Development of the System
This presentation is the property of its rightful owner.
Sponsored Links
1 / 31

Dr. Olga Jafarova , Ph.D., Mr. Eugen Tarasov , MS, PowerPoint PPT Presentation


  • 119 Views
  • Uploaded on
  • Presentation posted in: General

Development of the System for Continuous Medical Rehabilitation for Patients with Post-Stroke and Spinal Cord Injury Motor Disorders. Dr. Olga Jafarova , Ph.D., Mr. Eugen Tarasov , MS,

Download Presentation

Dr. Olga Jafarova , Ph.D., Mr. Eugen Tarasov , MS,

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Dr olga jafarova ph d mr eugen tarasov ms

Development of the System for Continuous Medical Rehabilitation for Patients with Post-Stroke and Spinal Cord Injury Motor Disorders

Dr.Olga Jafarova, Ph.D., Mr. Eugen Tarasov, MS,

Prof.Mark Shtark, MD, Ph.D.Institute for Molecular Biology and Biophysics of Russian Academy of Medical Sciences, Novosibirsk

Dr.Ruslana Yu. Guk, MDCenterforNeurorehabilitationSiberian Clinical Centre FMBA of the Ministry of Health and Social Development, Krasnoyarsk


Dr olga jafarova ph d mr eugen tarasov ms

  • The project is aimed to providea continuous course of medical rehabof the patients with motor disordersand limited physiological functioning(post-stroke, craniocerebral or spinal cord injury)

  • There are a lot of high-tech neuro-rehabilitation technologies which can be applied at hospitals and rehab centers:

    • Neuro-Robotics

    • Neural Prostheses

    • Virtual Rehabilitation

What can be used at patient’s HOME?


Dr olga jafarova ph d mr eugen tarasov ms

Point of Care Technologies

Quality-of-Life Technologies

Connected Health Technologies

“Smart Home” - a home environment “equipped with automated devices specifically designed for remote health care” (Rialle et al., 2002)

Telemonitoring - assess fall risk, control gait

Telediagnosis - evaluation of health status or rehab outcome

Telerehabilitation – inexpensive apparatus(Foot Mentor, Hand Mentor, Balance Trainer)


Dr olga jafarova ph d mr eugen tarasov ms

The principal aspect, which should be ensured during in-home rehabilitation is providing a total safety of a patient and securing sufficient level of professional control of the training process

Furthermore, it is necessary to provide the possibility of conducting rehabilitation sessions asynchronously, that is to separate in time:

doctor’s recommendations for home training,

fulfillment of these recommendations by a patient,

analysis of results


Dr olga jafarova ph d mr eugen tarasov ms

State-of-the-art rehabilitation technologies use feedback signals

Biological feedback (BIOFEEDBACK) technologywhich considers a patient as anactive subjecttake central position in all rehab models


Dr olga jafarova ph d mr eugen tarasov ms

Method

The project “Network NeuroRehabilitation” (NNR) comprisesa complexof neuro-rehabilitation technologiesbased on the electro-myographic (EMG)biofeedback which can be used not onlyin hospitals, but at home.

Thresholds

BOSLAB system screenshotof EMG biofeedback training – if Integral EMG is abovethe threshold Audio feedback signal appears


Dr olga jafarova ph d mr eugen tarasov ms

Multimedia and game-like sessions increase patient’s motivation for rehabilitation


Dr olga jafarova ph d mr eugen tarasov ms

Screenshot of a game form of EMG biofeedback If EMG signal lies in the range between the thresholds in so called target zone a flower grows and blooms


Dr olga jafarova ph d mr eugen tarasov ms

Structure of Network Rehabilitation

In the clinic or rehab centrea patient masters the required program of rehabilitation and gets the necessary instructions to continue practicing at home

At home the patient continues practicing rehab procedures, regularly sends out training reports and data, and gets more recommendations from the therapist


Dr olga jafarova ph d mr eugen tarasov ms

System of continuous distant medical rehabilitation

Interaction of Doctor and Patient

Level 2

Network information processing

Data & Reports

https

https

http

http

Level 3

Level 1

Doctor

Boslab

Biofeedback

System

Patient

Decision

making by

Rehab.

