in patients with ABI through motivational and adaptative exercises. We hypothesize that eBaViR, is feasible, safe and potentially effective in enhancing standing balance. Methods: In this contribution, we present a randomized and controlled single blinded study to assess the influence of a WBB-based virtual rehabilitation system on balance rehabilitation with ABI hemiparetic patients. This study describes the eBaViR system and evaluates its effectiveness considering 20 one-hour-sessions of virtual reality rehabilitation (n = 9) versus standard rehabilitation (n = 8). Effectiveness was evaluated by means of traditional static and dynamic balance scales. Results: The final sample consisted of 11 men and 6 women. Mean ± SD age was 47.3 ± 17.8 and mean ± SD chronicity was 570.9 ± 313.2 days. Patients using eBaViR had a significant improvement in static balance (p = 0.011 in Berg Balance Scale and p = 0.011 in Anterior Reaches Test) compared to patients who underwent traditional therapy. Regarding dynamic balance, the results showed significant improvement over time in all these measures, but no significant group effect or group-by-time interaction was detected for any of them, which suggests that both groups improved in the same way. There were no serious adverse events during treatment in either group. Conclusions: The results suggest that eBaViR represents a safe and effective alternative to traditional treatment to improve static balance in the ABI population. These results have encouraged us to reinforce the virtual treatment with new exercises, so an evolution of the system is currently being developed. http://www.jneuroengrehab.com/content/8/1/30 Jose-Antonio Gil-Gomez Roberto Llorens Mariano Alcaniz Carolina Colomer Journal of NeuroEngineering and Rehabilitation 2011, null:30 2011-05-23T00:00:00Z doi:10.1186/1743-0003-8-30 /content/figures/1743-0003-8-30-toc.gif Journal of NeuroEngineering and Rehabilitation 1743-0003 ${item.volume} 30 2011-05-23T00:00:00Z XML Loss of physical mobility makes maximal participation in desired activities more difficult and in the worst case fully prevents participation. This paper surveys recent work in assistive technology to improve mobility for persons with a disability, drawing on examples observed during a tour of academic and industrial research sites in Europe. The underlying theme of this recent work is a more seamless integration of the capabilities of the user and the assistive technology. This improved integration spans diverse technologies, including powered wheelchairs, prosthetic limbs, functional electrical stimulation, and wearable exoskeletons. Improved integration is being accomplished in three ways: 1) improving the assistive technology mechanics; 2) improving the user-technology physical interface; and 3) sharing of control between the user and the technology. We provide an overview of these improvements in user-technology integration and discuss whether such improvements have the potential to be transformative for people with mobility impairments. http://www.jneuroengrehab.com/content/9/1/20 Rachel Cowan Benjamin Fregly Michael Boninger Leighton Chan Mary Rodgers David Reinkensmeyer Journal of NeuroEngineering and Rehabilitation 2012, null:20 2012-04-20T00:00:00Z doi:10.1186/1743-0003-9-20 /content/figures/1743-0003-9-20-toc.gif Journal of NeuroEngineering and Rehabilitation 1743-0003 ${item.volume} 20 2012-04-20T00:00:00Z PDF IntroductionBrand's four reasons for clinical tests and his analysis of the characteristics of valid biomechanical tests for use in orthopaedics are taken as a basis for determining what methodologies are required for gait analysis in a clinical rehabilitation context.Measurement methods in clinical gait analysisThe state of the art of optical systems capable of measuring the positions of retro-reflective markers placed on the skin is sufficiently advanced that they are probably no longer a significant source of error in clinical gait analysis. Determining the anthropometry of the subject and compensating for soft tissue movement in relation to the under-lying bones are now the principal problems. Techniques for using functional tests to determine joint centres and axes of rotation are starting to be used successfully. Probably the last great challenge for optical systems is in using computational techniques to compensate for soft tissue measurements. In the long term future it is possible that direct imaging of bones and joints in three dimensions (using MRI or fluoroscopy) may replace marker based systems.Methods for interpreting gait analysis dataThere is still not an accepted general theory of why we walk the way we do. In the absence of this, many explanations of walking address the mechanisms by which specific movements are achieved by particular muscles. A whole new methodology is developing to determine the functions of individual muscles. This needs further development and validation. A particular requirement is for subject specific models incorporating 3-dimensional imaging data of the musculo-skeletal anatomy with kinematic and kinetic data.Methods for understanding the effects of interventionClinical gait analysis is extremely limited if it does not allow clinicians to choose between alternative possible interventions or to predict outcomes. This can be achieved either by rigorously planned clinical trials or using theoretical models. The evidence base is generally poor partly because of the limited number of prospective clinical trials that have been completed and more such studies are essential. Very recent work has started to show the potential of using models of the mechanisms by which people with pathology walk in order to simulate different potential interventions. The development of these models offers considerable promise for new clinical applications of gait analysis. http://www.jneuroengrehab.com/content/3/1/4 Richard Baker Journal of NeuroEngineering and Rehabilitation 2006, null:4 2006-03-02T00:00:00Z doi:10.1186/1743-0003-3-4 The first article of a series included in this special issue for which Ugo Della Croce served as guest-editor and involving recognized researchers and groups from all around the world tackling with open issues in human movement analysis. Richard Baker reviews the state of the art and open issues in gait analysis. /content/figures/1743-0003-3-4-toc.gif Journal of NeuroEngineering and Rehabilitation 1743-0003 ${item.volume} 4 2006-03-02T00:00:00Z XML Mobility technologies, including wheelchairs, prostheses, joint replacements, assistive devices, and therapeutic exercise equipment help millions of people participate in desired life activities. Yet, these