Search results for: elbow
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 25

Search results for: elbow

25 Design of High Torque Elbow Joint for Above Elbow Prosthesis

Authors: Irfan Hussain, Adnan Masood, Javaid Iqbal, Umar S. Khan

Abstract:

Above Elbow Prosthesis is one of the most commonly amputated or missing limbs. The research is done for modelling techniques of upper limb prosthesis and design of high torque, light weight and compact in size elbow actuator. The purposed actuator consists of a DC motor, planetary gear set and a harmonic drive. The calculations show that the actuator is good enough to be used in real life powered prosthetic upper limb or rehabilitation exoskeleton.

Keywords: Above Elbow prosthesis, Harmonic drive, Planetarygear set, Sagittal Plane

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24 Effect of Sand Particle Transportation in Oil and Gas Pipeline Erosion

Authors: Christopher Deekia Nwimae, Nigel Simms, Liyun Lao

Abstract:

Erosion in a pipe bends caused by particles is a major concern in the oil and gas fields and might cause breakdown to production equipment. This work investigates the effect of sand particle transport in an elbow using computational fluid dynamics (CFD) approach. Two-way coupled Euler-Lagrange and discrete phase model is employed to calculate the air/solid particle flow in the elbow. Generic erosion model in Ansys fluent and three particle rebound models are used to predict the erosion rate on the 90° elbows. The model result is compared with experimental data from the open literature validating the CFD-based predictions which reveals that due to the sand particles impinging on the wall of the elbow at high velocity, a point on the pipe elbow were observed to have started turning red due to velocity increase and the maximum erosion locations occur at 48°.

Keywords: Erosion, prediction, elbow, computational fluid dynamics, CFD.

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23 CFD Prediction of the Round Elbow Fitting Loss Coefficient

Authors: Ana Paula P. dos Santos, Claudia R. Andrade, Edson L. Zaparoli

Abstract:

Pressure loss in ductworks is an important factor to be considered in design of engineering systems such as power-plants, refineries, HVAC systems to reduce energy costs. Ductwork can be composed by straight ducts and different types of fittings (elbows, transitions, converging and diverging tees and wyes). Duct fittings are significant sources of pressure loss in fluid distribution systems. Fitting losses can be even more significant than equipment components such as coils, filters, and dampers. At the present work, a conventional 90o round elbow under turbulent incompressible airflow is studied. Mass, momentum, and k-e turbulence model equations are solved employing the finite volume method. The SIMPLE algorithm is used for the pressure-velocity coupling. In order to validate the numerical tool, the elbow pressure loss coefficient is determined using the same conditions to compare with ASHRAE database. Furthermore, the effect of Reynolds number variation on the elbow pressure loss coefficient is investigated. These results can be useful to perform better preliminary design of air distribution ductworks in air conditioning systems.

Keywords: Duct fitting, Pressure loss, Elbow.

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22 Study of Human Upper Arm Girth during Elbow Isokinetic Contractions Based on a Smart Circumferential Measuring System

Authors: Xi Wang, Xiaoming Tao, Raymond C. H. So

Abstract:

As one of the convenient and noninvasive sensing approaches, the automatic limb girth measurement has been applied to detect intention behind human motion from muscle deformation. The sensing validity has been elaborated by preliminary researches but still need more fundamental studies, especially on kinetic contraction modes. Based on the novel fabric strain sensors, a soft and smart limb girth measurement system was developed by the authors’ group, which can measure the limb girth in-motion. Experiments were carried out on elbow isometric flexion and elbow isokinetic flexion (biceps’ isokinetic contractions) of 90°/s, 60°/s, and 120°/s for 10 subjects (2 canoeists and 8 ordinary people). After removal of natural circumferential increments due to elbow position, the joint torque is found not uniformly sensitive to the limb circumferential strains, but declining as elbow joint angle rises, regardless of the angular speed. Moreover, the maximum joint torque was found as an exponential function of the joint’s angular speed. This research highly contributes to the application of the automatic limb girth measuring during kinetic contractions, and it is useful to predict the contraction level of voluntary skeletal muscles.

Keywords: Fabric strain sensor, muscle deformation, isokinetic contraction, joint torque, limb girth strain.