Specialist

Patient’s PC at Home

Rehab procedures

Training reports&data


Dr olga jafarova ph d mr eugen tarasov ms

System in action

Asynchronousaccess to portal

In the proposed structure there is no need for rehab specialist and patient to conduct training sessions in teleconference regime, therefore the process can be organized with greater flexibility.

0101

10…

0101

10…

0101

10…

0101

10…

0101

10…

0101

10…

0101

10…

0101

10…

0101

10…

0101

10…

0101

10…

0101

10…

0101

10…

0101

10…

0101

10…

0101

10…

0101

10…

0101

10…

0101

10…

0101

10…

On-line session

0101

10…

0101

10…

Doctors

Patients


Dr olga jafarova ph d mr eugen tarasov ms

On-line session

Patient

Internet

Doctor


Dr olga jafarova ph d mr eugen tarasov ms

Local and Server

Data Synchronization

Raw Data Dynamics

in Training Sessions

  • Pair Muscles Training (m. gastrocnemiusactivation by turns)

  • EMG Integral and Thresholds

  • Right

  • Left

L R

R L R L

Labels: Tense Right, Relax, Tense Left

Task: Tense Relax Tense Left Right Muscle Muscle

Session statistics

EMG averaged over periods

activation/relaxation, mkV


Experimental group and procedure

Experimental Group and Procedure

Since 2007 theSiberian Clinical Centre FMBA (Krasnoyarsk) has been a clinical base of the project

Experimental group: 73 patients who manifested severe motor disorders.

Among them 30 post-stroke 43 SCI consequences

Control group: 35 disabled in-patients of the Siberian Clinical Centre FMBA with motor disorders of the same origin who were examined in 2011-2012


Dr olga jafarova ph d mr eugen tarasov ms

Experimental Group and Procedure

At the first stage the patients underwent 5 to 10 sessions of EMG biofeedback at the hospital to get the required training skills. The choice of training type depended on the clinical picture of the disease

Patients with high muscle tone underwent the treatment of excessive spasticity, mainly aimed at spastic muscles’ relaxation and the rest practiced increasing muscle strength (alternation of activation and relaxation)

Later at home they continued practicing muscle activation and relaxation exercise 3 to 5 times a week during 2 to 4 months, depending on the severity of the cases and the level of affection, using distant network neuro-rehabilitation.


Experimental group and procedure1

Experimental Group and Procedure

Testing was conducted at the end of staying in a rehabilitation center and after the distant rehabilitation, which usually coincided with the rehospitalization

For the control group the testing was performed at the end of the period of staying in a rehabilitation center and before the next hospitalization

We used the following scales:

  • Modified Ashworth Scale for Grading Spasticity

  • Barthel ADL Index

  • Motor and Sensory Examination of ISCSCI-92


Dr olga jafarova ph d mr eugen tarasov ms

Dynamics of amplitude of hip joint movement(19 patients with SCI, group average)

5 Scores

Before

After

Network NeuroRehabilitationOutcome:

stable increase in EMG amplitude

increase of muscle strength

increase of limbs’ circumference and joint range of motions

improvement of the superficial sensitivity

reduction of anxiety and depression

***

4

***

*

**

**

**

**

3

2

1

0

Before

After

Unbending

Bending

Abduction

Adduction

Rotation outside

Rotation inside


Dr olga jafarova ph d mr eugen tarasov ms

Case study 1

PatientV. age: 50. Post-stroke Left side hemi paresis

EMG Dynamics in m. Tibialis anterior,left

04.12.09 :EMG biofeedback training at Rehab center

17.12.09 :Beginning of distant rehabilitation

03.02.10 :after 2 month of distant rehabilitation

400

300

200

100

0

100

200

300

400

Dynamics in m.Bicepsfemoris, left side

Dynamics in m. Gastrocnemius, left side

300

300

200

200

100

100

0

0

100

200

300

400

500

100

200

300

400

500


Dr olga jafarova ph d mr eugen tarasov ms

Case study 2

Patient M, age: 21. Lower paraparesis.

