Journal of NeuroEngineering and Rehabilitation最新文献

Background: Home exercise programs prescribed to children with cerebral palsy (CP) are often associated with low adherence. Interactive technologies can help motivate and guide children through exercise programs at home, reducing onus on parents. This study sought to understand the impact of movement-tracking feedback on children's engagement and parents' experiences within an interactive computer play home exercise program (ICP-HEP), Bootle Boot Camp.

Methods: A multi-case mixed methods study was conducted with three children with CP and their parents. In the quantitative single case experimental design with alternating treatments phase, children used the ICP-HEP with and without movement-tracking feedback for four weeks, and exercise adherence, exercise fidelity (movement performance quality), perceived level of fun and helpfulness for the body (i.e., 5-point rating scales and survey) were evaluated. The version (feedback/no feedback) with the highest exercise adherence was carried out for two additional weeks. Dyadic (child/parent) qualitative interviews followed. Quantitative data were analyzed using visual and statistical approaches. Qualitative data were analyzed using directed content analysis. Quantitative and qualitative results were merged through narrative weaving and joint displays.

Results: Accuracy of the movement tracking and feedback provided varied among children, exercises, and play environments. Feedback may have contributed positively to exercise adherence for two children, with a significant enhancement (p < 0.001) for one of these children, and no observed negative impacts for the third child. Parents and one child perceived feedback as generally being useful for learning about movement quality, however when perceived to be inaccurate, it may have been ignored. While children had varied perspectives on how fun and helpful feedback was, it was valued by all parents. All children experienced some frustration due to sporadic technical issues. All children/parents preferred Bootle Boot Camp over conventional home programs, and suggested game refinements to enhance this ICP-HEP experience.

Conclusion: Use of an interactive therapy game has the potential to support children's adherence to and children's/parents' experiences with home exercise, with feedback impacting children differently based on personal and environmental factors. This study serves as a foundation for future game refinements and larger-scale testing that will continue to explore the impact of feedback within an ICP-HEP.

Trial registration: NCT05998239.

Several procedures have been developed to enhance the rehabilitation of stroke patients. However, most techniques struggle to promote sustained recovery in the months following the treatment. Therefore, it is essential to understand the mechanisms that can be harnessed during treatment to potentiate retention of benefits and sustained recovery. While stroke patients often suffer from thalamocortical dysrhythmia (TCD), a perturbation in alpha (8-13 Hz) rhythms caused by decreased excitation in the cortico-thalamic projections, the functional relevance of TCD in stroke patients is not yet clear. We propose that TCD can be counteracted by combining focal stimulation of the motor cortex with virtual-reality (VR) based rehabilitation, which engages distributed networks associated with goal-oriented behavior. Critically, we investigate whether this can be the key to promoting sustained recovery in stroke patients. We compare thalamocortical rhythms and behavioral recovery in patients receiving Sham and bilateral tDCS stimulation of the motor cortex during therapy with the Rehabilitation Gaming System (RGS). Our results reveal that patients in the tDCS group show a sustained recovery in all clinical scales up to three months post-treatment, as opposed to the Sham group. Furthermore, we demonstrate that the slowing down of alpha rhythms can be counteracted by transcranial direct-current stimulation (tDCS), with a particular role for enhancing the excitability of parietal areas. That said, we found no correlation between changes in alpha rhythms and motor recovery. On one hand, our findings suggest that sustained recovery can be potentiated by tDCS-enhanced VR-based rehabilitation. On the other hand, enhancing the excitability of parietal areas while recruiting brain networks associated with goal-oriented behavior can successfully counteract TCD, even though this is likely not the main driver of sustained motor recovery.