1,721,346 research outputs found
The reality of practice: An action systems approach to serious gaming
Full text linkThe aim of this thesis is to introduce an action systems approach to rehabilitation science. More precisely, this thesis aims to promote a perspective that gives action, or activity, primacy in thinking about motor learning issues in rehabilitation. It will do so by focusing on the assumptions on which the adoption of serious gaming for prosthesis use is based. To make room for considering a novel perspective on motor learning in rehabilitation, the first chapters of the thesis will empirically evaluate the current generation of myogames. Such games are of particular interest because they are used to train patients to become dexterous at using a prosthesis, yet they have never been tested for their effect on prosthesis skill. Moreover, the use of myogames requires learning to modulate electric currents that are usually only a by-product of a goal-directed action. It will be argued that the rationale for conversely using electric currents to control such actions is typical for the traditional view on motor learning. After providing positive evidence that an action systems approach might provide a more promising framework to study motor learning issues in rehabilitation, this thesis unpacks the action system approach by focusing on its theoretical underpinnings
Triggering a change: switching behaviour in multi-articulating hand prostheses
Full text linkFor a user of a hand prosthesis, it is very important to be able to control his/her prosthetic hand when achieving goals in daily life. Lack of control increases the chance that people will not use their prosthesis. Our research focused on training strategies for multi-articulating myoelectric hand prostheses, which are prosthesis that are controlled using muscle signals collected on the skin of the forearm. These so-called myosignals are not only used to open and close the hand, but also for switching between between grips types. Different grip types are practical to perform different tasks, such as grasping a small object, such as a pencil, versus a large object, such as a cup of tea. The goal of this thesis was to examine how the production of triggers, needed to switch between the grip types, can be trained. Training usually consists of a lot of repetitions of a fixed set of tasks, and therefore can be perceived as boring and tiring. We examined the possibilities of using a computer game for training. Besides studying improvement within the training sessions with the game, we examined the period after training to see whether improvement in the training game would lead to improvements in prosthesis use of activities in daily life. Our results showed that motor learning related to arm prosthesis control is very complex and that training should be adjusted to the learning individual. The developed game had specific benefits and can be a promising addition to rehabilitation practice
Functioning of Young Individuals with Upper Limb Reduction Deficiencies: Prostheses, adaptive devices, and functional tests
Full text linkJongeren die geboren zijn met een korte arm (transversaal reductiedefect) kunnen de meeste dagelijkse activiteiten prima uitvoeren. Dit blijkt uit onderzoek vanuit het UMCG, uitgevoerd door promovenda Ecaterina Golea-Vasluian en haar begeleiders Corry van der Sluis, Raoul Bongers en Heleen Reinders-Messelink. Jongeren met een korte arm gebruiken het liefst hun hand, aangedane arm, en andere lichaamsdelen zoals benen, voeten, schouders, en hoofd om taken uit te voeren. Toch zijn er taken die wat moeilijker zijn en daarvoor gebruiken deze jongeren vaak hulpmiddelen. Adaptaties zijn hulpmiddelen die specifiek worden vervaardigd voor gebruik door de aangedane arm. Uit het onderzoek bleek dat adaptaties voor eten met bestek, fietsen, en vrijetijd activiteiten zoals een muziekinstrument bespelen of sporten, het meest worden gebruikt. In vergelijking met protheses, zijn jongeren met een korte arm meer tevreden over het gebruik van adaptaties dan van protheses. Zij vonden adaptaties makkelijker te gebruiken en aan te doen, lichter en goedkoper dan protheses. Prothesen worden meestal gebruikt om het staren van mensen te vermijden. Prothesen worden minder gebruikt om het uitvoeren van activiteiten makkelijker te maken. Om de functionaliteit van kinderen met een korte arm te kunnen meten, hebben de onderzoekers een meetinstrument voor volwassen prothesegebruikers aangepast voor 4-6-jarige kinderen. Het instrument, de Southampton Hand Assessment Procedure (SHAP), geeft inzicht in hoe een kind met een handaandoening op verschillende manieren dingen kan pakken. Uit de eerste testen bij gezonde kinderen blijkt dat het aangepaste instrument geschikt is voor het gebruik bij kinderen, maar er is verder onderzoek nodig om de kinder-SHAP zodanig te verbeteren dat het ook in de praktijk toepasbaar is
Intermanual transfer in prosthetic training
Full text linkThe concept of intermanual transfer might be used to start prosthesis training faster after the amputation. Intermanual transfer means that after training motor skills on one side, the other side will also improve. For prosthesis training this means that, directly after the amputation, one starts to train the unaffected arm. With this, the prosthesis skills of the affected side can improve. In this thesis the intermanual transfer effect of the prosthetic training was shown in healthy adults and children. After this, it is studied if the effect could be enlarged with adaptation in the training tasks, the inter-training intervals and by adding mirror therapy and mental imagery to the training. If, using intermanual transfer, the prosthesis training is started earlier this might lead to higher motivation to keep on using the prosthesis
Perspectives on outcome following hand and wrist injury in non-osteoporotic patients
Full text linkYoung patients without osteoporosis have high demands of the function of their hand and wrist following injury, because of an active working life. We reported on several outcome measures following hand and wrist injuries in this patient population. Following wrist fractures, presence of posttraumatic arthritis was high and seemed to worsen over time. Posttraumatic arthritis was associated with diminished movement of the wrist, but not with diminished grip strength. All motion measurements of the injured wrist were diminished compared to the uninjured wrist. An incongruency of the joint surface following injury was associated with diminished range of motion and diminished scores on patient reported outcome captured in questionnaires answered by patients regarding daily tasks with their hand and wrist. Diminished movement of the wrist was also associated with worse scores on the questionnaires. Of these specific patient reported outcome questionnaires for hand and wrist injuries, we validated two in the Dutch translated version: the DASH-DLV and the DF-PROMIS-UE v2.0 questionnaires. The latter uses a computer algorithm to reduce the number of questions that need to be answered to minimize the burden for patients. Hand and wrist injuries can evolve in major life events for young patients, due to possible impairment as we reported. For clinical practice, we advise a ‘lean’ core set of outcome measures with known thresholds to find changes in function that a patient actually notices in daily life, known as minimal important change. This will improve the interpretation of clinical relevant outcome following hand and wrist injuries
