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Stroke Project Presentation Pedro Kirk 2014

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Pedro Kirk

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Transcript of Stroke Project Presentation Pedro Kirk 2014

Haptic Musical Intervention For
Post-Stroke Patients

Research Questions
1. Can specialised musical instruments help stroke patients engage in the self-management of their rehabilitation?
2. How should one go about building musical systems that may help patients engage in a positive way with very repetitive exercises?
3. Do patients prefer informal music making in group settings or as individuals?
Pedro Kirk May 2014

The project aims to investigate the potential role of music in post-stroke rehabilitation.
Presentation Overview:
Key research questions
Project motivation
Stroke and difficulties with rehabilitation
Musical interventions and other systems
Three prototypes are introduced and discussed in some detail showing methods for building the hardware and software
Developing musical stroke workshops
Feedback from 25 patients, stroke group leaders and other professionals
Evaluation of prototypes
Live Demo and Questions
4. What is the neurological basis for many stroke survivors having great difficulty in releasing objects such as cup handles?
Project Motivation
A keen interest in designing and implementing products that can potentially help people in the real world
My own grandmother has suffered from multiple mini-strokes over the last few years making this research a very personal and emotional one
After having a meeting with a stroke group, alongside a research team from Goldsmiths, and hearing so many personal stories of determination and courage I became inspired to develop some prototypes
The difficulties of stroke rehabilitation
Stroke is an attack on the brain where the blood supply is cut off for a period of time causing damage to brain cells (“What Is a Stroke? | Stroke Association” 2014)

Stroke is the second biggest cause of death in the world, according to the World Health Organisation. (WHO, 2014)

There are two standard rehabilitation techniques:

physiotherapy
occupational therapy (OT)

The former usually focuses on motor disorders, while OT covers a wider set of needs in psychological and motor disorders. (Barghout et al. 2009)

Rehabilitation is a key part of a patients’ recovery and is effective, though it has proven hard to find out how much each intervention improves beyond the natural recovery of a patient (Gresham et al. 1997)

Once a patient is medically stable they are generally sent home and receive six weeks of intensive rehabilitation including assessments from experts in physiotherapy, OT and speech therapy.
Other Stroke Interventions
Music Therapy (MT):


MT has been used to help patients to improve mood and regain physical and mental health (Kim et al. 2011)
A 2007 study of 20 patients showed significant improvement in motor skills above those seen in a control group
(S Schneider et al. 2007)
Haptic Systems
A number of papers have suggested that various haptic devises could be used for measuring improvement in post-stroke patients at far less cost than one-on-one traditional therapies (Alamri et al. 2007).

A 2003 study focuses on a Virtual Reality (VR) program with a haptic foot device used in a seated position. Patients in the study were shown to gain strength in some ankle muscles (Boian et al. 2003).

Another study also uses VR combined with a haptic glove for measuring hand and arm movements. Using two simple scenarios, a virtual squeeze ball and a maze, the patients can be measured for their abilities in grasping and steadiness of hand among others (Alamri et al. 2007).
The strength of using haptic devices is that the system can be used to give detailed measurements of a patients progress, and also measure how long they spend doing the exercises.

Other Potential Rehab Systems
Soundbeam:
A system that allows for musical interaction via a MIDI hardware setup
Can be useful where patients have very limited movement as it does not require any pressure to activate
The lack of any tactile feedback has been highlighted as problematic in long-term patient engagement by music therapists


Apollo Ensemble:
A system that allows for many different input and output scenarios such as sound and video with wireless capabilities.
various products from the range have been used in workshops for people with many different learning disabilities.
One product they have for £200 is their Dual which is a wireless squeezable trigger
It could be useful to trial some of the sensors with stroke patients but would require buying the appropriate system



Proposed Musical Interventions
As stated there are three proposed musical interventions constructed and trialled in this project with feedback from the following:

stroke survivors,
stroke group leaders
other professionals
project supervisors
Through music workshops the prototypes have been trialed using the following criteria:


Repetition:
Each prototype was used to exercise simple hand and arm movements with multiple patients

Auditory Feedback:
Immediate auditory feedback reinforcing tempo and linking movement with sound (auditory sensorimotor coupling)

Emotional Engagement:
High motivational factors of playing music in a group and acquiring new skills


Proposed Intervention 1

Musical Stress Ball
Many patients lose strength in their hand and need regular exercise to help regain enough ability for standard everyday use (Sabine Schneider et al. 2010)
The prototype allows forms of music to be played when it is squeezed as a single trigger or when squeezed and released as a double trigger
Designed to be fun in a group or individual setting

A total of 8 stress balls are used in group sessions to create music together with the following possible interactions with the stress ball.

