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Technology applied in neurorehabilitation: a comparative study between the use of conventional therapies and therapies assisted with new technologies in patients affected by a cerebrovascular accident
Get PDFIntroducción:
Los avances en neurociencia y neurotecnología están transformando la rehabilitación del ictus. Las terapias asistidas por tecnologías avanzadas están adquiriendo cada vez mayor importancia debido a su capacidad para incorporar los elementos clave para una rehabilitación efectiva según la evidencia científica: intensidad, repetición, intervención temprana y la aplicación de terapias desafiantes, motivadoras y centradas en la función. En este contexto, dispositivos como MERLIN (sistema robótico basado en juegos serios) y FESIA GRASP (dispositivo basado en electroestimulación eléctrica funcional) pueden suponer un gran avance en la neurorrehabilitación del miembro superior con deterioro en la función motora. En la investigación y aplicación de tecnologías avanzadas dentro del ámbito biosanitario, se hacen imprescindibles la evaluación de dos factores: la usabilidad y la efectividad. Los estudios de usabilidad son fundamentales para el éxito de la implementación, ya que determinan en gran medida la utilidad, viabilidad y aceptación de una tecnología o producto. La efectividad proporciona una evaluación sólida del impacto de estas tecnologías avanzadas en los resultados clínicos de salud, fundamental para comprender su verdadero valor y beneficio en la práctica médica.
Objetivos:
Proyecto Merlín: Evaluar la usabilidad del dispositivo Merlín, así como demostar la viabilidad de incluir esta tecnología como complemento a un programa regular de telerehabilitación. Valorar la motivación y adhesión al tratamiento. Proyecto Fesia Grasp: Evaluar la efectividad en términos de recuperación motora del miembro superior, comparando resultados clínicos tras la aplicación de terapias convencionales frente a terapias asistidas por tecnologías avanzadas.
Material y métodos:
Proyecto Merlín: ensayo clínico con producto biosanitario, unicéntrico, abierto, longitudinal y no controlado. Nueve participantes en tres etapas diferentes de recuperación tras un ictus (subaguda, crónica a corto plazo y crónica a largo plazo) con función del brazo/mano deteriorada, fueron reclutados para usar el sistema MERLIN durante 3 semanas: 1 semana de entrenamiento en el Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), y 2 semanas en los domicilios de los pacientes. Para evaluar la usabilidad, se utilizó la Escala de Usabilidad del Sistema (SUS), el Inventario de Motivación Intrínseca Adaptada (IMI), la Evaluación de Usuario de Quebec de Satisfacción con la Tecnología Asistiva (QUEST) y el Cuestionario de Evaluación de Usabilidad de ArmAssist en el post-intervención. Se evaluaron los resultados clínicos de la función motora del miembro superior antes y después de la intervención. Proyecto Fesia Grasp: ensayo clínico con producto biosanitario controlado, aleatorizado y con evaluación ciega por terceros. 16 participantes en una fase de recuperación tras un ictus comprendida entre 1 y 8 meses, con afectación motora del miembro superior, fueron reclutados para completar 12 sesiones de rehabilitación. Los participantes fueron asignados aleatoriamente al grupo con Fesia Grasp o al grupo Control, ambos grupos con la misma duración de tratamieno. Las medidas de resultado, realizadas pre y post intervención, incluyeron la escala Fulg Meyer Assesment-upper extremity (FMA-UE), la escala de fuerza muscular modificada Medical Research Council (FMMMRC), la fuerza de agrre medida con dinamómetro, la escala modificada de Asworth (MAS) y la prueba de Box and Blocks Test (BBT). También se incluyó la escala IMI y una encuesta semiestructurada de usabilidad.
Resultados:
Proyecto Merlín: 9 pacientes completaron el estudio. Los resultados en la evaluación de usabilidad informaron de un alto nivel de satisfacción: puntuación media SUS 71,94 % (DE = 16,38), escala QUEST media 3,81 (DE = 0,38) y puntuación IMI adaptada media 6,12 (DE = 1,36). Los resultados del Cuestionario ArmAssist mostraron una media de 6 sobre 7, lo que indica que MERLIN es extremadamente intuitivo, fácil de aprender y fácil de usar. En cuanto a la evaluación clínica, las puntuaciones de Fugl-Meyer mostraron mejoras moderadas después de la intervención, en la puntuación total de la función motora (p = 0,002). No hubo cambios significativos en los resultados de la escala de Ashworth modificada (p = 0,169). Proyecto Fesia Grasp: 16 pacientes completaron el estudio. Tras 12 sesiones de rehabilitación, el grupo con Fesia Grasp obtiene diferencias significativas en todas las variables de la escala FMA-UE (muñeca p=0.005, mano p=0,022 y función motora total p=0,001), en 3 variables de la escala FMMMRC (flexión de muñeca p=0,007, extensión de muñeca p=0,033, flexión de dedos p=0,026) y en el BBT (p=0,036). El grupo control solo muestra diferencias significativas en la variable “mano” para la escala FMA-UE (p=0.014). Los resultados de la escala IMI y encuestas semiestructurada, muestran que la usabilidad del dispositivo es alta.