technologies are not yet fully transformative because many desired activities cannot be pursued or are difficult to pursue for the millions of individuals with mobility related impairments. This WTEC study, initiated and funded by the National Science Foundation, was designed to gather information on European innovations and trends in technology that might lead to greater mobility for a wider range of people. What might these transformative technologies be and how might they arise? Based on visits to leading mobility technology research labs in western Europe, the WTEC panel identified eight major trends in mobility technology research. This commentary summarizes these trends, which are then described in detail in companion papers appearing in this special issue. http://www.jneuroengrehab.com/content/9/1/22 David Reinkensmeyer Paolo Bonato Michael Boninger Leighton Chan Rachel Cowan Benjamin Fregly Mary Rodgers Journal of NeuroEngineering and Rehabilitation 2012, null:22 2012-04-20T00:00:00Z doi:10.1186/1743-0003-9-22 /content/figures/1743-0003-9-22-toc.gif Journal of NeuroEngineering and Rehabilitation 1743-0003 ${item.volume} 22 2012-04-20T00:00:00Z XML Background: Biomechanical energy harvesting from human motion presents a promising clean alternative to electrical power supplied by batteries for portable electronic devices and for computerized and motorized prosthetics. We present the theory of energy harvesting from the human body and describe the amount of energy that can be harvested from body heat and from motions of various parts of the body during walking, such as heel strike; ankle, knee, hip, shoulder, and elbow joint motion; and center of mass vertical motion. Methods: We evaluated major motions performed during walking and identified the amount of work the body expends and the portion of recoverable energy. During walking, there are phases of the motion at the joints where muscles act as brakes and energy is lost to the surroundings. During those phases of motion, the required braking force or torque can be replaced by an electrical generator, allowing energy to be harvested at the cost of only minimal additional effort. The amount of energy that can be harvested was estimated experimentally and from literature data. Recommendations for future directions are made on the basis of our results in combination with a review of state-of-the-art biomechanical energy harvesting devices and energy conversion methods. Results: For a device that uses center of mass motion, the maximum amount of energy that can be harvested is approximately 1 W per kilogram of device weight. For a person weighing 80 kg and walking at approximately 4 km/h, the power generation from the heel strike is approximately 2 W. For a joint-mounted device based on generative braking, the joints generating the most power are the knees (34 W) and the ankles (20 W). Conclusions: Our theoretical calculations align well with current device performance data. Our results suggest that the most energy can be harvested from the lower limb joints, but to do so efficiently, an innovative and light-weight mechanical design is needed. We also compared the option of carrying batteries to the metabolic cost of harvesting the energy, and examined the advantages of methods for conversion of mechanical energy into electrical energy. http://www.jneuroengrehab.com/content/8/1/22 Raziel Riemer Amir Shapiro Journal of NeuroEngineering and Rehabilitation 2011, null:22 2011-04-26T00:00:00Z doi:10.1186/1743-0003-8-22 /content/figures/1743-0003-8-22-toc.gif Journal of NeuroEngineering and Rehabilitation 1743-0003 ${item.volume} 22 2011-04-26T00:00:00Z XML Preventing falls and fall-related fractures in the elderly is an objective yet to be reached. There is increasing evidence that a supplementation of vitamin D and/or of calcium may reduce the fall and fracture rates. A vitamin D-calcium supplement appears to have a high potential due to its simple application and its low cost. However, published studies have shown conflicting results as some studies failed to show any effect, while others reported a significant decrease of falls and fractures. Through a 15-year literature overview, and after a brief reminder on mechanism of falls in older adults, we reported evidences for a vitamin D action on postural adaptations - i.e., muscles and central nervous system - which may explain the decreased fall and bone fracture rates and we underlined the reasons for differences and controversies between published data. Vitamin D supplementation should thus be integrated into primary and secondary fall prevention strategies in older adults. http://www.jneuroengrehab.com/content/7/1/50 Cedric Annweiler Manuel Montero-Odasso Anne Schott Gilles Berrut Bruno Fantino Olivier Beauchet Journal of NeuroEngineering and Rehabilitation 2010, null:50 2010-10-11T00:00:00Z doi:10.1186/1743-0003-7-50 /content/figures/1743-0003-7-50-toc.gif Journal of NeuroEngineering and Rehabilitation 1743-0003 ${item.volume} 50 2010-10-11T00:00:00Z XML Virtual Reality (VR) provides a unique medium suited to the achievement of several requirements for effective rehabilitation intervention. Specifically, therapy can be provided within a functional, purposeful and motivating context. Many VR applications present opportunities for individuals to participate in experiences, which are engaging and rewarding. In addition to the value of the rehabilitation experience for the user, both therapists and users benefit from the ability to readily grade and document the therapeutic intervention using various systems. In VR, advanced technologies are used to produce simulated, interactive and multi-dimensional environments. Visual interfaces including desktop monitors and head-mounted displays (HMDs), haptic interfaces, and real-time motion tracking devices are used to create environments allowing users to interact with images and virtual objects in real-time through multiple sensory modalities. Opportunities for object manipulation and body movement through virtual space provide frameworks that, in varying degrees, are perceived as comparable to similar opportunities in the real world. This paper reviews current work on motor rehabilitation using virtual environments and virtual reality and where possible, compares outcomes with those achieved in real-world applications. http://www.jneuroengrehab.com/content/1/1/10 Heidi Sveistrup Journal of NeuroEngineering and Rehabilitation 2004, null:10 2004-12-10T00:00:00Z doi:10.1186/1743-0003-1-10 /content/figures/1743-0003-1-10-toc.gif Journal of NeuroEngineering and Rehabilitation 1743-0003 ${item.volume} 10 2004-12-10T00:00:00Z XML