1. Baseline (no sensing just squeezing a standard stress ball as most have experienced and got "bored" of)
2. Basic Sample/Synth Triggering
3. Sequence Stepper (scales melodies etc)


"Six weeks is ridiculous. We were told to keep stroke patients on for six weeks and that was it so we used to discharge them and readmit them for the paperwork. You can't do anything in six weeks you only just get to know somebody and you have got to have their trust." (Speech Therapist, 2014)
After the six week period the rehabilitation is reduced to around one intervention session per week
After two or three months the patients are left with a recommended exercise list only
There is not enough support for patients according to an OT


.

Proposed Intervention 2

Sound Board
Moving objects on a flat surface such as empty cans is recommended by Stroke-Rehab.com and can help improve core strength and dexterity in the hand (“Hand Exercises for Stroke Patients” 2014).
The proposed
Sound Board
intervention can be played by placing various objects such as cups and pots onto numbered felt pads
Patients can also play by simply placing their hands onto the felt pads if lifting objects is too difficult
A full 8 note scale can be triggered in 3 directions, left to right, bottom to top and diagonally as seen above

Proposed Intervention 3

Electronic Chime Bar
The final proposed intervention is based upon an ongoing study by Rebeka Bodak who is undertaking a PHD in Psychology at Aarhus University, Denmark. The study contains findings that suggest patients suffering from visuo-spatial neglect after a right hemisphere stroke may gain improvements in spatial awareness from playing specific note sequences on chime bars in a horizontal space.

A large
Acoustic Chime Bar
set was used for the study and now after positive results with two patients a new control is required to create the
Electronic Chime Bars
.

For all the music workshops
Acoustic Chime Bars
have been used as part of the group music making. One
Electronic Chime Bar
was completed for the final music workshop with some feedback attained. Long-term twelve electronic bars need to be trialled alongside the traditional
Acoustic Chime Bars
for a comparison and to see if they are useful in a larger group setting.
Methods
Developing the three prototypes has taken quite a few different approaches. Some materials were trialled and then replaced when it became apparent they were not appropriate. All three prototypes required an ability to trigger sounds within a musical software package.
Musical Stress Ball Hardware
:
During initial prototyping a ¼ " high-density antistatic conductive foam was used and tested for resistance readings using a multimeter.

The key design problem with using the conductive foam was in creating a spherical object that was flexible and durable enough to take resistance readings as well as looking and feeling like a traditional stress ball. The foam was cut in layers and covered with a coating of flexible plastic to create a squeezable ball-like shape. This was quickly dropped as a usable prototype as it was not attractive or comfortable to hold.
Building Sensors
The velostat acted as a resister between the fabric layers allowing for very sensitive pressure readings. A single wire was attached to each layer of fabric and then on to a multimeter via alligator clips for initial testing of the Musical Stress Ball.
The change in resistance was far more noticeable than with the conductive foam with a range from approx. 2.3k ohms at rest to around 200 ohms when pressed with a finger with medium force.
Alternative conductive materials were researched and used to create a more sensitive and consistent pressure sensor. The sensor used a single pressure-sensitive conductive sheet of Velostat/Linqstat between two layers of conductive fabric Ripstop.
The final hardware build was created after the first stroke group workshop highlighted some weaknesses with wires popping out of a breadboard.
To solve this problem some hard single gauge wire was cut into small lengths with different colours for each stress ball. The bare wires were hooked and wound onto the corresponding speaker wire and then soldered to create a very strong fixing.
Musical Stress Ball Software
:
The library Maxuino has been used to achieve the talking between the Arduino and Max MSP
Calibration in the live workshops was essential and after some problems in the first few workshops a system was developed that allows for easy manipulation.
Sound Board Hardware
:
Using a standard cup as the main size scale a grid was created using buttons 9x9cm. The cup was the largest trigger item with patients being able to experiment with many different items used in daily routines. The first design was sketched out as a 7x7.
ambitious as required 49 separate trigger pads
did not allow for a full 8 note octave span
It was decided to trial a simpler hardware implementation first by building a trigger representing a single square from the grid
The trigger was a pressure sensor built in a similar way to that used in the Musical Stress Balls by using layers of conductive fabric and velostat.
One layer of velostat at 9x9cm was sandwiched between two layers of conductive fabric (Ribstop) at 7.5×7.5cm to make sure there are no short circuits.
Electrical tape used to attach the layers of fabric together.
Finally two wires were attached one to each layer of fabric taking care to make sure they could not touch in any way.
A 40 way ribbon cable was ordered from China and would be enough to wire in most of the trigger pads. Unfortunately the ribbon cable took some time to arrive and with a stroke group meeting booked in a decision was made to create a smaller grid of 7 squares and used speaker wires to attach to an Arduino Leonardo.
This soon changed to a new smaller grid design to accommodate an 8 note scale.
This speaker wire was not very appropriate as it was quite thick compared to the 40 way cable on order.
The first full working Sound Board was trialled in workshop 2 and was positioned on a peice of MDF and made use of gaffa to help hold the chunky speaker wires in place.
A remake with a 16 way grey ribbon cable with soldered single core wire for the breadboard.