Conclusiones:
Proyecto Merlín: La rehabilitación domiciliaria de miembros superiores con el sistema MERLIN es factible, útil, segura y motivadora en pacientes con deterioro de la función motora del miembro superior después de sufrir un ictus. La viabilidad del sistema MERLIN como una solución de rehabilitación de bajo costo y fácilmente adaptable para su uso en el hogar, resalta su capacidad para impulsar la telerehabilitación, aumentar la intensidad de las terapias y fortalecer la autonomía del paciente durante su proceso de recuperación. Proyecto Fesia Grasp: Este estudio muestra que la aplicación de Fesia Grasp en la rehabilitación post-ictus es efectiva para mejorar la función motora, fuerza muscular y destreza manual a corto plazo del miembro superior distal. La alta repetitividad de movimientos durante las sesiones se vincula con resultados positivos, sugiriendo que la terapia asistida con FES potencia el aprendizaje motor. La usabilidad, la motivación de los participantes y la ausencia de eventos adversos respaldan la integración exitosa de Fesia Grasp en la práctica clínica.Introduction:
Advances in neuroscience and neurotechnology are transforming stroke rehabilitation. Therapies assisted by advanced technologies are gaining increasing importance due to their ability to incorporate key elements for effective rehabilitation according to scientific evidence: intensity, repetition, early intervention, and the application of challenging, motivating, and function-centered therapies. In this context, devices like MERLIN (a serious game-based robotic system) and FESIA GRASP (a device based on functional electrical stimulation) could represent a significant advancement in upper limb neurorehabilitation for individuals with impaired motor function. In the research and application of advanced technologies within the biomedical field, the assessment of two factors becomes essential: usability and effectiveness. Usability studies are critical for successful implementation, as they largely determine the utility, feasibility, and acceptance of a technology or product. Effectiveness provides a solid assessment of the impact of these advanced technologies on clinical health outcomes, essential for understanding their true value and benefit in medical practice.
Objectives:
MERLIN Project: To evaluate the usability of the MERLIN device, as well as to demonstrate the feasibility of including this technology as a complement to a regular telerehabilitation program. To assess motivation and treatment adherence. Fesia Grasp Project: To evaluate the effectiveness in terms of upper limb motor recovery, comparing clinical outcomes following conventional therapies versus therapies assisted by advanced technologies.
Materials and Methods:
MERLIN Project: Clinical trial with a biomedical product, single-center, open-label, longitudinal, and uncontrolled. Nine participants at different stages of stroke recovery (subacute, short-term chronic, and long-term chronic) with impaired arm/hand function were recruited to use the MERLIN system for 3 weeks: 1 week of training at the Maimonides Biomedical Research Institute of Córdoba (IMIBIC), and 2 weeks at patients' homes. Usability was assessed using the System Usability Scale (SUS), the Intrinsic Motivation Inventory-Adapted (IMI), the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST), and the ArmAssist Usability Evaluation Questionnaire post-intervention. Clinical outcomes of upper limb motor function were evaluated before and after intervention. Fesia Grasp Project: Controlled clinical trial with a biomedical product, randomized, and blinded evaluation by third parties. Sixteen participants in the stroke recovery phase ranging from 1 to 8 months, with upper limb motor impairment, were recruited to complete 12 rehabilitation sessions. Participants were randomly assigned to the Fesia Grasp group or the Control group, both with the same treatment duration. Outcome measures, performed pre- and post-intervention, included the Fulg Meyer Assessment-upper extremity (FMA-UE) scale, modified Medical Research Council (MRC) muscle strength scale, grip strength measured with a dynamometer, modified Ashworth scale (MAS), and the Box and Blocks Test (BBT). The IMI scale and a semi-structured usability survey were also included.