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21 Kinematic Gait Analysis of Upper and Lower Limbs Joints in Hemiplegic Children

Authors: Zeinab A.Hussein, Manal S. Abd El-Wahab, Shorouk A. W. El-Shennawy

Abstract:

Children with hemiplgic cerebral palsy often walk with diminished reciprocal arm swing so the purpose of this study was to describe kinematic characteristics in children with hemiplegic cerebral palsy (CP) during the gait suphases, and find if there is a correlation between upper(shoulder and elbow) and lower(hip, knee, and ankle) limb joints either in involved or uninvolved.48 children with hemiplegic cerebral palsy (18boys, 30girls) with an average age of (5.1±0.87) years were selected randomly to evaluate joint angles during gait by 3D motion analysis system with 6 pro reflex cameras in a sagittal plane for both sides of the body. The results showed increased shoulder and elbow flexion, increased hip angular displacement, decreased knee and ankle arcs during gait cycle, also there is correlation between shoulder and elbow to hip, knee, and ankle joints during various subphases of gait.

Keywords: Cerebral palsy, Gait, Hemiplegia, Motion analysis.

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20 Effect of Submaximal Eccentric versus Maximal Isometric Contraction on Delayed Onset Muscle Soreness

Authors: Mohamed M. Ragab, Neveen A. Abdel Raoof, Reham H. Diab

Abstract:

Background: Delayed onset muscle soreness (DOMS) is the most common symptom when ordinary individuals and athletes are exposed to unaccustomed physical activity, especially eccentric contraction which impairs athletic performance, ordinary people work ability and physical functioning. Multitudes of methods have been investigated to reduce DOMS. One of the valuable methods to control DOMS is repeated bout effect (RBE) as a prophylactic method. Purpose: To compare the repeated bout effect of submaximal eccentric with maximal isometric contraction on induced DOMS. Methods: Sixty normal male volunteers were assigned randomly into three equal groups: Group A (first study group): 20 subjects received submaximal eccentric contraction on non-dominant elbow flexors as a prophylactic exercise. Group B (second study group): 20 subjects received maximal isometric contraction on nondominant elbow flexors as a prophylactic exercise. Group C (control group): 20 subjects did not receive any prophylactic exercises. Maximal isometric peak torque of elbow flexors and patient related elbow evaluation (PREE) scale were measured for each subject 3 times before, immediately after, and 48 hours after induction of DOMS. Results: Post-hoc test for maximal isometric peak torque and PREE scale immediately and 48 hours after induction of DOMS revealed that group (A) and group (B) resulted in significant decrease in maximal isometric strength loss and elbow pain and disability rather than control group (C), but submaximal eccentric group (A) was more effective than maximal isometric group (B) as it showed more rapid recovery of functional strength and less degrees of elbow pain and disability. Conclusion: Both submaximal eccentric contraction and maximal isometric contraction were effective in prevention of DOMS but submaximal eccentric contraction produced a greater protective effect against muscle damage induced by maximal eccentric exercise performed 2 days later.

Keywords: Delayed onset muscle soreness, maximal isometric peak torque, patient related elbow evaluation scale, repeated bout effect.

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19 Nanoindentation Behaviour and Microstructural Evolution of Annealed Single-Crystal Silicon

Authors: Woei-Shyan Lee, Shuo-Ling Chang

Abstract:

The nanoindentation behaviour and phase transformation of annealed single-crystal silicon wafers are examined. The silicon specimens are annealed at temperatures of 250, 350 and 450ºC, respectively, for 15 minutes and are then indented to maximum loads of 30, 50 and 70 mN. The phase changes induced in the indented specimens are observed using transmission electron microscopy (TEM) and micro-Raman scattering spectroscopy (RSS). For all annealing temperatures, an elbow feature is observed in the unloading curve following indentation to a maximum load of 30 mN. Under higher loads of 50 mN and 70 mN, respectively, the elbow feature is replaced by a pop-out event. The elbow feature reveals a complete amorphous phase transformation within the indented zone, whereas the pop-out event indicates the formation of Si XII and Si III phases. The experimental results show that the formation of these crystalline silicon phases increases with an increasing annealing temperature and indentation load. The hardness and Young’s modulus both decrease as the annealing temperature and indentation load are increased.

