Mias ATD
Introduction
There is a steady increase in age of the population in the western world. In Europe, recent statistics show that approximately 21% of the people are over 60 years of age, and it is estimated that this figure will increase to 26% by the year 2020. These demographic changes put a substantial pressure on our health care resources. The group of elderly people can suffer from a large variety of health problems; from just getting older (not disease specific) to suffering from multiple (neurologic) pathologies, such as stroke. The number of people suffering from a stroke in the Netherlands is 1.6 per 1000 inhibitants. In France, the United Kingdom and Germany the incidence rates are 1.0 per 1000, 1.2 per 1000 and 1.4 per 1000, respectively. The prevalence of stroke in Europe is estimated at 1.13 million people. A stroke causes a (partial) destruction of cortical tissue, resulting in a disturbed generation and integration of neural commands. The interrupted generation and integration of neural commands from sensorimotor areas of the cortex results in a reduction in, or even complete absence of, the ability to activate muscle tissue selectively, which affects the performance of a motor task. One of the consequences of a disturbed generation of neural commands in the sensorimotor cortex is impaired motor function of the arm and hand. This impaired arm and hand function causes limitations in activities of daily living for the majority of stroke patients. These problems occur also in other neurological diseases like TBI, (incidence: 50.000 new cases per year), SCI (incidence 11 per million traumatic; +/- 8 per million non traumatic/non oncological; +/- 100 per million oncological), and plexus lesions.
Intensive and task-specific treatment of the upper extremity, consisting of active, highly repetitive movements, is regarded one of the most effective approaches in neural rehabilitation for the restoration of arm and hand function.Unfortunately, current standard multi-disciplinary rehabilitation treatment is labor-intensive, requiring one-to-one manual interactions with therapists. The treatment protocols consist of daily therapy during several weeks. This makes it difficult to provide highly intensive treatment for all patients. Besides this, evaluation of patients' performance and progress is usually done subjectively, since few adequate objective measures are available. Recent technological developments (e.g. robotics, electrical stimulation, videogames) in rehabilitation provide the opportunity to create and implement intensive training in an efficient and safe way, without increasing time spent on supervision by the therapist. However a lot of the neurophysiological working mechanisms with respect to functional recovery are still unknown. In addition it is possible to objectively monitor the progression in functional recovery after neurological diseases and evaluate the effects of motor rehabilitation. Another advantage of sensing and monitoring this bio-data is the feedback of this data to the subjects as augmented cues and thereby increasing motor learning.
Objectives
The objective of this project is the generation of neurological and technological knowledge necessary for the development and integration of innovative technology (robotics, electrical stimulation and gaming interfaces) for the development of smart active therapeutic devices for the elderly population. As an example new knowledge and new concepts with respect to neuro-robotics, electrical stimulation and gaming interfaces will be generated and integrated within this project to optimize the restoration of upper limb functions after different neurological diseases (Stroke, TBI, SCI). In the near future these new concepts/technologies enables the user to exercise training independently of the therapists. As a result subjects receive large quantities of training (high intensity/frequency) and maximize the gain of training by staying highly motivated. The applications involve monitoring of user progress, necessary for evidence based medicine, and to enable to continue to supervise rehabilitation in an efficient way. Subsets of the training devices will enable to continue training extramurally, in a point of care situations.