Task-specific training methods to improve the upper limb function in stroke survivors
Full text linkAfter a stroke, the upper extremity is often affected which may result in a decrease in functioning. Task-specific training is necessary to improve the upper limb function after a stroke. Due to the increase in number of patients and less available healthcare personnel, we need to find different ways to provide task-specific training. This thesis describes two methods of training, namely group training and home training, to train the upper limb function with minimal therapist resources. Within a rehabilitation centre, a standardized group training is able to provide a lower workload for therapists, while providing evidence-based training to a group of patients. We developed a circuit class based training program which entails activities of daily life. When a patient is able to return home, training must continue to prevent non-use of the arm in daily life. Therefore, a home-based training program using an assistive device and telerehabilitation system was investigated. Patients were able to significantly improve their upper limb function, effects were even retained six months after the cessation of the training. These results showed the added benefit of assistive device training. Patients found this way of training enjoyable, however several device flaws were encountered. This thesis showed that task-specific training can be provided in different forms, such as group training or using assistive training devices, and they are effective in improving the upper limb function. We advise to involve patients more during the development of assistive training devices and training programs, to match the training to the patients’ wishes and needs
Machine-learning myoelectric prosthesis control: towards the advancement of assessing functional use and control skill
Full text linkThe technological state-of-the-art in upper limb prostheses has demonstrated impressive and rapid advancements. However, the introduction of these technologies has opened up new questions in two domains of the assessment paradigms – namely, whether the current clinical tests of prosthetic upper limb function are still adequate to fully assess these prostheses and how the user skill in controlling these devices can be quantified. The aim of this thesis was to investigate and to advance the assessment paradigms in machine-learning based myoelectric upper limb prostheses, with a focus on the assessment of functional prosthesis use and on the assessment of the user skill in controlling the prosthesis. For this purpose, this thesis investigates how state-of-the-art hand prostheses are used and which potential advantages (and disadvantages) come with the introduction of multi-function prosthetic hands and machine-learning based control interfaces. Subsequently, this thesis outlines how these technologies should be evaluated and how this could be realized within the constraints of clinical test routines for functional prosthesis use. Furthermore, this thesis investigates how characteristics of the users’ muscle activation patterns relate to the users’ control performance of machine-learning based myoelectric prostheses. Subsequently, this thesis investigates potential reasons why a common set of such muscle activation pattern characteristics paradoxically falls short of showing a strong association with the control performance. Finally, this thesis discusses the wider implications of the findings with regard to the assessment paradigm and the conceptual assumptions in machine-learning myoelectric prosthesis control
Long-term outcomes of sports injuries
Full text linkParticipation in sports is an important way to spend spare time. Being actively involved in sports has clear advantages, like the improvement of physical endurance and the prevention of Western diseases. However, it can be questioned whether these advantages are not outweighted by the notable side effects: the occurrence and the adverse outcome of a large number of injuries. Long-term consequences are of importance in determining this outcome, since sportsmen are generally young and, consequently, permanent or long lasting disablement will influence their number of productive life years and quality of life. Remarkably, little information is available on the long-term outcome of sports injuries. The primary aim of this thesis is therefore to determine the long-term outcome of sports injuries, treated at the emergency department of the University Hospital Groningen. In addition, the determinants of outcome are subject to investigation. ...
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Serious Gaming For Learning The Intuitive, Non-Natural Control Of Prosthetic Hands
Full text linkWhen someone loses their hand, they are often given a prosthetic hand to restore function. Most prosthetic hands can only open and close and are controlled by using two sensors to detect a weak electric signal which is generated when muscles in the stump contract. The most advanced prosthetic hands have more functions and are controlled using machine learning (artificial intelligence). Machine learning techniques uses many sensors to detect patterns of electrical activity in the stump to determine the intent of the user. Unfortunately, the patterns for different contractions are often too similar, which means that the intent of the user cannot be determined. However, users can train with a coach to learn how to perform the contractions in such a way so that the patterns become distinct. My PhD research explores user training with an emphasis on serious games. A serious game teaches the user a new skill by playing the game. The benefit of using serious games is that users can train at home and they might be more effective than training with a coach. The main results of my research are that a coach is not needed to train and that serious games can train users to generate more distinct pattens than training with a coach. However, I also found that when evaluating the effect of training on prosthetic control performance, neither coaching nor serious game training led to improvements. These results highlight the need for more research in user training for controlling prosthetic hands
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