Keywords: Nanoindentation, silicon, phase transformation, amorphous, annealing.

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18 The Applications of Four Fingers Theory: The Proof of 66 Acupoints under the Human Elbow and Knee

Authors: Chih-I. Tsai, Yu-Chien. Lin

Abstract:

Through experiences of clinical practices, it is discovered that locations on the body at a level of four fingerbreadth above and below the joints are the points at which muscles connect to tendons, and since the muscles and tendons possess opposite characteristics, muscles are full of blood but lack qi, while tendons are full of qi but lack blood, these points on our body become easily blocked. It is proposed that through doing acupuncture or creating localized pressure to the areas four fingerbreadths above and below our joints, with an elastic bandage, we could help the energy, also known as qi, to flow smoothly in our body and further improve our health. Based on the Four Fingers Theory, we understand that human height is 22 four fingerbreadths. In addition, qi and blood travel through 24 meridians, 50 times each day, and they flow through 6 cun with every human breath. We can also understand the average number of human heartbeats is 75 times per minute. And the function of qi-blood circulation system in Traditional Chinese Medicine is the same as the blood circulation in Western Medical Science. Informed by Four Fingers Theory, this study further examined its applications in acupuncture practices. The research question is how Four Fingers Theory proves what has been mentioned in Nei Jing that there are 66 acupoints under a human’s elbow and knee. In responding to the research question, there are 66 acupoints under a human’s elbow and knee. Four Fingers Theory facilitated the creation of the acupuncture naming and teaching system. It is expected to serve as an approachable and effective way to deliver knowledge of acupuncture to the public worldwide.

Keywords: Four Fingers theory, Meridians circulation, 66 Acupoints under a human’s elbow and knee, acupuncture.

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17 Effect of One-Handed Pushing and Puling Strength at Different Handle Heights in Vertical Direction

Authors: Tarik H. Badi, Amer A. Boushaala

Abstract:

The purpose of this study was to measure the maximal isometric strength and to investigate the effects of different handleheights and elbow angles with respect to Mid. sagittal plane on the pushing and pulling strength in vertical direction. Eight male subjects performed a series of static strength measurement for each subject. The highest isometric strength was found in pulling at shoulder height (S.H.) (Mean = 60.29 lb., SD = 16.78 lb.) and the lowest isometric strength was found also in pulling at elbow height (E.H.) (Mean = 33.06 lb., SD = 6.56 lb.). Although the isometric strengths were higher at S.H than at E.H. for both activities, the maximal isometric strengths were compared statistically. ANOVA was performed. The results of the experiment revealed that there was a significant different between handle heights. However, there were no significant different between angles and activities, also no correlation between grip strength and activities.

Keywords: Pushing and pulling, one arm, vertical direction, isometric strength.

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16 A Method for Controlling of Hand Prosthesis Based on Neural Network

Authors: Fereidoun Nowshiravan Rahatabad, Mohammad Ali Nekoui, Mohammad Reza Hashemi Golpaygani, AliFallah, Mehdi Kazemzadeh Narbat

Abstract:

The people are differed by their capabilities, skills and mental agilities. The evolution of human from childhood when they are completely dependent up to adultness the time they gradually set the dependency free is too complicated, by considering they have all started from almost one point but some become cleverer and some less. The main control command of a cybernetic hand should be posted by remaining healthy organs of disabled Person. These commands can be from several channels, which their recording and detecting are different and need complicated study. In this research, we suppose that, this stage has been done or in the other words, the command has been already sent and detected. So the main goal is to control a long hand, upper elbow hand missing, by an interest angle define by disabled. It means that, the system input is the position desired by disables and the output is the elbow-joint angle variation. Therefore the goal is a suitable control design based on neural network theory in order to meet the given mapping.

Keywords: Control - system design, Upper limb prosthesis, neuralnetwork.