It was difficult to decide upon the final hardware design for the Sound Board.

Sound Board 2 required a large section of green felt and 22 separate 8x8 squares marked with a fabric pen. To make placement of the buttons easier the same markings were drawn on the bottom and top of the felt.
The sound board 2 with an Ardunio Leonardo ready to plug in.
Once the board was soldered and a test was carried out it became obvious that different sets of resisters were required to calibrate the hardware. A set of 7 58ohm resisters and 1 560 ohm for grid 1 was used.
Sound Board Software
:
The patch created in Max MSP for the Musical Stress Balls has been used to take pressure readings from the Sound Board in a very similar way. The only difference required is that the calibration settings need to be set to a higher number. Notes are triggered when the objects are placed on the felt grid. There are some key states that were thought of to discuss and test with patients during feedback sessions.

1. Baseline (no sensing just a basic object is moved for example a cup)
2. Trigger one sound per object creating multiple layers such as chords
3. Trigger sounds using the affected hand without any objects

The sound board 2 breadboard diagram
Electronic Chime Bar Hardware
:
To create twelve separate channels a USB keyboard was hacked into and mapped to trigger sounds in Max MSP using the key object.

The initial prototype took some time to perfect and caused multiple issues with reading accurately
Soldering the pins was particularly problematic as well as the selection of appropriate materials
The Sound Trigger:

After the initial three builds for the USB a trigger mechanism for the user to hit with a beater was built.
Prototype 1 was not able to perform well when a beater struck it at a certain rapidity so a completely new approach was required.
Using the conductive fabric and velostat approach to measure resistance was found to trigger sounds with a beater hitting very soft or hard and at a variety of speeds.
Electronic Chime Bar Software
:
The Electronic Chime Bars had to have their own Max MSP patch built to achieve a different set of input constraints.

To achieve sound triggers when the blocks are hit very rapidly a
bucket
object has been used that acts as an n stage shift taking a signal sample just after the primary one to help calibrate the sensitive readings.

if input signal < bucket input signal – 0.0099 then send signal
Developing the musical stroke workshops
4 specially developed musical stroke workshops have been completed.

Workshops were used to gain feedback on the proposed interventions
Also gaining knowledge on other research questions
Workshops started off with patients being conducted to play one or more popular songs on Acoustic Chime Bars
They played the root notes of chords from the song in teams of 2 or more
After this the Musical Stress Balls were introduced and one ball was assigned to each team to be played alongside the Acoustic Chime Bars
Scales (major, minor and blues) as well other simple warm-ups and melodies would then be played by up to 8 group members on the Musical Stress Balls only
Quite often any patients or group attendees who were not playing would sing along with the workshop leader
Once all the patients had played there would be a swift break followed by individual patients playing on the Sound Board
The final session gained some feedback on a single Electronic Chime Bar


Specialist Considerations:
As the stroke groups had many levels of ability, ranging from very perceptive and physically able to severally aphasic and limited physical ability, calibrating the interventions for each patient was an important consideration.

One method of inclusion that had to be looked into was allowing patients to have access to an adjustable stand for angling the position of the acoustic chime bars allowing for greater ease in playing ability.
Each statement or question in the feedback forms was designed to have minimal effort for a stroke patient to answer with a simple sliding scale of choices to answer by giving the ability to select choices with a simple tick or cross. Rebeka and her supervisor Lauren Stewart devised the initial questionnaire format and the same core set of questions were asked at every subsequent session.