Dynamics in m.Biceps femoris, right side

500

400

18.08.09 Beginning training in Rehab center

02.12.09 Session of distant rehabilitation at home

300

200

100

0

100

200

300

400

500

EMG Dynamics in m. Gastrocnemius:left , right

Beginning of distant rehabilitation 20.08.09

Session of distant rehabilitation 20.01.10

80

60

20

40

15

20

10

0

100

200

300

100

200

300

400

500


Dynamics during network neuro rehabilitation course low spasticity subgroup

Dynamics during Network Neuro-Rehabilitation courseLow Spasticity Subgroup

NNR Group

195

80

1.5

85

ISCSCI-Sensory

ISCSCI-Motor

ADL Index

Ashworth Scale

(N=56)

P=0.028

P=0.000

Control Group

(N=27)

1

78

190

80

Before

After

0.5

185

76

75

P=0.000

p – level of significance

Wilcoxon matched pairs test

74

0

180

70

Before

After

Before

Before

After

After


Dynamics during network neuro rehabilitation course high spasticity subgroup

Dynamics during Network Neuro-Rehabilitation courseHigh Spasticity Subgroup

NNR Group

3.5

170

65

75

ISCSCI-Motor

ADL Index

ISCSCI-Sensory

Ashworth Scale

(N=17)

Control Group

(N=8)

P=0.004

3

160

60

70

Before

After

55

150

2.5

65

p – level of significance

Wilcoxon matched pairs test

2

50

140

60

Before

After

Before

Before

After

After


Discussion

Discussion

The results of patients’ examination before and after distant rehab showed that for the patients with increased spasticity the efficiency of biofeedback training was less pronounced. This could be due to their low motivation related to the relaxation training, as these patients wanted to improve their movement ability and increase self-service, for which purpose they thought it was expedient to practice muscle activation, not relaxation.

Therefore we believe that for patients with increased muscle tone the biofeedback relaxation training at home should be more exciting, with a sufficient motivational component


Discussion1

Discussion

In our study, during the relaxation training, the patient tried to relax muscles and increase the skin temperature, at the same time trying to keep the EMG signal on the monitor lower than the threshold set by the program. Upon reaching the required level of muscle relaxation a movie or slide show could be viewed without distortion, the flowers were growing, the mosaic pictures were opening


Dr olga jafarova ph d mr eugen tarasov ms

The use of the immersive virtual/ augmented reality aiming to relax muscle

is still a challenge


Dr olga jafarova ph d mr eugen tarasov ms

http://www.wilddivine.com.

http://www.wilddivine.com.

The most famous training set to develop the skills of self-control, uses cardio intervals and skin conductance, but not muscle characteristics


Dr olga jafarova ph d mr eugen tarasov ms

GAME BIOFEEDBACK

Control parameter Heart Rate


Functional independence assessment with and without network rehab

Functional Independence Assessmentwith and without Network Rehab

70

FIM(TM) score

P=0,02

60

NNR Group

(N=12)

Control

(N=23)

50

40

After Rehab 1

Before Rehab 2


Acknowledgments network neurorehabilitation project team

Acknowledgments: Network NeuroRehabilitationProject Team

  • Chernikova, L.A.

  • Shtark, M.B.

  • Sklyar, M.M.

  • Sokolov, A.V.

  • Tarasov, E.A.

  • Tarasevich, A.F.

  • Terleev A.A.

  • Tzirkin, G.M.

  • Voroninskiy, V.A.

The project made it real to rehabilitate the patients with severe motor disorders on everyday basis and secured constant contact between patients and therapists


Network neurorehabilitation project members

Network NeuroRehabilitation Project members:

  • Research Institute for Molecular Biologyand Biophysics of the Russian Academy of Medical Sciences

  • Siberian Clinical Centre of Federal Medical Biological Agency

  • Biofeedback Computer Systems Ltd.

  • Non-commercial InternationalCharity Foundation “SM, Charity”

  • Neurology Scientific Centerof the Russian Academy of Medical Sciences


Dr olga jafarova ph d mr eugen tarasov ms

THANK YOU!


  • Login