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15 CFD Modeling of Air Stream Pressure Drop inside Combustion Air Duct of Coal-Fired Power Plant with and without Airfoil

Authors: Pakawhat Khumkhreung, Yottana Khunatorn

Abstract:

The flow pattern inside rectangular intake air duct of 300 MW lignite coal-fired power plant is investigated in order to analyze and reduce overall inlet system pressure drop. The system consists of the 45-degree inlet elbow, the flow instrument, the 90-degree mitered elbow and fans, respectively. The energy loss in each section can be determined by Bernoulli’s equation and ASHRAE standard table. Hence, computational fluid dynamics (CFD) is used in this study based on Navier-Stroke equation and the standard k-epsilon turbulence modeling. Input boundary condition is 175 kg/s mass flow rate inside the 11-m2 cross sectional duct. According to the inlet air flow rate, the Reynolds number of airstream is 2.7x106 (based on the hydraulic duct diameter), thus the flow behavior is turbulence. The numerical results are validated with the real operation data. It is found that the numerical result agrees well with the operating data, and dominant loss occurs at the flow rate measurement device. Normally, the air flow rate is measured by the airfoil and it gets high pressure drop inside the duct. To overcome this problem, the airfoil is planned to be replaced with the other type measuring instrument, such as the average pitot tube which generates low pressure drop of airstream. The numerical result in case of average pitot tube shows that the pressure drop inside the inlet airstream duct is decreased significantly. It should be noted that the energy consumption of inlet air system is reduced too.

Keywords: Airfoil, average pitot tube, combustion air, CFD, pressure drop, rectangular duct.

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14 Robotic Arm Allowing a Diabetic Quadriplegic Patient to Self-Administer Insulin

Authors: L. Parisi

Abstract:

A method which allows a diabetic quadriplegic patient that has had four limb amputations (above the knee and elbow) to self-administer injections of insulin has been designed. The aim of this research project is to improve a quadriplegic patient’s selfmanagement, affected by diabetes, by designing a suitable device for self-administering insulin. The quadriplegic patient affected by diabetes has to be able to selfadminister insulin safely and independently to guarantee stable healthy conditions. The device also should be designed to adapt to a number of different varying personal characteristics such as height and body weight.

Keywords: Robotics, diabetes, quadriplegia, self-management.

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13 Modeling and Control of an Acrobot Using MATLAB and Simulink

Authors: Dong Sang Yoo

Abstract:

The problem of finding control laws for underactuated systems has attracted growing attention since these systems are characterized by the fact that they have fewer actuators than the degrees of freedom to be controlled. The acrobot, which is a planar two-link robotic arm in the vertical plane with an actuator at the elbow but no actuator at the shoulder, is a representative in underactuated systems. In this paper, the dynamic model of the acrobot is implemented using Mathworks’ Simscape. And the sliding mode control is constructed using MATLAB and Simulink.

Keywords: Acrobot, MATLAB and Simulink, sliding mode control, underactuated systems.

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12 Capture and Feedback in Flying Disc Throw with use of Kinect

Authors: Yasuhisa Tamura, Koji Yamaoka, Masataka Uehara, Takeshi Shima

Abstract:

This paper proposes a three-dimensional motion capture and feedback system of flying disc throwing action learners with use of Kinect device. Rather than conventional 3-D motion capture system, Kinect has advantages of cost merit, easy system development and operation. A novice learner of flying disc is trained to keep arm movement in steady height, to twist the waist, and to stretch the elbow according to the waist angle. The proposing system captures learners- body movement, checks their skeleton positions in pre-motion / motion / post-motion in several ways, and displays feedback messages to refine their actions.

Keywords: Flying disc, throwing movement, Kinect, capture, feedback

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11 Robust Control of a High-Speed Manipulator in State Space

Authors: M. M. Fateh, A. Izadbakhsh

Abstract:

A robust control approach is proposed for a high speed manipulator using a hybrid computed torque control approach in the state space. The high-speed manipulator is driven by permanent magnet dc motors to track a trajectory in the joint space in the presence of disturbances. Tracking problem is analyzed in the state space where the completed models are considered for actuators. The proposed control approach can guarantee the stability and a satisfactory tracking performance. A two-link elbow manipulator driven by electrical actuators is simulated and results are shown to satisfy conditions under technical specifications.

Keywords: Computed torque, manipulator, robust control, state space.

