Educational design insights for interprofessional immersive simulation to prepare allied health students for clinical placements.

Background: Positive outcomes of simulation programmes to prepare students for placement are widely noted. However, few studies adequately describe considerations for designing allied health placement simulations. There exists a conceptual framework to guide such simulation design, which draws on theory and educational expertise but to date lacks varied stakeholder perspectives.

Video Game-Based Trunk Exercises for Rehabilitation in Chronic Stroke Survivors: A Mixed-Methods Feasibility Study.

To assess the feasibility of video game-based trunk exercises using the Valedo system in a chronic stroke population. Ten chronic stroke survivors (eight males and two females, mean age 63 ± 15 years) were asked to complete 18 intervention sessions, each lasting 45 min., over 6-8 weeks.

Why do some people with stroke not receive the recommended 45 min of occupational therapy and physiotherapy after stroke? A qualitative study using focus groups.

Objectives: To generate qualitative data on the views of Occupational Therapists and Physiotherapists about why people do not receive the Royal College of Physicians' recommended minimum of 45 minutes (min) of daily therapy after stroke, in order to inform a Delphi study.

Design: Focus group study.

Setting: Stroke services in the South of England.

Why do some people who had a stroke not receive the recommended 45 min of occupational therapy and physiotherapy? A Delphi study.

Objectives: To gain a consensus among therapists for reasons why a person who had a stroke may not receive the Royal College of Physicians' recommended minimum of 45 min of daily therapy.

Design: Three-round remote e-Delphi study.

Setting: National study, based in the UK.

Preparing allied health students for placement: a contrast of learning modalities for foundational skill development.

Background: With increasing pressure on placement capacity for allied health students, a need for novel and creative means through which students can develop foundational skills and prepare for practice-based learning opportunities has arisen. This study aimed to explore the experiences of domestic and international first-year students completing pre-clinical preparation programs, contrasting between in-person simulation and online options to contribute to best practice evidence for program design and delivery.

Methods: First-year students from physiotherapy, podiatry and occupational therapy self-selected to either a one-weeklong in-person simulation program or an online preparation for placement program.

Validity and reliability of sensor system to measure trunk range of motion during Streamlined Wolf Motor Function Test in chronic stroke and aged-matched healthy participants.

Objective: To investigate the validity and reliability of using the Valedo® system to measure trunk Range of Motion (ROM) during performance of the streamlined Wolf Motor Function Test (SWMFT).

Methods: Twenty chronic strokes and 20 age-matched healthy participants performed SWMFT while wearing Valedo® sensors on their trunks to capture trunk movements. A paired sample T-test was used to examine the validity of the system in distinguishing between the healthy and stroke group, and between the affected and unaffected sides in the stroke group.

Task selection for a sensor-based, wearable, upper limb training device for stroke survivors: a multi-stage approach.

Purpose: Post-stroke survivors report that feedback helps to increase training motivation. A wearable system (M-MARK), comprising movement and muscle sensors and providing feedback when performing everyday tasks was developed. The objective reported here was to create an evidence-based set of upper-limb tasks for use with the system.

Instrumented trunk impairment scale (iTIS): A reliable measure of trunk impairment in the stroke population.

Background: The Trunk Impairment Scale (TIS) is recommended for use in clinical research to assess trunk impairment post-stroke. However, it is observer dependent and does not consider the quality of trunk movement. To address these challenges, this study proposes an instrumented TIS (iTIS).

New advances in mechanomyography sensor technology and signal processing: Validity and intrarater reliability of recordings from muscle.

Introduction: The Mechanical Muscle Activity with Real-time Kinematics project aims to develop a device incorporating wearable sensors for arm rehabilitation following stroke. These will record kinematic activity using inertial measurement units and mechanical muscle activity. The gold standard for measuring muscle activity is electromyography; however, mechanomyography offers an appropriate alterative for our home-based rehabilitation device.

Concurrent Validity of a Novel Wireless Inertial Measurement System for Assessing Trunk Impairment in People with Stroke.

The Trunk Impairment Scale (TIS) is recommended for clinical research use to assess trunk impairment post-stroke. However, it is observer-dependent and neglects the quality of trunk movements. This study proposes an instrumented TIS (iTIS) using the Valedo system, comprising portable inertial sensors, as an objective measure of trunk impairment post-stroke.

Rehab-Net: Deep Learning Framework for Arm Movement Classification Using Wearable Sensors for Stroke Rehabilitation.

In this paper, we present a deep learning framework "Rehab-Net" for effectively classifying three upper limb movements of the human arm, involving extension, flexion, and rotation of the forearm, which, over the time, could provide a measure of rehabilitation progress. The proposed framework, Rehab-Net is formulated with a personalized, light weight and low-complex, customized convolutional neural network (CNN) model, using two-layers of CNN, interleaved with pooling layers, followed by a fully connected layer that classifies the three movements from tri-axial acceleration input data collected from the wrist. The proposed Rehab-Net framework was validated on sensor data collected in two situations: 1) semi-naturalistic environment involving an archetypal activity of "making-tea" with four stroke survivors and 2) natural environment, where ten stroke survivors were free to perform any desired arm movement for the duration of 120 min.

Do trunk exercises improve trunk and upper extremity performance, post stroke? A systematic review and meta-analysis.