Developing Feedback Forms:

Q1. I found todays session interesting

Q2. I found todays session enjoyable

Q3. I found today’s session potentially relevant for physical rehabilitation

Q4. I like the idea of informal music making

Q5. I am interested in informal music making in a group

Q6. I am interested in informal music making one-on-one

Q7. Do you have any thoughts on the potential of including music as part of physical rehabilitation you would like to share?

Q8. I enjoyed playing the acoustic chime bars

Q9. I enjoyed playing the stress ball

Q10: I enjoyed the Sound Board

Q11: I enjoyed the Electronic Chime Bar

Q12: Any other comments:


25 stroke patients answers.
Q4. I like the idea of informal music making
Q5. I am interested in informal music making in a group
Q6. I am interested in informal music making one-on-one


Q7. I enjoyed playing the acoustic chime bars
Q8. I enjoyed playing the stress ball

25 stroke patients feedback on the Sound Board
9 stroke patients feedback on the Electronic Chime Bar
Q: Do you have any thoughts on the potential of including music as part of physical rehabilitation you would like to share?


Patient 1
“I think it is possible and fun – with so much to concentrate on and possibilities to rebuild so many pathways emotionally, physically and getting the brain working”

Patient 2
“Yes because it’s better than being in an office / gym & it’s fun! – It’s inclusive for friends and family – for everyone.”





Stroke Group Helper 1
“I think this is an excellent therapy service to accompany rehab services. It’s very relaxing and as a person who has not experienced a stroke I found it very useful. Definitely should be included with therapy”

Psychologist
“I‘m not a stroke survivor but psychologist who came to observe the group. This is such a great idea, our patients are always looking for new things to try to improve their mood as well as physical health. If we could recommend these ideas as a coping strategy that would be so useful.”

Teamwork!
The Soundbeam, an infrared music system borrowed from Goldsmiths was taken to the fourth workshop. All 9 patients had a go at improvising using string and trumpet sounds with much cheering and clapping for each performance. They helped each other to play as seen below.
Helping each other and encouraging was clearly seen when playing the
Sound Board 2
. Objects were too much effort for some and they used their hands in a variety of ways to trigger sounds instead.
Thoughts on self-management of rehabilitation:
One patient in particular showed interested in playing a Musical Stress Ball at her home with her family members after completing stroke workshop 3
Patients also stated they would like to have the Sound Board 2 at home to play music on their own

Patient 1 Workshop 1
"Even when you are on your own if your even only a tiny bit musical, and everybody is whatever they say, they'll have terrific fun playing. If they can't do it with their left hand they can do it with their right hand."

Support Coordinator 1
“Anything that makes the ongoing recovery, exercise or practice more interesting is a good thing.”

Spacticity
4. What is the neurological basis for many stroke survivors
having great difficulty in releasing objects such as cup handles?

The OT explained that patients who suffer from spasticity have signals between the limb and the brain which are interrupted creating either an increase or decrease in signal flow called increased tone or hyper tone.

This can cause problems such as locked arm and locked fingers and thumb. Velocity is a problem where the speed of movement can cause locking of the affected limb. At a slower speed the arm for example can move but at a faster speed this may be stopped by rapid locking due to hyper tone. The signal in this case needs to be relaxed.


Patient motivation
Key ideas surrounding patients long-term rehabilitation from OT.

“Fear isn’t a good long-term motivator, it’s great initially.”

“It’s what they enjoy the most, intrinsic motivation is the best form of motivation. Self-management of rehabilitation, if they are motivated and do it themselves.”

“…if I was to work with someone who was passionate about music the application of your devices [proposed interventions] would be fantastic."






Evaluation
Strengths of Musical Stress Balls
Helped stroke patients to become very engaged as evidenced by a lot of laughing and cheering when songs or exercises had been completed
Workshop 4 in particular was a very lively one with many showing much enjoyment when singing and playing “Happy Birthday To You” as it was a patients birthday
Having 8 stress balls in a group meant that not many patients were left out with the maximum number at any one workshop being 9.
The OT has stated that the Musical Stress Balls could benefit people in the third phase of stroke as well as the fourth which illustrates a potential for more extensive testing


Weaknesses of Musical Stress Balls
The fact that there are still wires coming out of the stress balls is not ideal
when the calibration settings were not fully developed the hard coding in a live environment was not very satisfactory causing some frustration amongst patients
both hardware and software could be developed further