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10 Bio-mechanical Analysis of Human Joints and Extension of the Study to Robot

Authors: S. Parasuraman, Ler Shiaw Pei

Abstract:

In this paper, the bio-mechanical analysis of human joints is carried out and the study is extended to the robot manipulator. This study will first focus on the kinematics of human arm which include the movement of each joint in shoulder, wrist, elbow and finger complexes. Those analyses are then extended to the design of a human robot manipulator. A simulator is built for Direct Kinematics and Inverse Kinematics of human arm. In the simulation of Direct Kinematics, the human joint angles can be inserted, while the position and orientation of each finger tips (end-effector) are shown. Inverse Kinematics does the reverse of the Direct Kinematics. Based on previous materials obtained from kinematics analysis, the human manipulator joints can be designed to follow prescribed position trajectories.

Keywords: Kinematics, Human Joints, Robotics, Robot Dynamics, Manipulators.

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9 Non-Invasive Capillary Blood Flow Measurement: Laser Speckle and Laser Doppler

Authors: A.K.Jayanthy, N.Sujatha, M.Ramasubba Reddy

Abstract:

Microcirculation is essential for the proper supply of oxygen and nutritive substances to the biological tissue and the removal of waste products of metabolism. The determination of blood flow in the capillaries is therefore of great interest to clinicians. A comparison has been carried out using the developed non-invasive, non-contact and whole field laser speckle contrast imaging (LSCI) based technique and as well as a commercially available laser Doppler blood flowmeter (LDF) to evaluate blood flow at the finger tip and elbow and is presented here. The LSCI technique gives more quantitative information on the velocity of blood when compared to the perfusion values obtained using the LDF. Measurement of blood flow in capillaries can be of great interest to clinicians in the diagnosis of vascular diseases of the upper extremities.

Keywords: Blood flow, Laser Doppler flowmeter, LSCI, speckle

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8 Termination of the Brachial Artery in the Arm and Its Clinical Significance

Authors: Ramya Rathan, Miral N. F. Salama

Abstract:

The variations in the arteries have been drawing attention of anatomists for a long time because of their clinical significance. The brachial artery is the principal artery of the arm which is the continuation of the axillary artery from the lower border of the Teres Major. It terminates into the radial and ulnar arteries below the elbow joint at the neck radius. The present study aims at exploring the clinical significance of the high termination of the brachial artery. During the routine cadaveric dissection of the arm, for the undergraduate students of medicine at our university, we observed a high bifurcation of the radial and the ulnar artery at the midshaft of the humerus. The median nerve was seen passing between these two junctions. Further, the course and the relations of this artery were studied. The accurate knowledge regarding these kinds of variation in the blood vessels is mandatory for planning of designing. General physicians, surgeons and radiologists should keep in mind the variations in the branching pattern of the arteries in their daily medical, diagnostic and therapeutic procedures to avoid complications in diagnostic and surgical procedures.

Keywords: Brachial artery, high termination, radial artery, ulnar artery.

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7 2D Human Motion Regeneration with Stick Figure Animation Using Accelerometers

Authors: Alpha Agape Gopalai, S. M. N. Arosha Senanayake

Abstract:

This paper explores the opportunity of using tri-axial wireless accelerometers for supervised monitoring of sports movements. A motion analysis system for the upper extremities of lawn bowlers in particular is developed. Accelerometers are placed on parts of human body such as the chest to represent the shoulder movements, the back to capture the trunk motion, back of the hand, the wrist and one above the elbow, to capture arm movements. These sensors placement are carefully designed in order to avoid restricting bowler-s movements. Data is acquired from these sensors in soft-real time using virtual instrumentation; the acquired data is then conditioned and converted into required parameters for motion regeneration. A user interface was also created to facilitate in the acquisition of data, and broadcasting of commands to the wireless accelerometers. All motion regeneration in this paper deals with the motion of the human body segment in the X and Y direction, looking into the motion of the anterior/ posterior and lateral directions respectively.

Keywords: Motion Regeneration, Virtual Instrumentation, Wireless Accelerometers.