Background: Post-stroke trunk control is reported to be associated with trunk performance and recovery of the upper limb, but the evidence for the influence of trunk exercise on both of these is unclear.

Objective: To evaluate the effect of trunk exercises on trunk performance post-stroke, and to determine if these exercises result in improved upper limb function.

Methods: A comprehensive search of the literature published between January 1990 and February 2017 was conducted using the following electronic databases; AMED, CINAHL, Cochrane Library, EMBASE, MEDLINE, PsychInfo and SPORTDiscus.

Telehealth, Wearable Sensors, and the Internet: Will They Improve Stroke Outcomes Through Increased Intensity of Therapy, Motivation, and Adherence to Rehabilitation Programs?

Background And Purpose: Stroke, predominantly a condition of older age, is a major cause of acquired disability in the global population and puts an increasing burden on health care resources. Clear evidence for the importance of intensity of therapy in optimizing functional outcomes is found in animal models, supported by neuroimaging and behavioral research, and strengthened by recent meta-analyses from multiple clinical trials. However, providing intensive therapy using conventional treatment paradigms is expensive and sometimes not feasible because of social and environmental factors.

Translation of evidence-based Assistive Technologies into stroke rehabilitation: users' perceptions of the barriers and opportunities.

Background: Assistive Technologies (ATs), defined as "electrical or mechanical devices designed to help people recover movement", demonstrate clinical benefits in upper limb stroke rehabilitation; however translation into clinical practice is poor. Uptake is dependent on a complex relationship between all stakeholders. Our aim was to understand patients', carers' (P&Cs) and healthcare professionals' (HCPs) experience and views of upper limb rehabilitation and ATs, to identify barriers and opportunities critical to the effective translation of ATs into clinical practice.

A personalized sensor-controlled microstimulator system for arm rehabilitation poststroke. Part 2: Objective outcomes and patients' perspectives.

Objective: To examine the effect of home-based electrical stimulation using closed-loop control of implanted microstimulators on upper limb function and impairment, and subjects' perception of the system.

Materials And Methods: Six subjects with poststroke hemiparesis, and reduced upper limb function, who had taken part in Phase 1 of the study, were fitted with a personalized closed-loop control system (Phase 2) and used it at home during performance of functional tasks for 12 weeks (Phase 3). Main outcome measures were: Action Research Arm Test (ARAT), Fugl-Meyer upper limb assessment (FMA), and motor control (Tracking Index).

A personalized sensor-controlled microstimulator system for arm rehabilitation poststroke. Part 1: System architecture.

Objectives: For rehabilitation of the poststroke upper limb in seven subjects, an external sensor-based system controls the timing of five to seven microstimulators implanted near radial nerve branches or their motor points to sequentially extend the elbow, wrist, and fingers with thumb extension and abduction, enabled at the subject's own pace. We hypothesize this system will support sequential activation of affected upper limb muscles intended to improve functional recovery.

Materials And Methods: Presented here is a personalized sensor-controlled stimulation system, including its architecture, sensor design, and testing of equipment specific to this study, including coils and sensors.

Reliability and sensitivity of a wrist rig to measure motor control and spasticity in poststroke hemiplegia.

Background: Objective assessment of impairments after stroke is vital for evidence-based therapy and progress monitoring.

Objective: This study determines the utility of outcome measures obtained from an instrumented wrist rig for future rehabilitation trials. The tests undertaken were evaluated in terms of sensitivity to detect differences between normal and impaired participants, test-retest repeatability (repeatability coefficient and intraclass correlation coefficient [ICC]), and interrater agreement (Bland and Altman limits of agreement).

Therapeutic effectiveness of electric stimulation of the upper-limb poststroke using implanted microstimulators.

Objective: To investigate the therapeutic effect of functional exercise augmented by programmable implanted microstimulators on arm and hand function.

Design: Before and after study.

Setting: Implantation was performed in a neurosurgery unit, systems were programmed, and tests were conducted in a university laboratory and subjects exercised at home.

Poststroke upper-limb rehabilitation using 5 to 7 inserted microstimulators: implant procedure, safety, and efficacy for restoration of function.

Objective: To investigate the feasibility of implanting microstimulators to deliver programmed nerve stimulation for sequenced muscle activation to recover arm-hand functions.

Design: By using a minimally invasive procedure and local anesthesia, 5 to 7 microstimulators can be safely and comfortably implanted adjacent to targeted radial nerve branches in the arm and forearm of 7 subjects with poststroke paresis. The microstimulators' position should remain stable with no tissue infection and can be programmed to produce effective personalized functional muscle activity with no discomfort for a preliminary 12-week study.

The relationship between upper limb activity and impairment in post-stroke hemiplegia.

Purpose: To investigate the relationship between upper limb impairments and activity limitation.

Method: A cross sectional, single assessment observational study in which people with hemiplegia as a result of a stroke underwent a testing procedure in an instrumented wrist rig in which the following measures of impairment were recorded: Spasticity; motor control (ability to track a moving target); muscle activation patterns during tracking; stiffness; range of active movement and isometric muscle strength. Participants also performed clinical tests of upper limb activity (Action Research Arm Test) and hyper-tonicity (Modified Ashworth Scale).