Strengths of Sound Board
Having the ability to play the same note sequence in three directions
Patients encouraged each other with words of support to stretch and lift up objects with their affected hand
The stroke group leader helped some patients by supporting their affected arm and also encouraging them to spread out their fingers and thumb to trigger sounds
Patients with more affected hands managed to trigger sounds using either their fingers, thumb, wrist or the sides of their hands
Many patients stated that they would like to have one at home as an individual exercise with one saying:



Weaknesses of Sound Board
The first Sound Board was a weak design until it was rebuilt and only just stood up to the patient use in workshops 2 and 3
Many patients with more affected hands could not cope with the weighted objects in this exercise that were trialed such as cups and pots
It is better sticking to patients initially using their hands in various ways
A musical pairs game needs to be developed still and has not be completed in time for this project but will be trialled and tested with patients in the future as many have requested follow up sessions with new ideas

Strengths of Electronic Chime Bar
The patients can play the Electronic Chime Bar in exactly the same as with the Acoustic Chime Bar allowing for an easy transition
Patients have stated they like the way one chime bar can trigger many notes
The fact it can be set to trigger percussion sounds means it is on the way to fulfilling the MVP aims set out by Rebeka Brokek
The design is now much more robust and can cater for the soft or hard hits as well as various velocities

Weaknesses of Electronic Chime Bar
Only one chime bar has been tested and this is not really enough for any conclusive results
Full testing alongside the Acoustic Chime Bars should be carried out
There is still work to be completed to smooth the signal within the hardware as well as completing the other 11 chime bars
For the clinical trials wireless versions may be required

Strengths of Acoustic Chime Bars
Weaknesses of Acoustic Chime Bars
All 25 patients managed to play a chime bar with their affected arm
Group members encouraged each other to keep at it
Each small group was given a chance to practice together which worked well to improve group timing
When a group had particular difficulty they were able to be conducted again in a practice session to improve group cohesion
We were able to offer an adjustable stand to anyone who may have needed an alternative to placing the chime bars on the table top after this requirement being noted in the first group workshop

In the first two workshops there was a patient in each who struggled to play with the chime bars lying flat on the table before we could offer an alternative
The only other complaint was when a patient stated she could not distinguish the tonal quality of the notes due to her loss of melodic perception

Future Considerations

With the motivational qualities of music and the overall positive response to the prototypes there is a strong case for developing many new ideas and trialling some more robust prototypes in clinical settings.

All three proposed interventions are still at a very basic stage of development but the Musical Stress Balls and Sound Board have performed satisfactorily in sessions providing the calibration settings are looked at frequently
This is very much an ongoing project and will allow for many more opportunities to meet stroke patients for genuine feedback and interaction with the prototypes as there are three more stroke workshops booked in for the end of May 2014
Developing any future software tracking capabilities would be a really strong feature and tablets could well be one of the best ways to get many patients using a variety of haptic devices for real time tracking

Reflection
When I started the project I had no idea how many people would be involved and how emotionally engaged I would become. Looking back from the first meeting with researchers at Goldsmiths up till now, having met with upwards of 40 different people closely involved with stoke from all walks of life, I now have a much deeper understanding of an ailment that affects just about everyone on our planet.

Communication has been at the core of the project from the outset with a clear demonstration that approaching many people with an open mind can deliver unexpected rewards. This become very apparent when one contact led to me meeting up with many patients, group leaders and the professional therapists.

Time management and keeping to an agile development strategy were both helped by keeping a detailed meetings and correspondence log as well as an online blog. The log and blog worked in tandem to help keep a clear set of goals in mind, despite the fact that the goal posts did move now and then and continue to do so.

Live Demo
25 stroke patients answers.
Q1. I found todays session interesting
Q2. I found todays session enjoyable
Q3. I found today’s session potentially relevant for physical rehabilitation

Feedback
Two designs to choose from
Sound Board 2 setting out 40 way ribbon cable
Soldering the 40 way ribbon to a PCD board
USB keyboard 2
USB keyboard 3
Mappings for the 12 triggers
First tin foil trigger pad

First copper tape trigger pad

Sketch of the circuit

Prototype 2 new design
Flow chart for Electronic Chime Bars
Questions and feedback are welcome
Methods
Developing the three prototypes has taken quite a few different approaches.

Some materials were trialled and then replaced when it became apparent they were not appropriate
All three prototypes required an ability to trigger sounds within a musical software package
The library Maxuino has been used to achieve the talking between 2 Arduino Leonardo boards and
Max MSP
Calibration in the workshops was essential and after some problems in the first few workshops the software was updated to allow for easy calibration
Building Sensors
All three prototypes have final builds using a similar pressure sensing trigger method.