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6 Human Motion Regeneration in 2-Dimension as Stick Figure Animation with Accelerometers

Authors: Alpha Agape Gopalai, Darwin Gouwanda, S.M.N. Arosha Senanayake

Abstract:

This paper explores the opportunity of using tri-axial wireless accelerometers for supervised monitoring of sports movements. A motion analysis system for the upper extremities of lawn bowlers in particular is developed. Accelerometers are placed on parts of human body such as the chest to represent the shoulder movements, the back to capture the trunk motion, back of the hand, the wrist and one above the elbow, to capture arm movements. These sensors placement are carefully designed in order to avoid restricting bowler-s movements. Data is acquired from these sensors in soft-real time using virtual instrumentation; the acquired data is then conditioned and converted into required parameters for motion regeneration. A user interface was also created to facilitate in the acquisition of data, and broadcasting of commands to the wireless accelerometers. All motion regeneration in this paper deals with the motion of the human body segment in the X and Y direction, looking into the motion of the anterior/ posterior and lateral directions respectively.

Keywords: Motion Regeneration, Virtual Instrumentation, Wireless Accelerometers

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5 Model Free Terminal Sliding Mode with Gravity Compensation: Application to an Exoskeleton-Upper Limb System

Authors: Sana Bembli, Nahla Khraief Haddad, Safya Belghith

Abstract:

This paper deals with a robust model free terminal sliding mode with gravity compensation approach used to control an exoskeleton-upper limb system. The considered system is a 2-DoF robot in interaction with an upper limb used for rehabilitation. The aim of this paper is to control the flexion/extension movement of the shoulder and the elbow joints in presence of matched disturbances. In the first part, we present the exoskeleton-upper limb system modeling. Then, we controlled the considered system by the model free terminal sliding mode with gravity compensation. A stability study is realized. To prove the controller performance, a robustness analysis was needed. Simulation results are provided to confirm the robustness of the gravity compensation combined with to the Model free terminal sliding mode in presence of uncertainties.

Keywords: Exoskeleton-upper limb system, gravity compensation, model free terminal sliding mode, robustness analysis, Monte Carlo, H∞ methods.

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4 Biomechanics Analysis of Bicross Start

Authors: M. Kalichová, S. Hřebíčková, R. Labounková, P. Hedbávný, G. Bago

Abstract:

The article deals with a biomechanics analysis of the classic bicross start with a backward movement of the bike. This is a case study analyzing this type of start in two bicross riders representing the Czech Republic. Based on the 3D kinematic analysis and with a special emphasis on the ankle movement we have divided the start into five phases – phase n. 1 – reaction time, phase n. 2 – preparation movements time, phase n. 3 – first pedal stroke time, phase n. 4 – dead point pedal passage time, phase n. 5 – second pedal stroke time. Further we have demonstrated the significance of kinematic characteristics in various stages of the bicross start including their values and the extent of change. These primarily include the vector of the instantaneous velocity of the head, wrists, elbows, shoulders, hip and knee joints. The significant angle characteristics have been noted in elbow, shoulder, hip and knee joints. The results of this work indicate the types of movement prevailing in the respective phases and as such are expected to serve as a basis for further analyses of this movement structure performed, however, on a large research sample.

Keywords: Bicross, start, kinematic analysis.

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3 Optimal Rest Interval between Sets in Robot-Based Upper-Arm Rehabilitation

Authors: Virgil Miranda, Gissele Mosqueda, Pablo Delgado, Yimesker Yihun

Abstract:

Muscular fatigue affects the muscle activation that is needed for producing the desired clinical outcome. Integrating optimal muscle relaxation periods into a variety of health care rehabilitation protocols is important to maximize the efficiency of the therapy. In this study, four muscle relaxation periods (30, 60, 90 and 120 seconds) and their effectiveness in producing consistent muscle activation of the muscle biceps brachii between sets of an elbow flexion and extension task were investigated among a sample of 10 subjects with no disabilities. The same resting periods were then utilized in a controlled exoskeleton-based exercise for a sample size of 5 subjects and have shown similar results. On average, the muscle activity of the biceps brachii decreased by 0.3% when rested for 30 seconds, and it increased by 1.25%, 0.76% and 0.82% when using muscle relaxation periods of 60, 90 and 120 seconds, respectively. The preliminary results suggest that a muscle relaxation period of about 60 seconds is needed for optimal continuous muscle activation within rehabilitation regimens. Robot-based rehabilitation is good to produce repetitive tasks with the right intensity and knowing the optimal resting period will make the automation more effective.

