VR-based rehabilitation strategies for functional motor recovery after stroke: individualization, reinforcement, and transfer
Stroke represents one of the main causes of adult disability and will be one of the main contributors to the burden of disease in 2030. However, our healthcare systems do not have enough resources to cover the current demand let alone its future increase. Partial and unmet rehabilitation needs may u...
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| Tipo de recurso: | tesis doctoral |
| Estado: | Versión publicada |
| Fecha de publicación: | 2016 |
| País: | España |
| Institución: | CBUC, CESCA |
| Repositorio: | TDR. Tesis Doctorales en Red |
| OAI Identifier: | oai:www.tdx.cat:10803/392145 |
| Acceso en línea: | http://hdl.handle.net/10803/392145 |
| Access Level: | acceso abierto |
| Palabra clave: | Stroke Ictus 62 |
| Sumario: | Stroke represents one of the main causes of adult disability and will be one of the main contributors to the burden of disease in 2030. However, our healthcare systems do not have enough resources to cover the current demand let alone its future increase. Partial and unmet rehabilitation needs may ultimately lead to a loss of functional independence. Hence, it is essential that new approaches are deployed that help to manage these chronic conditions and augment current rehabilitation approaches in order to enhance their e ciency. One of the latest approaches in the rehabilitation of a wide range of de- cits of the nervous system is based on the use of virtual reality (VR), which combines training scenarios with dedicated interface devices. It must be emphasized, however, that so far little work exists on the quantitative assessment of the clinical impact of VR based approaches. In this dissertation we present a number of studies that investigate the potential of VR technologies for motor recovery after stroke. First, we explore the transfer of VR-based rehabilitation systems from clinic based training to at home applications, and we compare the e ects of di erent rehabilitation approaches. Our results reveal that the development of compensatory behaviors, such as learned non-use, can greatly interfere with the recovery dynamics and prevent the retention of motor improvements. vii viii abstract Grounded in our observations, we introduce a novel rehabilitation strategy based on the sensorimotor augmentation of goal-oriented movements, that aims to correct these compensatory behaviors. We establish the principles behind this intervention using a computational model of recovery, and we validate its e cacy though a set of behavioral experiments that combine observational studies and a randomized controlled trial. This thesis work advances our understanding of the key mechanisms in uencing motor recovery after stroke, and provides a new perspective on how to maximize the retention of functional improvements. |
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