A layer of Velostat acts as a resister between two layers of conductive fabric

Two wires are connected into an Arduino board to send pressure readings onto Max MSP
Velostat layers

Conductive fabric and Velostat


A sensor within a stress ball


Musical Stress Ball Flow Chart


Musical Stress Ball Breadboard


Musical Stress Ball Schematic


Pseudocode for Max MSP software


The core focus of the project was to assess if there was any interest for musical interventions to help post-stroke patients perform repetitive physical exercises.

25 stroke survivors gave feedback during music workshops on 3 musical prototypes that were built for my project

What became very apparent was that most of the patients do not do any kind of regular recommended exercises causing a heightened risk of a second stroke within five years from their initial stroke

Self motivation to do recommended exercises after they have had the initial period in hospital
Depression is very common as well as stroke fatigue


A stroke specialist occupational therapist (OT) gave an in-depth overview of four key stages in rehabilitation.

Stage 1. The initial stroke:
Survival rates are greater due to thrombolysis, being able to dissolve the clot. The general public are more aware of the need for speed.

Stage 2. Acute rehab:
Once a patient is medically stable they are generally sent home and receive six weeks of intensive rehabilitation including assessments from experts in physiotherapy, OT and speech therapy.
Stage 3. Outpatients community rehab:
After the six week period the rehabilitation is reduced to around one intervention session per week, usually performed by a neuro-therapy team. After two or three months the patients “rehab potential” is reached where the weekly intervention is ceased and the patient is left with a recommended exercise list.

“In actual fact it is not normally “rehab potential” it’s resources which is the issue. We can’t provide the service that you need.”

Stage 4. Six months to a year plus:
Patients may be ready to start thinking about the instrumental activities, the leisure, productivity, working, volunteering, having a purpose. "....there isn’t enough focus on that area at that time.”(OT, 3014)

The fourth stage is the most important for all patients involved in this study as all 25 who have been involved are in the 6-month to one year plus category. This illustrates a real need for them to be looking at secondary intervention.

OT
“The support isn’t right at the moment.”

“Stroke recovery is a life-long thing… you use it or you loose it.”

“There is a high recurrence within five years. This could be prevented with secondary prevention. There is a whole range of things people can do, and should be doing because once they have one stroke they have got an increased risk basically.”

Key Difficulties
“....it’s resources which is the issue. We can’t provide the service that you need.
The support isn’t right at the moment.” (OT, 2014)
Musical Interventions In Rehabilitation
Music Therapy (MT):


MT has been used to help patients to improve mood and regain physical and mental health (Kim et al. 2011).

A 2007 study of 20 patients showed significant improvement in motor skills above those seen in a control group.
(S Schneider et al. 2007).
Neurologic Music Therapy (NMT):

Motor recovery in stroke patients has been studied, highlighting the way repetitive movements and auditory feedback during NMT, known as auditory sensorimotor coupling, can potentially be an efficient therapy (Sabine Schneider et al. 2010)

Melodic Intonation Therapy (MIT):

MIT helps patients to regain language fluency by singing or intoning groups of words, by utilising unharmed brain functions dedicated to singing (Norton et al. 2009, 431).

Recent studies suggest that MIT can improve certain right hemisphere brain networks in patients suffering with aphasia (Hamilton et al, 2011) and Sacks states that brain plasticity allows for an aphasic patient’s neural networks to be recruited for linguistic uses through MIT (Sacks 2011, 242).
A number of papers have suggested that various haptic devises could be used for measuring improvement in post-stroke patients at far less cost than one-on-one traditional therapies (Alamri et al. 2007)
The strength of using haptic devices is that the system can be used to give detailed measurements of a patients progress, and also track how long they spend doing the exercises
Haptic Systems:
“This would be a really fun way to exercise the arm and hand together.”
A final e-mail from the OT
"I attended a Constraint Induced Movement Therapy course yesterday, and thought it would be a good opportunity to get additional feedback from the physiotherapists running the course about your project. One of the people that ran the course actually specialises in paediatric neuro rehab, and also plays the piano and she loved the stress ball concept. She felt that this would work well with children and teenagers who are not just recovering from stroke but also acquired/traumatic brain injury and other neurological conditions. She highlighted that finding fun ways to get children and young people to engage in rehab activities can be difficult and your stress ball concept could work really well."
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