Keywords: Rest intervals, muscle biceps brachii, robot rehabilitation, muscle fatigue.

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2 Effects of Virtual Reality on the Upper Extremity Spasticity and Motor Function in Patients with Stroke: A Single Blinded Randomized Controlled Trial

Authors: K. Afsahi, M. Soheilifar, S. H. Hosseini, O. S. Esmaeili, R. Kezemi, N. Mehrbod, N. Vahed, T. Hajiahmad, N. N. Ansari

Abstract:

Background: Stroke is a disabling neurological disease. Rehabilitative therapies are important treatment methods. This clinical trial was done to compare the effects of virtual reality (VR) beside conventional rehabilitation versus conventional rehabilitation alone on the spasticity and motor function in stroke patients. Materials and methods: In this open-label randomized controlled clinical trial, 40 consecutive patients with stable first-ever ischemic stroke in the past three to 12 months that were referred to a rehabilitation clinic in Tehran, Iran in 2020 were enrolled. After signing the informed written consent form, subjects were randomly assigned by block randomization of five in each block as cases with 1:1 into two groups of 20 cases; conventional plus VR therapy group: 45-minute conventional therapy session plus 15-minute VR therapy, and conventional group: 60-minute conventional therapy session. VR rehabilitation is designed and developed with different stages. Outcomes were Modified Ashworth scale, Recovery Stage score for motor function, range of motion (ROM) of shoulder abduction/wrist extension, and patients’ satisfaction rate. Data were compared after study termination. Results: The satisfaction rate among the patients was significantly better in combination group (P = 0.003). Only wrist extension was varied between groups and was better in combination group. The variables generally had statistically significant difference (P < 0.05). Conclusion: VR plus conventional rehabilitation therapy is superior versus conventional rehabilitation alone on the wrist and elbow spasticity and motor function in patients with stroke.

Keywords: Stroke, virtual therapy, efficacy, rehabilitation.

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1 Virtual Reality in COVID-19 Stroke Rehabilitation: Preliminary Outcomes

Authors: Kasra Afsahi, Maryam Soheilifar, S. Hossein Hosseini

Abstract:

Background: There is growing evidence that Cerebral Vascular Accident (CVA) can be a consequence of COVID-19 infection. Understanding novel treatment approaches is important in optimizing patient outcomes. Case: This case explores the use of Virtual Reality (VR) in the treatment of a 23-year-old COVID-positive female presenting with left hemiparesis in August 2020. Imaging showed right globus pallidus, thalamus, and internal capsule ischemic stroke. Conventional rehabilitation was started two weeks later, with VR included. This game-based VR technology developed for stroke patients was based on upper extremity exercises and functions for stroke. Physical examination showed left hemiparesis with muscle strength 3/5 in the upper extremity and 4/5 in the lower extremity. The range of motion of the shoulder was 90-100 degrees. The speech exam showed a mild decrease in fluency. Mild lower lip dynamic asymmetry was seen. Babinski was positive on the left. Gait speed was decreased (75 steps per minute). Intervention: Our game-based VR system was developed based on upper extremity physiotherapy exercises for post-stroke patients to increase the active, voluntary movement of the upper extremity joints and improve the function. The conventional program was initiated with active exercises, shoulder sanding for joint ROMs, walking shoulder, shoulder wheel, and combination movements of the shoulder, elbow, and wrist joints, alternative flexion-extension, pronation-supination movements, Pegboard and Purdo pegboard exercises. Also, fine movements included smart gloves, biofeedback, finger ladder, and writing. The difficulty of the game increased at each stage of the practice with progress in patient performances. Outcome: After 6 weeks of treatment, gait and speech were normal and upper extremity strength was improved to near normal status. No adverse effects were noted. Conclusion: This case suggests that VR is a useful tool in the treatment of a patient with COVID-19 related CVA. The safety of developed instruments for such cases provides approaches to improve the therapeutic outcomes and prognosis as well as increased satisfaction rate among patients.

Keywords: COVID-19, stroke, virtual reality, rehabilitation.

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