Mixed reality for upper-limb stroke rehabilitation

Project Information

StrokeCare

Grant agreement ID: 897489

DOI

10.3030/897489

Project closed

EC signature date 12 May 2020

Start date 1 September 2021

End date 1 May 2024

Funded under

• EXCELLENT SCIENCE - Marie Skłodowska-Curie Actions

Total cost

€ 160 932,48

EU contribution

€ 160 932,48

Coordinated by

IRENEA NEURO-RHB SOCIEDAD LIMITADA
Spain

Periodic Reporting for period 1 - StrokeCare (Mixed reality for upper-limb stroke rehabilitation)

Reporting period: 2021-09-01 to 2023-08-31

Summary of the context and overall objectives of the project

The present Marie Sklodowska Curie Action (MSCA) project “Mixed reality for upper-limb stroke rehabilitation - StrokeCare” focuses on using new technologies for upper limb rehabilitation post-stroke. Stroke's increasing prevalence and the resultant mortality and disability make this research crucial. The World Health Organization (WHO) identifies stroke as a leading cause of disability and death worldwide. Between 1990 and 2019, the incidence and deaths due to stroke, prevalence, and Disability-Adjusted Life Years (DALY) have risen.The project targets stroke patients (at least six months post-stroke), where functional recovery slows but remains vital. Developing evidence-based rehabilitation techniques is paramount.

The innovation of the StrokeCare project lay in the way cutting-edge MR interfaces were used to promote upper limb paresis rehabilitation: the combination of real objects and VR in rehabilitation. This method addresses the challenge therapists face in implementing VR due to limited IT skills. Currently, clinical scores assess upper limb function recovery, but they are time-consuming and biased. The project explored kinematics (motion analysis) for a more precise and complementary recovery measurement.

The overall objectives of the project are to study:

Oa. Whether and how cutting-edge MR rehabilitation programs can have a positive impact on functional and affective measures of upper limb deficits in brain-damaged patients.
Ob. Whether an MR motor rehabilitation program of the upper limb has a beneficial effect on the recovery of cognitive function, and more particularly, on attention deficits.
Oc. Whether motion analysis of upper limb, and more precisely jerk measurements, could be used as a measure of functional assessment and thus indicate motor recovery.

Conclusions:
1. The fellowship demonstrated that upper limb paresis in chronic stroke patients could be rehabilitated using an MR interface, showing a 2.53-point increase in the Fugl-Mayer Assessment (FMA) scale in the MR group versus 0.07 in the control group.
2. Kinematics provided a rapid assessment of upper limb function concerning gross manual dexterity, evidenced by a Pearson correlation of 59 with the Box and Block test.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

The project was developed under 4 WPs.

WP1. Experiments Development
Two experiments (E) were designed:

E1: A virtual reality (VR) interface for a rehabilitation program, created by the Universitat Politècnica de València team, tested, and adjusted.
E2: Another VR interface for a kinematics experiment.

E1. MR Rehabilitation Program
The MR program involved a cooking game where patients prepared recipes using objects like plastic vegetables and cutlery. Nine movements (prono-supination, cuts, rotations, etc.) were trained for shoulder, elbow, wrist, and finger movements.

E2. Upper Limb Kinematics in Stroke
Patients performed tasks to touch and grasp objects from a central point to various angles (0, 45, 90, 135, 180 degrees). They repeated each task five times, with automatic hand position tracking.

WP2. Piloting
Pilot studies included 30 patients (15 in MR rehabilitation, 15 in standard rehabilitation control). Data showed significant motor and cognitive improvements in the MR group. Data on motor function, cognitive abilities, and motivation were collected before and after interventions using standardized tests.
E1: Motor function data were collected using Fugl-Meyer, MFT, WMFT, BBT, MAL scales. Cognitive data using CPT, D2, Color Trail tests. Motivation data with the IMI scale.
E2: Motor function data using FMA, BBT, NHPT scales. Data preprocessing aimed to reject noise, analyzing speed, acceleration, and jerk (smoothness measure).
Main Results

E1: MR rehabilitation improved upper limb function (FMA, WMFT, BBT) but no significant difference in motivation (IMI). Both groups improved in CPT reaction time.
E2: Mean jerk values correlated with functional scales (FMA, BBT, NHPT), suggesting jerk as a reliable recovery measure.
WP3. Dissemination
E1 findings were presented at the 24th Congress of the European Society for Physical and Rehabilitation Medicine in Ljubljana, Slovenia, April 2024. E2 findings were presented at the Marie Curie Alumni Association conference in Milano, March 2024.

WP4. Management
Effective project management and timely completion of milestones in the Career Development Plan.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

Progress beyond the state of the art
Training with real objects allows proprioception feedback and recreates an ecological setting, similar to the patient’s environment. The task used for the intervention consists of a cooking game that uses local recipes.
The kinematic experiment is also very innovative. It has been found that jerk (i.e. smoothness of the movement) in reach-to-touch movements is correlated to the Fugl-Meyer Assessment Scale (FMA) score in patients between one and three months post-stroke (van Dokkum et al, 2014). The FMA is the most widespread assessment tool for motor stroke recovery. Although slower, many patients continue recovering upper-limb function after the first 3 months post-stroke (Michaelsen et al., 2006). In the second study of the project, it was tested whether a correlation between jerk and FMA score is still present in chronic patients.
Moreover, to our knowledge, this is the first study comparing kinematics with and without objects in a reach-to-touch/grasp task. Such motion analysis can provide insight into the underlying mechanisms of motor recovery and lead to more effective rehabilitation programs.

Expected results until the end of the project
The clinical intervention compares the outcomes of two rehabilitation programmes:
- Control group, where stroke patients follow a standard rehabilitation programme of physiotherapy and occupational therapy
- MR intervention group, where stroke patients follow the described MR rehabilitation programme in addition to the standard rehabilitation programme
In regard to the kinematics experiment, it is anticipated that a correlation will be identified between jerk and the FMA score (or other assessment scale scores). Object manipulation entails a more intricate programming of a movement, which should result in kinematics with objects being task-dependent and exhibiting less correlation with assessment scales.

Potential impacts
In terms of societal impact, the project demonstrates Mixed Reality (MR) technology's potential to revolutionize stroke rehabilitation through technological advancements, interdisciplinary collaboration, and data-driven personalized interventions. MR's scalability and cost-effectiveness offer promising market opportunities, particularly with the healthcare sector's shift towards digitalization. This project aligns with European policy objectives by promoting high-quality healthcare, digital transformation, and social inclusion through improved rehabilitation methods. Potential users, including healthcare providers, policymakers, and the scientific community, benefit from understanding MR's efficacy, ultimately supporting its broader adoption in clinical practice. The innovative cooking game and kinematic experiments further highlight MR's ability to provide engaging, personalized, and adaptive therapy, significantly benefiting stroke patients and therapists.

Poster 24th Congress of the European Society for Physical and Rehabilitation Medicine

Poster 10th MCAA AC