Results:
MERLIN Project: 9 patients completed the study. Usability evaluation results reported a high level of satisfaction: mean SUS score 71.94% (SD = 16.38), mean QUEST scale 3.81 (SD = 0.38), and mean adapted IMI score 6.12 (SD = 1.36). ArmAssist Questionnaire results showed a mean score of 6 out of 7, indicating that MERLIN is extremely intuitive, easy to learn, and easy to use. Regarding clinical evaluation, Fugl-Meyer scores showed moderate improvements after intervention, in total upper limb motor function score (p = 0.002). There were no significant changes in modified Ashworth scale results (p = 0.169). Fesia Grasp Project: 16 patients completed the study. After 12 rehabilitation sessions, the Fesia Grasp group showed significant differences in all variables of the FMA-UE scale (wrist p = 0.005, hand p = 0.022, and total motor function p = 0.001), in 3 variables of the FMMMRC scale (wrist flexion p = 0.007, wrist extension p = 0.033, finger flexion p = 0.026), and in the BBT (p = 0.036). The control group only showed significant differences in the "hand" variable for the FMA-UE scale (p = 0.014). IMI scale results and semi-structured surveys showed high device usability
Conclusions:
MERLIN Project: Home-based upper limb rehabilitation with the MERLIN system is feasible, useful, safe, and motivating in patients with impaired upper limb motor function following a stroke. The viability of the MERLIN system as a low-cost, easily adaptable rehabilitation solution for home use highlights its ability to drive telerehabilitation, increase therapy intensity, and strengthen patient autonomy during the recovery process. Fesia Grasp Project: This study demonstrates that applying Fesia Grasp in post-stroke rehabilitation is effective in improving short-term distal upper limb motor function, muscle strength, and manual dexterity. The high repeatability of movements during sessions is linked to positive outcomes, suggesting that FES-assisted therapy enhances motor learning. Usability, participant motivation, and the absence of adverse events support the successful integration of Fesia Grasp into clinical practice
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
Author Under Sail The Imagination of Jack London, 1893-1902
No full textIn Author Under Sail, Jay Williams offers the first complete literary biography of Jack London as a professional writer engaged in the labor of writing. It examines the authorial imagination in London's work, the use of imagination in both his fiction and nonfiction, and the ways he defined imagination in the creative process in his business dealings with his publishers, editors, and agents. In this first volume of a two-volume biography, Williams traverses the years 1893 to 1902, from London's "Story of a Typhoon" to The People of the Abyss. The Jack London who emerges in the pages of Author Under Sail is a writer whose partnership with publishers, most notably his productive alliance with George Brett of Macmillan, was one of the most formative in American literary history. London pioneered many author models during the heyday of realism and naturalism, blurring the boundaries of these popular genres by focusing on absorption and theatricality and the representation of the seen and unseen. London created an impassioned, sincere, and extremely personal realism unlike that of other American writers of the time. Author Under Sail is a literary tour de force that reveals the full range of London as writer, creative citizen, and entrepreneur at the same time it sheds light on the maverick side of machine-age literature.Intro -- Title Page -- Copyright Page -- Dedication -- Contents -- Acknowledgments -- Introduction -- 1. Spirit Truth -- 2. From Absorption to Theatricality and Back Again -- 3. "I Will Build a New Present" -- 4. Sons as Authors -- 5. Fathers as Publishers -- 6. The Daughter as Author -- 7. Lovers as Authors -- 8. At Sea with the Family -- 9. Yellow News, Yellow Stories -- 10. The Return Home -- Notes -- Bibliography -- Index -- About Jay WilliamsIn Author Under Sail, Jay Williams offers the first complete literary biography of Jack London as a professional writer engaged in the labor of writing. It examines the authorial imagination in London's work, the use of imagination in both his fiction and nonfiction, and the ways he defined imagination in the creative process in his business dealings with his publishers, editors, and agents. In this first volume of a two-volume biography, Williams traverses the years 1893 to 1902, from London's "Story of a Typhoon" to The People of the Abyss. The Jack London who emerges in the pages of Author Under Sail is a writer whose partnership with publishers, most notably his productive alliance with George Brett of Macmillan, was one of the most formative in American literary history. London pioneered many author models during the heyday of realism and naturalism, blurring the boundaries of these popular genres by focusing on absorption and theatricality and the representation of the seen and unseen. London created an impassioned, sincere, and extremely personal realism unlike that of other American writers of the time. Author Under Sail is a literary tour de force that reveals the full range of London as writer, creative citizen, and entrepreneur at the same time it sheds light on the maverick side of machine-age literature.Description based on publisher supplied metadata and other sources.Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, YYYY. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries
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